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Majalah Kedokteran Bandung

mkb
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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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Kepatuhan Minum Obat Pada Pasien Lupus Eritematosus Sistemik di RSUP Dr. Hasan Sadikin Bandung Sheba, Shiane Hanako; Djuhaeni, Henni; Setiabudiawan, Budi; Sunjaya, Deni K.; Mutyara, Kuswandewi; Rinawan, Fedri Ruluwedrata
Majalah Kedokteran Bandung Vol 50, No 1 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Lupus eritematosus sistemik (LES) merupakan penyakit autoimun kronik yang mengharuskan penyandangnya minum obat dalam waktu lama bahkan seumur hidupnya. Keadaan ini selain menimbulkan dampak fisik, psikis maupun sosial juga menyebabkab biaya tinggi sehingga LES digolongkan sebagai penyakit catastrophic. Ketidakpatuhan minum obat penyandang LES akan berpengaruh langsung terhadap memburuknya outcome penyakit lupus. Penelitian bertujuan mengeksplorasi pelaksanaan dan kepatuhan minum obat pada pasien LES dengan harapan terjadinya perbaikan penatalaksanaan LES yang berdampak pada peningkatan kualitas hidup serta penurunan angka kematian karena LES. Telah dilakukan penelitian kualitatif terhadap 6 informan pasien LES suku Sunda di klinik reumatologi RSUP Dr. Hasan Sadikin Bandung pada bulan Juli sampai September 2016 dengan menggunakan pedoman wawancara mendalam open question yang dikembangkan sesuai dengan jawaban informan. Paradigma penelitan adalah constructivism dengan triangulasi terhadap 2 orang keluarga pasien dan 3 dokter konsultan klinik reumatologi RSUP Dr. Hasan Sadikin Bandung. Data yang diperoleh dianalisis secara bertahap melalui proses transkripsi, reduksi, koding, kategorisasi, penyusunan tema, interprestasi data serta pembangunan konsep. Hasil penelitian menunjukkan ada 57 koding, 14 kategori, dan 3 tema yang mengarah kepada kepatuhan minum obat pasien LES. Ke-14 kategori kepatuhan tersebut terdiri dari: karakteristik individu, daya ingat, pengetahuan, eksperimen, dan manajemen konsumsi (faktor predisposing); karakteristik penyakit, karakteristik obat, biaya, kebijakan rumah sakit, akses ke rumah sakit, terapi alternatif dan enabler agent (faktor enabling); karakteristik tenaga kesehatan dan dukungan eksternal dari berbagai pihak (faktor reinforcing). Konsep dan konstruk yang ditemukan membangun konstruk lokal Jawa Barat berlatar belakang karakteristik masyarakat Sunda dan bersifat kontekstual terhadap penyakit lupus.Kata kunci: Kepatuhan minum obat, lupus eritematosus sistemik, odapusDrug Adherence Drug in Systemic Lupus Erythematosus PatientsÂ in Dr. Hasan Sadikin General Hospital BandungSystemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that requires prolonged treatment. SLE creates physical, psychological, social, and economic burden for the patients; therefore, it is categorized as a catastrophic illness. Non-adherence to medication in SLE patient isan important factor that directly leads to poor outcome. The aim of this study was to explore the management and adherence of patients with SLE to improve the quality of life and to reduce the mortality rate. A qualitative study was undertaken to 6 sundanese SLE patients at the Rheumatology clinic in Dr. Hasan Sadikin General Hospital Bandung in July-September 2016 by using open-ended questions in in-depth interviews with probing based on informant answers. The paradigm used was constructivism with triangulation to family members of 2 patients and 3 rheumatologist consultants in Dr. Hasan Sadikin General Hospital Bandung. Data collected were analyzed gradually through transcription, reduction, coding, categorizing, theme analysis, data interpretation, and theorizing. The results showed 57 codes, 14 categories, 3 themes that focused on the medication adherence of Lupus patients.The themes were categorized as predisposing (individual characteristics, memory, knowledge, experimentation, and consumption management), enabling (drug characteristic, cost, hospital policies, access to hospital, alternative therapy, and enabler agent), and reinforcing (characteristics of health care professionals and social support) according to the predetermined theory. This study has also identified the local concepts and constructs Sundanese people in West Java, which is contextual to the lupus disease.Key words: Adherence, systemic lupus erythematosus, odapus

SENSITIVITAS, SPESIFISITAS DAN AKURASI PENGUKURAN KONTRAKSI UTERUS KALA I FASE AKTIF IBU BERSALIN MENGGUNAKAN TOKODINAMOMETER Bainuan, Lina Darmayanti; Husin, Farid; Anwar, Anita Deborah; Arifin, Achmad; Wirakusumah, Firman Fuad
Majalah Kedokteran Bandung Vol 50, No 1 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Pada umumnya, pemeriksaan kontraksi uterus dilakukan dengan menekan fundus uteri, namun demikian cara tersebut menyebabkan ketidaknyamanan dan hanya dapat mengetahui frekuensi kontraksi sedangkan durasi dan intensitas kontraksi pengukurannya bersifat subjektif. Cara lain yang digunakan adalah menggunakan Kardiotokografi, namun harganya mahal danl lebih sulit untuk menginterpretasikan hasil. Tokodinamometer dapat digunakan untuk menilai kemajuan persalinan karena dapat dibaca langsung, sederhana, dan harga terjangkau, sehingga dapat digunakan di komunitas. Penelitian ini bertujuan untuk mengukur sensitivitas, spesifisitas dan akurasi Tokodinamometer dalam mengukur kontraksi uterus kala I fase aktif pada ibu bersalin. Rancangan penelitian merupakan studi observasional analitik dengan desain Cross sectional (potong silang). Sampel penelitian berjumlah 47 orang yang memenuhi kriteria inklusi di Rumah Sakit Khusus Ibu dan Anak Kota Bandung, dengan teknik concecutive sampling. Pengambilan data dengan mengukur kontraksi uterus menggunakan Tokodinamometer dan Kardiotokografi (KTG) diukur secara bersamaan sebanyak 2 kali. Analisis menggunakan uji Wilcoxon?s, dan uji diagnostik. Hasil penelitian didapatkan, frekuensi dan intensitas kontraksi uterus tidak terdapat perbedaan (p>0,05), sedangkan durasi kontraksi terdapat perbedaan bermakna (p< 0,05) antara ibu bersalin kala I fase aktif yang diukur menggunakan Tokodinamometer dan KTG. Tokodinamometer memiliki nilai sensitivitas (90,47%), spesifisitas (78,26%) dan akurasi (87,21%). Tokodinamometer dapat digunakan untuk pemantauan kontraksi uterus di komunitas.Kata kunci : Fase aktif, Kontraksi uterus, Tokodinamometer Sensitivity, Specificity, and Accuracy Measurement of Stage I Active Labor Uterus Contraction Using TokodynamometerExamination of uterine contractions is generally done by pressing the uterine fundus. This method can cause discomfort and can only reveal the frequency of contraction while the duration and intensity of contraction measurement is subjective, leading to inaccurate decision making in early phase of labor. Labor monitoring should be done by cardiotocography. However, this device is expensive and interpretation of results needs specific skills. Since contraction assessment is important to understand the progress of labor, a device that can be used at the community level is needed. This study aimed to analyze the sensitivity, specificity and accuracy of Tokodynamometer in measuring uterine contraction in the first stage of active phase of labor. This was a crossectional analytic observational study on 47 women who met the inclusion criteria in Bandung City Maternal and Child Hospital t RSKIA Bandung, with concecutive sampling technique. Tokodynamometer and Cardiotocography were used to measure uterine contractions simultaneously. Each measurement was done twice or according to mother condition. Data collected were analyzed using Wilcoxon?s test and diagnostic test. The results showed that the frequency and intensity of uterine contractions did not differ (p>0.05), whereas the duration of contraction was significantly different with p=0.012 (p<0.05) between measurements taken using Tokodinamometer and CTG in active phase of labor. The Tokodynamometer has sensitivity specificity and accuracy values of 90.47 %, 78.26 %), and 87.21 %,, respectively. Tokodynamometer has almost similar sensitivity, specificity, and accuracy to Cardiotocography as the gold standard. Thus, Tokodynamometer can be used for monitoring uterine contractions in community setting.Key words: Active phase, uterine contractions, Tokodynamometer

KESESUAIAN TERHADAP PROSEDUR STANDAR RESUSCITATION BUNDLE 6 JAM PADA PELAKSANAAN PENDERITA SEPSIS BERAT DAN SYOK SEPSIS Wirawan, Chevie; Alisjahbana, Bachti; Sumardi, Uun
Majalah Kedokteran Bandung Vol 50, No 1 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Sepsis berat dan syok sepsis memiliki angka kematian tinggi. Resuscitation bundle 6 jam adalah panduan tata laksana sepsis berat dan syok sepsis yang terbukti menurunkan mortalitas. Kesesuaian penatalaksanaan sepsis berat dan syok sepsis dalam 6 jam pertama dengan prosedur standar resuscitation bundle diteliti. Penelitian observasional deskriptif ini dilaksanakan selama September?Desember 2015 terhadap penderita sepsis berat dan syok sepsis di SMF Ilmu Penyakit Dalam RSUP Dr. Hasan Sadikin Bandung. Data dikumpulkan adalah data umum penderita dan pelaksanaan prosedur 6 jam pertama sesuai standar: pemeriksaan laktat, kultur darah, pemberian antibiotik, resusitasi cairan, pemberian vasopresor, pengukuran CVP, dan pemeriksaan Scvo2/Svo2. Dari 80 subjek penelitian, 59 (74%) sepsis berat dan 21 (26%) syok sepsis. Pada sepsis berat dan syok sepsis, dalam 3 jam pertama pemeriksaan laktat dilakukan pada 2% dan 14%, kultur darah sebelum antibiotik 17% dan 10%, pemberian antibiotik spektrum luas 32% dan 43%, serta resusitasi cairan 30 mL/kgBB 2% dan 14%. Pada syok sepsis dalam 6 jam pertama pemberian vasopresor 62% dan pengukuran CVP 5%. Pemeriksaan Scvo2/Svo2 tidak dilakukan pada syok sepsis. Angka kematian sepsis berat 7% dan syok sepsis 19,1% dalam 6 jam pertama. Simpulan, kesesuaian penatalaksanaan 6 jam pertama penderita sepsis berat dan syok sepsis dengan prosedur standar masih kurang.Kata kunci: Resuscitation bundle 6 jam, sepsis berat, syok sepsis Compliance to 6-Hour Resuscitation Bundle Standard in Severe Sepsis and Septic Shock ManagementSevere sepsis and septic shock have a high mortality rate. Six-hour resuscitation bundle is a management standard for severe sepsis and septic shock that has been proven to reduce mortality rate. Compliance to the 6-hour resuscitation bundle standard was studied. This was a descriptive observational study on severe sepsis and septic shock patients in the Internal Medicine Department of Hasan Sadikin General Hospital Bandung in the period of September?December 2015. Data collected were patient?s general data and the implementation of the 6-hour management standard procedures that include lactate measurement, blood culture, broad spectrum antibiotics, fluid resuscitation, vasopressor use, CVP measurement, and Scvo2/Svo2 measurement. Of 80 subjects, 59 (74%) had severe sepsis and 21 (26%) had septic shock. In the first 3 hours, for severe sepsis and septic shock patients, lactate was examined in 2% and 14% respectively. For blood culture before antibiotics, broad spectrum antibiotic provision, and 30 mL/kgWt fluid resuscitation, the values were 17% and 10%, 32% and 43%; and 2% and 14%, respectively. In septic shock, in the 6 hours, vasopressor was given to 62% and CVP was measured in CVP 5%. Scvo2/Svo2 was not measured. The mortality rates in the first 6 hours for severe sepsis and septic shock were 7% and 19%. Compliance to first 6-hour standard procedure for severe sepsis and septic shock is still inadequate. Key words: Septic shock, severe sepsis, six hours resuscitation bundle

DETEKSI KEBERADAAN NYAMUK BERDASARKAN KETINGGIAN GEDUNG DI KAWASAN KAMPUS UNIVERSITAS PADJADJARAN JATINANGOR Faridah, Lia; Leonita, Inggrid; Sari, Sri Yusnita Irda
Majalah Kedokteran Bandung Vol 50, No 1 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Demam berdarah dengue (DBD) di Indonesia menurut data Kemenkes telah menjadi masalah kesehatan selama 45 tahun terakhir, sejak tahun 1968 sampai saat ini. Pada tahun 1973 dan 1983 progresivitasnya meningkat hingga lebih dari 50% kabupaten/kota telah terjangkit kasus DBD. Kabupaten Sumedang sendiri memiliki insidensi 63,75 per 1.000 penduduk dengan jumlah kasus DBD sekitar 715 kasus pada tahun 2012. Tujuan penelitian ini adalah mengevaluasi persebaran nyamuk berdasarkan ketinggian gedung menggunakan media ovitrap dan mosquitoes light trap pada tujuh gedung bertingkat di kawasan kampus Universitas Padjadjaran Jatinangor yang memiliki ketinggian hingga level empat (9,1?12,0 m). Penelitian ini dilakukan pada bulan Mei?Juni 2017. Semua ovitrap diletakkan pada lokasi yang berpotensi sebagai breeding site di dalam ruangan selama satu minggu, tiap-tiap lantai terdapat tiga ovitrap dengan jarak antar ovitrap 1,5 m. Perangkap nyamuk diletakkan pada setiap sudut ruangan yang memiliki sumber arus listrik selama 24 jam dan pengumpulan sampel dilakukan dalam kurun waktu tiga hari berikutnya. Semua sampel kemudian diidentifikasi di Laboratorium Parasitologi Fakultas Kedokteran Universitas Padjadjaran Jatinangor. Culex spp dan Aedes spp genus nyamuk yang dapat ditemukan pada gedung bertingkat di kawasan kampus Universitas Padjadjaran Jatinangor dengan jumlah terbanyak adalah Culex spp, sedangkan Aedes spp ditemukan dapat bertelur hingga tingkat tiga pada pemukiman yang padat.Kata kunci: Gedung bertingkat, genus, light trap, nyamuk, ovitrap Detection of Mosquito Presence based on Building Elevation in Universitas Padjadjaran JatinangorAccording to the Ministry of Health (KMoH), Dengue Hemorrhagic Fever (DHF) has been a big problem in Indonesia since 1968. In 1973 and 1983, the progressivity of DHF has increased. DHF cases have spread to more than 50% of districts/cities. Sumedang District has an incidence rate of 63.75 per 1,000 residents with the number of dengue cases of 715 in 2012. The purpose of this study was to evaluate of the presence of mosquito based on building elevation using ovitraps and mosquito light traps. A survey was conducted in seven locations with four different elevations (9.1?12.0 m) in Universitas Padjadjaran Jatinangor campus during the period of May to June 2017. All ovitraps were each placed in a potential location for mosquito breeding site for one week. For each elevation, in this case, each floor, three ovitraps were placed with a distance 1.5 m from each other. Modified mosquito light trap was turned on for 24 hours and sample collection was performed after three days. All samples were brought to the Parasitology Laboratory of the Faculty of Medicine, Universitas Padjajaran for identification. This study showed that two genera of mosquitoes were identified i.e. Culex spp and Aedes spp with Culex spp as the most frequently found genera. The eggs of Aedes spp can be found up to the third floor in dense settlements.Key words: Genera, high level building, light trap, mosquito, ovitrap

PEMBERIAN TERAPI OKSIGEN HIPERBARIK TIDAK MEMBERIKAN PENGARUH POSITIF PADA KETEBALAN ENDOMETRIUM PADA TIKUS MODEL SINDROM OVARI POLIKISTIK DENGAN RESISTENSI INSULIN Susanto, Lunardhi; Purwandono, Azham; Wittiarika, Ivon Diah; Santoso, Budi
Majalah Kedokteran Bandung Vol 50, No 1 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Sindrom ovari polikistik (SOPK) meningkatkan risiko hiperplasia dan keganasan endometrium. Faktor yang memicu kejadian tersebut adalah hiperandrogen, anovulasi kronik, dan hiperinsulinemia. Terapi oksigen hiperbarik (TOHB) diketahui memberikan manfaat positif bagi sensitivitas insulin. Berdasar atas hal tersebut maka ingin diketahui pengaruh terapi oksigen hiperbarik terhadap endometrium pada tikus model SOPK resistensi insulin. Untuk mengetahui hal tersebut maka dilakukan penelitian dengan desain post-test only control group menggunakan 28 tikus betina (Rattus norvegicus strain Wistar) yang kemudian dibagi menjadi empat kelompok: Kelompok normal, SOPK, TOHB 5 sesi dengan SOPK dan TOHB 10 sesi dengan SOPK. Model tikus SOPK diperoleh dengan menyuntikkan testosteron propionat 10 mg/100 gram bobot/ kali selama 28 hari berturut-turut. Pada tikus normal diberikan suntikan propilen glikol sebanyak 1 mL selama 28 hari. Dilakukan pengukuran ketebalan endometrium secara histopatologik. Penelitian dilakukan di Fakultas Kedokteran Universitas Airlangga, Fakultas Kedokteran Hewan Universitas Airlangga, dan LAKESLA TNI AL Drs. Med. R. Riyadi S, Phys pada periode Juni-September 2016. Didapatkan ketebalan endometrium pada kelompok normal (mean ± SD) (µm)) 1.109,98 ± 53,96; kelompok SOPK 35.651,47 ± 400,54; kelompok TOHB 5 sesi dengan SOPK 2.266,13 ±2 62,08; dan kelompok TOHB 10 sesi dengan SOPK 2.144,83 ± 305,83. Kelompok SOPK memiliki endometrium lebih tebal dibanding dengan kelompok normal. Tidak terdapat perbedaan ketebalan endometrium pascapemberian TOHB 5 sesi maupun 10 sesi.Kata kunci: Hiperplasia endometrium, sindrom ovari polikistik, terapi oksigen hiperbarik Hyperbaric Oxygen Therapy Does Not Improve the Endometrial Thickness in PCOS Rat with Insulin Resistance ModelPolycystic ovary syndrome (PCOS) increases the risk of endometrial hyperplasia and malignancy. Chronic anovulation, hyperandrogen, and hyperinsulinemia are known as the pathogenesis of endometrial hyperplasia and malignancy in PCOS women. Hyperbaric oxygen therapy (HBOT) has positive effects to improve peripheral insulin sensitivity. This study aimed to understand the effect of HBOT on endometrial thickness in PCOS rat with insulin resistance model. A laboratory experimental study was conducted involving twenty-eight healthy female rats divided into 4 groups: normal group, PCOS group, 5 session HBOT PCOS group, and 10 Session HBOT PCOS group. To induce a PCOS rat model with insulin resistance, testosterone propionate (10 mg/100-gram body weight) was administered for 28 days. Normal group was administered with 1 mL propylene glycol. Histopathological evaluation of endometrium of all groups was performed. This study was conducted in June-September 2016 in the School of Medicine Airlangga University, School of Veterinary Medicine Airlangga University, and LAKESLA TNI AL Drs. Med. R. Riyadi S, Phys. The endometrial thickness (mean ± SD (µm)) of the normal, PCOS p, 5-session HBOT PCOS, and 10-session HBOT PCOS were 1,109.98 ± 53.96, 35,651.47 ± 400.54, 2,266.13 ± 262.08, and 2,144.83 ± 305.83, respectively. The endometrium of PCOS group was thicker than that of the normal group. Five and ten sessions do not decrease the endometrial thickness when compared to PCOS group.Key words: Endometrial hyperplasia, hyperbaric oxygen therapy, polycystic ovary syndrome

Oral Manifestations of Systemic Lupus Erythematous and Its Comprehensive Management: Two Case Reports Rita Wardhani; Irna Sufiawati
Majalah Kedokteran Bandung Vol 50, No 1 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Systemic lupus erythematous (SLE) is an autoimmune collagen-vascular disease involving mucocutaneous and musculoskeletal systems as well as blood vessels that is characterized by diverse clinical manifestations, making it necessary to use a comprehensive multidisciplinary approach. Oral manifestations of SLE include oral ulcer, discoid lesions, oral lichen planus-like-lesion, oral candidiasis, and xerostomia. This study reports two cases of 19-year-old and 41-year-old female patients visiting the Oral Medicine Department Dr. Hasan Sadikin General Hospital in October 2016. These patients were referred by the Internal Medicine Department with SLE diagnosis, involving hematological, musculoskeletal and mucocutaneous systems. Extraoral examination revealed moon face in the first patient and malar rash and lips exfoliations in the second patient. Intraoral examination revealed oral ulcers on buccal and labial mucosa as well palate in both patients. Both patients were given methyl prednisolone, calcium, and folic acid by the Internal Medicine Department. Oral ulcers were treated with prednisone mouthwash, nystatin oral suspension, and vitamin B12. The oral ulcer on palate was considered very difficult to resolve so that topical corticosteroid was required. Prednisone mouthwash was chosen as drug of choice due to its efficacy on oral mucosa and its ability to minimize the systemic adverse effects which were resolved in 6 week after starting treatment. Comprehensive multidisciplinary approach associated with oral manifestation of SLE has significant effects in decreasing disease severity and improving the quality of life in patients with SLE.Key words: Oral ulcers, prednisone mouthwash, systemic lupus erythematosus Manifestasi Oral Lupus Eritematosus Sistemik dan Manajemen Komprehensifnya: Dua Laporan KasusSistemik lupus eritematosus (SLE) adalah penyakit kolagen-vaskular autoimun, yang melibatkan sistem mukokutan, muskuloskeletal, dan pembuluh darah yang ditandai dengan manifestasi klinis yang bervariasi, sehingga diperlukan pendekatan multidisiplin yang komprehensif. Manifestasi oral SLE meliputi ulkus mulut lesi diskoid, lichen planus-like lesion, kandidiasis oral, dan serostomia. Pasien wanita berusia 19 tahun dan 41 tahun yang dirujuk dari departemen Penyakit Dalam pada Oktober 2016 dengan diagnosis SLE yang melibatkan hematologis, muskuloskeletal, dan mukokutan. Pemeriksaan ekstraoral menunjukkan moon face pada pasien pertama, dan malar rash serta pengelupasan bibir pada pasien kedua. Pemeriksaan intra oral mengungkapkan ulkus oral, mukosa labial, dan palatum pada kedua pasien. Kedua pasien diberikan metil prednisolone, kalsium, dan asam folat dari departemen Penyakit Dalam. Ulkus oral diobati dengan obat kumur prednison, suspensi oral Nistatin, dan vitamin B12 yang diberikan dalam 6 minggu pengobatan. Ulkus oral adalah salah satu manifestasi oral yang umum pada pasien SLE. Ulkus oral pada palatum dianggap sangat sulit diatasi sehingga dibutuhkan kortikosteroid topikal. Prednisone mouth wash dipilih sebagai obat pilihan sebagai anti-inflamasi pada mukosa oral dan meminimalkan efek samping sistemik. Pendekatan multidisiplin komprehensif yang terkait dengan manifestasi oral SLE memiliki efek signifikan dalam menurunkan tingkat keparahan penyakit dan meningkatkan kualitas hidup pada pasien SLE.Kata kunci: Lupus eritematosus sistemik, ulser oral, obat kumur prednison

Aktivitas Makrofag Meningkat Pada Aorta Tikus Hiperkolesterolemia Kurniati, Neng Fisheri; Nurfatwa, Maritsa; Artarini, Aluicia Anita
Majalah Kedokteran Bandung Vol 50, No 1 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Aterosklerosis merupakan, kondisi inflamasi kronik, faktor resiko penyakit kardiovaskular disebabkan oleh tingginya kadar kolesterol. Tujuan penelitian ini mengevaluasi peran mieloperoksidase (MPO) dan makrofag di aorta dan jantung tikus yang diinduksi hiperkolesterolemia. Penelitian ini dilakukan pada Maretâ€“Agustus 2016 di Laboratorium Farmakologi dan Bioteknologi Institut Teknologi Bandung. Tikus dikelompokkan menjadi kelompok normal dan hiperkolesterolemia. Induksi hiperkolesterolemia dilakukan dengan pemberian pakan tinggi kolesterol, kolesterol murni, asam kolat dan propiltiourasil (KKT) selama 5 bulan. Kolesterol total diukur sebelum induksi, pertengahan, dan setelah induksi. HDL, trigliserida (TG), LDL, indeks aterogenik (IA), jumlah sel darah merah dan sel darah putih diukur setelah induksi. Deteksi ekspresi mieloperoksidase (MPO) dan CD68 pada aorta dan jantung dilakukan dengan metode dot blot dan ELISA. Induksi hiperkolesterolemia selama 5 bulan menghasilkan kadar kolesterol total (364,10Â±148,46 mg/dL), HDL (7,90Â±1,29 mg/dL), LDL (307,47Â±116,91 mg/dL), dan Indeks Aterogenik (1,04Â±0,23). Kadar kolesterol yang tinggi meningkatkan jumlah sel darah putih yang bersirkulasi namun tidak mempengaruhi jumlah sel darah merah. Jumlah makrofag yang berada di jaringan aorta dan jantung kelompok hiperkolesterolemia meningkat secara signifikan dibanding dengan kelompok normal. Namun, peningkatan aktivitas makrofag yang diukur dari ekspresi MPO hanya teramati pada aorta hewan hiperkolesterolemia, tidak pada jantung. Simpulan, aktivitas makrofag meningkat hanya pada aorta hewan hiperkolesterolemia diduga berperan dalam pembentukan plak ateroma di aorta.Â Kata kunci: Aorta, CD68, hiperkolesterolemia, makrofag, mieloperoksidaseÂ Macrophage Activity Increases in Hypercholesterolemia Rat AortaAtherosclerosis, which is an inflammatory chronic condition, is one of the major risk factors of cardiovascular disease caused by hypercholesterolemia. This study aimed to evaluate role of myeloperoxidase (MPO) and macrophage in aorta and heart of rat hypercholesterolemia. This research was conducted in Marchâ€“August 2016 at Pharmacology and Biotechnology Laboratory of Institut Teknologi Bandung. Rats were divided into normal and hypercholesterolemia groups. Hypercholesterolemia was induced by cholesterol feeding and CCT (cholesterol, cholic acid and propiltiourasil) oral administration for 5 months. Total cholesterol was measured before induction (T0), in the middle (T2.5), and after induction (T5). HDL, triglyceride (TG), LDL, aterogenic index (IA), red blood, and white blood cell count was measured after induction (T5). Success of induction was proven by the elevation of cholesterol total value of hypercholesterolemia group compared to normal group. Myeloperoxidase (MPO) and CD68 in aorta and heart hypercholesterolemia rat was detected by dot blot and ELISA method. Hypercholesterolemia group showed significant differences in total cholesterol value (364.10Â±148.46 mg/dL), HDL value (7.90Â±1.29 mg/dL ), LDL value (307.47Â±116.91) and Atherogenic Index (1.04Â±0.23). High level of cholesterol increases circulating white blood cells but have no effect onÂ circulating red blood cells. Macrophage in theÂ hypercholesterolemia group increased significantly compared to the normal group. However, the increase in macrophage activity identified throughMPO expression was only seen in hypercholesterolemic aorta but notÂ in the heart. It is concluded that macrophage activities increase in the aortic tissue, butÂ not in the heart tissue of the hypercholesterolemia group, which may contribute to the formation of atheroma plaque in aorta.Â Key words: Aorta, CD68, hypercholesterolemia, macrophage, myeloperoxidase

Prevalensi dan Pola Sensitivitas Antimikroba Multidrug Resistant Pseudomonas aeruginosa di RSUD Arifin Achmad Anggraini, Dewi; Gusti Yulindra, Utari; Savira, Maya; Djojosugito, Fauzia Andrini; Hidayat, Nopian
Majalah Kedokteran Bandung Vol 50, No 1 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Resistensi antimikrob merupakan salah satu masalah kesehatan masyarakat yang besar yang dihadapi manusia sejak era ditemukan antimikrob. Angka multidrug resistant P. aeruginosa salah satunya semakin meningkat di berbagai belahan dunia yang berdampak pada kesulitan penanganan infeksi oleh bakteri ini. Penelitian deskriptif retrospektif ini bertujuan mengetahui prevalensi MDR P.aeruginosa dan pola sensitivitasnya. Data diambil dari hasil kultur bakteri dan uji resistensi antibiotik dari berbagai spesimen klinis pasien di RSUD Arifin Achmad sepanjang tahun 2015. Uji resistensi dilakukan dengan menggunakan alat Vitek 2 compact. MDR P. aeruginosa didefinisikan sebagai P. aeruginosa yang tidak sensitif terhadap tiga atau lebih golongan antibiotik berikut: meropenem atau imipenem, siprofloksasin, gentamisin atau amikasin, seftazidim atau sefepim, dan piperasilin/tazobaktam. Prevalensi MDR P. aeruginosa adalah 45,5%. Isolat MDR P. aeruginosa serta paling banyak berasal dari instalasi perawatan surgikal dan instalasi perawatan intensif, dan paling banyak berasal dari spesimen pus dan sputum. Sensitivitas P. aeruginosa paling baik dengan amikasin (76,9%), piperasilin/tazobaktam (57,2%), meropenem (57,0%), gentamisin (54,5%), sefepim (53,7%), seftazidim (49,6%), ciprofloksasin (48,8%) dan aztreonam (35,5%). Sensitivitas MDR P.aeruginosa terhadap antibiotik jauh lebih rendah dibanding dengan P. aeruginosa. Penelitian ini menunjukkan angka MDR P. aeruginosa tinggi khususnya di Pekanbaru. Pola sensitifas P. aeruginosa dapat menjadi pedoman dalam memilih antibiotik yang sesuai untuk infeksi karena P. aeruginosa.Kata kunci: Multidrug resistant, Pekanbaru, pseudomonas aeruginosa, sensitivitas antibiotikÂ Prevalence and Antimicrobial Susceptibility Profile of Multidrug Resistant Pseudomonas aeruginosa in Arifin Achmad General HospitalAntimicrobial resistance is one of major public health problems since the era of antimicrobial discovery, inclusing multidrug resistant (MDR) P. aeruginosa. The prevalence of this resistance Â is increasing in different parts of the world, leading to the difficulties in dealing with this bacteria. The aim of this descriptive retrospective study was to determine the prevalence of MDR P. aeruginosa and its susceptibility profile. Data were collected from the bacteria cultures and antibiotic susceptibility test results from various clinical specimens in Arifin Achmad General Hospital throughout 2015. The test was performed in VITEK 2 Compact. MDR P. aeruginosa is defined as P. aeruginosa which is not sensitive to three or more following antibiotics: meropenem or imipenem, ciprofloxacin, gentamicin or amikacin, ceftazidime or cefepime, and piperacilin/tazobactam. The prevalence of MDR P. aeruginosa was 45.5%. The isolates of MDR P. aeruginosa was mostly derived from pus and sputum specimens from the surgical ward and intensive care unit. . Â The most sensitive antibiotics was amikacin (76.9%) followed by piperacilin/tazobactam (57.2%), meropenem (57.0%), gentamicin (54.5%), cefepime (53.7%), ceftazidime (49.6%), ciprofloxacin (48.8%), and aztreonam (35.5%). Antibiotic sensitivity in MDR P. aeruginosa was much lower than in P. aeruginosa. This study shows a high prevalence of MDR P. aeruginosa, especially in Pekanbaru. This susceptibility profile can serve as a guideline for the selection of appropriate antibiotics for infections caused by P. aeruginosa.Key words: Antibiotic susceptibility, multidrug resistant, Pekanbaru, pseudomonas aeruginosa

Internal and External Aspects Toward The Quality of Refill Water Station Production; Qualitative Study in Bandung City Raksanagara, Ardini Saptaningsih; Fitriyah, Sukhriyatun; Afriandi, Irvan; Iskandar, Hadyana; Sari, Sri Yusnita Irda
Majalah Kedokteran Bandung Vol 50, No 1 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Kualitas produksi Depot Air Minum (DAM) isi ulang ditengarai semakin menurun dan upaya menjaga kualitas DAM tidak hanya dilakukan oleh pemilik DAM, pemerintah mempunyai kewajiban berperan aktif dalam melakukan pengawasan DAM, namun belum banyak informasi mengenai kendala dan tantangan yang terjadi di lapangan dalam proses pengawasan kualitas DAM. Penelitian ini bermaksud mengeksplorasi aspek internal dan eksternal yang berkaitan dengan kualitas DAM yang tidak memenuhi syarat. Desain penelitian ini bersifat kualitatif menggunakan pendekatan fenomenologi dengan paradigma konstruktivisme. Teknik pengumpulan data dilakukan melalui observasi, wawancara mendalam dan studi dokumen, data dianalisis menggunakan analisis tema. Penelitian dilakukan di Dinas Kesehatan, Dinas Perdagangan, Puskesmas, dan DAM pada bulan Mei-Agustus 2017. Hasil penelitian menunjukan aspek internal yang berpengaruh terhadap DAM yang tidak memenuhi syarat terdiri dari sumber daya manusia, proses pengolahan, peralatan, dan higiene. Faktor sumber daya yang rendah menyebabkan proses pengolahan tidak sesuai dengan standar. Aspek eksternal meliputi pengawasan pemerintah, sanksi, dan kerjasama. Pemerintah memiliki hambatan dalam kegiatan pengawasannya seperti kekurangan tenaga sanitarian, alokasi dana pemeriksaan sampel air minum yang rendah, dan beban kerja ganda. Tidak ada sanksi tegas serta kurangnya kerjasama antarlintas sektoral turut berpengaruh terhadap kualitas air minum isi ulang tidak memenuhi syarat. Upaya terobosan baru diperlukan untuk meningkatkan kualitas produksi DAM terutama melalui pengembangan sistem pengawasan terintegrasi yang tidak hanya melibatkan pemerintah lokal, namun juga masyarakat dan konsumen.Kata kunci: Aspek eksternal, aspek internal, depot air minumÂ Internal and External Aspects Related to Quality of Refill Water Station Production: Qualitative Study in Bandung CityThe quality of water production in drinking water refill station (DWRS) has recently been decreasing. Maintaining the quality of DWRS is not only the responsibility of the owners because the government should also playe an active role as the external supervisor. However, few information is available on the obstacles in monitoring the quality of DWRS. This study aimed to explore the internal and external aspects related to quality of drinking water production in DWRS. It was a qualitative study using phenomenology approach with constructivism paradigm. Data were collected through observation, indepth interviews, and document study. Data were analyzed using theme analysis. The place of study was Bandung City Health Office, Trade Service Unit, Primary Health Centers, and some DWRSs with inadequate water quality during May-August 2017. The result showed that internal aspects that related to drinking water quality were human resources, proper processing, appropiate equipments, and hygienic environment.Â Inadequate human resource can cause unstandardized process production. External aspects included government supervision, sanctions, and law enforcement as well as collaboration between owner and local government. In conducting DWRS supervisory activities, the government has obstacles such as lack of human resources, lack of funding allocation, and multiple workloads. In addition, the absence of strict sanctions and the lack of cross-sectoral cooperation also contribute to the quality of refill drinking water, making it inadequate. New innovation should be developed to increase the quality of DWRS, particularly development of integrated supervison system which iincludes not only the local government but also the commmunity and consumers.Key words: Drinking water refill station, external aspect, internal aspect

Correlation Physical Activity, Energy Balance, and Metabolic Syndrome of Physical Fitness in Elderly Age Group Setiawan, Setiawan; Goenawan, Hanna; Lesmana, Ronny; Tarawan, Vita M.; Rosdianto, Aziiz Mardanarian; Purba, Ambrosius
Majalah Kedokteran Bandung Vol 50, No 1 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v50n1.1160

Fitness becomes an important benchmark for public health in every age group. Activities with poor adverse fitness are at risk of injury. Good fitness is gained from a balance in everyday physical activity with conditions that are free of metabolic syndrome. This study investigated the relationship of physical activity, energy balance, and metabolic syndrome to the fitness of 166 professors of Universitas Padjadjaran who underwent a 1-month fitness checkup at BAPELKES Bandung in the period of 2017. Based on the regression analysis, the results showed a significant relationship between physical activity, energy balance, and metabolic syndrome on the physical fitness of the elderly group (F = 25.9290> F table = 2.427) with normal data distribution (Kolmogorov-Smirnov test). The results also showed a moderate relationship (R = 0.569 and R2 = 0.324). It also partially showed significant influence between physical activity and fitness (t = 8.541> t table = 1.975), significant influence between energy balance and physical fitness (t = 2.248> t table = 1.975), and no significant partial influence between metabolic syndrome and physical fitness of the elderly group (t = -0.029 <t table = 1.975). Hence, there is a relationship between physical activity, energy balance, metabolic syndrome and physical fitness Â of Professors in Universitas Padjadjaran.Key words: Energy balance, metabolic syndrome, physical fitnessÂ Â Hubungan Aktivitas Fisik, Keseimbangan Energi, dan Sindrom Metabolik terhadap Kebugaran Fisik pada Kelompok Usia LanjutKebugaran menjadi tolak ukur penting bagi kesehatan masyarakat pada setiap kelompok usia. Aktivitas dengan kebugaran usia lanjut yang kurang baik berisiko terjadi cedera. Kebugaran yang baik diperoleh dari keseimbangan dalam aktivitas fisik sehari-hari dengan kondisi bebas dari sindrom metabolik. Penelitian ini mempelajari hubungan aktivitas fisik, keseimbangan energi, dan sindrom metabolik dengan kebugaran 166 orang Guru Besar di Universitas Padjadjaran yang dilakukan pemeriksaan kebugaran selama 1 bulan di BAPELKES Bandung periode tahun 2017. Berdasar atas analisis regresi hasil penelitian menunjukkan hubungan yang signifikan antara aktivitas fisik, keseimbangan energi, dan sindrom metabolik dengan kebugaran fisik kelompok usia lanjut (F=25,9290 > Ftable=2,427) dengan distribusi data normal (tes Kolmogorov-Smirnov). Hasil juga menunjukkan hubungan yang moderat (R= 0,569 dan R2= 0,324). Secara parsial juga menunjukkan pengaruh yang signfikan aktivitas fisik dengan kebugaran (t= 8.541> t tabel= 1.975), pengaruh signifikan keseimbangan energi dengan kebugaran fisik (t= 2,248> t tabel= 1,975), dan tidak ada pengaruh signifikan secara parsial terhadap sindrom metabolik dengan kebugaran fisik kelompok usia lanjut (t= -0,029 < t tabel= 1,975). Berdasar atas hasil penelitian dapat disimpulkan hubungan = aktivitas fisik, keseimbangan energi, dan sindrom metabolik dengan kebugaran fisik guru besar Universitas Padjadjaran.Kata kunci: Kebugaran, keseimbangan energi, sindrom metabolik

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Gedung Rumah Sakit Pendidikan Unpad/Pamitran Unpad (Teaching Hospital Building) Faculty of Medicine Unpad, 3rd Floor Jl. Prof. Eyckman No. 38 Bandung, 40161, Indonesia

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Kota bandung,

Jawa barat

INDONESIA