Hasil Pencarian  ::  Simpan CSV :: Kembali

"Latar Belakang: Penelitian pengaruh terapi reperfusi terhadap kesintasan satu tahun pasien STEMI usia lanjut sudah diteliti di negara lain sebelumnya, namun penelitian tersebut di Indonesia belum pernah dilakukan. Karena adanya perbedaan karakteristik, demografi dan budaya serta adanya kontroversi pemilihan terapi sehingga penelitian ini dilakukan. Penelitian-penelitian terdahulu belum banyak yang menggunakan analisis kesintasan, sehingga data survival pasien STEMI usia lanjut yang dilakukan terapi reperfusi sulit didapatkan.Tujuan: Mengetahui pengaruh terapi reperfusi terhadap kesintasan satu tahun pada pasien STEMI usia lanjut.Metode: Penelitian menggunakan metode kohort retrospektif dengan analisis kesintasan. Sampel dikumpulkan dari pasien STEMI usia lebih dari atau samadengan 60 tahun yang dirawat di ICCU RSCM januari 2007- mei 2013, yang kemudian dibagi menjadi dua kelompok yaitu pasien yang mendapat terapi reperfusi dan tidak reperfusi. Kurva Kaplan-Meier digunakan untuk mengetahui kesintasan masing-masing kelompok. Analisis bivariat mengunakan uji log-rank, analisis multivariat menggunakan cox proportional hazard regression. Besarnya hubungan variabel terapi reperfusi dengan kesintasan dinyatakan dengan crude HR dan IK 95% serta adjusted HR dan IK 95% setelah dimasukkan variabel perancu.Hasil: Terdapat 185 pasien STEMI usia lanjut yang dibagi menjadi dua kelompok yaitu 86 pasien kelompok terapi reperfusi dan 99 pasien kelompok tidak reperfusi. Hasil penelitian ini kelompok terapi reperfusi menurunkan mortalitas pada STEMI usia lanjut dengan crude HR 0,16 (0,07-0,33), p value <0,001, dengan kesintasan kumulatif satu tahun pasien STEMI usia lanjut yang dilakukan terapi reperfusi yaitu 91% (SE 3,1%), sedangkan kelompok tidak reperfusi 54% (SE % 5,0%). Rerata kesintasan pada kelompok terapi reperfusi 339,38 hari, dan kelompok tidak reperfusi 216,71 hari. Analisis multivariat menunjukkan terapi reperfusi merupakan prediktor independen terjadinya kesintasan satu tahun (Adjusted HR 0,17; IK95% 0,08-0,37).Simpulan: Terapi reperfusi memperbaiki kesintasan satu tahun pada pasien STEMI usia lanjut.

---

Background: This study was done because of the effect of reperfusion therapy on one year survival in elderly STEMI patients has not been studied in Indonesia. There are differences in characteristic, demographic and culture of elderly patients that had been studied in other countries and there are still controversies of therapy modality in elderly STEMI patients. Most of previous studies do not use survival analysis, hence, survival data of elderly STEMI patients is still limited.

Aim: To know about the effect of reperfusion therapy on one year survival in elderly STEMI patients.

Methods: Retrospective study was done with survival analysis approach. Sample was collected from STEMI patients aged > 60 years old that admitted to hospital in golden period (less than twelve hours) who was hospitalized in ICCU RSCM from january 2007 to may 2013, divided to reperfusion therapy and not reperfusion therapy group. Kaplan Meier curve was used to know survival in each group. Bivariate analysis was done by log rank test and multivariate analysis was done by cox proportional hazard regression test. The relation between reperfusion therapy variables with one year survival denoted as crude HR and 95%CI then as adjusted HR and 95%CI after confounding factors were calculated.

Results: There are 185 STEMI elderly patients that divided into two groups : 86 patients in reperfusion therapy group and 99 patients in not reperfusion therapy group. The result is reperfusion therapy reduces mortality in elderly STEMI patient with crude HR 0,16 (0,07-0,33), p value <0,001, One year survival cumulative in reperfusion therapy group is 91% ( SE 3,1%) and 54% ( SE 5,0%) in not reperfusion therapy group. Mean survival of reperfusion therapy group is 339,38 days, and the not reperfusion therapy group is 216,71 days. Multivariate analysis shows that reperfusion therapy is an independent predictor in one year survival of elderly STEMI patients (Adjusted HR 0,17 ; 95%CI 0,08-0,37).

Conclusion: Reperfusion therapy improves one year survival in elderly STEMI patients."

"Latar belakang. Berbagai studi sebelumnya menunjukkan bahwa insidens kolonisasi dan infeksi C.difficile semakin meningkat, terutama pada pasien rawat inap yang mendapat terapi antibiotika. Namun belum ada penelitian yang mendapatkan data kedua insidens tersebut di Indonesia, terutama di RSCM. Tujuan. Untuk mengetahui insidens kolonisasi dan infeksi C.difficile pasien rawat inap yang mendapat terapi antibiotika di RSCM. Metode. Dilakukan studi kohort prospektif berbasis surveilans pada 96 pasien rawat inap yang mendapat terapi antibiotika di RSCM pada periode penelitian. Dilakukan pemeriksaan feses dengan uji kromatografi cepat C.DIFF QUIK CHEK COMPLETETM pada awal dan akhir penelitian. Dilakukan follow-up selama 5-7 hari perawatan pada semua pasien. Insidens kolonisasi strain non-toksigenik adalah pasien yang memiliki hasil pemeriksaan fesesnya konversi GDH/Toksin -/- saat awal perawatan menjadi GDH/Toksin +/-. Insidens kolonisasi strain toksigenik adalah pasien yang memiliki konversi GDH/Toksin -/- saat awal perawatan menjadi GDH/Toksin +/+. Insidens infeksi adalah pasien yang memiliki konversi GDH/Toksin -/- saat awal perawatan menjadi GDH/Toksin +/+ yang disertai satu atau lebih gejala yang berhubungan dengan infeksi C.difficile. Hasil. Dari 96 subjek penelitian, 13 subjek mengalami kolonisasi non-toksigenik; 8 subjek mengalami kolonisasi toksigenik; 9 subjek mengalami infeksi. Terdapat 11 subjek yang mengalami gejala klinis, namun hasil pemeriksaan fesesnya tidak ditemukan toksin yang positif (2 subjek hanya mengalami kolinisasi non-toksigenik dan 9 subjek tidak mengalami kolonisasi atau infeksi) sehingga dianggap bukan merupakan infeksi C.difficile. Kesimpulan. Insidens kolonisasi C.difficile adalah 22%, dimana kolonisasi strain non-toksigenik adalah 14% (IK95% 13-16) dan strain toksi.

---

Background. Previous studies showed that there have been a significant increasing of the incidence of C.difficile colonization and infection, particularly among hospital inpatients prescribed antibiotics. However, there is no such data available in Indonesia, mainly at Cipto Mangunkusumo Hospital.

Objective. To determine the incidence of Clostridium difficile colonization and infection among hospital inpatients prescribed antibiotics at Cipto Mangunkusumo Hospital.

Methods. A surveillance-based prospective cohort study was conducted on 96 inpatients prescribed antibiotics at Cipto Mangunkusumo Hospital during the study period. All patient was followed-up for 5-7 days hospitalization. We obtained rectal swabs or stool samples on admission and day 5-7 of hospitalization and performed a rapid chromatography test C.DIFF QUIK CHEK COMPLETETM to determine colonization or infection. Incidence of non-toxigenic colonization was defined as a conversion of baseline result GDH/toxin -/- into GDH/toxin +/- as the second result. Incidence of toxigenic colonization was defined as as a conversion of baseline result GDH/toxin -/- into GDH/toxin +/+ as the second result. Incidence of infection was defined as a conversion of baseline result GDH/toxin -/- into GDH/toxin +/+ as the second result, accompanied by one or more C.difficile infection-associated clinical symptoms.

Results. A total of 96 subjects were included in the study; 13, 8 and 9 had a non-toxigenic colonization, toxigenic colonization, and infection, respectively. 11 subjects with clinical symptoms could not be determined whether they had a C.difficile infection because of the “toxin-negative” findings from their stool examination (2 subjects had non-toxigenic colonization and 9 subjects had neither colonization nor infection).

Conclusion. The incidence of C.difficile colonization was 22%, which 14% (95% CI 13-16) was the incidence of non-toxigenic colonization and 8% (95% CI 7-10) was the incidence of toxigenic colonization. The incidence of C.difficile infection was 9% (95% CI 8-11)."

"Latar Belakang: Osteoartritis (OA) lutut merupakan OA simptomatik yang paling banyak diderita dan menimbulkan hendaya. Tujuan tatalaksana penyakit kronis seperti OA lutut adalah tercapainya kualitas hidup terkait kesehatan yang baik. kibat prevalensi OA lutut yang meningkat sejalan dengan usia, maka komorbiditas sangat umum ditemukan pada penderitanya. Komorbiditas diduga sebagai faktor yang mempengaruhi kualitas hidup terkait kesehatan pada pasien OA lutut.Tujuan: Mengetahui hubungan indeks komorbiditas dengan kualitas hidup terkait kesehatan pada pasien OA lutut simptomatik.Metode: Desain penelitian adalah studi potong lintang dan dilakukan di Poliklinik Rematologi Rumah Sakit Cipto Mangunkusumo, Jakarta. Kualitas hidup terkait kesehatan diukur menggunakan instrumen generik Medical Outcome 36- Items Short Form (SF-36) Health Status Survey yang diisi secara subjektif oleh subjek. Indeks komorbiditas dinilai oleh peneliti menggunakan instrumen Cumulative Illness Rating Scale (CIRS). Analisis hubungan dilakukan dengan uji Chi-square dan alternatifnya, yaitu uji Fisher Exact.Hasil: Mayoritas subjek penelitan adalah wanita dengan rerata usia 62,62 tahun (SD8,02). Faktor risiko terbanyak OA lutut adalah berat badan lebih atau obes. Rerata IMT subjek adalah 27,54 kg/m2 (SD 4,44). Sebanyak 86,1% subjek memiliki ringkasan komponen fisik kualitas kehidupan terkait kesehatan yang buruk. Sedangkan 72,2% subjek memiliki ringkasan komponen mental kualitas hidup terkait kesehatan baik. Sebanyak 98,7% memiliki >1 komorbid. Tiga sistem komorbiditas terbanyak adalah endokrin- metabolik, vaskuler, serta muskuloskeletal dan integumen. Nilai median indeks komorbiditas CIRS adalah 1,68 (0-2,33) dengan kategori terbanyak adalah indeks komorbiditas sedang. Dalam analisis bivariat, tidak ditemukan hubungan indeks komorbiditas dengan ringkasan komponen fisik kualitas hidup terkait kesehatan (RO= 1,11; IK95%= 0,26-4,75), maupun dengan ringkasan komponen mental kualitas hidup terkait kesehatan (RO=1,21; IK95%= 0,41-3,61).Simpulan: Tidak terdapat hubungan antara indeks komorbiditas dengan komponen kualitas hidup terkait kesehatan, baik komponen fisik maupun mental pada pasien OA lutut simptomatik. Kondisi komorbiditas dan kualitas hidup yang homogen pada populasi studi ini mungkin berkontribusi terhadap hal ini.

---

Background: Knee osteoarthritis (OA) is the most prevalent symptomatic OA among adults and is the leading cause of disability. The ultimate treatment goal in such chronic disease is to achieve a good health related quality of life (HRQoL). Since knee OA prevalence is increasing throughout age, comorbidity become common condition. Comorbidity is presumed as contributing factor unto health related quality of life in knee OA patient.

Objective: To evaluate the relation between comorbidity index and health related quality of life in symptomatic knee OA patient.

Methods: This was a cross-sectional study conducted in Rheumatology Policlinic Cipto Mangunkusumo Hospital, Jakarta. HRQol was measured with a selfassesment generic instrument Medical Outcome 36- Items Short Form (SF-36) Health Status Survey. Comorbidity index was measured by researcher with Cumulative Illness Rating Scale (CIRS). Bivariate analysis was performed by using Chi-square test and its alternative Fisher Exact Test.

Results: Most subjects were woman with mean age of 62,62 years (SD8,02). The most prevalent risk factor was overwight or obesity. Mean value for body mass index in this study was 27,54 kg/m2 (SD 4,44). Eighty six percent of subjects were having poor physical component summary (PCS) of HRQoL. Whereas 72,2% of subjects waere having good mental component summary (MCS) of HRQoL. Ninety eight point seven percent subjects were having >1 comorbidity(ies). The three top positive comorbidity system were endocrine- metabolic, vascular, and musculosceletal and integument. The median value of comorbidity index was 1,68 (0-2,33) which is resembled moderate comorbidity index. There was no relation has been found in bivariate analysis between comorbidity index and PCS (OR= 1,11; CI95%= 0,26-4,75), neither with MCS (OR=1,21; CI95%= 0,41-3,61).

Conclusion: There is no relation between comobidity index and HRQoL, both physically and mentally component in symptomatic knee OA patients. The homogenicity of comorbidity condition and HRQoL in subjects may contributed to the result."

"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.

---

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."

"ABSTRAK Latar Belakang. Prevalensi disfungsi tiroid lebih tinggi pada pasien diabetes dibandingkan populasiumum. Hipotiroidisme memperburuk komplikasi, morbiditas, mortalitas, dan kualitas hidup pasiendiabetes melitus tipe 2 (DM tipe 2). Faktor risiko hipotiroidisme pada pasien DM tipe 2 selama ini masihkontradiktif dan belum dikaji secara lengkap. Keberadaan sistem skor hipotiroidisme pada pasien DMtipe 2 diperlukan untuk membantu diagnosis dan menapis pasien DM tipe 2 yang memerlukanpemeriksaan laboratorium fungsi tiroid sebagai baku emas diagnosis hipotiroidisme.Tujuan. Mengetahui prevalensi dan determinan hipotiroidisme pada pasien DM tipe 2.Metode. Penelitian dengan desain potong lintang dilakukan di Poliklinik Divisi Metabolik Endokrin(Poliklinik Diabetes) RSCM pada Juli sampai September 2015 dengan metode sampling konsekutif.Subjek menjalani anamnesis, pemeriksaan fisis, dan pemeriksaan laboratorium (TSH dan fT4). Analisisdata dilakukan dengan program statistik SPSS Statistics 17.0 untuk analisis univariat, bivariat,multivariat, dan Receiving Characteristics Operator (ROC) dan SPSS Statistics 20.0 untuk analisisbootstrapping pada Kalibrasi Hosmer-Lemeshow.Hasil. Sebanyak 303 subjek dianalisis untuk mendapatkan proporsi disfungsi tiroid dan 299 subjekdianalisis untuk mendapatkan determinan hipotiroidisme. Sebanyak 23 subjek (7,59%) terdiagnosishipotiroidisme, terdiri dari 43,5% subjek hipotiroid klinis dan 56,5% subjek hipotiroid subklinisberdasarkan Indeks Zulewski dan/atau Indeks Billewicz, dengan 16,7% hipotiroid klinis dan 83,3%hipotiroid subklinis berdasarkan hasil pemeriksaan fT4. Determinan hipotiroidisme pada pasien DMtipe 2 adalah riwayat penyakit tiroid di keluarga dengan OR sebesar 4,719 (95% IntervalKepercayaan/IK 1,07-20,8, p = 0,04), keberadaan goiter dengan OR sebesar 20,679 (95% IK 3,49122,66, p = 0,001),kontrol glikemik yang buruk dengan OR sebesar 3,460 (95%IK 1,075-11,14, p = 0,037), dan adanya sindrom metabolikOR sebesar 25,718 (95% IK 2,21-299,99, p = 0,01). Simpulan. Proporsi hipotiroidisme pada pasien DM tipe 2 adalah 7,59%. Determinan diagnosis dan komponen sistem skor hipotiroidisme pada pasien DM tipe 2 adalah riwayat penyakit tiroid di keluarga, keberadaan goiter, kontrol glikemik yang buruk, dan adanya sindrom metabolik. Sistem skor yang diberi nama Skor Hipotiroid RSCM ini diharapkan menjadi alat bantu diagnosis hipotiroidisme pada pasienDM tipe 2. ABSTRACT Background. Prevalence of thyroid dysfunction is greater in diabetes patients compared to generalpopulation. Hypothyroidism is worsening complications, morbidity, mortality, and quality of life in type2 diabetes mellitus (T2DM) patients. Risk factors of hypothyroidism in T2DM patients are stillcontradictive and not assessed completely. Presence of scoring system to estimate hypothyroidism inT2DM patients are needed to help diagnosing and screening of T2DM patients who need to undergothyroid function test as a gold standard diagnostic for hypothyroidism.Aim. To identify prevalence and estimators of hypothyroidism in T2DM patients.Methods. A cross-sectional study was conducted in Metabolic Endocrine (Diabetes) Outpatient ClinicCipto Mangunkusumo Hospital from July-September 2015 with consecutive sampling method. Allsubjects underwent interview, physical examination, and laboratory testing (TSH and fT4). Analysiswas done by using SPSS Statistics 17.0 for univariate, bivariate, multivariate, and ROC (ReceivingOperator Characteristics) analysis and SPSS Statistics 20.0 for bootstrapping analysis in HosmerLemeshowCalibration. Results. 303 subjects included for proportion study of thyroid dysfunction and 299subjects included for analysis of hypothyroidism determinants. 23 subjects (7,59%) are diagnosed as havinghypothyroidism, consisted of 43,5% clinical hypothyroidism and 56,5% subclinical hypothyroidismbased on clinical scoring index by Zulewski and Billewicz, and 16,7% subjects as having clinicalhypothyroidism and 83,3% subjects as having subclinical hypothyroidism based on fT4 examination.Determinants for hypothyroidism in T2DM patients are family history of thyroid disease with OR 4,719(95% Confident Interval/CI 1,07-20,8, p = 0,04), having goiter or difus struma with OR 20,679 (95%CI 3,49-122,66, p = 0,001), poor glycemic control with OR 3,460 (95% CI 1,075-11,14, p = 0,037), and metabolic syndrome with OR 25,718 (95% CI 2,21-299,99, p = 0,01). Conclusion. Proportion of hypothyroidism in T2DM patients is 7,59%. Determinants and componentsof scoring system of hypothyroidism in T2DM patients consist of family history of thyroid disease,having goiter or difus struma, poor glycemic control, and metabolic syndrome. Scoring system which iscalled RSCM Hypothyroid Score is expected to be a tool for helping diagnosis of hypothyroidism inT2DM patients.;Background. Prevalence of thyroid dysfunction is greater in diabetes patients compared to generalpopulation. Hypothyroidism is worsening complications, morbidity, mortality, and quality of life in type2 diabetes mellitus (T2DM) patients. Risk factors of hypothyroidism in T2DM patients are stillcontradictive and not assessed completely. Presence of scoring system to estimate hypothyroidism inT2DM patients are needed to help diagnosing and screening of T2DM patients who need to undergothyroid function test as a gold standard diagnostic for hypothyroidism.Aim. To identify prevalence and estimators of hypothyroidism in T2DM patients.Methods. A cross-sectional study was conducted in Metabolic Endocrine (Diabetes) Outpatient ClinicCipto Mangunkusumo Hospital from July-September 2015 with consecutive sampling method. Allsubjects underwent interview, physical examination, and laboratory testing (TSH and fT4). Analysiswas done by using SPSS Statistics 17.0 for univariate, bivariate, multivariate, and ROC (ReceivingOperator Characteristics) analysis and SPSS Statistics 20.0 for bootstrapping analysis in HosmerLemeshowCalibration. Results.303subjectsincludedforproportionstudyofthyroiddysfunctionand299subjectsincludedforanalysis of hypothyroidism determinants. 23 subjects (7,59%) are diagnosed as havinghypothyroidism, consisted of 43,5% clinical hypothyroidism and 56,5% subclinical hypothyroidismbased on clinical scoring index by Zulewski and Billewicz, and 16,7% subjects as having clinicalhypothyroidism and 83,3% subjects as having subclinical hypothyroidism based on fT4 examination.Determinants for hypothyroidism in T2DM patients are family history of thyroid disease with OR 4,719(95% Confident Interval/CI 1,07-20,8, p = 0,04), having goiter or difus struma with OR 20,679 (95%CI 3,49-122,66, p = 0,001), poor glycemic control with OR 3,460 (95% CI 1,075-11,14, p = 0,037), and metabolic syndrome with OR 25,718 (95% CI 2,21-299,99, p = 0,01).Conclusion. Proportion of hypothyroidism in T2DM patients is 7,59%. Determinants and componentsof scoring system of hypothyroidism in T2DM patients consist of family history of thyroid disease,having goiter or difus struma, poor glycemic control, and metabolic syndrome. Scoring system which iscalled RSCM Hypothyroid Score is expected to be a tool for helping diagnosis of hypothyroidism inT2DM patients.;Background. Prevalence of thyroid dysfunction is greater in diabetes patients compared to generalpopulation. Hypothyroidism is worsening complications, morbidity, mortality, and quality of life in type2 diabetes mellitus (T2DM) patients. Risk factors of hypothyroidism in T2DM patients are stillcontradictive and not assessed completely. Presence of scoring system to estimate hypothyroidism inT2DM patients are needed to help diagnosing and screening of T2DM patients who need to undergothyroid function test as a gold standard diagnostic for hypothyroidism.Aim. To identify prevalence and estimators of hypothyroidism in T2DM patients.Methods. A cross-sectional study was conducted in Metabolic Endocrine (Diabetes) Outpatient ClinicCipto Mangunkusumo Hospital from July-September 2015 with consecutive sampling method. Allsubjects underwent interview, physical examination, and laboratory testing (TSH and fT4). Analysiswas done by using SPSS Statistics 17.0 for univariate, bivariate, multivariate, and ROC (ReceivingOperator Characteristics) analysis and SPSS Statistics 20.0 for bootstrapping analysis in HosmerLemeshowCalibration. Results.303subjectsincludedforproportionstudyofthyroiddysfunctionand299subjectsincludedforanalysis of hypothyroidism determinants. 23 subjects (7,59%) are diagnosed as havinghypothyroidism, consisted of 43,5% clinical hypothyroidism and 56,5% subclinical hypothyroidismbased on clinical scoring index by Zulewski and Billewicz, and 16,7% subjects as having clinicalhypothyroidism and 83,3% subjects as having subclinical hypothyroidism based on fT4 examination.Determinants for hypothyroidism in T2DM patients are family history of thyroid disease with OR 4,719(95% Confident Interval/CI 1,07-20,8, p = 0,04), having goiter or difus struma with OR 20,679 (95%CI 3,49-122,66, p = 0,001), poor glycemic control with OR 3,460 (95% CI 1,075-11,14, p = 0,037), and metabolic syndrome with OR 25,718 (95% CI 2,21-299,99, p = 0,01).Conclusion. Proportion of hypothyroidism in T2DM patients is 7,59%. Determinants and componentsof scoring system of hypothyroidism in T2DM patients consist of family history of thyroid disease,having goiter or difus struma, poor glycemic control, and metabolic syndrome. Scoring system which iscalled RSCM Hypothyroid Score is expected to be a tool for helping diagnosis of hypothyroidism inT2DM patients."

"Latar Belakang: Jumlah usia lanjut (Usila) makin meningkat dan tumbuh cepat, yang membawa konsekuensi meningkatnya gangguan terkait usia, termasuk penurunan fungsi kognitif. Penelitian ini bertujuan untuk mengetahui efek pemberian aktivitas berjalan kaki terstruktur, yaitu minimal 6000 langkah/hari, terintegrasi dalam aktivitas sehari-hari dengan kecepatan yang nyaman selama 12 minggu, dalam memelihara fungsi kognitif pada usia lanjut dengan fungsi kognitif normal di komunitas. Metode: Desain penelitian ini adalah studi ekperimental, berupa uji klinis acak tersamar tunggal. Subyek terdiri dari 20 orang Usila pada kelompok perlakuan yang diberikan aktivitas berjalan kaki terstruktur, dan 19 orang Usila pada kelompok kontrol yang beraktivitas sebagaimana biasanya, selama 12 minggu. Subyek dinilai fungsi kognitifnya menggunakan MoCA Ina pada awal dan akhir perlakuan. Aktivitas berjalan kaki diukur menggunakan pedometer. Hasil: Aktivitas berjalan kaki terstruktur yang mampu dilakukan oleh kelompok perlakuan adalah 7531 langkah/hari, dan kelompok kontrol adalah 3527 langkah/hari (p=0,000). Pada akhir penelitian, skor total MoCA pada kelompok perlakuan (median=29) adalah lebih tinggi (p=0,022) dibandingkan kelompok kontrol (median=27), dan begitu pula untuk selisih skor MoCA antara awal dan akhir penelitian (rerata selisih pada kelompok perlakuan adalah 3,35; kelompok kontrol adalah 1,47; p=0,003). Efek perlakuan pada domain fungsi kognitif menunjukkan skor Visuospasial/Fungsi Eksekusi secara siknifikan (p=0,08) lebih tinggi pada kelompok perlakuan dibandingkan kelompok kontrol. Selisih skor domain MoCA pada awal dan akhir penelitian ditemukan lebih besar pada kelompok perlakuan pada domain Visuospasial/Fungsi Eksekusi, Bahasa, dan Abstraksi. Kesimpulan: Aktivitas berjalan kaki terstruktur 7500 langkah/hari memiliki efek positif dalam memelihara fungsi kognitif usia lanjut secara umum, dengan domain yang paling dipengaruhi adalah Visuospasial/Fungsi Eksekusi. Aktivitas ini juga memberikan peningkatan yang lebih besar pada fungsi kognitif secara umum dan pada domain Visuospasial/Fungsi Eksekusi, Bahasa, dan Abstraksi.

---

Background: Fast growing of elderly population increases disorders related to aging, including decreasing of cognitive function. The objective of this study is to evaluate the effect of structured walking activity, that characterized by minimally 6000 steps/day, integrated to daily activities, with comfortable pace, for 12 week, in maintaining cognitive function in elderly with normal cognitive function in community.

Method: This study design was experimental, single-blind randomized controlled trial. The subjects were 39 elderly, consist of 20 subjects in intervention group and 19 subject in control group. Intervention group were given structured walking activity, and control group did their usual activity, for 12 weeks. Cognitive function were assessed using MoCA Ina in the beginning and end of the study. Walking activity was measured using pedometer.

Results: Amount of walking activity that was able to do was 7531 steps/day in intervention group, and 3527 steps/day in control group (p=0,000). In the end of study, total MoCA score in intervention group (median=29) is significantly better (p=0,022) than control group (median=27), and so did the improvement of MoCA score in the end of study (mean of increasing score in intervention group was 3,35, and in control group was 1,47, p=0,003). Effect on domain of cognitive function showed Visuospatial/Executive function score in intervention group was signifantly better than control group. Improvement in Visuospatial/Excecutive function, Language, and Abstraction domains‟ score was also found larger in intervention group.

Conclusion: Structured walking activity, about 7500 steps/day had a positive effect in maintaining general cognitive function in elderly, and Visuospatial/Executive function was the most influenced domain. The effect of this activity also showed larger improvements in general cognitive function and Visuospatial/Excecutive function, Language, and Abstraction domains."

"Proses penuaan mengakibatkan perubahan fisiologis yang terkait dengan masalah kesehatan pada orang usia lanjut (usila). Penyakit degeneratif merupakan faktor risiko terjadinya gangguan kognitif pada orang usila. Terbentuknya akumulasi amyloid β (Aβ) merupakan hal utama terjadinya gangguan kognitif. Mineral seng memiliki peran penting sebagai antioksidan dan proses akumulasi Aβ. Penelitian ini dilakukan dengan desain potong lintang pada 58 orang usila di Kelurahan Kartini yang dilaksanakan pada bulan Januari 2019 untuk mengetahui korelasi kadar seng rambut dengan fungsi kognitif pada populasi usila. Pemeriksaan kadar seng rambut dengan inductively coupled plasma spectrometer (ICPS) dan fungsi kognitif dinilai dengan instrumen abbreviated mental test (AMT). Data dianalisis dengan menggunakan uji korelasi. Rerata usia subjek 65,4 ± 4,4 tahun. Nilai median asupan seng sebesar 5,65 (3,2-13,3) mg/hari. Rerata kadar seng rambut sebesar 123,23 ± 69,71 µg/gram rambut. Sebagian besar memiliki fungsi kognitif normal (91,4%). Hasil penelitian ini menunjukkan bahwa tidak terdapat korelasi asupan seng dengan kadar seng rambut (p=0,349 ; r= -0,125) serta tidak ditemukan adanya korelasi kadar seng rambut dengan fungsi kognitif pada populasi usila (p=0,871 ; r= -0,022). Kesimpulan penelitian ini adalah tidak terdapat korelasi antara kadar seng rambut dengan fungsi kognitif pada populasi usila.

---

Aging process cause physiological changes related to health problems in elderly. Degenerative diseases are the risk factor for cognitive impairment in elderly. Amyloid β (Aβ) accumulation is the major cause of cognitive impairment. Zinc has an important role in antioxidant and Aβ accumulation process. A cross sectional study of 58 elderly subjects was done at Kartini Regency in January 2019 to evaluate the correlation between hair zinc level and cognitive function in elderly population. Hair zinc level was measured by inductively coupled plasma spectrometer (ICPS) and cognitive function assessed by abbreviated mental test (AMT). Data analysis was done by correlation test. The mean age was 65.4 ± 4.4 years. The median value of zinc intake was 5.65 (3.2 - 13.3) mg/day. The mean hair zinc level was 123.23 ± 69.71 µg/gram hairs. Almost all subjects had normal cognitive function (91.4%). The results of this study indicate that there was no correlation between zinc intake and hair zinc level (p=0.349 ; r= -0.125) and there was no correlation between hair zinc level and cognitive function in elderly population (p=0.871 ; r= -0.022). In conclusion, there was no correlation hair zinc level and cognitive function in elderly population. "

"ABSTRAKLatar Belakang. Dengan meningkatnya jumlah populasi usia lanjut, masalah kesehatan yang dialami juga semakin banyak, salah satunya malnutrisi. Studi di luar negeri menunjukkan malnutrisi pada pasien geriatri yang dirawat di rumah sakit menurunkan kesintasan. Pasien usia lanjut di Indonesia mempunyai karakteristik yang berbeda dengan pasien usia lanjut di luar negeri. Di Indonesia belum ada studi tentang status nutrisi pasien usia lanjut yang dirawat di rumah sakit dan pengaruhnya terhadap kesintasan.Tujuan. Mengetahui pengaruh status nutrisi terhadap kesintasan 30 hari pasien usia lanjut yang dirawat di ruang rawat akut geriatri dan ruang rawat penyakit dalam rumah sakit.Metodologi. Penelitian kohort retrospektif, dengan pendekatan analisis kesintasan, dilakukan terhadap 177 pasien geriatri yang dirawat di ruang rawat akut geriatri dan ruang rawat penyakit dalam Rumah Sakit Cipto Mangunkusumo selama bulan April–September 2011. Data demografis, diagnosis medis, kadar albumin, indeks ADL Barthel, geriatric depression scale, status nutrisi dengan mini nutritional assessment (MNA) dikumpulkan, dan diamati selama 30 hari sejak mulai dirawat untuk melihat ada tidaknya mortalitas. Perbedaan kesintasan kelompok pasien dengan status nutrisi baik, berisiko malnutrisi dan malnutrisi ditampilkan dalam kurva Kaplan-Meier, diuji dengan uji Log-rank, serta analisis multivariat dengan Cox proportional hazard regression model untuk menghitung adjusted Hazard Ratio dan interval kepercayaan 95% terjadinya mortalitas 30 hari dengan memasukkan variabel-variabel perancu sebagai kovariat.Hasil. Kesintasan antara subyek yang status nutrisinya baik, berisiko malnutrisi dan malnutrisi ialah 94,7% dengan 89,0% dan 80,7%, namun perbedaan kesintasan 30 hari tak bermakna dengan uji Log-rank (p=0,106). Pada analisis multivariat didapatkan adjusted HR setelah penambahan variabel perancu sebesar 1,49 (IK 95% 0,29 – 7,77) untuk kelompok berisiko malnutrisi dan 2,65 (IK 95% 0,47 – 14,99) untuk kelompok malnutrisi dibandingkan dengan pasien nutrisi baikSimpulan. Perbedaan kesintasan 30 hari pasien geriatri yang dirawat di rumah sakit yang menderita malnutrisi dan berisiko malnutrisi dibandingkan dengan status nutrisi baik pada awal perawatan belum dapat dibuktikan.

---

ABSTRACTBackground. Increasing number of older population will also increased its health problems. Studies in foreign countries shown that poor nutrition worsen survival of geriatrics admitted to hospitals. Geriatric patients in Indonesia have different physical, psychological, social economic and cultural characteristics. There has been no study in Indonesia on role of nutritional status on survival in hospitalized geriatric patients.Objective. Investigating the impact of nutritional status on 30 days survival of geriatric patients hospitalized in geriatric and internal medicine wardMethods. Retrospective cohort study and survival analysis approach was conducted to 177 geriatric patients hospitalized in geriatric and internal medicine ward of Cipto Mangunkusumo from April – September 2011. Demographic data, albumin level, ADL Barthel, geriatric depression scale, nutritional status according to mini nutritional assessment (MNA) were collected. Patients were observed during 30 days since hospitalized. Difference in survival is shown in Kaplan-meier curve dan difference in survival between groups were tested with Log-rank test, and multivariate analysis with Cox proportional hazard regression to calculate adjusted HR of mortality and confounding variables as covariates.Results. The survival of well nourished, in risk of malnutrition and malnourished group was 94,7%, 89,0% and 80,7%, but non significant with Log-rank test (p=0,106). After multivariate analysis (Cox proportional hazard regression model), the adjusted HR was 1.49 (CI 95% 0.29 – 7.77) for group in risk of malnutrition and 2.65 (CI 95% 0.47 – 14.99) for malnourished group compared to well-nourished groupConclusion. Thirty days survival difference of hospitalized geriatrics with malnutrition and in risk of malnutrition compared to well-nourished have not been proved."

"ABSTRAKLatar Belakang: Gangguan keseimbangan dan mobilitas merupakan penyebab terbesar disabilitas pada usia lanjut 60 tahun atau lebih. Keseimbangan dan mobilitas merupakan faktor penting dalam melakukan aktivitas fungsional. Masalah paling serius dari gangguan mobilitas adalah kecenderungan usia lanjut untuk jatuh dan menjadi cedera akibat jatuh. Faktor lainnya yang mempengaruhi jatuh adalah rasa takut jatuh. Latihan keseimbangan dapat menurunkan insiden jatuh pada usia lanjut, namun usia lanjut yang berisiko jatuh sering menolak untuk mengikuti program latihan di rumah sakit. Program latihan di rumah memungkinkan individu untuk latihan secara mandiri, dengan biaya yang murah, dan sesuai untuk usia lanjut dengan keterbatasan akses ke fasilitas latihan. Penelitian ini bertujuan untuk mengetahui pengaruh latihan keseimbangan yang dilakukan di rumah selama 8 minggu terhadap mobilitas fungsional dan rasa takut jatuh pada usia lanjut.Metode: Disain penelitian ini adalah Randomized Controlled Trial. Populasi terjangkau adalah usia lanjut ≥ 60 tahun yang ada di Poliklinik Geriatri Terpadu dan Poliklinik Rehabilitasi Medik rumah sakit Cipto Mangunkusumo Jakarta yang memenuhi kriteria penelitian. Pengambilan sampel dilakukan secara consecutive sampling, dan dibagi menjadi dua kelompok secara randomisasi permutasi blok. Kelompok keseimbangan diberi latihan keseimbangan dan kelompok kontrol diberi latihan penguatan ekstremitas atas selama 8 minggu. Untuk menilai mobilitas fungsional digunakan uji Time Up and Go (TUG), sedangkan rasa takut jatuh dinilai dengan instrumen Falls Efficacy Scale – International (FES-I).Hasil: 94 responden mengikuti program latihan sampai selesai, kelompok keseimbangan (46 orang) dengan rerata umur 69,7 ± 6,03 tahun, dan kelompok kontrol (48 orang) dengan rerata umur 70,35 ± 6,95 tahun. Nilai uji TUG kelompok keseimbangan pada minggu ke-1 adalah 10,11 (7,41-16,52) detik dan menurun menjadi 9,24 (7,11-17,00) detik setelah 8 minggu latihan, (p < 0,001), dibandingkan dengan kelompok kontrol terdapat penurunan yang signifikan pada uji TUG minggu ke-1 dan minggu ke-8, p = 0,001. Nilai FES-I minggu ke-1 adalah 23,0 (16-38), dan setelah 8 minggu latihan terdapat penurunan menjadi 18,5 (16-35), p < 0,001, namun dibandingkan dengan kelompok kontrol tidak menunjukkan perbedaan yang signifikan, p = 0,166 Kesimpulan: Terdapat peningkatan mobilitas fungsional yang bermakna secara statistik berdasarkan uji TUG pada kelompok keseimbangan dibandingkan dengan kelompok kontrol, setelah 8 minggu latihan. Dan terdapat penurunan rasa takut jatuh yang diukur menggunakan nilai FES-I pada kelompok keseimbangan setelah 8 minggu latihan, namun dibandingkan dengan kelompok kontrol tidak ada perbedaan bermakna.

---

ABSTRACTBackground: Impaired balance and mobility are the biggest cause of disability in the elderly 60 years or more. Balance and mobility is an important factor in performing functional activities. The most serious problem is the tendency of the mobility-impaired elderly to fall and be injured by falling. Another factor affecting the fall is fear of falling. Balance training can reduce the incidence of falls in the elderly, however, older adults who are at risk usually refuse to participate in hospital-based exercise programs. Home-based exercises may allow individuals to practice independently, with low cost, and may be appropriate for the elderly with limited access to exercise facilities. The aim of this study is to determine the effect of balance exercises done at home for 8 weeks on functional mobility and the fear of falling in the elderly.Methods: The design of the study was randomized controlled trial. The population was the elderly ≥ 60 years old at Integrated Geriatric Polyclinic and Physical Medicine and Rehabilitation Polyclinic in Cipto Mangunkusumo Hospital Jakarta who fit the criteria. Sampling was done by consecutive sampling, and were divided into two groups by randomized block permutation. The balance group was given balance exercises and the control group was given upper extremity strengthening exercises for 8 weeks. Functional mobility was assessed by Time Up and Go test (TUG), and to assess fear of falling was used the Falls Efficacy Scale - International (FES-I) instrument.Results: 94 respondents were completed the exercise program, the balance group (46 people) mean age 69.7 ± 6.03 years old, and the control group (48 people) mean age 70.35 ± 6.95 years old. TUG test in balance group was 10.11 (7.41-16.52) seconds at week-1 and improved to 9.24 (7.11-17.00) seconds after 8 weeks training, (p < 0.001). Compared to the control, the balance group had significantly improvement between TUG test week-1 and week-8, p = 0.001. FES-I test in balance group was 23.0 (16-38) at week-1 and after 8 weeks there is a decline to 18.5 (16-35), p < 0.001, but compared to the control group showed no significant difference, p = 0.166 .Conclusion: There is statistically significant increasing of functional mobility based on the TUG test in the balance group compared to the control group, after 8 weeks of training program, and there is a statistically significant reduction in fear of falling were measured using FES-I instrument in the balance group after 8 weeks of training program, but compared to the control group there is no significant difference."

"ABSTRAKLatar Belakang: Mengukur berat badan pada kondisi tertentu pada pasien geriatri sulit untuk dilakukan sehingga diperlukan suatu alat bantu baru murah dan mudah yang dapat digunakan untuk mengestimasi berat badan aktual pada seorang geriatri.Tujuan: Mendapatkan faktor yang berperan terhadap estimasi berat badan aktual serta mendapatkan rumus estimasi berat badan aktual pada pasien geriatri.Metode: Penelitian ini merupakan studi potong lintang terhadap 150 pasien geriatri yang berobat di Poliklinik Geriatri RSCM periode Juli 2016. Pasien dengan overload cairan, riwayat amputasi tungkai, imobilitas, instabilitas, tidak dapat mengikuti perintah, riwayat operasi ganti sendi lutut atau total hip replacement, dan menolak diikutsertakan, dieksklusi dari penelitian ini. Pengukuran yang dilakukan adalah penimbangan berat tungkai, pengukuran lingkar lengan atas, pengukuran lingkar perut, dan pengukuran lingkar paha. Uji korelasi dilakukan untuk mengetahui faktor yang berperan terhadap estimasi berat badan aktual. Uji regresi linear dilakukan untuk memperoleh rumus estimasi berat badan aktual pada geriatri.Hasil Penelitian: Penelitian dilakukan pada 70 pria dan 80 wanita dengan usia rerata 70 tahun dengan indeks masa tubuh rerata 24,67 kg/m2. Hasil uji korelasi berat badan aktual terhadap berat tungkai adalah 0,91. Hasil tersebut akan lebih tinggi pada wanita dengan r = 0,95 dan pada pria r = 0,83. Lingkar perut pada pria diketahui memiliki korelasi terhadap berat badan dengan r = 0,85. Rumus estimasi berat badan aktual yang didapat = 16,262 12,414 berat tungkai. Formula tersebut dapat memprediksi keluaran sebesar 81 p

---

ABSTRACTBackground In Elderly, weight measurement in specific condition can be difficult, so we need a new cheap and easy tool that can be used to estimate the actual body weight on a geriatric.Objective Obtain a factors that contributes to estimate actual body weight. Make a formula for body weight estimation in geriatric patients.Methods This study is a cross sectional study on 150 geriatric patients who seek treatment at the Geriatric clinic RSCM period of July 2016. Patients with fluid overload, limb amputations, immobility, instability, can not follow orders, history replace the knee joint surgery or total hip replacement, and refused to involve the research were excluded from this study. Lower limbs weight measurement, upper arm circumference, abdominal circumference measurement, and the measurement of thigh circumference were taken in this study. Correlation test was conducted to determine the factors that contribute to the estimated actual weight. Linear regression analysis was conducted to obtain the actual body weight estimation formula in geriatrics.Results This study involve 70 man and 80 woman with average age is 70 and average body mass index is 24,67 kg m2. The correlation for actual weight to the weight of the lower limb is 0.91. The result would be higher if differentiated into women with r 0.95, and r 0.83 in men. Abdominal circumference in men have strong correlation with actual body weight r 0.85. Estimated actual body weight formula 16.262 12.414 weight of the lower limb. The formula can predict the output by 81 p"