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"ABSTRAKLATAR BELAKANG: perawatan kandung kemih dan pencegahan retensio urin postpartum sangatlah penting, apabila tidak dikenali secara baik, maka dapat berkembang menjadi kerusakan kandung kemih yang permanen akibat distensi yang berlebihan yang mengakibatkan denervasi. Hal ini akan menyebabkan terjadinya peningkatan resiko infeksi saluran kemih dan kerusakan saluran kencing bagian atas. Tatalaksana retensio urin saat ini adalah dengan melakukan kateterisasi. Penggunaan kateterisasi sangat bervariasi pada beberapa panduan praktek klinik. Selain kateterisasi, saat ini prostaglandin telah terbukti mampu menyebabkan terjadinya kontraksi otot polos kandung kemih sehingga diharapkan dapat menjadi stimulator kontraksi kandung kemih pada pasien retensi urin pasca persalinan pervaginam. TUJUAN: menentukan efektifitas prostaglandin E1 dan kateterisasi atau kateterisasi saja sebagai terapi pilihan dan kelayakan melalui telaah kritis suatu panduan praktek klinik dalam tatalaksana retensio urin postpartum METODE: Evidence Based Case Report ini melakukan pencarian melalui PubMed, TRIP Database, EBM Online, Clinical Evidence, Cochrane Library dan Google Scholar. Dengan menggunakan strategi pencarian ini, didapatkan 4 artikel pada PubMed, 101 artikel pada TRIP Database, 991 artikel pada EBM online, 687 artikel pada Clinical Evidence, 1 artikel pada Cochrane Library, dan 12600 artikel pada Google Scholar. Dari 21 artikel didapatkan 11 artikel yang berupa panduan praktek klinik dengan keseluruhan berupa naskah lengkap yang akan dilakukan telaah kritis dengan menggunakan AGREE II. HASIL: dari 11 panduan praktek klinik yang dilakukan telaah kritis, tidak ada satu panduan praktek klinik pun yang memperoleh penilaian pada setiap domain penilaian menurut AGREE II. Penilaian pada domain yang menjabarkan proses pengembangan panduan praktek klinik dengan pencarian evidence based, terapi alternatif, dan kebebasan editorial merupakan domain dengan penilaian terendah pada keseluruhan panduan praktek klinik. SIMPULAN: dari 11 panduan praktek klinik yang dilakukan telaah kritis, disimpulkan bahwa terapi untuk retensio urin postpartum yang digunakan saat ini adalah kateterisasi. Penggunaan terapi alternatif seperti prostaglandin tidak didapatkan pada keseluruhan panduan praktek klinik. Hanya saja keseluruhan panduan praktek klinik tidak didukung oleh evidence based yang sistematis sehingga kurang layak untuk dijadikan acuan untuk terapi. Dibutuhkan pencarian evidenced based secara sistematis terutama yang menggunakan desain randomized controlled trial RCT untuk dijadikan rujukan bagi terapi retensio urin postpartum.

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ABSTRACTBladder management and prevention of postpartum urinary retetntion are very important, and a failure in recognizing these conditions may lead to permanent bladder injury caused by overdistention which in turn lead to denervation. This may increase the risk of urinary tract infections and upper urinary tract damage. Current management of urinary retention is catherization. Besides catherization, prostaglandin have been proven to be effective in stimulating smooth muscle contraction of the bladder and is a promising alternative management in stimulating bladder contraction in vaginal postpartum urinary retention patients. GOALS to review several guidelines on postpartum urinary retention management METHOD The literature search for this Evidence Based Case Report conducted article from PubMed, TRIP Database, EBM Online, Clinical Evidence, Cochrane Library and Google Scholar were used for article searching. Using this strategy, we obtained 4 articles from PubMed, 101 articles from TRIP Database, 991 articles from EBM online, 687 articles from Clinical Evidence,1 article from Cochrane Library, and 12600 articles from Google Scholar. From 21 articles we found 11 with attached guidelines on its full text, and these articles will be critically reviewedusing AGREE II. RESULTS From 11 guidelines that have been critically reviewed, not one guideline had an appropriate score in each assessment domain according to AGREE II. Guideline development using evidence based materials, alternative management and editorial freedom were the lowest scored domains in general. CONCLUSION From the 11 guidelines that have been critically reviewed, we concluded that the current management of postpartum urinary retention is catherization. Alternative managements such as prostaglandin usage are not present in current guidelines. In general, current guidelines are not supported by systematic evidence based materials, rendering them less reliable to be used as the basis for management. A systematic evidence based search, especially randomized controlled trial RCT , is needed for references of postpartum urinary retention management."

"Masalah yang dialami oleh ibu post partum salah satunya inkontinensia urin. Inkontinensia urin merupakan suatu keadaan keluarnya urin tanpa mampu di kontrol yang akhirnya menimbulkan berbagai masalah pada individu yang mengalaminya. Penelitian deskriptif ini dilakukan pada 136 wanita (17 - 45 tahun). Tujuan untuk mengetahui angka kejadian, dampak dan penanganan inkontinensia pada ibu postpartum dengan menggunakan instrumem The Questionnaire for Urinary Incontinence Diagnosis (QUID) dan Incontinence Impact Questionnaire (UUQ) untuk mengevaluasi dampak inkontinensia. Hasil penelitian menunjukkan bahwa angka kejadian inkontinensia pada ibu adalah 37,5% dengan usia antara 30 s/d 34, dimana multipara 80,4%, dimana 56,9% mengalami stress inkontinensia, 7,8% urge inkontinensia, dan 35,3% inkontinenisa campuran. sebagian besar (76,4%) tidak merasakan dampak dari masalah inkontinensia, dan sebagian besar (86,3%) masih kurang baik dalam penanganan inkontinensia. Dari hasil penelitian disimpulkan bahwa perlu peningkatan kesadaran pada ibu post partum terhadap masalah inkontinensia.

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Problems experienced by post partum one of them is urinary incontinence. Urinary incontinence is a condition of urinary discharge without being able to control. eventually cause a variety of problems in individuals who experience. This descriptive study was conducted on 136 women (17 - 45 years). The objectives of this study were to know incidence rate, impact and managing incontinence in postpartum. To evaluate urinary incontinence used The Questionnaire for Urinary Incontinence Diagnosis (QUID), and Incontinence Impact Questionnaire (IIQ) were used to evaluate the impact of incontinence. The incontinence incidence rate was 37.5% with age between 30 s / d 34, where multipara was 80.4%, of which 56.9% had incontinence stress, 7.8% urge incontinence, and 35.3% mixed incontinence. Most mothers (76.4%) did not feel the impact of the incontinence problem, and most (86.3%) were still poor in managing incontinence. From the result of the research, it is concluded that need to increase awareness on post partum mother to incontinence problem. "

"Penelitian ini dilakukan untuk menggambarkan dan mengevaluasi manajemen gejala saluran kemih bawah LUTS laki-laki sugestif dari benign prostatic hyperplasia BPH oleh dokter umum di Jakarta. Penelitian cross-sectional observasional ini dilakukan pada periode Januari 2013 hingga Agustus 2013 di Jakarta. Peneliti mengembangkan kuesioner yang terdiri dari 10 pertanyaan yang menjelaskan manajemen LUTS laki-laki sugestif BPH oleh dokter dalam praktek sehari-hari pada bulan sebelumnya. Peneliti mengumpulkan kuesioner dari 200 dokter yang berpartisipasi dalam 4 simposium urologi yang diadakan di Rumah Sakit Cipto Mangunkusumo, Jakarta. Sebagian besar dokter berusia antara 25 dan 35 tahun 71,5 dan telah bekerja selama lebih dari 1 tahun 87,5 . Satu sampai lima kasus LUTS pada pria sugestif BPH diobati oleh 81 dokter setiap bulannya. Saat diagnosis, gejala yang paling umum ditemukan adalah retensi urin 55,5 , frekuensi 48 , dan nokturia 45 . Pemeriksaan diagnostik yang lazim termasuk pemeriksaan colok dubur 65 , sistem skoring 44 , pengukuran tingkat antigen spesifik prostat PSA 23,5 , dan penilaian fungsi ginjal 20 . Kebanyakan dokter merujuk pasien pria dengan LUTS sugestif dari BPH ke dokter spesialis urologi 59,5 dan 46,5 dokter umum meresepkan obat-obatan sebagai terapi awal. Antagonis antagonis alfa-adrenergik 71,5 adalah obat yang paling umum diresepkan. Terapi kombinasi dengan antagonis -adrenergik dan inhibitor 5a-reduktase tidak rutin diresepkan 13 . Tiga puluh delapan persen dari dokter umum merujuk pasien ketika retensi urin berulang dan 33 ketika terjadi komplikasi. Penelitian ini memberikan bukti bahwa manajemen LUTS pada laki-laki sugestif BPH oleh dokter umum di Jakarta menyarankan sisitem rujukan sebagian untuk pedoman yang tersedia dalam hal metode diagnostik dan terapi awal. Namun, beberapa aspek dari pedoman, seperti pengukuran tingkat PSA, penilaian fungsi ginjal, urinalisis, pemeriksaan ultrasound, dan peresepan terapi kombinasi, masih jarang dilakukan.

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This study was performed to describe and evaluate the management of male lower urinary tract symptoms LUTS suggestive of benign prostatic hyperplasia BPH by general practitioners GPs in Jakarta. This observational cross sectional study was performed between January 2013 and August 2013 in Jakarta. We developed a questionnaire consisting of 10 questions describing the management of male LUTS suggestive of BPH by GPs in their daily practice in the previous month. We collected questionnaires from 200 GPs participating in 4 urology symposiums held in Cipto Mangunkusumo Hospital, Jakarta. Most GPs were aged between 25 and 35 years 71.5 and had worked for more than 1 year 87.5 . One to 5 cases of male LUTS suggestive of BPH were treated by 81 of GPs each month. At diagnosis, the most common symptoms found were urinary retention 55.5 , frequency 48 , and nocturia 45 . The usual diagnostic workup included digital rectal examination 65 , scoring system 44 , measurement of prostate specific antigen PSA level 23.5 , and renal function assessment 20 . Most GPs referred their male patients with LUTS suggestive of BPH to a urologist 59.5 and 46.5 of GPs prescribed drugs as an initial therapy. Alpha adrenergic antagonist monotherapy 71.5 was the most common drug prescribed. Combination therapy with adrenergic antagonists and 5 reductase inhibitors was not routinely prescribed 13 . Thirty eight percent of GPs referred their patients when recurrent urinary retention was present and 33 when complications were present. Our study provides evidence that the management of male LUTS suggestive of BPH by GPs in Jakarta suggests referral in part to available guidelines in terms of diagnostic methods and initial therapy. However, several aspects of the guidelines, such as PSA level measurement, renal function assessment, urinalysis, ultrasound examination, and prescription of combination therapies, are still infrequently performed."

"Latar belakang. Kanker kolorektal merupakan keganasan saluran cerna yang menjadi salah satu penyebab morbiditas dan mortalitas terkait kanker paling banyak di dunia. Perkembangan sel normal menjadi kanker melalui proses mutasi genetik yang membutuhkan waktu bertahun-tahun. Program skrining dapat menurunkan angka kematian namun partisipasinya masih rendah. Saat ini tersedia metode yang bersifat tidak invasif diantaranya dengan dasar pemeriksaan feses yang telah luas digunakan baik sebagai tes tunggal maupun kombinasi. Berbagai metode skrining terus dikembangkan untuk mendapatkan nilai diagnostik yang baik. Dengan mengkombinasikan mRNA CEA feses dan FIT diharapkan dapat menghasilkan metode skrining dengan sensitivitas dan spesifistas yang baik serta terjangkau. Tujuan. Mengevaluasi nilai diagnostik pemeriksaan kombinasi mRNA CEA feses dan FIT dalam mendeteksi lesi neoplastik kolorektal. Metode. Studi potong lintang dengan populasi terjangkau pasien dewasa yang diduga kanker kolorektal di Rumah Sakit Cipto Mangunkusumo pada bulan November 2015 sampai Februari 2016. Analisis uji diagnostik digunakan untuk mendapatkan nilai sensitivitas, spesifisitas, NDP, NDN, RKP dan RKN kombinasi mRNA CEA feses dan FIT dalam mendeteksi lesi neoplastik kolorektal dengan pemeriksaan histopatologi jaringan yang diambil melalui kolonoskopi sebagai baku emas. Lesi neoplastik kolorektal terdiri dari lesi prakanker/adenoma dan kanker.Hasil. Sebanyak 78 subjek penelitian dengan rerata umur 55,32±12,6 tahun, 73,1% berumur 3 50 tahun dan 53,8% berjenis kelamin pria. Keluhan klinis terbanyak berupa perdarahan nyata saluran cerna 33,3%, nyeri perut 28,2%, dan perubahan pola defekasi 24,4%. Proporsi lesi neoplastik kolorektal sebesar 30,7% terdiri dari prakanker/adenoma 12,8% dan kanker 17,9%. Sensitivitas, spesifisitas, NDP, NDN, RKP dan RKN untuk mendeteksi lesi neoplastik kolorektal berturut turut 75%, 61,11%, 46,07%, 84,66%, 1,93, 0,41; adenoma berturut-turut 50,00%, 50,00%, 12,80%, 87,20%, 1,00, 1,00; dan kanker kolorektal berturut turut 92,86%, 59,37%, 33,26%, 97,44%, 2,29, 0,12. Kesimpulan. Kombinasi mRNA CEA feses dan FIT untuk mendeteksi lesi neoplastik kolorektal di Indonesia memiliki nilai NDN tinggi tetapi sensitivitas, spesifisitas, NDP, RKP dan RKN yang rendah.

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Background. Colorectal cancer is one of the gastrointestinal tract malignancy which is one of the most common causes of cancer-related morbidity and mortality in the world. The development of normal cells into cancer through genetic mutations process that take years. Screening programs can reduce mortality rates but low participation. Currently, non-invasive methods are available including the stool based examination which has been widely used as a single test or in combination. Various screening methods continue to be developed to obtain good diagnostic value. By combining faecal CEA and FIT mRNA, it is expected to produce a screening method with good sensitivity and specificity and is affordable. Objective. We aimed to evaluate the diagnostic value of combination faecal mRNA CEA and FIT to detect neoplastic lesions of colorectal Methods. Cross-sectional study with with suspected colorectal cancer at Ciptomangunkusumo Hospital from November 2015 to February 2016. Diagnostic test analysis was used to obtain sensitivity, specificity, PPV, NPV, PLR and NLR of the combination of faecal mRNA CEA and FIT in detecting neoplastic lesions of colorectal by histopathological examination of tissues taken through colonoscopy as the gold standard. Colorectal neoplastic lesions consist of precancerous/adenoma and cancerous lesions.

Results. A total of 78 subjects with a mean age of 55.32±12.6 years, 73.1% aged older than fifty and 53.8% were male. The most clinical complaints were obvious gastrointestinal bleeding 33.3%, abdominal pain 28.2%, and changes in bowel habits 24.4%. The proportion of colorectal neoplastic lesions was 33.3% consisting of 15.4% precancer/adenoma and 17.9% cancer. Sensitivity, specificity, PPV, NPV, PLR and NLR for detecting colorectal neoplastic lesions was 75%, 61.11%, 46.07%, 84.66%, 1.93, 0.41 respectively; adenoma 50.00%, 50.00%, 12.80%, 87.20%, 1.00, 1.00 repectively; colorectal cancer 92.86%; 59.37%; 33.26%; 97.44%; 2.29; 0.12 respectively. Conclusion. The combination of faecal CEA mRNA and FIT in detecting colorectal neoplastic lesions has high NPV but low sensitivity, specificity, PPV, PLR and NLR."

"ABSTRAKLatar Belakang : Diagnosis Inflammatory Bowel Disease (IBD) masih didasarkan pada pemeriksaan invasif (endoskopi dan histopatologi). Fecal calprotectin merupakan petanda inflamasi intestinal non invasif yang dapat digunakan untuk membedakan IBD dengan penyakit intestinal non inflamasi, namun studi-studi yang ada masih memberikan perbedaan nilai diagnostik dan hubungannya dengan derajat IBD.Tujuan : Membuktikan bahwa pemeriksaan fecal calprotectin memiliki nilai diagnostik yang tinggi untuk mendiagnosis IBD serta berhubungan dengan derajat IBD. Metode : Penelitian ini adalah studi potong lintang untuk melakukan uji diagnostik. Penelitian dilakukan di beberapa rumah sakit di Jakarta mulai bulan September 2014 sampai Februari 2015. Kurva ROC dibuat untuk mendapatkan nilai diagnostik fecal calprotectin dan uji Krusskal Wallis untuk menilai perbedaan kadar fecal calprotectin menurut derajat IBD.Hasil : Terdapat 71 pasien IBD berdasarkan pemeriksaan kolonoskopi diikutkan dalam penelitian. Dari pasien tersebut didapatkan sebanyak 57 pasien ditetapkan definite IBD berdasarkan pemeriksaan histopatologi. Kadar fecal calprotectin lebih tinggi bermakna pada pasien IBD dibanding yang bukan IBD (553,8 μg/g vs 76,95 μg/g, p < 0,001). Didapatkan nilai titik potong 179,3 μg/g dengan sensitivitas 96% (IK 95% 0,88-0,99), spesifisitas 93% (IK 95% 0,69-0,99) dan Area Under Curve (AUC) 99,5% (IK 95% 0,98-1,00). Didapatkan perbedaan bermakna kadar fecal calprotectin pada masing-masing derajat IBD (p < 0,001).Kesimpulan : Pemeriksaan fecal calprotectin memiliki nilai diagnostik yang tinggi untuk mendiagnosis IBD serta berhubungan dengan derajat IBD.

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ABSTRACT

Background : Diagnosis of inflammatory bowel disease (IBD) is still based on invasive examination such as endoscopy and biopsy. Fecal calprotectin as a intestinal inflammation marker can used for diagnosis, but studies still had different diagnostic value and it?s correlation with grading of IBD.

Objective : Proving that fecal calprotectin have a high diagnostic value for IBD and correlation with grading of IBD. Methods : A cross sectional study for diagnostic of IBD. This study was conducted at several Hospitals in Jakarta from September 2014 until February 2015. A curve of ROC to determined diagnostic value of fecal calprotectin and Krusskal Wallis analysis to assessed of different value of fecal calprotectin according grade of IBD were made.

Results : Based on colonoscopy, 71 patient IBD were participated in this study. There were 57 patient diagnosis as definite IBD based on histopathology examination. Value of fecal calprotectin for IBD patient was higher than non IBD (553.8 μg/g vs 76.95 μg/g, p < 0,001). Value of fecal calprotectin was 179.3 μg/g as a new cutoff value with sensitivity 96% (CI 95% 0.88-0.99), specificity 93% (CI 95% 0.69-0.99) and Area Under Curve (AUC) 99.5% (CI 95% 0.98- 1.00) for diagnostic IBD. There was significant differences value of fecal calprotectin according every grade of IBD ( p < 0.001 ).

Conclusion : Fecal calprotectin has a high diagnostic value for IBD and correlated with grading of IBD."

"[ABSTRAKLatar Belakang : Pada kanker pankreas dapat terjadi obstruksi pada duktus pankreatikus yang menghambat transfer enzim dan bikarbonat ke duodenum yang menyebabkan aktifitas enzim tidak cukup adekuat untuk mempertahankan proses pencernaan secara normal yang disebut sebagai pancreatic exocrine insufficiency (PEI), yang dapat dideteksi dengan pemeriksaan kadar fecal elastase 1.Tujuan : Mengetahui proporsi dan derajat PEI, proporsi steatore pada kanker pankreas, perbedaan kadar fecal elastase 1 antara kanker pankreas yang resectable dan unresectable dan perbedaan rerata kadar fecal elastase 1 berdasarkan stadium kanker pankreas.Metode : Penelitian ini adalah studi potong lintang untuk menentukan perbedaan kadar fecal elastase 1 antara kanker pankreas yang resectable dan unresectable. Penelitian ini dilakukan di Rumah Sakit Cipto Mangunkusumo, beberapa rumah sakit jejaring RSCM, dan RS Wahidin Sudirohusodo Makasar dari bulan November 2014 sampai dengan Mei 2015. Uji statistik yang digunakan untuk menilai perbedaan kadar fecal elastase 1 antara kanker pankreas yang resectable dan unresectable adalah Mann Whitney dan untuk menilai perbedaan rerata kadar fecal elastase 1 berdasarkan stadium kanker pankreas adalah Kruskal Wallis.Hasil : Sebanyak 48 subyek kanker pankreas diikutkan dalam penelitian, dengan kategori resectable sebanyak 19(39,6%) subyek, dan 29(60,4%) subyek yang unresectable. Proporsi pasien kanker pankreas yang mengalami PEI sebanyak 75% (IK 95% 0,63-0,87) dan proporsi pasien kanker pankreas yang memberikan gejala steatore sebanyak 68,8% (IK 95% 0,557-0,819). Tidak ada perbedaan kadar fecal elastase 1 yang bermakna (P=0,738) antara kelompok resectable dan unresectable dengan nilai median pada kelompok resectable adalah 38,0(15-500) μg/g dan pada kelompok unresectable adalah 35,0(15-500) μg/g. Tidak ada perbedaan bermakna (p=0,767) kadar fecal elastase 1 berdasarkan stadium kanker pankreas dengan nilai median(rentang) pada stadium IB 36(15-100) μg/g, stadium IIA 62(15-500) μg/g, stadium III 15(15-500) μg/g, dan stadium IV 36(15-500) μg/g.Kesimpulan : Pada penelitian ini didapatkan proporsi PEI dan steatore yang tinggi pada kanker pankreas. Tidak ditemukan perbedaan bermakna kadar fecal elastase 1 antara kanker pankreas yang resectable dan unresectable. Tidak terdapat perbedaan rerata kadar fecal elastase 1 berdasarkan stadium kanker pankreas.

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ABSTRACTBackground : In the pancreatic cancer can occur obstruction of the pancreatic duct that inhibit the enzyme transfer and bicarbonate into the duodenum which causes the enzyme activity is not quite adequate to maintain normal digestive process referred to as pancreatic exocrine insufficiency (PEI) that can be detected by measurement of fecal elastase 1 level.Objective : Knowing the proportion and the degree of PEI, the steatore proportion in pancreatic cancer, the difference levels of fecal elastase 1 between resectable and unresectable pancreatic cancer and differences between the mean levels of fecal elastase 1 based on the stage of pancreatic cancer.Methods : A cross-sectional study to determine the difference levels of fecal elastase 1 between resectable and unresectable pancreatic cancer. This research was conducted at Cipto Mangunkusumo hospital, some satellite of Cipto Mangunkusumo hospital, and Wahidin Sudirohusodo Makasar hospital at November 2014 until May 2015. The statistical test used to assess differences in the levels of fecal elastase 1 between resectable and unresectable pancreatic cancer is Mann Whitney and to assess the differences between the mean levels of fecal elastase 1 based on staging pancreatic cancer is the Kruskal Wallis.Results : A total of 48 subjects with pancreatic cancer were participated in this study, with resectable category were 19 (39.6%) subjects, and 29 (60.4%) subjects who unresectable. The proportion of patients with pancreatic cancer that experienced PEI are 75% (CI 95% 0.63 - 0.87) and the proportion of patients with pancreatic cancer which provide steatore symptoms are 68.8% (CI 95% 0.557 - 0.819). There is no significant difference levels of fecal elastase 1 (P = 0.738) between the resectable and unresectable where the resectable group median value is 38.0 (15-500) μg / g and in unresectable group was 35.0 (15-500) μg / g. There is no significant difference (p = 0.767) levels of fecal elastase 1 based on the stage of pancreatic cancer with median (range) in stage IB 36 (15-100) pg / g, stage IIA 62 (15-500) pg / g, stage III 15 (15-500) μg / g, and stage IV 36 (15-500) μg / g.Conclusion : This study found a high proportion of PEI and steatore in pancreatic cancer. there is no significant difference fecal elastase 1 levels between the resectable and unresectable pancreatic cancer. There is no significant difference between mean levels of fecal elastase 1 based on the stage of pancreatic cancer., Background : In the pancreatic cancer can occur obstruction of the pancreatic duct that inhibit the enzyme transfer and bicarbonate into the duodenum which causes the enzyme activity is not quite adequate to maintain normal digestive process referred to as pancreatic exocrine insufficiency (PEI) that can be detected by measurement of fecal elastase 1 level.Objective : Knowing the proportion and the degree of PEI, the steatore proportion in pancreatic cancer, the difference levels of fecal elastase 1 between resectable and unresectable pancreatic cancer and differences between the mean levels of fecal elastase 1 based on the stage of pancreatic cancer.Methods : A cross-sectional study to determine the difference levels of fecal elastase 1 between resectable and unresectable pancreatic cancer. This research was conducted at Cipto Mangunkusumo hospital, some satellite of Cipto Mangunkusumo hospital, and Wahidin Sudirohusodo Makasar hospital at November 2014 until May 2015. The statistical test used to assess differences in the levels of fecal elastase 1 between resectable and unresectable pancreatic cancer is Mann Whitney and to assess the differences between the mean levels of fecal elastase 1 based on staging pancreatic cancer is the Kruskal Wallis.Results : A total of 48 subjects with pancreatic cancer were participated in this study, with resectable category were 19 (39.6%) subjects, and 29 (60.4%) subjects who unresectable. The proportion of patients with pancreatic cancer that experienced PEI are 75% (CI 95% 0.63 - 0.87) and the proportion of patients with pancreatic cancer which provide steatore symptoms are 68.8% (CI 95% 0.557 - 0.819). There is no significant difference levels of fecal elastase 1 (P = 0.738) between the resectable and unresectable where the resectable group median value is 38.0 (15-500) μg / g and in unresectable group was 35.0 (15-500) μg / g. There is no significant difference (p = 0.767) levels of fecal elastase 1 based on the stage of pancreatic cancer with median (range) in stage IB 36 (15-100) pg / g, stage IIA 62 (15-500) pg / g, stage III 15 (15-500) μg / g, and stage IV 36 (15-500) μg / g.Conclusion : This study found a high proportion of PEI and steatore in pancreatic cancer. there is no significant difference fecal elastase 1 levels between the resectable and unresectable pancreatic cancer. There is no significant difference between mean levels of fecal elastase 1 based on the stage of pancreatic cancer.]"

"UI merencanakan pembangunan IPAM dengan sumber air baku dari Danau Kenanga. Namun berdasarkan penelitian sebelumnya didapatkan konsentrasi melebihi Baku Mutu Air Kelas I pada PP No.82 Tahun 2001. Dibutuhkan identifikasi kualitas parameter mikrobiologis pada aliran yang menyuplai Danau Kenanga, yaitu sudetan Kali Baru.Penelitian ini melakukan identifikasi menggunakan pemodelan kualitas aliran menggunakan QUAL2Kw dengan 3 skenario. Hasil dari pemodelan diketahui terdapat peningkatan konsentrasi pencemar di hilir mencapai 3645 MPN/100mL untuk fecal coliform   dan  31574 MPN/100mL untuk total coliform. Pada skenario intervensi dilakukan pengukuran beban pencemar untuk setiap jenis kegiatan dan perencanaan pembangunan IPAL. Kegiatan pemukiman, ruko, stasiun, dan pasar meghasilkan beban pencemar paling signifikan. Intervensi yang digunakan berupa IPAL activated sludge untuk sumber pencemar signifikan pada segmen 1 hingga segmen 3 serta IPAL anaerobic filter dan sand filter pada segmen 4. Dengan intervensi, kualitas aliran sudetan Kali Baru mengalami peningkatan hilir atau inlet Danau Kenanga sehingga memenuhi Baku Mutu Air Kelas III. Berdasarkan hasil penelitian, pengendalian sumber pencemaran dapat meningkatkan kualitas aliran sudetan Kali Baru.

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UI has been planning the construction of WTP which uses Kenanga Lake for its raw water source. However, the previous research concluded that Kenanga's Lake inlet didn't meet the 1^st class water quality standard in PP No.82 of 2001.  It's required an identification of microbiology parameter from Kali Baru waterway diversion (WD) stream which supplies water to Kenanga Lake. The research main objective is to identify the Kali Baru WD stream quality using QUAL2Kw modelling with 3 scenarios. The modelling result indicated that there were increasing number of pollutant in the downstream, with 3645 MPN/100mL for fecal coliform and 31574 MPN/100mL for total coliform. The intervention scenario is started with measurement of pollutant load in every segment and WWTP construction planning. The settlement, shop house, train station, and market are the activites that produce the most significant loading.  Activated sludge and combination of anaerobic filter and sand filter will be used as intervention technology for significant loading from 1^st to 3^rd segment and for 4^th segment.  There were increasing quality of Kali Baru WD downstream, so the 3^rd class water quality standard achieved. Based on the research result, pollutant source management can increase the quality of Kali Baru waterway stream."

"DAS Citarum hulu termasuk ke dalam wilayah Perencanaan Sumberdaya Air Wilayah Sungai (PSDWS) sejak tahun 2016, yang berfungsi sebagai daerah tangkapan air utama dari Sungai Citarum. DAS Citarum hulu mengalami pengembangan secara pesat dan dimanfaatkan sebagai daerah pemukiman, pertanian, dan industri. Kondisi eksisting pada Sungai Citarum hulu memiliki konsentrasi fecal coliform dan total coliform yang berada dibawah baku mutu kelas II untuk fecal coliform 2000 MPN/100 ml dan total coliform 10000 MPN/100 ml. Penelitian ini bertujuan untuk mensimulasikan pencemaran bakteri fecal coliform dan total coliform di aliran sungai Citarum hulu menggunakan QUAL2Kw, mengevaluasi strategi Rencana Aksi Citarum Harum serta memberikan rekomendasi untuk mempertahankan dan meningkatkan kualitas di DAS Citarum Hulu menggunakan QUAL2Kw, dan menganalisis sensitivitas paramater permodelan pencemaran fecal coliform dan total coliform. Hasil simulasi konsentrasi fecal coliform dan total coliform belum memenuhi baku mutu sungai level II, diatas 2000 MPN/100 ml, dengan memiliki nilai eror sebesar 11802,412 fecal coliform dan 16656,663 total coliform. Hasil simulasi pada skenario Strategi Rencana Aksi Citarum Harum tidak efektif, karena hasil simulasi pada fecal coliform tidak memenuhi baku mutu dan total coliform pada segmen 1 – 10 belum memenuhi baku mutu, pada segmen 11 – 13 memenuhi baku mutu. Pada simulasi skenario II pada fecal coliform segmen 1 – 10 belum memenuhi dan pada segmen 11 – 13 memenuhi baku mutu, pada total coliform segmen 2 – 13 memenuhi baku mutu, tetapi pada segmen 1 belum memenuhi baku mutu dan sudah sangat mendekati baku mutu. Pada skenario III fecal coliform dan total coliform segmen Cirawa – Nanjung sudah berada dibawah baku mutu. Hasil dari analisis sensitivitas untuk konsentrasi fecal coliform dan total coliform, parameter sungai yang paling mempengaruhi pada Manning, Light Eff Factor pengurangan 5%, Bot Width pengurangan 5%, dan slope pengurangan 5%. Pada total coliform parameter sungai yang adalah Manning peningkatan 5% dan penurunan 5%, Bot Width pengurangan 5%, Pathogen Light Eff Factor pengurangan 5%, dan Bot Width peningkatan 5%.

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The upstream of Citarum watershed has been included in the River Basin Water Resources Planning area since 2016, which functions as the main water catchment of ​​the Citarum River. The upstream of Citarum watershed is experiencing rapid development and is used as a residential, agricultural and industrial area. Now, in the upstream of Citarum River have fecal coliform and total coliform concentrations which are below the class II based on PP No. 21 Tahun 2021, the standar number of fecal coliform are 2000 MPN/100 ml and total coliform are 10000 MPN/100 ml. This research aims to simulating fecal coliform and total coliform bacterial contamination in the upstream of Citarum river using QUAL2Kw, evaluating the Citarum Harum Action Plan strategy and providing recommendations to maintain and improve quality in the Upper Citarum watershed using QUAL2Kw, and analyze the sensitivity of the modeling parameters for fecal coliform and total coliform pollution. The simulation results of fecal coliform and total coliform concentrations not qualified based on the river quality standard level II on PP NO. 21 Tahun 2021 which is above 2000 MPN/100 ml, with an error value of 11802.412 for fecal coliform and 16656.663 for total coliform. The simulation results in the Citarum Harum Action Plan Strategy scenario are not effective, because the simulation results on fecal coliforms   not fullfil the quality standards and total coliforms in segments 1-10 also not fullfil the quality standards, but in segments 11-13 meet the quality standards. In scenario II simulation, fecal coliform segments 1-10 not fullfil the standard but in segments 11-13 the fecal coliform fullfil the standard, in total coliform segments 2-13 fullfil the quality standard, however in segment 1, it does not fullfil the quality standard but very close to the number of the quality standard. In scenario III, the fecal coliform and total coliform in the Cirawa – Nanjung segment are already below the quality standard. The results of the sensitivity analysis for the concentration of fecal coliform and total coliform, the river parameters that most influence for the results are Manning, Light Eff Factor with 5% reduction, Bot Width with 5% reduction, and slope with 5% reduction. Meanwhile, in total coliform river parameters the most influential parameters are the incretion of 5% Manning number and decretion 5% manning number, Bot Width with 5% reduction, Pathogen Light Eff Factor with 5% reduction, and Bot Width with 5% increation."