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"Latar belakang: Strategi terapi sarkoma jaringan lunak (SJL) ekstremitas cukup menantang. Hal ini karena diagnosis sering terlambat dan gambaran klinisnya yang tidak spesifik sehingga hampir 50% pasien yang baru didiagnosis mengalami kematian. Berbagai modalitas terapi digunakan untuk meningkatkan angka kesintasan pasien sarkoma jaringan lunak ekstremitas. Namun faktor klinikopatologis dapat memengaruhinya angka kesintasan sehingga memengaruhi efektivitas terapi. Penelitian ini bertujuan mengetahui angka dan faktor-faktor yang memengaruh kesintasan hidup (overall survival) lima tahun pascaterapi pasien sarkoma jaringan lunak ekstremitas di RSCM tahun 2011-2015. Metode: Sebanyak 42 pasien sarkoma jaringan lunak ekstremitas ditegakkan dengan histopatologis dan menjalani terapi di RSCM tahun 2011-2015 menjadi subjek dalam penelitian ini. Analisis data dilakukan dengan metode Kapplan Meier, uji Cox Regression, dan Cox Regression with Time Dependent Variable Hasil penelitian: Median kesintasan hidup pascaterapi pasien sebesar 6 tahun ( 3 bulan - 8,25 tahun) dengan persentase kesintasan hidup lima tahun sebesar 52,4%. Faktor yang berpengaruh terhadap kesintasan hidup lima tahun pascaterapi pasien SJL adalah tindakan pembedahan berupa limb saving surgery (HR 0,852 IK95% 0,68 - 1,07, p =0,163). Kesimpulan: Kesintasan hidup lima tahun pada pasien sarkoma jaringan lunak ekstremitas adalah sebesar 52,4%, Kesintasan hidup dipengaruhi oleh derajat SJL tinggi, terapi tidak lengkap, dan stadium klinis metastasis. Kata kunci: kesintasan, sarkoma jaringan lunak ekstremitas.

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Background: The strategy for treating limb soft tissue sarcoma (SJL) is quite challenging. This is because the diagnosis is often delayed and the clinical picture is non-specific so that almost 50% of newly diagnosed patients die. Various therapeutic modalities are used to increase the survival rate of patients with extremity soft tissue sarcoma. However, clinicopathological factors can influence the survival rate and thus affect the effectiveness of therapy. This study aims to determine the numbers and factors that influence overall survival five years after therapy for patients with soft tissue sarcoma of the extremities at RSCM in 2011-2015.

Methods: A total of 42 patients with soft tissue sarcoma of the extremities were histopathologically established and underwent therapy at the RSCM in 2011-2015 as subjects in this study. Data analysis was carried out using the Kapplan Meier method, Cox Regression test, and Cox Regression with Time Dependent Variable.

Results: The median survival after therapy for patients was 6 years (3 months - 8.25 years) with a five-year survival percentage of 52.4%. Factors that affect five-year survival after SJL patients are surgical procedures in the form of limb saving surgery (HR 0.852 95% CI 0.68 - 1.07, p = 0.163).

Conclusion: The five-year survival rate for patients with soft tissue sarcomas of the extremities was 52.4%. Overal survival is affected by higher sarcoma grade, incomplete therapy, and worse clinical stage.

Keywords: survival, extremity soft tissue sarcoma."

"Latar belakang: Sinoviosarkoma adalah tumor agresif dan memiliki dua tipe histologi yang sering dijumpai yaitu bifasik dan monofasik. Tumor ini mengalami fusi gen SYT-SSX yang berefek menurunkan ekspresi supresor tumor p53. Prognosisnya berhubungan dengan mitosis dan diameter tumor. Penelitian ini bertujuan mempelajari bagaimana ekspresi p53 dan hubungannya dengan mitosis, diameter tumor, tipe histologi maupun faktor lainnya terkait prognosis sinoviosarkoma.Metode: Dua puluh kasus sinoviosarkoma yang terdiri 4 monofasik dan 16 bifasik di FKUI-RSCM tahun 2005-2011dianalisis kaitan ekspresi p53 dengan mitosis sebagai faktor prognostik. Sediaan hematoksilin-eosin digunakan untuk menghitung mitosis. Sediaan blok parafin digunakan untuk menganalisis ekspresi p53 melalui imunohistokimia dan untuk mengetahui translokasi gen SYT melalui FISH (Fluorescein in situ Hybridization).Hasil: Uji Fisher?s exact menunjukkan ekspresi positif p53 berhubungan dengan diameter tumor <5 cm meskipun tidak berhubungan dengan jumlah mitosis. Tipe histologi sinoviosarkoma tidak berhubungan dengan ekspresi p53 maupun mitosis. Melalui FISH diperoleh hanya 7/19 kasus mengalami translokasi gen SYT.Kesimpulan: Pada sinoviosarkoma ekspresi p53 berhubungan dengan ukuran tumor.

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It has SYT-SSX gene fusion that decreases expression of p53 tumor suppressor. The prognosis is associated with mitosis and tumor diameter. Therefore this study conducted to know the pattern of p53 expresion and its association with mitosis, histological subtype, and other prognosis factors.

Methods: Twenty synovial sarcoma cases consisted of 4 monophasic and 16 biphasic cases from Cipto Mangunkusumo Hospital ? Faculty of Medicine, Universitas Indonesia (CMHospital-FMUI) 2005-2011 were analyzed for association of p53 expression and mitosis as prognostic factor. Haematoxylin-eosin slides were used to count mitosis. Paraffin block materials were used to analyze p53 expression by immunohistochemistry and to detect SYT gene translocation by FISH (Fluorescein in situ Hybridization).

Results: The Fisher?s exact test showed that positive p53 expression was associated with tumor diameter <5 cm although it was not associated with mitosis. The histological subtype has no association with p53 expression and mitosis. Unfortunately, only 7/19 cases were positive for FISH-SYT gene translocation.

Conclusion: In synovial sarcoma, p53 expression is associated with tumor diameter."

"Kami laporkan satu kasus sarcoma Ewing pada ibu jari kaki kiri dengan trans-artikular skip-lesion pada diafisis tulang tibia kiri. Dalam periode 1995-2004 di rumah Sakit Ciptomangunkusumo, telah didiagnosis 20 kasus sarcoma Ewing, namun hanya terdapat satu kasus dengan skip-lesion. Diagnosis transarikular skip lesion pada sarcoma Ewing dikonfirmasi dalam forum clinicopathological conferrence. Riwayat penyakit, pemeriksaan fisik yang cermat dan pemeriksaan laboratorium darah serta foto ronsen toraks dan tulang yang terlibat disertakan dalam evaluasi rutin pasien dengan tumor tulang. Payaran tulang seluruh tubuh dengan menggunakan Tc 99 diperlukan untuk menentukan staging. Pada pasien ini, telah dilakukan amputasi ibu jari kaki kiri dan biopsy terbuka diafisis tibia untuk mengkonfirmasi diagnosis. Setelah itu, pasien menjalani kemoterapi induksi dan kemudian dilakukan amputasi diatas lutut. Pasien meninggal dunia 10 bulan setelah diagnosis ditegakkan akibat metastasis jauh.

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We report the case of the patient who had Ewing Sarcoma in whom radiological and hystopathological appearances revealed a tumor mass in the left big toe along with trans-artikular skip lesion on the left diaphysis of tibia. In Cipto Mangunkusomo Hospital since 1995 until 2004 we have found 20 Ewing sarcoma cases, but only one skip lesion Ewing sarcoma was found. The diagnosis of transarticular skip lesion in association of Ewing sarcoma was confirmed in clinicopathological conferrence. The initial evaluation of all patients included the recording of the medical history, physical examination, and hematological studies. Radiographs of the chest and the site of the primary tumor were made routinely. Systemic staging was performed with use of total-body bone scan. Ray amputation of left big toe and open biopsy from mass of mid-shaft of tibia had been done to confirm the diagnosis. The patient underwent induction chemotherapy and above knee amputation. Ten months after diagnosis, he died because of advanced-distant metastasis."

"Latar Belakang: Soft tissue sarcoma menjadi salah satu penyebab kematian karena angka kelangsungan hidup yang rendah. Tatalaksana utamanya merupakan pembedahan, dengan margin reseksi yang seringkali ditentukan sesuai opini atau pengalaman ahli bedah yang bersangkutan. Belum ada pedoman yang jelas dalam penggunaan surgical margin. Oleh karena itu, disusun telaah sistematis untuk menguraikan perbedaan luaran terhadap margin reseksi sehingga dapat diketahui manakah yang memberikan hasil terbaik untuk dijadikan pedoman tatalaksana di Indonesia. Metode: Penelitian merupakaan telaah sistematis yang menelaah studi tentang pengaruh dari surgical margin terhadap rekurensi lokal dan kesintasan pasien dengan soft tissue sarcoma. Hasil: Hasil yang didapatkan adalah pada analisis univariat, didapatkan pembedahan dengan margin reseksi R0 memberikan angka rekurensi lokal yang lebih rendah dan kesintasan yang lebih tinggi daripada R1 secara independen. Hasil analisis multivariat menunjukkan bahwa kemungkinan kelompok pasien dengan margin reseksi R1 mengalami rekurensi lokal dan kematian lebih besar daripada R0. Kesimpulan: Margin reseksi R0 dari klasifikasi R+1 UICC memberikan luaran yang lebih baik dari R1.

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Background: Soft tissue sarcoma is one of the common causes of death due to the relatively low survival rate, especially among adults. Surgery is the main treatment, whereas the surgical margin is often decided based on the opinions or experience of the surgeons. Therefore, we reviewed studies to learn more about the outcome of surgical margin to know of which giving the best and can be adopted as the guideline for management in Indonesia. Methods: This is a systematic review which reviewed studies about the influence of surgical margin towards local reccurence and survival in STS patients. Results: Based on univariate analysis, surgical margin R0 shows lower local reccurence rate and higher survival rate rather than R1. Based on multivariate analysis, patients R1 group is more likely to experience local recurrence and death. Conclusion: Surgical margin R0 based on R+1 classification UICC shows better outcomes than R1"

"Latar Belakang : Sarkoma sinovial adalah sarkoma jaringan lunak derajat tinggi. Modalitas terapi yang ada saat ini belum cukup memuaskan sehingga mendorong perlunya modalitas terapi baru, yaitu imunoterapi yang menargetkan NY-ESO-1 yang diekspresikan oleh sel tumor. Dalam penelitian, perbedaan ekspresi imunohistokimia NY-ESO-1 pada sarkoma sinovial dan diagnosis bandingnya yaitu malignant peripheral nerve sheath tumor (MPNST) dan dermatofibrosarcoma protuberans (DFSP) akan diteliti.Bahan dan Cara Kerja : Penelitian analitik potong lintang dilakukan terhadap 28 kasus sarkoma sinovial, 10 kasus MPNST dan 17 kasus DFSP yang berasal dari Departemen Patologi Anatomik FKUI/RSCM selama Januari 2013 sampai Juni 2019. Dilakukan pulasan NY-ESO-1 pada ketiga kelompok dan dikategorikan sebagai positif apabila terpulas pada lebih dari 50% sel tumor dengan intensitas positif sedang sampai kuat.Hasil : Ditemukan perbedaan bermakna ekspresi NY-ESO-1 pada kelompok sarkoma sinovial (18/28), MPNST (2/10) dan DFSP (1/17) (p<0,001). Pada analisis lebih lanjut sarkoma sinovial memiliki ekspresi NY-ESO-1 lebih tinggi secara signifikan terhadap MPNST (OR 7,2; p = 0,016; power  68,7%) dan terhadap DFSP (OR 28.8; p<0,001; power 98,9%).Kesimpulan : Sarkoma sinovial yang mengekspresikan NY-ESO-1 berpotensi untuk mendapat pemberian imunoterapi. Terdapat perbedaan ekspresi imunohistokimia NY-ESO-1 pada sarkoma sinovial terhadap MPNST dan DFSP.

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Background : Synovial sarcoma is a rare high grade soft tissue sarcoma. Nowdays, the available therapeutic modalities has not given a satisfactory result yet. Currently, there is a promising therapeutic strategy through immunotherapy targeting NY-ESO-1 which is expressed on tumor. The aim of this study was comparing NY-ESO-1 immunoexpression between synovial sarcoma and its histologic mimics i.e. malignant peripheral nerve sheath tumor (MPNST) and dermatofibrosarcoma protuberans (DFSP)Material and Methode : A cross sectional study was done in 28 cases of synovial sarcoma, 10 cases of MPNST and 17 cases of DFSP from archieval material in Department Anatomical Pathology, FMUI/RSCM from January 2013 to June 2019. Immunohistohemical stainning was performed using an antibody NY-ESO-1 and it was described positive if it was expressed in more than 50% of tumor with moderate to strong positive intensity.Results : There is a significant difference p<0,001) in NY-ESO-1 immunoexpression among synovial sarcoma (18/28), MPNST (2/10) and DFSP (1/17). Furthermore, synovial sarcoma showed a significantly higher immunoexpression compared to MPNST (OR 7,2; p = 0,016; power 68,7%) and DFSP (OR 28,8; p<0,001; power 98,9%).Conclusion : Synovial sarcoma showed a higher expression of NY-ESO-1 thus makes it as a good candidates for immunotherapy. There are differences in the expression of NY-ESO-1 in synovial sarcoma against MPNST and DFSP."

"Penelitian ini bertujuan untuk meneliti pengaruh modifikasi standar diet diabetes melitus terhadap penurunan sisa makanan lunak pasien diabetes melitus. Sisa makanan diukur dengan metode food weighing, sedangkan karakteristik dan penilaian pasien terhadap kualitas makanan RS diukur dengan wawancara dan pengisian kuesioner. Desain studi yang digunakan adalah eksperimental kuasi serial waktu. Sebanyak 12 orang pasien diabetes melitus yang dirawat di kelas III Gedung A RSCM diamati sisa makanan, selera makan, dan penilaiannya terhadap kualitas makanan RS selama tiga hari. Pada hari pertama pasien diberikan makanan sesuai standar diet diabetes melitus RSCM. Pada hari kedua hingga ketiga pasien diberikan intervensi berupa makanan sesuai standar diet diabetes melitus RSCM modifikasi untuk makanan lunak, kemudian sisa makanan pasien hari pertama dan rata-rata hari kedua dan ketiga akan dibandingkan. Hasil menunjukkan bahwa sisa makanan pasien sesudah intervensi mengalami penurunan yang signifikan (p=0,001). Rata-rata total berat sisa makanan lunak sesudah intervensi (571+381,6 gr) 31,9% lebih sedikit dibanding saat sebelum intervensi (839+471 gr). Usia dan lama masa rawat inap diketahui menjadi variabel perancu dalam intervensi. Penerapan standar diet diabetes melitus modifikasi untuk makanan lunak ini dapat dijadikan alternatif untuk meminimalisasi kejadian sisa makanan pada pasien. Selain itu, diharapkan ahli gizi dapat mengoptimalikan edukasi kepada pasien terutama pasien lansia dan/atau yang baru masuk rumah sakit agar lebih termotivasi untuk menghabiskan makanan yang diberikan RS.

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The objective of this study was to examine the effect of diabetes mellitus diet standard modification on diabetic patients decreased plate waste on soft food. Patients plate waste measured by food weighing method. Moreover, patients characteristics, appetite, and evaluation towards the quality of hospital food measured by interview and questionnaire. A time series quasi experimental study was conducted on twelve subjects in third class wards on RSCM A building. Subjects plate waste, appetite, and evaluation towards the quality of hospital food were observed for three days. On the 1st day, patients were given foods based on RSCM?s diabetes mellitus diet standard. After that, intervention were given to patients; food based on RSCM?s diabetes mellitus diet standard modified for soft food on the 2nd up to 3rd day. The plate waste before and after intervention were compared afterwards.

The results showed that patients plate waste after intervention were significantly less than those before intervention (p=0,001). The overall mean plate waste after intervention (571+381,6 gr) was 31,9% lower than before intervention (839+471 gr). Age and length of stay are shown as a confounding variables in the intervention. The implementation of diabetes mellitus diet standard modified for soft food can be an alternative to minimze plate waste on diabetic patients with soft food diet. In addition, dietitian should optimalize the education for the patients especially older and/or newly hospitalized patients, so that they can be more motivated in finishing the food given."

"Spesialis keperawatan medikal bedah(KMB)khususnya neurologi membentuk nersspesialis neurosains yang berperan dalam praktik residensi selama 2 semester di RSUP dr. Cipto Mangunkusumo dan RSP Otak Nasional untuk memberikan asuhan keperawatan lanjutan, melakukan Evidence Based Nursing dan penerapan inovasi. Asuhan keperawatan yang dilakukan pada satu kasus utama ensefalitis autoimundan 30 pasien resume dengan gangguan neurologis menggunakan pendekatan Model adaptasi Sister Callista Roy. Ensefalitis autoimun merupakan salah satu kasus emergensi neurologi yang memerlukan penata laksanaan cepat dan tepat agar gejala sisa yang ditimbulkan menjadi adaptif. Diagnosa keperawatan pada kasus resume yang terbanyak adalah ketidak efektifan perfusi jaringan serebral. Selanjutnya Evidence Based Nursing dilakukan dengan menerapkan sleep hygiene yang menunjukkan adanya peningkatan kualitas tidur yang signifikan pada 5 pasien stroke dengan insomnia(p value 0,00). Kompetensi ners spesialis yang harus dicapai secara berkelompok adalah penerapan inovasi berupa tata laksana perawatan stroke terkini dengan Constraint Induced Movement Therapy (CIAT), Tongue stretching exercises(TSE), Constraint Induced Movement Therapy (CIMT),sit to stand training(STS),mirror therapy(MT)dan sleep hygiene(SH) sebagai aktivitas intervensi terbaru dengan masalah gangguan bicara dan bahasa, kesulitan menelan, gangguan mobilisasi,dan gangguan tidur yang diaplikasikan dapat membantu untuk mencegah terjadinya komplikasi dan membantu proses penyembuhan.

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Surgical medical nursing specialists (KMB) especially neurology,form neuroscience specialists who play a role in the practice of KMB residency for 2 semesters at RSUP dr. Cipto Mangunkusumo and RSP National Brain to provide advanced nursing care, conduct Evidence Based Nursing and apply innovation. Nursing processwas performed in one major case of autoimmune encephalitis and 30 patients resumed with neurological disorders using the Sister Callista Roy model adaptation approach. Autoimmune encephalitis is one of the cases of neurological emergencies that requires prompt and precise management, than complication becomes adaptive. The nursing diagnosis in most resume cases is the ineffectiveness of cerebral tissue perfusion. Furthermore Evidence Based Nursing was carried out by applying sleep hygiene which showed a significant improvement in sleep quality in 5 stroke patients with insomnia (p value 0.00). Special nurses competencies that must be achieved in groups are the application of innovations in the form of the latest stroke care management with Constraint Induced Movement Therapy (CIAT), Tongue stretching exercises (TSE), Constraint Induced Movement Therapy (CIMT), sit to stand training (STS), mirrors therapy (MT)and sleep hygiene(SH) as the newest intervention activities with speech and language problems, difficultyswallowing, impaired mobilization, and insomniacan help to prevent complications and help the healing process."

"ABSTRAK Latar belakangKematian akibat sepsis dan syok septik pada pasien rawatan Intensive Care Unit (ICU) yaitu 20-30%. Pemberian antibiotik empirik yang tepat merupakan salah satu langkah awal yang sangat penting. Amikasin merupakan salah satu antibiotik terpilih untuk tata laksana sepsis di ICU RSUPN dr. Cipto Mangunkusumo (RSCM). Saat ini belum pernah dilakukan penelitian mengenai ketercapaian kadar terapi amikasin dengan menggunakan dosis standar amikasin pada pasien sepsis dewasa di ICU RSCM, sehingga studi ini menjadi penelitian pertama di Indonesia.Penelitian ini bertujuan untuk mengetahui ketercapaian kadar amikasin optimal pada pasien ICU RSCM.MetodeData dikumpulkan secara potong lintang melalui observasi terhadap hasil pemeriksaan kadar plasma amikasin, pengukuran minimum inhibitory concentration (MIC) dan perhitungan rasio Cmax/MIC pada pasien sepsis di ICU RSCM periode Mei-September tahun 2015.Hasil penelitianProporsi pasien sepsis dengan kadar amikasin optimal ialah sebesar 57% (4/7). Kadar puncak amikasin yang dapat dicapai dengan dosis 1000 mg sekali sehari tanpa menghiraukan berat badan ialah median 86,4 (43,5-238) µg/mL. Pada penelitian ini ditemukan 87% pasien dengan kadar puncak amikasin di atas 64 µg/mL, meskipun amikasin 1000 mg tersebut lebih rendah dari dosis yang dianjurkan untuk sepsis (25 mg/kgBB). Sebagian besar (78,3 %) subyek pada kenyataannya menerima dosis 15-25 mg/kgBB, dengan pemberian 1000 mg amikasin tanpa memperhatikan berat badan. Bakteri yang banyak ditemukan dari hasil kultur pasien sepsis di ICU RSCM, yaitu K. pneumoniae, A. baumanii, P. aeruginosa dan E. coli. Rentang nilai MIC untuk patogen tersebut berturut-turut yaitu 0,75 - >256 µg/mL, 0,75 - >256 µg/mL, 1,5 - >256 µg/mL dan 0,75 - 16) µg/mL. Sebanyak 84% isolat K. pneumoniae masih sensitif terhadap amikasin, diikuti oleh 63% untuk A. baumanii, 47% P. aeruginosa dan 100% untuk E. coli.KesimpulanOptimalitas amikasin terhadap bakteri Gram negatif penyebab sepsis bergantung kadar puncak dan MIC bakteri. Kadar puncak plasma amikasin yang dicapai dengan dosis 1000 mg sekali sehari sangat bervariasi. Pemberian amikasin dengan dosis per kgBB dapat dipertimbangkan. Kepekaan beberapa bakteri Gram negatif terhadap amikasin mulai menurun dengan rentang MIC yang cukup lebar. Pengukuran ketercapaian kadar optimal dalam terapi definitif dapat dilakukan untuk meningkatkan keberhasilan terapi.ABSTRACT BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment.;BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment.;BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment."

"Insiden disfungsi seksual pada pria diabetes sangat banyak dan sampai saat ini belum pernah dilakukan eksplorasi mendalam tentang pengalaman mereka. Penelitian ini bertujuan memperoleh gambaran pengalaman disfungsi seksual pada klien pria diabetes di RSUPN Dr. Cipto Mangunkusumo Jakarta dengan metode penelitian kualitatif dan pendekatan fenomenologi. Dilakukan wawancara mendalam kepada 7 partisipan. Temuan memberikan informasi rinci tentang pengalaman pria diabetes menghadapi disfungsi seksual dengan 11 tema utama, diantaranya gambaran disfungsi seksual, dampak, respon support sistem dan kebutuhan pelayanan kesehatan.Disimpulkan bahwa disfungsi seksual terjadi < 5 tahun semenjak terdiagnosa diabetes mellitus yang berdampak pada diri; pasangan dan sosial, klien berupaya mencari cara penyelesaian sesuai persepsinya dan mengharapkan dukungan keluarga, tenaga dan pelayanan kesehatan untuk memperbaiki fungsi seksual mereka.

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The incidence of sexual dysfunction on diabetic men clients is prodigious and until now has not been done in-depth exploration of their experiences. The research purpose is to identify the description of sexual dysfunction experiences oin diabetic men at RSUPN Dr. Cipto Mangunkusumo Jakarta, using qualitative research methods and phenomenology approach. In-depth interviews were conducted with 7 participans. The findings provide detailed information on diabetic men sexual dysfunction experiences, 11 themes were derived, including sexual dysfunction experiences overview and it's impact, the responses of support system and health care needs.Concluded that sexual dysfunction was occured < 5 years since diagnosed of diabetes mellitus. It is to be an effect to them self, social and couple relationship. Clients was seeking the problem solving by their perception with all the hope and support from family (couple), health professionals and health services to improve their sexual function."

"ABSTRAKTatalaksana kanker di suatu rumah sakit tidak dapat berjalan baik tanpa tersedianya data kanker yang baik. Registrasi kanker berbasis rumah sakit di RSUPN Cipto Mangunkusumo mulai diimplemetasikan kembali sejak ditanda tanganinya surat keputusan bersama terkait onkologi center oleh Direktur RSUPN Cipto Mangunkusumo dengan Dekan Fakultas Kedokteran Universitas Indonesia pada bulan April 2016. Penelitian ini merupakan penelitian deskriptif observasional dalam implementasi registrasi kanker dan evaluasi hasil data yang dihasilkannya. Pencatatan pada registrasi kanker menggunakan formulir SRiKandI dan diinput kedalam server menggunakan program CanReg5. Data yang dikumpulkan adalah data kanker pada tahun 2013 antara lain data data demografi, data klinis, data sumber, dan data follow-up. Permasalahan implementasi terjadi pada. Tim registrasi kanker mengolah 886.086 data mentah menjadi 5.554 data bersih pasien kanker tahun 2013 dan didapatkan 10 besar pasien kanker terbanyak antara lain Kanker Payudara, Kanker Serviks, Leukemia, Kolorektal, Limfoma, Nasofaring, Ovarium, Tiroid, Hepatoma dan Kulit. Penegakan diagnosis 73 menggunakan pemeriksaan mikroskopik Microscopic Verification MV .

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ABSTRACTCancer management in a hospital can rsquo t be done properly without the availability of cancer data. Hospital based cancer registry in Cipto Mangunkusumo began to be implemented since the signing of a joint decree of the oncology center by the Director of Cipto Mangunkusumo Hospital and the Dean of the Faculty of Medicine University of Indonesia in April 2016. Cancer registration use SRiKandI form as a template for data collection and inputted into the server using CanReg5 program. This study was an observational descriptive study in the implementation and evaluation of cancer registration data. The collected data is the data of cancer from year 2013, including demographic data, clinical data, source data, and follow up data. Implementation problems occurred in the bureaucracy, medical records, human resources, the use of Electronic Health Record EHR and CanReg5 program. Cancer registration team process 886.086 raw data into a 5.554 clean data of cancer patients in 2013 and found 10 highest number of cancer patients among others are Breast Cancer, Cervical Cancer, leukemia, colorectal, lymphoma, nasopharyngeal, ovary, thyroid, and skin hepatoma. Diagnosis of 73 using a microscopic examination Microscopic Verification MV ."