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Kecemasan pada Penderita Penyakit Ginjal Kronik yang Menjalani Hemodialisis di RS Universitas Kristen Indonesia Luana NA; Sahala Panggabean; Joyce VM Lengkong; Ika Christine
MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 3 YEAR 2012
Publisher : MEDIA MEDIKA INDONESIANA

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Anxiety in chronic renal failure patients underwent hemodialysis at Christian University of Indonesia HospitalBackground: Anxiety is a pathological condition, characterized by fear and somatic signs. Anxiety is also a response to unidentified, internal, vague threads and conflicts. One of the etiologies of anxiety is biological disorder, such as chronic renal failure (CRF) which needs hemodialysis. Hemodialysis patients experience anxiety, which probably due to its chronicity. The aim of this study is to identify the difference of frequency and period of hemodialysis in various level of anxiety in CRF patients underwent hemodialysis atChristian University of Indonesia Hospital.Methods: This is an observational study with cross-sectional design, conducted during October-December 2011. Anxiety level was measured using the Hamilton Rating Scale for Anxiety (HRSA). Kruskall Wallis test was used to analyze the difference of frequency and period of hemodialysis in three levels of anxiety (mild, moderate, and severe).Results: Twenty eight (51.9%) men and 26 (48.1%) women with CRF who underwent hemodialysis at Christian University of Indonesia Hospital were included in this research. There were 42 (77.78%) among them who experienced anxiety. Patients with the longest mean of period and frequency of hemodialysis experienced mild anxiety, whereas patients with the shortest mean of period and frequency of hemodialysis experience moderate anxiety. There are significant differences found between period and frequency of hemodialysis and levels of anxiety (p=0.002 and p=0.003, respectively).Conclusion: There are significant differences found between period and frequency of hemodialysis and levels of anxiety.Keywords: Hemodialysis, anxiety, HARS ABSTRAKLatar belakang: Cemas (ansietas) adalah suatu keadaan patologik yang ditandai oleh perasaan ketakutan diikuti dan disertai tanda somatik. Kecemasan juga merupakan respon terhadap suatu ancaman yang sumbernya tidak diketahui, internal, samar-samar, atau konfliktual. Kecemasan salah satunya disebabkan oleh gangguan biologik, seperti penyakit ginjal kronik (PGK) yang membutuhkan hemodialisis. Penderita hemodialisis mengalami kecemasan, salah satunya dapat diakibatkan oleh kronisitas penyakit. Penelitian ini bertujuan untuk mengetahui perbedaan frekuensi dan periode menjalani hemodialisis pada berbagai derajat kecemasan pada penderita penyakit ginjal kronik yang menjalani hemodialisis di RS Universitas Kristen Indonesia.Metode: Penelitian ini adalah penelitian observasional dengan rancangan cross-sectional, dilakukan selama bulan Oktober- November 2011. Pengukuran derajat cemas menggunakan instrument Hamilton Rating Scale for Anxiety (HRSA). Dilakukan analisis uji beda Kruskall Wallis untuk menganalisis perbedaan frekuensi dan periode hemodialisis pada tiga derajat kecemasan (ringan, sedang, dan berat).Hasil: Dua puluh delapan (51,9%) laki-laki dan 26 (48,1%) perempuan penderita PGK yang menjalani hemodialisis di Universitas Kristen Indonesia ikut serta dalam penelitian ini. Terdapat 42 (77,78%) di antaranya yang mengalami kecemasan. Penderita dengan rerata periode dan frekuensi hemodialisis terpanjang mengalami kecemasan ringan, sedangkan penderita rerata periode dan frekuensi hemodialisis terpendek mengalami kecemasan sedang. Terdapat perbedaan yang bermakna antara frekuensi dan periodehemodialisis dan derajat kecemasan pada penderita hemodialisis (p=0,002 dan p=0,003, secara berurutan).Simpulan: Terdapat perbedaan yang bermakna antara frekuensi dan periode hemodialisis dan derajat kecemasan pada penderita hemodialisis.
Kadar Imunoglobulin M Anti Phenolic Glycolipid-I Mycobacterium Leprae dan Tumor Necrosis Factor-α pada Penderita Lepra Subklinis Yuanita Dian Utama; Soejoto Soejoto; Sri Djoko Susanto; ES Indrayanti; Subakir Subakir; Dhiana Ernawati
MEDIA MEDIKA INDONESIANA 2010:MMI VOLUME 44 ISSUE 2 YEAR 2010
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Immunoglobulin M anti phenolic glycolipid-I mycobacterium leprae level and tumor necrosis factor-α level in subclinical leprosyBackground: In subclinical leprosy, patients have no clinical lesion but seropositive to anti PGL-I antibody specific to M. leprae. On the other hand, TNF-α is produced in majority during innate immunity, inhibits mycobacterial growth and mediates granuloma formation. Mutant allele of TNF2308A has protective role against the development of severe form of leprosy. This study analyzed the correlation between IgM anti PGL-I and TNF-α levels in subclinical leprosy. Method: Study was done at an orphanage, using observational study with cross-sectional approach. Three mililiter peripheral blood were centrifuged and divided into 2 cryotubes. Immunoglobulin M anti PGL-I Mycobacterium leprae levels were measured by quantitative indirect ELISA. Tumor necrosis factor-α levels of subclinical leprosy patients (IgM anti PGL-I M. leprae level ≥600 U/mL) were measured using Human TNF-α ELISA Bender Medsystems for sandwich ELISA. Analysis of distribution normality using Shapiro-Wilk, continued with Rank Spearman correlation test.Result: Immunoglobulin M anti PGL-I levels were ranged between 616.85-1753.8 U/mL. Tumor necrosis factor-α levels were ranged between 2.72-50.13 pg/mL. There was significant positive correlation between IgM anti PGL-I level 600-1000 U/mL and TNF-α level (p=0.714; p=0.006), and insignificant negative correlation between IgM anti PGL-I level ≥1000 U/mL and TNF-α level (p=-0.172; p=0.557). Conclusion: There were significant positive correlation between IgM anti PGL-I level 600-1000 U/mL and TNF-α level, and insignificant negative correlation between IgM anti PGL-I level ≥1000 U/mL and TNF-α level. ABSTRAKLatar belakang: Pada lepra subklinis tidak dijumpai lesi, namun ditemukan antibodi anti PGL-I yang spesifik terhadap M. leprae. Di sisi lain, TNF-α dihasilkan terutama pada imunitas alami, dapat menghambat pertumbuhan mikobakteria dan memperantarai pembentukan granuloma. Alel mutan TNF2308A diketahui protektif mencegah berkembangnya bentuk lepra yang lebih berat. Penelitian ini menganalisis hubungan antara kadar IgM anti PGL-I dan TNF-α lepra subklinis.Metode: Penelitian dilakukan di sebuah panti asuhan secara observasional dengan pendekatan cross-sectional. Tiga mililiter darah perifer, disentrifus, kemudian dibagi dalam 2 cryotube. Pemeriksaan kadar IgM anti PGL-I M. leprae menggunakan ELISA indirek kuantitatif. Pada penderita lepra subklinis (kadar IgM anti PGL-I M. leprae ≥600 U/mL) diperiksa kadar TNF-α menggunakan ELISA sandwich dengan Human TNF-α ELISA Bender Medsystems. Analisis uji normalitas distribusi dengan Shapiro-Wilk, dilanjutkan uji korelasi Rank Spearman.Hasil: Kadar IgM anti PGL-I berkisar antara 616,85-1753,8 U/mL. Kadar TNF-α berkisar antara 2,72-50,13 pg/mL. Terdapat hubungan positif bermakna (p=0,714; p=0,006) antara kadar IgM anti PGL-I 600-1000 U/mL dan kadar TNF-α, dan hubungan negatif tidak bermakna (p=-0,172; p=0,557) antara kadar IgM anti PGL-I ≥1000 U/mL dan kadar TNF-α. Simpulan: Pada kadar IgM anti PGL-I 600-1000 U/mL, semakin tinggi kadar IgM anti PGL-I, semakin tinggi pula kadar TNF-α; sedangkan pada kadar IgM anti PGL-I ≥1000 U/mL terdapat kecenderungan hubungan terbalik yang tidak bermakna.
Risk Factors of Stunting among 1-2 Years Old Children in Semarang City Aryu Candra; Niken Puruhita; JC Susanto
MEDIA MEDIKA INDONESIANA 2011:MMI Volume 45 Issue 3 Year 2011
Publisher : MEDIA MEDIKA INDONESIANA

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Abstract

ABSTRACTBackground: Prevalence of stunting in children under five years in Central Java is high, more than 33%. Semarang City has high prevalence of malnutrition therefore there is a need to identify risk factors of stunting in Semarang city.Method: This was a case control study, completed with qualitative study about risk factors of stunting. Samples were 58 cases and 58 controls. Data were analyzed by univariate analysis, bivariate analysis with chi square test, and multivariate analysis with multiple logistic regression. Qualitative study was done by using indepth interview, and presented in narration.Results: The multivariate analysis result showed that risk factors of stunting in children 1-2 years old were short stature father (<162 cm) (p=0.016; OR=2.7; CI=1.2-6), children had history of low birth weight (p=0.028; OR=11.2; CI=1.3-96.3), and children had history of underweight (p=0.006; OR=3.3; CI=1.4-7). Risk factors which were not proven to influence the incidence of stunting were maternal height, history of exclusively breastfed, complementary feeding history; sex, history of infection, and immunization history.Conclusions: Risk factors that influence the incidence of stunting in children 1-2 years olds are having father’s height <162 cm, and positive history of low birth weight, and of underweight.Keywords: Stunting, malnutrition, children, growth, risk factorsABSTRAKFaktor risiko dari stunting pada anak usia 1-2 tahun di kota SemarangLatar belakang: Stunting adalah perawakan pendek yang timbul akibat malnutrisi yang lama. Prevalensi stunting pada balita di Jawa Tengah tinggi, yaitu lebih dari 33%. Kota Semarang merupakan ibukota Jawa Tengah yang memiliki prevalensi malnutrisi cukup tinggi sehingga diperlukan studi untuk mengetahui faktor risiko stunting di Kota Semarang.Metode: Penelitian ini merupakan studi kasus kontrol, dilengkapi kajian kualitatif mengenai stunting pada status ekonomi kurang dan status ekonomi cukup. Jumlah sampel 58 kasus dan 58 kontrol. Analisis data dilakukan secara univariat, bivariat dengan chi square test, multivariat dengan metode regresi logistik ganda. Kajian kualitatif denganmetode indepth interview dan disajikan dalam bentuk narasi.Hasil: Hasil analisis multivariat menunjukkan faktor risiko yang berpengaruh terhadap kejadian stunting pada anak 1-2 tahun di kota Semarang adalah tinggi badan ayah <162 cm (p=0,016; OR=2,7; CI:1,2-6), anak yang mempunyai riwayat BBLR (p=0,028; OR=11,2; CI=1,3-96,3), dan anak mempunyai riwayat underweight (p=0,006; OR=3,3; CI=1,4-7). Faktor risiko yang tidak terbukti mempengaruhi kejadian stunting adalah jenis kelamin, tinggi badan ibu, riwayat ASI eksklusif, riwayat infeksi, riwayat imunisasi, dan riwayat makanan pendamping ASI.Simpulan: Faktor risiko yang mempengaruhi kejadian stunting pada anak 1-2 tahun adalah yang mempunyai ayah dengan tinggi badan <162 cm dan mempunyai riwayat BBLR, serta berat badan kurang.
Pemberian Cairan Karbohidrat Elektrolit, Status Hidrasi dan Kelelahan pada Pekerja Wanita Mardiana Mardiana; Apoina Kartini; Baju Widjasena
MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 1 YEAR 2012
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Abstract

Carbohydrate electrolyte solution improve hydration status and decrease fatigue among women workersBackground: Heat exposure cause dehydration and fatigue if water intake is insufficient. Carbohydrate electrolyte drinks consumption maintans workers hydration status and prevent fatigue. Women workers at ironing department in garment industry are at risk of dehydration and fatigue because of the heat exposure.Objective: To determine the effect of carbohydrate electrolyte solution on hydration and fatigue status among women workers.Method: This quasy experiment was conducted in pre post test control group design. Population of this study was women workersaged 18-35 years in ironing department of garment industry. Thirty-three subjects were selected by inclution criteria. Subjects were given three treatments, without intervention, drink water and carbohydrate electrolyte solution. Body weight and fatigue of the subjects were measured on the third, fourth, and fifth intervention days before and after each treatment. Body weight was measuredusing digital scales. Fatigue was measured by reaction timer to flash light. Data were analyzed using paired t test, Wilcoxon test, and Ancova.Result: Body weight decreased 0.1?0.2 kg after work without intervention and drinking water, while increased body weight of 0.1?0.1 kg after given carbohydrate electrolyte. Reaction timed to flash light decreased 12.2?49.0 milliseconds after given carbohydrate electrolyte solution increased 14.9?62.3 and 26.4?33.8 milliseconds after drinking water and without intervention respectively. Drinking carbohydrate electrolyte solution improved hydration status and decreased fatigue status before and aftercontrolled for energy and fluid intake, vitamin B1 and B6 intake.Conclusion: Carbohydrate-electrolyte solution improved the hydration status and decreased fatigue among women workers.Keywords: Carbohydrate-electrolyte solution, hydration status, fatigue, women workers ABSTRAKLatar belakang: Paparan panas selama bekerja dapat menyebabkan dehidrasi dan kelelahan jika asupan cairan tidak cukup. Penambahan cairan karbohidrat elektrolit selama bekerja diduga dapat mencegah dehidrasi dan kelelahan. Pekerja wanita di bagian ironing perusahaan garmen terpapar panas sehingga berisiko dehidrasi dan kelelahan. Tujuan penelitian ini untuk mengetahui pengaruh pemberian cairan karbohidrat elektrolit terhadap status hidrasi dan kelelahan pada pekerja wanita.Metode: Desain penelitian nonrandomized pre-post test control group design. Populasi adalah pekerja wanita perusahaan garmen berusia 18-35 tahun di bagian ironing. Subyek berjumlah 33 orang yang dipilih berdasarkan kriteria inklusi. Subyek mendapat tiga perlakuan, yaitu tanpa intervensi, pemberian air minum dan karbohidrat elektrolit. Subyek diukur berat badan dan kelelahan sebelum dan setelah bekerja selama tiga hari berturut-turut untuk setiap perlakuan. Pengukuran berat badan menggunakan timbangan injak digital. Kelelahan diukur melalui kecepatan dalam merespon cahaya dengan menggunakan alat reaction timer. Data dianalisis menggunakan paired t test, Wilcoxon, repeated measure, dan uji Ancova.Hasil: Pada kondisi tanpa intervensi dan pemberian air minum terjadi penurunan berat badan (0,1?0,1 kg) setelah bekerja, sedangkan pada pemberian karbohidrat elektrolit terjadi peningkatan berat badan sebesar 0,1?0,2 kg. Waktu reaksi rangsang cahaya menurun sebesar 12,2?49,0 millidetik setelah pemberian karbohidrat elektrolit dan meningkat sebesar 26,4?33,8 millidetik pada kondisi tanpa intervensi serta 14,9?62,3 millidetik pada pemberian air minum. Pemberian cairan karbohidrat elektrolit memperbaiki status hidrasi sebelum dan setelah dikontrol dengan asupan energi dan cairan serta menurunkan kelelahan sebelum dan setelah dikontrol dengan asupan energi, cairan, vitamin B1, dan vitamin B6. Simpulan: Pemberian cairan karbohidrat elektrolit dapat memperbaiki status hidrasi dan menurunkan kelelahan
Sindrom Stevens-Johnson dan Nekrolisis Epidermal Toksis di RSUP MH Palembang Periode 2006 - 2008 M. Athuf Thaha
MEDIA MEDIKA INDONESIANA 2009:MMI VOLUME 43 ISSUE 5 YEAR 2009
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Abstract

Steven-Johnson syndrome and toxic epidermal necrolysis in RSUP MH Palembang in year 2006-2008Background: Stevens-Johnson syndrome (SSJ) and toxic epidermal necrolysis (TEN) are rare, life-threatening, drug-induced cutaneous reactions.Methods: We conducted a retrospective study by gathering 43 SJS, SJS/TEN, and TEN patients data from RSUP MH General Hospital Palembang from 2006-2008. Variable that were evaluated covered the age, gender, incidence, drug causes, and results of medical treatment.Results: The number of SSJ cases was higher than SJS/TEN and TEN cases, most of SSJ patients were in 26-36 year age group (11 patients or 25.5%), with male/female ratio of: 55.8%:44.2%. The use of paracetamol, amoxycilline, tetracycline, cotrimoxsazole, methampirone, ciprofloxacine, and carbamazepine was associated with large increases in the risk of SSJ or TEN. Hospital stays for SSJ was 8.91 ± 5.52 days, and 13.2 ± 3.89 days for SJS/TEN. This retrospective study expressed the high incidence of the SJS inRSUP MH in 2006-2008 period, compared with the incidence reported in the bibliography.Conclusions: Although there were still controvercies in systemic corticosteroid use, this study showed the use of steroid gave satisfactory results.Keywords: Stevens-Johnson syndrome, toxic epidermal necrolysis, drug-induced cutaneous reactions ABSTRAKLatar belakang: Sindrom Stevens-Johnson (SSJ) dan nekrolisis epidermal toksis (NET) ialah reaksi kulit terutama akibat obat yang jarang ditemui dan dapat menyebabkan kematian.Metode: Penelitian dilakukan secara retrospektif dengan mengumpulkan data rekam medik RSUP MH Palembang periode 2006–2008, sebanyak 43 pasien rawat inap yang didiagnosis sebagai SSJ, SSJ/NET, dan NET. Variabel yang dievaluasi meliputi usia, jenis kelamin, angka kejadian penyakit, obat yang menyebabkan penyakit, lama perawatan, dan hasil pengobatan.Hasil: Hasil evaluasi menunjukkan jumlah kasus SSJ merupakan yang terbanyak dibandingkan NE lainnya, usia terbanyak SSJ terdapat pada kelompok usia 26-36 orang (11 orang atau 25,5%), rasio laki-laki/perempuan sebesar: 55,8%:44,2%. Obat yang terbanyak berturut-turut ialah parasetamol, amoksisilin, tetrasiklin, kotrimoksasol, metampiron, siprofloksasin dan karbamazepin. Lama perawatan pasien SSJ ialah 8,9 ± 5,5 dan SSJ/NET 13,2 ± 3,9 hari, dan semua pasien (kecuali yang pulang paksa) sembuh pada evaluasi paska rawat. Penelitian retrospektif ini mengungkap tingginya angka kejadian SSJ di RSUP MH periode 2006-2008, dibandingkan angka kejadian yang dilaporkan dalam kepustakaan. Terdapat perbedaan jenis obat penyebab SSJ di RSUP Palembang dari obat penyebab risiko tinggi yang dilaporkan dalam literatur.Simpulan: Walaupun masih terdapat silang pendapat penggunaan steroid sistemik pada SSJ, penelitian ini menunjukkan pemakaian steroid memberikan hasil yang  memuaskan.
Derajat Sindroma Distres Respirasi pada Foto Thorax dan Derajat Asfiksia pada Neonatus Prematur Farah Hendara Ningrum; Hermina Sukmaningtyas; Mardiana Wahyuni
MEDIA MEDIKA INDONESIANA 2010:MMI VOLUME 44 ISSUE 1 YEAR 2010
Publisher : MEDIA MEDIKA INDONESIANA

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The degrees of respiratory distress syndrome from thorax X-ray and degrees of asphyxia in preterm neonatesBackground: Respiration Distress Syndrome (RDS) is a complication of prematurity lung disorder and common causes of premature neonatal morbidity. Clinically RDS provides signs of asphyxia that can be assessed with APGAR score. Chest X-ray can also diagnose and determine the degree of RDS radiologically. This study aims to find the relationship degree of RDS clinically with radiologically.Methods: Analytic observational study with cross-sectional design. The subjects were premature neonates with asphyxia in Kariadi General Hospital Semarang who had APGAR score and RDS on the standard Chest x-ray examination and selected using consecutive sampling method. The relationship between the RDS clinical degree based on APGAR score with radiological degrees tested with the Chi square test (X2) and Kendall tau-b. There were four grading for RDS. Chest x-ray images were interpretated by 2 expert radiologists independently and then Kappa value was evaluated.Results: There were 23 RDS cases consisted 12 severe, 8 moderate and 3 mild asphyxia cases. Radiologically showed grade I (9), grade II (5), grade III (5) and grade IV (4) neonates. Kappa value=1 (p<0.001). Chi square test (X2) showed clinical asphyxia degree was not significantly different with the degree of RDS on chest x-ray. Kendall tau-b correlation test showed a significant and moderate degree correlation (r=0.5; p=0.01).Conclusions: The degree of asphyxia in premature infants are in line with radiological images.ABSTRAKLatar belakang: Sindroma distres respirasi (SDR) yang bermanifestasi dalam bentuk asfiksia merupakan kelainan paru komplikasi prematuritas penyebab tersering morbiditas neonatus prematur. X-foto thorax membantu diagnosis SDR sekaligus menentukan derajat SDR. Penelitian ini bertujuan menilai hubungan derajat klinis SDR dengan derajat radiologi.Metode: Studi observasional analitik dengan rancangan cross-sectional. Subjek penelitian adalah neonatus prematur dengan asfiksia di RSUP Dr. Kariadi Semarang yang mempunyai skor APGAR serta mendapatkan pemeriksaan X-foto thoraks standar. Pemilihan subjek menggunakan metode consecutive sampling. Terdapat empat derajat SDR secara radiologis Hubungan antara derajat klinis SDR berdasarkan skor APGAR dengan derajat radiologis diuji dengan Chi square(X2) dan derajat korelasi dengan uji Kendall tau-b. Hasil X-foto thorax diinterpretasi terpisah oleh 2 ahli radiologi dan diuji Kappa. Hasil: Dijumpai 23 asfiksia neonatus prematur dengan SDR terdiri dari 12 kasus asfiksia berat, 8 kasus asfiksia sedang dan 3 kasus asfiksia ringan. Secara radiologis ditemukan SDR derajat I sebanyak 9, 5 derajat II, 5 derajat III dan derajat IV pada 4 neonatus. Nilai Kappa=1 (p<0,001). Derajat asfiksia secara klinis tidak berbeda bermakna dengan derajat radiologi SDR (Chi square(X2) p=0,007). Uji korelasi Kendall tau-b menunjukkan korelasi bermakna tingkat sedang (r=0,5; p=0,01) antara derajat asfiksia secara klinis dengan derajat radiologi SDR. Simpulan: Derajat asfiksia pada bayi prematur sejalan dengan derajat radiologik foto thorax pada SDR.
Asupan Lemak dan Ekspresi Gen eNOS3 Alel Glu298Asp pada Penderita Hipertensi Etnik Minangkabau Delmi Sulastri; Lipoeto NI; Nasrul Zubir; Jamsari Jamsari
MEDIA MEDIKA INDONESIANA 2011:MMI Volume 45 Issue 1 Year 2011
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ABSTRACTIntake of fat and Gen eNOS3 Alel Glu298Asp expression in hypertensive Minangkabau personsBackground: eNOS 3 gene is one of the important genes which is related to the high prevalence of hypertension essensial. This gene expresses the nitric oxide synthase (NOS) enzyme which regulates the synthesis of nitric oxide (NO) in human body.Methods: A research has been done on hypertensive and normotensive patients aged 30-65 years old. The main purpose of this research was to evaluate the association of fat intake on eNOS3 gene Glu298Asp allel expression in hypertension subjects in Minangkabau ethnicity. One hundred thirty subjects had been interview about their eating habits, and measured their omega-3, eNOS3 gene and NO plasma level. The data were analysed with t-tes and chi-square.Results: The hypertensive’s plasma NO concentration was 26.91±15.40 μM/L and normotensive’s was 25.79±15.04 μM/L. 52.5% of the hypertensive subjects and 47.5% of the normotensive has eNOS3 gene heterozygotes GT allele. Mean rates for total fat, SFA, MUFA and PUFA consumption of hypertensive subjects are 28.05±6.57%, 12.31±4.21%, 4.21±1.79%, 3.77±1.97% and normotensive are 30.14±13.98%, 12.58±4.22%, 4.40±2.22%, 4.00±1.96%. Mean rate for plasma omega-3 concentration of hypertensive subjects is 14.45±0.10μg/dL and normotensive is 14.49±1.00 μg/dL. There is significant relationship between omega-3 with NO plasma level on hypertension with GT heterozygote alleles.Conclusion: In hypertensive patients with GT heterozygote alleles, only omega-3 plasma is associated with NO2 plasma.Keywords: Essensial hipertension, eNOS3 gene, NO plasma levelABSTRAKLatar belakang: Gen eNOS3 alel Glu298Asp merupakan salah satu gen yang berhubungan dengan kejadian hipertensi esensial. Kemampuan Gen eNOS3 alel ini untuk mensintesis enzim nitric oxide synthase (NOS) berkurang sehingga sintesis nitric oxide (NO) menurun.Metode: Penelitian pada subyek hipertensi dan normotensi berusia 30-65 tahun bertujuan untuk melihat hubungan asupan lemak dengan ekspresi gen eNOS3 alel Glu298Asp. Seratus tiga puluh subyek, diwawancara pola makannya lalu dilakukan pemeriksaan kadar omega-3 dan omega-6 plasma, gen eNOS3, serta kadar NO plasma. Data yang diperoleh dianalisis menggunakan uji T dan chi-square.Hasil: Kadar NO plasma subyek hipertensi adalah 26,91±15,40 μM/L dan normotensi 25,79±15,04 μM/L. 52,5% subyek hipertensi dan 47,5% normotensi mempunyai polimorfisme gen eNOS3 alel heterozigot GT. Rerata persentase asupan lemak total, ALJ, ALTJT, ALTJG pada subyek hipertensi adalah 28,05±6,57%, 12,31±4,21%, 4,21±1,79%, 3,77±1,97% dan pada subyek normotensi adalah 30,14±13,98%, 12,58±4,22%, 4,40±2,22%, 4,00±1,96%. Rerata kadar omega-3 plasma subyek hipertensi adalah 14,45±0,10 μg/dL dan normotensi 14,49±1,00 μg/dL. Terdapat hubungan kadar omega-3 dengan NO plasma pada penderita hipertensi dengan alel heterozigot GT.Simpulan: Pada penderita hipertensi dengan alel heterozigot GT, hanya omega-3 plasma yang berhubungan dengan kadar NO2 plasma.
Pengaruh Polifenol Teh Hijau Terhadap Sistem Imun Penderita Karsinoma Nasofaring yang Mendapat Radioterapi Kajian jumlah monosit, limfosit serta produksi TNF-α, IFN-γ dan IL-2 ex vivo Wiratno Wiratno
MEDIA MEDIKA INDONESIANA 2009:MMI VOLUME 43 ISSUE 4 YEAR 2009
Publisher : MEDIA MEDIKA INDONESIANA

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The effect of green tea polyphenols on the immunity of nasopharyngeal carcinoma patients treated with radiotherapy: A study on the number of monocytes and lymphocytes, and production of TNF-α, IFN-γ and IL-2 ex vivoBackground: Radiotherapy in patients with nasopharyngeal carcinoma gives side effects, among other is the suppression of immunity system. Green tea polyphenols (GTP) has been proven to modulate immune system. The study aimed to analyze the capacity of antioxidant GTP in inhibiting the suppression effect of radiotherapy to the immune system using monocytes, lymphocytes, TNF-α, IFN-γ and IL-2 parameters.Methods: An experiment study using pre-post test control group design was conducted to 50 NPC patients in II, III and IV stages, received 200 cGy/day 33 times. The treatment group was 25 patients consumed GTP (2900 mg of decaffeinated extract of green tea, containing 986 mg EGCG and 1711 mg of other polyphenols) 2 hours before and 10 hours after RT. The 10 ml blood of cubiti vein was taken 5 to 7 days prior and 3-5 hours after the whole RT. Monocytes and lymphocytes were cultured with autologous whole blood and TNF-α secretion of monocytes having been induced with LPS, IFN-γ and IL-2 by lymphocytes having been induced with PHA and LPS respectively, were measured using ELISA.Results: In the post RT, the control group, monocyte, lymphocyte, TNF-α, IFN-γ and IL-2 had decreased, and the treatment group, monocyte, lymphocyte, and TNF-α decrease, while IFN-γ and IL-2 increase. The t-test transformation logarithm data of monocyte, lymphocyte, and TNF-α comparing the two groups, the result of monocyte and lymphocyte was significantly different (p<0.05), except TNF-α. The Mann-Whitney test the delta data of the IFN-γ and IL-2 were significantly different (p<0.05).Conclusions: GTP significantly inhibit the decrease of the number of monocyte and lymphocyte as well as the production of IFN-γ and IL-2, except TNF-α.Keywords: Nasopharyngeal carcinoma, radiotherapy, green tea polyphenols, monocyte, lymphocyte, TNF-α, IFN-γ, IL-2ABSTRAK Latar belakang: Terapi radiasi pada karsinoma nasofaring (KNF) menimbulkan efek samping berupa supresi sistem imun. Polifenol teh hijau (PFTH) ditengarai dapat meningkatkan sistem imun. Dilakukan suatu penelitian untuk mengetahui kapasitas antioksidan polifenol teh hijau dalam menghambat efek supresi radioterapi (RT) terhadap monosit dan limfosit serta fungsinya ex vivo dalam memproduksi TNF-α, IFN-γ dan IL-2 pada penderita KNF.Metode: Penelitian dengan design pre-post test dengan kelompok kontrol dilakukan pada 50 penderita KNF stadium II, III dan IV yang mendapat radioterapi 200cGy/hari sampai 33 kali. Kelompok perlakuan 25 penderita mendapat PFTH (2900 mg ekstrak teh hijau non-kafein mengandung 986 mg EGCG dan 1711 mg polifenol yang lain) dikonsumsi 2 jam sebelum dan 10 jam setelah RT. 10 ml darah vena kubiti diambil 5-7 hari sebelum dan 3-5 jam setelah seluruh radioterapi. Monosit dan limfosit dikultur dalam darah lengkap penderita dan TNF-α sekresi dari monosit setelah diinduksi dengan LPS, IFN-γ dan IL-2 sekresi dari limfosit setelah diinduksi masing-masing dengan PHA dan LPS.  Diperiksa dengan metode ELISA .Hasil: Pasca RT, kelompok kontrol didapatkan monosit, limfosit, TNF-α, IFN-γ dan IL-2 semuanya menurun, sedangkan pada kelompok perlakuan yang menurun monosit, limfosit dan TNF-α, sedangkan IFN-γ dan IL-2 keduanya meningkat. Uji t tes terhadap data logaritma monosit, limfosit dan TNF-αantara kelompok perlakuan dan kelompok kontrol, hasilnya hanya monosit dan limfosit yang berbeda bermakna (p<0,05), sedangkan TNF-α tidak. Uji dengan Mann-Whitney terhadap data delta IFN-γ dan IL-2 antara kedua kelompok didapatkan berbeda bermakna (p<0,05).Simpulan: PFTH menghambat secara bermakna penurunan jumlah monosit dan limfosit serta produksi IFN-γ dan IL-2, sedangkan TNF-α tidak
Perbandingan Kadar Estrogen Serum dan TGF β-1 Plasma pada Penderita BPH-Non BPH di Atas 50 Tahun dan Usia Muda Eriawan Agung Nugroho; Selamat Budijitno
MEDIA MEDIKA INDONESIANA 2013:MMI VOLUME 47 ISSUE 1 YEAR 2013
Publisher : MEDIA MEDIKA INDONESIANA

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ABSTRACT Comparison of estrogen serum and TGF β-1 plasma levels in benign prostate hyperplasia (BPH) and non BPH patients, among 50-years old and young patients.Background: Benign prostatic hyperplasia (BPH) is often found in older men. This disease affects an estimated 70% of men over 60 years, increased by 90% in men over 80 years age. Many scientists tried explores the hypothesis of the mechanism of occurrence of BPH. The purpose of study compared the levels of estrogen and transforming growth factor (TGF) ß-1 in plasma related to the development of BPH, in BPH patients and non-BPH over 50 years and young age.Methods: A clinical analysis study was carried out on subjects who were divided into 3 groups: patients with BPH >50 years, non-BPH >50 years and younger non-BPH aged 30-40 years. T-test was used to analyze the data. Serum estrogen and plasma TGF β-1 were assessed using ELISA method.Results: There was no significant difference (p=0.129) between the level of estrogen in BPH patients >50 years (140.091±43.649) and non BPH patients >50 years (63.69±18.757) but there was a significant difference (p=0.015) between level of plasma TGF ß-1 BPH patients >50 years (10.47±4.507) and non BPH patients >50 years of age (25.8±16.1103). No significant differences (p=0.348) were found between serum estrogen level of non-BPH >50 years (63.69±18.757) and the young age (57.17±10.2748), and between plasma TGF ß-1 non-BPH group >50 years (25.80±16.1103) and the younger age group (31.4±17,576)(p=0.496).Conclusion: There is difference in the level of TGF ß-1 between younger and older age groups. Elderly men are recommended for early prostate examination, because at the age of 50 years there is already a tendency of enlarged prostate gland. Levels of transforming growth factor β-1 can predict prostate enlargement.Keywords: Estrogen, TGF ß-1, benign prostate hyperplasia (BPH)ABSTRAKLatar belakang: Benign prostate hyperplasia (BPH) sering ditemukan pada pria usia lanjut. Penyakit ini terjadi pada 70% pria di atas 60 tahun, dan meningkat hingga 90% pada pria di atas 80 tahun. Banyak ilmuwan mencoba mengetengahkan hipotesis faktor yang berpengaruh terjadinya BPH. Tujuan penelitian ini membandingkan tingkat estrogen dan transforming growth factor (TGF) ß-1 dalam plasma terkait pembentukan BPH.Metode: Penelitian klinik analitik dilakukan pada subyek yang dibagi 3 kelompok, pasien dengan BPH >50 tahun, pasien non-BPH berusia >50 tahun dan muda non-BPH berusia 30-40 tahun. Analisis data dengan uji beda kadar estrogen serum dan TGF β-1 plasma ketiga kelompok. Kadar TGF ß-1 dan estrogen diukur dengan metoda ELISA.Hasil: Serum estrogen pasien BPH usia >50 tahun (140,091±43,649) lebih tinggi tetapi tidak berbeda bermakna (p=0,129) dibandingkan non BPH usia >50 tahun (63,69±18,757). Estrogen serum non-BPH usia >50 tahun (63,69±18,757) dibandingkan usia muda (57,17±10,2748) tidak berbeda bermakna (p=0,348). TGF ß-1 plasma pasien BPH usia >50 tahun (10,47±4,507) lebih rendah (p=0,015) dibandingkan pasien non BPH usia >50 tahun (25,8±16,1103). TGF ß-1 plasma kelompok non-BPH >50 tahun (25,80±16,1103) dibandingkan kelompok usia muda (31.04±17,576) tidak berbeda bermakna (p=0,496).Simpulan: Ada perbedaan antara tingkat TGF β-1 pada kelompok yang lebih tua. Laki-laki usia tua disarankan lebih dini melakukan pemeriksaan prostat, usia >50 tahun cenderung didapatkan pembesaran kelenjar prostat. Pemeriksaan kadar TGF -1 dapat memprediksi risiko pembesaran kelenjar prostat.
Clinical Skills Training in the Community: Lesson Learned from Diponegoro and Gadjah Mada University Tri Nur Kristina; Widyandana Widyandana
MEDIA MEDIKA INDONESIANA 2011:MMI Volume 45 Issue 2 Year 2011
Publisher : MEDIA MEDIKA INDONESIANA

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ABSTRACTBackground: Community-based education (CBE) clerkship in Faculty of Medicine Diponegoro University (FMDU) is implemented after finishing clinical rotation in tertiary hospital, whereas in Gadjah Mada University (FMGMU), is a part of clinical rotation. To have insight information of this difference method, the CBE clerkship in FMDU and FMGMU were compared.Methods: Close and open-ended students’ questionnaires were administered in the end of CBE clerkship.Results: Response rate to the questionnaire was 97.8% (n=286). FMDU students reported the most unprepared skills for CBE clerkship was blood smear of malaria, whereas FMGMU’s students reported management of PHC centre. Both students perceived that they are well prepared in communication skills, management of communicable diseases, and several clinical skills, and also reported that they have frequent experience in outpatient department. FMDU’ students perceived that CBE clerkship gave opportunity to work independently, and they felt more prepared to work as a doctor in the community. On the other hand, FMGMU students felt not so confident in patient management, and reported that supervisor did not give enough assistance. They suggested that CBE clerkship should be done at least after clinical rotation in two Departments, i.e.: Internal Medicine or Paediatric andSurgery or Ob-gyn.Conclusions: CBE clinical clerkship required students’ confidence and independency. Preparation should be done properly not only for the students but also supervisor in the community. Tertiary hospital, which has enough skillful supervisors, is important to train basic clinical skills to students before sending them to the community.Keywords: Clerkships, clinical skills, medical students, CBE, communityABSTRAKKepaniteraan klinik di masyarakat: pembelajaran di Universitas Diponegoro dan Gadjah MadaLatar belakang: Kepaniteraan klinik di masyarakat di Fakultas Kedokteran Universitas Diponegoro diimplementasikan setelah mahasiswa kedokteran tingkat akhir menyelesaikan rotasi klinik di rumah sakit pendidikan tersier, sedangkan di Universitas Gadjah Mada kepaniteraan klinik di masyarakat menjadi bagian dari rotasi klinik. Dalam rangka mendapatkan informasi yang mendalam mengenai perbedaan metode tersebut, kepaniteraan klinik di masyarakat pada ke-2 institusi tersebut dievaluasi dan dibandingkan.Metode: Penelitian kuesioner dengan pertanyaan tertutup dan terbuka, diberikan pada mahasiswa di akhir dari kepaniteraan klinik di masyarakat.Hasil: Kuesioner yang dikembalikan sebesar 97,8% (n=286). Mahasiswa FK Undip melaporkan bahwa yang paling kurang dipersiapkan untuk kepaniteraan kinik di masyarakat adalah keterampilan dalam melakukan pemeriksaan darah hapus malaria, sedangkan mahasiswa FK UGM melaporkan bahwa mereka kurang dipersiapkan dalam hal manajemen puskesmas. Mahasiswa dari ke-2 institusi sama-sama merasa bahwa mereka cukup dipersiapkan dalam hal keterampilan komunikasi, manajemen penyakit infeksi, dan beberapa keterampilan klinik. Mereka juga sama-sama melaporkan pengalaman yang cukup sering di poliklinik. Mahasiswa FK Undip merasa bahwa kepaniteraan klinik di masyarakat memberi kesempatan pada mereka untuk bekerja secara independen, dan merasa lebih siap untuk bekerja sebagai dokter di masyarakat. Di lain pihak, mahasiswa FK UGM merasa kurang percaya diri dalam mengelola pasien dan melaporkan bahwa supervisor di puskesmas kurang memberikan supervisi. Mereka menyarankan agar kepaniteraan klinik di masyarakat dilakukan setelah minimal menjalani rotasi klinik di 2 departemen, misalnya:interna/pediatrik dan bedah/kebidanan.

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