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"Latar belakang: Perubahan fungsi seksual perempuan pascapersalinan berkisar 23% - 86% dan mempunyai dampak yang signifikan dalam keharmonisan keluarga. Berbagai studi dan penelitian tentang fungsi seksual perempuan pascapersalinan banyak dilakukan dengan hasil yang berbeda karena adanya perbedaan alat ukur, waktu pengukuran serta pengontrolan variabel perancu. Penelitian ini sebagai konfirmasi dari penelitian sebelumnya serta belum adanya data yang pasti terutama di Jakarta dan Indonesia umumnya. Tujuan: mengetahui perbandingan dorongan, bangkitan, orgasme, nyeri dan kepuasan fungsi seksual perempuan 3 bulan pascapersalinan spontan dengan seksio sesaria di Rumah Sakit Cipto Mangunkusumo Jakarta. Metode: Penelitian observasional, subyek kelompok persalinan spontan dan seksio sesaria, pengukuran fungsi seksualnya 3 bulan pascapersalinan menggunakan kuisioner Female Sexual Function Index (FSFI) desain penelitian cross sectional (potong lintang), pengambilan sampel consecutive sampling. Analisis komparatif katagorik tidak berpasangan dengan chi square atau uji fisher. Analisis variabel perancu dilakukan analisis multivariat regresi logistik. Hasil: Dari 150 responden 3 bulan pascapersalinan spontan dan seksio sesaria didapatkan 43,3% disfungsi seksual dengan 52 % spontan dan 34 % seksio sesaria. Analisa bivariat terjadinya disfungsi seksual 3 bulan pascapersalinan spontan 1,5 kali lebih besar (IK 95% 1,02-3,19) dibandingkan seksio sesaria. Gangguan hasrat/dorongan seksual 2 kali lebih besar (IK 95% 1,17-3,40) dibandingkan seksio sesaria, sedangkan gangguan orgasme 8 kali lebih besar (IK 95% 1,90-3,58) dengan variable perancu adanya robekan perineum. Gangguan bangkitan seksual, lubrikasi, kepuasan seksual dan nyeri tidak berbeda secara bermakna pada persalinan spontan dengan seksio sesaria. Analisa multivariat variabel persalinan spontan bermakna secara statistik untuk disfungsi seksual pasien 3 bulan pascapersalinan pada variabel disfungsi dorongan seksual dan pencapaian orgasme, dengan nilai p=0,008, RR 2,716 dan p=0,031 RR 6,952, sedangkan variabel usia lebih dari 30 tahun bermakna secara statistik pada disfungsi seksual pada variabel bangkitan seksual dengan p=0,021 dan RR 2,601. Kesimpulan: persalinan spontan bermakna secara statistik untuk terjadinya disfungsi seksual 3 bulan pascapersalinan, terutama variabel dorongan seksual dan tercapainya orgasme. Sedangkan variabel usia lebih dari 30 tahun merupakan variabel yang berpengaruh pada disfungsi seksual terutama pada variabel bangkitan seksual.

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Background: The alteration of postpartum sexual function on female is about 23%-86% and has a significant impact in a family?s tranquility. Many studies and research regarding postpartum sexual function on female were performed by various comparison variables such as Glasner, Barret, Thomson and Rochelle with different results because of the difference of measuring instruments, time of measurement and the control of confounding variables.

Objective: To know the comparison of encouragement, stimuli, orgasm, pain and satisfaction of female sexual function at 3 months post partum between spontaneous and cesarean section in Cipto Mangunkusumo National General Hospital in Jakarta.

Methods: This was an observational research involving subjects starting from identification of spontaneous and cesarean section group, and then their sexual function was measured at three months postpartum with Female Sexual Function Index (FSFI) questionnaire. The study design used was cross sectional with consecutive sampling. Analysis for non-paired of category comparative were chi square or fisher analysis. Analysis for confounding variables with multivariate logistic regression.

Results: From 75 respondents of spontaneous and Cesarean Section 43,3% have sexual dysfunction with 52% of spontaneous and 34% of cesarean section. Bivariate analysis of happening of sexual dysfunction at three months spontaneous was 1.5 times higher (IPK 95% 1,02-3,19) compared with cesarean section. Sexual encouragement shows a twice higher value (IPK 95% 1,17-3,40) compared to cesarean section. However, orgasm disturbance was 8 times higher (IPK 95% 1,90-3,58) with confounding variable of perineum rupture. Disturbance of sexual stimuli, satisfaction and pain were not significantly different between spontaneous and cesarean section. Multivariate analysis of vaginal labor was statistically significant for sexual dysfunction at three months postpartum in patient with sexual encouragement dysfunction and orgasm accession, with value of p=0,008, RR 2,716 and p=0,031 RR 6,952. However, more than 30 years old of age variable was statistically significant in sexual dysfunction variable with value of p=0,021 and RR=2,60.

Conclusion: Spontaneous labor is statistically significant for sexual dysfunction at three months postpartum, especially for sexual encouragement variable and orgasm accession. Meanwhile, the variables with the age of 30 years old or older."

"Gangguan otot rangka akibat kerja (gotrak) menjadi salah satu masalah kesehatan serius di berbagai industri yang diderita oleh pekerja. Walau tidak fatal gotrak cenderung mengurangi efisiensi kerja dan kualitas hidup. Keluhan gotrak yang dialami pekerja railway maintenance umumnya dirasakan pada bagian leher, punggung dan lutut, dimana keluhan tersebut disebabkan oleh postur janggal, bekerja di tempat yang sempit, berat beban dll. Pekerjaan railway maintenance memiliki faktor risiko yang dapat berpengaruh terhadap keluhan gotrak yaitu faktor risiko individu, fisik, psikososial, lingkungan dan organisasi. PT X merupakan BUMD di bidang perkeretaapian yang diantaranya mencakup pekerjaan railway maintenance. Penelitian ini bertujuan untuk mengetahui faktor risiko dari pekerjaan railway maintenance yang berpengaruh terhadap keluhan gotrak pekerja. Penelitian ini berjenis kuantitatif menggunakan desain cross sectional. Jumlah sampel menggunakan total populasi pada pekerja railway maintenance khususnya pada departemen yang menangani rolling stock maintenance (Departemen RSM dan Departemen RSIT) berjumlah 109. Departemen RSM mencakup light maintenance, sedangkan Departemen RSIT mencakup heavy maintenance. Manajemen data menggunakan SPSS 25, analisa data mengunakan analisa deskriptif, bivariat (uji chi square dan uji regresi logistik sederhana) dan multivariat menggunakan metode enter (uji regresi logistik ganda). Instrumen yang digunakan dalam penelitian ini adalah lembar kuesioner yang sudah diuji validitas dan reliabilitas dan lembar Rapid Entire Body Assesment (REBA). Hasil menunjukkan gambaran aktivitas pekerjaan di Departemen RSM terdiri dari pekerjaan di bagian rooftop, carbody, interior, underfloor dan di dalam kantor. Sedang pada Departemen RSIT terdiri dari pekerjaan di bagian carbody, pantograf, valve, brake, air compressor, motor traksi, bogie, elektrikal, AC, dan didalam kantor. Keluhan gotrak dirasakan oleh 62 pekerja railway maintenance di PT X (63.9%), dimana keluhan yang paling banyak dirasakan pada bagian leher, punggung bawah, kedua bahu, pergelangan tangan kanan dan punggung atas. Tingkat risiko ergonomi dari pekerjaan railway maintenance pada 2 departemen tersebut bervariasi mulai dari diabaikan hingga sangat tinggi, dimana penyumbang skor disebabkan oleh adanya postur janggal pada bagian leher, punggung, lengan atas, kedua kaki, dan berat objek. Faktor risiko yang berpengaruh terhadap keluhan gotrak yaitu dukungan sosial (OR 3.39, 95% CI 1,29-8.88). Intervensi yang dilakukan untuk mengurangi tingkat risiko ergonomi dari pekerjaan tersebut menggunakan hierarki pengendalian, sedangkan untuk mencegah keluhan gotrak yang berasal dari faktor risiko psikososial Upaya berfokus pada pengurangan tenaga manusia saat bekerja, peningkatan reward, peningkatan kepuasan kerja dan pengelolaan distres di tempat kerja.

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Musculoskeletal Disorders (MSDs) are one of the serious health problems in various industries suffered by workers. Although not fatal, MSDs tends to reduce work efficiency and quality of life. Complaints experienced by railway maintenance workers are generally felt in the neck, back and knees, where the complaints are caused by awkward posture, working in narrow places, heavy loads etc. Railway maintenance work has risk factors that can affect MSDs complaints, namely individual, physical, psychosocial, environmental and organizational risk factors. PT X is a BUMD in the field of railway which includes railway maintenance work. This study aims to determine the risk factors of railway maintenance work that affect MSDs workers complaints. This study was quantitative using a cross sectional design. The number of samples using the total population of railway maintenance workers, especially in departments that handle rolling stock maintenance (RSM Department and RSIT Department) amounted to 109. The RSM Department covers light maintenance, while the RSIT Department covers heavy maintenance. Data management using SPSS 25, data analysis using descriptive analysis, bivariate (chi square test and simple logistic regression test) and multivariate using enter method (multiple logistic regression test). The instruments used in this study were questionnaire sheets that had been tested for validity and reliability and Rapid Entire Body Assessment (REBA) sheets. The results show a picture of work activities in the RSM Department consisting of work on the rooftop, carbody, interior, underfloor and inside the office. While in the RSIT Department consists of work in the carbody, pantograph, valve, brake, air compressor, traction motor, bogie, electrical, air conditioning, and in the office. MSDs complaints were felt by 62 railway maintenance workers at PT X (63.9%), where the most complaints were felt in the neck, lower back, both shoulders, right wrist and upper back. The level of ergonomic risk of railway maintenance work in the 2 departments varies from negligible to very high, where the contributor to the score is caused by awkward posture on the neck, back, upper arms, both legs, and the weight of the object. Risk factors that influence gotrak complaints are social support (OR 3.39, 95% CI 1.29-8.88). Interventions carried out to reduce the level of ergonomic risk of the work use a hierarchy of control, while to prevent complaints of fatigue derived from psychosocial risk factors Efforts focus on reducing human labor while working, increasing rewards, increasing job satisfaction and managing stress at work."

"ABSTRAKLatar Belakang : Proses pematangan spermatzoa di epididimis terjadi melalui interaksi antara spermatozoa dengan berbagai protein yang disekresikan oleh epitel epididimis. Gen penyandi protein yang terlibat dalam proses maturasi ini masih banyak yang belum diketahui. Data penelitian sebelumnya menunjukkan bahwa gen-gen yang berperan dalam proses maturasi sperma ekspresinya dipengaruhi oleh androgen. Sperm associated antigen11a (Spag11a) merupakan salah satu gen yang ekspresinya dipengaruhi oleh androgen (Sipila et al, 2006), namun masih belum diketahui apakah Spag11a berperan pada proses maturasi sperma di epididimis.Tujuan : Mengkarakterisasi gen Spag11a pada epididimis mencit jantan strain DDYDesain : Penelitian ini menggunakan analisis bioinformatik dan eksperimentalMetode : Struktur gen Spag11a dan deteksi signal peptide dianalisis secara in silico. Quantitative Real time RT-PCR digunakan untuk mengukur ekspresi relatif Spag11a pada analisis spesifisitas jaringan, ketergantungan terhadap faktor endokrin dan faktor testikular. Untuk menganalisis ekspresi gen Spag11a pada tingkat protein dilakukan Western Blot, sedangkan untuk mengetahui lokasi protein SPAG11A pada sel epididimis dilakukan imunohistokimia.Hasil : SPAG11A termasuk dalam famili protein defensin beta dan analisis signal peptide menunjukan bahwa SPAG11A merupakan protein sekretori. Spag11a dieskpresikan secara spesifik pada organ epididimis, ekspresi di organ lain sangat rendah. Satu hal yang menarik yakni selain menunjukkan spesifisitas organ, Spag11a juga menunjukan spesifisitas regional pada caput epididimis. Ekspresi Spag11a dipengaruhi oleh androgen, penurunan ekspresi Spag11a sangat bermakna (p<0,001) pada hari ke 3 setelah gonadektomi dan mencapai ekspresi paling rendah pada hari ke 5. Ekspresi Spag11a meningkat kembali setelah penambahan testosteron eksogen. Ekspresi Spag11a juga dipengaruhi oleh faktor testikular, dimana pada perlakuan parsial gonadektomi (gonadektomi testis kanan saja) terjadi penurunan ekspresi relatif Spag11a yang lebih cepat dan lebih signifikan pada epididimis kanan dibandingkan dengan epididimis kiri. Pada tingkat protein SPAG11A juga terekspresi secara spesifik pada caput, dan analisis immunohistokimia menunjukan SPAG11A diekspresikan oleh sel prinsipal. Kesimpulan : Berdasarkan karakter Spag11a yang merupakan gen penyandi protein sekretori, terekspresi secara spesifik pada caput epididimis dan diregulasi oleh androgen maka dapat disimpulkan Spag11a terlibat dalam proses maturasi sperma. Penelitian lebih lanjut dalam tingkat uji fungsi perlu dilakukan.

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ABSTRACTBackground: Epididymal sperm maturation occurs through interactions between sperm and proteins sereted by epididymal epithelium. Genes encode for proteins involved in the sperm maturation process are still largely unknown. Previous studies showed that genes involved in sperm maturation are regulated by androgen. Sperm associated antigen 11a (Spag11a) is one of the epididymal genes influenced by androgen based on a global DNA microarray analysis (Sipila et al, 2006). However, little is known about the putative role of this gene in the sperm maturation process.Objective : To characterize expression and regulation of Spag11a genes in the mouse epididymis.Design : In silico analyses combined with experimental studyMethods : In silico analyses were used to predict Spag11a gene structure and signal peptide. Semi quantitative RT-PCR was used to measure the level of Spag11a expression in the tissue distribution, androgen dependency and testicular factors analyses. Western blot was performed to analyze gene expression at the protein level whereas immunocytochemstry was performed to localize SPAG11A in the epididymal cell.Results : SPAG11A is member of the defensin beta protein family and constitutes a secretory protein. Spag11a is expressed exclusively in the epididymis and not in other tissues. Moreover, Spag11a shows a region specific expression in the caput, typical for genes that is involved in creating a microenvironment suitable for sperm maturation. Spag11a expression is regulated by androgen. Significant decrease of Spag11a expression was observed after third day of gonadectomy (p<0.001). Interestingly, testosterone replacement therapy was able to bring the expression back to the normal level, indicating a high dependency on androgen. Besides androgen, testicular factor also slightly influence Spag11a expression. This was shown by partial gonadectomy experiment in which only the right testis was removed. Spag11a was down-regulated faster on the right epididymal caput compared to the left caput. Spag11a regional expression was also observed at protein level detected by Western immunoblot analyses showing a clear band in caput, not in other regions. Finally, the prediction that SPAG11A is a secretory protein was confirmed by immunocytochemical analyses showing a cell-specific expression in the principal cell. This cell type is known as the main secretor in the epididymal lumen.Conclusion : Based on the characters of Spag11a, it is most likely that this gene has a specific role in the epididymal sperm maturation. Further investigations using functional assays are needed to confirm the putative role."

"Perkembangan terapi edema makula diabetik hingga saat ini terus dieksplorasi, dengan terapi anti-VEGF sebagai lini pertama. Yellow Subthreshold Micropulse Laser (SMPL) merupakan inovasi laser fotokoagulasi konvensional yang menargetkan epitel pigmen retina (RPE) telah dianggap aman terhadap populasi kaukasian. Laser tersebut diajukan sebagai alternatif terapi edema makula ringan dengan ketebalan retina di bawah 400 μm. Data prospektif perubahan struktural dan elektrofisiologis SMPL sebagai monoterapi pada non proliferative diabetic retinopathy (NPDR) dengan DME ringan masih terbatas, khususnya di Asia yang memiliki perbedaan ketebalan densitas RPE. Studi eksperimental pre-post tanpa pembanding ini bertujuan untuk mengetahui perubahan Average Macular Thickness (AMT), amplitudo dan waktu implisit gelombang P1 dan N1 mfERG, dan DR score pada DME ringan pasca SMPL. Subyek yang masuk kriteria inklusi dilakukan laser SMPL dengan follow-up untuk menilai AMT dengan Optical Coherence Tomography (OCT) pada 4 dan 8 minggu, serta mfERG, dan DR score menggunakan RETeval Handheld ERG pada 8 minggu pasca laser. Terdapat 15 subyek (17 mata) yang diikutkan pada studi ini. Hasil menunjukkan perbaikan AMT signifikan pada minggu ke-8 pasca laser (p=0.001). Amplitudo dan waktu implisit gelombang P1 dan N1 tidak menunjukkan adanya perubahan bermakna pada setiap ring (p>0.05). Pemeriksaan DR score seluruh pasien DME menunjukkan hasil abnormal sesuai cut-off studi sebelumnya, serta tidak menunjukkan perubahan bermakna antara sebelum dan setelah terapi (p>0.05). Penelitian ini menunjukkan adanya perbaikan anatomis makula dan stabilisasi kondisi sel fotoreseptor dan Muler dilihat dari nilai elektrofisiologis dalam followup 8 minggu. Terapi SMPL dapat dipertimbangkan sebagai alternatif terapi yang aman dan bermanfaat untuk kasus NPDR dengan DME ringan.

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The management of DME is still under investigating and research, with currently intra vitreal anti-VEGF as the mainstay therapy. Yellow Subthreshold Micropulse Laser (SMPL) is a conventional photocoagulation laser innovation that targets retinal pigment epithelium (RPE) and has been reported its safety on Caucasian population. This laser method is considered as an alternative treatment for mild DME with retinal thickness below 400 μm. Prospective data on structural and electrophysiological changes of SMPL as monotherapy in non-proliferative diabetic retinopathy (NPDR) with mild DME are still limited, especially in Asia that has RPE density thickness differences. This pre-post study without comparison aims to determine changes in average macular thickness, amplitude and implicit time of P1 and N1 mfERG, and DR score in mild DME post SMPL. Subjects who met the inclusion criteria underwent SMPL laser was examined using Optical Coherence Tomography for average macular thickness parameter at 4- and 8-week post-laser, as well as mfERG and DR score using RETeval handheld ERG at 8-week post-laser. Fifteen subjects (17 eyes) were included in the study. Remarkable AMT improvement at 8-week post-laser was noted in this study (p=0.001). The amplitudes and implicit times of P1 and N1 waves showed no significant changes in each ring (p>0.05). All DME eyes showed abnormal DR score results at baseline according to the cut-off value of previous studies. There was no significant changes of DR score after therapy (p>0.05). This study showed an anatomical improvement of the macula and stabilization of photoreceptor and Muller cells as seen from electrophysiological values at 8-week follow-up. SMPL can be considered as a safe and beneficial alternative therapy in NPDR cases with mild DME."

"Deteksi progresi glaukoma penting untuk menentukan efektivitas terapi, dan inisiasi atau eskalasi terapi glaukoma sering kali bergantung pada penilaian progresi. Meskipun demikian, tingkat kesepakatan (agreement) di antara para ahli dalam mengidentifikasi progresi glaukoma bervariasi antar penelitian. Penelitian ini membandingkan agreement dan waktu interpretasi progresivitas glaukoma oleh dokter spesialis mata menggunakan dua metode: perangkat lunak FORUM® dan printouts hasil pemeriksaan OCT dan Humphrey. Sebanyak 36 sample cases yang masing-masing terdiri dari minimal 3 laporan OCT dan 5 laporan Humphrey dinilai oleh 12 dokter spesialis mata non-glaukoma (observers). Agreement terhadap status progresi glaukoma antara observers dan konsensus spesialis glaukoma dan dinyatakan dalam nilai Kappa. Waktu interpretasi merupakan total waktu yang dibutuhkan oleh observers untuk menilai progresivitas glaukoma pada seluruh kasus (n=36). Tingkat agreement terhadap status progresi glaukoma ketika menggunakan FORUM® dan ketika menggunakan metode konvensional (printouts) sama baik, dengan nilai Kappa rata-rata 0,62±0,16 vs. 0,63±0,22 (p=0,928). Metode FORUM® memiliki waktu interpretasi rata-rata yang lebih singkat dibandingkan dengan metode printouts, namun tidak bermakna secara statistik (29,1±9,5 vs. 38,8±13,6 menit, p=0,055). Studi ini menunjukkan bahwa penilaian progresi glaukoma menggunakan perangkat lunak FORUM® Glaucoma Workplace tidak memiliki keunggulan dibandingkan metode printouts dalam hal agreement terhadap status progresi dan waktu interpretasi.

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Detecting glaucoma progression is crucial for determining whether current therapy is effective, and the initiation or escalation of glaucoma therapy often depends on progression status. However, the level of agreement among experts in identifying glaucoma progression varies across studies. This study aims to compare the agreement and interpretation time of glaucoma progression assessment using two methods: the FORUM® software and printouts of OCT and Humphrey reports, as assessed by ophthalmologists. A total of 36 sample cases comprising minimum 3 OCT and 5 Humphrey reports were assessed by 12 ophthalmologists. Agreement on glaucoma progression between observers and standard reference was presented as Kappa value. Interpretation time was defined as the total time required by observers to assess glaucoma progression across all sample cases (n=36). The level of agreement on progression status between the observers when they used FORUM® and conventional (printouts) method were both good, with mean Kappa value 0.62±0.16 vs. 0.63±0.22 respectively (p=0.928). The FORUM® method had a shorter mean interpretation time compared to printouts method, but not statistically significant (29.1±9.5 vs. 38.8±13.6 minutes, p=0.055). This study showed that the assessment of glaucoma progression using FORUM® Glaucoma Workplace software has no superiority to printouts method in terms of agreement on progression status and interpretation time."