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All Journal eJurnal Kedokteran Indonesia Medical Journal of Indonesia Journal of General Procedural Dermatology and Venereology Indonesia ASEAN Journal of Community Engagement
Sri L. Menaldi
Department Of Dermatology And Venereology Faculty Of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital
Economics, Econometrics & Finance Education Medicine & Pharmacology Public Health Social Sciences Other

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Effectiveness of permethrin standard and modified methods in scabies treatment Zulkarnain, Hirzi; Santawi, Victor; Angkasa, Hansen; Herqutanto, Herqutanto; Fuady, Ahmad; Menaldi, Sri L.; Agustin, Triana; Sungkar, Saleha
Medical Journal of Indonesia Vol 23, No 2 (2014): May
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (337.121 KB) | DOI: 10.13181/mji.v23i2.594

Abstract

Background: Permethrin is the drug of choice for scabies with side effects such as erythema, pain, itching and prickling sensation. Whole-body (standard) topical application of permethrin causes discomfort; thus, modified application of permethrin to the lesion only, followed with baths twice daily using soap was proposed. The objective of the study is to know the effectiveness of standard against lesion-only application of permethrin in scabies treatment.Methods: An experimental study was conducted in pesantren in East Jakarta and data was collected in May-July 2012. Diagnosis of scabies was made through anamnesis and skin examination. Subjects positive for scabies were divided into three groups: one standard method group (whole-body topical application) and two modified groups (lesion-only application followed by the use of regular soap and antiseptic soap group). The three groups were evaluated weekly for three consecutive weeks. Data was processed using SPSS 20 and analyzed by Kruskal-Wallis test.Results: Total of 94 subjects was scabies positive (prevalence 50%) but only 69 subjects were randomly picked to be analyzed. The cure rate at the end of week III of the standard method group was 95.7%, modified treatment followed by the use of regular soap was 91.3%, and modified treatment followed by the use of antiseptic soap was 78.3% (p = 0.163). The recurrence rate of standard treatment was 8.7%,  modified treatment followed by the use of regular soap was 13% and modified treatment followed by the use of antiseptic soap was 26.1% (p = 0.250).Conclusion: The standard scabies treatment was as effective as the modified scabies treatment.
Poor treatment compliance leads to a higher mutation for rifampicin resistance in multibacillary leprosy patients Menaldi, Sri L.; Legiawati, Lili; Effendi, Evita H.; Siskawati, Yulia
Medical Journal of Indonesia Vol 27, No 4 (2018): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (395.047 KB) | DOI: 10.13181/mji.v27i4.1916

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Background: Multidrug therapy (MDT) is a safe and effective drug combination for leprosy treatment that can prevent drug resistance. Mycobacterium leprae resistance, especially to rifampicin, is a serious problem as it potentially thwarts the worldwide leprosy-elimination program by the World Health Organization (WHO). One of the suspected causes of rifampicin resistance is poor treatment compliance. It was necessary to assess the association between the treatment compliance and the occurrence of mutation rifampicin resistance in multibacillary (MB) leprosy patients.Methods: A comparative, analytical, cross-sectional study was performed in MB leprosy patients who had completed treatment at the Dermatovenereology Outpatient Clinic in Cipto Mangunkusumo Hospital and the Sitanala Center for Leprosy Hospital from Oc­tober 2012 to April 2013. Based on treatment regularity and history of drug discontinuation, the subjects were classified as either having good or poor compliance. Skin smear from a slit skin smear (SSS) examination was further analyzed by using the polymerase chain reaction (PCR) sequencing technique to detect rifampicin resistance.Results: Fifty-seven study subjects were enrolled in this study. In the good treatment compliance group (29 subjects), only 1 case of mutation for rifampicin resistance was found. Meanwhile, in the poor drug compliance group (28 subjects), 8 cases of mutation for resistance (29%) were found. This difference in mutation rate was statistically significant (OR=11.2; 95% CI=1.296–96.787; p=0.012).Conclusion: This study revealed that the risk of occurrence of M. leprae resistance to rifampicin in patients with poor drug compliance was significantly higher than in those with good drug compliance.
HEALTH CARE SERVICE FOR LEPROSY PATIENTS IN SITANALA TANGERANG (A PROPOSED APPROACH OF COMPREHENSIVE HEALTH CARE FOR LEPROSY PATIENT) Wahyuni, Luh Karunia; Kurniawardhani, Dewinta Retno; Menaldi, Sri Linuwih; Bani, Anna Puspitasari; Lestari, Yeni Dwi; Irawati, Yunia
ASEAN Journal of Community Engagement Vol. 2 No. 2 (2018)
Publisher : UI Scholars Hub

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Based on WHO data, Indonesia has the third largest leprosy burden in the world, afterIndia and Brazil. Although leprosy was declared to be eliminated in severalprovinces, there are still several leprosy settlements spread in Indonesia. Oneof these settlements is Neglasari village in Tangerang City, West Java, whereleprosy patients have been living since 1981. There is a scarcity ofinformation regarding the features of leprosy in Indonesia, especially aboutthe description of the patients’ posttreatment condition in terms of bothclinical sequelae and health services provided. A collaboration betweenmultiple departments of Ophthalmology, Dermatovenereology, and MedicalRehabilitation from the Cipto Mangunkusumo Hospital/Universitas Indonesia,Jakarta, was established in the form of a health service program to determinethe number and features of disabilities of ex-leprosy patients. We providehealth services, including physical examinations, extend free medication andeye glasses, and impart knowledge about the chronic complications to patientsand local cadres. A nonroutine health service program for leprosy patients wasconducted in Neglasari village, which performed four primary activities ofpromotive, preventive, curative, and rehabilitative. The program included atotal of 260 patients, with a mean age of 50.45 ± 10.15 years and most of thembeing males (60.4%). A duration of >5 years of leprosy was found in 47% ofsubjects, and 96% of them have been released from treatment. Disabilitiescomprised 52.5% in the eye, 87.7% in the hand, and 92% in the foot. In total,65% of the patients had an uncorrected visual acuity of normal to mildimpairment, whereas 5.8% were blind. Eye abnormalities included madarosis(43.9%), entropion (41%), cataract (26%), corneal hypoesthesia (20.6%),trichiasis (17.8%), and lagophthalmos (15.1%), and examination of theextremities revealed that 16% of the subjects had an amputated foot. Spectacleswere successfully distributed to 100% of patients who were visually correctable.This proposed model for leprosy health care program involving multidisciplinaryexpertise is effective for screening numerous disabilities in leprosy patientsat one time. This enables caretakers to determine a holistic management that atthe end is intended to improve the quality of life of patients.
Exploring Clinical Rotation Competence Improvements after Interpersonal Skills Development in At-Risk Medical Students Sri Linuwih Menaldi; Augustine D. Sukarlan; Dewi Matindas; Dharmayati B. Utoyo; Iwan Dwiprahasto; Ova Emilia; Yayi S. Prabandari
eJournal Kedokteran Indonesia Vol. 2, No. 2 (2014): Agustus
Publisher : Faculty of Medicine Universitas Indonesia

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AbstractPrior to admission, medical students were subject to psychological tests to measure their logical thinking skills and personality, hence predicting their ability to complete their studies. The results showed 56,45% of medical students obtained recommendation category 4 (doubtful) and 5 (not recommended), two categories which are considered to be at-risk group with a very small probability of completing their studies. These results predicted that students in the mentioned groups will have difficulties in achieving the clinical competence level required by the Indonesian Doctors’ Competency Standard (IDCS). The aim of the study was to investigate clinical competency achievement by at-risk medical students in the third year, after following interpersonal skills development training program on July 2011. This research used qualitative study design through psychological examination, written self-reflection and in-depth interview after the training. Interpersonal skills development training for at-risk medical students gave positive effects to theircharacter development for the helping profession. It was concluded that interpersonal skills training could help improve medical student’s achievement of clinical competence especially for at-risk group in their clinical rotations stage.Keywords: medical students, at-risk group, interpersonal skills, clinical competence AbstrakPada mahasiswa kedokteran yang baru masuk dilakukan pemeriksaan psikologis untuk memperoleh gambaran penalaran dan kepribadian untuk memprediksi kemampuan mahasiswa dalam menyelesaikan pendidikan. Berdasarkan pemeriksaan tersebut diperoleh 56,45% mahasiswa dengan hasil uji psikometrik kategori rekomendasi 4 (diragukan) dan 5 (tidak disarankan) yang disebut sebagai kelompok at-risk. Kelompok at risk memiliki peluang keberhasilan rendah untuk menyelesaikan pendidikan dan akan mengalami kesulitan mencapai kompetensi klinik sesuai Standar Kompetensi Dokter Indonesia. Tujuan penelitian ini adalah menggali pengalaman pencapaian kompetensi klinik mahasiswa kelompok at-risk pada tahun ketiga, setelah mengikuti pelatihan pengembangan keterampilan interpersonal yang dilaksanakan pada bulan Juli 2011. Penelitian ini menggunakan rancangan studi kualitatif dengan wawancara mendalam setelah dilakukan pelatihan. Pengembangan keterampilan interpersonal pada mahasiswa kedokteran kelompok at-risk memberikan dampak positif terhadap pembentukan kepribadian sebagai helping profession. Disimpulkan bahwa pengembangan keterampilan interpersonal yang diberikan dalam bentuk pelatihan dapat digunakan untuk membantu meningkatkan pencapaian kompetensi mahasiswa khususnya kelompok at-risk di tahap klinik.Kata Kunci: mahasiswa kedokteran, kelompok at-risk, keterampilan interpersonal, kompetensi klinik.
Failure to use routine prevention of disability (POD) assessment resulting In permanent disability Erika Zoulba; Emmy Soedarmi Sjamsoe; Sri Linuwih Menaldi; Melani Marissa; Yudo Irawan
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 1, No 2 (2016): June
Publisher : Universitas Indonesia

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Abstract

Disability is one of problems in leprosy or Morbus Hansen (MH), which can cause the patient loose his autonomy and may affect his social relationship with family and community. Disability occurs due to neurological inflammation that can manifest as silent neuritis (which develops without any pain). Silent neuritis can be recognized early with a routine prevention of disability (POD) assessment. A 19-year-old male patient was referred from a District General Hospital with a history of numbness and stiffness of his 4th and 5th fingers of his left hand since 1 month before admittance. The patient was refered by Community Health Center (CHC or PUSKESMAS) after a one year treatment and RFT. During his treatment at the CHC, no assessment of peripheral nerve or POD had ever been performed. The POD assessment at our hospital demonstrated sensory deficit at some points of assessment on both palms and reduced muscle strength of the first and 5th fingers in both hands. Nerve conduction velocity (NCV) performed at the outpatient of Neurology Department, showed multiple mononeuropathy MH with irreversible damage. Nerve damage is still considered reversible when it occurs less than 6 months. In this case, the silent neuritis was not detected early and there was delayed treatment; as showed by NCV which revealed a manifestation of irreversible nerve damage. Routine POD assessment may detect the condition and appropriate treatment may overcome the nerve damage. Keywords: Morbus Hansen, silent neuritis, prevention of disability assessment
Neural Leprosy: A case report Alida Widiawaty; Emmy Soedarmi Sjamsoe-Daili; Taruli Olivia; Sri Linuwih Menaldi; Melani Marissa; Fitri Octaviana
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 1, No 3 (2016): December
Publisher : Universitas Indonesia

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Neural leprosy is characterized by neurological deficit without skin lesions, with a prevalence ranging from 1% to 17.7%. Diagnosis might be difficult and need a multidisciplinary approach. This is a case of axonal type motor and sensory polyradiculoneuropathy of the peripheral facial nerve. A 26-year-old woman was referred from the neurology clinic with facial paralysis, suspected as leprosy. Physical examinations were as follows: no skin lesions, left eye lagophthalmos, thickening of right lateral peroneal and bilateral posterior tibial nerves, sensory impairment, peripheral bilateral facial palsy, and wasting of bilateral distal small muscles of the hands, with normal autonomic function. Nerve Conduction Study revealed multiple demyelinating mononeuropathy of upper and lower extremities. Her serum anti-PGL-1 IgM level was 1721 μ/mL, but after three months of treatment with MDT-PB regimen, it increased to 2815μ/mL. Therefore, the treatment was switched to MDT-MB regimen and 30 mg prednisone. The patient is still undergoing treatment. There has been a slight improvement after treatment with MDT-MB regimen. Nerve biopsy is the gold standard for diagnosis but has its limitations. However, serological test of anti PGL-1 can be a marker and a useful tool as an additional test to confirm the diagnosis, especially for patients with nerve impairments. Difficulties are due to the absence of skin lesions and neuropathy which may be caused by other diseases. Both diagnosis and treatment require multidisciplinary approach. Treatment given is intended to correct nerve damage and prevent further disabilities. Keywords: Neural leprosy, anti-PGL-1, systemic corticosteroid, multidisciplinary approach
Suspected resistance of MDT-MB in Multibacillary Leprosy of Hansen's disease: Two case reports Yudo Irawan; Sri Linuwih Menaldi; Emmy Soedarmi Sjamsoe-Daili; Melani Marissa; Erika Zoulba
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 1, No 3 (2016): December
Publisher : Universitas Indonesia

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Abstract

Resistance to multidrug therapy (MDT) is one of the complications in the treatment of Hansen’s disease/Morbus Hansen (MH). There are two types of resistancy, which are primary and secondary. MDT-multibacillary (MB) resistance must be suspected when no clinical improvement and the acid-fast bacilli (AFB) index is not reduced after 12 months of therapy. A 28-year-old woman with paresthesia on her face, arms and legs since 2.5 years ago, accompanied by thickening of the right posterior tibial nerve. The AFB examination showed a bacteriological index (BI) of 15/6 and morphological index (MI) of 0.50%. The second case, a 42-year-old man came with paresthetic lesions on his face, chest, back, both arms and legs since 2 years ago, accompanied by thickening of ulnar and lateral peroneal nerve. The BI was 12/5 and the MI was 0.40%. Both patients were diagnosed with borderline lepromatous type of MH and received MDT-MB for 12 months. Diagnosis of suspected resistance was established because no clinical improvement or any significant decrease of AFB index after completing the MDT treatment. The patients had secondary resistance after polymerase chain reaction evaluation showed that they were still rifampicin-sensitive. There was clinical improvement and significant decrease in FAB index after the patients continued the MDT-MB treatment with 600 mg additional rifampicin. The diagnosis of bacterial resistance should be made based on clinical evaluation before completion of treatment. Based on the two case reports, the resistance suspected may be secondary. Treatment using additional regimen can be initiated once the resistance has been proven. Keywords: Hansen’s disease, MDT resistance, clinical improvement, acid fast bacilli index
AplikasiTelemedicine dalam Merujuk Pasien dari Daerah Rural Lidwina Anissa; Sri Linuwih Menaldi
eJournal Kedokteran Indonesia Vol 3, No 3 (2015): December
Publisher : Faculty of Medicine Universitas Indonesia

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Kusta adalah penyakit menular yang disebabkan oleh basil lepra. Penderita kusta tersebar di seluruh Indonesia. Dalam Standar Kompetensi Dokter Indonesia, penanganan kusta tanpa komplikasi merupakankompetensi tingkat 4A, sedangkan penanganan reaksi kusta merupakan kompetensi tingkat 3A. Penanganankasus reaksi kusta dengan proses rujukan konvensional ke layanan kesehatan yang memilliki tenaga ahliterkendala oleh berbagai macam penyulit. Pemanfaatan teknologi smartphone berupa aplikasi Whatsapp,dengan menerapkan konsep telemedicine, diharapkan dapat menjadi solusi untuk meretas hambatanjarak, waktu dan finansial dalam proses rujukan pasien secara konvensional. Demi memberikan pelayanan kesehatan yang bersifat paripurna, sebaiknya konsep telemedicine dipelajari lebih lanjut dan diterapkan dalam pelayanan kesehatan. Kata Kunci: kusta, reaksi kusta, rujukan, smartphone, telemedicine, Whatsapp Telemedicine Application for Rural Patients’ Referral Abstract Leprosy is a communicable disease caused by leprosy bacillus. People with leprosy are distributed in all areas of Indonesia. In Indonesian Doctor Competence Standards, leprosy management is at level 4Acompetence; meanwhile leprosy reaction management is at level 3A competence. Management of leprosyreaction that needs a conventional referral to higher level of health centre has faced many obstacles.Smartphone instant messaging application (eg. Whatsapp) utilizes the concept of telemedicine, which will bea solution in solving distance, time and financial problems in conventional referral process. In order to provideholistic health service, telemedicine should be learnt further and applied. Keywords: leprosy, leprosy reaction, referral, smartphone, telemedicine, Whatsapp
Co-Authors Ahmad Fuady Alida Widiawaty Augustine D. Sukarlan Bani, Anna Puspitasari Dewi Matindas Dharmayati B. Utoyo Emmy Soedarmi Sjamsoe Emmy Soedarmi Sjamsoe-Daili Erika Zoulba Evita H. Effendi Fitri Octaviana Hansen Angkasa Herqutanto Herqutanto Hirzi Zulkarnain Irawati, Yunia Iwan Dwiprahasto Kurniawardhani, Dewinta Retno Lidwina Anissa Lili Legiawati Luh Karunia Wahyuni, Luh Karunia Melani Marissa Ova Emilia Saleha Sungkar Siskawati, Yulia Taruli Olivia Triana Agustin Victor Santawi Yayi S. Prabandari Yeni Dwi Lestari Yudo Irawan