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Majalah Kedokteran Bandung
Articles by issue : Vol 46, No 4 (2014)
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Articles
Kinetics of CD4+ T-Lymphocyte in Dengue Virus Infection

Laksono, Ida Safitri ( Department of Pediatrics, Faculty of Medicine Universitas Gadjah Mada/Dr. Sardjito Hospital, Jalan Kesehatan No. 1, Yogyakarta ) , Intansari, Umi S. ( Department of Clinical Pathology, Faculty of Medicine Universitas Gadjah Mada )

Majalah Kedokteran Bandung Vol 46, No 4 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Cellular immunity plays an important role in viral infection. The activation of effector T-lymphocytes and the release of cytokines define the course of dengue viral infection. CD4⁺ T-lymphocyte induces the immunopathology via various mechanisms; however,  its kinetics in different onset of fever and disease severity are not fully understood. This study was conducted to observe the kinetics of CD4+ T-lymphocyte level among dengue infected patients and to obtain the absolute cell count and relative percentage of CD4+ T-lymphocyte. This was a descriptive study on thirty six patients who met the WHO-1997 criteria of dengue infection, hospitalized in Dr. Sardjito Hospital in the period of March to May 2009. The CD4+ T-lymphocytes were examined using the flow cytometer. The significance of median CD4+ T-lymphocytes among days were assessed using Kruskal-Wallis and Mann-Whitney SPSS 11 for Window. The absolute CD4+ T-lymphocyte was significantly different among days (p<0.05) between DF and DHF patients, while the relative CD4+ percentage count was not  different (p>0.05).  The Absolute CD4+ T-lymphocytes count was low in the beginning of the disease course and increased from the 2nd day of fever to the normal level on the 7th day. In conclusion, DF and DHF do not differ in the absolute CD4+ T-lymphocytes count as well as in the relative CD4+ T-lymphocytes percentage.Key words: CD4+ T-lymphocyte, dengue fever, dengue hemorrhagic fever, dengue virusKinetik Limfosit T CD4+ pada infeksi Virus DengueAbstrakImunitas seluler berperan penting dalam infeksi virus. Aktivasi efektor limfosit T dan terlepasnya sitokin merupakan gambaran utama perjalanan klinis infeksi virus dengue. Sel limfosit T CD4+ menginduksi imunopatologi melalui berbagai mekanisme, namun bagaimana kinetikanya pada hari demam yang berbeda dan derajat berat penyakit masih belum sepenuhnya dipahami. Penelitian ini bertujuan untuk mengamati kinetika sel limfosit T CD4+ pada pasien infeksi dengue dan mendapatkan kadar absolut serta persentase relatif limfosit T CD4+. Penelitian deskriptif ini mengikutsertakan tiga puluh enam pasien yang memenuhi kriteria WHO 1997 untuk infeksi dengue, dirawat di RSUP Dr. Sardjito antara Maret sampai Mei 2009. Kadar limfosit T CD4+ diperiksa menggunakan flow cytometer. Perbedaan median limfosit T CD4+ pada berbagai hari demam dianalisis menggunakan Uji Kruskal-Wallis dan Mann-Whitney SPSS 11 untuk Windows. Kadar absolut limfosit T CD4+ berbeda secara bermakna antara hari demam (p<0,05). Persentase relatif limfosit T CD4+ tidak berbeda bermakna antara demam dengue dan demam berdarah dengue (p>0,05). Kadar absolut limfosit T CD4+ rendah pada awal perjalanan penyakit, meningkat pada hari ke-2 demam dan mencapai nilai normal pada hari ke-7 demam. Demam dengue dan demam berdarah dengue tidak menunjukkan kadar absolut maupun persentase relatif limfosit T CD4+ yang berbeda bermakna. Kata kunci: Demam berdarah dengue, demam dengue, limfosit T CD4+, virus dengue DOI: 10.15395/mkb.v46n4.341

Jumlah Sel Piramidal CA3 Hipokampus Tikus Putih Jantan pada Berbagai Model Stres Kerja Kronik

Arjadi, Fitrianto ( Jurusan Kedokteran Fakultas Kedokteran dan Ilmu Kesehatan Universitas Jenderal Soedirman, Jalan dr. Gumbreg No 1 Purwokerto ) , Soejono, Sri Kadarsih ( Lab. Fisiologi Fakutas Kedokteran Universitas Gadjah Mada ) , Maurits, Lientje Setyawati ( Lab. Ilmu Kesehatan Kerja Fakutas Kedokteran Universitas Gadjah Mada ) , Pangestu, Mulyoto ( Reproduction and Development, Departement Obstetric and Gynaecology Monash University )

Majalah Kedokteran Bandung Vol 46, No 4 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Paparan stres kronik dan berkepanjangan mengakibatkan hilangnya neuron di regio  CA3 (cornu ammonis) hipokampus dan  penurunan kognitif. Tujuan penelitian  mengetahui perbedaan jumlah sel piramidal CA3 hipokampus tikus putih jantan pada model stres kerja meliputi   paradoxical sleep deprivation (PSD), imobilisasi, dan footshock kronik. Metode penelitian adalah  post-test only with control group design experimental dengan rancangan acak lengkap  menggunakan 24 ekor tikus putih jantan galur Wistar usia 3–4 bulan yang dibagi 4 kelompok:  KI kontrol tanpa perlakuan,  KII (stres PSD), KIII (stres imobilisasi), dan KIV (stres footshock) dan sel piramidal CA3 hipokampus  diwarnai dengan toluidine-blue. Jumlah sel dihitung menggunakan  perangkat lunak Image raster v2.1, perbesaran 400x tiap 10 lapangan pandang. Penelitian dilakukan  6 bulan (April–September 2012) di Laboratorium Hewan Coba, Fakultas Kedokteran dan Ilmu Kesehatan Universitas Jenderal Soedirman. Analisis data menggunakan analysis of variance (ANOVA) dengan Post-Hoc least significant difference (LSD) menunjukkan  perbedaan jumlah sel piramidal CA3 hipokampus signifikan (p=0,037) pada minimal dua kelompok perlakuan. Uji statistik dengan Post-Hoc LSD menunjukkan perbedaan signifikan jumlah sel piramidal CA3 hipokampus antara  kelompok kontrol (12,9±2,47) dan kelompok imobilisasi (9,00±1,53) (p<0,05). Simpulan, kelompok imobilisasi kronik memiliki jumlah sel piramidal CA3 hipokampus terendah dibandingkan dengan ketiga kelompok lainnya.Kata kunci:  Model stres kerja kronik, sel piramidal CA3 hipokampus, tikus putih jantanNumber of CA3 Pyramidal Cell in Male Albino Rat   Hippocampus Exposed to Various Chronic Work Stress Models AbstractProlonged and chronic exposure to stress leads to the loss of neurons at the CA3 (cornu ammonis) hippocampus region and spatial memory deficits. The aim of this study was to study the number of CA3 pyramidal cells in albino rats that were exposed to chronic stress of works model consisting of paradoxical sleep deprivation (PSD), immobilization, and foot shock stresses. The method applied was the post-test only method with control group experimental design using completed randomized design (CRD on 24 3–4 month old male Wistar rats . The rats were divided into 4 groups: group I (control), group II (PSD stress), group III (immobilization stress), and group IV (footshock stress). The CA3 pyramidal cell hippocampus was stained with toluidine-blue. The number of CA3 pyramidal cell of hippocampus was counted using Image raster v2.1 software at 400x magnification in 10 duplicates for each sample. The study was conducted in six months (April–September 2012) at the Animal Laboratory, Faculty of Medical and Health Sciences, Jenderal Soedirman University. Analysis for the differences in the number of CA3 pyramidal cells was conducted using analysis of variance (ANOVA) with Post-Hoc LSD. The results of the ANOVA  showed a p value=0.037, meaning that there was significant difference in at least two groupsof treatment. Further statistical test using Post-Hoc LSD showed a significant difference  between the control group (12.9 ± 2.47) and the chronic immobillization group (9,00 ± 1,53) (p<0.05). In conclusion, the chronic immobillization stress group has the lowest average number of hippocampus CA3 pyramidal cells compared to other groups Key words: CA3 pyramidal cell in hippocampus, chronic works stress model, male albino rats DOI: 10.15395/mkb.v46n4.337

Pengendalian Risiko Ergonomi Kasus Low Back Pain pada Perawat di Rumah Sakit

Kurniawidjaja, L. Meily ( usat Kajian dan Terapan Keselamatan dan Kesehatan Kerja Fakultas Kesehatan Masyarakat Universitas Indonesia, Jalan Kampus Baru Universitas Indonesia Depok ) , Purnomo, Edy ( Program Studi Magister Keselamatan dan Kesehatan Kerja, Fakultas Kesehatan Masyarakat Universitas Indonesia ) , Maretti, Nadia ( Program Studi Magister Keselamatan dan Kesehatan Kerja, Fakultas Kesehatan Masyarakat Universitas Indonesia ) , Pujiriani, Ike ( Pusat Kajian dan Terapan Keselamatan dan Kesehatan Kerja, Fakultas Kesehatan Masyarakat Universitas Indonesia )

Majalah Kedokteran Bandung Vol 46, No 4 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Perawat berisiko tinggi nyeri pinggang bawah. Tujuan penelitian ini menilai faktor risiko akivitas fisik dan sarana kerja yang dominan dapat menimbulkan low back pain (LBP) pada perawat di ruang Rawat Inap dan Unit Gawat Darurat Rumah Sakit di Jakarta serta memberikan rekomendasi pengendalian risiko LBP. Observasi dilakukan untuk mengidentifikasi aktivitas berisiko tinggi LBP, metode rapid entirebody assessment (REBA) menilai tingkat risiko ergonomi, kuesioner dan Nordic body map menilai faktor risiko lainnya serta keluhan LBP, desain potong lintang untuk analisis asosiasi, pengukuran dan analisis untuk menilai alat kerja. Hasil penelitian mendapatkan prevalensi LBP cukup tinggi pada perawat UGD di RSUD Tarakan tahun 2013 (61,1%) dan perawat rawat inap di RS Bhayangkara tahun 2012 (31,8%), namun rendah pada perawat UGD di RSS bila dibandingkan dengan hasil survei global (43,1–87%); aktivitas yang dominan menimbulkan LBP adalah membungkuk dan angkat angkut pasien. Didapatkan hubungan yang bermakna postur membungkuk (p=0,031; OR=1,18–133,89), sudut lengkung punggung (p=0,024; OR=1,65-196,31), dan transfer pasien (p=0,011; OR=5,22–176,83) dengan tingkat risiko LBP. Simpulan, aktivitas fisik perawat dan sarana kerjanya dapat menyebabkan LBP sehingga disarankan menyediakan sarana kerja yang adjustable serta ‘meja’ dinding di toilet untuk pengukuran urin, memenuhi rasio perawat-pasien minimal, SOP, mendidik perawat agar mampu melakukan pengendalian.. Kata kunci: Ergonomi, low back pain, perawatErgonomic Risk Control on Low Back Pain among Hospitals NursesAbstract Nurses are at high risk of low back pain (LBP). This study aimed to assess physical activities and working facilities as the risk factors that can lead to LBP in nurses in the wards and the emergency units of several hospitals in Jakarta  to provide recommendations for controlling the risk of LBP. Observations were performed to identify high-risk activities and the rapid entire body assessment (REBA) method was used to assess the ergonomic risk. Questionnaires and Nordic body map were also used to assess the other risk factors and LBP-related complaints. In addition, the cross-sectional design for association analysis, measurement and analysis to assess the working tools were also applied. The results showed that the prevalence of LBP among nurses was higher in the RSUD Tarakan emergency unit in 2013 (61.1%) and RS Bhayangkara wards in 2012 (31.8%). In the private hospital  emergency unit, the LBP is lower compared to the results of a global survey (43.1–87%). The dominant causes of LBP were bending and patient-lifting. A significant association was evident between the risk level of LBP and bending posture (p=0.031, OR=1.18–133.89), curved spine angle (p=0.024, OR=1.65–196.31), and patients transfer (p=0.011, OR=5.22–176.83). In conclusion, nurse physical activities and their work facilities can induce LBP. Therefore, it is suggested to provide adjustable facilities and wall-mounted tables in the toilets for urine measurements. Meeting the the minimum nurse: patient ratio, providing SOPs, and educating the nurses to control the risks of LBP are also needed.Key words: Ergonomic, low back pain, nurse DOI: 10.15395/mkb.v46n4.342

Citra Radiografi Panoramik pada Tulang Mandibula untuk Deteksi Dini Osteoporosis dengan Metode Gray Level Cooccurence Matrix (GLCM)

Azhari, - ( Radiologi, Fakultas Kedokteran Gigi Universitas Padjadjaran Bandung, Jalan Sekeloa Selatan No. 1 Bandung ) , Suprijanto, - ( Laboratorium Instrumentasi Medik, Kelompok Keahlian Instrumentasi dan Kontrol Fakulas Teknologi Industri ) , Diputra, Yudhi ( Fakultas Informatika, Institut Teknologi Sepuluh November, Surabaya ) , Juliastuti, Endang ( Fakultas Informatika Institut Teknologi Sepuluh November, Surabaya ) , Arifin, Agus Zainal ( Fakultas Informatika Institut Teknologi Sepuluh November, Surabaya )

Majalah Kedokteran Bandung Vol 46, No 4 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Osteoporosis  salah satu penyakit degeneratif yang berkaitan dengan proses penuaan yang ditunjukkan perubahan struktur trabekula dan penurunan bone mineral density (BMD). Tujuan penelitian  adalah mendapatkan metode kuantifikasi citra panoramik  pada region of interest (ROI) di mandibula untuk menentukan BMD. Penelitian ini menggunakan  ROI (80x80 pixel) pada  kondilus mandibula untuk kuantifikasi citra dilakukan di Bagian Radiologi  Fakultas Kedokteran Gigi Universitas Padjadjaran bulan  Oktober sampai Desember 2013. Pendekatan analisis tekstur menggunakan prinsip gray level co-occurence matrix (GLCM).  Desain dari kuantifikasi citra terdiri atas tahapan pelatihan dan pengujian.  Tahapan pelatihan melalui  9 data latih terhadap subjek wanita berusia 52–73 tahun pascamenopause.  Data  BMD vertebra lumbar dari DEXA digunakan sebagai referensi pada tahap klasifikasi dengan support vector machine (SVM) dengan fungsi kernel multilayer perceptron. Pengujian digunakan 14 data uji dari subjek selain yang digunakan untuk data latih. Pengujian untuk klasifikasi kelas normal dan osteoporosis menggunakan SVM memberikan akurasi  85,71%; sensitivitas (tingkat benar positif) 90,91%; dan spesifisitas (tingkat benar negatif) 66,67%. Pengenalan fitur paling baik didapatkan menggunakan kombinasi fitur contrast, correlation, energy, dan homogeneity sebagai input bagi klasifikasi SVM. Simpulan, analisis tekstur trabekula menggunakan metode gray level co-occurence matrix (GLCM) citra panoramik gigi dapat digunakan untuk deteksi dini osteoporosis. Kata kunci: Grey level co-occorance matrix (GLCM), panoramik, osteoporosis Panoramic Radiograph Image using Cooccurence Gray Level Matrix Method (GLCM) for Early Detection of Osteoporosis in Mandibular Bone  Abstract Osteoporosis is one of the degenerative diseases associated with aging, which is apparent from changes in trabecular structure and decreased bone mineral density (BMD) The  aim of this study  was to obtain a panoramic image quantification method on a region of interest (ROI) to determine the BMD. This study used an ROI (80x80 pixels) of the mandibular condyle for image quantification. The study was performed at the Department of Radiology, Faculty of Dentistry, Padjadjaran University during the period of October to December 2013. A texture analysis approach was applied using the principles of gray level co-occurence matrix (GLCM). The design of image quantification consisted of training and testing stages. The training stage was performed through 9 training data on the subjects of post-menopausal women between 52–73 years old . Data from the lumbar vertebrae BMD DEXA was used as a reference in the classification stage using a support vector machine (SVM) with kernel function multilayer perceptron. The testing used 14 test data from subjects which were not used for training data. The results showed that for the normal and osteoporotic class classification using SVM the accuracy was 85.71%, sensitivity (true positive rate) was 90.91%, and specificity (true negative rate) was 66.67%.  The best feature recognition was obtained using a combination of feature contrast, correlation, energy, and homogeneity as inputs for SVM classification. In conclusion, analysis of the trabecular texture using dental panoramic image produced by gray level co-occurance matrix (GLCM) method can be useful for early detection of osteoporosis.Key words: Grey level co-occorance matrix (GLCM), panoramic, osteoporosis DOI: 10.15395/mkb.v46n4.338

Kebijakan Outsourcing Penyelenggaraan Makan Pasien di Rumah Sakit Umum Daerah Sumedang

Herawati, Dewi Marhaeni Diah ( Departemen Ilmu Gizi Medik Fakultas Kedokteran Universitas Padjadjaran, Jalan Prof. Eijkman No. 38 Bandung ) , Nurparida, Ida Siti ( Rumah Sakit Umum Daerah Sumedang ) , Arisanti, Nita ( Departemen Ilmu Kesehatan Masyarakat Fakultas Kedokteran Universitas Padjadjaran )

Majalah Kedokteran Bandung Vol 46, No 4 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Prevalensi malnutrisi pasien rawat inap di rumah sakit cukup tinggi. Pelayanan gizi  diharapkan dapat mengatasi terjadinya malnutrisi di rumah sakit. Penelitian ini bertujuan untuk melakukan analisis terhadap kebijakan outsourcing penyelenggaraan makan pasien di Rumah Sakit  Umum Sumedang. Desain penelitian adalah mixed method dengan strategi concurrent embedded. Pengambilan sampel kualitatif dilakukan secara purposive sampling. Subjek penelitian adalah tim pelayanan gizi rumah sakit. Sampel kuantitatif  menggunakan stratified simple random sampling, diperoleh jumlah sampel 154 pasien. Pengukuran status gizi pasien menggunakan subjective global assessment. Penelitian dilakukan pada bulan November sampai Desember 2012. Mekanisme penyediaan makan cukup  terstruktur dan jelas, meskipun masih ada Standar Operasional Prosedur (SOP) yang belum dimiliki katering seperti SOP untuk menu pasien anak-anak,  penyiapan logistik dan membersihkan peralatan makan pasien.  Beban kerja karyawan katering sangat tinggi dan rangkap tugas. Tim Panitia Asuhan Gizi (PAG) khususnya perawat dan petugas gizi dapat bekerja lebih baik, namun belum memiliki perencanaan stratejik untuk pelayanan gizi. Kapasitas tim PAG dalam pelayanan gizi belum optimal. Terdapat peningkatan gizi buruk dari 1,9% sebelum perawatan menjadi 13% setelah perawatan. Simpulan, penyelenggaraan makan dengan sistem outsourcing belum berdampak pada peningkatan status gizi pasien, namun mekanisme layanan asuhan gizi dan penyediaan makan menjadi lebih jelas dan lebih baik. Kata kunci: Analisis kebijakan, outsourcing, penyelenggaraan makanPolicy of Food Services Outsourcing  in Sumedang District HospitalAbstractThe prevalence of malnutrition remains high in hospital inpatients. Nutritional services can overcome such problem. This study aimed to perform a policy analysis of food service outsourcing in Sumedang District Hospital. The design of this study was a mixed method using a concurrent embedded strategy. The purposive sampling was chosen for the qualitative study in which the hospital nutritionist team members became the subjects. The sampling for the quantitative study was performed using the stratified simple random sampling. About 154 patients were selected as subjects. The subjective global assesment was used as the instrument. The study was conducted from November to December  2012.  The food service mechanism was well structured and clear even though there were missing Standard Operating Procedures (SOPs) such as SOPs for pediatric patient menus, logistic preparation, and patient meal equipment cleaning. Catering employees had a very high workload and were multitasking. The Nutrition Care Committee Team may work better. There was no strategic plan for nutrition services. The capacity of the team was not optimum in terms of nutritional care. The proportion of malnutrition increased from 1.9% to 13% after hospitalization when compared to the pre-hospitalization condition. In conclusion, the outsourcing system for food services has no impact on patients’  nutrition status; however, it is apparent that a clear and better mechanism of nutrition care and food provision is needed.Key words: Food services, outsourcing, policy analysis DOI: 10.15395/mkb.v46n4.343

Pengetahuan dan Perspektif Mahasiswa tentang Penuaan dan Keadaan Tua

Patrick, - ( Fakultas Kedokteran Universitas Katolik Indonesia Atma Jaya Jakarta, Jalan Pluit Raya 2, Jakarta ) , Arieselia, Zita ( Fakultas Kedokteran Universitas Katolik Indonesia Atma Jaya Jakarta, Jalan Pluit Raya 2, Jakarta ) , Rukmini, Elisabeth ( Fakultas Kedokteran Universitas Katolik Indonesia Atma Jaya Jakarta, Jalan Pluit Raya 2, Jakarta )

Majalah Kedokteran Bandung Vol 46, No 4 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Perspektif akan penuaan dan keadaan tua yang negatif akan memudar bila sejak muda ditanamkan pandangan positif. Penelitian ini bertujuan membandingkan pengetahuan dan mencari korelasi antara pengetahuan dan perspektif mahasiswa Fakultas Kedokteran (FK) dan Teknobiologi (FTb) mengenai penuaan dan keadaan tua. Penelitian ini merupakan studi analitik komparatif dan korelatif dengan metode potong lintang. Penelitian dilakukan di FTb dan FK Unika Atma Jaya periode Januari–Mei 2013. Pengetahuan mengenai penuaan dan keadaan tua diukur dengan Facts about Aging Quiz 1 (FAQ 1). Perspektif terhadap penuaan dan kondisi tua diukur dengan Anxiety about Aging  Scale (AAS) dan Aging Semantic Differential (ASD). Sampel sebanyak masing-masing 45 mahasiswa FK dan FTb. Data FAQ 1 memperlihatkan pengetahuan mahasiswa FK dan FTb mengenai penuaan dan keadaan tua kurang baik serta tidak ada perbedaan bermakna (p=0,199). Data AAS memperlihatkan kecenderungan responden tidak takut terhadap lansia, tidak khawatir dengan keadaan fisiologisnya, kurang memperhatikan penampilan fisik, dan tidak takut kehilangan. Data ASD menunjukkan kecenderungan responden merasa lansia akan lebih berguna, tidak bergantung pada orang lain, dan mampu menerima diri sendiri. Uji korelasi FAQ 1 dengan AAS dan ASD tidak menunjukkan hubungan sehingga dapat disimpulkan tidak ada hubungan pengetahuan dengan perspektif terhadap penuaan dan keadaan tua.Kata kunci: Keadaan tua, mahasiswa, penuaan Students’ Knowledge and Perspectives on Aged and AgingAbstractThe negative perspectives on aged and aging will be diminished if positive perspectives on aged condition and aging have been introduced in young age. This study aimed to compare and test the relationship between knowledge and perspective toward aged condition and aging among medical and biotechnology students. This study was a comparative analytical and correlative study with a cross-sectional method in the period of January to May 2013 conducted at the School of Biotechnology and the School of Medicine Atma Jaya Catholic University of Indonesia. Knowledge towards aged condition and aging was measured using the Facts about Aging Quiz 1 (FAQ 1). Perspective towards aged condition and aging was measured using the Anxiety about Aging Scale (AAS) and the Aging Semantic Differential (ASD). There were 45 students from each school.. Knowledge about aged condition and aging of the medical and biotechnology students was quite low. There were no significant differences (p=0.199) between the two groups. The AAS data showed that respondents did not have any fear of old people.They were also not really concern about physiological and physical appearances and were not afraid of lost. The ASD data showed that they tended to have positive views: the elderly people are useful, independent, and able to accept their condition. The correlation tests between FAQ 1-AAS and FAQ 1-ASD showed no correlation. In conclusion, there is no relationship between knowledge and perspective towards aged condition and aging.Key words: Aged, aging, students DOI: 10.15395/mkb.v46n4.339

Validitas Pemeriksaan Complex Specific Antigen Mycobacterium tuberculosis Region of Difference 1‒3 Metode Rapid Immunochromatography pada Sputum Penderita Tuberkulosis Paru

Gustiani, Nenny ( Departemen Patologi Klinik Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung Jl. Pasteur No. 38 Bandung ) , Parwati, Ida ( Departemen Patologi Klinik Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung Jl. Pasteur No. 38 Bandung ) , Tjandrawati, Anna ( Departemen Patologi Klinik Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung Jl. Pasteur No. 38 Bandung ) , Lismayanti, Leni ( Departemen Patologi Klinik Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung Jl. Pasteur No. 38 Bandung )

Majalah Kedokteran Bandung Vol 46, No 4 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Tuberkulosis (TB) paru merupakan masalah kesehatan global. Diagnosis tuberkulosis paru saat ini berdasarkan pemeriksaan mikroskopis basil tahan asam (BTA) pada sputum dengan pewarnaan Ziehl Nelseen, namun sensitivitasnya rendah. Pemeriksaan antigen TB metode rapid immunochromatography (ICT) adalah suatu tes yang cepat, mudah, praktis, dan tidak memerlukan keterampilan khusus. Tes ini mendeteksi antigen yang disekresi Mycobacterium tuberculosis yaitu early secretory antigenic target 6 kDa protein (ESAT6), culture filtrate protein (CFP10), dan Mycobacterium protein tuberculosis (MPT64) yang disandi oleh gen region of difference (RD)1, RD2, dan RD3. Tujuan penelitian untuk mengetahui validitas antigen TB ICT dalam mendiagnosis tuberkulosis paru. Penelitian dilaksanakan September 2012‒Maret 2013 di Rumah Sakit Dr. Hasan Sadikin Bandung. Bentuk penelitian adalah observasional deskriptif dengan rancangan penelitian potong lintang dan analisis uji diagnostik. Setiap spesimen sputum dilakukan pemeriksaan mikroskopis BTA dan antigen TB rapid ICT. Biakan M. tuberculosis pada medium Ogawa digunakan sebagai standar baku emas. Tes niasin dilakukan pada koloni yang tumbuh. Didapatkan 149 subjek penelitian, kelompok usia terbanyak pada usia 30–39 tahun. Hasil pemeriksaan biakan didapatkan 56 sampel tumbuh, 86 tidak tumbuh, dan 7 terkontaminasi. Sensitivitas dan spesifisitas pemeriksaan antigen TB rapid ICT masing masing adalah 95,7% dan 87,2%. Simpulan, pemeriksaan antigen TB rapid ICT mempunyai validitas yang tinggi, sehingga dapat digunakan sebagai alternatif pemeriksaan laboratorium untuk diagnosis TB paru. Kata kunci: Antigen TB rapid ICT, biakan M. tuberculosis, medium Ogawa, mikroskopis BTAValidity of Complex Specific Antigen Mycobacterium Tuberculosis Region of Difference 1‒3 Examination Using Rapid Immunochromatography Method in Pulmonary Tuberculosis Patient Sputum AbstractPulmonary tuberculosis (TB) is still a global health problem. The diagnosis of pulmonary tuberculosis is based on sputum smear microscopy for acid fast bacilli (AFB) using Ziehl-Neelsen staining. However, this method has low sensitivity. Tuberculosis antigen immunochromatographyrapid test (ICT) is a quick, easy, and practical test which does not require special skills. This test is used to detect the antigen secretion of early secretory antigenic target 6 kDa protein (ESAT6), culture filtrate protein (CFP10)and Mycobacterium protein tuberculosis (MPT64) from Mycobacterium tuberculosis which are encoded by the region of difference (RD) 1, RD2 and RD3 genes. The aim of this study was to determine the validity of TB antigen for the diagnosis of pulmonary tuberculosis. The study was conducted during the period of September 2012 to March 2013 in Dr. Hasan Sadikin General Hospital (RSHS) Bandung. This study is a descriptive observational study using cross sectional approach and validity analysis. From September 2012 until March 2013 there were 149 subjects, in which the dominant age group was 30‒39 years. All the specimens were cultured on Ogawa medium as the gold standard and niasin tests were performed on all positive cultures. The TB antigen rapid ICT and sputum smear microscopy AFB were done on all the samples. From 149 subjects, 56 were positive, 86 were negative and 7 were contaminated. The sensitivity and specificity of TB antigen rapid ICT were 95.7% and 87.2%, respectively. In conclusion, TB antigen rapid ICT has a high validity which can be used as alternative laboratory tests for screening in patients with suspected pulmonary tuberculosis.Key words: AFB smear, M. tuberculosis culture, Ogawa medium, TB antigen rapid ICT DOI: 10.15395/mkb.v46n4.344

Hubungan Jenis Kelamin, Status Pernikahan, dan Status Pekerjaan dengan Gangguan Ansietas Menyeluruh di Klinik Psikiatri RS dr. Pirngadi Medan

Sari, Nining Gilang ( Departemen Ilmu Kedokteran Jiwa Fakultas Kedokteran Universitas Sumatera Utara/RSUP Haji Adam Malik Medan, Jalan Bunga Lau No 17 Medan Tuntungan ) , Effendy, Elmeida ( Departemen Ilmu Kedokteran Jiwa Fakultas Kedokteran Universitas Sumatera Utara/RSUP Haji Adam Malik Medan, Jalan Bunga Lau No 17 Medan Tuntungan ) , Amin, Mustafa Mahmud ( Departemen Ilmu Kedokteran Jiwa Fakultas Kedokteran Universitas Sumatera Utara/RSUP Haji Adam Malik Medan, Jalan Bunga Lau No 17 Medan Tuntungan )

Majalah Kedokteran Bandung Vol 46, No 4 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Gangguan ansietas menyeluruh merupakan bagian penting dari beban global penyakit, dan diproyeksikan sebagai penyebab kedua paling umum kecacatan pada tahun 2020. Gangguan ansietas menyeluruh menyebabkan peningkatan  distres dan terganggunya fungsi kehidupan. Penelitian ini merupakan penelitian potong lintang dengan consecutive sampling pada 100 pasien klinik psikiatri Rumah Sakit dr. Pirngadi Medan selama periode 1 Juli hingga 31 Juli 2012. Pengumpulan data dilakukan melalui wawancara menggunakan kuesioner, Mini International Neuropsychiatric Interview for International Classification of Disease-10 (MINI ICD-10), dan dilanjutkan dengan kriteria diagnostik Pedoman Penggolongan dan Diagnosis Gangguan Jiwa di Indonesia III (PPDGJ III) yang digunakan di Indonesia untuk konfirmasi diagnosis. Hasil penelitian ini mengungkapkan, jumlah pasien dengan gangguan ansietas menyeluruh adalah 23%. Jumlah gangguan ansietas menyeluruh diidentifikasi lebih besar dalam kelompok subjek perempuan (14/23), menikah (13/23), dan bekerja (12/23). Simpulan, tidak ada hubungan jenis kelamin, status pernikahan, dan status pekerjaan dengan gangguan ansietas menyeluruh.Kata kunci: Gangguan ansietas menyeluruh, klinik psikiatri, MINI ICD-10The Relationship between Gender, Marital Status, Employment Status and Generalized Anxiety Disorder in Psychiatry Clinic of dr. Pirngadi Hospital MedanAbstractGeneralized anxiety disorder constitute a substantial proportion of the global burden of disease, and are projected to form the second most common cause of disability by 2020. Generalized anxiety disorder led to increased distress and impaired life functioning. This study was a cross-sectional study with consecutive sampling to 100 patients of psychiatric clinic of dr. Pirngadi hospital Medan during the period 1st July until 31th July 2012. Data was collected through interviews using questionnaire, Mini International Neuropsychiatric Interview for International Classification of Disease-10 (MINI ICD-10) form, and continued with the diagnostic criteria of Pedoman Penggolongan dan Diagnosis Gangguan Jiwa di Indonesia III (PPDGJ III) that have been used in Indonesia to confirm the diagnosis. Results of this research revealed, the number of patients with generalized anxiety disorder was 23%. The number of generalized anxiety disorder was larger identified in the groups of female’s subject, (14/23), married (13/23) and employed (12/23). In conclusion, there is no relationship between gender, marital status, employment status and generalized anxiety disorder.Key words: Generalized anxiety disorder, MINI ICD-10, psychiatric clinic DOI: 10.15395/mkb.v46n4.340

Hubungan Kadar βHCG Praevakuasi, Gambaran Histopatologi, dan Kista Lutein dengan Performa βHCG pada Penderita Mola Hidatidosa yang Berkembang Menjadi PTG dan Kembali Normal

Hidayat, Yudi Mulyana ( Departemen Obstetri dan Ginekologi Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Jl. Pasteur No. 38 Bandung ) , Gandamihardja, Supriadi ( Departemen Obstetri dan Ginekologi Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Jl. Pasteur No. 38 Bandung ) , Krisnadi, Sofie Rifayani ( Departemen Obstetri dan Ginekologi Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Jl. Pasteur No. 38 Bandung )

Majalah Kedokteran Bandung Vol 46, No 4 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Insidensi penyakit trofoblas di Indonesia maupun negara berkembang masih cukup tinggi dibandingkan dengan negara maju. Hal yang perlu diwaspadai adalah terjadinya penyakit trofoblast gestasional (PTG) pascaevakuasi mola hidatidosa berkisar 10-20%. Beberapa variabel klinis telah diteliti sebagai variabel faktor risiko keganasan seperti kadar β-human chorionic gonadotropin (βHCG) praevakuasi, gambaran histopatologi, dan terdapat kista lutein. Tujuan penelitian ini adalah mengetahui hubungan kadar βHCG praevakuasi, gambaran histopatologi dan kista lutein dengan performa penurunan βHCG pada penderita mola. Metode penelitian yang digunakan adalah case control study pada penderita mola hidatidosa komplet di Rumah Sakit Dr. Hasan Sadikin Bandung selama periode tahun 2007-2011. Hasil penelitian menunjukkan hubungan bermakna kadar βHCG ≥100.000 mIU/mL dengan keganasan pascamola (p<0,05), terdapat hubungan bermakna gambaran histopatologi proliferasi berlebih dengan keganasan pascamola (p<0,05), dan terdapat hubungan bermakna kista lutein positif dengan keganasan pascamola (p<0,05). Simpulan penelitian ini adalah variabel kadar βHCG praevakuasi ≥100.000 mIU/mL, gambaran histopatologi proliferasi berlebih, dan kista lutein positif memiliki korelasi dengan keganasan pascaevakuasi mola. Variabel faktor risiko tersebut  dapat digunakan untuk memilahkan penderita mola hidatidosa komplet risiko tinggi atau risiko rendah untuk kejadian keganasan dan variabel faktor risiko keganasan tersebut berpengaruh pada performa penurunan kurva regresi βHCG.Kata kunci: Gambaran histopatologi, kadar βHCG, kista lutein, mola hidatidosa komplit, PTGRelationship between Pre-Evacuation βHCG Level, Histopathologycal View, Lutein Cysts and βHCG Performance in Patients with Hydatidiform Mole which Developed into Gestational Trophoblastic Disease (GTD) and Back to NormalAbstractThe incidence of trophoblastic diseases in Indonesia and developing countries is relatively high compared to the developed countries. The incidence of gestational trophoblast tumors (GTT) after the evacuation of a hydatidiform mole ranges from 10% to 20%. Several clinical variables have been studied as the risk factors for malignancy, including the pre-evacuation level of beta human chorionic gonadotropin (βHCG), histopathological appearance, and the presence of lutein cysts. The purpose of this study was to determine the relationship between βHCG decline and pre-evacuation βHCG levels, histopathological features, and the lutein cysts status in patients with moles. This study was a case control study of patients with complete hydatidiform mole in Dr. Hasan Sadikin General Hospital during the period of 2007-2011. The results revealed that there was a significant correlation between the level of βHCG ≥100,000 mIU/mL and post-molar malignancy (p<0.05). There was also a significant relationship between the histopathologic feature of excessive post-molar cell proliferation and malignancy (p<0.05) and between the presence of lutein cyst and post-molar malignancy (p<0.05). This study concludes that the pre-evacuation βHCG level ≥100.000 mIU/mL, excessive proliferation, and the presence of lutein cysts are correlated with malignancy after molar evacuation. These risk factors are useful to differentiate whether a complete hydatidiform mole will become malignant or remain benign.Key words: Beta human chorionic gonadotropin levels, histopathologic features, lutein cysts, complete hydatidiform mole, gestational trophoblast tumors DOI: 10.15395/mkb.v46n4.345

Multidrug Resistant Tuberculosis (MDR-TB): Tinjauan Epidemiologi dan Faktor Risiko Efek Samping Obat Anti Tuberkulosis

Reviono, - ( Bagian Pulmonologi dan Ilmu Kedokteran Respirasi Fakultas Kedokteran Universitas Sebelas Maret Surakarta/Rumah Sakit Dr. Moewardi ) , Kusnanto, P. ( Bagian Penyakit Dalam Sub Bagian Gastrohepatologi ) , Eko, Vicky ( Bagian Telinga Hidung Tenggorokan-Kepala Leher Fakultas Kedokteran Universitas Sebelas Maret Surakarta/Rumah Sakit Dr. Moewardi ) , Pakiding, Helena ( Bagian Pulmonologi dan Ilmu Kedokteran Respirasi ) , Nurwidiasih, Dyah ( Bagian Pulmonologi dan Ilmu Kedokteran Respirasi )

Majalah Kedokteran Bandung Vol 46, No 4 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Kasus multi drug resistant tuberculosis (MDR TB) terus meningkat. Penatalaksanaan klinis MDR TB lebih rumit dibandingkan dengan TB sensitif karena menggunakan obat anti-TB lini I dan lini II, sehingga menyebabkan permasalahan toleransi dan efek samping. Desain penelitian ini kohort yang bertujuan untuk mengetahui jenis, frekuensi, dan faktor risiko efek samping obat. Pelaksanaan penelitian dilakukan antara Januari 2011–Juni 2013. Suspek MDR TB diambil sputum, dilakukan pengecatan Ziehl Nielsen, dilanjutkan pemeriksaan Xpert MTB/RIF pada regio gen rpoB untuk menentukan resistensi rifampisin. Selanjutnya  uji resistensi obat anti-TB dengan menggunakan media padat (Lowenstein Jensen) dan media cair Mycobacteria growth indicator tube test (MGIT). Penelitian dilakukan di RS Dr. Moewardi. Jumlah pasien yang terkonfirmasi MDR TB adalah 114 orang: 56 laki-laki dan 58 perempuan. Efek samping terbanyak gangguan gastrointestinal: mual 79,8%, muntah 78,9%. Sebagian besar efek samping derajat ringan 76,3%. Terdapat hubungan antara riwayat pengobatan TB dan gangguan renal (p=0,026), antara jenis kelamin dan gangguan renal (p=0,033) serta gangguan pendengaran (p=0,039). Tidak terdapat hubungan antara jenis kelamin dan gangguan psikiatri (p=0,062), antara riwayat pengobatan TB dan gangguan pendengaran (p=0,115) serta hipokalemia (p=0,968). Simpulan, efek samping terbanyak adalah gangguan gastrointestinal. Kata kunci: Efek samping, gangguan gastrointestinal, MDR TB, pendengaran, renalMultidrug Resistant Tuberculosis (MDR-TB): Epidemiologic Review and Adverse Events Risk Factors of Anti Tuberculosis Drugs  Abstract The number of Multi drug resistant tuberculosis (MDR-TB) cases is predicted to be increasing. The management of MDR-TB is more complex than susceptible TB due to the resistance to the first and second lines of anti tuberculosis drugs. Leading to anti tuberculosis drugs  tolerance and adverse event issues. This study was a cohort study conducted between January 2011 and June 2013 to describe the type, frequency, and risk factors of adverse events caused by drugs. Sputum samples of patients who were suspected to have MDR TB were collected and examined as sputum smears using Ziehl Nielsen staining and Gene Xpert MTB/RIF segment amplification of rpoB gene region methods to assess resistance towards rifampicin. Samples with positive results were cultured in solid medium (Lowenstein Jensen) and liquid medium (Mycobacteria growth indicator tube test,MGIT). This study was conducted in Moewardi General Hospital. The number of confirmed MDR-TB patients was114 subject consisting of 56 males and 58 females. The most common adverse events were gastrointestinal disturbances including nausea 79.8% and vomiting 78.9%. Minor adverse events also found in 76.3% patients.  There was a significant relationship between previous anti tuberculosis medication and renal impairment (p=0.026); between sex and  renal impairment (p=0.033); and between sex and hearing impairment (p= 0.039). There was no significant relationship between sex and mental illnesses (p=0.062) as well as between previous anti tuberculosis medication and  hearing impairment (p=0.115)  and  between previous anti tuberculosis medication and hypopotassemia (p=0.968),. In conclusion, the major adverse events in MDR-TB cases are gastrointestinal disturbances Key words: Adverse events, gastrointestinal disturbance, hearing impairment,  MDR-TB,  renal impairment DOI: 10.15395/mkb.v46n4.336