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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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A New Beginning For Majalah Kedokteran Bandung (MKB) in 2019 Ahmad Faried; Reni Ghrahani
Majalah Kedokteran Bandung Vol 50, No 4 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (145.105 KB) | DOI: 10.15395/mkb.v50n4.1589

Abstract

[no abstract available]
Perkembangan dan Faktor-faktor yang Memengaruhi Tingkat Kemandirian Pasien Strok Selama Rawat Inap di Yogyakarta berdasar atas Skor Modifikasi Indeks Barthel Chayati, Nur; Putranti, Dwi Puji; Firmawati, Erfin
Majalah Kedokteran Bandung Vol 50, No 4 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (80.946 KB) | DOI: 10.15395/mkb.v50n4.1427

Abstract

Strok adalah gangguan fungsional otak fokal maupun global, bersifat akut, terjadi lebih dari 24 jam, berasal dari gangguan aliran darah otak dan bukan disebabkan oleh gangguan peredaran darah otak. Salah satu dampak dari strok adalah kelemahan anggota gerak baik hemiplegia atau hemiparesis sehingga mengganggu kemandirian pasien dalam aktivitas kehidupan sehari-hari (AKS). Tujuan penelitian ini mengetahui perkembangan tingkat kemandirian pasien strok berdasar atas skor Modifikasi Indeks Barthel serta faktor-faktor yang memengaruhi tingkat kemandirian pasien. Penelitian dilakukan di rumah sakit PKU Muhammadiyah Yogyakarta dan Rumah Sakit PKU Muhammadiyah Gamping pada bulan Mei hingga Juni 2016. Penelitian dilakukan dengan desain prospective longitudinal. Sejumlah 42 responden dipilih melalui accidental sampling. Instrumen yang digunakan adalah kuesioner Modifikasi Indeks Barthel.  Data dianalisis dengan regresi logistik berganda. Hasil penelitian menunjukkan untuk pasien strok perdarahan, pada saat masuk rumah sakit mayoritas dengan kondisi tingkat ketergantungan total (44%) dan pada saat keluar sakit sebagian besar menjadi tingkat ketergantungan parah (44%). Untuk pasien dengan strok iskemik, saat masuk rumah sakit mayoritas juga berada pada tingkat ketergantungan total (49%) dan terjadi perbaikan kondisi menjadi tingkat ketergantungan parah (42%) pada saat keluar rumah sakit. Variabel lama rawat inap berhubungan secara signifikan terhadap skor Modifikasi Indeks Barthel (p<0,05). Tidak ada faktor yang paling dominan berpengaruh terhadap skor Modifikasi Indeks Barthel pasien strok. Kata kunci: Aktivitas kehidupan sehari-hari, modifikasi indeks barthel, strok Development and Factors Affecting the Level of Independence of Stroke Patients During Hospitalization in Yogyakarta based on Modified Barthel Index ScoreStroke is a focal or global brain functional disorder which occur more than 24 hours and originating from a disruption of cerebral blood flow which is not caused by cerebral circulatory disorders. Consequences of stroke are extremity disability, hemiplegia, or hemiparesis. Furthermore, stroke makes it difficult for patients to do activities of daily life (ADL). The aim of this study was to determine the DLA independency level of stroke patient based on the Modified of Barthel Index score and to analyze the determinants that affect patient’s dependency level. The study was conducted at PKU Muhammadiyah Yogyakarta Hospital and PKU Muhammadiyah Gamping Hospital in May to June 2016. This was a prospective longitudinal study on forty two respondents selected through accidental sampling. Barthel Index Modification instrument was used to measure the ADL independency level. Data were analyzed by multiple logistic regression. Majority of hemorrhagic stroke patients had total dependency when they were admitted to hospital (44.4%) which improved to moderate dependency when they were discharged (44.4%). Meanwhile, ischemic stroke patients were in total dependency the first time they came to hospital (44.4%) and they also improved to severe dependency at discharge (42.4%). Length of hospital stay has a significant correlation with Barthel Index score (p<0.05). None of the variables affects the Modified of Barthel Index score dominantly. Key words: Activities of daily living, modified of barthel index, stroke
APLIKASI KRIOPROTEKTAN EKSTRASELULER TUNGGAL SECARA EFEKTIF MEMPERTAHANKAN KUALITAS SPERMA MANUSIA PASCAVITRIFIKASI Widyastuti, Rini; Syamsunarno, Mas Rizky A. A.; Ghozali, Mohammad
Majalah Kedokteran Bandung Vol 50, No 4 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (176.359 KB) | DOI: 10.15395/mkb.v50n4.1319

Abstract

Pemilihan jenis krioprotektan merupakan salah satu kunci keberhasilan dalam mempertahankan motilitas dan viabilitas sperma pascavitrifikasi. Secara konvensional, vitrifikasi menggunakan konsentrasi krioprotektan dan laju kecepatan pembekuan yang tinggi untuk menghindari pembentukan kristal es intra dan ekstraseluler yang menyebabkan kerusakan dan kematian pada sel. Berdasar atas kemampuan menembus membran sel, krioprotektan dibedakan menjadi krioprotektan ekstra dan intraseluler. Sperma manusia memiliki struktur morfologi yang sangat padat dan sedikit mengandung sitoplasma sehingga perpindahan cairan selama proses vitrifkasi sangat kecil. Selain itu, sperma manusia juga mengandung beberapa jenis protein yang dapat berfungsi sebagai krioprotektan intraseluler. Berdasar atas kondisi tersebut, penggunaan krioprotektan pada vitrifkasi sperma manusia memerlukan studi lebih lanjut. Penelitian ini dilakukan di Laboratorium Sentral Universitas Padjadjaran dan dilaksanakan pada bulan Desember 2017?Januari 2018.Penelitian ini bertujuan mengetahui motilitas dan viabilitas sperma pascavitrifikasi dengan menggunakan tipe krioprotektan yang berbeda dan kombinasi keduanya. Earle?s balanced salt solution digunakan sebagai krioprotekan ekstraseluler, sementara EG 0,57% sebagai krioprotektan intraseluler. Sampel yang telah ditambahkan medium vitrifikasi diequilibrasi selama 10 menit, kemudian dikemas di dalam straw 0,25 mL dan langsung dipaparkan ke dalam nitrogen cair. Evaluasi dilakukan dengan melakukan thawing setelah 24 jam penyimpanan. Hasil menunjukkan bahwa motilitas dan viabilitas sperma tertinggi pada kelompok yang menggunakan media vitrifikasi krioprotektan ekstraseluler, walaupun secara statistik tidak berbeda nyata dengan kelompok lainnya (34%; 50%; p<0,05). Sebagai simpulan, krioprotektan ekstraseluler merupakan media vitrifikasi terbaik untuk menjaga motilitas dan viabilitas sperma pascavitrifikasiKata kunci: Krioprotektan, sperma manusia, vitrifikasi  Single Extracellular Cryoprotectant Application Effectively Maintain Post-Vitrification Human Sperm QualitySelection of cryoprotectant is one of the keys to maintain sperm motility and viability after vitrification. Conventionally, vitrification uses cryoprotectants with high concentration and cooling rate to avoid the formation of intra- and extra-cellular ice crystals that can induce cell damage and cell death. Morphology structure of human sperm is very dense and contain less cytoplasm compartment; therefore mobilization of fluid is minimum during vitrification. In addition, human sperm also contains several types of protein that function as intracellular cryoprotectants. Based on this condition, the use of cryoprotectants in human sperm vitrification needs a further study. This study was conducted at the Central Laboratory of Universitas Padjadjaran in December 2017?January 2018. The aim was to determine the motility and viability of post-vitrification sperm by using different types of cryoprotectants. Samples that had been mixed with vitrification medium were equilibrated for 10 minutes, packed in a 0.25 mL straw, and directly exposed to liquid nitrogen. The evaluation was conducted  by thawing after 24 hours of storage. The results showed that the highest sperm motility and viability was  found in the group that used extracellular cryoprotectant vitrification media although it was not statistically different ( 34%; 50%, p <0.05) In conclusion, extracellular cryoprotectants are the best vitrification medium for maintaining motility and viability of post-vitrification sperm.Key words: Cryoprotectant, sperm, vitrification  
KORELASI JUMLAH FOLIKEL ANTRAL DENGAN KADAR 25(OH)D SERUM PADA PENDERITA SINDROM OVARIUM POLIKISTIK Mustari, Asri Dini; Rostini, Tiene; Indrati, Agnes Rengga; Bayuaji, Hartanto; Rachmayati, Sylvia
Majalah Kedokteran Bandung Vol 50, No 4 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (624.066 KB) | DOI: 10.15395/mkb.v50n4.1469

Abstract

Sindrom ovarium polikistik (SOPK) ditandai oleh hiperandrogenisme, oligo atau anovulasi, dan morfologi ovarium polikistik. Penanda ovarium polikistik, yaitu terdapat ?12 folikel antral dengan diameter 2?9 mm pada pemeriksaan ultrasonografi. Vitamin D (25-hidroksivitamin D; 25(OH)D) berperan pada proses steroidogenesis di sel teka ovarium dan pengaturan ekspresi reseptor follicle stimulating hormone (FSH) di sel granulosa ovarium. Defisiensi 25(OH)D menyebabkan penurunan aktivitas FSH, sehingga folikel antral di ovarium berukuran kecil dan berjumlah banyak. Tujuan penelitian ini mengetahui korelasi jumlah folikel antral dengan kadar 25(OH)D serum pada penderita SOPK. Uji observasional analitik  dengan rancangan potong lintang di Rumah Sakit Umum Pusat Dr. Hasan Sadikin (RSHS) Bandung dilakukan selama bulan September 2017?Juni 2018. Subjek penelitian adalah 52 penderita SOPK yang telah didiagnosis oleh klinisi obstetri dan ginekologi RSHS Bandung. Pengambilan darah vena dilakukan untuk pemeriksaan kadar 25(OH)D serum dengan metode ELISA. Hasil penelitian ini mendapatkan 56% subjek memiliki kadar 25(OH)D serum ?20 ng/mL. Hasil uji korelasi Spearman didapatkan korelasi negatif kuat yang bermakna (r = -0,867, p<0,001) jumlah folikel antral dengan kadar 25(OH)D serum. Kadar 25(OH)D serum yang rendah pada penderita SOPK berkorelasi dengan jumlah folikel antral yang banyak. Terdapat korelasi negatif antara jumlah folikel antral dan kadar 25(OH)D serum pada penderita SOPK.  Kata kunci: Folikel antral, 25(OH)D serum, sindrom ovarium polikistik  Correlation between Antral Follicles Count and Serum 25(OH)D Levels in Polycystic Ovary Syndrome PatientsPolycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, oligo- or anovulation, and polycystic ovarian morphology. Vitamin D (25-hydroxyvitamin D; 25(OH)D) plays a role in the steroidogenesis process in the ovarian theca cells and regulates follicle stimulating hormone (FSH) receptor expression in granulosa cells. In 25(OH)D deficiency there is a decrease in FSH activity that the follicles become small and the antral follicles count in the ovary increases. The aim of this study was to determine the relationship between antral follicles count and serum 25(OH)D levels in PCOS patients. A cross-sectional analytical observational study was conducted in Dr. Hasan Sadikin General Hospital Bandung in September 2017?June 2018. Subjects of this study were 52 PCOS patients diagnosed by obstetricians and gynecologists of the hospital. Blood vein samples were collected to examine serum 25(OH)D levels using ELISA method. Serum 25(OH)D level of ?20 ng/mL was found in 55.8% of the subjects in this study. Analysis using Spearman?s correlation test showed a significant negative correlation (r = -0.867, p <0.001) between antral follicles count and serum 25(OH)D level in patients with PCOS. Lower levels of 25(OH)D serum in PCOS patients correlates with higher number of antral follicles count. There is a negative correlation between antral follicles count and serum 25(OH) D level in PCOS patients.Key words: Antral follicle count, 25(OH)D serum levels, polycystic ovary syndrome 
AREA UNDER THE CURVE DAN AKURASI CYSTATIN C UNTUK DIAGNOSIS ACUTE KIDNEY INJURY PADA PASIEN POLITRAUMA Maskoen, Tinni T.; Purnama, Djaya
Majalah Kedokteran Bandung Vol 50, No 4 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (405.214 KB) | DOI: 10.15395/mkb.v50n4.1342

Abstract

Pasien yang mengalami cedera dengan Injury Severity Score (ISS) >16 didefinisikan sebagai politrauma. Pada politrauma terjadi hipoksia jaringan, autoregulasi terganggu, mikrosirkulasi glomerulus, cedera sel tubular serta proses inflamasi yang apabila tidak diatasi secara adekuat dapat menyebabkan acute kidney injury (AKI). Saat ini diagnosis AKI berdasar atas kenaikan kreatinin serum yang terdeteksi setelah terjadi kerusakan ginjal. Cystatin C merupakan penanda biologis yang dapat mendeteksi AKI. Tujuan penelitian ini adalah mengetahui nilai area under the curve (AUC) dan akurasi cystatin C untuk diagnosis AKI pada pasien politrauma di Instalasi Gawat Darurat (IGD) RSUP Dr. Hasan Sadikin Bandung. Penelitian uji diagnostik ini dengan analisis data sekunder pada sebagian data penelitian Academic Leadership Grant (ALG) pasien politrauma di IGD RSUP Dr. Hasan Sadikin Bandung dari Januari?Juni 2017. Analisis data menggunakan kurva receiver operating characteristic (ROC) dengan program statistical product and service solution (SPSS)versi 24.0 for windows. Hasil penelitian dari 23 sampel menunjukkan pada cut-off point 354,97 ng/mL cystatin C plasma memiliki sensitivitas 100%, spesifisitas 88,9%, nilai duga positif 71,4%; nilai duga negatif 100%; nilai AUC 0,967; dan akurasi 91,3%. Simpulan penelitian ini adalah nilai AUC dan akurasi cystatin C memberikan hasil yang baik dalam diagnosis AKI pada pasien politrauma.Kata kunci: Acute kidney injury, akurasi, cystatin C, nilai AUC, politrauma Area Under the Curve and Cystatin C Accuracy for Acute Kidney Injury Diagnosis in Polytrauma PatientsPatients experiencing injuries with an Injury Severity Score (ISS) of >16 are defined as polytrauma patients. Polytrauma can cause hypoxia, disruption of autoregulation, glomerular microcirculation, tubular cell injury, and inflammation processes that, without adequate treatment, may lead to acute kidney injury (AKI). The current diagnosis of AKI is based on the elevated serum creatinine that can be detected after kidney damage. Cystatin C is a biomarker that can detect AKI. The aim of this study was to determine the value of area under the curve (AUC) and accuracy of cystatin C for diagnosing AKI in polytrauma patients in the Emergency Room (ER) of Dr. Hasan Sadikin Bandung. A diagnostic test study using secondary data  from theAcademic Leadership Grant (ALG) study onpolytrauma patients in the ER of Dr. Hasan Sadikin General Hospital Bandung, from January 2017?June 2017 was performed. Data was analyzed using the receiver operating characteristic (ROC) curve with statistical product and service solution (SPSS) version 24.0 for windows. Results from 23 samples showed that the cut off point of plasma cystatin C was 354.97ng/mL with a sensitivity of 100.0%, specificity of 88.9%, positive predictive value of 71.4%, negative value of 100.0%, AUC value of 0.967 and accuracy of 91.3%. Hence, the AUC values and cystatin C accuracy present  good results for diagnosing AKI in polytrauma patients.Key words: Accuracy, acute kidney injury, cystatin C, the value  of AUC, polytrauma 
Perbandingan Angka Kejadian Batuk Pascabronkoskopi pada Kelompok Premedikasi Kombinasi Kodein 10 mg dan Klorfeniramin Maleat 4 mg dengan Premedikasi Tunggal Kodein 10 mg Saputra, Maulidar; Zulfariansyah, Ardi; Rismawan, Budiana
Majalah Kedokteran Bandung Vol 50, No 4 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v50n4.1512

Abstract

Bronkoskopi merupakan tindakan esensial dalam penegakan diagnosis maupun terapetik pada saluran pernapasan. Beberapa penelitian menunjukkan kejadian batuk yang tinggi baik selama tindakan maupun setelah bronkoskopi. Saat ini belum ada konsensus tentang pemberian premedikasi yang optimal mengurangi kejadian batuk pada pasien yang menjalani bronkoskopi. Tujuan penelitian ini adalah mengetahui perbedaan efektivitas pemberian premedikasi kodein dengan kombinasi kodein-klorfeniramin maleat (CTM) dalam mengurangi batuk setelah bronkoskopi. Penelitian ini merupakan penelitian eksperimental yang dilakukan secara prospektif terhadap 52 subjek penelitian yang menjalani bronkoskopi di Rumah Sakit Paru Rotinsulu pada bulan Desember 2017–Februari 2018. Pada penelitian ini data numerik diuji dengan uji t tidak berpasangan, untuk data kategorik diuji dengan uji chi-square. Hasil penelitian ini didapatkan angka kejadian batuk pascabronkoskopi pada kelompok pasien yang diberikan premedikasi dengan kombinasi kodein 10 mg dan CTM 4 mg lebih rendah dibanding dengan kelompok yang diberikan premedikasi tunggal dengan kodein 10 mg pada semua pengukuran dengan perbedaan bermakna (p<0,05). Simpulan penelitian ini adalah pemberian premedikasi dengan kombinasi kodein 10 mg dan CTM 4 mg lebih efektif menurunkan kejadian batuk pascabronkoskopi dibanding dengan premedikasi tunggal Kodein 10 mg.Kata kunci: Batuk pascabronkoskopi, premedikasi kodein, premedikasi kodein-CTM Comparison of Postbronchoscopic Cough Incidence betweeb Patients Premedicated with 10 mg Codeine  and 4 mg Chlorpheniramine Maleate Combination and premedicated with 10 mg Codeine OnlyBronchoscopy is an essential airway procedure for diagnostic and therapeutic purposes that could cause discomfort and complications. Some studies have shown that cough complaint is often made during and after the procedure. There is no consensus that explains how to optimally premedicate a patient to reduce cough. The objective of this study was to understand the difference in the effectiveness of codeine and codeine and chlorpheniramine maleat (CTM) combination as a premedication to prevent coughing after bronchoscopy. This was a double blind, prospective experimental study in Rotinsulu Pulmonary Hospital from December 2017 to February 2018. Fifty two patients who were undergoing bronchoscopy under general anesthesia were randomly allocated to codeine group (n=26) and  Codeine-CTM Group (n=26). It was showed that the incidence of cough after bronchoscopy in the group using combination of 10 mg Codeine and 4 mg CTM premedication was lower than in the group with 10 mg Codeine premedication in all measurements. Therefore, premedication using 10 mg codeine and 4 mg CTM combination is more effective to reduce the incidence of cough after bronchoscopy when compared to the single premedication with codeine 10 mg.Key words: Postbronchoscopic cough, premedication with codeine, premedication with codeine-CTM
Paparan Pestisida terhadap Kejadian Anemia pada Petani Hortikultura Agustina, Norsita; Norfai, Norfai
Majalah Kedokteran Bandung Vol 50, No 4 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (373.188 KB) | DOI: 10.15395/mkb.v50n4.1398

Abstract

Pengaruh keracunan pestisida terhadap kadar hemoglobin menyebabkan penurunan produksi atau peningkatan penghancuran sel darah merah. Tujuan penelitian ini mengetahui dan menganalisis paparan pestisida, jenis kelamin, masa kerja, dan status gizi terhadap kejadian anemia pada petani hortikultura. Penelitian ini merupakan survei analitik dengan pendekatan cross sectional.  Jumlah sampel berjumlah 50 petani hortikultura di RT. 07. Kelurahan Landasan Ulin Utara Kota Banjarbaru pada bulan Juni-Agustus 2018. Data kadar cholinesterase dan kadar hemoglobin didapatkan melalui uji laboratorium di Laboratorium dasar Dinas Kota Banjarmasin, sedangkan data status gizi didapatkan dengan cara melakukan pengukuran menggunakan alat timbangan digital dan stature meter serta data jenis kelamin dan masa kerja didapatkan dengan wawancara menggunakan kuesioner. Hasil pengumpulan data dianalisis dengan menggunakan statistik univariate, bivariate dengan uji statistik chi square menggunakan alat bantu program komputer aplikasi statistical product and service solutions (SPSS) dengan nilai kemaknaan p=0,05. Variabel yang secara statistik terdapat hubungan bermakna dengan kejadian anemia pada petani hortikultura adalah paparan pestisida (variabel independen) dan status gizi (variabel perancu) dengan nilai p≤0,05, sedangkan variabel yang secara statistik tidak terdapat hubungan dengan kejadian anemia pada petani hortikultura adalah jenis kelamin dan masa kerja dengan nilai p>0,05. Paparan pestisida dan status gizi mempunyai kontribusi dan peranan yang sangat penting terjadi anemia pada petani hortikultura.Kata kunci: Anemia, paparan pestisida, petani hortikultura Pesticides Exposure and Anemia in Horticultural FarmersPesticide poisoning is a serious problem in agricultural communities in poor and developing countries. Pesticide poisoning on hemoglobin levels causes a decrease in production or increased destruction of red blood cells. The purpose of this study was to explore and analyze the influence of pesticide exposure, gender, working period and nutritional status on the incidence of anemia in horticultural farmers. This was a cross-sectional analytical survey on 50 horticultural farmers in Banjarbaru Landasan Ulin Utara Village RT. 07. Data on cholinesterase levels and hemoglobin levels was obtained through laboratory tests at the Banjarmasin City’s basic laboratory while the nutritional status data were obtained through measurements using digital scale and stature meter. Data on gender and working period were gained through questionnaire-based interviews. Data collected were analyzed using univariate and bivariate statistics with the chi square statistical test using the statistical product and service solutions (SPSS) with a significance value of p=0.05. Variables with statistically significant relation with the incidence of anemia in horticultural farmers were exposure to pesticides (independent variables) and nutritional status (confounding variables) with a  p-value of ≤0.05 while variables that are not statistically related to anemia in horticultural farmers are gender and working period with a p-value of >0.05. Pesticide exposure and nutritional status have a very important contribution and role in the occurrence of anemia among horticultural farmers.Key words: Anemia, exposure of pesticides, farmers of  horticulture
erbandingan Positivitas Metode MODS, Pewarnaan ZN, dan GeneXpert untuk Mendeteksi M. tuberculosis pada Pasien Meningitis TB Paramitha, Niken Ayu; Sribudiani, Yunia; Rizal, Ahmad
Majalah Kedokteran Bandung Vol 50, No 4 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (458.693 KB) | DOI: 10.15395/mkb.v50n4.1267

Abstract

Salah satu permasalahan dalam diagnosis meningitis tuberkulosis (TB) adalah rendahnya positivitas metode yang digunakan. Berbagai metode telah dikembangkan, mulai dari metode kultur MODS (microscopic observation drug susceptibility), pewarnaan Ziehl-Neelsen (ZN), hingga GeneXpert. Penelitian ini dilakukan untuk menentukan metode diagnostik terbaik mendeteksi M. tuberculosis berdasar atas nilai positivitasnya. Penelitian ini merupakan observasional analitik dengan rancangan potong lintang. Data berasal dari penelitian kohort dan ReDEFINe meningitis TB di Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung. Data diambil dari case report form pasien dengan diagnosis meningitis TB pada periode Juli 2014–Juni 2016. Kriteria inklusi penelitian ini adalah usia ≥18 tahun dan memiliki hasil pemeriksaan MODS, pewarnaan ZN, dan GeneXpert. Analisis data menggunakan Uji Cochran’s Q dan uji lanjut dengan Uji McNemar. Sebanyak 135 subjek penelitian memenuhi kriteria inklusi dan didapatkan positivitas deteksi M. tuberculosis menggunakan MODS, pewarnaan ZN, dan GeneXpert berturut-turut adalah 46,7%; 20,0%; dan 37,8%. Nilai positivitas antara ketiga metode tersebut secara statistik berbeda bermakna dengan nilai p<0,05. Sensitivitas dan spesifisitas GeneXpert dibanding dengan MODS berturut-turut mencapai 68,3% dan 88,9%, sedangkan sensitivitas pewarnaan ZN sebesar 34,9% dan spesifisitas 93.1%. Berdasar atas nilai positivitas dan sensitivitas, hasil penelitian ini menunjukkan bahwa metode MODS masih merupakan metode diagnostik terbaik untuk meningitis TB.  Kata kunci: Diagnosis, GeneXpert, meningitis tuberkulosis, MODS, pewarnaan Ziehl- Neelsen  Comparison of Positivity Rate of MODS, Ziehl-Neelsen Staining, and GeneXpert Methods in M. tuberculosis Detection among Tuberculous Meningitis PatientsOne of the problems in the diagnosis of tuberculous meningitis (TBM) is the low positivity rate of the diagnostic methods. Various methods have been developed, starting from culture MODS (microscopic observation drug susceptibility) to Ziehl-Neelsen (ZN) staining and to GeneXpert. This study was conducted to determine the best diagnostic method to detect M. tuberculosis based on its positivity rate. This cross-sectional analytic observational study was conducted on TBM cohort of the ReDEFINe study in Dr. Hasan Sadikin General Hospital. Data were collected from the case reports of TBM inpatients during the period of  July 2014–June 2016. Patients ≥18 years who had complete result from MODS, ZN staining, and GeneXpert were included. Data were analyzed using Cochran’s Q test and post-hoc analysis using McNemar test. In total, 135 subjects were included in this study. The positivity rates of M. tuberculosis  detection using MODS, ZN staining, and GeneXpert were 46.7%, 20.0%, and 37.8%, respectively. The positivity rate differences among the three diagnostic methods were statistically significant with a p-value of <0.05. The sensitivity and specificity of GeneXpert compared to those of MODS were 68.3% and 88.9%,respectively. Meanwhile the sensitivity and specificity of ZN staining were 34.9% and 93.1%, respectively. Based on the positivity rate and sensitivity, the results of this study indicates that the MODS method is still the best diagnostic method for TB meningitis.Key words: Diagnosis, GeneXpert, MODS, tuberculous meningitis, ziehl-neelsen Staining 
Perbedaan antara Faktor Intrinsik dan Ekstrinsik pada Pasien Infeksi Nosokomial di Bagian Bedah dan Medikal RSUP. Dr. Hasan Sadikin Bandung Wahyudi, Bayu; Setiawati, Elsa Puji; Shahib, Nurhalim; Wirakusumah, Firman F.
Majalah Kedokteran Bandung Vol 50, No 4 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (211.764 KB) | DOI: 10.15395/mkb.v50n4.1576

Abstract

Infeksi nosokomial merupakan satu masalah komplikasi di rumah sakit dan menjadi permasalahan penting bagi kesehatan publik di dunia. Kecenderungan pasien menderita infeksi nosokomial (HAIs) ditentukan oleh faktor intrinsik dan faktor ekstrinsik. Metode penelitian yang digunakan adalah potong lintang. Terdapat 287 pasien yang mengalami infeksi nosokomial yang disebabkan oleh Klebsiella pneumoniae di Bagian Bedah dan Medikal Rumah Sakit Dr. Hasan Sadikin Bandung (RSUP) selama periode Januari sampai Juni tahun 2015 yang telah memenuhi kriteria inklusi dan tidak termasuk eksklusi. Hasil penelitian menunjukkan perbedaan antara faktor intrinsik dan ekstrinsik pada pasien infeksi nosokomial yang disebabkan oleh klebsiella pneumoniae di bagian Bedah dan Medikal RSUP Dr. Hasan Sadikin Bandung dengan nilai p<0,05. Terdapat perbedaan kejadian resistensi terhadap karbapenem pada kasus infeksi nosokomial selain kadar Hb adalah tindakan medis untuk tindakan medis sedang mempunyai risiko 2,06 kali (IK 95%; 1,0–4,28 ), pada tindakan medis berat 3,03 kali (IK 95%; 1,21–7,61) bila dibanding dengan tindakan medis ringan. Terdapat perbedaan dengan ketidaksembuhan pada kasus infeksi nosokomial adalah kasus rawat medikal, leukosit >16.600, tindakan medis berat, dan keadaan kulit terbuka dengan OR masing masing 2,89; 2,09; 5,05; dan 1,88. Saran, untuk memberikan pelayanan yang prima dengan memperhatikan faktor intrinsik pasien baik usia, jenis kelamin, keadaan luka kulit dan status gizi, juga memperhatikan faktor ektrinsik berupa lamanya masa rawat, tempat pengambilan sampel, dan tindakan medik yang dilakukan. Kata kunci: Faktor intrinsik dan ekstrinsik, infeksi Klebsiella pneumoniae, kasus bedah dan medikal, nosokomialinfeksiDifference between Intrinsic and Extrinsic Factors of  Nosocomial Infection Patients in The Surgery and Medical Ward of Dr. Hasan Sadikin General Hospital BandungNosocomial infection or Hospital-Acquired Infection (HAI) occurs as a complication during hospitalization in hospitals and becomes an important global public health problem. The tendency of patients suffering from nosocomial infectionis determined by intrinsic and extrinsic factors. This was a cross-sectional study on 287 patients with nosocomial infection caused by Klebsiella pneumoniae at the Surgical and Medical wards of Dr. Hasan Sadikin General Hospital during the period January to June 2015 who met the inclusion and exclusion criteria. Results showed the difference in intrinsic and extrinsic factors in patients with nosocomial infections caused by Klebsiella (p<0.05). There was a difference in the resistance towards Carbanepem in nosocomial infections. Factors influencing this were Hb level and medical actions. Patients with intermediate medical procedures had 2.06 times higher risk (CI 95%; 1.0–4.28 ) while in those with complicated medical procedures, the risk was 3.03 times higher (CI 95%; 1.21–7.61) when compared to those receiving simple medical procedures. A difference was also seen in the failure to recover in nosocomial infection between the medical inpatient cases (leucocyte of >16,600), complicated medical procedure, and open-skin condition with ORs of 2.89; 2.09; 5.05; and 1.88, respectively. It is suggested to provide excelent services by paying atttention to the intrinsic factors of patients, i.e. age, gender, skin wound status, and nutrition status and the extrinsic factors, i.e. length of stay, sampling sites, and medical procedures performed.Key words: Intrinsic and extrinsic factors , Klebsiella pneumoniae infection, nosocomial infection, surgical andmedical cases
Perbandingan Hispatologi Neovascular Tuft pada Retina Tikus yang Mengalami Oxygen-Induced Retinopathy dengan dan tanpa Pemberian L-Carnitine Rustam, Raihana; Sayuti, Kemala; Hendriati, Hendriati
Majalah Kedokteran Bandung Vol 50, No 4 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v50n4.1393

Abstract

Retinopathy of prematurity (ROP) adalah salah satu penyebab kebutaan pada anak. Metode oxygen-induced retinopathy (OIR) pada tikus, menilai patogenesis dan terapi neovaskularisasi retina pada ROP. Hiperoksia retina berperan dalam patogenesis ROP dengan meningkatkan Reactive Oxygen Species (ROS). L-carnitine (LC) berpotensi melawan stres peroksidatif dengan mencegah pembentukan ROS. Tujuan penelitian ini mengetahui efek L-carnitine (LC) terhadap neovascular tuft pada retina tikus dengan oxygen induced retinopathy. Penelitian ini dilakukan dari Februari–April 2018 di Fakultas Kedokteran Universitas Andalas menggunakan 36 tikus baru lahir galur Wistar yang terbagi dalam 2 kelompok. Kelompok 1 diberi paparan oksigen 75% dan mendapat L-carnitine intraperitoneal 0,2 mg/gram/hari. Kelompok 2 hanya mendapat paparan oksigen 75%. Setelah tikus berusia 13 hari, kedua kelompok dipindahkan ke ruangan biasa dan usia 20 hari dilakukan enukleasi dan pemeriksaan histopatologi menggunakan imunohistokimia griffonia simplicifolia lectin (GSL) untuk menilai neovascular tuft. Bobot badan tikus kelompok OIR dengan LC rerata lebih berat daripada tikus OIR tanpa LC. Neovascular tuft yang dinilai adalah rerata jumlah neovascular tuft per 10-4 panjang penampang retina. Jumlah rerata neovascular tuft kelompok OIR tanpa LC sebanyak 62,98±14 dibanding dengan kelompok OIR dengan LC; 22,43±9,87 (p<0,05). Simpulan, L-carnitine berpengaruh terhadap perubahan histopatologi retina tikus dengan oxygen induced retinopathy. Kata kunci: L-carnitine, neovascular tuft, oxyge-induced retinopathy (OIR) Comparison of Retinal Neovascular Tuft Histopatological Features in Rats with Oxygen-Induced Retinopathy with and without L-Carnitine ProvisionRetinopathy of prematurity (ROP) is the leading cause of blindness in childhood. Oxygen-induced retinopathy (OIR) method in  rats can help in investigating  the  pathogcnesis and therapy for retinal neovascularization in ROP. Hyperoxia plays an important role in ROP pathogenesis with increased ROS levels. L-carnitine (LC) has protective effects on tissues through its mechanisms against peroxidative stress by preventing the formation of ROS. This study aimed to assess the effects of L-carnitine on rats with oxygen-induced retinopathy in terms of neovascular tuft formation. This study was performed in February–April 2018 at the Faculty of Medicine, Andalas University. xThirty six Wistar rat pups were randomly divided into 2 groups. Group 1 was exposed to 75% hyperoxygen and received 0,2 mg/gram/day LC intraperitoneally. Group 2 was only exposed to 75% hyperoxygen. Both groups were transferred to room air condition 13 after birth.  After postnatal day 20, enucleation was performed to investigate the retinal neovascular tuft formation. Ariffonia simplicifolia lectin immunohistochemistry (GSL) was used to assess the neovascular response. Analysis showed that the average weight of rats  in OIR group with LC was heavier than those in the group without LC. The mean ofneovascular tuft per 10-4 μm retinal section was 62.98 ± 14 neovascular tuft in OIR group without LC and 22.43 ± 9.87 neovascular tuft in OIR group with LC (p<0.05). Hence, LC has beneficial effects on the histopathological changes in oxygen-induced retinopathy in rats.. Key words: L-carnitine, neovascular tuft, OIR

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