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"ABSTRACTSystemic lupus erythmatosus (SLE) is an autoimmune disease which involved many organs. One of its severe manifestations is lupus nephritis (LN). Treatment of LN consist of two phases, induction and maintenance. Inappropriate treatmen approach could increase morbidity and mortality in LN pantients. Renal flare is among many bad outcomes of LN that should be mitigated with an approciate therapuitec approach. Various guidelines stated usage of mycophenolate mofetil (MMF) or azathioprine (AZA) as an appropriate immunosuppresant in the maintenence phase"

"Latar Belakang: Tujuan studi ini adalah membandingkan terapi antara siklofosfamid dan mikofenolat mofetil pada remisi nefritis lupus melalui sebuah laporan kasus berbasis bukti (evidence-based case report) yang diperoleh dari telaah sistematis dan meta-analisis.Metode: Metode yang digunakan pada studi ini adalah laporan kasus berbasis bukti menggunakan telaah sistematis dan meta-analisis. Pertanyaan klinis adalah manakah terapi imunosupresan yang memberikan hasil lebih baik pada remisi nefritis lupus; siklofosfamid atau mikofenolat mofetil? Untuk menjawab pertanyaan tersebut, kami melakukan pencarian dari situs PubMed dengan kata kunci ?lupus nephritis AND mycophenolate mofetil AND cyclophosphamide? dengan batasan telaah sistematis dan/atau meta-analisis, bahasa Inggris, dan hanya melakukan perbandingan secara spesifik terhadap kedua obat.Hasil: Dari pencarian awal, kami memperoleh 11 artikel telaah sistematis dan/atau meta-analisis terkait terapi nefritis lupus. Satu artikel dieksklusi karena berbahasa Yahudi, empat artikel lain dieksklusi karena tidak spesifik melakukan perbandingan terhadap mikofenolat mofetil dan siklofosfamid sehingga diperoleh enam studi yang ikut serta dalam telaah kritis dan diskusi laporan kasus kami.Kesimpulan: Berdasarkan bukti-bukti ilmiah yang diperoleh, mikofenolat mofetil memberikan efektivitas yang sama (non-inferior) dengan siklofosfamid dalam mencapai remisi pada nefritis lupus, tetapi memiliki tingkat keamanan yang lebih baik daripada siklofosfamid. Pasien pada kasus mendapatkan mikofenolat mofetil dan telah menunjukkan perbaikan secara klinis ke arah remisi pada evaluasi pasca-rawat inap

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Background: The aim of this case study is to compare the effectiveness between cyclophosphamide and mycophenolate mofetil to achieve remission of lupus nephritis in an evidence-based case report from meta-analyses.

Methods: Method in this case study is evidence-based case report using meta-analyses. Clinical question used in this paper is; which immunosuppressant gives better result in achieving remission in lupus nephritis patient: cyclophosphamide or mycophenolate mofetil? To answer this question, we search the evidence from PubMed with the keywords: ?lupus nephritis AND mycophenolate mofetil AND cyclophosphamide? with inclusion criteria of meta-analysis, written in English, and focused comparing cyclophosphamide and mycophenolate mofetil.

Results: From the searching method, we found 11 articles which is relevant. One has been excluded since it written in Hebrew, 4 articles excluded since are not focus answering the clinical question. At the end, 6 studies were included to the critical appraisal step.

Conclusion: Based on the evidences, mycophenolate mofetil is non-inferior to cyclophosphamide in achieving remission in lupus nephritis patients, but with the better safety profile. Patient in our case study get mycophenolate mofetil and shows better clinical condition towards remission as she are evaluated in the outpatient clinic."

"Background. Systemic lupus erythematosus (SLE) has diverse clinical manifestations, including renal and non-renal. Renal manifestation is related to significant morbidity and mortality. SLE is also characterized by serological aberrations, including levels of complement C3, C4 and anti-dsDNA, but the association of them with clinical manifestations including renal and non-renal is unclear. This study investigated the associations of C3, C4 and anti-dsDNA levels with renal and non-renal manifestations in SLE patients.Method. A cross-sectional study was conducted in the Polyclinic of Rheumatology, Dr. Saiful Anwar Hospital Malang. A number of 43 subjects fulfilled the 1997 American College of Rheumatology criteria participated in this study, that consisted of 11 patients with renal manifestation and 32 patients with non-renal manifestations. Serum C3 and C4 levels were measured using immunoturbidimetry, and serum anti-dsDNA levels were measured using enzyme-linked immunosorbent assays (ELISA). The independent T-test was used to compare C3 levels and the Mann-Whitney U test was used to compare C4 and anti-dsDNA levels between groups.Result. SLE with renal manifestation had significant lower levels of serum C3 compare to non-renal manifestations (mean ± SD: 71.27 ± 32.65 mg/dL and 94.47 ± 26.29 mg/dL respectively, p=0.022). SLE with renal manifestation also had significantly lower levels of serum C4 compare to non-renal manifestations (mean ± SD: 14.55 ± 8.20 mg/dL and 25.50 ± 11.05 mg/dL respectively, p=0.002). Conversely, SLE with renal manifestation had significantly higher levels of serum anti-dsDNA compare to non-renal manifestations (mean ± SD: 249.27 ± 240.34 IU/mL and 109.91 ± 166.11 IU/mL respectively, p=0.014).Conclusion. SLE patients with renal manifestation have significantly lower levels of serum C3 and C4 and a higher level of serum anti-dsDNA than SLE patients with non-renal manifestations."

"Tuberous sclerosis complex (TSC) has several renal manifestations including angiomyolipomas (AML) and renal epithelial neoplasms. A bilateral giant renal AML is extremely rare. We report a case of giant bilateral AML and discuss the diagnosis and treatment of it. The 22-year-old man was admitted due to bilateral flank pain, gross hematuria, and abdominal fullness. He had history of epilepsy, mental retardation, and delayed development during childhood. He had angiofibroma on his face since 10 years ago. Abdominal CT and MRI revealed large lobulated heterogeneous mass with fatty content. Based on those findings, we diagnosed the patient with bilateral giant renal AML. We gave conservative management for the patient and planned to total nephrectomy on the left kidney if the continued bleeding occurred. AML associated with TSC occur more frequently as multiple lesions and grows to larger size than idiopathic AML. Bilateral giant AML, which is very rare, could be treated with conservative management if no significant hemorrhage occurred.

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Kompleks tuberous sklerosis memiliki beberapa manifestasi di ginjal meliputi angiomiolipoma dan neoplasma epithelial renalis. Angiomiolipoma bilateral besar sangatlah jarang dijumpai. Kami melaporkan kasus angiomiolipoma bilateral besar dan mendiskusikan diagnosis dan manajemen kasus tersebut. Laki-laki usia 22 tahun masuk ke rumah sakit karena nyeri pinggang, hematuria, dan rasa penuh di perut. Pasien memiliki riwayat epilepsy, retardasi mental, dan gangguan perkembangan saat masa kanak-kanak. Pasien didiagnosis memiliki angiofibroma pada wajah sejak 10 tahun yang lalu. CT scan dan MRI abdomen iddapatkan massa besar berlobus-lobus yang memiliki densiteas heterogen bersesuaian dengan densitas lemak. Berdasarkan penemuan tersebut, kami mendiagnosis pasien dengan angiomiolipoma bilateral besar. Dilakukan manajemen konserfatif dan direncanakan nefrektomi total pada ginjal kira apabila perdarahan sangat masif. Angiomiolipoma yang disertai kompleks tuberous sclerosis biasanya bersifat multiple dan dapat tumbuh sangat besar. Angiomiolipoma bilateral besar, yang kasusnya sangat jarang, dapat ditatalaksana dengan terapi konserfatif apabila tidak dijumpai perdarahan yang signifikan."

"Background: resistive index (RI) is highly utilised to assess the graft function using Doppler ultrasonography. The RI has been shown as the best ultrasound parameter to assess kidney allograft dysfunction. Several studies have established the role of the RI as a predictor of transplant failure. However, these studies were using RI measurement in the later stages post transplantation. The present study has conducted to identify the association between early RI measurement and early graft function represented as delayed graft function (DGF) and immediate graft function (IGF), as well as long-term graft survival. Methods: an evidence based clinical review of studies published before May 2018 was conducted from Medline, Science Direct, EMBASE and Cochrane databases. Studies on early measurement of RI whereby the primary or secondary goals of the study related to graft function and/or graft survival were included. Studies using late RI measurement and without RI value groups were excluded. The Mantzel Haenzel method was used to analyse pooled risk ratio and 95% confidence interval, while the heterogeneity of the study was calculated through I2 value. Data analysis was performed using Review Manager 5.3. Results: nine studies with a total of 1802 patients who had undergone a kidney transplant were analysed. DGF was found in 19% (193/1015) of the low RI group and in 42.8% (337/787) of the high RI group (RR 2.04 (95% CI 1.72 - 2.41), p < 0.00001, I2 = 28%). IGF was found in 39.5% (62/157) of the low RI group and in 10.5% (28/268) of the high RI group (RR 0.26 (95% CI 0.17 0.40), p < 0.00001, I2 = 0%). Long term graft survival, with follow up between 60 144 months, was found in 83% (701/845) of the low RI group and in 69.4% (395/569) of the high RI group (RR 0.82 (95% CI 0.72 0.93), p = 0.002, I2 = 63%). Conclusion: the results of this study emphasise the association between early measurement of RI and early graft function, and longterm graft survival. An elevated RI provides the chance of recognizing the patients with poor longterm prognosis, from the first moment after kidney transplant.

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Latar belakang: pemeriksaan Resistive Index (RI) sering dilakukan untuk menilai fungsi organ transplant dengan menggunakan alat Doppler ultrasonography. Hasil pemeriksaan RI merupakan parameter terbaik untuk menilai disfungsi ginjal transplant. Beberapa studi telah menunjukkan peran RI sebagai prediktor kegagalan transplantasi namun studi-studi tersebut menggunakan hasil RI yang tidak segera pasca transplantasi. Tujuan studi ini untuk mengidentifikasi hubungan antara hasil pemeriksaan RI yang dilakukan segera pasca transplantasi dengan fungsi awal ginjal transplant yang direpresentasikan oleh delayed graft function (DGF) dan immediate graft function (IGF) beserta angka kelangsungan hidup ginjal transplant dalam jangka waktu lama.

Metode:artikel yang merupakan tinjauan klinis berbasis bukti dilakukan pada penelitian yang dipublikasikan sebelum Mei 2018 menggunakan sumber dari Medline, Science Direct, EMBASE dan Cochrane. Penelitian yang mengukur hasil RI segera pasca transplantasi dimana tujuan utama atau tujuan sekundernya berkaitan dengan fungsi ginjal transplant dan/atau angka kelangsungan hidup ginjal transplant dimasukkan ke dalam studi ini. Penelitian yang mengukur hasil RI tidak segera pasca transplantasi dan tanpa kelompok tingkat RI, tidak dimasukkan ke dalam studi ini. Metode Mantzel-Haenzel digunakan untuk menganalisis pooled risk ratio dan 95% interval kepercayaan, sementara heterogenitas dianalisis melalui tingkat I2. Analisis menggunakan program Review Manager 5.3.

Hasil:analisis dilakukan pada sembilan penelitian dengan total pasien sebanyak 1802 pasca transplantasi ginjal. DGF ditemukan pada 19% (193/1015) pasien di kelompok RI rendah dan 42.8% (337/787) pasien di kelompok RI tinggi (RR 2.04 (95% IK 1.72-2.41), p < 0.00001, I2 = 28%). IGF ditemukan pada 39.5% (62/157) pasien di kelompok RI rendah dan 10.5% (28/268) pasien di kelompok RI tinggi (RR 0.26 (95% IK 0.17-0.40), p < 0.00001, I2 = 0%). Ginjal transplant yang masih berfungsi ditemukan pada 83% (701/845) pasien di grup RI rendah dan 69.4% (395/569) pasien di grup RI tinggi (RR 0.82 (95% IK 0.72-0.93), p = 0.002, I2 = 63%), dengan follow-up antara 60-144 bulan.

Kesimpulan: hasil studi ini menegaskan hubungan antara hasil pemeriksaan RI yang dilakukan segera pasca transplantasi dengan fungsi awal ginjal transplant dan kelangsungan hidup ginjal transplant dalam jangka waktu lama. Peningkatan RI memberikan peluang untuk mengenali pasien dengan prognosis jangka panjang yang buruk, bahkan disaat-saat awal pasca transplantasi ginjal"

"Penanganan perkara kartel merupakan bagian dari penegakan hukum persaingan usaha. Di Indonesia, penanganan perkara kartel yang dilakukan oleh KPPU memiliki banyak permasalahan terutama berkenaan dengan pembuktian kartel yang masih sulit dan kewenangan KPPU sebagai penegak hukum persaingan usaha. Sedangkan negara lain seperti Amerika Serikat telah melakukan penanganan perkara kartel dengan lebih baik. Untuk itu, penelitian ini akan membahas perbandingan penanganan perkara kartel di Indonesia dengan Amerika Serikat. Melalui perbandingan tersebut, penulis mengungkapkan berbagai hal dalam penanganan perkara kartel di Amerika Serikat yang dapat diaplikasikan di Indonesia antara lain penggunaan circumstantial evidence, penerapan program leniency, dan kewenangan upaya paksa oleh lembaga penegak hukum persaingan usaha.

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The handling of cartel case is part of the enforcement of competition law. In Indonesia, the handling of cartel cases which is conducted by the KPPU has several problems, especially in connection with the difficulty of proving of cartel and the authority of the KPPU as a competition law enforcement agency. Whereas, other countries such as the United States has had the handling of cartel cases better. Therefore, this research will discuss the comparison of the handling of cartel case in Indonesia and the United States. Through this comparison, the authors explain several things from the handling of cartel case in United States that can be applied in Indonesia, among others, the use of circumstantial evidence, the application of leniency programs, and the authority of competition law enforcement agencies to do forceful measures."

"ABSTRAKSurvei Demografi dan Kesehatan Indonesia (SDKI) 2007 menunjukkan angkakematian balita di Indonesia adalah sebesar 44 kematian per 1000 kelahiran hidup.Secara keseluruhan, angka kematian balita di Indonesia sudah mengalamipenurunan. Namun, bila dilihat di setiap tahun penurunannya semakin kecil.Penelitian ini merupakan penelitian kuantitatif dengan disain potong lintang dankasus kontrol yang bertujuan untuk melihat hubungan antara kemandirian ibu dankejadian kematian balita di Indonesia, dengan mengikutsertakan beberapakarakteristik responden. Hasil penelitian ini memperlihatkan bahwa ibu yangkemandiriannya kurang baik, dalam kelompok pendidikan rendah memiliki risiko7,95 kali untuk mengalami kematian balita, dalam kelompok pendidikanmenengah memiliki risiko 1,127 kali untuk mengalami kematian balita, sertadalam kelompok pendidikan tinggi memilki risiko 1,135 kali untuk mengalamikematian balita. Selain itu, beberapa karakteristik ibu, karakteristik balita,karakteristik sosial ekonomi dan lingkungan tempat tinggal, serta interaksi antarakemandirian dan pendidikan juga berhubungan dengan kematian balita. Olehkarena itu, untuk mengatasi masalah kematian balita, proporsi wanita denganpendidikan tinggi perlu ditingkatkan.

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ABSTRACTIndonesia Demographic and Health Survey (IDHS) 2007 shows that under-fivemortality in Indonesia is 44 deaths per 1000 live births. Overall, the number ofunder-five mortality in Indonesia has reduced. But, if seen in every years, thereduction is more minor. This research is the quantitative research, uses crosssectionaland case control design and wants to know the relation betweenmother’s autonomy and under-five mortality in Indonesia, including somecaracteristics. According to this research, mother who has not too good autonomy,in low education has probability 7,95 times in under-five mortality, in mediumeducation has probablity 1,127 times in under-five mortality, in high educationhas probablity 1,135 times in under-five mortality. Besides, some mother’scaracteristics, child’s caracteristics, socioeconomic and sorrounding caracteristic,and interaction of autonomy and education also related to under-five mortality.Thus, decreasing under-five mortality problem can be done by increasingproportion of woman with high education."

"Background: health workers are one of the groups affected physically as well as psychologically from the pandemic. Recent studies showed many of the health workers reported experiencing anxiety, depression, and insomnia. This study aims to identify psychotherapy as a psychological health intervention, for healthcare workers during the COVID-19 pandemic. Methods: an evidence based clinical review of psychotherapy as a psychological health intervention, reported in the literature, which is developed for healthcare workers during the COVID-19 pandemic. The review was conducted following set out for Evidence-based clinical review by searching the following digital libraries: PubMed, ProQuest, Cochrane, and Google Scholar. Results: six publications were selected. The identified psychotherapy used as a mental or psychological intervention for healthcare workers during COVID-19 consists of supportive psychotherapy, psychoeducation, social support, and music therapy. Overall, it shows that psychotherapy, especially supportive psychotherapy, can reduce anxiety, depression, and insomnia. Conclusion: the physiological condition of health workers needs to get attention during the COVID-19 pandemic. Although there is no standard of therapy yet, psychotherapy could be an option as it is proven to be able to reduce anxiety, depression, and insomnia."

"This paper aims to: (1) specify factors mediating the effects of consumer animosity towards theconsumers’ willingness to purchase imported products; (2) specify factors mediating the effects of allocentrismtowards consumers’ purchasing willingness on imported product; and (3) examine whetherproduct quality comparison between domestic vis-à-vis imported products moderates the relationshipsbetween: (a) consumer animosity and consumers’ willingness to purchase (b)ethnocentrism andconsumers’ willingness to purchase. A survey was conducted to 209 respondents that have boughtMalaysian products in the past three months and lived in Jabodetabek (Jakarta, Bogor, Depok, andBekasi) area. The result shows that ethnocentrism mediated the relationship between animosity andconsumers’ willingness to purchase; while it does not work as a mediator in the relationship betweenallocentrism and consumers’ willingness to purchase. In addition, product quality comparison doesnot moderate the relationship between animosity and consumers’ willingness to purchase as well asethnocentrism and consumers’ willingness to purchase. Interpretations, contributions, and implicationsfor manager are also discussed.Studi yang bersifat eksplorasi ini fokus pada persepsi dokter terhadap produk farmasi domestikdan multinasional . Dokter dapat mempengaruhi keputusan pembelian obat dengan menjalankanperan sebagai pengguna ( user ), pemberi pengaruh (influencer) , penjaga arus informasi (gatekeeper)dan pembuat keputusan (deciders), sedangkan pasien melakukan peran sebagai pembeli (buyer) danpengguna (user). Perbedaan persepsi diukur dalam hal produk, citra merek dan harga. Data dikumpulkandari sampel 15 dokter (n = 15) dengan menggunakan kuesioner yang terdiri dari 12 pertanyaanyang diukur dalam skala Likert . Penelitian ini mengungkapkan bahwa citra merek merupakan faktoryang paling mempengaruhi harga obat-obatan dan citra merek sangat berkaitan dengan kualitas dantingkat promosi untuk produk yang mendasarinya. Selain itu, dokter menganggap produk multinasionalberbeda dan lebih baik dari produk dalam negeri karena citra merek yang lebih kuat . Penelitianini juga memberikan kesimpulan bahwa preferensi dokter tidak sepenuhnya bebas bias dan dapat dipengaruhioleh perusahaan obat-obatan. Karena penelitian ini merupakan penelitian eksplorasi, makatemuan penelitian ini perlu divalidasi dalam studi lanjutan dengan sampel yang lebih besar."