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Suzy Maria
Proporsi keberhasilan virologis dan faktor-faktor yang berhubungan pada reintroduksi terapi antiretroviral lini pertama pasca interupsi tidak terencana pada pasien HIV = Proportion of virological success and its associated factors in first line antiretroviral reintroduction after unplanned interruption in HIV patients
"ABSTRAK
Latar Belakang: Hingga saat ini belum ada panduan mengenai paduan terapi
antiretroviral (antiretroviral therapy/ART) terpilih pada pasien HIV dewasa
dengan riwayat interupsi tidak terencana. Kondisi pasien pada saat reintroduksi
ART perlu dievaluasi sebagai dasar pemilihan paduan ART
Tujuan: Mengetahui proporsi keberhasilan virologis pada reintroduksi ART lini
pertama pasca interupsi tidak terencana. Mengetahui hubungan antara berbagai
faktor klinis dan laboratoris dengan keberhasilan virologis pada reintroduksi
tersebut.
Metode: Penelitian kohort retrospektif dilakukan pada pasien HIV yang
mendapatkan reintroduksi ART lini pertama pasca interupsi tidak terencana
selama minimal 1 bulan. Data didapatkan dari rekam medis RS dr. Cipto
Mangunkusumo di Jakarta. Viral load (VL) dinilai 6-18 bulan setelah reintroduksi
ART lini pertama, dinyatakan berhasil bila VL <400 kopi/ml. Dilakukan analisis
terhadap faktor yang berhubungan dengan keberhasilan virologis tersebut.
Hasil: Selama periode Januari 2005 s.d. Desember 2014 terdapat 100 subjek yang
mendapatkan reintroduksi ART lini pertama dan memiliki data viral load 6-18
bulan pasca reintroduksi. Pasca reintroduksi ART didapatkan keberhasilan
virologis pada 55 (55%) subjek. Pada analisis didapatkan dua faktor yang
berhubungan dengan keberhasilan virologis pada reintroduksi ART lini pertama,
yaitu frekuensi interupsi satu kali (adjusted OR/aOR 5,51; IK95% 1,82-16,68;
p=0,003), nilai CD4 saat reintroduksi ≥200 sel/mm
xi
3
(aOR 4,33; IK95% 1,1416,39,
p=0,031).
Simpulan:
Proporsi keberhasilan virologis pada reintroduksi ART lini pertama
pasca interupsi tidak terencana adalah 55%. Pasien dengan frekuensi interupsi 1
kali dan pasien dengan nilai CD4 saat reintroduksi ≥200 sel/mm
3
memiliki kecenderungan untuk mencapai keberhasilan virologis pada reintroduksi ART.
ABSTRACT
There is no guideline concerning antiretroviral therapy (ART) of
choice for adult HIV patients after unplanned interruption. Hence, patients?
conditions at time of ART reintroduction need to be evaluated as a basis for
selecting ART regiment.
Objectives: To know the proportion of virological success of first line ART
reintroduction after unplanned interruption. To know the association between
either clinical or laboratory factors and virological success in reintroduction.
Methods: We conducted a retrospective cohort study in HIV patients that were
reintroduced to first line ART after having unplanned interruption for at least one
month period. The data were collected from medical records of Dr. Cipto
Mangunkusumo Hospital in Jakarta. Viral load (VL) was evaluated at 6-18
months after first line ART reintroduction, declared as a success if VL <400
copies/mL. Analysis was done to factors associated with such virological success.
Results: Between January 2005 and December 2014, 100 subjects were
reintroduced to first line ART and having VL data in 6 to 18 months after the
reintroduction. Virological success was achieved in 55 (55%) subjects. In the
analysis we found that virological success was associated with interrupted once
(adjusted OR/aOR 5.51%, 95%CI 1.82-16.68, p=0.003) and CD4 ≥200 cell/mm
xii
Universitas Indonesia
3
at the time of reintroduction (aOR 4.33, 95%CI 1.14-16.39, p=0.031).
Conclusions: Proportion of virological success on first line ART reintroduction
after unplanned interruption was 55%. Patients who were having interrupted once
and patients with CD4 ≥200 cell/mm
3
at the time of reintroduction would have
higher odds of virological success on first line ART reintroduction.
;Background: There is no guideline concerning antiretroviral therapy (ART) of
choice for adult HIV patients after unplanned interruption. Hence, patients?
conditions at time of ART reintroduction need to be evaluated as a basis for
selecting ART regiment.
Objectives: To know the proportion of virological success of first line ART
reintroduction after unplanned interruption. To know the association between
either clinical or laboratory factors and virological success in reintroduction.
Methods: We conducted a retrospective cohort study in HIV patients that were
reintroduced to first line ART after having unplanned interruption for at least one
month period. The data were collected from medical records of Dr. Cipto
Mangunkusumo Hospital in Jakarta. Viral load (VL) was evaluated at 6-18
months after first line ART reintroduction, declared as a success if VL <400
copies/mL. Analysis was done to factors associated with such virological success.
Results: Between January 2005 and December 2014, 100 subjects were
reintroduced to first line ART and having VL data in 6 to 18 months after the
reintroduction. Virological success was achieved in 55 (55%) subjects. In the
analysis we found that virological success was associated with interrupted once
(adjusted OR/aOR 5.51%, 95%CI 1.82-16.68, p=0.003) and CD4 ≥200 cell/mm
xii
Universitas Indonesia
3
at the time of reintroduction (aOR 4.33, 95%CI 1.14-16.39, p=0.031).
Conclusions: Proportion of virological success on first line ART reintroduction
after unplanned interruption was 55%. Patients who were having interrupted once
and patients with CD4 ≥200 cell/mm
3
at the time of reintroduction would have
higher odds of virological success on first line ART reintroduction.
;Background: There is no guideline concerning antiretroviral therapy (ART) of
choice for adult HIV patients after unplanned interruption. Hence, patients?
conditions at time of ART reintroduction need to be evaluated as a basis for
selecting ART regiment.
Objectives: To know the proportion of virological success of first line ART
reintroduction after unplanned interruption. To know the association between
either clinical or laboratory factors and virological success in reintroduction.
Methods: We conducted a retrospective cohort study in HIV patients that were
reintroduced to first line ART after having unplanned interruption for at least one
month period. The data were collected from medical records of Dr. Cipto
Mangunkusumo Hospital in Jakarta. Viral load (VL) was evaluated at 6-18
months after first line ART reintroduction, declared as a success if VL <400
copies/mL. Analysis was done to factors associated with such virological success.
Results: Between January 2005 and December 2014, 100 subjects were
reintroduced to first line ART and having VL data in 6 to 18 months after the
reintroduction. Virological success was achieved in 55 (55%) subjects. In the
analysis we found that virological success was associated with interrupted once
(adjusted OR/aOR 5.51%, 95%CI 1.82-16.68, p=0.003) and CD4 ≥200 cell/mm
xii
Universitas Indonesia
3
at the time of reintroduction (aOR 4.33, 95%CI 1.14-16.39, p=0.031).
Conclusions: Proportion of virological success on first line ART reintroduction
after unplanned interruption was 55%. Patients who were having interrupted once
and patients with CD4 ≥200 cell/mm
3
at the time of reintroduction would have
higher odds of virological success on first line ART reintroduction.
;Background: There is no guideline concerning antiretroviral therapy (ART) of
choice for adult HIV patients after unplanned interruption. Hence, patients?
conditions at time of ART reintroduction need to be evaluated as a basis for
selecting ART regiment.
Objectives: To know the proportion of virological success of first line ART
reintroduction after unplanned interruption. To know the association between
either clinical or laboratory factors and virological success in reintroduction.
Methods: We conducted a retrospective cohort study in HIV patients that were
reintroduced to first line ART after having unplanned interruption for at least one
month period. The data were collected from medical records of Dr. Cipto
Mangunkusumo Hospital in Jakarta. Viral load (VL) was evaluated at 6-18
months after first line ART reintroduction, declared as a success if VL <400
copies/mL. Analysis was done to factors associated with such virological success.
Results: Between January 2005 and December 2014, 100 subjects were
reintroduced to first line ART and having VL data in 6 to 18 months after the
reintroduction. Virological success was achieved in 55 (55%) subjects. In the
analysis we found that virological success was associated with interrupted once
(adjusted OR/aOR 5.51%, 95%CI 1.82-16.68, p=0.003) and CD4 ≥200 cell/mm
xii
Universitas Indonesia
3
at the time of reintroduction (aOR 4.33, 95%CI 1.14-16.39, p=0.031).
Conclusions: Proportion of virological success on first line ART reintroduction
after unplanned interruption was 55%. Patients who were having interrupted once
and patients with CD4 ≥200 cell/mm
3
at the time of reintroduction would have
higher odds of virological success on first line ART reintroduction.
"
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Lusiana
Perbandingan efikasi mikologis, keamanan, kekambuhan, dan efikasi biaya antara sampo selenium sulfida 1,8% dengan ketokonazol 2% pada pitiriasis versikolor : uji klinis acak tersamar ganda = The Comparative assessment of mycological efficacy, safety, relaps, and cost-efficacy of selenium sulfide 1.8% versus ketoconazole 2% shampoo in pityriasis versicolor : a double-blind randomized controlled trial.
"Latar belakang: Pitiriasis versikolor (PV) merupakan infeksi jamur superfisial kronik dengan prevalensi tinggi. Belum ada data yang membandingkan sampo SeS2 1,8% dengan ketokonazol 2% pada terapi PV. Tujuan: Mengetahui efikasi mikologis, keamanan, kekambuhan, dan efikasi biaya antara sampo selenium sulfida 1,8% dibandingkan dengan ketokonazol 2% pada PV. Metode: Uji klinis acak tersamar ganda terhadap pasien PV bulan September hingga Desember 2018, dengan terapi sampo SeS2 1,8% atau ketokonazol 2% sesuai dengan alokasi random. Dilakukan pemeriksaan fisik, uji provokasi skuama, lampu Wood, dan kalium hidroksida. Efikasi mikologis dianalisis dengan intention to treat dan kekambuhan dengan analisis per-protokol. Efikasi biaya dengan menghitung Incremental Cost-Effectiveness Ratio (ICER). Hasil: Efikasi mikologis lebih tinggi pada ketokonazol 2%, yaitu sebesar 94% vs 86%, tetapi tidak berbeda secara statistik (RR=2,3(95%IK0,6-8,5), p=0,182). Efek samping pada ketokonazol 2% lebih tinggi, yaitu 22% vs 8%. SeS2 1,8% lebih murah 14.880 rupiah, dengan risiko KOH masih positif sebesar 8% lebih tinggi dibanding ketokonazol 2%. Kekambuhan sebulan didapatkan lebih besar pada SeS2 1,8%, yaitu sebesar 8% vs 14%. Kesimpulan: Tidak terdapat perbedaan efikasi mikologis, efek samping, dan kekambuhan sebulan, antara SeS2 1,8% dengan ketokonazol 2%. Penggunaan SeS2 1,8% pada terapi PV lebih murah dengan risiko gagal terapi lebih tinggi dibandingkan ketokonazol 2%.
Background: Pityriasis versicolor (PV) is a chronic superficial fungal infection which highly prevalent. There is no data comparing SeS2 1.8% with 2% ketoconazole shampoo in the treatment of PV. Objective: To assess the mycological efficacy, safety, relaps, and cost-efficacy of SeS2 1.8% and ketoconazole 2% shampoo for the treatment of PV. Methods: A double blind randomized controled trial was performed in patients with PV during September-December 2018, based on block randomization. Physical examinations, scale provocation test, Woods lamp and potassium hydroxide examination were conducted. Intention to treat analysis was performed to evaluated mycological efficacy and per-protocol analysis to evaluated relaps. Cost-efficacy was analyzed by calculating the Incremental Cost-Effectiveness Ratio (ICER). Result: The mycological efficacy, side effect and relaps were higher in the ketoconazole group; 94% vs 86% (RR=2.3(95%CI 0.6-8.5), p= 0.182), 22% versus 8%, and 14% versus 8%. We found lesser cost for SeS2 1.8% of about 14.880 rupiah with risk of persistent positive KOH smear is 8% higher than ketoconazole. Conclusion: There were no significant differences of mycological efficacy, side effect, and relaps, between both arms. The cost-efficacy revealed a lesser cost for SeS2 1.8% with higher risk of persistent positive KOH as compared to ketoconazole."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
T57685
UI - Tesis Membership  Universitas Indonesia Library
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Muhammad Reza Saputra
Penggunaan Denosumab pada Tata Laksana Giant Cell- Tumour: Meta Analisis = Denosumab in the Management of Giant Cell Tumor: A Meta Analysis
"Pendahuluan: World Health Organization (WHO) mendefinisikan Giant Cell-Tumour (GCT) merupakan tumor tulang yang bersifat jinak, mempunyai sifat dan kecenderungan untuk agresif lokal. Tujuan tata laksana GCT adalah menghilangkan jaringan tumor, mempertahankan fungsi tulang yang terkena, serta mencegah rekurensi. Sampai saat ini belum ada konsensus seragam untuk tata laksana GCT primer. Denosumab merupakan antibodi monoklonal yang berikatan dengan RANKL. Dengan adanya ikatan antara denosumab dengan RANKL, ikatan antara RANKL dengan RANK tidak terjadi, sehingga diharapkan tidak terjadi pertumbuhan tumor. Akan tetapi masih ada beberapa masalah yang masih menjadi pertanyaan antara lain: apakah pemakaian denosumab menurunkan angka rekurensi dibandingkan tata laksana konvensional sebelumnya, bagaimana efikasi denosumab pada tata laksana GCT, serta berapa dosis dan lama terapi denosumab diberikan. Dengan belum adanya pedoman baku penggunaan denosumab, dan belum adanya telaah sistematis serta penelitiannya di Indonesia, maka meta-analisis ini dilakukan untuk menjawab pertanyaan-pertanyaan tersebut dalam membantu menyusun pedoman penggunaannya sehingga menghasilkan kebijakan baru dalam tata laksana GCT di Indonesia.
Metode: Telah dilakukan pencarian dalam lima database menggunakan kata kunci ("DENOSUMAB" AND ("GIANT CELL TUMOR" OR "GCT") AND "OUTCOME"). Penilaian risiko bias studi dengan desain randomized controlled trial dilakukan dengan Cochrane Collaboration’s tool for assessing risk of bias, sedangkan penilaian risiko bias studi dengan desain nonrandomized controlled trial dan kohort dilakukan dengan Newcastle-Ottawa Quality Assessment Form for cohort study.
Hasil Setelah diseleksi, didapatkan 21 studi yang dilakukan penilaian risiko bias. Meta-analisis menemukan bahwa terdapat 85,5% (IK95%: 74,9-96,0%) pasien mendapatkan perbaikan klinis; perbaikan radiologis pada 82.4% (95% IK: 73,3-91,4%) pasien; perubahan histopatologis pada 96,5% (95% IK: 93,6-99,3%) pasien; serta rekurensi sebesar 27,2% (95% IK: 18,7-35,7%) dan rekurensi pada denosumab dibanding kontrol yakni RR: 2,6 (95% CI: 1,66-4,09); total kejadian efek samping berat pada rahang sebesar 2,7% (95% IK: 1,4-4,0%).
Kesimpulan: Administrasi Denosumab pada pasien GCT sebagai terapi sistemik memiliki efikasi yang baik dalam perbaikan klinis; perbaikan radiologis; penurunan aktivitas sel GCT; potensi efek samping yang rendah; akan tetapi angka kejadian rekurensi lebih tinggi dibanding kontrol. Meski demikian, studi komparatif eksperimen acak terkontrol dirasa perlu lebih banyak untuk meningkatkan kualitas hasil studi.
Introduction: The World Health Organization (WHO) defines GCT as a benign bone tumor, with the nature and tendency for local aggressiveness. The goal of GCT management is to remove tumor tissue, maintain the function of the affected bone, and prevent recurrence. To date there has been no uniform consensus for primary GCT management. Denosumab is a monoclonal antibody that binds to RANKL. With the bond between denosumab and RANKL, the bond between RANKL and RANK does not occur, so that no tumor growth is expected. However, there are still a number of questions that remain questionable, among others: whether the use of denosumab reduces recurrence rates compared to previous conventional management, how the efficacy of denosumab in the management of GCT, and how much dose and duration of denosumab therapy is given. With no standard guidelines for using denosumab, and no systematic study and research in Indonesia. This meta-analitic study was conducted to answer these questions in helping to develop guidelines for their use so as to produce new policies in the management of GCT in Indonesia.
Methods: Five databases have been searched using keywords ("DENOSUMAB" AND ("GIANT CELL TUMOR" OR "GCT") AND "OUTCOME"). After being selected, 21 studies were carried out with a bias risk assessment with the Newcastle-Ottawa Quality Assessment Form for cohort studies for studies with cohort designs and nonrandomized controlled trials while for one study a randomized controlled trial was conducted with the Cochrane Collaboration's tool for assessing risk of bias with results 4 poor quality studies.
Results: The meta-analysis found that there were 85.5% (CI 95%: 74.9-96.0%) patients received clinical improvement, there was a reduction in VAS scale pain in 98.9% (CI 95%: 96.5-101.4% ) patient; radiological improvement in 85.5% 82.4% (95% CI: 73.3-91.4%) patients; histopathological changes in 96.5% (95% CI: 93.6-99.3%) patients; and recurrence of 27.2% (95% CI: 18.7-35.7%) and recurrence in denosumab compared to controls namely RR: 2.6 (95% CI: 1.66-4.09); the total incidence of severe side effects on the jaw was 2.7% (95% CI: 1.4-4.0%).
Conclusions: Denosumab administration in GCT patients as a systemic therapy has good efficacy in clinical improvement; radiological repair; decreased GCT cell activity; low potential for side effects; however the recurrence rate is higher than the control. However, comparative studies of randomized controlled trials are deemed necessary to improve the quality of study results."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Muthia Farani
Perbandingan kesintasan, patensi, dan efektivitas biaya antara pemasangan sten bilier plastik dengan sten bilier metal per endoskopik sebagai tata laksana paliatif pada pasien ikterus obstruktif maligna = Survival, stent patency and cost effectiveness of plastic versus metal biliary stent for palliation in malignant biliary obstruction in a developing country tertiary hospital
"Latar Belakang/Tujuan: Pasien ikterus obstruktif maligna stadium lanjut membutuhkan
drainase bilier. Sten metal memiliki efektivitas yang lebih baik, namun klinisi perlu
mempertimbangkan patensi sten dan keterbatasan sumber daya, mengingat kesintasan
pasien yang rendah. Oleh karena itu analisis efektivitas biaya pada kasus ini penting untuk
dilakukan.
Metode: Penelitian ini merupakan studi kohort retrospektif yang dilakukan di rumah
sakit tersier terhadap pasien ikterus obstruktif maligna yang menjalani pemasangan sten
bilier paliatif pada Januari 2015 sampai Desember 2018. Perbedaan kesintasan 180-hari
dianalisis dengan uji log-rank. Perbedaan durasi patensi dianalisis dengan uji Mann-
Whitney U. Efektivitas didefinisikan sebagai patensi sten, biaya dihitung dengan
perspektif rumah sakit menggunakan model decision tree dan dinyatakan dalam
incremental cost effectiveness ratio.
Hasil: Sebanyak 81 laki-laki dan 83 perempuan dengan rentang usia 24 -88 tahun ikut
dalam penelitian ini. Kesintasan 180-hari kelompok sten plastik 35,9% (median 76, 95%
IK 50-102 hari) dan sten metal 33,3% (median 55, 95% IK 32 -78 hari). Rerata (SB)
patensi sten plastik 123 (8) hari dan sten metal 149 (13) hari (p=0,489). Pemasangan sten
bilier metal dapat menghemat biaya sebesar Rp. 1.217.750 untuk setiap penambahan
durasi patensi 26 hari.
Simpulan: Tidak didapatkan perbedaan antara kesintasan dan patensi antara kedua
kelompok. Pemasangan sten bilier metal sebagai tata laksana paliatif pada pasien ikterus
obstruktif maligna lebih cost-effective dibandingkan sten plastik.
Background/Aim: Patients with advanced stage of malignant obstructive jaundice often
require biliary drainage. Metal stent is more effective than plastic stent, but we also ought
to consider of stent patency and resources restraint due to poor patient survival. Hence,
cost effectiveness analysis in this case was necessary.
Methods: We conducted a retrospective cohort of malignant biliary obstruction patients
who underwent palliative biliary stenting between January 2015 to December 2018 at a
tertiary hospital. We evaluated the difference of 180-day survival using log-rank test and
stent patency duration using Mann-Whitney U test. Effectiveness was defined as stent
patency, cost was calculated using hospital perspective following a decision tree model
and reported as incremental cost effectiveness ratio.
Results: A total of 81 men and 83 women aged 24-88 years old were enrolled in this
study. 180-day survival was 35.9% (median 76, 95% CI 50 -102 days) and 33.3%
(median 55, 95% CI 32 -78 days) for plastic and metal stent group respectively. Mean
(SD) of stent patency 123 (8) vs 149 (13) days for plastic and metal stent group
respectively (p=0.489). Metal stent insertion could save IDR 1,217,750 to get additional
26 days of stent patency.
Conclusion: There were no differences in survival and patency between the two groups.
Metal biliary stent is cost effective than plastic stent for palliation in malignant biliary
obstruction."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library