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"ABSTRAKLatar BelakangObstructive Sleep Apnea (OSA) merupakan faktor risiko stroke yang belum lamadiketahui dan salah satu metode skrining OSA adalah kuesioner STOP-Bang.Penelitian ini bertujuan untuk mengetahui prevalensi risiko OSA menggunakankuesioner STOP-Bang dan melihat hubungannya dengan faktor risiko stroke lain.MetodeStudi secara potong lintang. Sebanyak 202 subjek berusia ≥ 35 tahun non stroke,dari lima wilayah Jakarta bulan April hingga Juni 2013, diwawancara tentangkuesioner STOP-Bang dan faktor resiko vaskular lain, kemudian dianalisa.HasilSebanyak 100 subjek (49.5%) memiliki risiko tinggi OSA, dimana 70%diantaranya adalah pria dan risiko meningkat seiring dengan peningkatan usia.Item pertanyaan dengan nilai estimasi kemungkinan risiko paling tinggi adalahlingkar leher (p=0.000, OR 23.5; 95%CI 5.5-101.5), diikuti dengan berhentibernapas saat tidur (p=0.000, OR 22.9; 95%CI 6.8-77.4), mendengkur (p=0.000,OR 19.1; 95%CI 9.3-38.9), jenis kelamin (p=0.000, OR 5.9; 95%CI 3.2-10.8),kelelahan di siang hari (p=0.000, OR 4.3; 95%CI 2.4-7.7), usia (p=0.000, OR 4.1;95%CI 2.3-7.3) dan riwayat pengobatan tekanan darah (p=0.000, OR 3.9; 95%CI1.9-8). Item indeks massa tubuh tidak dapat dianalisa. Faktor-faktor risiko strokelain berhubungan dengan risiko tinggi OSA dengan kontribusi secara berturutandari yang paling tinggi adalah aritmia (p=0.000, OR 9.5; 95%CI 2.1-42.6),diabetes melitus (p=0.000, OR 4.5; 95%CI 1.9-11), merokok (p=0.000, OR 3.7;95%CI 1.9-6.9), hipertensi (p=0.000, OR 3.6; 95%CI 2-6.5), obesitas sentral(p=0.002, OR 2.6; 95%CI 1.4-4.7), dan dislipidemia (p=0.046, OR 2.1; 95%CI 1-4.1).KesimpulanSemua item pertanyaan kuesioner, kecuali indeks massa tubuh, menunjukkanperbedaan yang bermakna antara risiko tinggi dan risiko rendah OSA. Faktorrisiko stroke lain yang memiliki estimasi risiko OSA dari yang paling tinggiadalah aritmia, diikuti dengan diabetes melitus, merokok, hipertensi, obesitassentral, dan dislipidemia

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ABSTRACTBackgroundObstructive Sleep Apnea (OSA) is one of the recent stroke risk factor to bediscovered. One screening method is the STOP-Bang questionnaire. The purposeof this study is to know the prevalence of high risk OSA using the STOP-Bangquestionnaire and analyze its correlation to other stroke risk factors.MethodsAs much as 202 subjects age ≥ 35 years old who never had a stroke, wereanalysed cross sectionally, from five regions of Jakarta, between April 2013 untilJune 2013. Each subject was interviewed using the STOP-Bang questionnaire,and other stroke risk factors, and then analysedResultsAs much as 100 subjects (49.5%) had high risk OSA, whereas 70% of them weremale and the risk of developing OSA increases with age. Questionnaire’s itemwith the highest odds ratio were neck circumference (p=0.000, OR 23.5; 95%CI5.5-101.5), followed by observed of not breathing(p=0.000, OR 22.9; 95%CI 6.8-77.4), snoring (p=0.000, OR 19.1; 95%CI 9.3-38.9), sex (p=0.000, OR 5.9;95%CI 3.2-10.8), daytime sleepiness (p=0.000, OR 4.3; 95%CI 2.4-7.7), age(p=0.000, OR 4.1; 95%CI 2.3-7.3) and history of hypertensive treatment(p=0.000, OR 3.9; 95%CI 1.9-8). Body mass index could not be analysed. Otherstroke risk factors that correlate with high risk OSA from the greatest likelihoodwere arrhytmia (p=0.000, OR 9.5; 95%CI 2.1-42.6), diabetes melitus (p=0.000,OR 4.5; 95%CI 1.9-11), smoking (p=0.000, OR 3.7; 95%CI 1.9-6.9),hypertension (p=0.000, OR 3.6; 95%CI 2-6.5), central obesity (p=0.002, OR 2.6;95%CI 1.4-4.7), and dyslipidemia (p=0.046, OR 2.1; 95%CI 1-4.1).ConclusionsAll of the questionnaire items, except body mass index, revealed significantdifference between high risk and low risk OSA. Other stroke risk factors from thegreatest likelihood to coincide with high risk OSA were arrhtmia, diabetesmellitus, smoking, hypertension, central obesity, and dyslipidemia"

"ABSTRAKLatar Belakang. Gangguan fungsi kognitif dapat ditemukan pada berbagai kondisi medis baik pada usia muda maupun usia tua. Pemeriksaan Status Mental Neurologi Strub & Black merupakan suatu instrumen yang dapat digunakan untuk mendeteksi adanya gangguan fungsi kognitif. Sayangnya, publikasi yang menggunakan Pemeriksaan Status Mental Neurologi Strub & Black sangat jarang. Pemeriksaan Status Mental Neurologi Strub & Black versi Indonesia telah dikembangkan. Meskipun demikian, nilai normal pada orang Indonesia dengan fungsi kognitif yang normal belum diketahui.Metode. Penelitian yang bertujuan untuk mendapatkan nilai rerata Pemeriksaan Status Mental Neurologi Strub & Black versi Indonesia pada orang Indonesia dengan fungsi kognitif yang normal berdasarkan usia dan tingkat pendidikan ini dilakukan dengan menggunakan desain potong lintang. Subyek penelitian adalah seluruh orang Indonesia yang memenuhi kriteria inklusi dan eksklusi yang ditemui peneliti selama periode penelitian. Pengumpulan data dilakukan pada bulan Juli hingga Oktober 2012. Hasil. Sebanyak 545 subyek penelitian yang terdiri dari 230 (42,2%) subyek laki-laki dan 315 (57.8 %) subyek perempuan diikutsertakan dalam penelitian ini. Usia dari subyek penelitian berkisar antara 18-83 tahun. Berdasarkan tingkat pendidikan, sebanyak 251 (46,1%) subyek merupakan tamatan SMP, sedangkan 294 (53,9%) subyek lainnya merupakan tamatan SMA atau lebih tinggi. Nilai median (min-maks) skor total Pemeriksaan Status Mental Neurologi Strub & Black pada kelompok usia <40 tahun, 40-49 tahun, 50-59 tahun, dan ≥60 tahun berturut-turut adalah 88,00 (75-97), 83,00 (67-96), 82,00 (65-96), dan 78,00 (61-92). Nilai median (min-maks) skor total Pemeriksaan Status Mental Neurologi Strub & Black pada tamatan SMP adalah 78,00 (61-95), sedangkan pada tamatan SMA atau lebih tinggi adalah 87,00 (77-97). Perbedaan nilai rerata skor total Pemeriksaan Status Mental Neurologi Strub & Black versi Indonesia antar kelompok usia dan antar kelompok tingkat pendidikan ditemukan bermakna dengan masing-masing memiliki nilai p = 0,000.Kesimpulan. Telah didapatkan nilai rerata Pemeriksaan Status Mental Neurologi Strub & Black versi Indonesia pada orang Indonesia dengan fungsi kognitif yang normal berdasarkan usia dan tingkat pendidikan. Usia dan tingkat pendidikan secara bermakna mempengaruhi nilai rerata skor total Pemeriksaan Status Mental Neurologi Strub & Black versi Indonesia.

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ABSTRACTBackground. Impairment of cognitive function can be found in various medical conditions, either at a young age or old age. Strub and Black Mental Status Examination of Neurology is an instrument that can be used to detect cognitive impairment. Unfortunately, publications about Strub and Black Mental Status Examination are very rare. The Indonesian version of Strub and Black Mental Status Examination in neurology has been developed. However, the normative values for Indonesian people with normal cognition are still unknown.Method. A cross-sectional study which aimed to obtain the normative value of the Indonesian version of Strub and Black Mental Status Examination in Neurology according to age and level of education was conducted. The study subjects were all Indonesian who met inclusion and exclusion criteria during the period of the study. Data were collected between July and October 2012.Result. A total of 545 subjects, i.e. 230 (42.2%) male subjects and 315 (57.8%) female subjects, were included in this study. The ages of the subjects were between 18 and 83 years. Based on level of education, 251 (46.1%) subjects were junior high school graduates, whereas 294 (53.9) subjects were senior high school or university graduates. The median (min-max) total score of the Indonesian Version of Strub and Black Mental Status Examination in Neurology for age <40 years, 40-49 years, 50-59 years, and ≥60 years are 88.00 (75-97), 83.00 (67-96), 82.00 (65-96), and 78.00 (61-92), respectively. The median (min-max) of the total score of the Indonesian Version of Strub and Black Mental Status Examination in Neurology for junior high school graduates is 78.00 (61-95), wheras for senior high school or university graduates is 87.00 (77-97). The total score of the Indonesian Version of Strub and Black Mental Status Examination in Neurology differs significantly between age groups and education groups, each of them has p = 0,000. Conclusion. The total score of the Indonesian version of Strub and Black Mental Status Examination of Neurology in Indonesian with normal cognition based on age and level of education has been found. Age as well as level of education have significant effects on the total score of the Indonesian version of Strub and Black Mental Status Examination of Neurology."

"ABSTRAKLatar Belakang. Gangguan otonom merupakan gejala yang cukup sering dialamioleh pasien Parkinson. Gangguan ini sudah dapat ditemukan sejak awal stadiumpenyakit. Gangguan otonom meliputi gangguan gastrointestinal, urologi,kardiovaskular, seksual dan termoregulasi. Untuk mendeteksi gangguan otonomdapat digunakan kuesioner SCOPA-AUT (Scale for Outcomes in Parkinson’sDisease for Autonomic Symptoms). Tujuan dari penelitian ini adalah untukmengetahui gambaran gangguan otonom pada pasien Parkinson di PoliklinikSaraf RSUPN Cipto Mangunkusumo dan RSUPN Fatmawati.Metode. Penelitian dilakukan dengan menggunakan desain potong lintang.Pengumpulan data dilakukan pada bulan April hingga Juni 2012.Hasil. Sebanyak 54 subyek penelitian yang terdiri dari 33 (61,1%) pria dan 21(38,9 %) wanita diikutsertakan dalam penelitian ini. Pasien Parkinson padapenelitian ini berusia antara 45-79 tahun. Sebagian besar pasien memiliki durasisakit kurang dari 5 tahun (63%), stadium Hoehn & Yahr 1-2 (63%) dan memakaiterapi kombinasi levodopa dengan agonis dopamin (79,6%). Gangguan otonomdidapatkan pada seluruh subyek penelitian. Gangguan otonom yang paling seringdialami pasien Parkinson adalah masalah urologi berupa nokturia (79,6%) danurinary frequency (57,3%), serta masalah gastrointestinal yaitu sialorea (51,9%)dan mengejan kuat saat buang air besar (50%) Tidak ada pasien yang mengalamiinkontinensia feses atau jatuh pingsan.Kesimpulan. Seluruh pasien Parkinson pada penelitian ini mengalami gangguanotonom. Telah diketahui proporsi gangguan otonom pada pasien Parkinson diPoliklinik Saraf RSUPN Cipto Mangunkusumo dan RSUPN Fatmawati.

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ABSTRACTBackground. Autonomic symptoms are quite often reported by Parkinson’sdisease patients. These symptomps are found already in early stage of disease.Autonomic symptomps comprise gastrointestinal, urinary, cardiovascular, sexualand thermoregulation symptomps. SCOPA-AUT (Scale for Outcomes inParkinson’s Disease for Autonomic Symptoms) questionnaire can detectautonomic dysfunctions. The purpose of this study is to obtain profile ofautonomic symptomps in Parkinson’s disease patients in neurology clinic inRSUPN Cipto Mangunkusumo and RSUPN Fatmawati.Methods: a cross sectional study was conducted between April and June 2012Results: A total of 54 patients, i.e. 33 (61,1%) man and 21 (38,9 %) woman, wererecruited in this study. The age of patients was between 45 and 79 years. Mostpatients have illness duration less than 5 years (63%), Hoehn & Yahr stage 1-2(63%) and use combination therapy (levodopa with dopamine agonist) (79,6%).Autonomic symptoms are complained by all patients. Most frequent autonomicsymptomps reported by Parkinson’s disease patients are nocturia (79,6%), urinaryfrequency (57,3%), sialorea (51,9%) and strain hard when pass stools (50%).There are no patients who complained involuntary loss of stools or fainted.Conclusion. All Parkinson’s disease patients in this study reported autonomicsymtomps. Autonomic symptomps profile has been known in Parkinson’s diseasepatients in neurology clinic in RSUPN Cipto Mangunkusumo and RSUPNFatmawati"

"ABSTRAKLatar Belakang. Pasien pasca cedera kepala seringkali mengalami gangguan kognitif. Instrumen komputer “Stimulasi Kognitif” (STIMKOG) adalah salah satu bentuk intervensi terapetik kognitif eksternal yang dapat diberikan pada pasien cedera kepala. STIMKOG memiliki tujuh stimulus yang mencakup lima domain kognitif. Tujuan dari penelitian adalah mengetahui fungsi kognitif pada pasien cedera kepala setelah distimulasi dengan STIMKOG.Metode. Penelitian menggunakan desain eksperimental. Subyek penelitian adalah pasien cedera kepala ringan-sedang yang dibagi atas kelompok intervensi dan kelompok kontrol. Kelompok intervensi diberikan latihan STIMKOG selama 12 hari berturut-turut sedangkan kelompok kontrol hanya diberikan di hari 1, 6 dan 12. Evaluasi perubahan fungsi kognitif menggunakan pemeriksaan neuropsikologi Skrining tes Luria Nebraska.Hasil. Sebanyak 60 subyek ikut dalam penelitian, terbagi atas 30 subyek di tiap kelompok. Rasio jumlah laki-laki dan perempuan adalah 2:1. Usia dari subyek penelitian berkisar antara 17-45 tahun, sebagian besar berusia 20-40 tahun (63.3%). Berdasarkan tingkat pendidikan, sebagian besar berpendidikan tamat SMU (51.6 %). Sebanyak 80% subyek adalah cedera kepala sedang sedangkan 20% adalah cedera kepala ringan. Perbaikan nilai STIMKOG kelompok intervensi lebih besar dari kelompok kontrol pada kecepatan waktu, keberhasilan, kegagalan dan persentase jawaban benar. Pada Skrining Tes Luria Nebraska di awal penelitian terdapat gangguan terutama pada tes Kalkulasi 3, Abstraksi dan Bahasa, Working Memory, New Learning Ability, Immediate memory dan atensi. Pasca latihan STIMKOG terjadi penurunan jumlah subyek yang mengalami gangguan kognitif pada kelompok intervensi sebesar 46.7% lebih besar dibandingkan kelompok kontrol (23.3%).Kesimpulan. Instrumen STIMKOG dapat meningkatkan fungsi kognitf pada pasien cedera kepala ringan-sedang.

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ABSTRACTBackground. Patients with traumatic brain injury were frequently had cognitive disfunction. Computer instrument “Stimulasi Kognitif” (STIMKOG) is one of external therapeutic intervention which can be applied to traumatic brain injury patients. STIMKOG has seven stimulus which include five cognitive domains. The objectives of the study were to obtain cognitive function in traumatic brain injury patients after being stimulated by STIMKOG.Method. An experimental study was conducted. Participants were mild-moderate traumatic brain injury patients which classified into intervention and control group. Intervention group were trained for 12 days consecutively whereas the control group only in day 1, 6 and 12 with level of difficulty 2. Cognitive evaluation was conducted using neuropsychology examination Screening Test Luria Nebraska.Result. A total of 60 subjects participated in this study, divided into 30 subjects in each group. The ratio of man and woman was 2:1. The age of the subjects was between 17 and 45 years, with age majority between 20-40 years (63,3%). Based on level of education, 51.6% subjects were secondary high school graduates. The subjects consisted of 80% moderate traumatic brain injury and 20% mild traumatic brain injury. The improvement of STIMKOG score in intervention group was greater than control group in time response velocity, success rate, failure rate and correct answer persentage. Post STIMKOG training, number of subjects with cognitive disfunction had decreased 46,7% in intervention group greater than control group (23,3%).Conclusion. STIMKOG instrument could improve cognitive function in light-moderate traumatic brain injury patients."

"ABSTRAKLatar Belakang. Sekitar 75% perawat di rumah sakit menjalani kerja gilir. Salah satu dampak negatif akibat kerja gilir jangka panjang adalah gangguan fungsi kognitif. Mekanisme yang menjelaskan gangguan fungsi kognitif adalah gangguan tidur kronik, desinkronisasi irama sirkadian dan stress kerja. Pengetahuan mengenai fungsi kognitif pada perawat gilir merupakan hal yang penting karena akan mempengaruhi produktivitas kerja perawat.Metode. Desain penelitian berupa studi potong lintang. Subyek penelitian adalah perawat gilir di IGD, ICU dan bangsal gedung A RSCM yang memenuhi kriteria inklusi dan eksklusi. Subyek diperoleh secara konsekutif proporsional. Pada subyek dilakukan wawancara, pengisian kuesioner, pemeriksaan fisik dan fungsi kognitif. Pemeriksaan fungsi kognitif dilakukan minimal dua malam setelah gilir malam terakhir. Dilakukan analisis data menggunakan perangkat SPSS 17.0.Hasil. Diperoleh 36 subyek perawat gilir di masing – masing unit kerja. Prevalensi gangguan kognitif pada perawat gilir berdasarkan MoCA-Ina adalah 14,8%. Proporsi gangguan fungsi kognitif terbanyak terdapat pada perawat IGD (50,0%) diikuti oleh bangsal gedung A (31,2%) dan ICU (18,8%). Pada domain fungsi kognitif rerata tertinggi terdapat pada perawat ICU, kecuali pada domain visuospasial terdapat pada perawat bangsal, sedangkan pada domain orientasi sama pada semua unit.Kesimpulan. Sebagian perawat gilir mengalami gangguan fungsi kognitif. Tidak terdapat perbedaan bermakna rerata skor MoCA-Ina maupun proporsi gangguan fungsi kognitif antar unit kerja. Pada domain MoCA-Ina perbedaan rerata yang bermakna hanya terdapat pada domain atensi-konsentrasi-working memory.

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ABSTRACTBackground. About 75% hospital nurses work in shift. One of negative effects due to long term shift work is cognitive function impairment. Mechanisms explaining the cognitive function impairment are chronic sleep disorder, circadian rhythm desynchronisation, and work stress. Knowledge of cognitive function in shift nurses is important because affects nurse work productivity.Method. This is a cross sectional study. The subjects of this study were shift nurses working at Emergency Ward, Intensive Care Unit, and Inpatient Ward of RSCM who are eligible based on inclusion and exclusion criteria. This study used proportional concecutive sampling, where all subjects were interviewed, filled questionnaires, and underwent physical and cognitive examination. The cognitive examination were done at least two nights after last night shift. Data was analyzed by using SPSS 17.0.Result. There were 36 shift nurses in each work unit. Prevalence of cognitive impairment in shift nurses based on MoCA-Ina battery was 14.8%, which the most prevalence was found at Emergency Ward (50.0%), followed by Inpatient Ward (32.1%) and Intensive Care Unit (18.8%). The highest score of all cognitive domains was found at Intensive Care Unit, except in visuospatial which was found at Inpatient Ward, meanwhile every unit had similar mean score in orientation.Conclusion. A few shift nurses had cognitive impairment. There was no significant difference in both MoCA-Ina mean score and proportion of cognitive impairment among work units. There was significant difference in mean score of attention-concentration-working memory."

"Pengelolaan hipertensi dan diabetes melitus yang memerlukan pengelolaan terkoordinasi, menjadi perhatian karena prevalensinya semakin meningkat. Kemampuan dokter sebagai care coordinator tidak terlepas dari kemampuan kepemimpinan, dan belum ada penilaiannya di Indonesia. Penelitian ini bertujuan mengembangkan intrumen penilaian kinerja dokter di layanan primer sebagai care coordinator dan kaitannya dengan kepemimpinan.Pendapat pakar dan metode Delphi digunakan untuk mengembangkan dimensi dan butir penilaian. Validasi instrumen dilakukan dengan analisis faktor eksplorasi. Kurva ROC digunakan untuk mencari titik potong skor care coordinator pada pasien hipertensi atau DM terkontrol dibandingkan tidak terkontrol. Korelasi Pearson dilakukan untuk melihat korelasi antara skor care coordinator dengan skor kepemimpinan klinis, kepemimpinan transformasional, komitmen, kepuasan kerja, dan budaya organisasi, serta faktor-faktor sosiodemografis dokter dan praktik keprofesian.Pengumpulan data dilakukan selama periode April−November 2015. Melalui penggalian pendapat 19 orang pakar (akademisi, praktisi, pengandil), 2 kali putaran Metode Delphi (110 sampel dan 81 sampel), dan 249 sampel analisis faktor, didapatkan instrumen penilaian kinerja dokter pengelola kasus PTM di puskesmas sebagai care coordinator yang terdiri dari 11 dimensi dan 33 butir penilaian dengan koefisien alpha sebesar 0,94 dan korelasi butir penilaian dengan dimensinya lebih dari 0,4. Terdapat perbedaan skor care coordinator antara pasien hipertensi atau diabetes terkontrol dan tidak terkontrol (p = 0,02) dengan titik potong sebesar 7,7. (skor maksimal 9). Terdapat korelasi positif antara skor kepemimpinan klinis, skor kepemimpinan transformasional, skor kepuasan kerja, usia dokter, lama lulus dokter, lama bekerja di puskesmas, pelatihan dokter keluarga, dan status kepegawaian terhadap skor care coordinator. Faktor yang paling berperan terhadap peningkatan skor care coordinator adalah skor kepemimpinan klinis dan skor kepemimpinan transformasional (R square 0,47).Telah dikembangkan instrumen penilaian kinerja dokter sebagai care coordinator di layanan primer yang valid dan handal. Walaupun dokter pengelola kasus dalam kesehariannya berinteraksi dengan pasien dan tidak menduduki jabatan struktural sebagai pimpinan, namun mereka harus tetap memiliki kemampuan kepemimpinan klinis serta kepemimpinan transformasional untuk menunjang kinerja sebagai care coordinator dalam pengelolaan masalah kesehatan pasien.

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Hypertension and Diabetes Mellitus management that need coordination of care is vital because of their increasing prevalence. To become care coordinator, primary care physician should have leadership capabilities. However, there is no instrument available to measure care coordination and leadership for primary care physician in Indonesia. This research aims to develop instruments for primary care physician's performance as care coordinator in primary care facilities and its correlation with leadership.Data collection was conducted from April to November 2015. Expert opinion and Delphi method were conducted to develop dimensions and item indicators. Exploratory Factor Analysis was performed for instrument validation. ROC curves were used to gain cut-off point of care coordinator's score from controlled and uncontrolled hypertension or diabetes mellitus patient. Pearson correlation was conducted to determine correlation between care coordinator score and clinical leadership, transformational leadership, commitment, job satisfaction, and organizational culture, as well as doctor's sociodemographic factors and professional practice.Nineteen experts panel (academics, practitioners, health policy makers), 110 participants of 1st round Delphi Method, 81 participant of 2nd round of Delphi Method, and 249 samples for factor analysis were gathered to create 11 dimensions and 33 items with loading factors at least 0.4 and alpha cronbach as high as 0,94. There was care coordinator score difference between controlled and uncontrolled hypertension or diabetes mellitus patients (p = 0.02) with cut-off point 7,7 (maximum score 9). There was positive correlation between care coordinator score and clinical leadership score, transformasional leadership score, satisfaction score, age, graduation period, working period, family medicine training, and employment status. Dominant factors correlate to care coordinator score were clinical leadership score and transformational leadership score (R square 0.47).A valid and reliable instrument of care coordinator performance for Indonesian primary care physician has been developed. Although the main activity of practitioner is very much relate to patient interaction, they should also have leadership capacities to support their role as care coordinator for patient?s health management."

"Disfungsi dasar panggul adalah komplikasi persalinan per vaginam dengan manifestasi utama prolaps organ panggul (POP), inkontinensia urin dan inkontinensia fekal sehingga menurunkan kualitas hidup. Diduga terdapat peran jaringan ikat kolagen dan elastin, namun biopsi berulang memiliki risiko perdarahan, nyeri serta infeksi. Oleh karena itu, dipikirkan produk metabolitkolagen dan elastin serum untuk mewakili kadar kolagen dan elastin di jaringan penunjang dasar panggul. Tujuan penelitian ini adalah mendapatkan penanda serum produk metabolit kolagen dan elastin untuk memprediksi disfungsi dasar panggul setelah persalinan per vaginam.Penelitian tahap pertama menggunakan desain prospektif kohort satu sisi untuk mengukur angka kejadian disfungsi dasar panggul 3 bulan setelah persalinan. Penelitian dilakukan di Poliklinik Obstetri Departemen Obstetri dan Ginekologi FKUI/RSUPN dr.Cipto Mangunkusumo dan Puskesmas di lingkungan DKI Jakarta, selama periode Januari 2015 sampai Juli 2019. Tahap kedua menggunakan desain nested case control untuk menganalisis hubungan penanda serum kolagen dan elastin serta aktivitas MMP-9 pada kehamilan dan setelah persalinan dengan disfungsi dasar panggul. Penanda metabolit kolagen dan elastin (ICTP, desmosin), remodeling kolagen dan elastin (PINP, PIIINP, tropoelastin), serta MMP-9 diukur pada saat hamil, 24–48 jam, dan 6 minggu setelah persalinan. Tiga bulan setelah persalinan, inkontinensia urin, tekanan dan POP dinilai berdasarkan gejala, pemeriksaan POP-Q dan tes batuk. Data luaran sebelum dan sesudah persalinan dianalisis dengan uji t tidak berpasangan dan uji Mann Whitney. Dari 177 calon subjek, 4 subjek dieksklusi dan 113 subjek drop out. Dari 60 subjek yang diinklusi, 38 (63,3%) mengalami POP derajat 2 dan 25 subjek di antaranya (41,7%) mengalami sistokel derajat 2. Tidak ada perbedaan rerata seluruh marker degradasi dan sintesis kolagen 1,3 dan elastin serta MMP-9 antara kelompok POP dan kontrol. Analisis dilakukan dengan analisis kategorik menggunakan titik potong pada variabel yang memiliki AUC > 0.6. Pada hasil analisis bivariat prolaps organ panggul didapatkan hasil yang bermakna adalah yang memiliki nilai variabel p < 0,05 yaitu PINP setelah persalinan dan ICTP setelah persalinan. Setelah itu, dilakukan analisis multivariat dengan mengambil nilai variabel p < 0,25 ditemukan pada biomarker PINP setelah persalinan 106,9 dengan RR = 1,76 (95%CI: 1,14–3,00). Pada hasil analisis bivariat sistokel didapatkan hasil yang bermakna adalah yang memiliki nilai variabel p < 0,05 yaitu PINP kehamilan dan PINP setelah persalinan. Setelah itu, dilakukan analisis multivariat sistokel dengan menggambil nilai variabel p < 0.25 yaitu ditemukan biomarker PINP setelah persalinan 106,9 dengan RR = 2,53 (95%CI: 1,05–6,09).

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Pelvic floor dysfunction is a complication of vaginal delivery with the main manifestations of pelvic organ prolapse (POP), urinary incontinence and fecal incontinence, thereby reducing quality of life. It is suspected that there is a role for collagen and elastin connective tissue, but repeated biopsies carry the risk of bleeding, pain and infection. Therefore, it was considered the metabolic products of serum collagen and elastin to represent the levels of collagen and elastin in the pelvic floor supporting tissues. The aim of this study was to obtain serum markers of collagen and elastin metabolism products to predict pelvic floor dysfunction after vaginal delivery.

The first phase of the study used a one-sided prospective cohort design to measure the incidence of pelvic floor dysfunction 3 months after delivery. The study was conducted at the Obstetrics Polyclinic, Department of Obstetrics and Gynecology, FKUI/RSUPN dr. Cipto Mangunkusumo and Puskesmas in DKI Jakarta, during the period January 2015 to July 2019. The second phase used a nested case control design to analyze the relationship between serum collagen and elastin markers and MMP-9 activity in pregnancy and after delivery with pelvic floor dysfunction. Markers of collagen and elastin metabolism (ICTP, desmosin), collagen and elastin remodeling (PINP, PIIINP, tropoelastin), and MMP-9 were measured during pregnancy, 24–48 hours, and 6 weeks after delivery. Three months after delivery, urinary incontinence, pressure and POP were assessed on the basis of symptoms, POP-Q examination and cough test. The outcome data before and after delivery were analyzed by unpaired t test and Mann Whitney test.

From 177 prospective subjects, 4 subjects were excluded and 113 subjects dropped out. Of the 60 included subjects, 38 (63.3%) had grade 2 POP and 25 (41.7%) had grade 2 cystocele. There was no difference in the mean of all markers of degradation and synthesis of collagen 1,3 and elastin and MMP-9 between the POP and control groups. The analysis was carried out by categorical analysis using cut points on variables that had AUC > 0.6. In the bivariate analysis of pelvic organ prolapse, significant results were obtained which had a variable value of p < 0.05, there were PINP after delivery and ICTP after delivery. After that, multivariate analysis was carried out by taking the variable value p < 0.25 it was found in PINP biomarkers after delivery ≥ 106.9 with RR = 1.76 (95% CI: 1,14–3,00). In the results of bivariate cystocele analysis, significant results were obtained which had a variable value of p < 0.05, there were PINP during pregnancy and PINP after delivery. After that, multivariate analysis of cystocele was carried out by taking the value of the variable p < 0.25, it was found in PINP biomarkers after delivery ≥ 106.9 with RR = 2.53 (95% CI: 1,05–6,09)."

"Insiden osteosarkoma di seluruh dunia mencapai 3,4 kasus per satu juta penduduk per tahun. Sebanyak 10%-20% pasien osteosarkoma ditemukan telah mengalami metastasis. Kemampuan metastasis yang tinggi pada osteosarkoma ini didukung dengan karakteristik populasi selnya yang memiliki tingkat proliferasi yang tinggi, serta peran cancer stem cells (CSC) dalam proses tumorigenesis dan metastasis osteosarkoma. Salah satu metode untuk mendeteksi CSC adalah dengan mendeteksi marker permukaan dan ekspresi stem-like gene, antara lain CD133 dan CXCR4. Tujuan penelitian ini untuk mengetahui hubungan kadar CD133 dan CXCR4 dengan kejadian metastasis pada pasien osteosarkoma. Penelitian ini menggunakan pendekatan cross sectional, dengan sampel serum darah pasien yang didiagnosis osteosarkoma berdasarkan hasil histopatologi di RSCM dan RSUP Prof. Dr. I.G.N.G. Ngoerah. Pemeriksaan kadar CD133 dan CXCR4 menggunakan KIT ELISA Reed Biotech dengan menilai absorbansi secara kuantitatif. Data metastasis diperoleh dari rekam medik. Hubungan kadar CD133 dan CXCR4 dengan kejadian metastasis pada osteosarkoma dianalisis dengan uji chi-square dengan tingkat kemaknaan p<0,05 dianggap signifikan. Penelitian ini melibatkan 40 orang dengan 80% diantaranya berusia <40 tahun. Rerata kadar CD133 yang diperolah sebesar 0.23±0.02 pg/ml, sedangkan rerata kadar CXCR4 yang diperoleh sebesar 6015.82±2345.55 pg/ml. Dari penelitian ini didapatkan adanya hubungan yang signifikan antara kadar CD133 dan CXCR4 dengan kejadian metastasis.

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The incidence of osteosarcoma worldwide reaches 3.4 cases per million population per year. As many as 10%- 20% of osteosarcoma patients are found to have experienced metastasis. The high metastatic ability in osteosarcoma is supported by the characteristics of its cell population which has a high proliferation rate, as well as the role of cancer stem cells (CSC) in the process of tumorigenesis and metastasis of osteosarcoma. One method to detect CSC is to detect surface markers and stem-like gene expression, including CD133 and CXCR4. The purpose of this study was to determine the relationship between CD133 and CXCR4 levels and the incidence of metastasis in osteosarcoma patients. This study used a cross-sectional approach, with blood serum samples from patients diagnosed with osteosarcoma based on histopathology results at RSCM and Prof. Dr. I.G.N.G. Ngoerah Hospital. Examination of CD133 and CXCR4 levels using the Reed Biotech ELISA KIT by assessing absorbance quantitatively. Metastasis data were obtained from medical records. The relationship between CD133 and CXCR4 levels with the incidence of metastasis in osteosarcoma was analyzed using the chi-square test with a significance level of p<0.05 considered significant. This study involved 40 people with 80% of them aged <40 years. The average CD133 level obtained was 0.23±0.02 pg/ml, while the average CXCR4 level obtained was 6015.82±2345.55 pg/ml. From this study, a significant relationship was found between CD133 and CXCR4 levels with the incidence of metastasis."