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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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SUPINE HYPOTENSION SYNDROME PADA KEHAMILAN Bisri, Dewi Yulianti; Redjeki, Ike Sri; Bisri, Tatang
Majalah Kedokteran Bandung Vol 47, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Supine hypotension syndrome (SHS) dapat terjadi mulai kehamilan trimester 2 dan didefinisikan sebagai penurunan tekanan sistol ?30% pada posisi supine dibanding dengan lateral. Tujuan penelitian mengetahui insidensi SHS pada wanita hamil aterm di Indonesia. Penelitian observasional pada 200 wanita hamil aterm, kehamilan pertama dan kedua, usia 18?40 tahun, tidak memiliki penyakit sertaan, dan akan dilakukan seksio sesarea elektif di Rumah Sakit Ibu dan Anak Melinda dalam periode Maret?Juli 2012. Pasien diberikan 500 cc cairan kristaloid Ringer laktat sebagai pengganti puasa, kemudian dilakukan pemeriksaan tekanan sistol, diastol, rata-rata, laju nadi, dan saturasi oksigen selama 5 menit dengan jarak 1 menit pada posisi supine dan miring kiri 45O. Hasil pengukuran tekanan sistol supine 113,49 (13,20) mmHg, miring 105,20 (12,08) mmHg dengan nilai p=0,93. Tekanan diastol supine  69,05 (7,31) mmHg dan miring 58,58 (7,73) mmHg (p=0,51). Tekanan darah rata-rata supine 84,59 (8,38) mmHg dan miring 75,87 (8,82) mmHg (p=0,62). Laju nadi supine 88,95 (12,19) x/menit, dan miring 86,26 (11,47) x/menit, (p=0,86). SpO2 supine 99,95 (1,11)% dan miring 99,64 (0,67)% (p=0,07). Simpulan, tidak ada perbedaan tekanan sistol, diastol, rata-rata, laju nadi, dan SpO2 wanita hamil aterm pada posisi berbaring dengan posisi miring kiri 450. [MKB. 2015;47(2):102?8]Kata kunci: Posisi supine, posisi miring kekiri, supine hypotension syndrome, wanita hamil atermSupine Hypotension Syndrome in PregnanciesAbstractSupine hypotension syndrome (SHS) can occur starting from the second trimester of pregnancy and is defined as a reduction of systolic blood pressure of ?30% in the supine position compared to lateral position. The purpose of this study was to determine the incidence of SHS in full term pregnant women in Indonesia. An observational study on 200 full term pregnant women, first and second pregnancy, aged 18?40 years, no coexisting diseases, and was going to have an elective cesarean section in Melinda Woman and Child Hospital in the period of March?July 2012. Patients were given 500 cc of Ringer?s lactate crystalloid fluid instead of fasting. Systolic and diastolic blood pressure, mean blood pressure, pulse rate, and oxygen saturation for 5 minutes were then examined every  minute. The examination was conducted in the supine and left lateral position of 45O. The results show a systolic blood pressure in supine position of 113.49 (13.20) mmHg and in lateral position of 105.20 (12.08) mmHg (p=0.93). Meanwhile, the supine diastolic blood pressure was  69.05 (7.31) mmHg and lateral position was 58.58 (7.73) mmHg (p=0.51). The mean blood pressure in supine position was 84.59 (8.38) mmHg and 75.87 (8.82) mmHg (p=0.62) in lateral position . The pulse rates for supine and lateral position were 88.95 (12.19)x/min and 86.26 (11.47) x/min (p=0.86), respectively. Supine SpO­2 was 99.95 (1.11) % and lateral SpO2 was 99.64 (0.67) % (p=0.07). In conclusion, there is no differences in systolic, diastolic, mean blood pressure, pulse rate and SpO2 of full term pregnant women in supine or left lateral position of 45O. [MKB. 2015;47(2):102?8]Key words: Full term pregnant women, left lateral decubitus, supine hypotension syndrome, supine DOI: 10.15395/mkb.v47n2.461
PENGARUH EKSTRAK ETANOL DAUN KELOR (MORINGA OLEIFERA) PADA EKSPRESI INSULIN DAN INSULITIS TIKUS DIABETES MELITUS Sulistyorini, Ratna; Sarjadi, -; Johan, Andrew; Djamiatun, Kis
Majalah Kedokteran Bandung Vol 47, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Kandungan quercetin pada Moringa oleifera secara ilmiah memiliki potensi sebagai antioksidan dan anti-inflamasi dengan menghambat aktivitas NF-?B, serta triterpenoid menstimulasi regenerasi sel ? pankreas dan meningkatkan sekresi insulin. Penelitian ini bertujuan melihat pengaruh pemberian ekstrak etanol daun Moringa oleifera terhadap insulitis dan ekspresi insulin pankreas tikus Sprague-Dawley jantan. Penelitian dilakukan di laboratorium Unit Pangan dan Gizi, Pusat Antar Universitas Universitas Gadjah Mada serta Laboratorium Histologi dan Biologi Sel Fakultas Kedokteran Universitas Gadjah Mada, periode Mei?Juli 2013. Penelitian ini menggunakan desain randomized post test only controlled group. Hewan coba sebanyak 24 ekor tikus, diperiksa kadar gula darahnya pada hari ketiga setelah induksi streptozotosin, untuk melihat tikus sudah dalam keadaan hiperglikemik. Tikus kemudian  dibagi dalam tiga kelompok: satu kelompok kontrol dan  dua kelompok perlakuan yang  diberi ekstrak etanol daun Moringa oleifera dosis 250 dan 500 mg/kg/hari selama 21 hari. Gambaran histopatologik dinilai  derajat insulitis pada pulau Langerhans dan dinilai ekspresi insulin dengan skor Allred. Uji statistik yang digunakan adalah Kruskal Wallis dilanjutkan Mann-Whitney dengan taraf kemaknaan p<0,05 karena data tidak berdistribusi normal. Derajat insulitis dan ekspresi insulin pankreas tikus pada kedua kelompok perlakuan menunjukkan perbedaan bermakna dibanding dengan kelompok kontrol (p<0,005). Pada penelitian ini dapat disimpulkan bahwa ekstrak etanol daun Moringa oleifera dosis 250 dan 500 mg/kg menyebabkan ekspresi insulin lebih tinggi dan derajat insulitis lebih rendah dibanding dengan kelompok kontrol.[MKB. 2015;47(2):69?76]Kata kunci: Ekspresi insulin, insulitis, Moringa oleifera, streptozotosinEffect of Ethanol Extract of Moringa oleifera Leaves on Insulin Expression and Insulitis in Diabetes Mellitus RatsAbstractQuercetin content in Moringa oleifera has scientific potential antioxidant and anti-inflammation effects by inhibiting the activity of NF-?B. In addition, triterpenoids stimulate pancreatic ? cell regeneration and increases insulin secretion. This study aimed to discover the effect of  Moringa oleifera extract on insulitis and insulin expression in pancreas of  Sprague-Dawley male rats. The study was performed at the laboratory of Food and Nutrition Unit of The Inter University Center of Gadjah Mada University and the laboratory of Histology and Cell Biology Faculty of Medicine  Gadjah Mada University during May?July 2013. This was a randomized post test only controlled group study. Twenty four rats were included. Blood glucose test was performed on the third day after streptozotocin induction to ensure that all rats were in hyperglycemic condition. The rats were then divided into three groups: one control group and two treatment groups receiving Moringa oleifera ethanolic leaves extract for 21 days in doses of 250 and 500 mg/kg/day, respectively. Histopathological analysis of pancreas were performed by evaluating insulitis  based on the infiltration of mononuclear inflammatory cells to the Langerhans islets. Insulin expression was evaluated using Allred score. Statistical analysis used was Kruskal-Wallis test, followed by  Mann-Whitney  with a level of significance of p<0.05. The insulitis degree and insulin expression of the two treatment groups were significantly  different compared to the control group (p<0.005). It can be concluded that Moringa oleifera ethanolic leaf extract doses of 250 and 500 mg/kg/day cause higher insulin expression and lower  insulitis degree than in the control group. [MKB. 2015;47(2):69?76]Key words: Insulin expression, insulitis, Moringa oleifera, streptozotocin DOI: 10.15395/mkb.v47n2.456
PERBEDAAN EFEK TERAPI PENGGUNAAN DUA UKURAN JARUM DRY NEEDLING DENGAN PENURUNAN NYERI DAN TENDERNESS PADA SINDROM NYERI MIOFASIAL OTOT UPPER TRAPEZIUS TIPE AKTIF Taofik, Nora; Prabowo, Tertianto; Sastradimaja, Sunaryo. B.
Majalah Kedokteran Bandung Vol 47, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Sindrom nyeri miofasial adalah kumpulan gejala sensorik, motorik, dan autonom akibat miofasial trigger point. Sindrom ini paling sering didapatkan pada usia muda dan mengenai otot postural, salah satunya adalah otot upper trapezius. Terapi yang digunakan berupa terapi invasif maupun noninvasif. Terapi invasif dengan ukuran jarum yang berbeda dapat memberikan penurunan gejala dalam beberapa saat setelah terapi. Uji klinis dilakukan dengan metode pengambilan sampel consecutive sampling. Penelitian dilakukan di Departemen Kedokteran Fisik dan Rehabilitasi Medik Rumah Sakit Dr. Hasan Sadikin Bandung periode April?Mei 2104. Subjek penelitian kelompok I diberikan terapi dry needling menggunakan jarum injeksi 25G (0,50x25 mm) dan kelompok II diberikan terapi dry needling menggunakan jarum akupuntur 1 cun (0,25x25 mm). Subjek penelitian sebanyak 74 orang dibagi menjadi 2 kelompok. Perbandingan nilai numeric rating scale antara terapi dengan jarum injeksi 25G dan jarum akupunktur 1 cun tidak didapatkan perbedaan bermakna (p=0,230). Perbandingan nilai algometer antara terapi dengan jarum injeksi 25G dan jarum akupunktur 1 cun tidak didapatkan perbedaan bermakna (p=0,134). Tidak ada perbedaan efek terapi dry needling terhadap penurunan nyeri dan tenderness pada penderita sindrom nyeri miofasial otot upper trapezius tipe aktif antara menggunakan jarum injeksi 25G dan jarum akupunktur 1 cun. [MKB. 2015;47(2):91?5]Kata kunci: Dry needling, jarum akupunktur, jarum injeksi, upper trapezius, sindrom nyeri miofasialEffect of Treatment Differences between the Use of Two Different Sizes of Dry Needling to Decrease Pain and Tenderness in Active Upper Trapezius Myofascial Pain SyndromeAbstractMyofascial pain syndrome is a collection of sensoric, motoric, and autonomic symptoms due to myofascial trigger points. This is commonly seen in young age and involves postural muscles; one of those is upper trapezius muscle. Invasive and non-invasive therapies have been used as modalities to treat myofascial pain syndrom. Invasive therapy is superior due to its mechanical mechanism in deactivating trigger points. Different sizes of needles are used in invasive therapy to decrease symptoms.  A clinical trial has been conducted in the outpatient clinic of Department of Physical Medicine and Rehabilitation, Dr. Hasan Sadikin Hospital, Bandung in the period of April?May 2014 with consecutive sampling method. Subjects in group I were given dry needling therapy with 25G injection needle (0.50x25 mm) and subjects in group II received the therapy using 1 cun accupuncture needle (0.25x25 mm). Seventy four subjects participated in this study. The comparison of numeric rating scale between the 25G injection needle therapy group and the 1 cun accupuncture needle therapy group was not significantly different (p=0.230). The comparison of algometer value between the 25G injection needle therapy group and the 1 cun accupuncture needle therapy group was also not significantly different (p=0.134). In conclusion, there is no difference in pain and tenderness decrease in dry needling therapy using 25G injection needle and 1 cun accupuncture needle for active type of myofascial pain syndrome of upper trapezius muscle therapies. [MKB. 2015;47(2):91?5]Key words: Acupuncture needle, dry needling, myofascial pain syndrome, needle, upper trapezius DOI: 10.15395/mkb.v47n2.462
Kesehatan Reproduksi Remaja Putri di Pondok Pesantren Sidoarjo Jawa Timur Nisa Mairo, Queen Khoirun; Rahayuningsih, Sri Endah; Purwara, Benny Hasan
Majalah Kedokteran Bandung Vol 47, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

terkait kesehatan reproduksinya. Remaja lebih banyak menghabiskan waktunya di sekolah. Pondok pesantren merupakan model pendidikan yang bercirikan asrama dengan pola interaksi 24 jam dengan teman sebaya. Penelitian ini bertujuan menganalisis faktor yang berhubungan dengan kesehatan reproduksi remaja putri di pondok pesantren. Penelitian ini dilakukan pada 100 remaja putri Pondok Pesantren Darul Falah Pusat pada kurun waktu September−Oktober 2012 dengan menggunakan kuesioner yang telah teruji validitas dan reliabilitasnya. Variabel pengetahuan, sikap, komunikasi orangtua, komunikasi guru, komunikasi teman sebaya, dan sumber informasi sebagai independen, sedangkan kesehatan reproduksi sebagai dependen. Data dianalisis secara univariabel, bivariabel, dan multivariabel. Hasil penelitian menunjukkan remaja yang bermasalah dalam kesehatan reproduksi sebanyak 68%. Kesehatan reproduksi remaja terdapat hubungan bermakna dengan faktor pengetahuan  (p=0,022),  sikap (p=0,002) dan komunikasi teman sebaya (p<0,001), tetapi tidak terdapat hubungan bermakna terhadap kesehatan reproduksi remaja pada komunikasi orangtua (p=0,655), komunikasi guru (p=0,833), dan sumber informasi (p=0,532). Faktor yang paling berhubungan dengan kesehatan reproduksi remaja putri di pondok pesantren adalah komunikasi teman sebaya (p=0,001). Simpulan, masalah kesehatan reproduksi di pondok pesantren masih tinggi dengan pengetahuan mengenai kesehatan reproduksi masih rendah, sikap terhadap kesehatan reproduksi kurang, dan faktor yang paling berhubungan adalah komunikasi teman sebaya. [MKB. 2015;47(2):77–83]Kata kunci: Kesehatan reproduksi remaja, lingkungan, pengetahuan, pondok pesantren, sikapReproductive Health of Adolescent Girls in Islamic Boarding School Sidoarjo East JavaAbstractReproductive organ maturation process in adolescence is often prone to health issues. Adolescents spend more time in school, especially when they study in an islamic boarding school. Islamic boarding school is an educational model which is characterized by a dorm with 24 hour interaction pattern among peers. This study aimed  to analyze factors associated with adolescent reproductive health in Islamic boarding school female students. This study was conducted on 100 adolescent girls in Darul Falah Center Islamic boarding school during September to October 2012 using questionnaires with proven validity and reliability. Knowledge, attitudes, parent communication, teacher communication, peer communication, source of information were used as the independent variables and reproductive health was used as the dependent variable. All variables were analyzed ini univariabel, bivariable, and multivariable manners. The results of this study show that 68% adolescents had reproductive health problems. There was a significant relationship between knowledge (p=0.022), attitude (p=0.002) and peers communication (p<0.001) factors and  adolescent reproductive health withno significant relationship discovered between the reproductive health of adolescents and parent communication (p=0.655), teacher communication (p=0.833), and sources of information (p=0.532). The most influencing factor associated with reproductive health in adolescent girls Islamic boarding school was peer communications (p=0.001). In conclusions, reproductive health problem in Islamic boarding school remains high with inadequate knowledge of reproductive health and  low attitude towards reproductive health with peer communication as the most influencing factor. [MKB. 2015;47(2):77–83]Key words: Adolescent reproductive health, attitudes, environment knowledge, Islamic boarding school DOI: 10.15395/mkb.v47n2.457
Pola Antibodi Antinuklear Sebagai Faktor Risiko Keterlibatan Sistem Hematologi Lupus Eritematosus Sistemik pada Anak Ghrahani, Reni; Setiabudiawan, Budi; Sapartini, Gartika
Majalah Kedokteran Bandung Vol 47, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Lupus eritematosus sistemik (LES) adalah penyakit autoimun kronik yang melibatkan berbagai sistem organ ditandai dengan produksi berbagai autoantibodi. Penyakit ini memiliki manifestasi klinis yang sangat bervariasi. Antibodi antinuklear diketahui memiliki pola-pola tertentu yang diduga berkorelasi dengan keterlibatan sistem organ tertentu pada LES. Penelitian ini dilakukan untuk melihat hubungan pola antibodi antinuklear (ANA) dengan  keterlibatan berbagai sistem organ pada anak yang menderita LES. Studi potong lintang dilakukan terhadap 93 anak dengan diagnosis LES yang datang ke Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Padjajaran/Rumah Sakit Dr. Hasan Sadikin Bandung, pada periode September 2006–April 2015. Analisis data dilakukan dengan uji chi kuadrat dan uji-t. Subjek terdiri atas 85 (91%) perempuan dan 8 (9%) laki-laki, dengan rasio perempuan:laki-laki adalah 10,6:1. Usia rata-rata adalah 10,5±3 tahun dan rentang usia 2–17 tahun. Pola ANA terbanyak adalah speckled (58%) dan homogen (19%). Subjek dengan pola ANA homogen lebih berisiko mengalami keterlibatan hematologi yaitu anemia (OR 4,8; IK 95%: 1,1–19) dan leukopenia (OR 3,9; IK 95%: 2,0–7,5) dibanding subjek dengan pola ANA bukan homogen. Tidak didapatkan hubungan pola ANA dengan keterlibatan sistem organ lain. Titer antidsDNA pada subjek dengan pola ANA homogen lebih tinggi dibanding subjek dengan pola ANA bukan homogen (p=0,02). Simpulan, subyek dengan pola ANA homogen memiliki risiko lebih besar mengalami keterlibatan hematologi dibanding dengan pola ANA yang lain. [MKB. 2015;47(2):124–28]Kata kunci: Keterlibatan sistem organ, lupus eritematosus sistemik, pola antibodi antinuklear (ANA)Antinuclear Antibody Pattern as a Risk Factor in Hematological System Involvement in Pediatric Systemic Lupus ErythematosusAbstractSystemic lupus erythematosus (SLE) is a chronic autoimmune disease that can involve any organ system with the evidence of autoantibody production. The disease has a wide range of clinical manifestation. Antinuclear antibody is known to have particular staining patterns and suspected have a correlation with multiorgan involvement. The objective of this study was to define  antinuclear antibody (ANA) staining pattern correlation from multiorgan involvement in 93 children with SLE. This was a cross-sectional study conducted at the Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung during the period of September 2006 to April 2015. Data were analyzed using chi-square test and t-test. This study involved 93 children with SLE, consisted of 85 (91%) females and 8 (9%) males, with a ratio of 10.6:1. Mean age was 10.5±3 years with age range of 2 to 17 years. The most frequent ANA staining patterns were speckled (58%) and homogenous (19%). Subjects with homogenous pattern have a higher hematology involvement risk, which are anemia (OR: 4.8, CI 95%, 1.1–19) and leukocytopenia (OR 3.9, 95% CI 2.0–7.5). Subjects with homogenous ANA pattern had a higher titer of anti-dsDNA than those with other patterns (p=0.02). In conclusion, subjects with homogenous pattern have a higher hematology involvement risk. [MKB. 2015;47(2):124–28]Key words: Antinuclear antibody staining pattern, multisystem organ involvement, systemic lupus erythematosus  DOI: 10.15395/mkb.v47n2.571
Ekstrak Air Daun Padi Memperbaiki Hematopoesis pada Tikus yang Terpajan Plumbum Santosa, Budi; Sunoko, Henna Ria; Sukeksi, Andri
Majalah Kedokteran Bandung Vol 47, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Plumbum (Pb) asetat menyebabkan gangguan hematopoesis melalui hambatan biosintesis heme dan defisiensi enzim G-6PD yang menimbulkan penurunan hemoglobin dan jumlah eritrosit, serta peningkatan sel retikulosit. Ekstrak daun padi mengandung protein metallothionein yang mengikat Pb. Tujuan penelitian adalah membuktikan ekstrak daun padi memperbaiki gangguan hematopoesis pada tikus terpajan Pb. Metode penelitian adalah randomized post test only control-group design, 28 tikus dibagi ke dalam 4 kelompok yaitu 1 kelompok kontrol dan 3 kelompok perlakuan. Kelompok kontrol dan perlakuan dipajan Pb 0,5 g/kgBB/hari dan kelompok perlakuan diberi ekstrak daun padi 0,2; 0,4; 0,8 setiap hari melalui sonde sampai minggu ke-8. Hari terakhir  minggu ke-8 diperiksa jumlah kadar Hb menggunakan cyanmethemoglobin dan jumlah eritrosit diukur menggunakan haematology analyzer, serta retikulosit menggunakan pengecatan BCB. Tempat penelitian dilaksanakan di LPPT UGM dan laboratorium biomedik UNIMUS Semarang, Maret–Mei 2014. Perbedaan antarkelompok untuk kadar Hb dan jumlah eritrosit dilakukan uji one way enzyme linked immunosorbent assays (ANOVA) dan Kruskal-Wallis untuk jumlah retikulosit. Hasil penelitian menunjukkan kadar Hb rata-rata mengalami kenaikan tidak bermakna (p=0.81), jumlah eritrosit rata-rata tidak ada perbedaan antara kelompok kontrol dan perlakuan (p=0,83), jumlah retikulosit rata-rata menurun bermakna dari kelompok kontrol sampai perlakuan (p=0,00). Simpulan, ekstrak daun padi mampu memperbaiki hematopoesis pada tikus terpajan Pb. [MKB. 2015;47(2):84–90]Kata kunci: Ekstrak daun padi, hematopoesis, pajanan Pb, tikusRice Leaf Water Extract Improves Hematopoiesis in Lead-Exposed Rats  Abstract Plumbum ( Pb ) acetate leads to hematopoiesis disruption by inhibiting heme biosynthesis and creating G-6PD enzyme deficiency, leading to decreased hemoglobin concentration and red cell count as well as  increased reticulocyte cells. Rice leaf extract contains metallothionein proteins that bind Pb. This study aimed to prove the ability of rice leaf extract wa to improve hematopoiesis disorder conditions in rats exposed to Pb. The method used was the randomized post-test only control group design. Twenty eight rats were divided into 4 groups: 1 control group and 3 treatment groups . In the control group and the treatments groups, the experimental rats were treated with 0.5 g/kg/day Pb. The treatment groups were treated by 0.2, 0.4, and 0.8 rice leaf extract, respectively, every day for 8 weeks. On the last day of the 8th week, blood samples were collected for Hb concentration measurements using cyanmethemoglobin and the erythrocytes and reticulocytes number were counted using a hematology analyzer and BCB, respectively. This study was conducted in LPPT UGM and Biomedicine UNIMUS in March–May 2014. The differences between groups in hemoglobin and erythrocyte parameters were tasted  using one way ANOVA while  Kruskal-Wallis test was used for the reticulocyte count. The results show that rice leaf extract treatment to rats exposed to Pb did not affect Hb (p=0.81) and erythrocytes count  (p=0.83), However, the mean reticulocyte count decreased significantly in Pb-exposed rats treated with rice leaf extract (p=0.00). In conclusion, rice leaf extract is able to improve hematopoiesis in rats exposed to Pb. [MKB. 2015;47(2):84–90]Key words: Hematopoiesis, Pb, rice leaf extract, rat DOI: 10.15395/mkb.v47n2.458
Public Health Orientation Program (PHOP): Persepsi Dokter Internship Fakultas Kedokteran Universitas Padjadjaran Gondodiputro, Sharon; Paramita, Sekar Ayu; Amalia, Indah; Djuhaeni, Henni
Majalah Kedokteran Bandung Vol 47, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Perubahan paradigma sakit menjadi sehat, kuratif menjadi preventif dan berbasis komunitas menempatkan ilmu kesehatan masyarakat yang dikemas dalam Public Health Oriented Program (PHOP) sebagai materi yang sangat penting di Fakultas Kedokteran Unpad. Persepsi mahasiswa mengenai materi dalam kurikulum pendidikan dapat menggambarkan bagaimana efektivitas kurikulum tersebut. Atas dasar tersebut maka dilakukan penelitian tentang persepsi dokter internship FK Unpad mengenai manfaat PHOP pada saat mereka menjalankan internship. Penelitian deskriptif dilakukan terhadap 97 dokter Fakultas Kedokteran Unpad kelas reguler Angkatan 2007 dan 2008 (respons rate 74,2%), telah atau sedang melakukan program internship periode Juli–November 2014. Kuesioner yang telah diuji coba dan divalidasi, berisi 52 pertanyaan skala Likert, dikelompokkan menjadi 4 kelompok serta, disebarkan kepada responden menggunakan Research Electronic Data Capture (REDCap). Pengambilan sampel menggunakan consecutive sampling. Data diolah menggunakan distribusi frekuensi dan narasi. Hasil penelitian menunjukkan sebagian besar responden menyatakan bahwa materi-materi yang terdapat di PHOP bermanfaat pada waktu internship, namun  beberapa topik kurang aplikatif, peranan mereka sebagai dokter fungsional, tidak diberi kesempatan untuk melakukan fungsi manajemen, preventif dan promotif di masyarakat. Dari hasil ini dapat disimpulkan, perlu ada penyesuaian materi lebih aplikatif, laboratorium khusus untuk PHOP, mendatangkan expert dari lapangan dan  wahana intership melibatkan dokter dalam bidang manajemen, preventif dan promotif di masyarakat. [MKB. 2015;47(2):115–23] Kata kunci: Internship, persepsi, Public Health Oriented Program (PHOP)Public Health Orientation Program (PHOP): Perception of Medical Doctor Internship Program Participants at the Faculty of Medicine, Universitas PadjadjaranAbstractThe shift  from disease paradigm to healthy paradigm, from curative to preventive and community-based medical education has positioned the Public Health Oriented Program (PHOP) as a very important program of the Faculty of Medicine, Universitas Padjadjaran. Students’ perception of  the educational curriculum materials can describe the effectiveness of the curriculum. Based on this situation, the aim of this study was to describe the perception of doctors who participated in the internship program of the Faculty of Medicine, Universitas Padjadjaran on the benefits of PHOP. A descriptive study was carried out on 97 doctors of the Faculty of Medicine class 2007 and 2008 (response rate 74.2%) who had been and was involved in the internship program as participants. A validated questionnaire was used, containing 52 questions in Likert scale, divided into 4 groups of questions that was distributed to the respondents using Redcap (Research Electronic Data Capture). A consecutive sampling was used. The data was analyzed using frequency distribution and narratives.The results showed that most of the respondents stated that the materials in PHOP were very useful  during internship but some topics were  less applicable because the main role they played during internship was the role of a clinician and they were not given the opportunity to perform management, preventive and promotive functions in the community. From these results it can be concluded that there are needs for material adjustment towards more applicable, special laboratory activities for PHOP, inviting public health practitioners/experts to give lecture, and creating opportunities for the students to apply management, preventive and promotive actions during internship. [MKB. 2015;47(2):115–23]Key words: Internship, perception, Public Health Oriented Program (PHOP) DOI: 10.15395/mkb.v47n2.570
Hubungan Kadar Apelin dengan Disfungsi Diastol pada Penderita Gagal Jantung dengan Fraksi Ejeksi Normal Rostiati, Dini; Erwinanto, -; Yahya­, Achmad Fauzi; Achmad, Chaerul; Tedjokusumo, Pintoko; Hidayat, Syarief; Purnomowati, Augustine; Aprami, Toni Mustahsani
Majalah Kedokteran Bandung Vol 47, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Apelin merupakan peptida yang berperan dalam mempertahankan performa jantung pada beban tekanan kronik. Penelitian ini bertujuan menilai hubungan antara kadar apelin dan disfungsi diastol pada penderita gagal jantung dengan fraksi ejeksi normal. Analisis statistik korelasi Spearman-Rank. Penelitian dilakukan di Instalasi Rawat Jalan Jantung dan Divisi Diagnostiik Noninvasif Departmen Kardiologi dan Kedokteran Vaskular Rumah Sakit Dr. Hasan Sadikin Bandung periode Januari–April 2014. Hasil penelitian didapatkan 50 penderita laki-laki sebanyak 24 (48%) dan perempuan 26 (52%), usia rata-rata 58,72 (11,02) tahun, durasi hipertensi 1–30 tahun, median 5 tahun. Indeks massa tubuh rata-rata 24,13 kg/m2. Median tekanan darah sistol 130 (120–180) mmHg, median tekanan darah diastol 90 (70–110)mmHg. Fraksi ejeksi median 65 (49–77%), pengobatan dengan Angiotensin converting enzyme inhibitor (ACEI) sebanyak 48%, calcium channel blocker (CCB) 27%, beta bloker 6%, angiotensin receptor blocker (ARB) 3%, dan diuretik 1%. Pengukuran fungsi diastol, tissue doppler imaging (TDI) rata-rata 10,32, deceleration time rata-rata 228,2 detik, median rasio E/A (early/atrial (late) ventricular filling velocities) 0,77 (0,43–1,53), median isovolumic relaxation time (IVRT) 92 (60–177) detik. Median kadar apelin 1080,5 (993,2–1113) pg/mL. Sebagai simpulan, terdapat korelasi positif antara kadar apelin dan disfungsi diastol yang dihitung dengan TDI (R=0,3445, p=0,014). Apelin dapat digunakan untuk menilai gejala dan prognosis pada penderita gagal jantung dengan fraksi ejeksi normal karena kadarnya meningkat pada beban tekanan disertai fibrosis yang  sedikit dan menurun pada beban tekanan disertai fibrosis yang luas.[MKB. 2015;47(2):91–5]Kata kunci: Apelin, disfungsi diastol, fraksi ejeksi normal, gagal jantung, TDICorrelation between Plasma Apelin Level and Diastolic Dysfunction in Heart Failure Patients with Preserved Ejection Fraction AbstractApelin ia a novel multifunction peptide implicated in cardiovascular performance regulation in chronic pressure overload. Plasma apelin level and its correlation to diastolic dysfunction in patient heart failure with preserved ejection fraction were investigated. Hypertensive patients with heart failure but without coronary artery disease, atrial fibrillation, obese, and diabetes mellitus were enrolled in this study. Each patients underwent plasma apelin measurement and echocardiographic assessment of left ventricular diastolic function. Statistical analysis was conducted using Spearman Rank. Fifty patients,  24 males (48%) and 26 females (52%),  met the inclusion criteria.  The mean age of the participants was 58.72 (11.02) years with a duration of hypertension between 1–30 years, median 5 year. Mean body mass index was 24.13 kg/m2. Systolic blood pressure median was 130 (120–180)mmHg while the diastolic blood pressure median was 90 (70–110)mmHg. Left ventricular ejection fraction median was 65 (49–77)%, treatment with Angiotensin converting enzyme inhibitor (ACEI) was 48%, calcium channel blocker (CCB) was 27%, beta blocker was 6%, angiotensin receptor blocker (ARB) was 3%, and diuretic was 1%. Diastolic function assessment with tissue doppler imaging (TDI) resulted in a mean of 10.32, deceleration time mean of 228.2, E/A (early/atrial (late) filling velocities) ratio median of 0.77 (0.43–1.53),and IVRT (isovolumic relaxation time) median of 92 (59–177). Plasma apelin measurement median was 1080.5 (993.2–11) pg/mL. In conclusion, there is a positive correlation between plasma apelin level and diastolic function (TDI) (R=0.3445, p=0.014). There is no significant correlation between plasma apelin level and diastolic function using other criteria. In conclusion, apelin can be used for assessing symptoms and prognosis of heart failure patients with preserved ejection fraction because apelin level is upregulated when pressure overload occurs with less fibrosis and down-regulated when pressure overload occurs with marked fibrosis. [MKB. 2015;47(2):91–5]Key words: Apelin, diastolic dysfunction, heart failure, preserved ejection fraction DOI: 10.15395/mkb.v47n2.459
Pengaruh Ekstrak Etanol Propolis Terhadap Aktivitas dan Kapasitas Fagositosis pada Kultur Makrofag yang Diinfeksi Enteropathogenic Escherichia coli (EPEC) Herawati, Iis; Husin, Usep A.; Sudigdoadi, Sunarjati
Majalah Kedokteran Bandung Vol 47, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Penanganan penyakit infeksi diperlukan suatu imunostimulator. Propolis adalah campuran resin yang dikumpulkan lebah dari tumbuh-tumbuhan, digunakan sebagai material isolasi sarang lebah, merupakan bahan yang berpotensi sebagai imunostimulator. Penelitian dilakukan di Laboratorium Penelitian dan Pengujian Terpadu Universitas Gadjah Mada, pada Januari–Maret 2013. Penelitian ini bertujuan menganalisis peningkatan aktivitas dan kapasitas fagositosis kultur makrofag yang diberi ekstrak etanol propolis terhadap Enteropathogenic Escherichia coli (EPEC). Desain penelitian eskperimen. Ke dalam kultur makrofag yang diperoleh dari tiga orang subjek, masing-masing diberi ekstrak etanol propolis 6,25, 12,5, 25, 50, dan 100 µg/mL serta kontrol tanpa ekstrak etanol propolis. Inkubasi dilakukan satu hari. Kultur diinfeksikan EPEC selama 30 menit, diwarnai dengan Giemsa dan diamati dengan mikroskop. Persentase aktivitas fagositosis diperoleh dengan menghitung jumlah makrofag yang aktif dalam 100 makrofag. Nilai kapasitas fagositosis diperoleh dengan menghitung jumlah bakteri yang difagosit oleh 50 makrofag. Uji analysis of variance (ANOVA) menunjukkan perbedaan signifikan aktivitas maupun kapasitas fagositosis kultur makrofag yang diberi ekstrak etanol propolis dibanding dengan kontrol (p=0,000). Uji Tukey HSD pada aktivitas fagositosis menunjukkan hasil signifikan antara kontrol dan konsentrasi 6,25 µg/mL (p=0,008), sedangkan pada kapasitas fagositosis terlihat antara kontrol dan konsentrasi 12,5 µg/mL (p=0,001). Simpulan, ekstrak etanol propolis meningkatkan aktivitas dan kapasitas fagositosis kultur makrofag terhadap EPEC dengan konsentrasi minimum 12,5 µg/mL. [MKB. 2015;47(2):102–8]Kata kunci: Aktivitas fagositosis, Enteropathogenic Escherichia coli (EPEC), kapasitas fagositosis, makrofag, propolis.    The Effect of Ethanolic Extract Propolis on Phagocytosis Activity and Capacity Macrophages Culture which Infected by Enteropathogenic Escherichia coli (EPEC)AbstractThe use of immunostimulant for treatment infectious diseases is needed. Propolis is mixture of resin collected from plants by bees, used as an insulating material in beehives, which has potential as immunostimulant. The research was performed at Laboratory of research and integrated testing Gadjah Mada University in January−March 2013. This experimental research is amied to analyze the increase of phagocytosis activity and capacity on macrophages culture which added by propolis ethanolic extract againts Enteropathogenic Escherichia coli (EPEC). The design research is experimental. Macrophage culture obtained from three subjects, individually culture supplemented with the propolis ethanolic extract 6.25, 12.5, 25, 50, and 100 µg/mL as well as control without the addition of propolis ethanolic extract. The cultures were incubated for one day. Macrophage cultures infected by EPEC for 30 minutes, stained by Giemsa and observed by microscope. Percentage of phagocytosis activity is determined by the number of active macrophages per 100 macrophages. Phagocytosis capacity value determined by counting the number of bacteria that phagocytized by 50 macrophages.  Analysis of variance (ANOVA) showed significantly different phagocytosis activity and capacity between macrophage cultures that added by propolis ethanolic extract and control (p=0.000). Tukey HSD analysis showed significantly different phagocytosis activity between control and subject with concentration 6.25 µg/mL (p=0.008) whereas on phagocytosis capacity appears between control and subject with concentration 12,5 µg/mL (p=0.001). In conclusion, propolis ethanolic extract is able to increase the phagocytosis activity and capacity of macrophages againts EPEC with minimum concentration 12.5µg/mL. [MKB. 2015;47(2):102–8] Key words: Enteropathogenic Escherichia coli (EPEC), macrophage, phagocytosis activity, phagocytosiscapacity, propolis DOI: 10.15395/mkb.v47n2.460
Perbedaan Kadar HSP90 pada Preeklamsi Berat dengan Kehamilan Normal Soetrisno, -; Hari, Supriyadi; Sulistyowati, Sri; Antoni, Yusuf
Majalah Kedokteran Bandung Vol 47, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Preeklamsi berat merupakan penyebab kedua terbesar kematian ibu di seluruh dunia. Radikal bebas menstimulir kadar heat shock protein 90 (HSP90), diduga menentukan terjadinya preeklamsi berat. HSP90 merupakan protein penting untuk membantu pembentukan dan pemeliharaan protein lain serta untuk memacu kelangsungan hidup sel setelah terjadi berbagai macam keadaan patologis (fungsi chaperone). Fungsi chaperone merupakan faktor kunci adaptasi terhadap stres endogen di beberapa jaringan. Dengan mengetahui kadar HSP90, sebagai deteksi dini preeklamsi berat, maka dapat dilakukan upaya pencegahan dan penanganan secara dini. Penelitian ini bertujuan membuktikan bahwa kadar HSP90 pada kehamilan dengan preeklamsi berat lebih tinggi dibanding dengan kehamilan normal. Metode penelitian studi kuantitatif observasional pendekatan potong lintang dengan pendekatan uji laboratoris kadar HSP90. Studi dilakukan bulan September–November 2013 di Bagian Obstetri dan Ginekologi RS Dr. Moewardi Surakarta dan Prodia Jakarta. Subjek 30 pasien terdiri atas 15 pasien hamil dengan preeklamsi berat dan 15 pasien normal. Dilakukan pemeriksaan kadar HSP90 serum dengan metode enzyme-linked immunosorbent assay (ELISA). Data dianalisis menggunakan uji-t dengan SPSS versi 17.00 for Windows. Didapatkan kadar  HSP90 rata-rata kelompok preeklamsi berat sebesar 131,91±26,66, sedangkan kelompok kehamilan normal 80,28±13,39 dengan p=0,00 (p<0,05). Kadar HSP90 serum preeklamsi berat lebih tinggi dibanding dengan kehamilan normal karena pada preeklamsi berat terjadi stres oksidatif. [MKB. 2015;47(2):65–8]Kata kunci: HSP90, preeklamsi berat, radikal bebasThe Difference of HSP 90 Level between Severe Pre-Eclampsia and Normal PregnancyAbstractsSevere pre-eclampsia is the second highest cause of maternal mortality. Free radicals that stimulate heat shock protein 90 (HSP 90) are believed to determine severe pre-eclampsia. HSP90 is an important protein that helps the establishment and maintenance of other proteins. It also increases the life time of cells after various pathological conditions (chaperone function). The chaperone function is the adaptation key factor to endogenous stress in tissues. By recognizing HSP90 level in early detection of severe pre-eclampsia, prevention and management can be started early. This study aimed to prove that the HSP90 level in pregnancy with severe pre-eclampsia is higher than normal pregnancy. This was a quantitative study using cross sectional approach by testing the HSP90 level.  The study was conducted during the period of September to November 2013, at the Obstetrics and Gynecological Unit, Moewardi Hospital Surakarta and Prodia Laboratory Jakarta. The number of subjects was 30 patients, consisting of 15 normal pregnant mothers and 15 pregnant  mothers with pre-eclampsia . The calculation of serum HSP90 level was conducted using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using t-test using SPSS for Windows version 17 for Windows. The mean of HSP90 in the severe pre-eclampsia group was 131.91±26.66 while the mean in the normal pregnancy group was 80.28±13.39 with p=0.00 (p<0.05). Level of HSP90 serum in severe pre-eclampsia is higher than in normal pregnancy, due to the occurrence of oxidative stress in severe pre-eclampsia. [MKB. 2015;47(2):65–8]Key words: Free radicals, HSP90,  severe pre-eclampsia DOI: 10.15395/mkb.v47n2.455

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