Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
Resistensi insulin adalah penurunan kemampuan jaringan (otot, hati, dan jaringan adiposa) untuk merespon insulin yang bersirkulasi secara normal dalam darah yang berisiko berkembang menjadi penyakit diabetes melitus tipe 2. Rasio tinggi asupan asam lemak omega-6/omega-3 diduga berperan dalam menurunkan sensitivitas insulin. Penelitian ini bertujuan untuk mengetahui hubungan antara rasio asupan omega-6/omega-3 dan HOMA-IR pada perempuan usia reproduktif. Studi potong lintang ini dilakukan di Jakarta, pada bulan Juli sampai Oktober 2021. Pengambilan sampel menggunakan metode consecutive sampling dan diperoleh 79 subjek perempuan yang memenuhi kriteria penelitian. Pengumpulan data dilakukan melalui wawancara 24-hours food recall sebanyak 3 kali, pengukuran antropometri untuk menilai status gizi, dan pengambilan serum untuk mengukur kadar glukosa darah puasa dan insulin. Rerata asupan omega-6 pada subjek adalah 9.43 ± 3.69 gram/hari, median asupan omega-3 pada subjek adalah 0.79 (0.23–3.53) gram/hari, dan rerata rasio asupan omega-6/omega-3 adalah 12.32 ± 4.32. Rerata HOMA-IR pada subjek adalah 3.04 ± 1.24. Terdapat korelasi positif lemah antara rasio asupan omega-6/omega-3 dan HOMA-IR, namun tidak signifikan (r=0.161, p=0.157). Ditemukan hubungan signifikan antara DHA dan HOMA-IR setelah mengontrol faktor perancu (p=0.014). Tidak ada hubungan antara rasio asupan asam lemak omega-6/omega-3 dan HOMA-IR pada perempuan usia reproduktif. Namun, ditemukan hubungan antara asupan DHA dan HOMA-IR yang menunjukkan bahwa peningkatan asupan asam lemak tidak jenuh dapat mencegah terjadinya resistensi insulin. ......Insulin resistance is a decrease in the ability of tissues (muscle, liver, and adipose tissue) to respond to insulin that circulates normally in the blood which is at risk of developing type 2 diabetes mellitus. A high ratio of omega-6/omega-3 fatty acid intake is thought to play a role in reducing insulin sensitivity. This study aims to determine the association between the ratio of omega-6/omega-3 intake and HOMA-IR in reproductive-aged women. This cross-sectional study was conducted in Jakarta, from July to October 2021. Sampling used the consecutive sampling method and obtained 79 women subjects who met the research criteria. Data was collected through 24-hour food recall interviews 3 times, anthropometric measurements to assess nutritional status, and serum sampling to measure fasting blood glucose and insulin levels. The mean omega-6 intake in the subjects was 9.43 ± 3.69 grams/day, the median omega-3 intake in the subjects was 0.79 (0.23–3.53) grams/day, and the mean ratio of omega-6/omega-3 intake was 12.32 ± 4.32. The mean HOMA-IR in the subjects was 3.04 ± 1.24. There was weak positive correlation between the ratio of omega-6/omega-3 intake and HOMA-IR, but not significant (r=0.161, p=0.157). A significant relationship was found between DHA and HOMA-IR after adjusted confounding factors (p=0.014). There was no association between the ratio of omega-6/omega-3 fatty acid intake and HOMA-IR in reproductive-aged women. However, it was found that there was a assocation between DHA intake and HOMA-IR which indicated that increasing intake of unsaturated fatty acids could prevent insulin resistance

Abstrak :
ABSTRAK
Background: hypoglycemia is a major adverse event of insulin therapy for diabetes mellitus patients. The study was conducted to evaluate the incidence of hypoglycemia among insulin treated patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) in the Indonesian cohort. Methods: this Indonesian cohort study consisted of retrospective and prospective evaluation of hypoglycemic episodes, using International Operations Hypoglycemia Assessment Tool (IO HAT) in 374 patients with diabetes (T1DM; n=17 or T2DM; n=357). The patients of ≥18 years of age and treated with insulin for >12 months were selected for this study (ClinicalTrials.gov number: NCT02306681). Results: a total of 374 patients were enrolled in this study and completed SAQ1. All patients with T1DM (17 [100%]), and 347 (97.2%) patients with T2DM completed SAQ2. Almost all the patients in the 4-week prospective period reported at least one hypoglycemic event (T1DM 100%, T2DM 99.4%) and the incidence rate of any hypoglycemia was 67.5 events per patient-year (PPY) and 25.7 events PPY for T1DM and T2DM patients, respectively. Among patients with T1DM and T2DM, 5.9% and 36.4%, respectively, did not know what hypoglycemia was at baseline, also high proportion of patients had impaired hypoglycemic awareness in the study (82.4% and 62.7%, respectively). Conclusion: overall, high proportion of patients reported hypoglycemic events in the prospective period indicating under reporting during the retrospective period due to recall bias. Therefore, there is a need for patient education program to improve the awareness of hypoglycemia in diabetes patient in Indonesia.

Abstrak :
ABSTRAK
Penelitian mengenai hubungan inulin dan fruktooligosakarida FOS terhadap kadar gula darah masih terbatas dan hasilnya kontradiktif. Penelitian ini merupakan penelitian potong lintang untuk menilai hubungan antara asupan serat total, inulin, dan FOS dengan kadar Hemoglobin A1cpada wanita Suku Minangkabau dan Sunda. Dilakukan penilaian asupan terhadap 298 wanita menggunakan semi quantitative food frequency questionnaire. Analisis data menggunakan uji regresi linier ganda. Median serat, inulin, dan FOS lebih tinggibermakna pada wanita Sunda dibandingkan Minangkabau.Median kadar HbA1ctidak berbeda bermakna antara kedua suku. Setelah dilakukan penyesuaian terhadap faktor pengganggu, asupan serat ?=-0,011, p=0,211 , inulin ?=-0,019, p=0,733 , dan FOS ?=-0,092, p=0,357 tidak berhubungan dengan kadar HbA1cpada wanita Suku Minangkabau dan wanita Sunda.

---

ABSTRACT
Inulin and Fructooligosaccharide FOS are recently known to have effect on lowering blood glucose, but this finding was still multivocal. A cross sectional study was conducted to assess the relationship between dietary fiber, inulin, and FOS intake with hemoglobin A1c HbA1c level in Minangkabau and Sundanese women. A total of 298 women were selected. Fiber, inulin and FOS intake was assessed using semi quantitative food frequency questionaire. Data was analyzed using multiple linear regression. Median of dietary fiber, inulin, and FOS are signfificantly higher in Sundanese than in Minangkabau women. Median of HbA1c level was not stastically different between two ethnics. After adjustment with potential confouders, there was no relationship between total dietary fiber 0,011, p 0,211 , inulin 0,019, p 0,733 , dan FOS 0,092, p 0,357 intake with HbA1c level in Minangkabau and Sundanese women.

Abstrak :
Latar Belakang: Penyakit ginjal diabetik (PGD) merupakan salah satu penyebab terbanyak penyakit ginjal kronik tahap akhir. Podositopati sebagai gambaran dini PGD dapat ditandai oleh adanya protein spesifik podosit (nefrin dan podosin) di urin. Asymmetric dimethylarginine (ADMA) merupakan penanda disfungsi endotel yang diketahui meningkat pada hiperglikemia serta berhubungan dengan albuminuria dan progresivitas kerusakan ginjal. Mekanisme terjadinya gangguan ginjal akibat disfungsi endotel belum sepenuhnya diketahui. Tujuan: Penelitian ini bertujuan untuk mengetahui korelasi ADMA plasma dengan kadar nefrin, podosin, dan rasio podosin nefrin (RPN) urin pada pasien PGD. Metode: Studi potong lintang dilakukan terhadap pasien PGD pada dua rumah sakit di Jakarta sepanjang periode April sampai Juni 2023. Dilakukan pengumpulan data karakteristik subjek, riwayat penyakit dan pengobatan, serta data laboratorium yang relevan. Pemeriksaan ADMA dilakukan dengan metode liquid chromatography dari darah, sedangkan nefrin dan podosin dilakukan dengan metode ELISA dari urin. Uji korelasi dilakukan untuk menilai hubungan ADMA dengan nefrin, podosin, dan RPN. Regresi linier dilakukan untuk menilai pengaruh variabel perancu terhadap hubungan tersebut. Hasil: Dari data 41 subjek yang dianalisis ditemukan rerata ADMA 70,2 (SD 17,2) ng/mL, median nefrin 65 (RIK 20-283) ng/mL, dan median podosin 0,505 (RIK 0,433-0,622) ng/mL. Ditemukan korelasi bermakna antara ADMA dengan nefrin (r=0,353; p=0,024) dan korelasi bermakna antara ADMA dengan RPN (r=–0,360; p=0,021). Tidak ditemukan korelasi bermakna antara ADMA dengan podosin (r=0,133; p=0,409). Analisis multivariat menunjukkan indeks massa tubuh sebagai faktor perancu. Simpulan: Terdapat korelasi positif lemah antara ADMA dengan nefrin urin dan korelasi negatif lemah antara ADMA dengan RPN urin pada pasien PGD. Tidak ditemukan korelasi antara ADMA dengan podosin urin. ......Background: Diabetic kidney disease (DKD) is the leading cause of end-stage kidney disease, and podocytopathy is an early manifestation of DKD characterized by the urinary excretion of podocyte-specific proteins, such as nephrin and podocin. Asymmetric dimethylarginine (ADMA), a biomarker of endothelial dysfunction, is associated with progressive kidney dysfunction. However, the mechanism of endothelial dysfunction in DKD progression is unclear. Objectives: The aim of this study was to investigate the correlations of ADMA levels with nephrin, podocin, and the podocin nephrin ratio (PNR) in DKD patients. Methods: A cross-sectional study of 41 DKD outpatients was performed in two hospitals in Jakarta from April to June 2023. The collected data included the subjects’ characteristics, histories of disease and medication, and relevant laboratory data. Serum ADMA was measured using liquid chromatography, while urinary podocin and nephrin were measured using the enzyme-linked immunosorbent assay (ELISA) method. A correlation analysis was performed to evaluate the correlation of ADMA with nephrin, podocin, and PNR. Regression analysis was performed to determine confounding factors. Results: The mean value of ADMA was 70.2 (SD 17.2) ng/mL, the median for nephrin was 65 (20-283 ng/mL), and the median of podocin was 0.505 (0.433-0.622) ng/mL. ADMA correlated significantly with nephrin (r = 0.353, p = 0.024) and PNR (r = -0.360, p = 0.021), but no correlation was found between ADMA and podocin (r = 0.133, p = 0.409). The multivariate analysis showed that body mass index was a confounding factor. Conclusion: This study revealed weak positive correlations between ADMA and urinary nephrin, and weak negative correlations between ADMA and PNR in DKD patients. No correlation was found between ADMA and urinary podocin.

Abstrak :
Latar Belakang: Panjang interval QTc dipengaruhi oleh berbagai faktor, salah satunya oleh inflamasi. Pada pasien COVID-19 sering terjadi badai sitokin sehingga menyebabkan peningkatan signifikan dari sitokin inflamasi, termasuk interleukin 6. Peningkatan interleukin 6 menyebabkan perubahan pada kanal ion kardiomiosit sehingga menyebabkan pemanjangan interval QTc yang berisiko aritmia. Tujuan: Mengetahui korelasi dengan melihat beda rerata kadar interleukin 6 dan panjang interval QTc, nilai titik potong kadar interleukin 6 terhadap panjang interval QTc > 500 ms dan kekuatan kadar interleukin 6 dalam menilai risiko aritmia ventrikular. Metode: Penelitian ini menggunakan desain studi potong lintang dengan mengambil data sekunder rekam medik pasien COVID-19 yang menjalani rawat inap di RSCM Kiara sejak November 2020 hingga Maret 2021. Pada penelitian ini dilakukan analisis bivariat menggunakan uji Spearman. Selanjutnya dilakukan analisis terhadap beda rerata kadar interleukin 6 pada kelompok subyek dengan panjang interval QTc > 500 ms dan kelompok subyek dengan panjang interval QTc normal. Dilakukan analisis dengan Receiver Operating Curve (ROC) untuk melihat Area under curve (AUC) dan menentukan titik potong kadar interleukin 6 terhadap panjang interval QTc > 500 ms. Hasil: Pada penelitian ini didapatkan korelasi kadar interleukin 6 dan panjang interval QTc (r=0,72). Median kadar interleukin 6 pada kelompok subyek dengan interval QTc > 500 ms yaitu 99,36 pg/ml sedangkan pada kelompok subyek dengan interval QTc normal yaitu 19,51 pg/mL. Didapatkan AUC=0,852 untuk menentukan titik potong kadar interleukin 6 terhadap panjang interval QTc > 500 ms dengan nilai 59 pg/ml, dengan sensitivitas 80,6% dan spesifisitas 80%. Kejadian aritmia ventrikular tidak ditemukan sehingga tidak dapat dilakukan analisis untuk menilai kekuatan kadar interleukin 6 untuk menentukan risiko aritmia ventrikular. Kesimpulan: Terdapat korelasi kadar interleukin 6 dan panjang interval QTc dengan beda rerata kadar interleukin 6 pada subyek dengan interval QTc > 500 ms 5 kali lebih besar dibandingkan kelompok subyek dengan panjang interval QTc normal. Kadar interleukin 6 59 pg/mL ditentukan sebagai nilai titik potong terhadap panjang interval QTc > 500 ms. ......Background: The length of the QTc interval is influenced by various factors, one of which is inflammation. In COVID-19 patients, cytokine storms often occur, causing a significant increase in inflammatory cytokines, including interleukin 6. An increase in interleukin 6 can cause changes in the ion channels of cardiomyocytes, which can lead to prolonged QTc interval which is at risk of arrhythmias. Objective: Knowing the correlation by looking at the differences in interleukin 6 levels and the length of the QTc interval, the cut-off value of interleukin 6 levels to the length of the QTc interval > 500 ms and the strength of interleukin 6 levels in assessing the risk of ventricular arrhythmias. Method: This study used a cross-sectional study design by taking secondary data from the medical records of COVID-19 patients who were hospitalized at RSCM Kiara from November 2020 to March 2021. In this study, a bivariate analysis was carried out using the Spearman test. Furthermore, an analysis of the mean difference in interleukin 6 levels was carried out in the subject group with a QTc interval length> 500 ms and the subject group with a normal QTc interval length. Analyzes were performed using the Receiver Operating Curve (ROC) to see the area under curve (AUC) and determine the interleukin 6 cutoff point for the QTc interval length> 500 ms. Result: The correlation between interleukin 6 levels and the length of the QTc interval (r=0.72) was found. The median level of interleukin 6 in the group of subjects with a QTc interval > 500 ms was 99.36 pg/ml while in the group of subjects with a normal QTc interval it was 19.51 pg/mL. AUC = 0.852 was obtained to determine the cut-off point for interleukin 6 levels to the QTc interval length > 500 ms with a value of 59 pg/ml, with a sensitivity of 80.6% and specificity of 80%. The incidence of ventricular arrhythmias was not found so that an analysis could not be performed to assess the power of interleukin 6 levels to determine the risk of ventricular arrhythmias. Conclusion: There is a correlation between levels of interleukin 6 and the length of the QTc interval. The mean difference of interleukin 6 levels in subjects with QTc intervals> 500 ms was 5 times greater than those in groups of subjects with normal QTc interval lengths. The level of interleukin 6 59 pg / mL was determined as the cutoff value for the QTc interval length> 500 ms.

Abstrak :
[ABSTRAK
Latar Belakang: Pasien DM dengan ulkus kaki lebih banyak yang mengalamidepresi dan memiliki kualitas hidup yang buruk. Dalam tatalaksana ulkus kaki diabetic perlu diperhatikan faktor psikososial karena diperkirakan dapat mempengaruhi penyembuhan luka melalui induksi gangguan keseimbangan neuroendokrin-imun. Beberapa penelitian mengenai pengaruh depresi pada proses penyembuhan ulkus diabetik telah dilakukan dengan hasil yang masih kontroversial.

Tujuan: Mengetahui pengaruh depresi terhadap proses perbaikan infeksi ulkus kaki diabetik, serta tingkat depresi pada pasien ulkus kaki diabetik rawat inap.

Metode: Observasional, kohort prospektif, terhadap 95 pasien ulkus kaki diabetic terinfeksi yang dirawat di RSCM dan RS jejaring dalam kurun waktu penelitian, terbagi 2 kelompok yaitu kelompok depresi dan kelompok tidak depresi. Data klinis, penilaian depresi, dan data laboratorium diambil saat pasien masuk rumah sakit kemudian dinilai perbaikan infeksi ulkus kaki diabetik dalam 21 hari masa perawatan. Dilakukan analisis bivariat dengan uji Chi-square berdasarkan batas kemaknaan (α) sebesar 5% dan analisis multivariat.

Hasil: Dari 95 subyek penelitian, 38 orang (40%) masuk dalam kelompok tidak depresi, sedangkan kelompok depresi terdiri atas 57 orang (60%). Subyek perempuan jumlahnya dominan pada kelompok depresi (70%). Komorbid terbanyak adalah hipertensi, dengan angka komorbiditas dan penyakit kardivaskular lebih tinggi pada kelompok depresi. Malnutrisi dan obesitas juga lebih banyak pada kelompok depresi (64,9% dan 31,6%), demikian pula dengan kontrol glikemik yang buruk (73,7%). Sebagian besar pasien (73,7%) yang masuk dalam kelompok depresi memiliki depresi ringan. Pada kelompok depresi 40,4% mengalami perbaikan infeksi dalam 21 hari masa perawatan, sedangkan pada kelompok tidak depresi 68,4%.

Simpulan: Depresi cenderung meningkatkan risiko atau kemungkinan tidak terjadinya perbaikan infeksi ulkus kaki diabetik, walaupun setelah dilakukan penyesuaian terhadap variabel perancu, hasil tersebut tidak bermakna secara statistik (adjusted OR 2,429 dengan IK 95% 0,890-6,632). Lebih banyak subjek dengan depresi sedang yang tidak mengalami perbaikan infeksi ulkus kaki diabetik dibandingkan dengan subjek dengan depresi ringan (93,3% dan 47,6%).

---

ABSTRACT
Background: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial.

Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers.

Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis.

Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%.

Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%). ;Background: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial. Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers. Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis. Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%. Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%). ;Background: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial. Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers. Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis. Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%. Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%). , Background: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial. Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers. Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis. Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%. Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%). ]

Abstrak :
Latar belakang: Penyakit kardiovaskular sangat umum ditemukan dan berakibat fatal pada pasien dengan usia lanjut. Disfungsi sistolik ventrikel kiri yang asimptomatik atau subklinis sering kali mendahului penyakit ini. Deteksi dini terhadap disfungsi sistolik ventrikel kiri dapat mengurangi morbiditas dan mortalitas akibat penyakit kardiovaskular. Salah satu metode deteksi dini adalah dengan penilaian global longitudinal strain (GLS). Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui nilai rerata GLS pada pasien usia lanjut dengan frailty maupun non frailty dan mengetahui faktor-faktor yang berhubungan. Metode: Penelitian potong lintang dilakukan pada pasien usia lanjut diatas 60 tahun di poliklinik geriatri dan kardiologi Ilmu Penyakit Dalam RSCM. Data diperoleh dari wawancara, rekam medik dan pemeriksaan ekokardiografi transtorakal. Variabel penelitian berupa usia, frailty, hipertensi, penyakit jantung koroner, dislipidemia, dan diabetes melitus dianalisis sebagai determinan penurunan GLS. Analisis univariat terhadap masing-masing variabel. Analisis bivariat menggunakan uji chi kuadrat dengan tingkat signifikan p<0,25 dan interval kepercayaan (IK) sebesar 95%. Analisis multivariat menggunakan uji regresi logistik. Hasil: Sebanyak 194 subjek yang memenuhi kriteria pemilihan diikutkan dalam penelitian, rerata usia 66 tahun dengan 118 (60,8%) di antaranya perempuan. Penelitian ini mendapatkan beberapa determinan yang memiliki nilai p<0,25 yaitu frailty, hipertensi, dislipidemia, dan diabetes melitus dengan hasil analisis multivariat, frailty memiliki OR sebesar 2,002 (95% IK 1,042-3,925), dan diabetes melitus memiliki OR sebesar 2,278 (95% IK 1,033-5,025). Simpulan : Nilai median GLS pada usia lanjut secara umum adalah sebesar -21,6% (minimal -5,3% sampai dengan maksimal -29,9%). Faktor yang mempengaruhi penurunan GLS adalah frailty dan diabetes melitus.

---

Background: Cardiovascular disease is very common and can be fatal in elderly patients. It is often preceded by asymptomatic or subclinical left ventricular systolic dysfunction (LVSD). Early detection of LVSD can reduce morbidity and mortality due to cardiovascular disease. One method used in the early detection of LVSD is an assessment of global longitudinal strain (GLS). Objective: To determine the mean value of GLS and GLS-related factors. Methods: This cross-sectional study was conducted among elderly patients aged > 60 years in the geriatric and cardiology polyclinic, Internal Medicine, CMH Hospital. Data were obtained from interviews, medical records, and transthoracic echocardiography examination. The variables of age, frailty, hypertension, coronary artery disease, dyslipidemia, and diabetes mellitus were analyzed as the determinants of a decrease in GLS. Univariate analysis was conducted for each variable. Bivariate analysis was conducted using the chi-square test with a significance level of p<0.25 and confidence interval (CI) of 95%, and multivariate analysis used a logistic regression test. Results: A total of 194 patients were admitted according to the study criteria, with a mean age of 66 years. The proportion of women was 60.8%. The study revealed that the determinants with p<0.25 are frailty, hypertension, dyslipidemia, and diabetes mellitus, with multivariate analysis frailty having an OR of 2.002 (95% CI 1.042-3.925) and diabetes mellitus having an OR of 2.278 (95% CI 1.033-5.025). Conclusions : The median value of GLS in elderly is -21,6% (minimum value -5,3% and maximum value 29,9%). The factors that influence the decrease of GLS are frailty and diabetes mellitus.

Abstrak :
ABSTRAK
Latar Belakang: Pada artritis reumatoid diketahui terjadi kehilangan masa tulang, baik secara lokal maupun sistemik (osteoporosis). Inflamasi sistemik pada AR menyebabkan kehilangan massa tulang melalui gangguan homeostasis dimana terjadi resorpsi tulang yang lebih besar dibanding formasi tulang. Peran IL-17 sebagai sitokin proinflamasi diketahui dapat menstimulasi terjadinya osteoklastogenesis dan menghambat osteoblastogenesis melalui pembentukan antagonis jalur Wingless (Wnt) Catenin signalling yaitu DKK-1, SFRP dan sklerostin pada hewan coba dan secara lokal pada sinovium. Namun saat ini belum ada penelitian yang menilai hubungan sitokin proinflamsi IL-17 dengan formasi dan resorpsi tulang secara sistemik pada pasien artritis reumatoid.

Tujuan: Penelitian ini bertujuan untuk menilai hubungan IL-17 terhadap osteoblastogenesis dengan hambatan jalur Wnt melalui DKK-1, SFRP-1 dan sklerostin dan hubungan IL-17 dengan CTX sebagai penanda resorpsi oleh osteoklas dan P1NP sebagai penanda formasi oleh osteoblas.

Metode: Studi potong lintang ini melibatkan 38 perempuan AR premenopause. Pengambilan sampel dilakukan secara konsekutif. Pemeriksaan IL-17, DKK-1, SFRP-1, sklerostin, CTX dan P1NP dilakukan dengan metode ELISA.

Hasil: Pada penelitian ini didapatkan rerata kadar serum IL-17 yaitu 10,61 ± 0,68 pg/ml, rerata kadar DKK-1 4027,29 ± 1516,80 pg/ml, rerata kadar SFRP-1 9,28 ± 3,17 ng/ml, median kadar sklerostin 101,72 (38,36-255,18) pg/ml. Penanda resopsi serum CTX meningkat dengan rerata 2,74 ± 1,37 ng/ml dan penanda formasi serum P1NP menurun dengan median 34,04 (3,46-220,61). Korelasi IL-17 dengan DKK-1 (r=0,142; p=0,396), IL-17 dengan SFRP-1 (r=0,169; p=0,309), IL-17 dengan sklerostin (r=0,061; p=0,718), IL-17 dengan CTX (r=-0,252; p=0,128) dan IL-17 dengan P1NP (r=0,116; p=0,487).

Kesimpulan: Meskipun terdapat penurunan formasi tulang dan peningkatan resropsi tulang, pada penelitian ini tidak terdapat korelasi yang bermakna antara kadar serum IL-17 dengan penghambat jalur Wnt (DKK-1, SFRP-1 dan sklerostin) dan tidak terdapat korelasi yang bermakna antara kadar serum IL-17 dengan penanda turnover tulang (CTX dan P1NP) pada pasien perempuan premenopause dengan artritis reumatoid

---

ABSTRACT
Background: Rheumatoid arthritis is known to have a loss of bone mass, both locally and systemically (osteoporosis). Systemic inflammation in AR causes bone mass loss through interference of homeostasis where bone resorption is greater than bone formation. The role of IL-17 as a proinflammatory cytokine is known to stimulate osteoclastogenesis and inhibit osteoblastogenesis through Wingless (Wnt) pathway antagonists Catenin signalling are DKK-1, SFRP and sclerostin in experimental animals and locally in the synovium. However, there are currently no studies that assess the association of proinflammatory cytokines IL-17 with systemic bone formation and resorption in rheumatoid arthritis patients

Objective: This study aims to assess the relationship of IL-17 to osteoblastogenesis with inhibitor Wnt signalling through DKK-1, SFRP-1 and sclerostin and the association of IL-17 with CTX as a marker of resorption by osteoclasts and P1NP as a marker of formation by osteoblasts

Methods: This cross-sectional study involves 38 premenopausal women with AR. Sampling is done consecutively. IL-17, DKK-1, SFRP-1, sclerostin, CTX and P1NP measurement was done using ELISA

Results: In this study the mean serum IL-17 level was 10.61 ± 0.68 pg/ml, mean serum levels of DKK-1 4027.29 ± 1516.80 pg / ml, mean serum levels of SFRP-1 9.28 ± 3,17 ng / ml, median sclerostin serum level 101.72 (38.36-255.18) pg / ml. Markers of CTX resorption increased with a mean of 2.74 ± 1.37 ng / ml and markers of serum P1NP formation decreased with a median of 34.04 (3.46-220.61) pg/ml. IL-17 correlation with DKK-1 (r = 0.142; p = 0.396), IL-17 with SFRP-1 (r = 0.169; p = 0.309), IL-17 with sclerostin (r = 0.061; p = 0.718), IL-17 with CTX (r = -0.252; p = 0.128) and IL-17 with P1NP (r = 0.116; p = 0.487).

Conclusions: Although there was a decrease in bone formation and increased bone resorption, there was no significant correlation between serum IL-17 levels with Wnt signalling (DKK-1, SFRP-1 and sclerostin) inhibitors and there was no significant correlation between serum IL- 17 with a bone turnover marker (CTX and P1NP) in premenopause AR woman.

Abstrak :
Latar Belakang: Pasien hemodialisis (HD) kronik memiliki peningkatan risiko kematian. Penyakit kardiovaskular seperti aritmia merupakan penyebab kematian utama pasien HD kronik. Kidney Disease Outcome Quality Initiative merekomendasikan HD 3 kali per minggu, tetapi sebagian besar pasien di Indonesia menjalani HD dengan frekuensi 2 kali per minggu. Hal ini menyebabkan interdialytic weight gain, volume ultrafiltrasi, dan laju ultrafiltrasi menjadi lebih besar dan perubahan kadar elektrolit yang mendadak dapat mencetuskan arritmia. Tujuan: Mengetahui pengaruh volume ultrafiltrasi, kadar kalsium ion pre HD, penurunan kadar kalium dan magnesium serum terhadap pemanjangan dispersi QTc pasien yang menjalani HD 2 kali seminggu. Metode: Penelitian ini merupakan penelitian kohort prospektif di lakukan di ruang Hemodialisis RSUPN Dr. Cipto Mangunkusumo, Jakarta. Sebanyak 128 pasien memenuhi kriteria inklusi dan ekslusi. Pemeriksaan kalium, magnesium dan elektrokardiogram untuk menilai dispersi QTc dilakukan sebelum dan sesudah HD serta kalsium ion sebelum HD. Analisis data dihitung menggunakan perangkat SPSS. Perbandingan antara pasien dengan atau tanpa pemanjangan dispersi QTc dilakukan dengan uji Chi-square dan uji Fisher exact untuk data kategorik dan uji T tidak berpasangan untuk data kontinu distribusi normal atau uji Mann whitney bila distribusi tidak normal. Analisis multivariat regresi logistik multivariabel digunakan untuk mengidentifikasi faktor-faktor yang berpengaruh terhadap pemanjangan dispersi QTc. Hasil: Penelitian ini melibatkan 112 pasien. Terdapat pemanjangan dispersi QTc sebanyak 51 %. Pengaruh volume ultrafiltrasitehadap pemanjangan dispersi QTc tidak bermakna secara statistik (risiko relatif 1,069 dan IK (95%) 0,742-1,530 serta p=0,715). Pengaruh perubahan kadar kalium dan kadar kalsium ion pre HD terhadap pemanjangan dispersi QTc tidak bermakna secara statistik (p=0,943 dan p=0,842). Perubahan kadar magnesium terhadap pemanjangan dispersi QTc didapatkan berbeda bermakna secara statistik (p=0,023). Tidak dilakukan analisis multivariat karena hanya terdapat satu variabel dengan p < 0,02. Simpulan: Pengaruh volume ultrafiltrasi, perubahan kadar kalium dan kadar kalsium ion pre HD terhadap pemanjangan dispersi QTc  tidak bermakna secara statistik. Perubahan kadar magnesium terhadap pemanjangan dispersi QTc berbeda bermakna secara statistik. ...... Introduction: Patients with end-stage renal disease (ESRD) requiring hemodialysis have a high mortality rate. Cardiovascular mortality is usually occurs suddenly. Kidney Disease Outcome Quality Initiative recommended three time a week HD but in Indonesia only two time a week HD. Two time a week HD increase the risk of higher interdialytic weight gain and  ultrafiltration volume (UFV) contributing to high serum electrolyte changes that cause arrhytmia.  Objective: The aim of this study is to find effect of ultrafiltration volume, serum potassium changes, pre hemodialysis serum ionic calsium, serum magnesium changes on increased QTc dispersion in chronic hemodialysis patients twice a week. Methode: This study is a prospective cohort study. A total 112 patient underwent twice-weekly regimens of HD in Cipto Mangunkusumo Hospital, Jakarta. Blood samples were Drawn for measurement of serum electrolytes, and a 12-lead ECG were performed to measure the QTc interval and QTc dispersion, immediately before and just after dialysis sessions. Analyzes were performed with SPSS. Chi-square or Fisher exact was used to compare QTc dispersion changes before and after dialysis and ultrafiltration volume. Paired t test was used to compare QTc dispersion changes and serum electrolytes before and after dialysis within the study group. Mann Whitney test was used for abnormal distribution. Multivariate analysis was used to find effect of ultrafiltration volume, serum potassium changes, pre HD serum ionic calsium, serum magnesium changes on increased QTc dispersion in chronic hemodialysis patients twice a week.  Result: One hunDred twelve patients underwent twice weekly HD  were analyzed. Proportion of patients with prolong of QTc dispersion was 51 %.  The effect of ultrafiltration volume with the prolong of QTc dispersion was not statistically significant (relative risk 1,069, CI (95%) 0,742-1,530, p=0,715). The effect of serum potassium changes and pre HD serum ionic calsiumon increased QTc dispersion were not statistically significant (p=0,943 and p=0,842). The effect of serum magnesium changes with the elevated of QTc dispersion was statistically significant (p=0,023). Multivariate analysis was not done. Conclusion: The effect of ultrafiltration volume, serum potassium changes and Pre HD serum ionic calsium on increased QTc dispersion was not statistically significant. The effect of serum magnesium changes with the elevated of QTc dispersion was statistically significant.

Abstrak :
Latar Belakang: COVID-19 dapat menimbulkan konsekuensi kesehatan jangka panjang yang serius, yang disebut Post-COVID-19 Syndrome (SPC). Saat ini, bukti dan pemahaman yang tersedia tentang manajemen SPC masih terbatas. Oleh karena salah satu gejala SPC dikaitkan dengan gejala psikis, maka psikoterapi dipercaya memiliki peran dalam penatalaksanaan SPC. Tujuan: Mengetahui efektivitas psikoterapi suportif pada pasien SPC di RSUPN dr. Cipto Mangunkusumo. Metode: Penelitian ini merupakan penelitian klinis acak tersamar tunggal menggunakan kontrol sebelum-setelah intervensi. Peserta secara acak dibagi menjadi dua kelompok: kelompok psikoterapi yang terdiri dari 40 peserta dan kelompok edukasi yang terdiri dari 37 peserta. Setiap kelompok diberikan psikoterapi atau edukasi berbasis internet tiga kali seminggu dalam bentuk kelompok yang terdiri dari 6-8 peserta. Kuesioner Symptom Checklist-90 digunakan untuk mengevaluasi gejala psikis dan somatik. Variabilitas Denyut Jantung (VDJ) dan Rasio Limfosit Neutrofil (RNL) juga dinilai. Analisis data dilakukan dengan menggunakan uji Mann-Whitney atau uji T tidak berpasangan. Hasil: Perbaikan skor SCL-90 ditemukan sebesar 17,51 (SD 30,52) pada kelompok psikoterapi dan 19,79 (SD 35,11) pada kelompok edukasi (p = 0,771). Baik psikoterapi maupun edukasi meningkatkan RNL sebanyak 0,03 (IQR -0,17 – 0,27) pada kelompok psikoterapi dan 0,085 (IQR -0,385 – 0,41) pada kelompok edukasi (p = 0,534). Baik psikoterapi maupun edukasi juga menurunkan VDJ sebesar 3,83 (RIK -7,245 – 5,605) pada kelompok psikoterapi dan 0,705 (RIK -6,49 – 4,462) pada kelompok edukasi (p = 0,827). Simpulan: Baik psikoterapi suportif kelompok dan edukasi berbasis internet memperbaiki secara bermakna gejala psikis dan somatik pasien SPC, meskipun tidak didapatkan perbedaan bermakna antara kelompok psikoterapi dan edukasi. Baik psikoterapi suportif kelompok dan edukasi berbasis internet tidak memperbaiki RNL dan VDJ. Saran dilakukan penelitian lebih lanjut dengan melakukan penambahan frekuensi sesi psikoterapi kelompok berbasis internet kepada pasien SPC dan dilaksanakan pada pagi hari untuk mencapai hasil yang lebih optimal. ...... Background: COVID-19 can have serious long term health consequences, which is called Post-COVID-19 Syndrome (PCS). Currently, the available evidence and understanding of PCS management is limited. Because one of the symptoms of PCS is associated to psychological symptoms, psychotherapy is believed to have a role in the management of PCS. Objective: To identify the effectiveness of supportive psychotherapy in PCS patients at Cipto Mangunkusumo National General Hospital. Methods: This study was a single blind randomized clinical trial using a pre-and post-test with control group study design. Participants were randomly divided into two groups: a psychotherapy group with 40 participants and an education group with 37 participants. Each group was given internet-based psychotherapy or education three times a week in a form of group consisting of 6-8 participants. Symptom Checklist-90 questionnaire was used to evaluate somatic and psychological symptoms. Heart rate variability and neutrophil lymphocyte ratio were also investigated. Data analysis was performed using either the Mann-Whitney test or the independent T test. Results: An improvement in the SCL-90 score was found to be 17.51 (SD 30.52) in the psychotherapy group and 19.79 (SD 35.11) in the education group (p = 0.771). Both psychotherapy and education increased NLR by 0.03 (IQR -0.17 – 0.27) in the psychotherapy group and 0.085 (IQR -0.385 – 0.41) in the education group (p = 0.534). Both psychotherapy and education also decreased HRV by 3.83 (RIK -7.245 – 5.605) in the psychotherapy group and 0.705 (RIK -6.49 – 4.462) in the education group (p = 0.827). Conclusion: Both internet-based group supportive psychotherapy and education improved psychological and somatic symptoms in PCS patients, although there was no significant difference between supportive psychotherapy and education groups. Both internet-based group supportive psychotherapy and education did not improve NLR and HRV. Suggestions for further research regarding adding frequency of internet-based group psychotherapy in PCS patients and held in the morning to achieve more optimal results.