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Profil Demografik, Hematologi, serta Gula Darah Sewaktu Pasien Ulkus Diabetik Pro Amputasi Radian Tunjung Baroto; Yohanes Firmansyah; Giovanno Sebastian Yogie; William Gilbert Satyanegara; Joshua Kurniawan
MAHESA : Malahayati Health Student Journal Vol 3, No 10 (2023): Volume 3 Nomor 10 (2023)
Publisher : Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/mahesa.v3i10.11346

Abstract

ABSTRACT Diabetes mellitus is a chronic metabolic disease. Diabetic Foot is one of the macrovascular complications of diabetic patients. Diabetic foot that is not handled properly will cause infection and will lead to amputation. To find out the demographic, hematologic, and blood sugar level profiles of patients with diabetic ulcer pro amputation. This study is an descriptive observational study done at RSUD K.R.M.T. Wongsonegoro Semarang, Middle Java on July 2023. Data obtained through patients medical record. Samples in the study are patients diagnosed with diabetic ulcer pro amputation on period of July 2022 – June 2023. Technique used for gathering sample is total sampling method. The study found 21 respondents that fulfull the criteria, with more female respondents (52.4%), mean age of 55,67 (±10,21) years, 9 (42.9%) respondents have uncontrolled blood pressure, with mean systolic blood pressure of 134.62 (±30.63) and mean diastolic blood pressure of 77.43 (±16.80). All respondents have anemia (mean Hb = 8.57 ± 1.18) and leukocytosis (mean leukocyte = 24.39 ± 11.33 thousand). The blood sugar level in patients are uncontrolled with mean of 403.1 (±108.12) mg/dL. There are many factors that could affect diabetic ulcer. Extra attention for treatment of diabetic ulcer is necessary to prevent the need of amputation.Terdapat berbagai faktor yang dapat mempengaruhi ulkus diabetik. Penanganan ulkus diabetik memerlukan perhatian lebih untuk mencegah diperlukannya tindakan amputasi. Keywords: Amputation, Diabetes Melitus, Diabetic Ulcer  ABSTRAK Diabetes melitus merupakan penyakit metabolik yang bersifat kronik. Kaki diabetes merupakan salah satu komplikasi mikrovaskular yang dialami penderita diabetes. Kaki diabetes yang tidak diatasi dengan baik akan menyebabkan infeksi dan berujung pada amputasi. Mengetahui profil demografik, hematologik, dan kadar gula darah sewaktu pada pasien ulkus diabetes pro amputasi. Penelitian ini merupakan penelitian deskriptif observasional yang dilaksanakan RSUD K.R.M.T. Wongsonegoro Semarang, Jawa Tengah pada bulan Juli 2023. Data diperoleh dari rekam medis pasien. Sampel pada penelitian ini adalah pasien yang terdiagnosa ulkus diabetes dan pro amputasi pada periode Juli 2022 – Juni 2023. Teknik pengambilan sampel pada penelitian ini berupa total sampling. Pada penelitian didapatkan 21 responden yang memenuhi kriteria, dengan lebih banyak responden perempuan (52,4%), rerata usia 55,67 (±10,21) tahun, dan terdapat 9 (42,9%) responden memiliki tekanan darah tidak terkontrol, dengan rerata tekanan darah sistolik 134,62 (±30,63) dan rerata tekanan darah diastolik 77,43 (±16,80). Seluruh responden mengalami anemia (rerata Hb = 8,57 ± 1,18) dan leukositosis (rerata leukosit = 24,39 ± 11,33 ribu). Kadar gula sewaktu pada pasien tidak terkendali dengan rerata 403,1 (±108,12) mg/dL. Terdapat berbagai faktor yang dapat mempengaruhi ulkus diabetik. Penanganan ulkus diabetik memerlukan perhatian lebih untuk mencegah diperlukannya tindakan amputasi. Kata Kunci: Amputasi, Diabetes Melitus, Ulkus Diabetik
Korelasi Kadar Gula Darah Sewaktu dengan Nilai Fecal Incontinence Severity Index (FISI) pada Kelompok Lanjut Usia Jeffrey Jeffrey; Yohanes Firmansyah; Joshua Kurniawan; William Gilbert Satyanagara; Giovanno Sebastian Yogie; Edwin Destra
MAHESA : Malahayati Health Student Journal Vol 3, No 11 (2023): Volume 3 Nomor 11 (2023)
Publisher : Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/mahesa.v3i11.11402

Abstract

ABSTRACT Physiological changes occur to every organ systems along with age. Fecal incontinence (FI) is one of them. FI should not be underestimated. There are a lot of risk factors for FI in elderly, including age, obesity, gender, and comorbidities like dementia and diabetes melitus. High prevalence of FI and diabetes mellitus will affect clinical and managements in elderly care. To find out the correlation between blood sugar level and fecal incontinence severity index (FISI) score in elderly patients. This is an analytic study with cross sectional design. Samples are elderly patients in Santa Anna Nursing Home in July 2023 that met the criteria. Data obtained through questionnaire interview and blood examination. Statistical analysis used in the study are Pearson or Spearman correlation test. Data distribution is tested with Kolmogorov-Smirnov test. Level of significance in the study is 5%. There are 60 respondents with the mean age of 76,30 (±7,88) years, dominated by female (66,7%). High blood sugar level obtained in 11,7% of the respondents. There is a significant correlation between blood sugar level and FISI score (p-value = 0,041; r-correlation : 0,264). From the R square evaluation we found a value of 0.091, which indicates that 9.1% of FISI score is influenced by blood sugar level. There is a correlation between elevated blood sugar and fecal incontinence. Fecal incontinence in older adults requires attention due to its adverse impact on their quality of life. Keywords: Blood Sugar Level, Elderly, Fecal Incontinence  ABSTRAK Perubahan fisiologis terjadi pada seluruh sistem organ seiring dengan bertambahnya usia. Salah satu hal yang dapat terjadi pada lansia adalah fecal incontinence (FI). Hal ini tidak dapat dipandang sebelah mata. Terdapat berbagai faktor risiko untuk FI pada lansia, termasuk bertambahnya usia, obesitas, jenis kelamin, dan berbagai jenis penyakit penyerta, seperti demensia dan diabetes melitus. Tingginya prevalensi FI dan diabetes melitus akan berdampak pada klinis dan manajemen perawatan lansia. Mengetahui korelasi kadar gula darah sewaktu dengan nilai fecal incontinence severity index (FISI) pada kelompok lanjut usia. Penelitian ini merupakan penelitian analitik dengan desain penelitian cross sectional. Sampel merupakan pasien lanjut usia di Panti Lansia Santa Anna pada Juli 2023 serta memenuhi kriteria. Data diperoleh melalui wawancara kuesioner dan pemeriksaan darah. Analisa statistik pada penelitian ini menggunakan korelasi Pearson atau korelasi Spearman. Distribusi data diperiksa menggunakan uji Kolmogorov-Smirnov. Nilai kemaknaan dalam penelitian ini adalah sebesar 5%. Didapatkan 60 responden dengan rerata usia adalah 76,30 (±7,88) tahun, yang didominasi jenis kelamin perempuan (66,7%). Kadar gula darah sewaktu yang tergolong tinggi didapatkan pada 11,7% responden. Terdapat korelasi yang bermakna antara kadar Gula Darah Sewaktu dengan nilai FISI (p-value = 0,041; r-correlation : 0,264). Penelusuran dari nilai R square didapatkan nilai sebesar 0,091, yang menunjukkan bahwa 9,1% nilai FISI dipengaruhi oleh kadar gula darah sewaktu. Terdapat korelasi antara peningkatan gula darah sewaktu dengan inkontinensia fekal. Inkontinensia fekal pada usia lanjut perlu mendapat perhatian karena dapat menurunkan kualitas hidup. Kata Kunci: Gula Darah Sewaktu, Fecal Incontinence, Lanjut Usia
Hubungan Gejala Kolesistolitiasis dengan Kejadian Gastritis dan Karakteristiknya Hardianto Setiawan; Rio Saputra; Yohanes Firmansyah; Fernando Nathaniel; Giovanno Sebastian Yogie
MAHESA : Malahayati Health Student Journal Vol 3, No 9 (2023): Volume 3 Nomor 9 (2023)
Publisher : Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/mahesa.v3i9.11116

Abstract

ABSTRACT Cholecystolithiasis and gastritis are both very common conditions in the modern era, and they can occur together. The relationship between cholecystolithiasis and gastritis in terms of their characteristics and clinical implications is not yet fully understood. This study aims to determine the association between cholecystolithiasis symptoms and the occurrence of gastritis as observed through endoscopy, along with the analysis of their characteristics. This study employed a cross-sectional design with a total of 114 participants obtained from medical records of several hospitals in Jakarta from January 2020 to 2023. Data analysis was conducted using Pearson Chi-Square test with Yates Correction and Fisher's exact test to test the hypotheses. The results of the study showed no significant association between gender, H. pylori infection, and bile reflux with positive endoscopy results for gastritis in patients with cholecystolithiasis (p > 0.05). Clinical exploration revealed that male gender, H. pylori infection, and the presence of bile reflux symptoms did have a higher risk for positive endoscopy results [PR: 1.152 (0.996 - 1.333) vs. 1.169 (1.080 - 1.264) vs. 1.165 (1.078 - 1.258)]. There was a significant association between gastrointestinal symptoms and positive endoscopy results (PR: 1.802, p-value < 0.001). Abdominal pain obtained a 100% value for positive endoscopy results of gastritis in patients diagnosed with cholecystolithiasis. There is no significant association between gender, H. pylori infection, and bile reflux with the occurrence of gastritis in patients with cholecystolithiasis. However, there is a significant association between gastrointestinal symptoms and positive endoscopy results, with abdominal pain being the most strongly associated symptom.  Keywords : Cholecystolithiasis, Gastritis, Risk factors  ABSTRAK Kolesistolitiasis dan gastritis keduanya merupakan kondisi yang sangat umum di era modern dan kejadian tersebut dapat terjadi secara bersamaan. Hubungan antara kolesistolitiasis dengan gastritis ditinjau dari karakteristiknya serta implikasi klinisnya masih belum sepenuhnya dipahami. Studi ini bertujuan untuk mengetahui hubungan gejala kolesistolitiasis dengan kejadian gastritis yang ditinjau dari endoskopi beserta analisis karakteristiknya. Penelitian ini menggunakan desain penelitian potong lintang dengan total 114 partisipan yang diperoleh dari rekam medis dari beberapa rumah sakit di Jakarta periode januari 2020 hingga 2023. Analisis data dilakukan dengan menggunakan uji statistik Pearson Chi Square with Yates Correction dan Fisher Exact untuk menguji hipotesis. Hasil penelitian menunjukan tidak ada hubungan yang signifikan antara jenis kelamin, infeksi H.pylori, dan bile reflux  dengan hasil endoskopi positif untuk gastritis pada pasien kolesistolitiasis (p > 0,05). Penelusuran secara klinis mengungkapkan bahwa jenis kelamin laki-laki, infeksi H. pylori dan adanya gejala bile reflux  memang memiliki risiko lebih tinggi untuk hasil endoskopi positif [PR: 1,152 (0,996 - 1,333) v.s 1,169 (1,080 - 1,264) v.s. 1,165 (1,078 - 1,258)]. Terdapat hubungan yang signifikan antara gejala gastrointestinal dengan hasil endoskopi yang positif (PR: 1,802, nilai p <0,001). Keluhan nyeri perut mendapatkan nilai 100% untuk hasil endoskopi positif gastritis pada pasien telah terdiagnosis kolesistolitiasis. Tidak ada hubungan yang signifikan antara jenis kelamin, infeksi h.pylori, dan bile reflux  dengan kejadian gastritis pada pasien kolesistolitiasis. Namun terdapat hubungan signifikan antara gejala gastrointestinal dengan hasil endoskopi yang positif, dimana keluhan nyeri perut memiliki kejadian yang paling kuat. Kata Kunci: Faktor Risiko, Gastritis, Kolesistolitiasis
Korelasi Kadar Gula Darah Sewaktu dengan Kadar Air dan Sebum Kulit di Rukun Warga (RW) 008 Kelurahan Cipondoh Novia Yudhitiara; Sukmawati Tansil Tan; Giovanno Sebastian Yogie; Dean Ascha Wijaya; William Gilbert Satyanegara; Fernando Nathaniel; Joshua Kurniawan; Catharina Sagita Moniaga; Yohanes Firmansyah; Alexander Halim Santoso; Astin Mandalika; Linginda Soebrata
MAHESA : Malahayati Health Student Journal Vol 3, No 11 (2023): Volume 3 Nomor 11 (2023)
Publisher : Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/mahesa.v3i11.11607

Abstract

ABSTRACT Skin hydration is influenced by various factors. Blood glucose levels are also known to affect the protective function of the skin. This cross-sectional study aims to investigate the profile of skin hydration status and its correlation with blood glucose levels among subjects at RW 08 Cipondoh. Skin hydration status measurements were done using an Over The Counter (OTC) skin analyzer. Blood glucose levels were measured using Point of Care Testing (POCT) Out of 101 respondents, the average age was 51.38 years with 75.2% of the respondents were female. The mean blood glucose was 122.71 mg/dL. The mean oil and water hydration were 22.99% and 42.96%, respectively. The data showed a negative correlation between blood glucose and water hydration, with a correlation coefficient power of 0.319 significantly, and between blood glucose and oil hydration, with 0.236 significantly. This study concludes that higher blood glucose levels was associated with worse skin hydration status.  Keywords : Blood glucose, Hydration Status ABSTRAK Kelembaban kulit dipengaruhi oleh banyak faktor. Kadar gula darah merupakan salah satu faktor yang dapat mempengaruhi fungsi kelembaban kulit. Penelitian potong lintang ini bertujuan untuk mengetahui gambaran status hidrasi kulit dan korelasinya dengan kadar gula darah pada komunitas yang tinggal di RW 08 Cipondoh. Pengukuran status hidrasi kulit menggunakan alat Over The Counter (OTC) skin analyzer. Kadar gula darah diukur menggunakan Point of Care Testing (POCT). Dari 101 responden, rata-rata usia subjek penelitian adalah 51,38 tahun dengan 75,2% responden adalah perempuan. Rerata gula darah sewaktu (GDS) sebesar 122,71 mg/dL. Rerata hidrasi sebum dan air, masing-masing sebesar 22,99% dan 42,96%. Hasil uji statistik menunjukan hasil korelasi negatif antara GDS dengan hidrasi air sebesar 0,319 secara signifikan dan hidrasi sebum sebesar 0,236 secara signifikan. Penelitian ini menyatakan bahwa semakin tinggi kadar gula darah, maka semakin menurun status hidrasi kulit seseorang. Kata Kunci: Kadar Gula Darah, Kadar Hidrasi
Gambaran Radiologi Magnetic Resonance Imaging (MRI) pada Pasien Meningioma di Rumah Sakit Daerah K.R.M.T Wongsonegoro Luh Putu Endyah Santi Maryani; Fernando Nathaniel; Dean Ascha Wijaya; Yohanes Firmansyah; Giovanno Sebastian Yogie
MAHESA : Malahayati Health Student Journal Vol 3, No 9 (2023): Volume 3 Nomor 9 (2023)
Publisher : Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/mahesa.v3i9.11232

Abstract

ABSTRACT Meningioma, the most prevalent tumor in central nervous system, can be thoroughly evaluated using contrast MRI. This cross-sectional study aimed to analyze radiological characteristics of meningioma patients who underwent contrast-enhanced head MRI at K.R.M.T Wongsonegoro Regional Hospital. The patients were selected based on total sampling criteria, using medical records data from January to June 2023. The study examined various variables such as primary and secondary meningioma lesions, lesion size, location, increased intracranial pressure, midline shift, infarction, cranial nerve defects, and sinusitis. Data were presented descriptively. Among 30 respondents, average age was 49.33 years, and majority were females (96.7%). Most common location for primary meningiomas was right parafalcine region (16.7%). Average dimensions of primary meningioma lesions in the anterior-posterior, lateral-lateral, and cranial-caudal directions were 4.93 cm, 4.51 cm, and 4.43 cm, respectively. Meningomatosis was the predominant imaging finding in 33.3% of respondents, while 26.7% had secondary meningioma lesions. On average, the midline shift was 5.54 mm, with 93.3% of respondents experiencing midline shift, most frequently towards left side (53.3%). Clinical and radiological reviews demonstrated that all patients had increased intracranial pressure (ICP), among them, 9.9% experienced incidents of infarction, 13.3% had defects in cranial nerve II, and 43.3% had maxillary sinusitis. The conclusion of this study is that the location of meningioma generally varies with typical symptoms in the form of a midline shift and an increase in ICP Keywords : Central Nervous System, Head Tumor, Meningioma, MRI  ABSTRAK Meningioma merupakan tumor sistem saraf pusat yang paling sering. MRI kontras mampu memberikan evaluasi cukup lengkap terhadap meningioma. Penelitian potong lintang ini bertujuan untuk mengetahui gambaran radiologi pasien meningioma yang menjalani pemeriksaan MRI kepala dengan kontras di Rumah Sakit Daerah K.R.M.T Wongsonegoro yang dipilih sesuai kriteria secara total sampling menggunakan data rekam medis pada periode waktu Januari 2023 sampai Juni 2023. Variabel dalam penelitian ini yaitu lesi meningioma primer dan sekunder, ukuran lesi meningioma, letak lesi meningioma, peningkatan tekanan intrakranial, midline shift, insiden infark, defek nervus kranial, dan sinusitis. Data disajikan dalam bentuk deskriptif. Dari 30 responden, rerata usia adalah 49,33 tahun dan didominasi oleh perempuan (96,7%). Lokasi meningioma primer umumnya di parafalcine kanan (16,7%), ukuran meningioma primer secara anterior-posterior, lateral-lateral, cranial-kaudal berturut-turut adalah 4,93 cm, 4,51 cm, dan 4,43 cm, dominasi gambaran meningioma adalah meningomatosis pada 33,3% responden, serta 26,7% responden memiliki lesi meningioma sekunder. Rerata midline shift sebesar 5,54 mm pada 93,3% responden dan umumnya bergeser ke sisi kiri (53,3%). Peninjauan dari segi klinis dan radiologi ditemukan bahwa seluruh pasien mengalami peningkatan tekanan intrakranial (TIK), terdapat 9,9% responden mengalami insiden infark, 13,3% responden mengalami defek pada nervus kranial II, dan 43,3% responden mengalami sinusitis maksilaris. Kesimpulan penelitian ini berupa letak meningioma umumnya bervariasi dengan gejala yang khas berupa midline shift dan peningkatan TIK Kata Kunci: Meningioma, MRI, Sistem Saraf Pusat, Tumor Otak
Efektivitas Terapi Kombinasi Microneedling dan Vitamin C Terhadap Perbaikan Parameter Kulit Wajah Sukmawati Tansil Tan; Giovanno Sebastian Yogie; Edwin Destra; Putri Mahirah Afladhanti; Alicia Sarijuwita; Anggita Tamaro
Jurnal Ners Vol. 8 No. 1 (2024): APRIL 2024
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jn.v8i1.22054

Abstract

UV rays can affect various skin physiology, including changes in skin thickness and skin color. Vitamin C acts as an antioxidant to reduce melanin and skin damage caused by the sun, but it requires a combination with other therapies to get optimal results. This research focuses on the effectiveness of microneedling with vitamin C against pigmentation and skin damage due to sun exposure. The design of this research is quasi experimental. Patients who have atrophic acne scars who meet the inclusion criteria and are treated at Sukma Cliniq Tangerang are the population in this study. The intervention in this study was microneedling with a mixture of 10% vitamin C serum to improve the skin (given when the intervention was carried out and used at home for 21 days). The intervention will be carried out on day 0 according to the procedure previously explained and measured again on day 42. The variable measurements in this study aim at the value of UV damage and skin pigmentation before and after the combination therapy. Results: There were 36 respondents who met the inclusion criteria for this study with an average age of 33.03 years and 69.4% of respondents were women. There were changes and improvements in roughness, porphyrin, and pigmentation parameters (p value <0.001), but there was no change in UV damage parameters (p value 0.500) both before and after the intervention. There were changes and improvements in roughness, porphyrin, and pigmentation parameters after microneedling and vitamin C therapy before and after 42 days of therapy. However, there are no changes and improvements to the UV damage parameters.
Hubungan Kadar 25(OH)D3 dengan Lingkar Betis Pada Kelompok Lanjut Usia di Panti Santa Anna: Studi Potong-Lintang Alexander Halim Santoso; Susi Olivia Lontoh; Yohanes Firmansyah; Giovanno Sebastian Yogie; Daniel Goh; Andini Ghina Syarifah; Stanislas Kotska Marvel Mayello Teguh; Anthon Eka Prayoga Khoto
Malahayati Nursing Journal Vol 6, No 7 (2024): Volume 6 Nomor 7 2024
Publisher : Universitas Malahayati Lampung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/mnj.v6i7.13124

Abstract

ABSTRACT The research on vitamin D is still developing until its role in the immune system, the absorption of phosphate from the intestine, and preventing its excretion in the kidneys are known. The prevalence of low levels of vitamin D is high, and recently, it was discovered that there was a relationship between vitamin D deficiency and the incidence of sarcopenia in the elderly. Determining vitamin D levels and the incidence of sarcopenia in the elderly at the Santa Anna Nursing Home. This study was an analytical study with a cross-sectional design conducted on elderly residents of the Santa Anna Nursing Home in July 2023 to assess vitamin D levels and calf circumference to assess sarcopenia. The data obtained were analyzed using Mann-Whitney. Result Of the 32 respondents, the average age was 72.66 years, and 22 (68.7%) respondents were women. It was found that 30 (93.8%) respondents experienced vitamin D deficiency, and 15 (46.9%) respondents experienced sarcopenia. The results of statistical tests showed that there was no difference in the mean levels of vitamin D between the sarcopenic and non-sarcopenic groups. However, the group of patients with sarcopenia had vitamin D levels that tended to be lower compared to the group without sarcopenia (18 vs. 21 ng/mL; MR 15.50 vs. 17.38). There was no statistically significant difference in mean vitamin D levels between the groups with and without sarcopenia. However, there is a tendency for groups of patients with sarcopenia to have vitamin D levels that tend to be lower than those in groups without sarcopenia. Keywords: Vitamin D, Sarcopenia, Elderly  ABSTRAK Hingga saat ini, penelitian terhadap vitamin D terus berkembang hingga diketahui perannya dalam sistem imun, absorpsi fosfat dari usus dan mencegah terekskresinya pada ginjal. Tingginya prevalensi kurangnya kadar vitamin D dan baru-baru ini, diketahui ada hubungan defisiensi vitamin D dengan kejadian sarkopenia pada lansia. Mengetahui kadar vitamin D dengan kejadian sarkopenia pada lansia di Panti Werda Santa Anna. Penelitian ini adalah analitik dengan desain potong lintang yang dilakukan pada lansia penghuni Panti Werdha Santa Anna pada Juli 2023 untuk menilai kadar vitamin D dan lingkar betis untuk menilai sarkopenia. Data yang didapat kemunian dianalisis menggunakan Mann-Whitney. Didapat 32 responden dengan rerata usia 72,66 tahun dan sebanyak 22 (68,7%) responden adalah perempuan. Didapat 30 (93,8%) responden mengalami defisiensi vitamin D dan 15 (46,9%) responden mengalami sarkopenia. Hasil uji statistic didapat hasil tidak terdapat perbedaan rerata kadar vitamin D antara kelompok sarkopenia dan tidak. Namun dapat terlihat bahwa kelompok pasien dengan sarkopenia memiliki kadar vitamin D yang cenderung lebih rendah dibandingan dengan kelompok tanpa sarkopenia (18 vs 21 ng/mL; MR 15,50 vs 17,38). Tidak terdapat perbedaan rerata kadar vitamin D yang bermakna secara statistik antara kelompok dengan atau tanpa sarkopenia. Namun terdapat kecenderungan kelompok pasien dengan sarkopenia memiliki kadar vitamin D yang cenderung lebih rendah dibandingan dengan kelompok tanpa sarkopenia. Kata Kunci: Vitamin D, Sarkopenia, Lanjut Usia