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"Background. Metformin is the first-line oral antidiabetic agent used in the treatment of diabetes mellitus. One of the adverse reactions of the long term use of metformin is cobalamin malabsorption. Clinical and laboratory findings are important in the diagnosis of cobalamin deficiency.Objective. This study aimed to evaluate the risk of cobalamin deficiency symptoms related to long-term use of metformin in type 2 diabetes mellitus patients at Pasar Rebo General Hospital in Jakarta.Setting. This quantitative, observational study with retrospective cohort design was conducted in outpatient department Pasar Rebo General Hospital November 2015 until January 2016.Methods. 200 subjects were recruited and divided into two groups, patients who had been taking metformin for 1-3 years and patients who had been taking metformin for more than 3 years. Each patient was assessed for thepresence of cobalamin deficiency symptoms. Main outcome measure. Cobalamin deficiency symptoms evaluated were symptoms of neuropathy(measured by DN4 questionnaire) and hematologic abnormalities associated to cobalamin deficiency, i.e. macrocytic erythrocyte, hypersegmented neutrophils, and giant bands.Results. There are significant differences in the proportions of neuropathy symptoms (RR 2.36, 95%, p=0.000) and hematologic abnormalities (RR 1.5, 95%, p=0.007) between the two groups.Conclusions. Long-term use of metformin (≥3 years) may increase the risk of cobalamin deficiency symptoms in type 2 diabetes mellitus patients."

"Latar Belakang : Sindrom frailty berkaitan dengan angka morbiditas dan kematian yang lebih tinggi, sehingga dipakai sebagai prediktor kesehatan pada orang usia lanjut (usila). Polifarmasi sebagai salah satu faktor risiko sindrom frailty, dapat berkaitan dengan obat PPI yang sering diberikan pada usila, atas indikasi adanya keluhan gangguan saluran cerna bagian atas. Sampai saat ini belum ada penelitian yang mempelajari hubungan PPI jangka panjang dan sindrom frailty pada usila. Penelitian ini diharapkan dapat memberikan data mengenai penggunaan PPI jangka panjang (≥ 6 bulan) terhadap risiko sindrom frailty pada usila. Metode : Desain studi kasus kontrol dengan kriteria inklusi subjek penelitian 60 tahun ke atas dan berstatus kognitif baik. Kriteria ekslusi adalah data yg tidak lengkap atau terdapat kontraindikasi PPI. Kasus adalah usila terdiagnosis Frailty menurut FI-40 item dan kontrol adalah usila yang tidak frailty berdasarkan instrumen yang sama. Pengambilan data primer termasuk status frailty telah dilakukan bulan Maret-Juni 2013 oleh Seto E dan Sumantri S. Pengambilan data sekunder yang digunakan pada penelitian ini dilakukan pada bulan Oktober-November 2014 dari data primer tersebut, ditambah dengan data dari rekam medis poliklinik Geriatri dan poliklinik diabetes RS Cipto Mangunkusumo. Hasil : Didapatkan 225 subjek (75 kasus:150 kontrol), 59,6% berjenis kelamin perempuan (rerata usia 72,14 tahun; simpang baku ± 6,4 tathun) dan 47,1% berpendidikan tinggi. Subjek yang berpendidikan rendah, berstatus cerai mati, berstatus nutrisi lebih buruk, tidak mandiri, memerlukan caregiver, hidup tidak berkecukupan dan kondisi kesehatan yang lebih buruk lebih banyak didapatkan pada kelompok frailty dibandingkan kelompok yang tidak frail. Proporsi pengguna PPI Jangka Panjang sebesar 40,9%. Penggunaan PPI jangka panjang meningkatkan risiko sindrom frailty (Crude OR 2,15; IK 95% 1,22-3,78; p<0,007) dengan adjusted OR 1,83 (IK 1,0-3,36) terhadap variabel nutrisi dan merokok. Kesimpulan : Penggunaan PPI jangka panjang (≥ 6 bulan) secara independen meningkatkan salah satu risiko sindrom frailty pada usila.

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Background: Frailty syndrome as being used as the newest elderly health predictor, associated with higher morbidity and mortality. PPI are often used in elderly due to presence of upper gastrointestinal complaints, and related with polypharmacy as one of the risk factor for frailty syndrome. No study has studied the relationship of long term PPI and frailty syndrome in elderly. The objective of the study is to find whether long term use of PPI (≥ 6 months) would increase the risk of frailty syndrome in the elderly.

Methods: A case control study includes subjects 60 years and above with good cognitive status. All subject with history of hypersensitivity of PPI is excluded. Elderly diagnosed as frailty based in FI-40 item is defined as cases, while individuals that are not frailty are classified as the control. Primary data (included frailty status) was collected on March-June 2013 by Seto E and Sumantri S, et al. Secondary data used in the current study was gathered on October-November 2014, from the primary data above and from the medical record taken from geriatric and diabetic outpatient clinics Cipto Mangunkusumo Hospital.

Result: There were 225 subjects collected (75 cases : 150 controls), 59,6% were female (mean age 72,14 years old, SD ± 6,4 years) and 47,1% with higher education. Lower education, divorced, poor nutrition, dependent, needed caregiver, economicaly insufficient, more comorbidity and poor health condition are seen in frailty group.The proportion of long term PPI use were 40,9%. Long term PPI medication increase the risk of frailty syndrome (Crude OR 2,154; CI 95% 1,225-3,778; p<0,007) with adjusted OR 1,83 (CI 95% 1,02-3,37) after adjusting to nutrition and smoking variables.

Conclusion: Long term use of PPI significantly increase the risk of frailty syndrome compared to the non-users."

"Latar belakang. Ulkus kaki diabetes (UKD) merupakan salah satu komplikasi kronik diabetes yang muncul sebagai ulserasi kaki dan menyebabkan morbiditas serta beban finansial yang tinggi. Hal tersebut secara kumulatif menurunkan kualitas hidup pasien UKD. Isu kualitas hidup pasien UKD setelah perawatan dan faktor-faktor yang memengaruhi belum banyak diteliti.Tujuan. Studi ini bertujuan melihat skor kualitas hidup setelah enam bulan pasca perawatan pasien dengan riwayat dan faktor-faktor yang memengaruhi.Metode. Studi ini merupakan studi kohort, dengan data dasar diambil dari registri kaki DM RSCM dan data kualitas hidup didapat melalui proses wawancara. Pasien UKD dengan riwayat perawatan di RSCM dan terdata di registri kaki RSCM periode Januari 2019 - Agustus 2023, dapat diwawancarai, serta tidak memiliki UKD aktif diikutsertakan ke penelitian. Skor kualitas hidup diukur menggunakan kuesioner Diabetic foot ulcer scale-short form (DFS-SF) dan ditampilkan dalam bentuk rerata atau nilai tengah. Hubungan faktor-faktor determinan yang diteliti dengan kualitas hidup dianalisis dengan analisi bivariat, multivariat, dan lajur.Hasil. Sebanyak 131 subjek diikutsertakan dalam penelitian ini. Rerata skor kualitas hidup keseluruhan adalah 57,46. Pada analisis bivariat, lama observasi berhubungan bermakna dengan semua domain kualitas hidup kecuali waktu luang sedangkan neuropati perifer hanya berhubungan dengan domain kesehatan fisik, waktu luang, dan kualitas hidup keseluruhan. Jumlah area keterlibatan ulkus berhubungan dengan domain rasa terganggu. Analisis multivariat menunjukkan bahwa lama observasi berhubungan bermakna dengan kualitas hidup keseluruhan, kesehatan fisik, rasa khawatir, dan rasa terganggu. Neuropati perifer berhubungan dengan domain waktu luang. Analisis lajur mendapati bahwa lama observasi berhubungan langsung dengan kualitas hidup keseluruhan dan neuropati perifer berhubungan langsung sekaligus tidak langsung dengan kualitas hidup melalui derajat infeksi, lama perawatan, dan keluaran ulkus.Diskusi. Studi-studi terdahulu menemukan bahwa secara umum kualitas hidup pasien UKD ditentukan dari faktor fisik, sosioekonomi, dan psikologis. Pada studi dengan desain potong lintang yang dilakukan pada pasien dengan UKD aktif, faktor yang sering memengaruhi adalah derajat luka, kadar gula darah dan tingkat pendapatan. Faktor terkait luka tidak lagi berpengaruh terhadap kualitas hidup pasca perawatan mengindikasikan bahwa selama luka dapat ditatalaksana dengan baik dan penyembuhan luka dapat tercapai, kualitas hidup optimal juga dapat dicapai.Kesimpulan. Kualitas hidup pasca perawatan pasien UKD relatif rendah. Lama observasi dan neuropati perifer berhubungan langsung dengan kualitas hidup.

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Introduction: Diabetic foot ulcer (DFU) is one of chronic complication of diabetes that appear as foot ulceration and causing high morbidity and financial burden. These cumulatively reduce quality of life of DFU patients. The issue of quality of life (QoL) of DFU patients after hospitalization and its influencing factors has not been widely studied yet. This study aimed to evaluate predictors to long term health-related quality of life in patients with history of DFU.

Method. This study was an ambispective cohort study in which baseline data was taken from the diabetic foot registry of Cipto Mangunkusumo Hospital and QoL data were obtained through interview minimum 6 months after participants were discharged from hospital. Quality of life scores are measured using the Diabetic Foot uUcer Scale-Short Form (DFS-SF) questionnaire and were displayed in mean or median value. The association between determinant factors studied and QoL was analyzed using bivariate, multivariate and path analysis.

Results. A total of 131 subjects were included in this study. The overall mean of QoL score was 57.46. In bivariate analysis, length of observation, peripheral neuropathy, and total ulcer areas were associated with QoL. Multivariate analysis showed that length of observation was significantly related to overall QoL, physical health, worry about ulcers, and bothered by ulcers domain. Peripheral neuropathy was related to the leisure domain. Path analysis found that length of observation was directly associated with overall QoL whilst peripheral neuropathy was both directly and indirectly associated with QoL through degree of ulcer infection, length of stay, and ulcer outcome.

Conclusion. Length of observation and peripheral neuropathy are directly related to quality of life. Peripheral neuropathy is also indirectly related to quality of life through the degree of infection, length of hospitalization, and ulcer outcome."

"The authors evaluated the effect of a brief tailored smoking control intervention delivered during basic military training on tobacco use in a population of military personnel (N = 33,215). Participants were randomized to either a tobacco use intervention (smoking cessation, smokeless tobacco use cessation, or prevention depending on tobacco use history) or a health education control condition. Results indicated that smokers who received intervention were 1.16 (95% confidence interval [CI] = 1.04, 1.30) times (7-day point prevalence) and 1.23 (95% CI = 1.07, 1.41) times (continuous abstinence) more likely to be abstinent than controls from smoking cigarettes at the 1-year follow-up (p < .01); the cessation rate difference was 1.60% (31.09% vs. 29.49%) and 1.73% (15.47% vs. 13.74%) for point prevalence and continuous abstinence, respectively. Additionally, smokeless tobacco users were 1.33 (95% CI = 1.08, 1.63) times more likely than controls (p < .01) continuously abstinent at follow-up, an overall cessation rate difference of 5.44% (33.72% vs. 28.28%). The smoking prevention program had no impact on smoking initiation. These results suggest potential for large-scale tobacco control efforts."

"ABSTRAKArmed conflicts create drastic socioeconomic shocks that lead to land use and land cover changes in ways that are not yet well understood. Several studies have used satellite imagery to detect such changes during periods of conflict. However, there has been an insufficient examination of older conflicts before the 1970s. By examining older conflicts, we can examine the effects of conflict on land use and land cover over a long time span. This study reveals land use and land cover changes during the Second Indochina War (1960-75) and the wars immediate and long-term effects on land use and land cover by combining an analysis of aerial and satellite photographs with fieldwork. This study concludes that the war created an abnormal situation in which a large number of people from a different ethnic group came to live amongst the original inhabitants of the research site. This led to a unique farming landscape and vast areas of forest destruction. The study also reveals that forest destruction during the war was a significant milestone in the history of the vegetation of the research site, and the vegetative landscape has still not recovered to its prewar condition. These findings, as well as the results of previous research, suggest that we need to be more conscious of the effects of war on forest degradation in Laos."

"Summary: Overview: Now in its 6th Edition, ASSISTING IN LONG-TERM CARE is the complete learning solution for Certified Nursing Assistants! The user-friendly book delivers all required content to prepare you for the certification exam while developing career skills for long-term care and sub-acute hospital settings. Topics include professional communication, daily CNA responsibilities, residents' rights, nutrition and hydration, restorative care, resident mobility, and maintaining a safe environment - all according to federal OBRA standards for nursing home care. ASSISTING IN LONG-TERM CARE, 6th Edition also walks you through more than one hundred clinical procedures, detailing your role as a CNA in each. Available in hard copy and e-book formats, ASSISTING IN LONG-TERM CARE, 6th Edition's helpful study features include review questions and self-tests, icons that point out key material, and a robust package of interactive, supplemental learning tools."

"Latar Belakang : Pasien Penyakit Ginjal Kronik (PGK) stadium 5 memerlukan terapi pengganti ginjal seperti hemodialisis. Pemasangan akses vaskular untuk hemodialisis pada tahap awal adalah melalui catheter double lumen (CDL) vena sentral. Posisi ujung distal kateter hemodialisis jangka panjang menjadi hal yang penting untuk efisiensi dialisis jangka panjang. Penelitian mengenai pengaruh posisi ujung kateter CDL terhadap kejadian disfungsi CDL jangka panjang belum banyak dilakukan, terutama di Indonesia. Metode: Penelitian ini bersifat retrospektif kohort dan dilaksanakan di RSUP Nasional Dr. Cipto Mangunkusumo Jakarta dan RS Hermina Bekasi selama bulan September hingga November 2023. Hasil: Terdapat 36 subjek penelitian yang memenuhi kriteria. Pasien gagal ginjal tahap akhir di RSUP Cipto Mangunkusumo Jakarta dan RS Hermina Bekasi sebagian besar terdiri dari perempuan (52,8%), kelompok usia >60 tahun (33,3%), memiliki lama patensi kateter ≥3 bulan (52,8%), letak ujung kateter pada cavoatrial junction (38,9%) dan mengalami disfungsi akibat terbentuknya fibrin sheath (68,3%). Terdapat korelasi derajat sedang yang tidak signifikan secara statistik antara letak ujung kateter dengan lama patensi kateter CDL jangka panjang kurang atau lebih dari 3 bulan (p=0,202). Terdapat korelasi derajat sedang yang tidak signifikan secara statistik antara letak ujung kateter dengan penyebab terjadinya disfungsi kateter CDL yaitu fibrin sheath, trombosis, atau stenosis (p=0,209). Kesimpulan: Penelitian ini menemukan bahwa korelasi antara letak ujung kateter dengan lama patensi CDL jangka panjang atau penyebab terjadinya disfungsi kateter CDL jangka panjang tidak signifikan secara statistik.

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Background: Chronic Kidney Disease (CKD) stage 5 patients require renal replacement therapy such as hemodialysis. The initial vascular access for hemodialysis is through a central venous double lumen (CDL) catheter. The distal tip position of the long-term hemodialysis catheter is important for long-term dialysis efficiency. Research on the effect of CDL catheter tip position on the incidence of long-term CDL dysfunction has not been widely conducted, especially in Indonesia. Method: This retrospective cohort study was conducted at Dr. Cipto Mangunkusumo National Hospital Jakarta and Hermina Hospital Bekasi from September to November 2023. Results: There were 36 research subjects who met the criteria. Patients with end-stage renal failure at Cipto Mangunkusumo National Hospital Jakarta and Hermina Bekasi Hospital were mostly female (52.8%), aged >60 years (33.3%), had catheter patency ≥3 months (52.8%), catheter tip location at cavoatrial junction (38.9%) and experienced dysfunction due to fibrin sheath formation (68.3%). There was a statistically insignificant moderate correlation between the location of the catheter tip and the duration of long-term CDL catheter patency of less or more than 3 months (p=0.202). There was a statistically insignificant moderate correlation between the location of the catheter tip and the causes of CDL catheter dysfunction, namely fibrin sheath, thrombosis, or stenosis (p=0.209). Conclusion: This study found that the correlation between catheter tip location and the length of long-term CDL patency or the cause of long-term CDL catheter dysfunction was not statistically significant.

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