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"ABSTRAK Latar Belakang. Gangguan cemas menyeluruh (GCM) merupakan salah satu bentuk gangguan ansietas tersering pada populasi epilepsi yang dapat menurunkan kualitas hidup, sehingga deteksi dini sangatlah penting. Generalized Anxiety Disorder-7 (GAD-7) merupakan instrumen penapis GCM satu-satunya yang pernah divalidasi pada pasien epilepsi, yaitu di Korea dengan titik potong ≥7. Instrumen GAD-7 dapat dikerjakan pasien sendiri kurang dari 3 menit, sehingga cocok digunakan di poliklinik neurologi. Penelitian ini bertujuan untuk mendapatkan kuesioner GAD-7 versi bahasa Indonesia yang valid, reliabel dan akurat untuk menapis GCM pada pasien epilepsi dewasa.Metode Penelitian. Penelitian dibagi menjadi 2 tahap. Tahap pertama meliputi adaptasi lintas budaya berdasarkan ketentuan World Health Organization (WHO), uji validitas isi berdasarkan penilaian pakar mengenai relevansi butir pertanyaan GAD-7 hasil adaptasi, dilanjutkan uji validitas interna, reliabilitas interna dan reliabilitas test-retest pada 30 pasien epilepsi yang memenuhi kriteria inklusi. Tahap kedua adalah uji diagnostik. Hasil GAD-7 dengan titik potong ≥7 dibandingkan dengan wawancara Mini International Neuropsychiatric Interview International Classification of Diseases-10 (MINI ICD-10) sebagai baku emas.Hasil. Koefisien validitas isi berdasarkan metode Martuzua dari GAD-7 hasil adaptasi bahasa Indonesia adalah 0,847. Hasil uji validitas interna dengan korelasi Spearman didapatkan koefisien korelasi 0,648 hingga 0,800 (p<0,01). Uji reliabilitas konsistensi interna dengan Cronbach?s Alpha 0,867. Perbedaan nilai koefisien korelasi dan Cronbach?s Alpha antara pemeriksaan pertama dan retest menunjukkan reliabilitas test-retest yang baik. Dari 146 subyek uji diagnostik, prevalensi GCM hasil pemeriksaan MINI ICD-10 sebesar 16,4%. Dengan titik potong ≥7, GAD-7 memiliki sensitivitas 100% dan spesifisitas 84,4%. Kesimpulan. Kuesioner GAD-7 versi Indonesia terbukti valid dan reliabel sehingga dapat digunakan untuk menapis GCM. Dengan titik potong ≥7, GAD-7 memiliki nilai akurasi yang tinggi untuk menapis GCM pada pasien epilepsi dewasa.ABSTRACT Background. Generalized anxiety disorder (GAD) is one of the most common type among anxiety disorders in epilepsy population that can impaired patients quality of life. The Generalized Anxiety Disorder-7 (GAD-7) is a screening tool for detecting GAD that has been validated in epilepsy patients in Korea with cut-off point ≥7. The GAD-7 could be filled by the patients themselves in less than three minutes; hence, it is appropriate to be used in the neurology outpatient setting. The objective of this study is to obtain a valid, reliable, and accurate GAD-7 in Indonesian language as a screening tool of GAD in adult epilepsy patients.Method. The study was conducted in two phases. The first phase included transcultural adaptation based on World Health Organization standards, content validity test based on expert consideration regarding the relevance of GAD-7 question items, followed by internal validity test, internal reliability test and test-retest in 30 epilepsy patients. The second phase was diagnostic test, in which, the GAD-7 with cut off point ≥7 will be compared with Mini International Neuropsychiatric Interview International Classification of Diseases-10 (MINI ICD-10) as the gold standard examination for diagnosing GAD.Results. Content validity coefficient of GAD-7 adapted version based on Martuzua method was 0.847. Internal validity test with Spearman correlation obtained the correlation coefficient 0.648 to 0.800 (p< 0.01). Internal consistency reliability test with Cronbach?s Alpha was 0.867. The difference of correlation coefficient and Cronbach?s Alpha between the first and the retest showed good test-retest reliability. Out of 146 subjects of diagnostic test, the prevalence of GAD using MINI ICD-10 was 16.4%. With cut off point >7, GAD-7 had sensitivity 100% and specificity 84.4%.Conclusion. The Indonesian version of the the GAD-7 was proven to be valid and reliable, also was found to be accurate as a screening tool for GAD in adult epilepsy patient with cut off point ≥7.;Background. Generalized anxiety disorder (GAD) is one of the most common type among anxiety disorders in epilepsy population that can impaired patients quality of life. The Generalized Anxiety Disorder-7 (GAD-7) is a screening tool for detecting GAD that has been validated in epilepsy patients in Korea with cut-off point ≥7. The GAD-7 could be filled by the patients themselves in less than three minutes; hence, it is appropriate to be used in the neurology outpatient setting. The objective of this study is to obtain a valid, reliable, and accurate GAD-7 in Indonesian language as a screening tool of GAD in adult epilepsy patients.Method. The study was conducted in two phases. The first phase included transcultural adaptation based on World Health Organization standards, content validity test based on expert consideration regarding the relevance of GAD-7 question items, followed by internal validity test, internal reliability test and test-retest in 30 epilepsy patients. The second phase was diagnostic test, in which, the GAD-7 with cut off point ≥7 will be compared with Mini International Neuropsychiatric Interview International Classification of Diseases-10 (MINI ICD-10) as the gold standard examination for diagnosing GAD.Results. Content validity coefficient of GAD-7 adapted version based on Martuzua method was 0.847. Internal validity test with Spearman correlation obtained the correlation coefficient 0.648 to 0.800 (p< 0.01). Internal consistency reliability test with Cronbach?s Alpha was 0.867. The difference of correlation coefficient and Cronbach?s Alpha between the first and the retest showed good test-retest reliability. Out of 146 subjects of diagnostic test, the prevalence of GAD using MINI ICD-10 was 16.4%. With cut off point >7, GAD-7 had sensitivity 100% and specificity 84.4%.Conclusion. The Indonesian version of the the GAD-7 was proven to be valid and reliable, also was found to be accurate as a screening tool for GAD in adult epilepsy patient with cut off point ≥7.;Background. Generalized anxiety disorder (GAD) is one of the most common type among anxiety disorders in epilepsy population that can impaired patients quality of life. The Generalized Anxiety Disorder-7 (GAD-7) is a screening tool for detecting GAD that has been validated in epilepsy patients in Korea with cut-off point ≥7. The GAD-7 could be filled by the patients themselves in less than three minutes; hence, it is appropriate to be used in the neurology outpatient setting. The objective of this study is to obtain a valid, reliable, and accurate GAD-7 in Indonesian language as a screening tool of GAD in adult epilepsy patients.Method. The study was conducted in two phases. The first phase included transcultural adaptation based on World Health Organization standards, content validity test based on expert consideration regarding the relevance of GAD-7 question items, followed by internal validity test, internal reliability test and test-retest in 30 epilepsy patients. The second phase was diagnostic test, in which, the GAD-7 with cut off point ≥7 will be compared with Mini International Neuropsychiatric Interview International Classification of Diseases-10 (MINI ICD-10) as the gold standard examination for diagnosing GAD.Results. Content validity coefficient of GAD-7 adapted version based on Martuzua method was 0.847. Internal validity test with Spearman correlation obtained the correlation coefficient 0.648 to 0.800 (p< 0.01). Internal consistency reliability test with Cronbach?s Alpha was 0.867. The difference of correlation coefficient and Cronbach?s Alpha between the first and the retest showed good test-retest reliability. Out of 146 subjects of diagnostic test, the prevalence of GAD using MINI ICD-10 was 16.4%. With cut off point >7, GAD-7 had sensitivity 100% and specificity 84.4%.Conclusion. The Indonesian version of the the GAD-7 was proven to be valid and reliable, also was found to be accurate as a screening tool for GAD in adult epilepsy patient with cut off point ≥7.;Background. Generalized anxiety disorder (GAD) is one of the most common type among anxiety disorders in epilepsy population that can impaired patients quality of life. The Generalized Anxiety Disorder-7 (GAD-7) is a screening tool for detecting GAD that has been validated in epilepsy patients in Korea with cut-off point ≥7. The GAD-7 could be filled by the patients themselves in less than three minutes; hence, it is appropriate to be used in the neurology outpatient setting. The objective of this study is to obtain a valid, reliable, and accurate GAD-7 in Indonesian language as a screening tool of GAD in adult epilepsy patients.Method. The study was conducted in two phases. The first phase included transcultural adaptation based on World Health Organization standards, content validity test based on expert consideration regarding the relevance of GAD-7 question items, followed by internal validity test, internal reliability test and test-retest in 30 epilepsy patients. The second phase was diagnostic test, in which, the GAD-7 with cut off point ≥7 will be compared with Mini International Neuropsychiatric Interview International Classification of Diseases-10 (MINI ICD-10) as the gold standard examination for diagnosing GAD.Results. Content validity coefficient of GAD-7 adapted version based on Martuzua method was 0.847. Internal validity test with Spearman correlation obtained the correlation coefficient 0.648 to 0.800 (p< 0.01). Internal consistency reliability test with Cronbach?s Alpha was 0.867. The difference of correlation coefficient and Cronbach?s Alpha between the first and the retest showed good test-retest reliability. Out of 146 subjects of diagnostic test, the prevalence of GAD using MINI ICD-10 was 16.4%. With cut off point >7, GAD-7 had sensitivity 100% and specificity 84.4%.Conclusion. The Indonesian version of the the GAD-7 was proven to be valid and reliable, also was found to be accurate as a screening tool for GAD in adult epilepsy patient with cut off point ≥7."

"Latar Belakang: Infeksi HIV merupakan suatu proses inflamasi kronik, diawali dengan cidera endotel yang mengakibatkan penebalan kompleks intima media. Pada HIV yang disertai infeksi oportunistik intrakranial resiko terjadinya penebalan kompleks intima media akan menjadi lebih besar serta akan memberikan manifestasi gangguan pembuluh darah, khususnya pembuluh darah karotis. Oleh karena itu perlu dilakukan deteksi dini pembuluh darah karotis sebagai salah satu dasar untuk menentukan perlu tidaknya pencegahan kejadian serebrovaskular. Metode: Desain penelitian adalah potong lintang untuk mengetahui gambaran ketebalan KIM karotis pada pasien HIV dengan infeksi oportunistik intrakranial. Subjek penelitian sejumlah 65 orang didapatkan di ruang rawat inap, poliklinik UPT HIV RSCM. Dilakukan wawancara menggunakan form penelitian, dan pemeriksaan ultrasonografi karotis. Hasil: Didapatkan kadar rerata ketebalan KIM karotis pada pasien HIV dengan infeksi oportunistik intrakranial sebesar 0.62±0.07 mm, sedangkan rerata ketebalan KIM karotis pada pasien HIVtanpa infeksi oportunistik intrakranial sebesar 0.61±0.08 mm. Tidak terdapat perbedaan rerata yang bermakna antar kedua kelompok tersebut (p=0,79). Simpulan: Rerata ketebalan KIM karotis pada pasien HIV dengan infeksi oportunistik intrakranial dibandingkan tanpa infeksi oportunistik intrakranial tidak ditemukan perbedaan yang bermakna. Rerata ketebalan KIM karotis pasien HIV dengan infeksi oportunistik intrakranial lebih tebal dibandingkan pasien sesuai umurnya.

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Background: HIV infection is a chronic inflammatory process that causes endothelial injury leading to thickening of the intima media complex. As a result, HIV patients with intracranial opportunistic infections have a higher risk to manifest vascular disturbance, especially within the carotid vessels. Therefore, early detection using carotid vessel examination is fundamental to determine the need for preventive action against cerebrovascular incidents.

Methods: This was a cross-sectional study in adult HIV patients with intracranial opportunistic infection. Sixty-five patients were recruited in neurology ward, and integrated outpatient clinic of HIV at Pokdisus AIDS Cipto Mangunkusumo hospital. Data was obtained via interview and questionnaires and the complex intima media thickness (CIMT) was assessed using carotid ultrasonography.

Results: Mean CIMT in HIV patients with intracranial opportunistic infection was 0.62±0.07mm, while it was 0.61±0.08mm in HIV patients without intracranial opportunistic infection. There was no significant difference in mean CIMT in HIV patients with or without intracranial opportunistic infection (p=0.79).

Conclusion: There was no significant difference in mean CIMT in HIV patients with or without intracranial opportunistic infection. Mean CIMT in HIV patients with intracranial opportunistic infection was higher than that in age-adjusted normal population."

"LATAR BELAKANG : Stroke iskemik merupakan manifestasi aterosklerosis yang prosesnya dimulai jauh sebelum terjadinya serangan stroke. Bila seseorang mempunyai faktor risiko seperti hipertensi, diabetes melitus, hiperlipidemia, dan lain-lain, proses patologis yang sedang berjalan akan dipercepat sesuai jumlah faktor risiko .Sindroma metabolik bila ditemukan tiga atau lebih komponen hipertensi, obesitas sentral, hipertrigliserida, HDL kolesterol yang rendah, dan gula darah puasa yang tinggi. Dengan mendapatkan sindroma metabolik pada anak dari penderita stroke iskemik dapat dilakukan pencegahan primer.TUJUAN : Melihat gambaran sindroma metabolik pada anak dari penderita stroke iskemik dan sebaran komponennyaMETODOLOGI : Penelitian deskriptif analitik pada 87 orang anak dari penderita stroke iskemik, berusia antara 20 - 50 tahun. Dilakukan pemeriksaan tekanan darah, lingkar pinggang, kadar trigliserida , HDL kolesterol dan gula darah puasa.HASIL : 31% anak dari penderita stroke iskemik menderita sindroma metabolic. Laki-laki lebih sering dibanding perempuan. Komponen sindroma metabolik yang sering ditemui adalah HDL kolesterol yang rendah, hipertrigliserida dan obesitas sentral. Bila yang menderita stroke iskemik ayah maka lebih sering sindroma metabolik ditemukan pada anak dengan usia lebih muda. Jika ibu yang menderita stroke iskemik, kemungkinan anak menderita sindroma metabolik lebih sering pada anak laki-Iaki dengan usia lebih tua. Etnis sunda kejadian sindroma metabolik lebih rendah dibanding etnis lainnya.KESIMPULAN : Anak dari penderita stroke iskemik merupakan populasi utama untuk terjadinya aterosklerosis yang merupakan keadaan vaskuler beresiko menjadi stroke iskemik dimasa mendatang. Sindroma metabolik dengan komponen HDL kolesterol rendah, hipertrigliserida, dan obesitas sentral ditemukan lebih sering pada anak laki-laki dari penderita stroke iskemik, dan lebih jarang pada etnis sunda.

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Background ; ischemic stroke is a manifestation of arteriosclerosis which have a long-term and gradual process before manifested. If a person has risk factors such as hypertension, diabetes mellitus and hyperlipidemia, pathologic process would be accelerated according to the number of risk factors he has. Nowadays, the term of metabolic syndrome is introduced in a person who has three or more of these components: hypertension, central obesity, hypertriglyceridemia, tow HDL cholesterol and high level of fasting blood glucose. In finding metabolic syndrome in the ischemic stroke patients' descendant, primary prevention can be done.

Objectives ;The objective of this study is knowing the pattern of metabolic syndrome and it's component in ischemic stroke patients' descendants

Methods ;We performed descriptive and analytic study in 87 subjects of 20-50 years-old by examined blood pressure, waist diameters, triglyceride level, HDL-cholesterol level and fasting blood glucose level.

Results ;We found 31% of subjects who have metabolic syndrome which was more frequent in man. Among metabolic syndrome components, low level of HDL-cholesterol is the most frequent, followed by hypertriglyceridemia, and central obesity. Metabolic syndrome is more frequent in young age if the father had ischemic stroke while in older age if the mother who had ischemic stroke in Sundanese, metabolic syndrome is less frequent.

Conclusions ;The descendants of ischemic stroke patients is main target population of arteriosclerosis which is have high risk to have ischemic stroke in the future. Metabolic syndrome with low level of HDL-cholesterol, hypertriglyceridemia, and central obesity found more frequent in men and less frequent in Sundanese."

"Latar belakang: Metilasi dari gen promoter O6-methylguanine-DNA methyltransferase (MGMT) adalah salah satu faktor yang berperan pada karsinogenesis dan berkembang menjadi marker dalam menilai progresivisitas dan respons terapi astrositoma. Tujuan: Untuk mendapatkan gambaran frekuensi status metilasi gen promoter MGMT pada pasien astrositoma menggunakan methylation specific polymerase chain reaction (MS-PCR) dan methylation specific high resolution melting (MS-HRM). Metode: Dilakukan pengumpulan data klinis, imajing dan blok parafin jaringan astrositoma di RSCM dalam kurun waktu 2008-2012. Status metilasi gen promoter MGMT dianalisis menggunakan MS-PCR dan MS-HRM serta dihubungkan dengan berbagai faktor prognostik klinis. Penelitian ini adalah penelitian potong-lintang. Hasil: Didapatkan 13 sampel yang terdiri dari 7 astrositoma derajat rendah dan 6 astrositoma derajat tinggi. Metilasi gen promoter MGMT didapatkan pada 1/13 sampel astrositoma dengan MS-PCR dan 4/13 sampel dengan MS-HRM yang seluruhnya adalah astrositoma derajat rendah. Terdapat perbedaan yang bermakna antara status metilasi gen promoter MGMT dengan derajat keganasan astrositoma yaitu astrositoma derajat rendah 4/7 sampel, tanpa ditemukan pada astrositoma derajat tinggi (p=0.049) sedangkan faktor lain seperti usia, jenis kelamin, karnofsky performance scale (KPS), lokasi astrositoma dan derajat WHO tidak terdapat perbedaan yang bermakna (p= 1,000; p= 0,657; p= 0,354; p= 0,538). Simpulan: Penelitian saat ini menunjukkan frekuensi status metilasi gen promoter MGMT pada astrositoma sedikit berbeda dengan berbagai penelitian lain sebelumnya yaitu hipermetilasi hanya terjadi pada astrositoma derajat rendah. Penelitian ini merupakan penelitian pertama di Indonesia yang melaporkan gambaran status metilasi gen promoter MGMT pada pasien astrositoma.

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Background: Astrocytoma is the most common primary central nervous system tumor with difficult management as it requires a combination of surgery, chemotherapy and radiotherapy. This multimodal approach increases patients survival rate significantly, however chemotherapy resistance is now commonly seen. One of the potential causes of chemotherapy resistance is the epigenetic factors from O6 methylguanine-DNAmethyltransferase (MGMT) gene. MGMT gene has role in DNA repair and also have a protective effect against exyogen and endogeneous alkylating agent. The methylation of MGMT gene promoter leads to the decrease of MGMT protein, attenuating its function. Therefore, the methylation status of MGMT gene promoter can act as an indicator for astrocytomas progresivity and treatment aggressiveness.

Objective: To determine the frequency of MGMT gene promoter methylation among patients with astrocytomas using methylation specific polymerase chain reaction (MS-PCR) and methylation sensitive high resolution melting (MS-HRM).

Methods: Clinical data, imaging and parafin blocks from astrocytoma patients were collected in RSCM from 2008-2012. The methylation status of MGMT gene promoter was confirmed using MS-PCR and MS-HRM. This is cross-sectional study.

Results: The total of 13 samples collected including 7 low-grade and 6 high-grade astrocytomas. The MGMT gene promoter was methylated in 1/13 cases using MS-PCR and 4/13 cases using MS-HRM. All methylated cases were low-grade astrocytoma. There was significant association between methylation status of MGMT gene promoter with degree of malignancy which is 4/7 samples hypermethylated in low-grade with no hypermethylation in high-grade astrocytomas (p=0.049). While other factors like age, sex, KPS and astrocytomas location have no significant association (p= 1,000; p= 0,657; p= 0,354; p= 0,538).

Conclusions: The present study showed difference of methylation of MGMT gene promoter in astrocytomas with others studies which is hypermethylated MGMT only found in low grade astrocytomas. Our study was the first to report the frequency of MGMT promoter methylation among Indonesian astrocytoma patients."