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"Latar belakang: Laporan mengenai hubungan obesitas dan GERD semakin meningkat dalam beberapa tahun terakhir. Dengan meningkatnya pemahaman mengenai mekanisme GERD, diketahui terdapat peran sitokin proinflamasi dan adipositokin yang banyak terdapat di jaringan lemak viseral. Pada beberapa populasi di dunia, ketebalan lemak viseral diketahui berhubungan dengan meningkatnya insiden esofagitis erosif.Tujuan: Mengetahui profil ketebalan lemak viseral pasien GERD di RSCM.Metode: Penelitian ini merupakan studi potong lintang pada 56 subyek GERD. Subyek direkrut secara konsekutif pada bulan April hingga Oktober 2018 di RSUPN Cipto Mangunkusumo, Jakarta. Pemilihan subyek GERD berdasarkan Gastroesophageal Reflux Disease Questionnaires(GERDQ) dan pengukuran tebal lemak viseral menggunakan ultrasonografi. Erosi esofagus ditegakkan berdasarkan hasil endoskopi saluran cerna bagian atas. Analisis bivariat digunakan untuk menentukan perbedaan ketebalan lemak viseral antara grup esofagitis dan non-esofagitis.Hasil: Lebih dari separuh subyek penelitian ini menderita erosive reflux disease(ERD) (55,4%), didominasi oleh pasien dengan esofagitis kelas A berdasarkan klasifikasi Los Angeles sebanyak 64,5%. Rerata ketebalan lemak viseral grup NERD sedikit lebih rendah daripada grup ERD (47,9 mm untuk NERD dan 49,0 mm utk ERD). Terdapat kecenderungan peningkatan rerata ketebalan lemak viseral seiring dengan peningkatan derajat esofagitis (47,6 mm untuk esofagitis derajat A, 50,0 mm untuk esofagitis derajat B, dan 53,5 mm untuk esofagitis derajat C).Kesimpulan: Subjek ERD lebih banyak daripada NERD pada populasi GERD di RSUPN Cipto Mangunkusumo. Rerata ketebalan lemak viseral subjek NERD lebih rendah daripada ERD. Terdapat kecenderungan peningkatan rerata ketebalan lemak viseral seiring dengan peningkatan derajat esofagitis.

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Background: Reports about thecorrelation between obesity and GERD had been increasedin the past few years. Along with the increasing understanding of GERD, there are roles of proinflammatory cytokines and adipocytokines which are mostly contained in abdominal fat tissue. In several populations, visceral fat thicknessis associated with the increased incidence of erosive esophagitis.

Objective: To determine visceral fat thickness profile in GERD population in Cipto Mangunkusumo National General Hospital.

Methods: A cross-sectional study of 56 adult patients with GERD symptoms was conducted. The subjects were recruited consecutively between April and Oktober 2018 at Cipto Mangunkusumo National Hospital in Jakarta. Gastroesophageal Reflux Disease Questionnaires (GERDQ) were used to select research subjects and Ultrasonography examination was used to determine visceral fat thickness. Esophageal erosions were diagnosed using upper gastrointestinal endoscopy. Bivariate analysis was used to determine visceral fat thickness difference between esophagitis and non-esophagitis group.

Results: More than half of this research subject were patients who suffer erosive reflux disease(55,4%), which dominated by patient with esophagitis class A, regarding to Los Angeles (LA) classifications, there were 64,5% of all ERD patients. The mean visceral fat thickness in erosive reflux disease (ERD) group slightly higher than in non-erosive reflux disease (NERD) group (49,0 mm vs 47,9 mm respectively). There is an increasing trend in mean visceral fat thickness as the esophageal erosion progresses (47.6 mm for grade A, 50.0 mm for grade B, and 53,5 for grade C).

Conclusion: ERD is more common than NERD in Cipto Mangunkusumo General Hospital's GERD population. The mean visceral fat thickness in ERD group is higher than in NERD group. There is an increasing trend in mean visceral fat thickness as the esophageal erosion progresses."

"Latar Belakang/Tujuan. Angka kematian dan kejadian metastasis kanker payudara cukup tinggi. Faktor metabolik termasuk resistensi insulin mempunyai peranan terhadap progresivitas kanker payudara namun terdapat hanya sedikit penelitian yang menilai hubungan resistensi insulin dengan kejadian metastasis kanker payudara. Terdapat hubungan yang erat antara beberapa variabel dalam kelompok pasca-menopause terhadap kejadian metastasis, pemberian terapi hormonal aromatase inhibitor dan kemoterapi terhadap nilai HOMA-IR. Mengetahui hubungan resistensi insulin yang dinilai menggunakan nilai homeostatic model assessment for insulin resistance (HOMA-IR) dengan kejadian metastasis kanker payudara.Metode. Studi potong lintang yang meneliti 150 pasien kanker payudara di Rumah Sakit Cipto Mangunkusumo (RSCM) dan Rumah Sakit Siloam Mochtar Riady Comprehensive Cancer Centre (MRCCC) Jakarta dalam rentang waktu agustus 2019-april 2020. Terdapat 150 subjek penelitian, nilai titik potong HOMA-IR ditentukan dengan kurva receiver operating curve (ROC). Dilakukan analisis subgrup kelompok pasca menopause terhadap metastasis, terapi hormonal dan kemoterapi terhadap HOMA-IR.Hasil. Tidak didapatkan nilai titik potong optimal HOMA-IR terhadap kejadian metastasis (Area under curve (AUC) 0,50, P : >0,05, interval kepercayaan (IK) 95% : 0,406-0,593). Tidak terdapat hubungan bermakna variabel pasca-menopause dengan kejadian metastasis dan kemoterapi terhadap nilai HOMA-IR. Terdapat hubungan bermakna pemberian terapi hormonal aromatase inhibitor terhadap peningkatan nilai HOMA-IR, P : <0,01Simpulan. Tidak terdapat hubungan yang bermakna antara resistensi insulin dengan kejadian metastasis pada pasien kanker payudara.

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Background/Purpose. Mortality and incidence rate of metastatic breast cancer is quite high.

Metabolic factors including insulin resistance have a role in the progression of breast cancer,

but there are only a few studies that assess the relationship of insulin resistance with the incidence of breast cancer metastases. There is a close relationship between variables in the postmenopausal group for the occurrence of metastases, administration of hormonal aromatase inhibitors and chemotherapy to the value of HOMA-IR. Knowing the relationship of insulin resistance which was assessed using the value of

the homeostatic model assessment for insulin resistance (HOMA-IR) with the incidence of metastatic breast cancer.

Method. A cross-sectional study examining 150 breast cancer patients at Cipto Mangunkusumo General Hospital and Siloam Hospital Mochtar Riady Comprehensive Cancer Center Jakarta in August 2019-April 2020. There are 150 subjects research, the HOMA-IR cutoff value is determined by the receiver operating curve (ROC) curve. Postmenopausal subgroups were analyzed for metastases, hormonal therapy and chemotherapy for HOMA-IR.

Results. There was no optimal HOMA-IR cut off value for metastatic events (Area under curve (AUC) 0.50,

P:> 0.05, 95% confidence interval (IK): 0.406-0.593). There was no significant relationship between postmenopausal variables with the incidence of metastasis and chemotherapy on the value of HOMA-IR. There was a significant

relationship between the administration of hormonal aromatase inhibitor therapy to the increase of HOMA-IR value, P: <0.01"

"Latar Belakang. Kesintasan 3 tahun pasien KNF stadium lokal lanjut di Indonesia lebih rendah dibandingkan luar negeri. Prediktor alternatif dari rasio hemoglobin-trombosit (RHT) lebih sederhana, murah, dan stabil nilainya dibanding rasio dari komponen sel leukosit, namun belum ada studi yang meneliti perannya dalam memrediksi mortalitas tiga tahun pasien KNF stadium ini.Tujuan. Mengetahui peran RHT sebelum terapi dalam memrediksi kesintasan tiga tahun pasien KNF stadium lokal lanjut.Metode. Studi kohort retrospektif yang meneliti 289 pasien KNF stadium lokal lanjut yang diterapi di Rumah Sakit Cipto Mangunkusumo (RSCM) dalam rentang waktu Januari 2012 - Oktober 2016. Nilai RHT optimal didapatkan menggunakan receiver operating curve (ROC). Subjek penelitian dibagi menjadi 2 kelompok, di bawah dan di atas titik potong. Kurva Kaplan-Meier digunakan untuk menilai kesintasan tiga tahun dan dilakukan uji regresi Cox sebagai uji multivariat terhadap variabel perancu (usia > 60 tahun, stadium, jenis kelamin, dan indeks massa tubuh) untuk mendapatkan nilai adjusted hazard ratio (HR).Hasil. Nilai titik potong RHT optimal adalah 0,362 (AUC 0,6228, interval kepercayaan (IK) 95% : 0,56-0,69, sensitivitas 61,27%, spesifisitas 60,34%). 48,44% pasien memiliki nilai RHT <0,362 dan memiliki mortalitas tiga tahun lebih besar dibandingkan kelompok lainnya (50%vs31,54%). RHT < 0,362 secara signifikan memrediksi kesintasan tiga tahun (p = 0,003; HR 1,75; IK 95% 1,2-2,55). Pada analisis multivariat, RHT < 0,362 sebelum terapi merupakan faktor independen dalam memrediksi kesintasan tiga tahun pada pasien KNF stadium lokal lanjut (adjusted HR 1,82; IK 95% 1,25-2,65).Simpulan. RHT < 0,362 sebelum terapi dapat memrediksi kesintasan tiga tahun pasien KNF stadium lokal lanjut

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Background. The 3-year survival of locally advanced nasopharyngeal cancer (NPC) patients in Indonesia is lower than in foreign countries. Alternative predictors from the hemoglobin-platelet ratio (HPR) are easier, cheaper, and stable in value than the ratio of leukocyte cell components, but there are no study conducted to know its potential in predicting three-year survival in locally advanced

nasopharyngeal cancer.

Objective. To determine the role of pre-treatment hemoglobin to platelet ratio in predicting three-year survival of locally advanced nasopharyngeal cancer patients.

Method. Retrospective cohort study that examined 289 locally advanced NPC patients who underwent therapy at the National Government General Hospital-Cipto Mangunkusumo from January 2012 to October 2016. HPR cut-off was determined using ROC, and then subjects were divided into two groups according to its HPR value. The Kaplan-Meier curve was used to determine the three-year survival of the patients and cox regression test used as multivariate analysis with confounding variables in order to get adjusted hazard ratio (HR).

Results. The optimal cut-off for HPR was 0,362 (AUC 0,6228, 95% CI: 0,56-0,69, sensitivity 61,27%, specificity 60,34%). Patients with HPR < 0,362 occurred in 48, 44% and had higher three-year mortality (50% vs. 31, 54%). HPR <0.362 significantly predicted the three years of survival (p = 0,003; HR 1, 75; IK 95% 1, 2-2, 55). In multivariate analysis,

it was concluded that pre-treatment HPR < 0,362 was an independent factor in predicting three-year

survival in locally advanced NPC patients (adjusted HR 1, 82; IK 95% 1, 25-2, 65).

Conclusion. Pre-treatment HPR < 0, 362 could predict the three-year survival of locally advanced nasopharyngeal cancer patients."

"Latar Belakang: Variabilitas hemoglobin (var-Hb) merupakan suatu fenomena fluktuasi kadar Hb dalam satuan waktu tertentu yang dialami oleh pasien penyakit ginjal kronikyang menjalani hemodialisis rutin (PGK-HD).Var-Hb telah diketahui sebagai prediktor independen luaran klinis buruk. Namun,faktor-faktor yang mempengaruhinya belum banyak diketahui. Tujuan: Mengetahui besaran proporsi var-Hb pada pasien PGK-HD di Indonesia dan faktor-faktor yang mempengaruhinya. Metode: Penelitian ini merupakan studi kohort prospektif yang melibatkan pasien GGK-HD berusia ≥18 tahun di Unit Hemodialisis RSCM. Faktor-faktor yang dinilai saat awal ialah kadar Hb, reticulocyte-hemoglobin equivalent(RET-He), albumin, fosfatase alkali, dan C-reactive protein (CRP)serum, serta adekuasi dialisis (Kt/V). Adanya perdarahan saluran cerna(termasuk darah samar feses), dosis erythropoietin-stimulating agent(ESA)dan zat besi, serta kejadian transfusi darah akan dicatat. Kadar Hb kemudian diperiksa setiap 4 minggu hingga 24 minggu pengamatan. Var-Hb dinilai dengan standar deviasi residual dan nilai ≥1,0dianggap sebagai var-Hb tinggi. Uji hipotesis dilakukan dengan uji bivariat sesuai jenis data, dilanjutkan dengan analisis multivariat menggunakan uji regresi logistikmultipel. Hasil: Sejumlah 127 subyek (rerata[SD]usia 49,06[15,1], perempuan 52%, rerata[SD]kadar Hb 9,75[1,00]g/dL) diikutsertakan dalam analisis. Proporsi subyek dengan var-Hb tinggi ialah 47,24%. Berdasarkan analisis bivariat dan multivariat, faktor yang mempengaruhi var-Hb adalah kadar RET-He(p=0,004), dosis ESA (p=0,032), dan kejadian transfusi darah (adjustedOR6,967, IK95% 2,74-17,71;p<0,001). Kesimpulan: Proporsi pasien PGK-HD di Indonesia yang memiliki var-Hb tinggi ialah 47,24%(IK95% 38,3-56,3%). Faktor-faktor yang mempengaruhi var-Hb ialah kadar RET-He,dosis ESA, dan kejadian transfusi darah.

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Background: Hemoglobinvariability(Hb-var) is a phenomenon of Hb fluctuation during a course of time that is frequently observed in chronic kidney disease on hemodialysis (CKD-HD)patients. Hb-varis now recognized asapredictor of poor clinical outcomes. However, factors that influence the Hb-var are not well understood.Objectives.This study was aimedto measure the proportion of Hb-var in CKD-HD patients in Indonesia and identify factors associated. Methods: This was a prospective cohort study involving CKD-HD patients aged ≥18 years old in Hemodialysis Unit in RSCM. Factors identified at baseline were serum levels of Hb,reticulocyte-hemoglobin equivalent (RET-He), albumin,alkalinephosphatase, C-reactive protein (CRP), and dialysis adequacy (Kt/V). Hb level was measured every 4 weeks until 24weeks of follow up. Any evidence of gastrointestinal bleeding (including occult blood feces), erythropoietin-stimulating agent (ESA) dosage, and blood transfusion werealsonoted. Hb-var was calculatedas the residual standardofdeviation, and value ≥1.0 was considered as high.Hypothesis testing was performed by bivariate analysis, thencontinued with multivariateanalysis using multiple regression logistic test. Results: As 127 subjects (mean[SD]of age 49.06[15.1], female 52%, mean[SD]of Hb 9.75[1.00]g/dL) were included in the analysis. The proportion of subjects with high Hb-var were 47.24%. According to bivariate and multivariate analysis, factors that determined Hb-var were RET-Helevels (p=0.004), ESA dosage (p=0.032), and blood transfusion (adjustedOR 6.967, 95%CI2.74-17.71,p<0.001). Conclusion: Theproportion of CKD-HD patients in Indonesia with high Hb-var was47.24% (95%CI 38.3-56.3%). Factors that determined Hb-var wereRET-Helevels, ESA dosage, and blood transfusion."

"ABSTRAKLatar Belakang. Konstipasi idiopatik kronik adalah masalah yang cukup banyak terjadi, dan berhubungan dengan proses inflamasi. Proses inflamasi yang diwakili oleh rasio neutrofil limfosit merupakan marker inflamasi yang cukup stabil dan banyak digunakan, dan diduga ada hubungannya dengan terjadinya gejala depresi.Tujuan. Studi ini bertujuan untuk mengetahui hubungan rasio neutrofil limfosit dengan gejala depresi pada konstipasi idiopatik kronik.Metode. Penelitian ini merupakan studi potong lintang yang melibatkan pasien konstipasi idiopatik kronik berusia 18-59 tahun di populasi. Di saat bersamaan, dinilai gejala depresi dengan menggunakan Beck Depression Inventory-II kemudian diambil sampel darah untuk menilai rasio neutrofil limfosit. Uji hipotesis dilakukan dengan uji korelasi Pearson.Hasil. Sebanyak 73 subyek didapatkan rerata (SB) usia adalah 40,29 (11,2) tahun, dengan proporsi perempuan 90,4%. Median RNL (min-maks) adalah 1,72 (0,27-7,18). Hasil analisis korelasi didapatkan hasil koefisien korelasi (r) = 0,028 (p = 0.811).Kesimpulan. Rasio neutrofil limfosit tidak berhubungan dengan gejala depresi pada konstipasi idiopatik kronik.

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ABSTRACTBackground. Chronic idiopathic constipation is a problem that is quite common and is related to the inflammatory process. Inflammation marker is represented by neutrophil lymphocyte ratio that is quite stable and widely used and is thought to have something to do with the occurrence odd depressive symptoms.Objectives. This study was aimed to determine relationship between neutrophil lymphocyte ratio and depressive symptom in chronic idiopathic constipation.Methods. This was a cross sectional study involving chronic idiopathic constipation patients aged 18-59 years old in population. At the same time depressive symptoms were assessed using the Beck Depression Inventory-II and blood sample were taken to assess the neutrophil lymphocyte ratio. Pearson correlation test was done for hypothesis testing.Results. From total of 75 subjects, the mean (SB) age is 40.29 (11.2) years and the proportion of women is 90.4%. The median RNL (min-max) is 1.72 (0.27-7.18). The results of correlation coefficient obtained from correlation analysis is (r) = 0.028 (p= 0.811).Conclusion. The neutrophil lymphocyte ratio is not associated with depressive symptom in chronic idiopathic constipation."

"Latar belakang. Bersihan kolon yang adekuat berkaitan dengan persiapan kolonoskopi yang baik namun hingga saat ini belum ada penelitian mengenai dua preparat bersihan kolon yang paling umum digunakan di Indonesia yaitu polyethylene glycol (PEG) dan sodium phosphate (SP).Tujuan. Mengetahui perbandingan bersihan kolon antara PEG dan SP pada pasien yang akan dilakukan kolonoskopi di Indonesia. Metode. Uji klinis acak tersamar tunggal, satu sentral penelitian di pusat endoskopi saluran cerna (PESC) RS. Cipto Mangunkusumo (RSCM) pada pasien usia lebih dari 18 tahun yang menjalani kolonoskopi periode Maret ? September 2014. Randomisasi manual, teknik sampling konsekutif dilakukan untuk mengalokasikan preparat PEG dan SP, kemudian penilaian bersihan kolon secara tersamar tunggal dilakukan oleh dua orang dengan Boston Bowel Preparation Scale (BBPS). Nilai adekuat bila skor ≥ 5. Analisis dilakukan dengan intention to treat.Hasil. Dari 135 subyek yang dirandomisasi, dieksklusi 14 subyek sehingga yang dianalisis 121 subyek (PEG n=62; SP n=59). Semua subyek menjalani penelitian hingga selesai. Bersihan adekuat pada PEG 88,7% dengan rerata skor BPPS 5,89, sedangkan pada SP 89,8% dengan rerata skor BPPS 6,34 (nilai p=0,84). Didapatkan nilai Control Event Rate (CER) 11,3%, Experiment Event Rate (EER) 10,17%, Absolute Risk Reduction (ARR) 1,13%, Relative Risk Reduction (RRR) 9,92%, dan Number Needed to Treat (NNT) untuk SP sebesar 90 subyek. Efek samping pada PEG adalah mual (19,4%), rasa tidak enak (3,2%), muntah (1,6%) sedangkan pada SP hanya rasa tidak enak (5,1%). Kedua kelompok tidak mengalami alergi.Kesimpulan. Tidak ada perbedaan bermakna secara statistik dan klinis antara PEG dan SP dalam bersihan kolon yang adekuat menggunakan skor BPPS.

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Background. Adequate clearance of the colon is associated with a good preparation for colonoscopy. Up until now research on colon adequate clearance by using two of the most commonly used preparations in Indonesia, namely polyethylene glycol and sodium phosphate has not been done.Aims. To compare the effectivity of PEG and SP in colon clearance for patients undergoing colonoscopy in Indonesia.Design and Methods. A single blind randomized clinical trial in one centre at gastrointestinal endoscopy centre RSCM, was conducted on patients aged over 18 years old that had colonoscopy in the period from March to September 2014. Consecutive manual randomization was performed to allocate the PEG and SP lavage and assessment of adequate colon clearance will be evaluated by two investigators using the Boston Bowel Preparation Scale (BBPS). Adequate score if > 5. Analysis was done by intention to treat.Results. From the 135 randomized subjects, 14 was excluded, and 121 subjects obtained (PEG n=62; SP n=59). All subjects completed the research. Adequate clearance in PEG was 88.7% with BPPS mean score 5.89. While, SP had adequate clearance of 89.8% with BPPS mean score 6.34 (p value=0.84). Analysis resulted in CER 11.3%, EER 10.17%, ARR 1.13%, RRR 9.92%, and NNT for SP was 90 subjects. Side effects in PEG participants were nausea (19.4%), unpleasant taste (3.2%), vomit (1.6%) while in SP participants only experienced unpleasant taste (5.1%). Both groups did not experience allergic reaction.Conclusion. There was no significant difference in terms of adequate colon clearance preparation between PEG and SP using BPPS score."

"Latar Belakang : Penelitian perbandingan kesintasan pasien karsinoma paru bukan sel kecil usia lanjut stadium IIIB/IV yang menjalani kemoterapi dan non-kemoterapi sudah pernah diteliti di negara lain sebelumnya, namun penelitian tersebut di Indonesia belum pernah dilakukan. Penelitian-penelitian terdahulu belum banyak yang memperhitungkan faktor perancu seperti komorbiditas, jenis histopatologi, indeks massa tubuh, stadium, usia dan status fungsional dalam meneliti pengaruh kemoterapi terhadap kesintasan karsinoma paru bukan sel kecil usia lanjut.Tujuan : Mengetahui adakah perbedaan kesintasan satu tahun antara pasien kanker paru karsinoma bukan sel kecil usia lanjut stadium IIIB/IV yang menjalani kemoterapi dan non-kemoterapi.Metode : Kohort retrospektif dengan analisis kesintasan terhadap 232 pasien kanker paru karsinoma bukan sel kecil stadium IIIB/IV dan status fungsional ECOG 0-2 yang berobat jalan maupun rawat inap di RS Cipto Mangunkusumo dan RS Kanker Dharmais Januari 2007-April 2013, terbagi menjadi dua kelompok yaitu yang menjalani kemoterapi dan non-kemoterapi. Kurva Kaplan-Meier digunakan untuk mengetahui kesintasan satu tahun masing-masing kelompok. Analisis bivariat menggunakan uji log-rank, analisis multivariat menggunakan cox proportional hazard regression. Besarnya hubungan variabel kemoterapi dengan kesintasan dinyatakan dengan crude HR dan IK 95% serta adjusted HR dan IK 95% setelah dimasukkan variabel perancu.Hasil : Terdapat 232 pasien kanker paru karsinoma bukan sel kecil yang dibagi menjadi dua kelompok yaitu kemoterapi (118 subyek) dan non-kemoterapi (114 subyek). Persentase mortalitas satu tahun adalah 93,9% pada kelompok non-kemoterapi dan 57,6% pada kelompok kemoterapi. Median kesintasan kelompok non-kemoterapi adalah 2 bulan, sedangkan kelompok kemoterapi 9,73 bulan, p<0,001, HR 3,447(IK 95% 2,522-4,711). Analisis bivariat menunjukkan hubungan bermakna antara kemoterapi dengan kesintasan satu tahun. Analisis multivariat menunjukkan stadium adalah perancu kemoterapi terhadap kesintasan.Simpulan : Kesintasan satu tahun pasien kanker paru bukan sel kecil usia lanjut stadium IIIB/IV yang menjalani kemoterapi lebih baik dibandingkan dengan non-kemoterapi.

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Background : The effects of chemotherapy on survival in elderly with advanced non-small cell lung cancer has been studied in other country before, but in Indonesia this topic hasn?t been studied. The influence of confounding factors such as comorbidity, histopathology, body mass index, functional status, age and stage of cancer were seldom considered in the earlier studies.Objective : To determine whether there?s a difference in one year survival between elderly with advanced non-small cell lung cancer who received chemotherapy and those who received non-chemoterapeutic approaches.Methods : Retrospective cohort design and survival analysis were used to 232 elderly with advanced non-small cell lung cancer (IIIB/IV) and performance status of ECOG 0-2 who visited Cipto Mangunkusumo Hospital and Dharmais Cancer Hospital between January 2007 and April 2013 that divided into 2 groups according to therapy that they received (chemotherapy and non-chemotherapy). Kaplan-Meier curve was used to evaluate the one year survival of each group. Bivariate analysis was conducted using log-rank test, multivariate analysis was conducted using Cox proportional hazard regression. The extend of relation between advancing age and survival was expressed with crude HR with 95% CI and adjusted HR with 95%CI after adjusting for confounders.Results : There were 232 elderly advanced non-small cell lung cancer that divided into two groups ; chemotherapy (118 subjects) and non-chemotherapy (114 subjects). One year mortality percentage were 93,9% and 57,6% to non-chemotherapy and chemotherapy group. The survival median were 2 months in non-chemotherapy group and 9,73 months in chemotherapy group, with p< 0,001 and HR 3,447 (95% CI : 2,522-4,711). Bivariate analysis showed statistically significant relation between chemotherapy and one year survival. Multivariate analysis showed that stage of cancer was a confounder to chemotherapy relation to survival.Conclusion : One year survival in elderly with advanced non-small cell lung cancer who received chemotherapy were better compared to those who received non-chemotherapeutic approaches."

"Latar Belakang: Angka kejadian Tuberkulosis Ekstra Paru (TBEP) lebih tinggi pada pasien dengan infeksi HIV. Pasien TBEP dengan infeksi HIV berisiko mengalami perburukan yang cepat dan angka kematian yang tinggi. Oleh karena nya perlu diketahui karakterisitik klinis setiap jenis TBEP agar dapat mendeteksi HIV dan memulai tatalaksana TBEP lebih dini. Tujuan: Mengetahui pola demografi pasien TBEP dan mengetahui karakteristik klinis TBEP pada pasien HIV positif dan HIV negatif. Metode: Penelitian ini dilakukan dengan desain potong lintang dengan menggunakan data sekunder dari rekam medis pasien TBEP di seluruh RSCM baik rawat jalan maupun rawat inap selama tahun 2008-2012. Semua data dikumpulkan dan diseleksi. Kriteria inklusi penelitian ini adalah pasien TBEP dewasa dan memiliki data rekam medis yang lengkap serta dilakukan pemeriksaan Elisa anti HIV. Data yang terkumpul diolah secara deskriptif dengan menggunakan piranti lunak SPSS. Hasil: Penelitian ini mendapatkan 620 pasien TBEP yang terdiri dari 75,97% dengan HIV positif dan 24,03% dengan HIV negatif. Kelompok usia terbanyak 18-40 tahun. Jenis kelamin pria didapat sebesar 76,6%. Sebagian besar (57,7%) berpendidikan SMA dan sederajatnya dan 46,13% tidak bekerja. Distribusi organ terbanyak pada kelompok HIV positif adalah limfadenitis TB ( 42,59%) dan pada kelompok HIV negatif adalah meningitis TB (36,18%). Gambaran klinis sistemik terbanyak adalah penurunan berat badan, demam lama, dan lemah/lemas. Karakteristik klinis tiap jenis TBEP pada kelompok HIV positif dan HIV negatif pada umumnya serupa dan keluhan terbanyak adalah nyeri. Simpulan : Proporsi TBEP pada pasien HIV positif lebih banyak dari pada HIV negatif. Pola demografi TBEP adalah sebagian besar pria, kelompok usia 18-40 tahun, berpendidikan SMA dan sederajatnya, sudah menikah, dan tidak bekerja. Karakteristik klinis setiap jenis TBEP pada pasien HIV positif dan HIV negatif serupa.

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Background: Prevalence of Extrapulmonary TB (EPTB) increases along with an escalated number of HIV infection. Patients with EPTB with HIV infection are at risk of having rapid deterioration and higher death rate. Therefore, it is important to identify clinical characteristics of each EPTB in both HIV positive and negative patients allowing early EPTB management and thus decreasing its mortality rate.

Objectives: To recognize the demographic pattern of EPTB patients and identify clinical characteristics of EPTB in HIV positive and negative patients.

Methods: This was a cross sectional study that utilized secondary data from medical records of EPTB patients from all units in RSCM, both outpatient and inpatient during a period from 2008 - 2012. Data were gathered and selected. All EPTB patients who had complete medical record and had anti HIV ELISA examined were included in this study. Gathered data were processed descriptively by using SPSS software to be presented.

Result: This study obtained data from 620 EPTB patients consisted of 75,97% with HIV positive and 24,03% with HIV negative. Most patients were in 18 - 40 year-old age group, 70% were male, 57,7% had education at senior high school or equivalent level while 46,13% were unemployed. Distribution of organ involvement in HIV positive were lymphadenitis ( 42,59%) and in HIV negetive were meningitis (36,18%). Systemic clinical presentation were mostly weight loss, prolonged fever, and weakness/fatigue. Clinical characteristics in each EPTB both in HIV positive and negative were generally similar. The most common symptoms were pain.

Conclusion: EPTB proportion in HIV positive patients were higher than in HIV negative. Demographic pattern of EPTB were mostly male, age group 18 - 40 year-old, senior high school or equivalent level and unemployed. Clinical characteristics from each type of EPTB in HIV positive and negative were similar."

"Latar Belakang: Banyaknya jemaah haji Indonesia dengan kebiasaan merokok yang bisa menyebabkan gangguan faal paru. Gangguan faal paru tersebut bisa berupa obstruktif, restriktif, dan campuran. Belum ada penelitian tentang gambaran faal paru pada jemaah haji perokok di Indonesia. Tujuan: Mendapatkan karakteristik dan gambaran faal paru serta hubungan antara perilaku merokok dengan gambaran faal paru jemaah haji perokok pada jemaah haji embarkasi Jakarta-Pondok Gede tahun 2012. Metode: Disain studi adalah potong lintang pada jemaah haji perokok pada saat menjalani pemeriksaan kesehatan haji di Puskesmas Kecamatan dan Embarkasi Jakarta-Pondok Gede. Penilaian perilaku merokok berdasarkan Indeks Brinkman dan penilaian gambaran faal paru berdasarkan pemeriksaan spirometri. Analisis bivariat menggunakan metode Kolmogorov-Smirnov. Hasil: Pada studi ini didapatkan 209 subjek jemaah haji perokok. Karakteristik jemaah haji perokok umumnya laki-laki (99,5%), usia < 60 tahun (78,0%), IMT kategori lebih (63,2%), tidak disertai komorbid (68,9%), pendidikan kategori tinggi (75,1%), Indeks Brinkman kategori sedang (53,1%). Gambaran faal paru masuk kategori restriktif 51,2%, obtruktif 8,6%, campuran 8,1%, dan normal 32,1%. Penelitian ini tidak menunjukan hubungan bermakna antara perilaku merokok dengan gambaran faal paru pada kelompok kategori Indeks Brinkman sedang-berat dibandingkan kelompok kategori Indeks Brinkman ringan (p=0,925). Simpulan: Karakteristik jemaah haji perokok umumnya laki-laki, usia < 60 tahun, IMT kategori lebih, tidak disertai komorbid, pendidikan kategori tinggi, Indeks Brinkman kategori sedang. Gambaran faal paru umumnya masuk kategori restriktif. Penelitian ini tidak menunjukan adanya hubungan yang bermakna antara perilaku merokok dengan gambaran faal paru pada kelompok kategori Indeks Brinkmansedang-berat dibandingkan kelompok Indeks Brinkman ringan.

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Background: There are many of Indonesian pilgrims who have smoking habits. Smoking can cause pulmonary function disorder. Pulmonary function could be normal, obstructive, restrictive, or mixed. Previous studies had showed a close association between smoking behavior and respiratory tract diseases. There is no research about pulmonary function on smoking Indonesian pilgrims.

Aims: To obtain characteristics of pulmonary function and the association between smoking behavior with pulmonary function on smoking Indonesian pilgrims at Jakarta-Pondok Gede embarkation in 2012.

Method: This was a cross-sectional study on smoking Indonesian pilgrims during Hajj health checkup at the health center and embarkation District of Jakarta-Pondok Gede. Assessment of smoking behavior based on Brinkman index and pulmonary function assessment based on spirometry screening using spirometry. Bivariate analysis using Kolmogorov-Smirnov.

Result: This study got 209 subjects of smoker pilgrims. Subjects are generally male (99.5%), < 60 years (78.0%), overweight (63.2%), no comorbidity (68.9%), high education level (75.1%), medium Brinkman index (53.1%). Pulmonary functions are categorized as restrictive 51.2%, obtructive 8,6%, mixed 8,1%, and normal 32,1%. This study showed no significant association between smoking behavior with pulmonary function in the medium-heavy Brinkman index group than the light Brinkman Index group (p = 0.925).

Conclusion: Subjects are generally male, < 60 years, overweight, no comorbidity, high education level, medium Brinkman index. Pulmonary functions are generally categorized as restrictive. This study showed no significant association between smoking behavior with pulmonary function in the medium-heavy Brinkman index group than the light Brinkman Index group."

"Latar Belakang: Pasien geriatri memiliki kompleksitas unik yang dapat meningkatkan beban dan biaya perawatan. Perbaikan status fungsional dan penurunan rehospitalisasi merupakan luaran keberhasilan pelayanan pasien geriatri yang dapat dicapai lebih baik dengan P3G (Pendekatan Paripurna Pasien Geriatri). Sejak implementasi sistem pembiayaan Jaminan Kesehatan Nasional (JKN) pada Januari 2014 belum diketahui perbandingan luaran perbaikan status fungsional, rehospitalisasi, dan efektivitas biaya pasien geriatri di RSCM dengan P3G.Tujuan: Mengetahui perbandingan perbaikan status fungsional, kejadian rehospitalisasi, dan efektivitas biaya pasien geriatri yang dirawat di RSCM pada era sebelum dan sesudah penerapan JKN.Metode: Kohort retrospektif dengan kontrol historis dilakukan pada pasien geriatri yang dirawat di RSCM pada periode Januari-Juni 2014 sebagai kelompok JKN dan Juli-Desember 2013 sebagai kelompok pra-JKN. Pengumpulan data dilakukan secara total sampling dari rekam medis. Pasien meninggal dieksklusi. Status fungsional dinilai dengan indeks ADL (activity of daily living) Barthel. Kemudian dilakukan analisis perbedaan proporsi rehospitalisasi, perbaikan status fungsional, dan perhitungan efektivitas biaya menggunakan incremental cost-effectiveness ratio (ICER).Hasil: Dari total 158 pasien, 72 subjek berada di kelompok pra-JKN dan 86 subjek di kelompok JKN dengan karakteristik yang relatif tidak berbeda. Tidak ada perbedaan median perbaikan status fungsional dan kejadian rehospitalisasi antara kelompok pra-JKN dan JKN (1 [-5 to 13] vs 2 [-2 to 15], p=0,715 dan 21,7,1% vs 18,1%, p=0,603). Telaah efektivitas biaya menunjukkan dengan menginvestasikan 3,7 juta rupiah pada implementasi JKN menyebabkan peningkatan 1 skor ADL Barthel dan penghematan 600 ribu rupiah pada implementasi JKN menyebabkan penurunan rehopitalisasi 3,6%; namun secara klinis dan statistik perbedaan tersebut tidak bermakna.Simpulan: Tidak ada perbedaan perbaikan ADL, kejadian rehospitalisasi, dan efektivitas biaya pasien geriatri yang dirawat di RSCM pada era JKN dan pra-JKN.

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Background: Geriatric patients have unique characteristics with high burden of care and cost. Functional status improvement and reduction of rehospitalization are the outcome of health care that can be achieved better by implementation of CGA (Comprehensive Geriatric Assessment). Since January 2014, National Health Insurance Program (NHIP) has been implemented and there are no data that explain the comparison of fuctional status improvement, rehospitalization, and cost-effectiveness ratio in geriatric patients receiving CGA at RSCM.

Objectives: to determine the comparison of functional status improvement, rehospitalization, and cost-effectiveness ratio in patients admitted to RSCM acute geriatric ward before and after implementation of NHIP.

Method: Retrospective cohort with historical control was done toward geriatric patients in periode of January-June 2014 as NHIP group and periode of July-December 2013 as pra-NHIP group. Data was collected from medical record and enrolled by total sampling. Death cases were excluded. Functional status was measured using activity of daily living (ADL) Barthel index. Analysis the difference of activity of daily living score, rehospitalization, and incremental cost effectiveness ratio (ICER) were done to compare both groups.

Result : From 158 patients, 72 subjects are in pra-NHIP group and 86 subject in NHIP groups. Both group have similar characteristics. There are no difference of functional status improvement and rates of rehospitalization between pra-NHIP and NHIP group (1 [-5 to 13] vs 2 [-2 to 15], p=0,715 and 21,7% vs 18,1%, p=0,603). ICER shows that by investing 3,7 million rupiah on implementation of NHIP cause 1 score improvement of ADL Barthel index and by saving 600 thousand rupiah on NHIP cause 3,6% declining rehopitalization rates. Statistically and clinically both ICER are not significant.

Conclusion: There are no difference of functional status improvement, rates of rehospitalization, and cost-effectiveness ratio in geriatric patients between NHIP and pra-NHIP groups."