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Majalah Kedokteran Bandung
Published by Universitas Padjadjaran
ISSN : 0126074X     EISSN : 23386223     DOI : 10.15395/mkb
Core Subject : Health,
Medicine & Pharmacology
Majalah Kedokteran Bandung (MKB)/Bandung Medical Journal publishes peer-reviewed original articles and case reports in basic medical research, clinical research, and applied medical science. This journal is published quarterly (March, June, September, and December) by Faculty of Medicine Universitas Padjadjaran. Articles are original research that needs to be disseminated and written in English. All submitted manuscripts will go through the double-blind peer review and editorial review before being granted with acceptance for publication.
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Efektivitas Pemberian Metilprednisolon terhadap Pembentukan Seroma Pascaoperasi Mastektomi Modifikasi Radikal Setiawan, Jonny; Abdurahman, Maman; Rizki, Kiki A.
Majalah Kedokteran Bandung Vol 46, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Seroma adalah pengumpulan cairan serous di subkutis dan merupakan komplikasi pascaoperasi kanker payudara yang paling sering dijumpai. Insidensinya mencapai lebih dari 60%. Walaupun tidak mengancam jiwa, namun dapat menimbulkan morbiditas yang serius. Berbagai penelitian dilakukan untuk menentukan faktor risiko untuk mencegah timbulnya seroma. Saat ini, seroma terjadi karena proses inflamasi pascaoperasi. Teori inilah yang mendasari peranan antiinflamasi terhadap pembentukan seroma. Diketahui obat golongan glukokortikoid, memiliki peranan menghambat respons inflamasi. Tujuan penelitian ini untuk menilai efek profilaksis pemberian metilprednisolon perioperatif mastektomi terhadap pembentukan seroma. Penelitian ini merupakan uji klinis secara acak tersamar ganda terhadap 2 kelompok, yaitu antara kelompok karsinoma payudara stadium lokal lanjut yang diberikan metilprednisolon perioperatif mastektomi sebagai kelompok perlakuan dan kontrol. Penelitian ini dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung, periode April–Juli 2013. Subjek penelitian meliputi 30 wanita yang memenuhi kriteria inklusi dan dibagi menjadi dua kelompok, 15 pasien diberikan metilprednisolon dan 15 pasien sebagai kontrol. Penelitian ini menggunakan uji-t tidak berpasangan dan Mann Whitney. Didapatkan perbedaan rata-rata volume drainase hari ke-1, pada kelompok metilprednisolon sebanyak 104,7 mL dan pada kontrol sebanyak 158 mL, namun secara statistik tidak bermakna (p=0,053). Demikian pula dengan hari-hari selanjutnya dan total seroma, tidak didapatkan perbedaan yang bermakna. Simpulan, pemberian metilprednisolon tidak efektif menurunkan volume drainase seroma pascaoperasi mastektomi. [MKB. 2014;46(2):88–93]Kata kunci: Mastektomi, metilprednisolon, seromaEffectiveness of Methylprednisolone on Post-Operative Seroma Formation Following Radical Modified MastectomySeroma is a collection of serous fluid in the subcutaneous and is the most common complication of breast cancer surgery. The incidence is more than 60%. Although it is not life-threatening but it can cause serious morbidity. Various studies were conducted to determine the risk factors to prevent seroma formation. Currently, seroma occurrs due to postoperative inflammatory processes. This theory underlies the antiinflammatory role for seroma formation. Glucocorticoid drugs is known as playing a role in inhibiting the inflammatory response. The purpose of this study was to assess the prophylactic effect of perioperative administration of methylprednisolone on seroma formation. This study was a double-blind randomized control trial of 2 groups, i.e. a group of locally advanced breast carcinoma which were given methylprednisolone perioperatively as a treatment group and a control group. The research was conducted in Dr. Hasan Sadikin General Hospital Bandung from April to July 2013. Thirty women who met the inclusion criteria were included as subjects who were then divided into two groups: 15 women received methylprednisolone and 15 women serve as controls. This study used independent t and Mann-Whitney tests. There was a difference in the mean volume of drainage on day 1 between the methylprednisolone and control group as much as 104.7 mL and 158 mL, respectively, but not statistically significant (p=0.053). The same situation was also seen for the following days and total seroma, which was no significant difference was found. In conclusion, the use of methylprednisolone is not effective for reducing postoperative seroma drainage volume after mastectomy. [MKB. 2014;46(2):88–93]Key words: Mastectomy, methylprednisolone, seroma DOI:  10.15395/mkb.v46n2.279
RISIKO MASALAH PERKEMBANGAN DAN MENTAL EMOSIONAL ANAK YANG DIASUH DI PANTI ASUHAN DIBANDINGKAN DENGAN DIASUH ORANGTUA KANDUNG Riyadi, -; Rusmil, Kusnandi; Effendi, Sjarif Hidajat
Majalah Kedokteran Bandung Vol 46, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Anak tinggal di panti asuhan dihubungkan dengan terjadinya keterlambatan perkembangan. Anak yang memiliki waktu interaksi bermain bersama lebih lama dengan pengasuhnya lebih sedikit mengalami masalah perkembangan. Tujuan penelitian ini untuk mengetahui perbandingan masalah perkembangan dan mental emosional antara anak yang tinggal di panti asuhan dan orangtua kandung. Penelitian kuantitatif analitik komparatif desain potong lintang dengan uji chi-kuadrat untuk mengetahui perbedaan masalah perkembangan menggunakan kuesioner preskrining perkembangan (KPSP) yang menilai aspek motorik, bahasa, dan personal sosial, sedangkan masalah mental emosional menggunakan kuesioner masalah mental emosional (KMME) yang menilai perilaku, dilanjutkan penelitian kualitatif desain in depth interview untuk mengetahui faktor penyebab masalah perkembangan dan mental emosional. Penelitian dilaksanakan Juni 2011?Januari 2012, pada subjek 102 anak usia 3?6 tahun yang memenuhi kriteria inklusi. Pada 51 subjek kelompok panti asuhan terdapat 8 anak dengan masalah perkembangan, sementara pada kelompok orangtua kandung tidak ada. Kemungkinan masalah mental emosional pada dua kelompok sama masing-masing sebanyak 29 anak. Masalah perkembangan anak di panti asuhan lebih tinggi (p=0,002), terdapat hubungan bermakna waktu interaksi bermain bersama dengan terjadinya masalah perkembangan (p=0,003). Simpulan, anak di panti asuhan terjadi masalah perkembangan lebih tinggi, sedangkan masalah mental emosional tidak berbeda antara anak di kelompok panti asuhan dan diasuh orangtua kandung. [MKB. 2014;46(2):118?24]Kata kunci: Interaksi, mental emosional, orangtua, panti asuhan, perkembanganRisk of Developmental and Emotional Problems in Children Living in Orphanages Compared to Children Living with Their ParentsChildren living in orphanage are associated with delays in development. The children demostrate less developmental problems when they interact with caregivers. The aim of this study was to compare developmental and mental emotional problems between children living in orphanage and those who live with their parents. A comparative analytical cross sectional study by chi square to test the developmental problem using kuesioner preskrining perkembangan (KPSP) or the development pre-screening questionnaire, for motoric, language, and personal social assessment. The mental emotional problems are assessed using kuesioner masalah mental emosional (KMME) or mental emotional problem questionnaire for behavior assessment. These were followed by a qualitative study through interviews to evaluate the cause of developmental and mental emotional problems. Conducted from June 2011?January 2012, this study inclused children 3 to 6 years old who met the inclusion criteria as the subjects with a total of 102 subjects participated. From 51 children from the orphanages there were 8 children who had developmental problem while none was found in children living with their parents. The mental emotional problems in both group were equal (29 children). There was a higher number of developmental problem in children living in the orphanage (p=0.002), and a corelation between caregiver-children play time interaction and developmental problem (p=0.003) was found. In conclusion, children living in orphanage have higher risk for developmental problem while the risk for the mental emotional problems is not different between children living in orphanage and those who live with their parents. [MKB. 2014;46(2):118?24]Key words: Development, interaction, mental emotional, orphanage, parents DOI: 10.15395/mkb.v46n2.284
MANFAAT INTERVENSI DINI ANAK USIA 6–12 BULAN DENGAN KECURIGAAN PENYIMPANGAN PERKEMBANGAN Susanty, Anne; Fadlyana, Eddy; Nataprawira, Heda Melinda
Majalah Kedokteran Bandung Vol 46, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Penyimpangan perkembangan masih merupakan masalah bagi anak di Indonesia. Untuk meminimalkan penyimpangan perkembangan yang dicurigai maka intervensi perkembangan secara dini dapat dilakukan sebagai upaya untuk merangsang berbagai aspek perkembangan. Tujuan penelitian untuk mengetahui manfaat intervensi perkembangan secara dini terhadap anak usia 6?12 bulan yang mengalami kecurigaan penyimpangan perkembangan. Penelitian intervensi tes pra dan pasca dilakukan selama bulan Januari?Maret 2011. Subjek adalah anak sehat usia 6?12 bulan di kelurahan Cibangkong dan Kebongedang Kiaracondong, Bandung. Penapisan perkembangan anak dilakukan dengan menggunakan kuesioner praskrining perkembangan (KPSP) dengan interpretasi hasil sesuai, meragukan, dan penyimpangan. Apabila didapatkan hasil yang meragukan maka orangtua diajarkan melakukan intervensi setiap hari di rumah selama 2 minggu dengan pemantauan setiap 2 hari dengan menggunakan kartu harian. Apabila masih terdapat hasil meragukan pada pascaintervensi, maka dilakukan intervensi ulang selama 2 minggu dengan pengawasan seperti sebelumnya. Analisis perbedaan pra dan pascaintervensi dini dilakukan dengan Tes Cochran. Dari 242 anak sehat yang diperiksa terdapat 208 (86,0%) anak dengan perkembangan sesuai, 33 (13,6%) anak perkembangan meragukan, dan 1 (0,4%) anak mengalami penyimpangan perkembangan. Drop out terjadi pada 1 dari 33 anak karena dirawat di rumah sakit. Setelah intervensi kecurigaan penyimpangan perkembangan turun menjadi 12/32 setelah 2 minggu, dan 4/32 pada akhir intervensi (p<0,001). Simpulan: terdapat manfaat intervensi dini anak usia 6?12 bulan yang mengalami kecurigaan penyimpangan perkembangan. [MKB. 2014;46(2):63?8]Kata kunci: Deteksi dini, kuesioner praskrining perkembangan Early Intervention Benefits for Children 6?12 Months Old with Suspect Developmental DelayDevelopmental delay is still a main problem for children in Indonesia. Early intervention is an effort to minimize this delay. The aim of this study was to determine the advantages of early intervention in children 6?12 months old who were suspected as experiencing developmental delay. An intervention study with pre and post design was performed on physically healthy children aged 6?12 months in Cibangkong and Kebongedang, Kiaracondong Bandung between January and March 2011. Children developmental screening was performed using kuesioner praskrining perkembangan (KPSP), or development pre-screening questionnaire, to show appropriate, suspected, or delayed interpretation. When the result of the questionnaire was not really clear for making conclusion, parents were tought to do the intervention at home every day for two weeks with a monitoring performed every 2 days using the daily card. If the result was still not clear after the intervention, the same intervention was repeated for 2 weeks under monitoring. The differences found in the pre and post design were analyzed with Cochran`s test. From 242 healthy children involved in this study, 208 (86.0%) were categorized as appropriate, 33 (13.6%) were suspected to experience developmental delay and one child (0.4%) was delayed. One of thirty three children dropped out from this study because he was admitted to the hospital due to illness. After the intervention, the number of children who were suspected as experiencing delay decreased to 12/32 in two weeks and to 4/32 (p<0.001) after the intervention ended. In conclusion, early intervention provides benefits to children aged 6?12 months who are suspected as experiencing developmental delay.[MKB. 2014;46(2):63?8]Key words: Early detection, KPSP (development pre-screening questionnaire) DOI: 10.15395/mkb.v46n2.275
AKTIVITAS ANTIMIKROB FRAKSI EKSTRAK ETANOL BUAH PINANG (ARECA CATECHU L) PADA BAKTERI METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS Nursidika, Perdina; Saptarini, Opstaria; Rafiqua, Nurul
Majalah Kedokteran Bandung Vol 46, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Infeksi merupakan penyakit penyebab kematian di Indonesia. Salah satu penyebab perkembangan penyakit infeksi di Indonesia adalah resistensi bakteri terhadap antibiotik standar. Methicillin resistant Staphylococcus aureus (MRSA) merupakan penyebab utama infeksi nosokomial dan komunitas.Telah dilakukan uji aktivitas antimikrob fraksi dari ekstrak etanol buah pinang (Areca catechu L) pada bakteri MRSA. Penelitian dilaksanakan di Laboratorium Mikrobiologi Stikes Jenderal Achmad Yani Cimahi, Laboratorium Farmakologi Institut Teknologi Bandung, dan Laboratorium Pusat Penelitian dan Pengembangan Geologi Kelautan Bandung pada Mei?Juni 2011. Aktivitas antimikrobekstrak dan fraksi diuji menggunakan metode broth microdilution, bioautografi, dan scanning electron microscope (SEM). Hasil pengujian menunjukkan bahwa fraksi yang paling efektif ialah fraksi air dengan minimum inhibitory concentration (MIC) 256 µg/mL. Hasil bioautografi menunjukkan bercak kromatogram kromatografi lapis tipis (KLT) yang memberikan hambatan terhadap bakteri uji adalah bercak dengan Rf 0,6. Bercak ini diduga merupakan senyawa fenolat karena memberikan hasil positif dengan penyemprotan FeCl3. Hasil SEM menunjukkan bakteri uji yang telah dipapar dengan tanaman uji diduga mengalami kerusakan pada membran atau bagian yang lebih dalam, sehingga sel bakteri menciut dan bergelembung hingga rusak.Simpulan, ekstrak etanol buah pinang dapat menghambat pertumbuhan bakteri MRSA. [MKB. 2014;46(2):94?9]Kata kunci: Aktivitas antimikrob, Areca catechu, microdilution, MRSA, SEM Antimicrobial Activity of Betel Nut Ethanolic Extract Fractions in Methicillin Resistant Staphylococcus aureusInfection is the major cause of death in Indonesia. Antibiotic resistant is responsible for this progression. Methicillin resistant Staphylococcus aureus (MRSA) is known as the main cause of nosocomial and community infections.The antimicrobial activity of ethanolic extract fractions of betel nut (Areca catechu L) was studied on MRSA. The research was performed at the Microbiology Laboratory, School of Health Sciences, Jenderal Achmad Yani University, Cimahi, the Pharmacology Laboratory of Bandung Institute of Technology, and Research and Development of Ocean Geology Laboratory in May?June 2011.The antimicrobial activities of the extract and fraction were tested by microdilution broth method, bioautography and scanning electron microscope (SEM). The most effective result showed by water fraction with minimum inhibitory concentration (MIC) was 256 µg/mL. Bioautography result showed a spot on thin layer chromatography (TLC) chromatogramof water fraction which inhibited the bacterial growth, which was the spot with Rf 0.6. The spot was suggested as a phenolic substance due to positive result to FeCl3. The electron microscope image showed the breakdown of membrane cell/inner site of bacteria which was exposed by betel nut extract and fractions in which the bacteria was shrinked, bubbled and broken.In conclusion, betel nut ethanolic extract has the ability to inhibit MRSA. [MKB. 2014;46(2):94?9]Key words: Antimicrobial activity, Areca catechu, microdillution, MRSA,SEM DOI: 10.15395/mkb.v46n2.280
PENURUNAN KADAR PRO-ADRENOMEDULLIN MENCIT BALB/C MODEL SEPSIS DENGAN KORTIKOSTEROID DOSIS RENDAH Prasetyo, Diding Heri; Nurwati, Ida; Indrayanto, Yoseph; Hermawan, A. Guntur
Majalah Kedokteran Bandung Vol 46, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Penggunaan kortikosteroid dosis rendah pada penatalaksanaan sepsis tahap awal masih diperdebatkan. Pemberian kortikosteroid dosis rendah pada sepsis dapat mengurangi respons inflamasi sitemik, menghambat produksi sitokin proinflamasi dan mediator inflamasi, serta menurunkan adhesi leukosit ke endotel. Pro-adrenomedullin (pro-ADM) merupakan biomarker keparahan sepsis. Penelitian ini bertujuan untuk menganalisis efek penggunaan kortikosteroid dosis rendah pada kadar pro-ADM serum pada mencit Balb/C model sepsis tahap awal. Penelitian ini merupakan penelitian eksperimental laboratoris, dengan sampel 30 ekor mencit Balb/C jantan yang dibagi menjadi kelompok kontrol, sepsis, dan sepsis+kortikosteroid dosis rendah. Penelitian dilakukan di Laboratorium Histologi dan Biomedik, Fakultas Kedokteran, Universitas Sebelas Maret Surakarta, selama periode April?September 2012. Untuk membuat model sepsis, hewan coba diinokulasi lipopolisakarisa/LPS (E. coli) dosis 0,1 mg/mencit secara intraperitoneal (i.p). Kelompok tikus kontrol tidak diinokulasi selama penelitian. Kortikosteroid dosis rendah yang digunakan adalah metil prednisolon dosis 0,05 mg/mencit/12 jam secara i.p. Mencit kontrol tidak diinokulasi selama penelitian. Kadar pro-ADM serum ditentukan menggunakan enzyme-linked immunosorbent assay (ELISA). Uji kadar pro-ADM serum menggunakan analysis of variance (ANOVA) dan untuk menentukan perbedaan kemaknaan digunakan p<0,05. Kortikosteroid dosis rendah secara bermakna menurunkan kadar pro-ADM dibandingkan dengan kelompok sepsis (33,0±2,9 pg/mL vs 48,5±6,1 pg/mL; p<0,001). Simpulan, penggunaan kortikosteroid dosis rendah menurunkan kadar pro-ADM pada hewan coba model sepsis tahap awal. [MKB. 2014;46(2):68?72]Kata kunci: Kortikosteroid dosis rendah, pro-adrenomedullin, sepsisPro-adrenomedullin Level Reduction in Balb/C Sepsis Model Mice through the Use of Low-Dose CorticosteroidThe use of low-dose corticosteroids in the management of early stage of sepsis is still debated. Low-dose corticosteroids in sepsis can reduce the systemic inflammatory response, inhibit the production of pro-inflammatory cytokine, inflammatory mediators, and decrease adhesion of leukocytes to the endothelium. Pro-adrenomedullin (pro-ADM) is a biomarker of sepsis severity. This study aimed to analyze the effects of the use of low-dose corticosteroids on the levels of pro-ADM in the serum in Balb/C mice model of sepsis at the early stage. This study was an experimental research laboratory, with 30 male Balb/C mice which were divided into control, sepsis, and sepsis+low-dose corticosteroids groups. The study was conducted at the Histology and Biomedical Laboratory, Faculty of Medicine, Sebelas Maret University, Surakarta, during the period of April to September 2012. Sepsis was induced in the male Balb/C mice by inoculation through an intraperitoneally (i.p) injection of lipopolysaccharide/LPS (E. coli) with 0.1 mg/mice/i.p. dose for sepsis mice model. Control mice were not inoculated during the study. Low-dose corticosteroids used was methyl prednisolone at a dose of 0.05 mg/mice/12 hours/i.p. Pro-ADM serum level was measured with enzyme-linked immunosorbent assay (ELISA). One way analysis of variance (ANOVA) for pro-ADM serum level and p<0.05 were used to determine the significant differences. Low-dose corticosteroids significantly decreased pro-ADM level (33.0±2.9 pg/mL vs 48.5±6.1 pg/mL, p<0.001) compared to the sepsis group. In conclusion, the use of low-dose corticosteroids reduce levels of pro-ADM in the early stages of sepsis. [MKB. 2014;46(2):68?72]Key words: Low-dose corticosteroids, pro-adrenomedullin, sepsis DOI: 10.15395/mkb.v46n2.276
Kadar Hypoxia Inducible Factor-1α pada Penderita Diabetes Melitus Tipe 2 Disertai Mikroalbuminuria dan Retinopati Hoo, Yumilia; Permana, Hikmat; Soetedjo, Nanny Natalia M; Arifin, Augusta Y. L.
Majalah Kedokteran Bandung Vol 46, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Diabetes melitus tipe 2 (DMT2) sampai saat ini masih menjadi masalah kesehatan karena bersifat progresif dan menimbulkan komplikasi. Menurut data epidemiologi dari International Diabetes Federation (IDF) tahun 2011, dinyatakan bahwa retinopati diabetik sering kali mendahului mikroalbuminuria. Komplikasi tersebut diawali oleh disfungsi endotel yang akan meningkatkan sekresi sitokin yang menginduksi angiogenesis dan limpangiogenesis. Pada keadaan hipoksia akibat perubahan mikrovaskular, hypoxia inducible factor-1 alpha (HIF-1α) disekresikan dan akan merangsang produksi vascular endothelial growth factor (VEGF) yang menginduksi angiogenesis. Penelitian ini bertujuan untuk mengetahui hubungan kadar HIF-1α plasma penderita DMT2 dengan mikroalbuminuria dan retinopati diabetik. Penelitian menggunakan rancangan studi potong lintang terhadap 158 penderita DMT2 yang berobat di poliklinik endokrinologi Rumah Sakit Dr. Hasan Sadikin Bandung periode Juli─Desember 2012. Data dianalisis menggunakan uji-t, Mann Whitney, dan multivariate analysis of variance (MANOVA). Subjek penelitian terdiri atas 82 orang pria (51,9%) dan 76 orang wanita (48,1%). Delapan puluh orang (50,6%) normoalbuminuria dan 78 orang (49,4%) mikroalbuminuria. Pada penelitian ini didapatkan 38 orang dengan retinopati diabetik (24,1%). Median kadar HIF-1α kelompok mikroalbuminuria adalah 0,103 (0,041–0,735) ng/mL dan pada normoalbuminuria 0,144 (0,041–0,481) ng/mL (p=0,257). Median kadar HIF-1α kelompok retinopati positif 0,041 (0,041–0,33) ng/mL, sedangkan kelompok tanpa retinopati 0,167 (0,041–0,735) ng/mL dengan p<0,01. Simpulan, kadar HIF-1α plasma yang rendah atau normal bergantung pada derajat retinopati diabetik. Kadar HIF-1α plasma yang tinggi pada penderita tanpa retinopati diabetik, menunjukkan akan terjadi retinopati diabetik di masa mendatang. [MKB. 2014;46(2):100–5]Kata kunci: Hypoxia inducible factor-1α, mikroalbuminuria, retinopati diabetikHypoxia Inducible Factor-1α in Type 2 Diabetes Mellitus with Microalbuminuria and RetinopathyType 2 diabetes mellitus (T2DM) is still considered a major problem in healthcare, mainly for its progressivity and complications. According to the epidemiological data from the International Diabetes Federation (IDF) in 2011, it is stated that microalbuminuria often precedes the onset of diabetic retinopathy. Complications are preceded by endothelial dysfunction that will increase the secretion of cytokines inducing angiogenesis and limpangiogenesis. In hypoxic conditions induced by microvascular changes, hypoxia inducible factor-1 alpha (HIF-1α) is secreted, stimulating the production of vascular endothelial growth factor (VEGF) which induce angiogenesis. The aim of this study was to know the correlation between plasma HIF-1α concentration with microalbuminuria pattern and diabetic retinopathy in T2DM patients. This cross-sectional study was conducted on 158 T2DM patients in Endocrinology Outpatient Departement of Dr. Hasan Sadikin Hospital during July to December 2012. Data were analyzed using t-test, Mann Whitney, and multivariate analysis of variance (MANOVA) methods. Eighty two males (51.9%) and 76 females (48.1%) participated in the study, making up 158 subjects. Eighty patients (50.6%) had normoalbuminuria and 78 patients (49.4%) had microalbuminuria. Thirty eight patients were found with diabetic retinopathy (24.1%). The median of HIF-1α plasma concentrations was 0.103 (0.041–0.735) ng/mL in the microalbuminuria group and 0.144 (0.041–0.481) ng/mL (p=0.257).in the normoalbuminuria group. The median of HIF-1α plasma concentration in the group with diabetic retinopathy was 0.041 (0.041–0.33) ng/mL, while in the group without diabetic retinopathy the median was 0.167 (0.041–0.735) ng/mL (p<0.01). In conclusion, low or normal HIF-1α plasma levels in patients without diabetic retinopathy predict the grading of diabetic retinopathy, while high levels of plasma HIF-1α suggests the likehood of retinopathy event in the future. [MKB. 2014;46(2):100–5]Key words: Diabetic retinopathy, hypoxia inducible factor-1α, microalbuminuria DOI: 10.15395/mkb.v46n2.281
Analisis Keberhasilan Terapi Bermain terhadap Perkembangan Potensi Kecerdasan Anak Retardasi Mental Sedang Usia 7–12 Tahun Lisnawati, Lilis; Shahib, M. Nurhalim; Wijayanegara, Hidayat
Majalah Kedokteran Bandung Vol 46, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Retardasi mental (RM) merupakan gangguan heterogen yang terdiri atas fungsi intelektual di bawah rata-rata disertai gangguan keterampilan adaptif. Terapi bermain merupakan pendekatan yang efektif untuk melatih anak RM taraf sedang dalam mempelajari suatu konsep pembelajaran. Terapi bermain dilakukan dalam ruang khusus yang didesain sebagai tempat bermain yang dilengkapi dengan perangkat mainan khusus untuk menstimulus perkembangan potensi anak RM taraf sedang. Tujuan dilakukannya penelitian ini untuk meningkatkan keberhasilan pengembangan potensi kecerdasan anak RM sedang dengan menggunakan instrumen The Wechsler-Intelligence Scale for Children (WISC) melalui penerapan terapi bermain.  Rancangan penelitian ini menggunakan metode eksperimen semu (quasi experiment) dan analisis kualitatif. Subjek dalam penelitian ini adalah anak RM sedang di SDLB Aisiyah usia 7–12 tahun sejumlah 13 anak. Pendekatan analisis yang digunakan adalah analisis statistik dengan pendekatan Wilcoxon dan Kruskal Wallis yang selanjutnya dilakukan analisis deskriptif untuk memberikan gambaran kondisi RM yang menyertai anak meliputi: faktor internal yaitu fase yang dialami anak pada masa kehamilan, persalinan, menyusui dan tahap tumbuh kembang, serta faktor eksternal yaitu kondisi sosial ekonomi keluarga dan pola asuh pada anak. Hasil penelitian 7 dari 13 anak RM sedang berhasil mengalami peningkatan dalam pengembangan potensi kecerdasannya. Bila dilihat dari hubungan frekuensi diberikannya terapi dengan tingkat keberhasilan anak, dari 7 anak RM sedang yang berhasil, 5 di antaranya termasuk kategori sering diberikan terapi bermain. Simpulan, terapi bermain mampu meningkatkan keberhasilan pengembangan potensi kecerdasan anak RM sedang. Keberhasilan tersebut berhubungan dengan frekuensi diberikannya terapi bermain dan didukung oleh kondisi penyerta (faktor internal dan eksternal) pada diri anak. [MKB. 2014;46(2):73–82]Kata kunci: Terapi bermain, kecerdasan, retardasi mental sedang Analysis of the Effectiveness of Play Therapy in Developing the Intelligence of 7–12 Years Old Children with Moderate Mental RetardationMental Retardation (MR) is a heterogeneous disorder that consists of lower than average intellectual function along with the disruption of adaptive skills. Play therapy is an effective approach to train children with moderate MR in studying the concept of learning. Play therapy is conducted in a special room designed as a playground, equipped with special toys to stimulate potential development of children with moderate MR. This research aimed to improve the success of the potential development of intelligence in children with moderate MR using WISC instrument through play therapy. The study design used quasi-experimental method (quasi-experiment) and qualitative analysis. The subjects of this study were thirteen 7–12 years old children with moderate MR in extraordinary primary school Aisiyah. The analysis approach used was statistical analysis with Wilcoxon and Kruskal Wallis approaches. A descriptive analysis was subsequently carried out to provide a snapshot of MR conditions that accompany the child including: internal factors, i.e. the phase experienced by the child during pregnancy, childbirth, breastfeeding and the stage of growth and development, and external factors i.e. the family's socioeconomic condition and children upbringing. The results showed that 7 out of 13 children with moderate MR had experienced an increase in the potential development of intelligence. In terms of the relation between the therapy frequency and the children success rate, 5 of 7 moderate MR children who were successful were in the category of frequent treatment of play therapy. In conclusion, play therapy can increase the potential for successful intelligence development of children with moderate MR. This success is associated with treatment frequency and is supported by the presence of concomitant conditions (internal and external factors) in children. [MKB. 2014;46(2):73–82]Key words: Play therapy, intelligence, moderate mental retardation DOI:  10.15395/mkb.v46n2.277
Hubungan Imunoekspresi NF-kB dengan Sinus Rokitansky Aschoff pada Kolesistitis Kronik Yulianti, Herry; Hernowo, Bethy S.
Majalah Kedokteran Bandung Vol 46, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Karsinoma kandung empedu relatif jarang, tetapi merupakan penyakit yang sangat mematikan. Keganasan kandung empedu merupakan 3−4% dari seluruh lesi ganas dan menempati urutan ke-5 di antara tumor sistem pencernaan. Karsinoma kandung empedu sulit dideteksi dan didiagnosis pada stadium awal, karena biasanya gejalanya sangat sedikit atau tanpa gejala. Oleh karena itu sangat penting menegakkan diagnosis secara dini dan mendeteksi pasien risiko tinggi, termasuk batu dan riwayat kolesistitis kronik. Kolesistitis kronik merupakan peradangan kronik pada kandung empedu dan disertai kolelitiasis pada lebih dari 90% kasus. Batu empedu merupakan faktor etiologi yang penting pada karsinoma kandung empedu. Pada gambaran histopatologi kolesistitis kronik ditemukan sinus Rokitansky Aschoff. Pendekatan genetik telah membuktikan komponen inflamasi berperan dalam karsinogenesis, seperti primary inflammatory cytokines, interleukin-1 (IL-1), tumor necrosis factor (TNF), IL-6, dan nuclear factor-kappaB (NF-kB). Tujuan penelitian ini untuk mengetahui hubungan imunoekspresi NF-kB dengan sinus Rokitansky Aschoff pada kolesistitis kronik. Metode penelitian adalah potong lintang terhadap 30 kasus kolesistitis kronik yang berasal dari Departemen Patologi Anatomi Rumah Sakit Dr. Hasan Sadikin Bandung/Fakultas Kedokteran Universitas Padjadjaran tahun 2010−2011. Potongan blok parafin dari jaringan kolesistitis kronik setebal 4 µm diwarnai dengan hematoksilin eosin untuk evaluasi gambaran histopatologi dan pemeriksaan imunohistokimia menggunakan polyclonal NF-kB antibody. Perhitungan sel yang imunoreaktif dilakukan di bawah mikroskop cahaya dengan pembesaran 400x, dihitung rata-rata pada 5 tempat. Hasil penelitian menunjukkan hubungan yang signifikan antara imunoekspresi NFkB dan sinus Rokitansky Aschoff (p=0,000). Simpulan, terdapat hubungan imunoekspresi NFkB dengan sinus Rokitanski Aschoff, semakin tinggi imunoekspresi NFkB semakin banyak sinus Rokitansky Aschoff. [MKB. 2014;46(2):106–11]Kata kunci: Kolesistitis kronik, NFkB, sinus Rokitansky AschoffCorrelation between Immunoexpression of NF-kB and Rokitansky Aschoff Sinuses in Chronic CholecystitisCarcinoma of the gallbladder is relatively uncommon but it is a very lethal disease. Gallbladder cancer constitutes 3−4% of all malignant lesions and ranks 5th among the digestive system tumors. Gallblader carcinoma is difficult to detect and diagnose in early stage because it usually has very slight symptoms or asymptomatic. It becomes increasingly necessary to make early diagnosis and identification of high-risk patient,as well as gallstone and history of chronic cholecystitis. Chronic cholecystitis is a chronic inflammation of gallbladder associated with cholelithiasis in more than 90% of cases. Cholelithiasis is one of the important etiological factors in carcinoma of the gallbladder. The histological examination of chronical cholecystitis shows the presence of Rokitansky Aschoff sinuses. Genetic approaches have proven that the components of inflammation such as primary inflammatory cytokines, interleukin-1 (IL-1), tumor necrosis factor (TNF), IL-6 and nuclear factor-kB (NF-kB) play the key roles in carcinogenesis. The purpose of this study was to understand the correlation between the immunoexpression of NF-kB and Rokitansky Aschoff sinuses in chronic cholecystitis. The method was cross sectional of 30 cases of chronic cholecystitis from Department of Pathology Anatomy of Dr. Hasan Sadikin General Hospital Bandung/Faculty of Medicine Universitas Padjadjaran in 2010−2011. A section from 4 µm-thick paraffin embedded tissue of chronic cholecystitis was stained with hematoxylin eosin for histopatological evaluation and immunohistochemical using polyclonal NF-kB antibody. Immunoreactive cells was counted in five tumor areas of 400x field by light microscopy. The result showed a significant correlation between the immunoexpression of NFkB and Rokitansky Aschoff sinuses (p=0.000). In conclusion, there is a correlation between immunoexpression of NFkB and Rokitansky Aschoff sinuses because as the immunoexpression of NFkB increase, more Rokitansky Aschoff sinuses will be formed. [MKB. 2014;46(2):106–11]Key words: Chronic cholecystitis, NFkB, Rokitansky Aschoff sinuses DOI:  10.15395/mkb.v46n2.282
Perbedaan Kadar Liver Fatty Acid Binding Protein (L-FABP) Urine Penderita Diabetes Melitus Tipe 2 dengan Normoalbuminuria dan Mikroalbuminuria Wiharjo, Kristina; Permana, Hikmat; Noormartany, -; Rachmayati, Sylvia
Majalah Kedokteran Bandung Vol 46, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Diabetes melitus (DM) merupakan salah satu penyebab end stage renal disease (ESRD), 20−40% akan mengalami nefropati diabetik yang berkembang menjadi ESRD. Prevalensi nefropati diabetik meningkat pada DM tipe 2. Akumulasi stres oksidatif dapat menyebabkan peningkatan permeabilitas glomerulus sehingga menyebabkan peningkatan ekskresi albumin pada urine yang terbagi menjadi normoalbuminuria, mikroalbuminuria, dan makroalbuminuria. Kerusakan glomerulus terjadi setelah kerusakan tubulointerstisial ginjal yang menyebabkan penurunan aliran kapiler peritubular dan menyebabkan hipoksia. Liver fatty acid binding protein (L-FABP) berfungsi mengurangi hipoksia dengan mengikat stres oksidatif dan mengeluarkannya ke dalam urine. Penelitian ini bertujuan untuk menganalisis apakah terdapat perbedaan kadar L-FABP antara penderita DM tipe 2 normoalbuminuria dan mikroalbuminuria. Metode penelitian adalah observasional analitik dengan rancangan potong lintang. Subjek penelitian sebanyak 70 orang penderita DM tipe 2 dengan normoalbuminuria (38 orang) dan mikroalbuminuria (32 orang) yang diambil secara acak pada pasien yang datang ke Laboratorium Rawat Jalan Rumah Sakit Dr. Hasan Sadikin pada periode Juli−September 2012. Uji statistik menggunakan Uji Mann-Whitney. Hasil penelitian menunjukkan perbedaan bermakna kadar L-FABP urine pada normoalbuminuria dengan mikroalbuminuria dengan nilai ZM-W=3.513; p<0,001, median pada normoalbuminuria adalah 5, dan mikroalbuminuria adalah 7. Dari penelitian ini didapatkan kadar L-FABP urine meningkat karena kompensasi pembentukan stres oksidatif dan hipoksia yang terjadi sebelum kerusakan glomerulus. Simpulan, kadar L-FABP urine pada pasien DM tipe 2 dengan mikroalbuminuria lebih tinggi daripada pasien DM tipe 2 dengan normoalbuminuria. [MKB. 2014;46(2):83–7]Kata kunci: Diabetes melitus tipe 2, kadar L-FABP urine, mikroalbuminuria, nefropati diabetik, normoalbuminuria Comparison of Urinary Liver-Fatty Acid Binding Protein (L-FABP) in Normoalbuminuria and Microalbuminuria in Type 2 Diabetes Mellitus PatientsDiabetes mellitus (DM) is the leading cause of the end stage renal disease (ESRD). Around 20−40% patients with DM develop diabetic nephropathy and eventually progress into ESRD. Type 2 DM has a greater prevalence to develop diabetic nephropathy. Oxidative stress accumulation can increase permeability of the glomerulus which results in increased urine albumin excretion, which is divided into three groups: normoalbuminuria, microalbuminuria and macroalbuminuria. Glomerulus dysfunction occurs after tubulointerstisial renal dysfunction which decreases peritubular capillary flow that leads to tubulointerstisial hypoxia. Liver fatty acid binding protein function is to reduce hypoxia by binding oxidative stress and excretes it into urine. The aim of this study was to analyze the differences in the urine L-FABP level between normoalbuminuria and microalbuminuria type 2 DM patients. The study design was observational analytic using cross-sectional method. Subjects were 70 DM type 2 patients with normoalbuminuria (38 patients) and microalbuminuria (32 patients). Statistical analysis was performed using the Mann Whitney test The results found that there were significant differences in levels of urine L-FABP between normoalbuminuria and microalbuminuria type 2 DM patients (ZM-W=3.513, p<0.001) with medians of 5 and 7 in normoalbuminuria and microalbuminuria, respectively. The urine L-FABP level increased because of the oxidative stress and hypoxia that happened before the glomerulus dysfunction. In conclusion, urine L-FABP level in patients DM type 2 with microalbuminuria is higher than that of the normoalbuminuria. [MKB. 2014;46(2):83–7]Key words: diabetic nephropathy, L-FABP urine level, microalbuminuria, normoalbuminuria, type 2 DM DOI: 10.15395/mkb.v46n2.278
Hypercalcemia of Malignancy: Clinical Characteristics and Treatment Outcome Wijaya, Indra; Oehadian, Amaylia; Sumantri, Rachmat
Majalah Kedokteran Bandung Vol 46, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Hypercalcemia is one of the most common paraneoplastic syndromes in hospitalized malignancy patients. The aim of this study was to determine the clinical characteristics and treatment outcome in hypercalcemia of malignancy. This was a study using medical records of patients with malignancy hospitalized in the Departement of Internal Medicine, Dr. Hasan Sadikin Hospital Bandung between December 2008 and March 2011. Statistical analysis was performed by Wilcoxon and Mann-Whitney tests. There were 40 patients with hypercalcemia of malignancy, consisted of 22 hematologic malignancies and 18 solid tumors. Disturbance of consiousness were found in 4, dehydration in 18, constipation in 6, and nausea and vomiting in 6 subjects. In 16 subjects, no symptoms were found. All subjects received rehydration with normal saline. Bisphosphonate was given in 26 subjects. The difference of decreasing ion calcium level, between the groups who were treated with or without bisphosphonate was 0.59 (0.01–1.17) mg/dL, p=0.0001. In conclusion, hematologic and solid tumors are found in about the same proportion in hypercalcemia associated malignancy. Treatment either with or without bisphosphonate shows good results. [MKB. 2014;46(2):111–17]Key words: Bisphosphonate, hypercalcemia of malignancy, rehydrationHiperkalsemia pada Keganasan: Karakteristik Klinik dan Luaran TerapiHiperkalsemia merupakan salah satu sindrom paraneoplasma yang sering ditemukan pada pasien keganasan. Tujuan penelitian ini untuk mengetahui karakteristik klinis dan respons terapi penderita dengan hiperkalsemia pada keganasan. Penelitian ini menggunakan data rekam medis pasien yang dirawat di Departemen Penyakit Dalam Rumah Sakit Dr. Hasan Sadikin Bandung periode Desember 2008–Maret 2011. Analisis statistik menggunakan Uji Wilcoxon. Dari 40 penderita dengan hiperkalsemia pada keganasan, didapatkan 22 keganasan hematologi dan 18 tumor padat. Gejala klinis yang ditemukan adalah gangguan kesadaran pada 4 subjek, dehidrasi pada 18 subjek, konstipasi pada 6 subjek, mual dan muntah pada 6 subjek. Pada 16 subjek tidak ditemukan gejala. Semua subjek mendapatkan rehidrasi dengan NaCl 0,9%. Dua puluh enam subjek mendapat terapi bisfosfonat. Perbedaan penurunan kadar kalsium ion antara kelompok yang mendapatkan bisfosfonat dan tidak adalah 0,59 (0,01–1,17) mg/dL, p=0,0001. Simpulan, proporsi keganasan penyebab hiperkalsemia hampir sama antara keganasan hematologi dan tumor padat. Terapi rehidrasi dengan NaCl 0,9% tanpa atau disertai bisfosfonat memberikan hasil yang baik. [MKB. 2014;46(2):111–17]Kata kunci: Bisfosfonat, hiperkalsemia pada keganasan, rehidrasi DOI: 10.15395/mkb.v46n2.283

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