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Knowledge, Attitude and Practice of Diabetes Mellitus Type 2 Patients towards Compliance to Treatment in Pusat Kesehatan Masyarakat Zahari, Asila Zahiri binti; Yunivita, Vycke; Martha, Januar Wibawa
Althea Medical Journal Vol 3, No 3 (2016)
Publisher : Althea Medical Journal

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (159.548 KB)

Background: Diabetes mellitus (DM) is one of the top ten chronic diseases in the world and the prevalence of this disease will increase in the future including in Indonesia. Treatment of DM needs collaboration between the patients and the providers to prevent multiorgan complications and increase the compliance to treatment. The correlation among the level of knowledge (K), attitude (A) and practice (P) plays an important role of patients towards compliance to treatment. The objectives of this study was to identify the level of knowledge, attitude and practice of DMT2 patient towards compliance to treatment at a primary care facility.Methods: This study was carried out by using cross sectional descriptive study from August until November 2013 in Public Health Center (Pusat Kesehatan Masyarakat/Puskesmas) Tanjungsari, Sumedang, West Java. There were 49 respondents and the sampling method used was non-probability sampling. The data was collected through face to face interview using questionnaire which consist of 27 questions about knowledge, attitude and practice. The collected data was anayzed using computer and was presented in the form of tables and a figure.Results: This study discovered that 22 patients had moderate knowledge, 17 patients had good knowledge and 10 patients had poor knowledge. As for attitude, there were 32 patients had good attitude and 17 patients had moderate attitude. Whereas, for practice, 44 patients were good and 5 patients were moderate.Conclusions: Majority of respondent had moderate knowledge, good attitude and practices. [AMJ.2016;3(3):416â20]DOI: 10.15850/amj.v3n3.871

Hubungan Beberapa Faktor Klinis dan Pengobatan Penyakit Arteri Koroner dengan Pembentukan dan Gradasi Kolateral Arteri Koroner Martha, Januar Wibawa; Purnomowati, Augustine
Majalah Kedokteran Bandung Vol 49, No 4 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Penyakit arteri koroner (PAK) ditandai lesi aterosklerosis yang menyebabkan penurunan suplai oksigen ke miokardium. Sebagian pasien PAK membentuk pembuluh kolateral yang menambah suplai darah ke miokardium. Pembentukan kolateral didasari proses angiogenesis dan dipengaruhi oleh berbagai faktor. Aspirin telah digunakan sebagai pencegahan angiogenesis. Penelitian ini bertujuan mencari pengaruh faktor klinis dan pengobatan terhadap pembentukan kolateral koroner. Penelitian ini menggunakan metode potong lintang pada pasien PAK yang dilakukan angiografi koroner. Klasifikasi kolateral koroner dinilai menggunakan kriteria Rentrop. Subjek penelitian dibagi menjadi kolateral baik dan kolateral buruk, ditentukan berdasar atas penilaian intervensionis. Faktor yang dianalisis adalah keluhan angina, obat-obatan, lesi stenosis, dan faktor risiko kardiovaskular. Analisis statistik menggunakan korelasi Spearman dan regresi logistik. Sebanyak 382 pasien diikutsertakan dalam penelitian. Seluruh subjek penelitian memiliki stenosis koroner di atas 80% pada salah satu arteri koroner. Analisis kolateral koroner mendapatkan 164 pasien kolateral baik dan 158 orang kolateral buruk. Secara bivariat, faktor-faktor yang berpengaruh pada pembentukan kolateral koroner yang buruk adalah: penggunaan inhibitor ACE (p=0,048), penggunaan aspirin (p=0,047), oklusi pada pembuluh left circumflex (p=0,032), tidak ada keluhan angina (p=0,036), dan diabetes (p=0,047). Regresi logistik tidak menunjukkan kemaknaan dari faktor-faktor diatas terhadap pembentukan kolateral koroner (p=0,088). Penelitian ini menyimpulkan bahwa aspirin, inhibitor ACE, oklusi pembuluh left circumflex, tidak ada keluhan angina dan riwayat diabetes memiliki potensi untuk menghambat pembentukan kolateral koroner. [MKB. 2017;49(4):274â€“80]Kata kunci: Faktor klinis, kolateral koroner, penyakit arteri koronerÂ Relationship between Several Clinical and Treatment Factors in Cad Patients in Coronary Collateral Development and GradationÂ Coronary artery disease (CAD) involves atherosclerotic plaques that caused reduction of myocardial oxygen supply. Some CAD patients develop collaterals which augment myocardial blood circulation. Angiogenesis is a precursor for collateral development and influenced by multiple factors. Aspirin has been used as an angiogenesis inhibitor. This study was intended to elucidate clinical and treatment factors that may affect collateral development. This study employed cross-sectional methodology. Subjects were CAD patients who underwent coronary angiography. Grading of coronary collaterals was classified using Rentrop criteria. Subjects were categorized into poor collaterals and good collaterals, determined by an interventionist. FactorsÂ analyzed were anginal symptoms, medications, stenotic lesions, and cardiovascular risk factors. Data were examined using Pearson or Spearman correlation and logistic regression. A total of 382 patients were selected. All subjects had 80% or more stenotic lesions in one or more coronary arteries. There were 164 patients assigned as good collaterals and 158 patients was assigned as poor collaterals. Factors that hampered collateral development were: ACE (p=0.048) and aspirin (p=0.047) use, occlusion of left circumflex artery (p=0.032), no anginal symptoms (p=0.036) and diabetics (p=0,047). None of these factors was statistically significant in logistic regression (p=0.088). The study concluded that aspirin has a potential to diminish coronary collateral development. [MKB. 2017;49(4):274â€“80]Key words: Clinical factors, coronary artery disease, coronary collaterals

HUBUNGAN KADAR LEPTIN SERUM DENGAN KOMPLEKSITAS LESI KORONER BERDASARKAN SKOR SYNTAX PADA PENDERITA PENYAKIT ARTERI KORONER STABIL Ashari, Fajar; Aprami, Toni Mustahsani; Akbar, Muhammad Rizki; Purnomowati, Augustine; Martha, Januar Wibawa; Achmad, Chaerul; Martanto, Erwan
Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Leptin memiliki peran penting dalam pembentukan plak ateroskleosis dengan mengaktifkan respons sel imun dan respons inflamasi ataupun peran langsung terhadap dinding pembuluh darah koroner. Penelitian terdahulu mengenai hubungan antara kadar leptin serum dan kompleksitas lesi koroner masih menunjukkan kontroversi. Penelitian ini bertujuan mengetahui hubungan antara kadar leptin serum dan kompleksitas lesi koroner berdasarkan skor SYNTAX pada penderita penyakit arteri koroner stabil. Metode penelitian berupa observasional, deskriptif, dan analisis korelasi dengan rancangan potong lintang. Subjek penelitian sebanyak 44 orang penderita penyakit arteri koroner (PAK) stabil yang memenuhi kriteria inklusi, menjalani pemeriksaan angiografi koroner di Rumah Sakit Dr. Hasan Sadikin Bandung selama bulan Januari?Mei 2014. Pengambilan sampel darah untuk pemeriksaan kadar leptin serum dilakukan sebelum tindakan angiografi. Kompleksitas lesi arteri koroner dinilai menggunakan skor SYNTAX. Hasil penelitian didapatkan subjek penelitian 84% laki-laki dengan usia rata-rata 54,68 (+10,24) tahun. Indeks massa tubuh rata-rata 24,71 (+ 3,05) kg/m2. Faktor risiko terbanyak adalah dislipidemia (84%), merokok (72%), hipertensi (38,4%), diabetes melitus (22,7%), dan obesitas (4,5%). Median kadar leptin serum 7.242 (780?36.929) pq/mL, nilai rata-rata skor SYNTAX sebesar 19,52 (+9,93). Analisis menggunakan uji korelasi rank-Spearman tidak didapatkan hubungan (p=0,61; r= 0,078). Perbedaan hasil penelitian ini dengan penelitian sebelumnya disebabkan oleh perbedaan subjek dan kriteria penilaian kompleksitas lesi arteri koroner. Simpulan, tidak terdapat hubungan antara kadar leptin serum dan kompleksitas lesi koroner berdasarkan skor SYNTAX pada penderita penyakit arteri koroner stabil. [MKB. 2016;48(1):26?31]Kata kunci: Kompleksitas lesi koroner, leptin serum, penyakit arteri koroner stabil, skor SYNTAXCorrelation between Serum Leptin Levels and Complexity of Coronary Artery Lesion based on SYNTAX Score in Patients with Stable Coronary Artery DiseaseAbstractLeptin has been shown to play a potential role in the atherosclerotic plaque formation by activating immune and inflammatory cells or directly acting on the vessel wall. Earlier reports of the correlation of serum leptin levels with the degree of coronary lesion stated are still controversial. This study determined the correlation between serum leptin levels and complexity of coronary artery lesion in patients with stable coronary artery disease (SCAD). This is an observational cross-sectional study. Data were collected from January to May 2014 in Dr. Hasan Sadikin Central General Hospital Bandung. Blood samples were collected before angiography procedures. The complexity of coronary artery lesion was assessed using SYNTAX score. There were 44 patients who met inclusion criteria, male 84%, median age 54.68 (+10.24) years. Mean body mass index 24.71 (+ 3.05) kg/m2. Dyslipidemia was the most common risk factor (84%), followed by smoking (72%), hypertension (38.4%), diabetes mellitus (22.7%), and obesity (4.5%). Median leptin level was 7,242 (780-36,929) pq/mL. Mean SYNTAX score was 19.52 (+9.93). Leptin level had no correlation with the complexity of coronary artery lesion (p=0.61, r=0.078). The difference between this study from prior studies might be caused by differences in subject selection and criteria used for complexity of coronary artery lesion. In conclusion, there is no correlation between serum leptin levels and complexity of coronary artery lesion in patients with stable coronary artery disease. [MKB. 2016;48(1):26?31]Key words: Complexity of coronary artery lesion, leptin, stable coronary artery disease, SYNTAX score

Knowledge, Attitude and Practice of Diabetes Mellitus Type 2 Patients towards Compliance to Treatment in Pusat Kesehatan Masyarakat Asila Zahiri binti Zahari; Vycke Yunivita; Januar Wibawa Martha
Althea Medical Journal Vol 3, No 3 (2016)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (183.296 KB)

Background: Diabetes mellitus (DM) is one of the top ten chronic diseases in the world and the prevalence of this disease will increase in the future including in Indonesia. Treatment of DM needs collaboration between the patients and the providers to prevent multiorgan complications and increase the compliance to treatment. The correlation among the level of knowledge (K), attitude (A) and practice (P) plays an important role of patients towards compliance to treatment. The objectives of this study was to identify the level of knowledge, attitude and practice of DMT2 patient towards compliance to treatment at a primary care facility.Methods: This study was carried out by using cross sectional descriptive study from August until November 2013 in Public Health Center (Pusat Kesehatan Masyarakat/Puskesmas) Tanjungsari, Sumedang, West Java. There were 49 respondents and the sampling method used was non-probability sampling. The data was collected through face to face interview using questionnaire which consist of 27 questions about knowledge, attitude and practice. The collected data was anayzed using computer and was presented in the form of tables and a figure.Results: This study discovered that 22 patients had moderate knowledge, 17 patients had good knowledge and 10 patients had poor knowledge. As for attitude, there were 32 patients had good attitude and 17 patients had moderate attitude. Whereas, for practice, 44 patients were good and 5 patients were moderate.Conclusions: Majority of respondent had moderate knowledge, good attitude and practices. [AMJ.2016;3(3):416–20]DOI: 10.15850/amj.v3n3.871

Drug Induced Long QT Januar Wibawa Martha
Jurnal Kardiologi Indonesia Vol. 29, No. 1 Januari - April 2008
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v29i1.199

A 54 years old cattle-farm owner was found un-conscious by his daughter at his living room. After she repeatedly shook his body, he regained consciousness without any impairment. He told his daughter that before collapse he suddenly felt weakness all over his body, a bit lightheaded and a brief period of palpitation. On the next day he experienced the same symptom, and this time he fainted at the farm. He was rushed to 24-hour infirmary, but he recovered before reaching the clinic. He afterwards was seen by a doctor and was told to have a mild stroke. He was referred to emergency department at a nearby hospital where he passed out for the third time; but this time was witnessed by his daughter. She noted that before he fell down, he was having a short period of seizure. A neurologist was among the first physician who saw him and noticed that the patient had a very slow pulse. He accordingly consulted the patient to cardiologist due to bradycardia.

Gambaran Fungsi Diastolik Ventrikel Kiri Pada Penderita Keganasan Yang Mendapat Kemoterapi Doxorubicin Januar Wibawa Martha; Sunarya Surianata; Amiliana M Soesanto
Jurnal Kardiologi Indonesia Vol. 28, No. 5 September 2007
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v28i5.217

Background. Doxorubicin is one of the first-line chemoterapy against many form of neoplasm but the use is hampered by its cardiotoxic poten-tial with the end result of congestive heart failure. It is imperative that specific monitoring scheme is applied to detect as early as possible the cardiac damage due to doxorubicin. There is large body of evidence that left ventricular diastolic dysfunction precede systolic dysfunction. There-fore, diastolic function may serve as am early monitoring parameter in patients receiving doxorubicin. This study is aimed to delineate the preva-lence of diastolic dysfunction among patients receiving doxorubicin, to define the lowest cumulative dosage of doxorubicin that already cause di-astolic dysfunction, and to describe the association between cumulative dosage of doxorubicin with grade of diastolic dysfunction.Methods. This study utilizes cross sectional design, conducted in Depart-ment of Cardiology and Vascular Medicine to 38 cancer patients receiving doxorubicin in Subdivision of Hematology-Oncology Department of Inter-nal Medicine, Faculty of Medicine, Padjadjaran University. The study com-menced from September 2006 until January 2007.Results. The prevalence of diastolic dysfunction among patients who re-ceived doxorubicin is 86,8%. The actual lowest cumulative dose of doxoru-bicin that already had diastolic dysfunction is 112 mg/m2 but the crossing point between correlation line and the occurrence of E/A ratio and Em/Am ratio of less than 1 is between 110-130 mg/m2. There is negative correlation between cumulative dose of doxorubicin and E/A ratio (r = -0,62) and Em/Am ratio (r = -0,69). Cumulative dose of doxorubicin among normal dias-tolic function, grade 1 diastolic dysfunction and grade 2 diastolic dysfunction are 101,4 + 3,9 mg/m2 , 168,3 + 7,6 mg/m2 and 237,1 + 11 mg/m2, respec-tively (p < 0,01). There is positive correlation between cumulative dose of doxorubicin with grade of diastolic dysfunction (r = 0,7)Conclusions. The prevalence of diastolic dysfunction among patients who received doxorubicin is 86,8%. The lowest cumulative dose of doxorubi-cin that already had diastolic dysfunction is between 110-130 mg/m2 . There is a strong positive correlation between cumulative dose of doxorubicin with grade of diastolic dysfunction.

Pretibial Edema Is One of the Sign of Thyrotoxicosis A Case of Thyroid Heart Disease and Unilateral Pretibial Edema Januar Wibawa Martha
Jurnal Kardiologi Indonesia Vol. 28, No. 4 Juli 2007
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v28i4.235

Thyroid heart disease is one of the many and frequent complication of thyrotoxicosis, which also manifest in extra cardiovascular system. Opthalmopathy is a well-known and well-studied complication of thyro-toxicosis, and another is dermopathy, which manifests as pretibial edema.This case presentation describes a patient of long standing thyrotoxicosis with thyroid heart disease. In this particular case, the patient developed unilateral pretibial edema which posed a diagnostic challenge.In dealing with that, it would be important to con-sider several differential diagnosis. Some of the differ-ential diagnosis of unilateral pretibial edema are actu-ally not proven due to limited hospital stay, but an analysis of differential diagnosis will be presented and hopefully will lead to better recognition of clinical symptoms and signs of thyrotoxicosis, its complica-tions and lead to appropriate diagnostic studies.

Intervensi Koroner pada pasien Angina Pektoris Stabil: Penggunaan Fractional Flow Reserve sebagai Alat Pengambil Keputusan Angioplasti Januar Wibawa Martha
Jurnal Kardiologi Indonesia Vol. 34, No. 1 Januari - Maret 2013
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v34i1.305

Coronary angioplasty is a definitive, percutaneous intervention to improve myocardial oxygen supply. The benefit of coronary angioplasty for stable angina pectoris is still a controversy. The COURAGE trial had shown that angioplasty for stable angina pectoris gave no additional benefit compared with optimal medical therapy, while the recently done FAME II trial showed the opposite. FAME II trial proved that angioplasty could reduce MACEs in stable angina pectoris patients. The conflicting results from COURAGE and FAME II trials is due to the difference in decision making methodology used for angioplasty. COURAGE used plain angiogram while FAME II utilized Fractional Flow Reserve (FFR) as a tool to decide whether a lesion should undergo angioplasty. The result of FAME II demonstrate FFR is far more reliable to determine coronary lesion which cause ischemia, hence a better decision making tool for angioplasty. The specificity of FFR is proven high, while angiography has an excessive false positives. The use of FFR before angioplasty is still low although there is a considerable evidence that FFR is a better decion making tool for angioplasty compared to angiography. Health economic analysis displayed the use of FFR for stable angina pectoris is cost effective in the long term.

Pelayanan Kesehatan Kardiologi di Era Badan Penyelenggara Jaminan Sosial Kesehatan: Sebuah Antitesis Januar Wibawa Martha
Jurnal Kardiologi Indonesia Vol. 38, No. 1 Januari-Maret 2017
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v38i1.670

Sehat adalah kebutuhan dasar setiap manusia, dan menjamin kesehatan warga adalah tugas setiap negara. Di sisi lain, untuk menjaga kesehatan diperlukan biaya yang tidak sedikit.Pada awal praktik pengobatan, pembiayaan kesehatan ditanggung oleh perseorangan. Pasien berobat ke dokter dan sebagai tanda terima kasih, pasien memberikan penghargaan berupa uang atau bentuk lainnya. Perkembangan sistem pembiayaan kesehatan dewasa ini mengarah kepada pembiayaan kolektif ketika masyarakat yang menjadi peserta dibebani premi yang dikumpulkan oleh suatu badan tertentu dan dipakai apabila peserta tersebut menerima pelayanan kesehatan. Pada dasarnya, sistem pembiayaan kolektif ini sangat baik karena akses terhadap pelayanan kesehatan menjadi lebih terbuka, biaya pelayanan kesehatan seharusnya menjadi lebih murah, dan dapat terjadi pembiayaan silang untuk mereka yang kurang mampu. Sistem pembiayaan kesehatan secara kolektif ini dikenal dengan asuransi kesehatan, dan yang tengah menjadi primadona di negara kita adalah asuransi kesehatan yang diselenggarakan oleh Badan Penyelenggara Jaminan Sosial – Kesehatan (BPJS-K). Meskipun banyak manfaat yang dapat diperoleh dari BPJS-K, apakah ada kelemahan dari sistem ini ditinjau dari profesional medis? Beberapa prinsip pengelolaan pasien yang memiliki potensi bermasalah pada pelayanan kesehatan berbasis asuransi kesehatan adalah sebagai berikut.

Controlled Resistant Hypertension Following A Successful Renal Artery Stenting: A Rare Case Report in A Developing Country Munita, Fatihatul Firdaus; Tiksnadi, Badai Bhatara; Martha, Januar Wibawa; Ratna, Margareta Ginanti
Jurnal Kardiologi Indonesia Vol 45 No 2 (2024): April - June, 2024
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1687

Background Renal artery stenosis is among the etiologies of secondary hypertension in which the diagnosis and therapy are difficult. We report a case of a patient with uncontrollable hypertension with frequent episodes of malignant hypertension, treated with renal artery stenting. Case Illustration A 36-year-old female visited the cardiovascular polyclinic on a common control for her hypertension. She was diagnosed with hypertension two years, and she had several episodes of malignant hypertension. At the beginning of her treatment, she has prescribed an angiotensin-converting-enzyme inhibitor, yet her pressure was uncontrolled and worsened. By the visit, she was treated using two alpha-2-adrenergic agonists, a loop diuretic, a beta-blocker, a calcium-channel blocker, an angiotensin-receptor blocker, and an aldosterone-receptor antagonist without any satisfactory outcome on her blood pressure status. She had a blood pressure of 196/130 mmHg with tachycardia of 112 times/minute. We found cardiomegaly on physical examination, which was proven by a chest x-ray. Echocardiography indicated hypertensive heart disease. Screening for secondary hypertension, including laboratory tests (complete blood count, potassium, sodium, creatinine, fasting glucose, lipid profile, urinalysis, thyroid-stimulating hormone, and 24-hour urinary-free cortisol), suggested normal results. Renal ultrasound and doppler were also conducted and showed a suspicion of right renal artery stenosis. Therefore, angiography of the renal artery was performed for diagnosis and therapy when indicated. The angiography suggested a normal left renal artery, while the right artery had a 95% stenosis on the proximal part. An intravascular ultrasound-guided percutaneous transluminal angioplasty on her right renal artery was conducted, and two vascular stents were implanted. The patient showed a remarkable development following her decreasing blood pressure on follow-up. After one week, her blood pressure is controllable on a single antihypertensive and antiplatelet therapy. Conclusion The diagnosis and management of a patient with resistant hypertension might be challenging, particularly in the setting of a developing country. Renal artery angiography, among other examinations, might be crucial in the diagnosis sequence, yet it was only sometimes readily available. We present a case in which a diagnosis of renal artery stenosis was made, followed by a definite treatment resulting in unprecedented hypertension control. An identifiable etiology is the key to a proper and the best treatment option for the patient.

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