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Berkala Ilmiah Kedokteran Duta Wacana

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Published by Universitas Kristen Duta Wacana

ISSN : 24609684 EISSN : 24768863 DOI : -

Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

Berkala Ilmiah Kedokteran Duta Wacana is a Scientific Journal to publish medical research articles, and other scientific medical articles from Medical Faculty of Duta Wacana Christian University academic community and also receive articles from other resources with appropriate and related topics. The policies taken for the largest composition of articles are the results of research, but can also receive scientific articles in the form of literature review and case reports. To maintain the quality of writing, Berkala Ilmiah Kedokteran Duta Wacana also cooperate with other Medical Education Institutions, especially in the recruitment of reviewer partner to conduct a "review" of all incoming articles. Funding for publication is entirely sourced from the Faculty of Medicine and also from Duta Wacana Christian University.

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HUBUNGAN VISUS DENGAN RISIKO JATUH PADA LANSIA DI KELURAHAN BACIRO YOGYAKARTA Amadea Rigenastiti; The Maria Meiwati Widagdo; Yanti Ivana Suryanto
Berkala Ilmiah Kedokteran Duta Wacana Vol 3, No 2 (2018): BERKALA ILMIAH KEDOKTERAN DUTA WACANA
Publisher : Faculty of Medicine Universitas Kristen Duta Wacana

Background: The aging process causes changes of physiological and psychosocial functions. The percentage of older people population in Yogyakarta Province in 2015 was 13,49%, the highest in Indonesia. The increased number of older people is followed by the increased number of problems in older people. One of the most common problems of older people is falls. Risk of falls consists of intrinsic and extrinsic factors. Visual acuity is a part of the intrinsic factor of risk of falls in the older people. Objective: To find out the correlation between visual acuity and the risk of falls of older people in Baciro Village Yogyakarta. Methods: The research method was observational-analytic with cross sectional design. Researchers took samples in Baciro Village Yogyakarta. The inclusion criteria was people aged ≥60 years old. The exclusion criteria were older people who were illiterate and had neuromotor limitations in lower extremity.The data was collected by checking the visual acuity of the older people with Snellen chart. Falls Efficacy Scale International (FES-I) questionnaire was used to determine the risk of falling. Results: Ninety-seven older people participated in this research.The results of bivariate analysis used Spearman correlation test showed that there was no correlation between the better eye visual acuity and the risk of falls in the older people (FES-I) (r = 0.190 and p = 0.063) and there was a significant correlation between the worse eye visual acuity and the risk of falls in the older people (r = 0.240 and p = 0.018). Conclution: 1) There is no correlation between the better eye visual acuity and the risk of falls in the older people. 2) There is a correlation between the worse eye visual acuity and the risk of falls in the older people. Keywords: Visual acuity, Risk of Falls, FES-I

Book Review : NEUROTRAUMA AND CRITICAL CARE OF THE BRAIN Septian Dewi Periska
Berkala Ilmiah Kedokteran Duta Wacana Vol 3, No 2 (2018): BERKALA ILMIAH KEDOKTERAN DUTA WACANA
Publisher : Faculty of Medicine Universitas Kristen Duta Wacana

Traumatic Brain Injury (TBI) is one of the leading cause of death and disability. TBI and spinal cord injuries have impacts on patients life, their families and also to the comunity. This edition retained the book structure of the first edition with emphasis in critical care and also it offers review the updated guideline recommendation. A review gives the reader not only summary of the content but also a critical assesment about the content. Additionally, this book gives the reader content about a brief review of a basic ethical framework. The concern is not only about science but also about prehospital care, critical care, outcome, ethical issue, prevention and sosioeconomic.

HIDUP DI USIA LANJUT TETAP SEHAT, AKTIF DAN PRODUKTIF Tejo Jayadi
Berkala Ilmiah Kedokteran Duta Wacana Vol 3, No 2 (2018): BERKALA ILMIAH KEDOKTERAN DUTA WACANA
Publisher : Faculty of Medicine Universitas Kristen Duta Wacana

Kesimpulan dari editorial ini adalah adanya pergeseran demografi usia karena peningkatan penduduk lanjut usia, menjadi perhatian khusus dan membutuhkan peran serta lembaga pemerintah dan swasta, masyarakat, keluarga dan tenaga kesehatan untuk melakukan peningkatan pelayanan kesehatan preventif, promotif dan kuratif terhadap lansia yang rentan mengalami multimorbidity yang diketahui didasari oleh proses multi patologi.

HUBUNGAN AKTIVITAS FISIK TERHADAP KEJADIAN OBESITAS BERDASARKAN INDEKS MASSA TUBUH DI DESA BANJAROYO Deni Aditya Christianto
Berkala Ilmiah Kedokteran Duta Wacana Vol 3, No 2 (2018): BERKALA ILMIAH KEDOKTERAN DUTA WACANA
Publisher : Faculty of Medicine Universitas Kristen Duta Wacana

Obesitas merupakan keadaan kelebihan berat badan yang dapat membawa manifestasi negatif bagi kesehatan. Indeks massa tubuh merupakan parameter dalam menentukan seseorang mengalami obesitas atau tidak, parameter ini sering digunakan karena mudah diterapkan, cepat dan memiliki hasil yang tepat. Salah satu faktor yang berperan penting dalam kejadian obesitas adalah aktivitas fisik, yakni segala pergerakan tubuh yang mengeluarkan energi serta membakar lemak. Tujuan dari penelitian ini adalah mengidentifikasi perbedaan antara aktivitas fisik ringan, sedang dan berat terhadap kejadian obesitas berdasarkan indeks massa tubuh. Penelitian ini merupakan penelitian observasional analitik dengan jenis penelitian potong lintang. Pengambilan sampel dilakukan secara non-random sampling dengan teknik purposive sampling dan didapat responden sebanyak 236 orang. Pengambilan data aktivitas fisik dilakukan menggunakan kuisioner IPAQ dan perhitungan indeks massa tubuh dengan mengukur berat badan dan tinggi badan. Analisis data penelitian ini menggunakan SPSS 22 dengan taraf kepercayaan 95%. Hasil penelitian menunjukkan tidak terdapat pengaruh yang bermakna (p = 0,18) antara aktivitas fisik berat dan sedang terhadap kejadian obesitas berdasarkan indeks massa tubuh pada warga dewasa di Desa Banjaroyo, Kecamatan Kalibawang, Kabupaten Kulonprogo, Yogyakarta.

PRIMARY MASTITIS TUBERCULOSIS CLINICALLY MIMICKING FIBROADENOMA MAMMAE Kristin Purnama Dewi
Berkala Ilmiah Kedokteran Duta Wacana Vol 3, No 2 (2018): BERKALA ILMIAH KEDOKTERAN DUTA WACANA
Publisher : Faculty of Medicine Universitas Kristen Duta Wacana

Introduction: Breast tuberculosis (mastitis TB) is a rare extrapulmonary presentation of tuberculosis that marked pathologily with involvement extensively mamma lobules, which because of infection of Mycobacterium tuberculosis. Many epidemiology studies stated that the incidence of mastitis TB is more common in developing countries than developed countries. Mastitis TB occurs mainly in reproductive woman. Case: A 32-year-old woman came to Surgery Department with chief complaint right upper quadrant palpable breast lump for 4 months. Mammae dextra physical examination confirmed single nodule, size ± 3cm x 3cm x 2.5cm in superior quadrant, mobile, tender, well defined shape, feel like marble, reddish skin, warm, no skin retraction and no nipple discharge. VAS score 2. Mammosonogram was performed and indicated mastitis in the superior quadrant of mammae dextra. Fine needle aspiration revealed negative malignant cells and granulomatous with suppurative inflammation. The histopathological evaluation from mammae excision confirmed datia langhans cells and indicated granulomatous mastitis. Then patient referred to the Pulmonary Department. On TB pulmonary examination confirmed normal chest x-ray and negative acid fast basil (AFB). Patient was diagnosed with primary mastitis TB. Patient was treated with anti-tuberculosis drug (OAT) and gave good response and no side effects. Discussion: Based on the International Standards for Tuberculosis Care (ISTC) diagnosis of mastitis TB can be confirm by anamnesis, physical examination, and also some additional diagnostic test such as sonomammographic imaging, fine needle aspiration or surgical specimens for pathology examination and culture or AFB with Ziehl-Neelsen staining. In Indonesian National Guidelines for TB Control, mastitis TB was treated with fixed drug combination (FDC), intensive phase in 2 months using 4 FDC and advanced phase in 4 months using 2 FDC. In case followed up in 2 months, patient recovered very well and advised to continue the treatment. Conclusions: TB mastitis is rare even in countries with TB endemic. Diagnosis of primary mastitis TB based on clinical, radiological, pathological and microbiological. Treatment of mastitis TB with FDC for 6 months consists of an intensive phase and an advanced phase in this patient gave good outcome. Keywords: Mastitis tuberculosis, diagnosis, treatment.

CENTRAL VERTIGO SYNDROME AS A CLINICAL MANIFESTATION IN ALCOHOL INTOXICATION irfan pranowo
Berkala Ilmiah Kedokteran Duta Wacana Vol 3, No 2 (2018): BERKALA ILMIAH KEDOKTERAN DUTA WACANA
Publisher : Faculty of Medicine Universitas Kristen Duta Wacana

ABSTRACT Background : Vertigo syndrome is one of the clinical features in patients with alcohol intoxication. Cerebellar dysfunction (ie, ataxia, sluured speech, and nystagmus) generally occurs in a state of toxicity with greater alcohol concentration, a condition caused by involvement in the brainstem. Among the neurological complications of alcoholism, brainstem lesions are often present in Wernicke-Korsakoff syndrome, cerebellar degeneration, and central pontine myelinolysis.3 Objective: To Describe a central vertigo case in alcohol intoxication patient Case Description: A 21-year-old male, with a neck complaint that feels left and right pulled, since 1 day before admission. felt appeared 8 times. followed with dizzines, mild-moderate intensity, with symptoms of heartburn and nausea. Patients is an alcohol drinkers since 8 years ago, and active smokers who can spend a day a pack of cigarettes. On examination was found sufficient nutritional status, blood pressure 117/73 mmHg, pulse 80x / minute, respiration 22x / minute, temperature 36,8o C, and scale VVS 2. From physical examination obtained vertical and bidirectional horizontal nystagmus. The results of routine blood laboratory examination found blood leukocyte level 12.12 x103 / uL, others in normal limit Therapy: injection omeprazole 1 amp / 12 hours, flunarizin 5 mg / 12 hours, alprazolam 0.5 mg / 24 hours. After 3 days treatment, he was discharged with clinical improvement. Conclusions: An Alcohol intoxication patients in the presence of central vertigo syndrome in this case showed clinical improvement after treatment, then patients were advised to routine control.

ACQUIRED HEMOPHILIA A IN DIABETIC WOMAN, Case Report Wiwiek Probowati
Berkala Ilmiah Kedokteran Duta Wacana Vol 3, No 2 (2018): BERKALA ILMIAH KEDOKTERAN DUTA WACANA
Publisher : Faculty of Medicine Universitas Kristen Duta Wacana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21460/bikdw.v3i2.108

Background Acquired hemophilia is a rare condition in which autoantibodies, usually IgG class are produced against factor VIII or IX. Age distribution is bimodal. Although hemophilia is a hereditary disease, approximately 20-30% of patients have no family history of clotting disorders. Case report A 55-year-old lady with major complaints of gums bleeding, bruises on the both of leg and thighs that are varying colour (multiple spontaneus haematomas. No previous history of bleeding and no history of blood clotting disorders in the family. She has diabetes mellitus for 8 years was treated metformin three times a day, and )controlled level of blood glucose. Laboratory findings showed decreased haemoglobin (5,7 mg/dl) with prolonged aPTT 129 s(28 s control) but still got the normal PPT that is 17.2 s (14.4 s control) and normal INR 1,3, factor VIII activity got decrease with result of 1,5% (control 91,1%) but factor IX activity still normal 118,7% (control 108%). The Factor VIII inhibitor was 19.52 Bethesda Unit. After exclusion of other possible pathological condition and on the basis of lab criteria we diagnosed the case as acquired hemophilia A. Discussion The diagnosis of Acqured hemophlia A (AHA) shoud be considered in patient who present with bleeding and prolonged aPPT. The pattern of bleeding in AHA differs from that in congenital hemophilia A. Bleeding tends to occur in soft tissue, muscle, retroperitoneal space, iatrogenic bleeding is also common. The diagnosis is then confirmed by a Bethesda positive assay for F VIII inhibitor titre. Diagnostic test in AHA are clotting factor measurement (isolated low FVIII level) and quantification of the inhibitor titer (presence of inhibitor). Most often the cause is idiopathic in 50% of patient or it can be associated with autoimun disorders, hepatitis and diabetes. Chronic disease or diabetes mellitus makes misrecognition tends to self antigen.1,3 Conclusion A 55-years-old lady with diabetes got symptoms gum bleeding, multiple spontaneuos hematomes and very low in factor VIII activity and presence of factor VIII inhibitor. It is concluded that this patient is diagnosed of acquired hemophilia A. Keywords: Acquired Haemophilia A, activated partial thromboplastin time (APTT), Factor VIII. Multiple haematomes in acquired haemphilia References 1. Ma AD, Carrizosa D. Acquired Factor VIII Inhibitors: Pathophysiology and Treatment. American Society of Hematology. 2006. 2. Antonela Tufano, Antonio Copola, Anna Guida, Acquired Hemophilia in Elderly, Current Gerontology and Geriatric Research volume 2010 3. Giangrande P. Acquired Hemophilia. World Federation of Hemophilia. 2012. 4. Sakurai Y, Takeda T. Acquired Hemophilia A: A Frequently Overlooked Autoimmune Hemorrhagic Disorder. Journal of Immunology Research. 2014. 5. Srivastava A, et al. Guidelines for the Management of Hemophilia 2nd edition. World Federation of Hemophilia. 2012 6. Rotty LWA. Hemofilia A dan B dalam Buku Ajar Ilmu Penyakit Dalam. Interna Publishing. Jakarta. 2014. Laporan Kasus ACQUIRED HEMOPHILIA A PADA WANITA PENDERITA DIABETES Wiwiek Probowati1, Mardiah Suci Hardanti2 1 Bagian Penyakit Dalam, Rumah Sakit Bethesda, Yogyakarta 2 Bagian Haematologi Onkologi Medik, Bagian Penyakit Dalam Universitas Gadjah Mada, Rumah Sakit Umum Pusat Sardjito Yogyakarta Latar Belakang Acquired Hemofilia adalah kondisi sangat jarang di mana autoantibodi, IgG diproduksi terhadap faktor VIII atau IX. Distribusi usia adalah bimodal. Meskipun hemofilia adalah penyakit keturunan, sekitar 20-30% pasien tidak memiliki riwayat keluarga gangguan pembekuan. Laporan kasus Seorang wanita berusia 55 tahun dengan keluhan utama perdarahan gusi, memar di kedua kaki dan paha yang warnanya bervariasi (multiple spontaneus hematoma). Tidak ada riwayat perdarahan sebelumnya dan tidak ada riwayat gangguan pembekuan darah dalam keluarga. Ia menderita diabetes mellitus selama 8 tahun diterapi dengan metformin dan kadar glukosa darah terkontrol. Hasil laboratorium menunjukkan penurunan hemoglobin (5,7 mg / dl) dengan PT 129 (kontrol 28), PPT normal yaitu 17,2 s (kontrol 14,4 s) dan INR normal 1,3, aktivitas faktor VIII mengalami penurunan dengan hasil 1,5% (kontrol 91,1%) tetapi aktivitas faktor IX masih normal 118,7% (kontrol 108%). Inhibitor Faktor VIII adalah 19,52 Unit Bethesda. Berdasarkan kriteria laboratorium, diagnosis kasus ini adalah acquired hemofilia A. Diskusi Diagnosis Acqured hemophlia A (AHA) harus dipertimbangkan pada pasien yang datang dengan perdarahan dan pemanjangan PPT. Pola perdarahan pada AHA berbeda dari pada hemofilia kongenital A. Perdarahan cenderung terjadi pada jaringan lunak, otot, ruang retroperitoneal, perdarahan iatrogenik juga sering terjadi. Tes Bethesda positif untuk titer inhibitor F VIII. Tes diagnostik dalam AHA adalah dengan mengukur faktor pembekuan (tingkat FVIII rendah terisolasi) dan kuantifikasi titer inhibitor (inhibitor). Penyebab tersering pasien dikaitkan dengan gangguan autoimun, hepatitis dan diabetes. Penyakit kronis atau diabetes mellitus menimbulkan misrecognition terhadap antigen penderita.1,3 Kesimpulan Seorang wanita 55 tahun dengan diabetes mengalami gejala perdarahan gusi, hematom spontan di paha dan perut dengan aktivitas faktor VIII yang sangat rendah dan munculnya faktor VIII inhibitor. Pasien ini didiagnosis menderita Acquired hemofilia A. Kata kunci: Acquired Haemophilia A, activated partial thromboplastin time (APTT), Factor VIII. Hematom multipel pada acquired hemofilia Daftar Pustaka 1. Ma AD, Carrizosa D. Acquired Factor VIII Inhibitors: Pathophysiology and Treatment. American Society of Hematology. 2006. 2. Antonela Tufano, Antonio Copola, Anna Guida, Acquired Hemophilia in Elderly, Current Gerontology and Geriatric Research volume 2010 3. Giangrande P. Acquired Hemophilia. World Federation of Hemophilia. 2012. 4. Sakurai Y, Takeda T. Acquired Hemophilia A: A Frequently Overlooked Autoimmune Hemorrhagic Disorder. Journal of Immunology Research. 2014. 5. Srivastava A, et al. Guidelines for the Management of Hemophilia 2nd edition. World Federation of Hemophilia. 2012 6. Rotty LWA. Hemofilia A dan B dalam Buku Ajar Ilmu Penyakit Dalam. Interna Publishing. Jakarta. 2014.

PERBANDINGAN KEJADIAN PENDARAHAN SALURAN CERNA ANTARA PENGGUNAAN ANTIPLATELET TUNGGAL DAN GANDA PADA PASIEN STROKE ISKEMIK AKUT Ni Putu Gita Yanti
Berkala Ilmiah Kedokteran Duta Wacana Vol 3, No 2 (2018): BERKALA ILMIAH KEDOKTERAN DUTA WACANA
Publisher : Faculty of Medicine Universitas Kristen Duta Wacana

Pendahuluan: Terapi antiplatelet merupakan terapi yang efektif untuk kejadian stroke iskemik akut, tetapi antiplatelet mempunyai efek samping perdarahan saluran cerna yang dapat meningkatkan angka kematian.Tujuan: Penelitian ini bertujuan untuk mengukur perbedaan pengunaan antiplatelet tunggal dan ganda pada pasien stroke iskemik akut terhadap kejadian pendarahan saluran cerna di Rumah Sakit Bethesda Yogyakarta selama periode 2015 – 2017. Metode: Penelitian ini merupakan penelitian observasional analitik dengan rancangan nested case control dan menggunakan data retrospektif. Data dianalisis dengan analisis deskriptif, analisis bivariat, dan analisis multivariat. Analisis bivariat menggunakan uji Chi-square apabila data yang diperoleh memenuhi syarat atau uji Fisher apabila data yang diperoleh tidak memenuhi syarat serta analisis multivariat jika nilai p 0,05. Kesimpulan: Kesimpulan dari penelitian menunjukkan tidak terdapat perbedaan dalam penggunaan antiplatelet tunggal dan ganda terhadap kejadian pendarahan saluran cerna pada pasien stroke iskemik akut di Rumah Sakit Bethesda Yogyakarta.

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