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Ayatullah Khomaini
Abstrak :
Pendahuluan Edukasi dan kepatuhan minum obat antihipertensi pada pasien hipertensi usia lanjut adalah salah satu faktor yang menjadi bagian tatalaksana hipertensi secara holistik dan komprehensif, mengingat hipertensi merupakan salah satu masalah pada usia lanjut yang sangat penting, dan memberikan dampak berbagai komplikasi kardiovaskular yang tinggi pada usia lanjut. Tujuan Mempelajari pengaruh edukasi terstruktur dan kepatuhan minum obat antihipertensi dalam bentuk pengisian checklist untuk membantu penurunan tekanan darah sebagai bagian dari tatalaksana hipertensi pada pasien usia lanjut Metode Dilakukan uji klinis acak tersamar ganda mulai Oktober 2012 hingga Februari 2013 terhadap 188 pasien usia lanjut dengan hipertensi di tiga poliklinik di RSCM Jakarta Indonesia. Subyek dibagi menjadi 3 kelompok, yaitu kelompok I yang mendapat edukasi terstruktur dan checklist, kelompok II yang mendapat edukasi terstruktur dan kelompok III tanpa edukasi terstruktur dengan checklist. Edukasi terstruktur dan checklist diberikan sebanyak 3 kali perbulan selama 90 hari. Dilakukan analisis dengan uji anova untuk melihat perbedaan tekanan darah pada ketiga kelompok setelah intervensi dengan prinsip analisis per protocol. Hasil Hasil randomisasi pada ketiga kelompok, didapatkan 182 subyek yang sesuai kriteria penelitian dan mengikuti penelitian sampai akhir, masing-masing terdiri dari 60 subyek pada kelompok I, 61 subyek pada kelompok II dan 61 subyek pada kelompok III. Pada akhir pengamatan, TDS kelompok I turun menjadi 130 (90- 179) mmHg, TDS kelompok II turun menjadi 135(80-174) mmHg, sedangkan TDS kelompok III turun menjadi 133 (102-209) mmHg (p=0,04). TDD kelompok I turun menjadi 70 (48-100) mmHg, TDD kelompok II turun menjadi 74 (45-103) mmHg, sedangkan TDD kelompok III turun menjadi 78 (60-102) mmHg (p<0,001). Simpulan Edukasi terstruktur memiliki pengaruh bermakna terhadap penurunan tekanan darah sistolik dan diastolik pada kelompok hipertensi usia lanjut. Kepatuhan minum obat antihipertensi dalam bentuk checklist tidak memiliki pengaruh bermakna terhadap penurunan tekanan darah sistolik dan diastolik pada kelompok hipertensi usia lanjut. ......Background Hypertension is one of the important problems in elderly due to high impact of cardiovascular complications. Education and antihypertensive medications adherence in elderly hypertensive patients are factors that influenced treatment effect in a holistic and comprehensive way. Objectives To determine the effect of structured education and antihypertensive medications adherence in decreasing blood pressure as part of the hypertension treatment in elderly patients. Methods A randomized clinical trial was conducted since October 2012 until February 2013 on 188 elderly patients with hypertension at clinics in Jakarta Indonesia Cipto Mangunkusumo. Subjects were divided into groups that received structured education and checklist (group I), structured education group (group II) and the group with no structured education but received checklist (group III). Structured education was given 3 times per month for 90 days. Systolic and Diastolic Blood pressure (SBP and DBP) were measured on day-1 and day-90. Analysis with anova test to see the difference of blood pressure among all three groups after intervention was conducted based on per protocol analysis. Results Among 188 subjects who met the initial criteria after randomization in all three groups, we received 182 subjects who fit the study criteria and completed the study, each consisting of 60 subjects in group I, 61 subjects in group II and 61 subjects in group III. The three groups were comparable in all important prognostic factors. At the end of the observation, SBP of group I reduced to 130 (90-179) mmHg, group II to 135 (80-174) mmHg, while group III to 133 (102-209) mmHg (p=0.04). DBP of group I reduced to 70 (48-100) mmHg, group II to 74 (45-103) mmHg, while group III to 78 (60-102) mmHg (p <0.001 ). Conclusion Structured education significantly decrease systolic and diastolic blood pressure in elderly hypertensive patients. Adherence to antihypertensive medication wasn?t significantly decrease systolic and diastolic blood pressure in elderly hypertensive patients.
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
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Hasan
Abstrak :
ABSTRAK
Latar Belakang : Pasien diabetes melitus tipe 2 dengan penyakit arteri perifer (terutama critical limb ischemia) memiliki tingkat amputasi yang masih tinggi. Perkembangan teknik endovaskular memungkinkan tindakan revaskularisasi dengan tingkat keberhasilan yang tinggi dan komplikasi yang rendah dibandingkan operasi bypass. Tujuan : Penelitian ini bertujuan mengetahui tingkat keberhasilan klinis 1 tahun setelah tindakan Percutaneus Transluminal Angioplasty dan distribusi faktor-faktor yang mempengaruhi keberhasilan klinis. Metode : Penelitian ini merupakan studi kohort retrospektif pada pasien diabetes melitus tipe 2 dengan penyakit arteri perifer yang menjalani tindakan PTA pada tahun 2008-2012 di Pelayanan Jantung Terpadu Rumah Sakit Cipto Mangunkusumo Jakarta. Pasien diikuti selama 1 tahun setelah tindakan PTA. Luaran yang dinilai pada penelitian ini adalah keberhasilan klinis dan limb salvage. Definisi keberhasilan klinis adalah tidak mengalami amputasi mayor, tidak terjadi restenosis, dan tidak mengalami nyeri berulang. Sedangkan tingkat limb salvage adalah proporsi pasien dengan plantar stand yang utuh setelah tindakan PTA. Hasil : Tindakan PTA dilakukan pada 43 pasien dengan diabetes tipe 2. Manifestasi paling sering adalah gangren (30.2%) dan luka iskemik (30.2%). Sedangkan 8(18.2%) pasien datang dengan nyeri pada istirahat dan 9(20.2%) pasien datang dengan klaudikasio. Selama 1 tahun, 3 pasien mengalami amputasi mayor, 3 pasien mengalami restenosis, dan 4 pasien mengalami nyeri berulang. Keberhasilan klinis untuk 1 tahun adalah 75% dan tingkat limb salvage selama 1 tahun adalah 90%. Pasien dengan diabetes terkendali dan CTO memiliki proporsi keberhasilan klinis yang lebih tinggi. Simpulan : Tindakan PTA pada pasien diabetes melitus tipe 2 dengan PAD memiliki keberhasilan klinis dan tingkat limb salvage yang cukup baik. Kata Kunci : Angioplasti; diabetes; critical limb ischemia; penyakit arteri perifer; PTA; limb Salvage
ABSTRACT
Background : Diabetic patient with PAD (especially critical limb ischemia) still have a high rate of limb amputation. The development in endovascular technique allows revascularization with high level of success and low complication compare to surgical (bypass). Objectives :The aim of this study is to evaluate the clinical outcome 1 year after PTA in type 2 diabetic patient with PAD. Methods : This was a retrospective cohort study, with 1 year follow up, to evaluate the clinical outcome of diabetic patients with PAD that has undergone PTA procedure in 2008-2012 in Cipto Mangunkusumo Hospital. The main outcome measured were clinical success and limb salvage rate. Clinical success defined as no major amputation, no restenosis, and no reccurence pain after PTA. Limb salvage rate defined as proportion of patient with intact plantar stand after PTA. Results : PTA was performed in 43 patient with diabetes. In this study most frequent manifestation were gangren (30.2%) and ischemic wounds (30.2%), while 8 patients (18.2%) came with resting pain, and 9 patients (20.2%) have claudication. During one year follow up 3 patients (6.9%) had major amputation, 3 patients (6.9%) had restenosis, and 4 patients had resting pain reccurence. The clinical succes rate for one year is 75%, with limb salvage rate for 1 year is 90%. Patients with controlled diabetes and chronic total occlusion had a higher proportion of clinical success. Conclusion : PTA procedure for diabetic patient with PAD has good clinical outcome with high level of limb salvage rate. Keyword : Angioplasty; critical limb ischemia; diabetes; peripheral arterial disease; PTA; limb salvage
2013
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Fransiska
Abstrak :
ABSTRAKk
Latar Belakang: Proses destruksi trombosit pada pasien trombositopenia imun primer diduga terutama terjadi melalui perantaraan antibodi terhadap glikoprotein permukaan trombosit. Antibodi anti-GPIIb/IIIa dan anti-GPIb/IX merupakan antibodi yang spesifik terhadap trombosit dan megakariosit. Beragamnya karakteristik klinis serta respon terapi pada pasien trombositopenia imun dipikirkan dipengaruhi oleh heterogenitas kompleks glikoprotein spesifik. Belum ada data tentang profil antibodi antiglikoprotein permukaan trombosit pada pasien trombositopenia imun primer dewasa. Tujuan: Mengetahui profil antibodi antiglikoprotein permukaan trombosit pada pasien trombositopenia imun primer dewasa. Metode: Penelitian ini merupakan studi potong lintang dengan subjek pasien trombositopenia imun primer dewasa di RSUPN Cipto Mangunkusumo pada bulan Maret-Oktober 2013. Variabel yang diteliti adalah antibodi anti-GPIIb/IIIa dan anti-GPIb/IX dengan teknik MAIPA direk. Hasil: Didapatkan 40 subjek selama penelitian. Sebanyak 10 subjek dengan diagnosis trombositopenia imun primer newly diagnosed yang belum mendapatkan terapi dan 30 subjek trombositopenia imun primer persisten/kronik yang sudah atau pernah mendapatkan terapi di Poliklinik Hematologi Onkologi Medik Departemen Ilmu Penyakit Dalam RSUPNCM selama penelitian. Median usia seluruh subjek adalah 24,5 tahun (rentang 17-55) dengan 82,5% subjek berjenis kelamin perempuan. Tujuh puluh persen subjek memiliki skor ITP Bleeding Score (IBLS) 2. Persentase respon komplit, respon, dan tidak respon terhadap terapi kortikosteroid adalah 42,5%, 45%, dan 12,5%. Pada kelompok trombositopenia imun kronik/persisten proporsi antibodi anti-GPIIb/IIIa adalah 20/30 dengan median optical density (OD) 0,461(rentang 0,093-2,116) dan proporsi antibodi anti-GPIb/IX adalah 25/30 dengan median OD 0,507(rentang 0,190-1,924). Pada kelompok trombositopenia imun newly diagnosed proporsi antibodi anti-GPIIb/IIIa adalah 7/10 dengan rerata OD 0,802±0,71 dan proporsi antibodi anti-GPIb/IX adalah 8/10 dengan rerata OD 0,82±0,57. Simpulan: Sebesar 85% pasien trombositopenia imun primer memiliki antibodi anti-GPIIb/IIIa dan anti-GPIb/IX. Terdapat proporsi respon terhadap terapi yang hampir sama antara subjek yang memiliki maupun tidak memiliki antibodi anti-GPIIb/IIIa dan anti-GPIb/IX.
ABSTRAK
Background: Platelet destructions in immune thrombocytopenia was mediated by autoantibodies against platelet antigen. Antibody anti-GPIIb/IIIa and anti-GPIb/IX were two major antibodies spesific for platelet and megakaryocytes. The diversity of clinical characteristics and therapeutic responses was thought to be influenced by heterogeneity of spesific glycoprotein complexes. There were no data about antiplatelet antibody profile in adult primary immune thrombocytopenia (ITP). Objectives: To find out antiplatelet glycoprotein antibody profile in adult primary immune thrombocytopenia. Methods: This is a cross sectional study of adult primary immune thrombocytopenia patients who attend Hematology Medical Oncology Polyclinic Internal Medicine Department Cipto Mangunkusumo Hospital in March to October 2013. Antibodies against the platelet GPIIb/IIIa and GPIb/IX were performed by direct MAIPA technique. Results: A total of 40 patients who had been diagnosed with primary immune thrombocytopenia attended to Polyclinic Hematology Medical Oncology Internal Medicine Department Cipto Mangunkusumo Hospital during the study. The subjects divided in two groups, 10 subjects with newly diagnosed ITP, and 30 subjects with persistent or chronic ITP. Median age for this study is 24,5 (17-55) years, with 82,5% were female. Seventy subjects have ITP Bleeding Score (IBLS) 2. Response to corticosteroid therapy in all subjects were complete response 42,5%, response 45%, and no response 12,5%. In persistent/chronic ITP group proportion of anti-GPIIb/IIIa is 20/30 with median optical density (OD) 0,461(0,093-2,116) and proportion of anti-GPIb/IX is 25/30 with median OD 0,507(0,190-1,924). In newly diagnosed ITP group proportion of anti-GPIIb/IIIa is 7/10 with mean OD 0,802±0,71 and proportion of anti-GPIb/IX is 8/10 with mean OD 0,82±0,57. Conclusion: Eighty five percent of primary immune thrombocytopenia have antibody anti GPIIb/IIIa and anti GPIb/IX. In response to therapy, there were similary response between subjects that with and without antibody anti-GPIIb/IIIa and anti-GPIb/IX.
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
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Yeti Hariyati
Abstrak :
[ABSTRAK
Latar Belakang:Artritis Reumatoid (AR) merupakan penyakit inflamasi sendi autoimun yang multi-sistemik persisten, eksaserbatif dan progresif. Anti-mutated citrullinated vimentin antibodies (Anti MCV) adalah autoantibodi golongan anti citrullinated protein antibody (ACPA) yang memiliki sensitifitas sama namun lebih spesifik dibandingkan dengan anti cyclic citrullinated protein (Anti CCP). Anti MCV berkaitan erat dengan gen HLA DRB1*04 yang berperan penting dalam patogenesis AR. Studi korelasi anti MCV dengan destruksi sendi dan aktifitas penyakit masih kontroversial dan karakteristik pasien AR di Indonesia yang berbeda, menjadi alasan penting dilakukannya penelitian ini.

Tujuan: Mengetahui hubungan antara kadar anti MCV dengan destruksi sendi dan aktifitas penyakit pada pasien artritis reumatoid

Metode: Penelitian ini merupakan studi potong lintang pada 37 pasien AR berdasarkan kriteria EULAR/ACR 2010 yang berobat di poliklinik Reumatologi RSCM periode September-Nopember 2014 dengan metode consecutive sampling. Anti MCV diukur dengan metode ELISA. Penilaian destruksi sendi menggunakan skor Sharp yang dimodifikasi Van der Heijde (SSvH) sedangkan aktifitas penyakit dinilai dengan disease activity score (DAS) 28 meliputi DAS 28-CRP dan DAS 28-LED. Korelasi anti MCV dengan destruksi sendi dan aktifitas penyakit dinilai dengan uji korelasi Spearman serta p untuk kemaknaan. Data penyerta lain adalah data demografis, jenis dan dosis terapi, status gizi, faktor reumatoid (FR), CRP, LED, dan darah tepi.

Hasil: Sebanyak 37 subjek diikutsertakan pada penelitian ini, dengan 34 (91,9%) adalah perempuan. Anti MCV positif ditemukan 26 subjek (70,3%), sedangkan FR positif ditemukan 21 (56.%). Median anti MCV didapatkan 26 IU/ml (minimal 10 IU/ml, maksimal 151 IU/ml) termasuk titer rendah. Median SSvH yaitu 31 (2-107), dengan nilai median erosi 5(0-49) dan joint space narrowing (JSN) 26 (0-64). Rerata nilai DAS 28-CRP 2,69 (SB 1,34) dan median DAS 28-LED 4,08 (2,10-5,97) yang masing-masing termasuk dalam kelompok aktivitas penyakit rendah dan sedang.Pada analisis bivariat didapatkan korelasi positif yang lemah antara anti MCV dengan SSvH sebesar r = 0,393 (p=0,016) dan korelasi positif yang lemah antara anti MCV dengan skor DAS 28-CRP (r=0,365, p=0,013) namun tidak ada korelasi antara anti MCV dengan skor DAS 28-LED.

Simpulan: Terdapat korelasi positif lemah yang bermakna antara titer anti MCV dengan destruksi sendi dan skor aktivitas penyakit DAS 28-CRP, korelasi antara titer anti MCV dengan skor DAS 28-LED tidak ada.;
ABSTRACT
Background:Rheumatoid Arthritis is a multi-systemic, persistent, exasperated and progressive auto immune joint inflamation disease. Anti-mutated citrullinated vimentin antibodies (Anti MCV) is an auto antibody in the category of anti citrullinated protein antibody (ACPA) that has same sensitivity but more specific compared with anti cyclic citrullinated protein (anti CCP). Anti MCV is closely related to gen HLA DRB1*04 which has important role in pathogenesis of rheumatoid arthritis. Study on correlation between anti MCV and joint destruction and disease activity is still controversial and the different characteristics of AR patients in Indonesia become a strong reason for this study.

Objective:The aim of this study was to described the correlation between anti-mutated citrullinated vimentin (anti MCV) with joint destruction and disease activity of in rheumatoid arthritis patients.

Methods:This is a cross-sectional study on 37 RA patients based on criteria of EULAR/ACR 2010 who came to Rheumatology outpatient clinic Cipto Mangunkusumo Hospital, period of September ? November 2014 with the method of consecutive sampling. Anti MCV is measured with ELISA method, while joint destruction is scored with Sharp score modified with Van der Heijde ( SSvH ). disease activity score (DAS) 28 is used in disease activity covering DAS 28-CRP and DAS 28-LED. Correlation between anti MCV and joint destruction as well as disease activity is measured with Spearman correlation test with p for significance. Other supporting data include demography, type and dose of therapy, nutrition status, rheumathoid factor, CRP, LED, and peripheral blood.

Results:37 subjects were taken into this study, with 34 (91,9%) are women. Positive anti MCV was found in 26 subjects (70,3%) while positive FR was found in 21 subjects (56%). Median of anti MCV was obtained 26 IU/ml (minimal 10 IU/ml, maximal 151 IU/ml )which is including in low titer. Median of SSvH was 31 (2 ?107) with erosion median score of 5 (0-49) and joint space narrowing (JSN) of 26 (0-64). Average score of DAS 28-CRP was 2,69 (SD1,34) and median score of DAS 28-LED was 4,08 (2,10-5,97), each of which is included in low and medium disease activity. In bivariate analysis it?s found that there is a weak significant positive correlation between anti MCV and SSvH of r = 0,393 (p=0,016) and between anti MCV and score of DAS 28-CRP (r= 0,365 , p=0,013) but there is no correlation between anti MCV and score of DAS 28-LED.

Conclusion:There is a weak significant positive correlation between anti MCV and joint destruction and level of disease activity score DAS 28-CRP. Apart from that, there is no correlation between anti MCV and DAS 28-LED., Background:Rheumatoid Arthritis is a multi-systemic, persistent, exasperated and progressive auto immune joint inflamation disease. Anti-mutated citrullinated vimentin antibodies (Anti MCV) is an auto antibody in the category of anti citrullinated protein antibody (ACPA) that has same sensitivity but more specific compared with anti cyclic citrullinated protein (anti CCP). Anti MCV is closely related to gen HLA DRB1*04 which has important role in pathogenesis of rheumatoid arthritis. Study on correlation between anti MCV and joint destruction and disease activity is still controversial and the different characteristics of AR patients in Indonesia become a strong reason for this study. Objective:The aim of this study was to described the correlation between anti-mutated citrullinated vimentin (anti MCV) with joint destruction and disease activity of in rheumatoid arthritis patients. Methods:This is a cross-sectional study on 37 RA patients based on criteria of EULAR/ACR 2010 who came to Rheumatology outpatient clinic Cipto Mangunkusumo Hospital, period of September – November 2014 with the method of consecutive sampling. Anti MCV is measured with ELISA method, while joint destruction is scored with Sharp score modified with Van der Heijde ( SSvH ). disease activity score (DAS) 28 is used in disease activity covering DAS 28-CRP and DAS 28-LED. Correlation between anti MCV and joint destruction as well as disease activity is measured with Spearman correlation test with p for significance. Other supporting data include demography, type and dose of therapy, nutrition status, rheumathoid factor, CRP, LED, and peripheral blood. Results:37 subjects were taken into this study, with 34 (91,9%) are women. Positive anti MCV was found in 26 subjects (70,3%) while positive FR was found in 21 subjects (56%). Median of anti MCV was obtained 26 IU/ml (minimal 10 IU/ml, maximal 151 IU/ml )which is including in low titer. Median of SSvH was 31 (2 –107) with erosion median score of 5 (0-49) and joint space narrowing (JSN) of 26 (0-64). Average score of DAS 28-CRP was 2,69 (SD1,34) and median score of DAS 28-LED was 4,08 (2,10-5,97), each of which is included in low and medium disease activity. In bivariate analysis it’s found that there is a weak significant positive correlation between anti MCV and SSvH of r = 0,393 (p=0,016) and between anti MCV and score of DAS 28-CRP (r= 0,365 , p=0,013) but there is no correlation between anti MCV and score of DAS 28-LED. Conclusion:There is a weak significant positive correlation between anti MCV and joint destruction and level of disease activity score DAS 28-CRP. Apart from that, there is no correlation between anti MCV and DAS 28-LED.]
2015
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UI - Tesis Membership  Universitas Indonesia Library
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Nadya Magfira
Abstrak :
ABSTRAK
Latar belakang: Penelitian mengenai Disfungsi Seksual pada Wanita (DSW) masih jauh tertinggal dibandingkan pada pria, saat ini hipertensi diketahui mempengaruhi terjadinya disfungsi seksual pada pria. Namun, bagaimana hipertensi mempengarhui kejadian DSW belum banyak diketahui. Penelitian ini bertujuan untuk mengetahui hubungan antara hipertensi esensial dengan kejadian DSW. Metode: Penelitian ini merupakan penelitian potong lintang yang dilakukan di Klinik Ikhalas Medika Kota Serang, Banten pada bulan Agustus-September 2019. Seluruh perempuan yang berusia diatas 18 tahun, berpendidikan minimal SD, menikah, melakukan hubungan seksual dalam 4 minggu terakhir, tidak memiliki riwayat diabetes, kemoterapi, radiasi maupun operasi didaerah panggul selain section caesare diikutsertakan dalam penelitian. Fungsi seksual wanita diukur menggunakan Female Sexual Function Index-Indonesia (FSFI-I), subjek dikategorikan memiliki DSW apabila nilai FSFI-I < 26.55. Analisa menggunakan modified Cox-regression digunakan untuk mengetahui hubungan DSW dengan hipertensi esensial yang dinyatakan dalam Rasio Prevalensi (PR) dan Interval Kepercayaan 95% (95%CI). Hasil: Sebanyak 442 wanita diikutsertakan dalam penelitian ini dengan respons rate penelitian sebesar 86.3%. Sebanyak 91.67% wanita dengan hipertensi (121/132) dalam penelitian ini mengalami DSW dan sebanyak 72.9% (226/310) wanita tanpa hipertensi mengalami DSW. Hipertensi diketahui meningkatkan kejadian DSW dengan nilai aPR sebesar 1.76 kali lipat (95%CI: 1.20-2.60). Kesimpulan: DSW merupakan masalah kesehatan yang umum dijumpai dan kejadiannya diketahui meningkat pada wanita dengan hipertensi. Pengelolaan hipertensi dengan pendekatan holistik perlu dilakukan termasuk didalamnya penilaian gangguan fungsi seksual pada wanita dengan hipertensi.
ABSTRACT
Introduction: Comapared to male, the study regarding Female Sexual Dysfunction (FSD) was far left behind. Recent study showed that high blood pressure is a major cause of male sexual dysfunction. However, how hypertension affects women sexual function was not completely understood. This study aims to investigate the relationship between hypertension and FSD. Methods: This is a cross-sectional study conducted in a private primary healthcare clinic, in Serang City, Banten Province Indonesia from August-September 2019. All women aged 18 years or older, at least elementary school graduated, had sexual activities during the last 4 weeks were recruited. Exclusion criteria were pregnant, had history of diabetes, or chemotherapy, radiation, or surgery in the pelvic region except for caesarean section. Patient sexual function was assessed by the Indonesian validated Female Sexual Function Index (FSFI-I). Patients were classified as having sexual dysfunction (SD) if the total FSFI-I score was < 26.55. Modified cox-regression performed to evaluate the association between hypertension and SD and to calculate the Prevalence Ratio (PR) for SD in HT women. Results: A total of 442 women were included in this study with a response rate of 86.3%. A total of 91.67% women with hypertension (121/132) in this study had FSD and a total of 72.9% women without hypertension (226/310) had FSD. Hypertension increased the proportion of FSD with an aPR 1.76 (95% CI: 1.20-2.60). Conclusion: FSD is a common problem and the prevalence increase in women with hypertension. Holistic approach management in hypertension needs to be done including the assessment of sexual function in women with hypertension.
Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2020
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Verawati
Abstrak :
Objektif. Penelitian ini bertujuan untuk mengetahui pengaruh pemberian dark chocolate 30 g/hari selama 15 hari berturut-turut terhadap kadar NOx serum dan tekanan darah karyawan administrasi laki-laki dan perempuan penderita prahipertensi. Metode. Penelitian ini adalah suatu uji klinis paralel. Sebanyak 32 subyek penelitian yang memenuhi kriteria dibagi dalam dua kelompok secara randomisasi blok. Sebanyak 16 orang mendapat dark chocolale 30 g/hari disertai dengan penyuluhan gizi dan 16 orang mendapat white chocolate 25 g/hari disertai dengan penyuluhan gizi. Data yang diambil meliputi usia aktivitas fisik, indeks massa tubuh, asupan energi, natrium, dam polifenol, kadar NOx scrum dan tekanan darah. Pemeriksaan kadar NOx serum dilakukan pra perlakuan (HO) dan pasca perlakuan (H+l6), sedangkan pengukuran tekanan darah dilakukan pra perlakuan (HO), selama perlakuan (I-I+8) dan pasca perlakuan (H+l 6). Hasil. Asupan polifenol selama perlakuan lebih tinggi pada kelompok perlakuan dibanding kelompok kontrol. Pasca perlakuan, didapatkan perbedaan yang bermakna pada kadar NOx serum antara kelompok P dengan kelompok K (p=0,00l). Tekanan darah pada kedua kelompok mengalami penurunan. Tekanan darah sistolik pasca perlakuan berbeda bermakna antara kelompok P dan kelompok K (p=0,00l), sedangkan tekanan darah diastolik menurun tidak bermakna (p=0,308). Tekanan darah sistolik dan diastolik pra dan pasca perlakuan kelompok P menurun bermakna (p<0,000), sedangkan tekanan darah sistolik dan diastolik pra dan pasca perlakuan pada kelompok K menurun tidak bermakna. Kesimpulan. Setelah 15 hari perlakuan, terjadi peningkatan asupan polifenol di kelompok perlakuan yang disertai peningkatan kadar NOx serum dan penurunan bermakna tekanan darah sistolik, sedangkan tekanan darah diastolik menurun tidak bermakna. ......Objective. This study was conducted to investigate the effect of dark chocolate 30 g/day for fifteen day on NOx serum level and blood pressure in male and female administration employee with prehypertension. Methods. The study was a parallel clinical trial. A total of thirty two subjects who were selected using certain criteria divided into two groups using block randomization. Sixteen subjects received 30 g/day dark chocolate and dietary counseling (Treatment Group) and other 16 subjects received white chocolate 25 g/day and dietary counseling (Control Group) for fifteen days. Data collected in this study consist of age, physical activity, body massa index, intake of energy, sodium, and polyphenol, NOx serum levels and blood pressure. Assessment on NOx serum level were done in pre treatment and after treatment, while blood pressure were assessed in pre treatment, in treatment period and after treatment. Results. Polyphenol intake in treatment periode in treatment group was significantly higher compared with control groups. After 15 days treatment, NOx scrum level between treatment and control groups was significantly different (p=0,00l). Both group had decreased systolic and diastolic blood pressure. Systolic blood pressure was decreased significantly between groups after treatment (p=0,001), while diastolic blood pressure was not significant (pr0,308). Systolic and diastolic blood pressure pre and after treatment in ueatment group were significantly decreased, while it was not significant in control group. Conclusions. There was increased polyphcnol intake in treatment group which increased serum NOx level, significantly decreased systolic blood pressure while no significant decrease in diastolic blood pressure after 15 days treatment.
Depok: Fakultas Kedokteran Universitas Indonesia, 2010
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Shirly Elisa Tedjasaputra
Abstrak :
Latar Belakang. Kalsifikasi vaskular yang ditandai dengan penebalan tunika intima-media (TIM) karotis pada pasien diabetes melitus (DM) tipe 2 merupakan faktor prediktor terhadap kejadian serebro-kardiovaskular. Osteoprotegerin (OPG) merupakan petanda disfungsi endotel yang dapat digunakan sebagai prediktor terhadap penebalan TIM karotis. Penggunaan ultrasonografi (USG) karotis untuk menilai ketebalan TIM karotis masih terbatas di Indonesia sehingga diperlukan metode diagnostik lain yang lebih cost effective. Tujuan. Menentukan faktor-faktor determinan yang bermakna dan nilai tambah diagnostik pemeriksaan OPG dalam mendeteksi penebalan TIM karotis pada pasien DM tipe 2. Metodologi. Studi potong lintang dilakukan di poliklinik Metabolik Endokrin dan poliklinik spesialis Ilmu Penyakit Dalam RS Cipto Mangunkusumo (RSCM) pada bulan April-Juni 2012 pada pasien DM tipe 2 tanpa komplikasi serebro-kardiovaskular, tanpa komplikasi penyakit ginjal kronik (PGK) stadium III – V dan tidak merokok. Pada penelitian ini dilakukan analisis bivariat dan multivariat pada variabel lama menderita DM, hipertensi, dislipidemia, HbA1c dan OPG, kemudian ditentukan nilai tambah pemeriksaan OPG dalam mendeteksi penebalan TIM karotis pada pasien DM tipe 2. Hasil dan Pembahasan. Dari 70 subyek penelitian, didapatkan jumlah subyek dengan peningkatan OPG dan penebalan TIM karotis adalah sebesar 45,7 % dan 70 %. Dari 49 subyek dengan penebalan TIM karotis, didapatkan 61,2 % subyek dengan peningkatan OPG. Lama menderita DM (OR 26,9; IK 95 % 2 – 365,6), hipertensi (OR 22; IK 95 % 2,3 – 207,9), dislipidemia (OR 85,2; IK 95 % 3,6 – 203,6) dan OPG (OR 12,9; IK 95 % 1,4 – 117,3) berhubungan secara bermakna dengan penebalan TIM karotis. Pemeriksaan OPG mempunyai spesifisitas dan nilai duga positif tinggi (90,5 % dan 84 %). Nilai tambah diagnostik OPG hanya sebesar 2,3 % dalam mendeteksi penebalan TIM karotis. Kesimpulan. Faktor-faktor determinan yang bermakna untuk mendeteksi penebalan TIM karotis pada pasien DM tipe 2 adalah lama menderita DM, hipertensi, dislipidemia dan OPG. Nilai tambah diagnostik dari pemeriksaan OPG adalah sebesar 2,3 % dalam mendeteksi penebalan TIM karotis pada pasien DM tipe 2 ......Background. Vascular calcification measured by carotid intima-media thickness (CIMT) in type 2 diabetes mellitus (DM) patient is a predictor for cerebrocardiovascular event. Osteoprotegerin (OPG) as a marker for endothelial dysfunction can be used as a predictor for increased CIMT. Applicability of carotid ultrasonography (USG) in Indonesia is still limited, therefore other diagnostic method that is more cost effective is needed. Objective. To determine the significant determinant factors and the diagnostic added value of OPG to detect increased CIMT in type 2 DM patient. Methods. Cross sectional study was conducted in Metabolic Endocrine and Internal Medicine outpatient clinic Cipto Mangunkusumo Hospital between April and June 2012 in type 2 DM patient without history of cerebro-cardiovascular event, without history of chronic kidney disease (CKD) stage III – V and without smoking. Bivariate analysis and multivariate analysis were performed to variables duration of DM, hypertension, dyslipidemia, HbA1c and OPG, followed by determining the diagnostic added value of OPG to detect increased CIMT in type 2 DM patient. Results. From 70 subjects, there were 45,7 % subject with increased OPG and 70 % subject with increased CIMT. From 49 subject with increased CIMT, 61,2 % subject had increased OPG. Duration of DM (OR 26,9; IK 95 % 2 – 365,6), hypertension (OR 22; IK 95 % 2,3 – 207,9), dyslipidemia (OR 85,2; IK 95 % 3,6 – 203,6) and OPG (OR 12,9; IK 95 % 1,4 – 117,3) were correlated significantly to increased CIMT. OPG measurement had high specificity and positive predictive value (90,5 % and 84 %). Diagnostic added value of OPG was only as 2,3 % to detect increased CIMT in type 2 DM patient. Conclusion. The significant determinant factors for detection of increased CIMT in type 2 DM patient were duration of DM, hypertension, dyslipidemia and OPG. The diagnostic added value of OPG was 2,3 % to detect increased CIMT in type 2 DM patient.
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2012
T42723
UI - Tesis Open  Universitas Indonesia Library
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Sinaga, Ariska
Abstrak :
Latar Belakang: Aktivitas penyakit Artritis Reumatoid (AR) merupakan ekspresi dari kaskade inflamasi. Inflamasi jaringan sinovium yang disertai pembentukan pannus memerlukan asupan nutrisi dan oksigen melalui angiogenesis. Peningkatan penanda angiogenik menunjukkan inflamasi sendi yang progresif dan peningkatan aktivitas penyakit. Salah satu faktor pertumbuhan yang memiliki peran pada angiogenesis adalah nerve growth factor (NGF). Beberapa penelitian terdahulu mendapatkan kadar NGF yang meningkat baik pada serum maupun pada cairan sinovium pasien AR. Nerve growth factor (NGF) dapat menginduksi faktor-faktor pro-angiogenik dan faktor pertumbuhan lain yang berperan pada AR. Saat ini belum ada penelitian yang menghubungkan kadar serum NGF terhadap aktivitas penyakit AR. Tujuan: Mengetahui korelasi antara kadar NGF dengan aktivitas penyakit (yang dinilai dengan DAS28 LED dan DAS28 CRP) pada pasien AR di Rumah Sakit Cipto Mangunkusumo. Metode: Penelitian potong lintang yang mengevaluasi kadar NGF menggunakan two site immunoenzymatic assay (ELISA) pada 50 pasien (47 orang perempuan dan 3 orang laki-laki) AR di poliklinik Reumatologi Rumah Sakit Cipto Mangunkusumo pada Oktober sampai Desember 2015. Aktivitas penyakit AR pada penelitian ini dinilai menggunakan skor DAS28 LED dan DAS28 CRP melalui kalkulator yang diakses dari internet pada http://www.das-score.nl/. Analisis statistik bivariat digunakan untuk mendapatkan korelasi antara NGF dengan aktivitas penyakit AR. Hasil: Rerata usia subjek penelitian ini adalah 43,44 tahun. Median kadar serum NGF adalah 4,33 pg/mL (2,35-20,83). Hasil analisis memperlihatkan korelasi antara kadar serum NGF dengan skor DAS28 LED (r = +0,427; p = 0,002) dan DAS28 CRP (r =+0.407; p = 0,003). Kesimpulan: Terdapat korelasi positif sedang antara kadar serum NGF dengan aktivitas penyakit AR. ...... Background: Disease activity of Rheumatoid Arthritis (RA) is an expression of the inflammatory cascade. Disease activity of a given joint is correlated with the synovial vascularization. Synovial tissue inflammation accompanied by pannus formation requires intake of nutrients and oxygen through angiogenesis. Angiogenesis plays an integral part of the development of the pannus formation. Increased angiogenic markers shows a progressive increase of joint inflammation and disease activity. One of the contributing factors to angiogenesis is the nerve growth factor (NGF). Several previous studies show increased NGF concentrations in both the serum and synovial fluid of RA. Nerve growth factor can induce pro-angiogenic factors and other growth factors contribute in RA. Currently, there has not been any studies yet that correlates the NGF serum concentration with RA disease activity. Objective: To determine the correlation between the serum concentration of NGF and disease activity of RA patients at Cipto Mangunkusumo General Hospital (using DAS28 ESR and DAS28 CRP score). Methods: A cross-sectional study was used. Recruited were 50 RA patients (47 women and 3 men) of outpatient clinic of Rheumatology at Cipto Mangunkusumo General Hospital from October to December 2015. Concentrations of NGF were evaluated with a two site immunoenzymatic assay (ELISA). Disease activity in this study was assessed using DAS28 ESR and DAS28 CRP score using a calculator accessible from the internet on http://www.das-score.nl/. The correlation between NGF with disease activity was analyzed by bivariate analysis. Results: The mean age of the study subjects was 43.44 years. Median serum NGF was 4.33 pg / mL (2.35 to 20.83). The results shows correlation between serum NGF with DAS28 ESR (r = +0.427; p = 0.002) and DAS28 CRP (r = + 0407; p = 0.003). Conclusion: Significant positive correlation between serum concentration of NGF with diesease activity in patient with AR was found.
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
cover
Shirly Elisa Tedjasaputra
Abstrak :
ABSTRAK
Latar Belakang. Kalsifikasi vaskular yang ditandai dengan penebalan tunika intima-media (TIM) karotis pada pasien diabetes melitus (DM) tipe 2 merupakan faktor prediktor terhadap kejadian serebro-kardiovaskular. Osteoprotegerin (OPG) merupakan petanda disfungsi endotel yang dapat digunakan sebagai prediktor terhadap penebalan TIM karotis. Penggunaan ultrasonografi (USG) karotis untuk menilai ketebalan TIM karotis masih terbatas di Indonesia sehingga diperlukan metode diagnostik lain yang lebih cost effective.

Tujuan. Menentukan faktor-faktor determinan yang bermakna dan nilai tambah diagnostik pemeriksaan OPG dalam mendeteksi penebalan TIM karotis pada pasien DM tipe 2.

Metodologi. Studi potong lintang dilakukan di poliklinik Metabolik Endokrin dan poliklinik spesialis Ilmu Penyakit Dalam RS Cipto Mangunkusumo (RSCM) pada bulan April – Juni 2012 pada pasien DM tipe 2 tanpa komplikasi serebro-kardiovaskular, tanpa komplikasi penyakit ginjal kronik (PGK) stadium III – V dan tidak merokok. Pada penelitian ini dilakukan analisis bivariat dan multivariat pada variabel lama menderita DM, hipertensi, dislipidemia, HbA1c dan OPG, kemudian ditentukan nilai tambah pemeriksaan OPG dalam mendeteksi penebalan TIM karotis pada pasien DM tipe 2.

Hasil dan Pembahasan. Dari 70 subyek penelitian, didapatkan jumlah subyek dengan peningkatan OPG dan penebalan TIM karotis adalah sebesar 45,7 % dan 70 %. Dari 49 subyek dengan penebalan TIM karotis, didapatkan 61,2 % subyek dengan peningkatan OPG. Lama menderita DM (OR 26,9; IK 95 % 2 – 365,6), hipertensi (OR 22; IK 95 % 2,3 – 207,9), dislipidemia (OR 85,2; IK 95 % 3,6 – 203,6) dan OPG (OR 12,9; IK 95 % 1,4 – 117,3) berhubungan secara bermakna dengan penebalan TIM karotis. Pemeriksaan OPG mempunyai spesifisitas dan nilai duga positif tinggi (90,5 % dan 84 %). Nilai tambah diagnostik OPG hanya sebesar 2,3 % dalam mendeteksi penebalan TIM karotis.

Kesimpulan. Faktor-faktor determinan yang bermakna untuk mendeteksi penebalan TIM karotis pada pasien DM tipe 2 adalah lama menderita DM, hipertensi, dislipidemia dan OPG. Nilai tambah diagnostik dari pemeriksaan OPG adalah sebesar 2,3 % dalam mendeteksi penebalan TIM karotis pada pasien DM tipe 2.
ABSTRACT
Background. Vascular calcification measured by carotid intima-media thickness (CIMT) in type 2 diabetes mellitus (DM) patient is a predictor for cerebrocardiovascular event. Osteoprotegerin (OPG) as a marker for endothelial dysfunction can be used as a predictor for increased CIMT. Applicability of carotid ultrasonography (USG) in Indonesia is still limited, therefore other diagnostic method that is more cost effective is needed.

Objective. To determine the significant determinant factors and the diagnostic added value of OPG to detect increased CIMT in type 2 DM patient. Methods. Cross sectional study was conducted in Metabolic Endocrine and Internal Medicine outpatient clinic Cipto Mangunkusumo Hospital between April and June 2012 in type 2 DM patient without history of cerebro-cardiovascular event, without history of chronic kidney disease (CKD) stage III – V and without smoking. Bivariate analysis and multivariate analysis were performed to variables duration of DM, hypertension, dyslipidemia, HbA1c and OPG, followed by determining the diagnostic added value of OPG to detect increased CIMT in type 2 DM patient.

Results. From 70 subjects, there were 45,7 % subject with increased OPG and 70 % subject with increased CIMT. From 49 subject with increased CIMT, 61,2 % subject had increased OPG. Duration of DM (OR 26,9; IK 95 % 2 – 365,6), hypertension (OR 22; IK 95 % 2,3 – 207,9), dyslipidemia (OR 85,2; IK 95 % 3,6 – 203,6) and OPG (OR 12,9; IK 95 % 1,4 – 117,3) were correlated significantly to increased CIMT. OPG measurement had high specificity and positive predictive value (90,5 % and 84 %). Diagnostic added value of OPG was only as 2,3 % to detect increased CIMT in type 2 DM patient.

Conclusion. The significant determinant factors for detection of increased CIMT in type 2 DM patient were duration of DM, hypertension, dyslipidemia and OPG. The diagnostic added value of OPG was 2,3 % to detect increased CIMT in type 2 DM patient.
2013
T42723
UI - Tesis Membership  Universitas Indonesia Library
cover
Eka Widya Khorinal
Abstrak :
ABSTRAK
Latar Belakang. Hiperglikemia yang terjadi selama masa perawatan di rumah sakit pada pasien dengan penyakit kritis telah diketahui akan memberikan luaran klinis yang buruk bahkan dapat berujung pada kematian. Hiperglikemia yang terjadi pada pasien sindrom koroner akut (SKA) akan berakibat pada gangguan regenerasi sel endotel dan pembentukan pembuluh darah kolateral (revaskularisasi). Sayangnya, manajemen hiperglikemia sampai saat ini masih belum dicapai kata sepakat terutama perbedaan dalam menentuksn nilai potong dalam evaluasi glukosa lanjutan.

Tujuan. Untuk mengetahui pengaruh hiperglikemia selama perawatan terhadap kesintasan (mortalitas) enam bulan pasien SKA dan mencari nilai potong ideal jntuk evaluasi lanjutan dan target kendali selama perawatan

Metodologi. Penelitian dilakukan secara kohort retrospestif pada pasien SKA di dirawat di instalasi ICCU RSUPN Cipto Mangunkusumo Jakarta, dengan melibatkan pasien yang dirawat sampai dengan Desember 2011. Pengambilan data subjek penelitian dilakukan melalui data sekunder dengan pendaraan rekam medis dan dilakukan secara konsekutif.

Hasil. Kami mendapatkan 807 pasien SKA selama periode Januari tahun 2000 sampai dengan Desember tahun 2011 yang memenuhi kriteria inklusi dan ekslusi. Hiperglikemia selama perawatan terjadi 242 (30 %) subjek penelitian. Hiperglikemia yang memberikan pengaruh pada kesintasan enam bulan dengan meningkatkan resiko kematian (HR 2,16 dengan IK 95% 1,77 sampai 2,63). Nilai potong glukosa darah yang memberikan kemaknaan pada kesintasan berada pada nilai 142,5 mg/dL.

Kesimpulan. Pasien dengan hiperglikemia memiliki kesintasan yang lebih buruk dibandingkan pasien tanpa hiperglikemia. Nilai glukosa darah 142,5 mg/dL dapat dipergunakan sebagai nilai potong untuk evaluasi glukosa darah lanjutan selama masa perawatan.
ABSTRACT
Background. Hyperglicemia during hospitalization especially on critically ill patients has worse clinical outcome and deadly. Patient with hyperglicemiain in acute coronary syndrome (ACS) will hamper endotelial regeneration and revascularization of coronary blood vessels. Unforrtunately, up until now rate of blood glucose cut off in hyperglycemia management had not reached any consession although we undoubtfully agree that this concept is very important in evaluation and choosing goal treatment.

Aim. To determine the impact of hyperglicemia during admission in six month mortality rate of ACS patients and the best blood glucose cut off for evaluation and goal treatment.

Method. This research used retrospective cohort on ACS patients admitted in ICCU, Cipto Mangukusumo Hospital, Jakarta, untill December 2011. Subjects' data were collected through medical records consecutively.

Results. This research found that there were 807 ACS patients admitted during Januari 2000 to December 2011 that met inclusion and exclusion criterias. Hyperglicemia during admission was found on 242 (30 %) subjects. This condition statistically proven to increase six month mortality rate (HR 2, 16 with CI 95% 1,77 till 2,63). The best rate of Blood Glucose cut of for evaluation and management was 142,5mg/dL.

Conclussion. There was significant difference mortality rate between hyperglicemia patients and non hyperglicemia.Blood glucose level on 142, 5 mg/dL could be used as cut off evaluation during admission.
Fakultas Kedokteran Universitas Indonesia, 2013
T32144
UI - Tesis Membership  Universitas Indonesia Library
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