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eJurnal Kedokteran Indonesia
Published by Universitas Indonesia
ISSN : 23501426     EISSN : 23386037     DOI : 10.23886
Core Subject : Health,
Elektronik Journal Kedokteran Indonesia (eJKI) is a peer-reviewed and open access journal that prioritize the publication manuscript of students (medical education program, magister/specialist, doctoral). This journal publishes editorial, research article, reviews, evidence-based case report, and also interesting case reports/case study. eJKI published three times a year (April, August, December) and published by Faculty of Medicine Universitas Indonesia
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Articles 12 Documents
Search results for , issue "Vol 8, No 1 (2020): Vol 8, No. 1 (2020): April" : 12 Documents clear
Kematian Janin yang Berakhir dengan Litopedion Juli Purwaningrum; Ariyanto Wibowo
eJournal Kedokteran Indonesia Vol 8, No 1 (2020): Vol 8, No. 1 (2020): April
Publisher : Faculty of Medicine Universitas Indonesia

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Litopediondalam bahasa Yunani kuno berarti “bayi batu”yaitu fenomena langka yang terjadi ketika janin meninggal selama kehamilan ektopik atau kehamilan perutdenganfrekuensi 1,5-2% dari kehamilan ektopik dan 0,0054% dari semua kehamilan. Janin yang mati terlalu besar untuk diserap kembali oleh tubuh sehingga menjadi benda asing bagi sistem kekebalan pasien. Untuk melindungi dari kemungkinan infeksi, tubuh akan membungkus janin dengan zat kalori. Janin secara bertahap dimumikan menjadi bayi batu. Kalsifikasi atau pembatuan dapatmencegah infeksi. Litopedion dapat terjadi sejak usia kehamilan 14 minggu hingga masa penuh. Bayi batu dapatditemukan sekian puluh tahun kemudian ketika pasien memeriksakan diri dan diperiksadengan sinar-X. Pada makalahinidisampaikankasus bayi batu pada seorang perempuanberusia61 tahun yang dilakukanfoto rontgen abdomen di RSUD dr.Soetomo Surabaya karena keluhan nyeri perut. Fetal Death that Ended with Lithopedion Lithopedion in ancient Greek means “stone baby”, a rare phenomenon that occurs most often when a fetus dies during an ectopic pregnancy or during a stomach pregnancy, constituting about 1.5-2% of all ectopic pregnancies and 0.0054% of all pregnancies. The dead fetus is too big to be reabsorbed by the mother’s body, it becomes a foreign object to the mother’s immune system. To protect from possible infection, the mother’s body will wrap the fetus with caloric substances. The fetus is gradually mummed into a stone baby. Such calcification or sterilization prevents infection. Lithopedion can occur from 14 weeks gestation to full term. It is common for newborn babies to be discovered a few decades later. Generally when the patient checks for another reason or the examination involves X-rays, then the baby is found. Here we will explain the known case of this phenomenon. This case describes a stone baby found at RSUD Dr.Soetomo Surabaya from a woman 61 years after doing abdominal x-ray for complaints of abdominal pain.
Patients Infected by Extended-Spectrum Beta-Lactamase Producing Klebsiella pneumoniae: Risk Factors and Outcomes Delly Chipta Lestari; Anis Karuniawati; Yulia Rosa Saharman; Rudyanto Sedono
eJournal Kedokteran Indonesia Vol 8, No 1 (2020): Vol 8, No. 1 (2020): April
Publisher : Faculty of Medicine Universitas Indonesia

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Infections due to resistant bacteria including Extended-Spectrum Beta-Lactamase (ESBL) producing Klebsiella pneumoniae becomes the major health problem worldwide. The aim of this study is to understand the prevalence of ESBL producing K. pneumoniae in Intensive Care Unit (ICU) dr. Cipto Mangunkusumo National Hospital (CMNH) and also to understand the risk factors related to these bacteria and its correlation with patients' outcomes. This retrospective study using the sample from clinical isolates of ICU's patients in CMNH who were treated in 2011 and known to have an infection with the K. pneumoniae based on microbiological examination. Phenotypic confirmation for ESBL conducted using double disk synergy test (DDST) and patient's history of illness was traced through the medical record. From 35 patients infected by K. pneumoniae, 25 isolates were ESBL positive. Central venous catheter (CVC) utilization is found to be a probable risk factor in getting an infection by such bacteria. Infection by ESBL producing K. pneumoniae could prolong ICU stays more than 20 days. Infeksi oleh Klebsiella pneumoniae penghasil Extended-Spectrum Beta-Lactamase (ESBL): Faktor Risiko dan Luaran Klinis Infeksi yang disebabkan oleh bakteri resisten termasuk Klebsiella pneumoniae penghasil ExtendedSpectrum Beta-Lactamase (ESBL) saat ini menjadi masalah kesehatan utama di seluruh dunia. Tujuan penelitian ini adalah untuk mengetahui prevalensi K. pneumoniae penghasil ESBL di Intensive Care Unit (ICU) Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo (RSUPNCM) serta mengetahui faktor risiko terkait infeksi oleh bakteri tersebut dan hubungannya dengan luaran klinis pasien. Penelitian ini merupakan suatu studi restrospektif pada isolat pasien ICU RSUPNCM yang dirawat pada tahun 2011 dan diketahui mengalami infeksi oleh bakteri K. pneumoniae berdasarkan pemeriksaan mikrobiologi. Uji konfirmasi fenotip ESBL dilakukan dengan teknik DDST dan data pasien ditelusuri pada rekam medik. Dari 35 pasien yang terinfeksi oleh K. pneumoniae, 25 isolat merupakan penghasil ESBL. Penggunaan kateter vena sentral dapat menjadi faktor risiko terinfeksi oleh K. pneumoniae penghasil ESBL dan infeksi oleh bakteri tersebut dapat memperpanjang lama rawat pasien di ICU hingga lebih dari 20 hari.
Validation and Reliability Test of Indonesian Version of the Haemo-QoL Questionnaire Putri Khaerani; Ellyana Sungkar; Dian M. Sari
eJournal Kedokteran Indonesia Vol 8, No 1 (2020): Vol 8, No. 1 (2020): April
Publisher : Faculty of Medicine Universitas Indonesia

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Hemophilia, blood clotting disorder that requires multidiscipline treatment is a chronic condition which limit the child’s ability and reduce quality of life. Quality of life can be measured by Haemo-QoL, the first hemophilia questionnaire, produced 3 sets versions of psychometric. The aim of this study is to obtain a measuring tool to assess the quality of life in children with hemophilia in Indonesia using the Indonesian version of Haemo-QoL questionnaire. This is a cross sectional–observational analysis study, involved 105 hemophilia patients as respondents, aged 4-16 years. Acquisition data was conducted on April to July, 2018 in Bandung. Haemo-QoL was translated into Indonesian and then back translated, further is cognitive debriefing and afterward was tested on each subject. There are several invalid questions in each age group due to lack of respondents and inconsistencies in filling. This inconsistency caused by using Indonesian as a second daily language by more than 50% of respondents. Cronbach’s alpha for all types of questionnaires has a r– coefficient ≥ 0.5 which means that the Haemo-QoL reliability in Indonesian for all categories has been tested with good results and it can be used to assess the quality of life of hemophilia patients.Uji Validasi dan Reliabilitas Kuesioner Haemo-QoL Versi Bahasa Indonesia Hemofilia adalah kelainan pembekuan yang memerlukan penanganan multidisiplin; bersifat kronik dan membatasi kemampuan anak sehingga menurunkan kualitas hidup. Haemo-QoL merupakan kuesioner hemofilia pertama yang memiliki 3 set versi kuesioner psikometri. Tujuan penelitian ini untuk mendapatkan alat ukur dalam menilai kualitas hidup anak hemofilia menggunakan kuesioner Haemo-QoL versi Bahasa Indonesia. Penelitian menggunakan desain observasional analitik potong lintang yang melibatkan 105 responden berusia 4-16 tahun. Pengambilan data dilakukan pada bulan April - Juli 2018 di Bandung. HaemoQoL diterjemahkan ke bahasa Indonesia kemudian diterjemahkan kembali ke bahasa Inggris dan dilakukan cognitive debriefing. Selanjutnya dilakukan pengujian pada setiap subjek menurut kelompok usia. Pada penelitian ini didapatkan hasil yang tidak valid pada masing-masing kelompok usia karena kurangnya jumlah responden dan ketidakkonsistenan dalam pengisian antara lain disebabkan penggunaan Bahasa Indonesia sebagai bahasa kedua oleh lebih dari 50% responden. Cronbach’s alpha untuk semua jenis kuesioner memiliki nilai koefisien r ≥0,5 sehingga reliabilitas baik, yang berarti kuesioner Haemo-QoL dalam Bahasa Indonesia ini dapat digunakan untuk menilai kualitas hidup pasien hemofilia.
Validitas Isi Alat Ukur Burnout Staf Pengajar Fakultas Kedokteran di Indonesia Mona Marlina; Ardi Findyartini; Natalia Widiasih
eJournal Kedokteran Indonesia Vol 8, No 1 (2020): Vol 8, No. 1 (2020): April
Publisher : Faculty of Medicine Universitas Indonesia

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Staf pengajar kedokteran memiliki tugas dalam pendidikan, penelitian, dan pengabdian kepada masyarakat atau pelayanan kesehatan yang dapat memberikan risiko burnout. Burnout dapat dinilai menggunakan alat ukur seperti Maslach Burnout Inventory Educator Survey (MBI-ES). Penelitian ini bertujuan untuk menilai kesesuaian konten alat ukur MBI-ES untuk mengetahui burnout staf pengajar kedokteran di Indonesia. Penelitian dilaksanakan di Fakultas Kedokteran Universitas Indonesia pada bulan Februari – Mei 2018. Metode potong lintang dengan pendekatan kualitatif dilakukan melalui 2 tahap, yaitu tahap focus group discussion (FGD) terhadap 17 staf pengajar kedokteran dan tahap kajian dari 24 panel ahli. Analisis tematik data transkripsi verbatim FGD menghasilkan 3 tema utama: tugas dan tanggung jawab staf pengajar, pemahaman burnout, dan MBI-ES modifikasi. Tahap telaah oleh panel ahli menganalisis butir pernyataan MBI-ES modifikasi berdasarkan kesepakatan ≥ 80% panel ahli. Kesepakatan meliputi 3 kategori penilaian. Kategori I adalah butir pernyataan MBI-ES modifikasi yang diterima, kategori II butir yang memerlukan perbaikan bahasa dan redaksional, dan kategori III adalah butir yang dieksklusi karena tidak memiliki konteks burnout yang relevan dengan staf pengajar kedokteran. Disimpulkan bahwa MBI-ES belum dapat menggambarkan burnout yang terjadi pada staf pengajar kedokteran di Indonesia. Penelitian selanjutnya perlu difokuskan pada evaluasi validasi konstruk, proses respons, dan validasi konkuren. Content Validity of Burnout Measurement of Medical Teacher in Indonesia Medical teachers have important tasks in teaching, research, and community services/patient care which can be very demanding and might risk them from experiencing burnout. Burnout can be assessed using tools such as Maslach Burnout Inventory Educator Survey (MBI-ES). This study aimed to assess content validity of MBI-ES with the context of burnout in medical education. The study was conducted in Faculty of Medicine Universitas Indonesia in February-May 2018. The cross-sectional design using qualitative approach was carried out through two stages. First, Focus Group Discussion (FGD) with 17 medical teaching staff, and second, expert panel review with 24 experts. Thematic analysis of the verbatim transcription of the FGD resulted in 3 main themes: duties and responsibilities of teaching staff, understanding of burnout, and modified MBI-ES. Analysis of the modified MBI-ES items during expert panel stage was carried out based on an agreement of ≥80% of expert panels. The agreement covers 3 categories: category I is MBI-ES accepted items, category II is accepted items with required language improvement, and category III is excluded items due to irrelevance with burnout among medical teachers. In conclusion, MBI-ES is not yet able to represent burnout in medical teaching staff in Indonesia. Future research will focus on evaluating construct validity, response processes, and concurrent validity if needed
Alkaline Phosphatase, Bilirubin, and Gamma-Glutamyl Transferase Profiles as Supporting Diagnosis in Liver Cirrhosis Based on Aspartate Aminotransferase to Platelet Ratio Index Score Yusra Yusra; Timotius Alvonico; Sri Suryo Adiyanti
eJournal Kedokteran Indonesia Vol 8, No 1 (2020): Vol 8, No. 1 (2020): April
Publisher : Faculty of Medicine Universitas Indonesia

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Liver cirrhosis is defined as the end-stage of chronic liver disease, marked by fibrosis and alteration of the liver&rsquo;s architecture from regular to nodular, and causing alteration of liver function markers. The aspartate aminotransferase (AST) to platelet ratio index (APRI) score has been used as the non-invasive methods to diagnose and classify liver cirrhosis progression. The aim of this study was to assess several profiles of liver function tests namely alkaline phosphatase (ALP), bilirubin, and gamma-glutamyl transferase (GGT) to determine their conditional uses in the classification of liver cirrhosis based on APRI scores. This study used a cross-sectional design with 60 subjects, classified into three stages of APRI scores: <0.5, 0.5 to 2.0, and >2.0. Data were obtained from medical records of dr. Cipto Mangunkusumo National Hospital in 2017. ALP, bilirubin, and GGT profiles were analysed using Kruskal-Wallis. The bilirubin profile showed a significantly higher APRI score of <0.5 and 0.5-2.0 with >2.0 (p<0.05). The GGT profile showed significantly higher in the APRI stage, with scores <0.5 with 0.5-2.0 (p<0.05). There were significant differences in bilirubin and GGT profiles at the stage of liver cirrhosis based on APRI scores; however, this finding did not occur in the ALP profile. Profil Fosfatase Alkali, Bilirubin, dan Gamma-Glutamyl Transferase sebagai Pendukung Diagnosis Sirosis Hati Berdasarkan Skor Aspartate Aminotransferase Platelet Ratio Index Sirosis hati adalah penyakit hati kronik tahap akhir yang ditandai dengan fibrosis dan kerusakan struktur hati dari regular menjadi noduler dan menyebabkan tes fungsi hati terganggu. Skor aspartat aminotransferase (AST) terhadap platelet ratio index (APRI) telah digunakan sebagai salah satu metode non-invasif untuk menentukan diagnosis dan klasifikasi proses sirosis hati. Tujuan penelitian ini adalah untuk menilai profil tes fungsi hati yaitu alkaline phosphatase (ALP), bilirubin, dan gama-glutamil transferase (GGT) untuk menentukan kegunaan komparatifnya dalam klasifikasi sirosis hati berdasarkan skor APRI. Penelitian ini menggunakan desain potong lintang dengan 60 subjek yang dibagi menjadi 3 kelompok berdasarkan skor APRI, yaitu <0,5; 0,5-2,0 dan >2,0. Data diperoleh dari rekam medis RSUPN dr. Cipto Mangunkusumo tahun 2017. Profil ALP, bilirubin, dan GGT dianalisis dengan uji Kruskall Wallis. Profil bilirubin menunjukkan skor APRI lebih tinggi secara signifikan pada skor <0.5 and 0.5-2.0 dibandingkan skor >2,0 (p<0,05). Profil GGT menunjukkan stadium APRI yang lebih tinggi secara bermakna dengan skor <0,5 dibandingkan skor 0,5-2,0 (p<0,05). Terdapat perbedaan bermakna pada profil bilirubin dan GGT pada stadium sirosis hati berdasarkan skor APRI namun tidak terjadi pada profil ALP.
Non-Alcoholic Fatty Liver as a Risk Factor for Breast Cancer among Indonesian Pre-Menopausal Women: A Case-Control Study Noorwati Sutandyo; Kardinah Kardinah; Denni Joko
eJournal Kedokteran Indonesia Vol 8, No 1 (2020): Vol 8, No. 1 (2020): April
Publisher : Faculty of Medicine Universitas Indonesia

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Non-alcoholic fatty liver was commonly found in breast cancer patients. However, the role of fatty liver as risk factor for breast cancer development has not been established in Indonesian population. We designed a case-control study to evaluate the effect of obesity and/or fatty liver on breast cancer occurrence in Indonesian women. Subjects were breast cancer patients between July and December 2018 in Dharmais National Cancer Centre Hospital. Control group was female hospital staff. Characteristics of subjects included age, body mass index, and presence of fatty liver by abdominal ultrasound. Independent risk factor was identified using logistic regression analysis and expressed as adjusted OR with its 95% confidence interval (CI). A total of 218 patients and 218 controls were enrolled. Both of subject and control group had equal mean of age. Among breast cancer patients, tumor was predominated by estrogen-receptor positive (69.7%) and luminal A subtype (57.8%). Mean of body mass index was significantly higher in subject group compared to control (26.8 kg/m2 vs 25.7 kg/m2 ; p=0.007). Fatty liver (49.5% vs 35.8%; p=0.004) was significantly more common in subject groups than controls. In multivariate analysis, fatty liver was confirmed as risk factor for breast cancer in subjects (ORadj: 1.56; 95%CI: 1.04&ndash;2.33; p=0.032). Obesity and fatty liver are common in breast cancer patients. Fatty liver is an independent risk factor for sporadic breast cancer. These findings warrant further studies to evaluate the mechanism of breast cancer in younger women that associated with non-alcoholic fatty liver pathogenesis. Perlemakan Hati Non-Alkoholik sebagai Faktor Risiko Kanker Payudara pada Perempuan Pre-Menopause Indonesia: Studi Kasus-KontrolPerlemakan hati non-alkoholik sering ditemukan pada pasien kanker payudara namun studi terkait peran perlemakan hati sebagai faktor risiko kanker payudara, hingga saat ini belum ada di Indonesia. Studi kasuskontrol ini dilakukan untuk mengevaluasi efek obesitas dan atau perlemakan hati terhadap kejadian kanker payudara pada perempuan Indonesian. Subjek adalah pasien kanker payudara antara bulan Juli hingga Desember 2018 di RS Pusat Kanker Nasional Dharmais. Kelompok kontrol adalah staf perempuan rumah sakit. Karakteristik subjek yang diteliti adalah usia, indeks massa tubuh, perlemakan hati yang didiagnosis dari pemeriksaan ultrasonografi abdomen. Faktor risiko independen dinilai menggunakan analisis regresi logistik dan ditampilkan sebagai adjusted OR dengan interval kepercayaan 95%. Sebanyak 218 pasien dan 218 kontrol diikutsertakan dalam studi. Kedua kelompok memiliki nilai mean usia yang sama. Pada kelompok pasien kanker payudara, jenis kanker didominasi oleh tipe estrogen-receptor positive (69,7%) dan subtype luminal A (57,8%). Mean dari indeks massa tubuh lebih tinggi bermakna dibandingkan kelompok kontrol (26,8 kg/m2 vs 25,7 kg/m2 ; p=0,007). Perlemakan hati (49,5% vs 35,8%; p=0,004) secara bermakna lebih sering ditemukan pada kelompok subjek dibandingkan kelompok kontrol. Pada analisis multivariat, perlemakan hati terbukti bermakna sebagai faktor risiko kanker payudara (ORadj: 1,56; 95%CI: 1,04&ndash;2,33; p=0,032). Disimpulkan obesitas dan perlemakan hati sering ditemukan pada pasien kanker payudara. Perlemakan hati merupakan faktor risiko independen kasus kanker payudara yang sporadik. Temuan ini dapat menjadi landasan penelitian berikutnya untuk meneliti patogenesis perlemakan hati menyebabkan kanker payudara pada perempuan usia muda.
Neonatal Mastitis Treatment: Oral or Intravenous Antibiotics Dion Darius Samsudin; Jason Julianus Samsudin; Sonny Samsudin
eJournal Kedokteran Indonesia Vol 8, No 1 (2020): Vol 8, No. 1 (2020): April
Publisher : Faculty of Medicine Universitas Indonesia

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Neonatal mastitis (NM) is an infection of the breast which ultimately leads to abscess and sepsis. Up to date, there is no general consensus of therapy for NM, and physicians have broad therapy preferences. Twenty-eight-day-old baby came to the outpatient clinic with chief complaint of enlarged breast since 1 week before admission, with a mild sign of infection and no systemic symptoms. Laboratory examination revealed a normal result. The patient was discharged with oral antibiotics. Is this treatment adequate? Is intravenous antibiotics needed for this case? A literature search was performed from 3 databases: Pubmed, Google Scholar, Cochrane with keywords: &ldquo;neonatal mastitis,&rdquo; treatment,&rdquo; &ldquo;oral antibiotics,&rdquo; &ldquo;intravenous antibiotics,&rdquo; and &ldquo;effectiveness&rdquo;. Two articles were found to be relevant to answer the research questions. Failure with oral antibiotics in NM reached up to 71%, and intravenous antibiotics is still the treatment of choice for severe NM. Complete blood count and blood and discharge culture should be performed in all NM cases. A suggestion for clinical pathway of NM in Indonesia was provided in this article. NM is a severe infection which might develop into abscess or sepsis. Complete blood count and blood and discharge culture should be performed in all suspected NM cases. Oral antibiotics can only be considered in mild NM cases with routine follow-up.Mastitis pada Bayi: Terapi Antibiotik Oral atau Intravena Mastitis neonatal (MN) adalah kondisi infeksi pada payudara bayi yang dapat menyebabkan abses dan sepsis. Sampai saat ini tidak ada panduan terapi untuk MN, dan setiap dokter memiliki preferensi yang berbeda dalam menangani kasus tersebut. Bayi usia 28 hari datang ke klinik dengan keluhan payudara membesar sejak 1 minggu yang lalu dengan tanda infeksi ringan. Pemeriksaan laboratorium didapatkan hasil normal, kemudian pasien dilakukan rawat jalan dengan antibiotik oral. Apakah terapi ini sudah adekuat dan apakah terapi antibiotik intravena masih diperlukan? Dilakukan pencarian literatur terhadap 3 database: Pubmed, Google Scholar, Cochrane dengan kata kunci &ldquo;neonatal mastitis,&rdquo; &ldquo;treatment,&rdquo; &ldquo;oral antibiotics,&rdquo; &ldquo;intravenous antibiotics,&rdquo; and &ldquo;effectiveness.&rdquo; Ditemukan 2 artikel yang relevan untuk menjawab pertanyaan penelitian. Kegagalan terapi oral antibiotik pada kasus MN mencapai 71%. Kasus MN berat harus mendapat antibiotik intravena selama 2-5 hari, kemudian dilanjutkan dengan antibiotik oral selama 7-14 hari. Pemeriksaan laboratorium lengkap dan kultur resistensi dianjurkan terhadap seluruh kasus MN. Rekomendasi clinical pathway penanganan MN di Indonesia disertakan dalam artikel ini. MN adalah kondisi infeksi serius yang dapat berkembang menjadi abses dan sepsis. Pemeriksaan darah lengkap dan kultur resistensi harus dilakukan terhadap seluruh kasus MN, dan antibiotik oral hanya dapat dipergunakan untuk kasus MN ringan dengan pengawasan ketat.
Survival after Minimally Invasive Surgery versus Abdominal Radical Hysterectomy for Early-Stage Cervical Cancer in dr. Cipto Mangunkusumo National Hospital, Jakarta Sigit Purbadi; Lisa Novianti
eJournal Kedokteran Indonesia Vol 8, No 1 (2020): Vol 8, No. 1 (2020): April
Publisher : Faculty of Medicine Universitas Indonesia

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stract Cervical cancer is one of the most frequent cancer among women in the world. Indonesian&rsquo;s gynecologic oncologists have started using laparoscopic approach for radical hysterectomy for early stage cervical cancer. There are still limited data and studies reporting survival outcomes after laparoscopic or open abdominal radical hysterectomy, thus we would like to compare the survival outcomes between laparoscopic and open technique of radical hysterectomy in early stage cervical cancer. A retrospective study included 415 early stage cervical cancer was conducted in dr. Cipto Mangunkusumo Hospital. Patient were treated with radical hysterectomy, laparotomy, or laparoscopy, and followed for 3 years period. Survival outcome was reported in univariate and multivariate design, to know the effect of age, parity, tumor size, free margin, and lymph nodal status on overall survival. From 415 patients, 268 patients fulfilled the inclusion criteria. A total of 44 patients underwent laparoscopy radical hysterectomy and 224 to open surgery. Positive resection margins rate for laparoscopic patient was lower than open group (25,9% versus 12.5%). The mean survival of laparoscopic patient was 30 months while open surgery patient was 34 months. The overall 3-year survival rate in open surgery group was 90.2% and 81.8% among those who underwent minimally invasive surgery (hazard ratio 1.7; 95% confidence interval 0.9 to 3.1; p=0.11 by the log-rank test). Laparoscopic approach for radical hysterectomy is a feasible method for early stage cervical cancer other than laparotomy.Sintasan Bedah Invasif Minimal Dibandingkan Radikal Abdominal Histerektomi pada Kanker Serviks Stadium Awal di RSUPN dr. Cipto Mangunkusumo Jakarta Kanker serviks adalah kanker yang paling sering pada perempuan di dunia. Onkologi ginekologis Indonesia telah menggunakan pendekatan laparoskopi untuk melakukan histerektomi radikal pada kanker serviks stadium awal. Data dan penelitian yang melaporkan hasil sintasan laparoskopi atau radikal abdominal histerektomi, masih terbatas sehingga perlu penelitian untuk membandingkan kesintasan laparoskopi dan radikal abdominal histerektomi pada kanker serviks stadium awal. Studi dilakukan secara retrospektif dengan menginklusi 415 data pasien kanker serviks stadium awal di RSUPN dr. Cipto Mangunkusumo. Pasien ditatalaksana dengan histerektomi radikal, laparotomi atau laparoskopi, dan ditindaklanjuti selama 3 tahun. Kesintasan dilaporkan dalam data univariat dan multivariat, untuk mengetahui hubungan usia, paritas, ukuran tumor, batas tumor, dan status kelenjar getah bening pada seluruh sintasan. Dari 415 pasien, sebanyak 268 pasien memenuhi kriteria inklusi. Sebanyak 44 pasien menjalani laparoskopi histerektomi radikal dan 224 menjalani laparotomi. Angka kejadian batas reseksi positif untuk pasien laparoskopi lebih rendah dari laparotomi (25,9% versus 12,5%). Rerata kesintasan pasien laparoskopi adalah 30 bulan dan laparotomi adalah 34 bulan. Seluruh sintasan pasien laparotomi dalam 3 tahun adalah 90,2%, dan 81,8% pada pasien operasi invasif minimal (hazard ratio 1,7; 95% confidence interval 0,9-31; p=0,11 dengan tes log-rank). Disimpulkan metode laparoskopi untuk histerektomi radikal dapat dikerjakan untuk pasien kanker serviks stadium awal.
Indonesian Urologists’ Current Practice on Nocturnal Enuresis Harrina Erlianti Rahardjo
eJournal Kedokteran Indonesia Vol 8, No 1 (2020): Vol 8, No. 1 (2020): April
Publisher : Faculty of Medicine Universitas Indonesia

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Nocturnal enuresis (NE) is a symptom and a condition of intermittent incontinence which takes place during periods of sleep. Being the most common form of incontinence in children, the prevalence of NE in Indonesia is 2.3%. The objective of the study was to review Indonesian urologists' current practice on NE. This was a descriptive cross-sectional study using a self-constructed questionnaire which was distributed during several urological scientific meetings from August 2017 until August 2018. Indonesian urologists were asked to fill out these questionnaires which contained characteristics of the respondents and NE patients they had seen in their practices, diagnostic modalities and treatment options for NE. 133 out of 400 urologists participated. Most urologists had to deal with 1-5 cases NE per month. It was most commonly seen in 5-10 age group and affecting more girls than boys (45.9% vs 27.8% respectively). Approximately only half of Indonesian urologists utilized bladder diary for NE cases. Almost 90% urologist educated and proposed lifestyle intervention to manage NE. Alarm therapy and desmopressin was chosen by 51.1% and 21.8% of urologists respectively as treatment. Desmopressin was still less commonly prescribed compared to antimuscarinic and beta 3 agonist. To conclude, diagnostic strategies for NE are mostly in accordance with available guidelines although bladder diary was only opted by approximately half of urologists. Regarding treatment, education, lifestyle intervention and alarm therapy were the most form of treatment utilized for this condition.Praktik Terkini Spesialis Urologi Indonesia dalam Menangani Enuresis Nokturnal Enuresis nokturnal adalah bentuk inkontinensia urine intermiten yang terjadi saat tidur yang merupakan inkontinensia urine tersering pada anak dengan prevalensi di Indonesia 2,3%. Tujuan penelitian ini adalah mengetahui praktik terkini dokter spesialis urologi dalam menangani enuresis nokturnal. Studi deskriptif potong lintang ini menggunakan kuesioner yang dibagikan pada dokter spesialis urologi pada bulan Agustus 2017&ndash;Agustus 2018. Sebanyak 133 dari 400 spesialis urologi berpartisipasi dalam studi ini. Mayoritas spesialis urologi mendapat 1-5 kasus enuresis nokturnal per bulan. Usia pasien tersering adalah 5-10 tahun dan lebih banyak anak perempuan dibandingkan anak laki-laki (45,9% vs 27,8%). Setengah spesialis urologi menggunakan catatan harian berkemih untuk diagnosis enuresis nokturnal. Hampir 90% responden memilih edukasi dan intervensi gaya hidup sebagai tata laksana. Terapi alarm dan desmopressin digunakan oleh 51,1% dan 21,8% responden untuk terapi. Anti-muskarinik dan beta-3-agonis lebih sering diberikan dibandingkan desmopressin. Disimpulkan strategi diagnostik untuk enuresis nokturnal telah sesuai dengan panduan tata laksana kecuali untuk catatan harian berkemih. Terapi yang paling banyak dipilih adalah edukasi, intervensi gaya hidup, dan terapi alarm.
Manajemen Retensio Urin Pasca Persalinan Pervaginam Suskhan Djusad
eJournal Kedokteran Indonesia Vol 8, No 1 (2020): Vol 8, No. 1 (2020): April
Publisher : Faculty of Medicine Universitas Indonesia

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Retensio urin pascapersalinan (RUPP) adalah ketidakmampuan berkemih spontan atau dapat berkemih spontan 6 jam setelah persalinan dengan residu urin >200 mL. RUPP menimbulkan peregangan kandung kemih berlebihan sehingga mengganggu persarafan dan atonia otot detrusor. Faktor risiko RUPP adalah primipara, persalinan dengan alat, persalinan kala II lama, dan ruptur perineum luas. Gejala klinis berupa buang air kecil (BAK) sedikit atau tidak dapat BAK. Manajemen RUPP dengan residu urin 200-500 mL dilakukan kateterisasi intermiten tiap 6 jam sampai residu urin <200 mL. Jika residu urin 500-1.000 mL dilakukan dauer kateter 1x24 jam dan 6 jam kemudian pasien diminta berkemih spontan, 5 menit kemudian diukur residu urin. Jika residu urin 1.000-2.000 mL, dipasang dauer kateter selama 2x24 jam dan buka tutup kateter/4-6 jam selama 24 jam. Jika residu urin >2.000 mL, dauer kateter 3x24 jam dan bladder training selama 24 jam. Enam jam kemudian diukur volume residu urin dan bila residu urin <200 mL maka volume residu urin dikatakan normal. Pascapersalinan, tatalaksana dilakukan secara simultan dengan pemasangan kateter diikuti pemberian prostaglandin, antibiotik, dan edukasi minum air 2-3 liter perhari. Perlu pemeriksaan klinis yang baik pada pengawasan lama kala II, pengosongan kandung kemih dan tatalaksana robekan jalan lahir. Post-Partum Urinary Retention Management Postpartum urinary retention (PPUR) is defined as inability to pass urine spontaneously or able to pass urine spontaneously in 6 hours following delivery with residual urine volume of >200 ml. PPUR is causing overdistention of bladder resulted in neurologic dysfunction and detrusor muscle atonia. Risk factor for PPUR including primipara, assisted vaginal delivery, prolonged second stage of labor and extensive perineal rupture. Clinical symptoms related to PPUR are decreasing urine volume or unable to urinate spontanously. Management in PPUR with residual urine 200-500 ml is by intermitten catether every 6 hours continued with spontaneously urinate and residual urine will be measured after 5 minutes. PPUR management with residual urine 500-1000 ml is by applied dauer catheter 1x24 hours continued with spontaneously urinate after 6 hours and residual urine also will be measured after 5 minutes. PPUR management with residual urine 1000-2000 ml is by applied dauer catheter 2x24 hours, continued with opening and closing catheter every 4-6 hours for 24 hours. If residual urine >2000 ml, dauer cathetetr will be applied for 3x24 hours, continued with bladder training for 24 hours. Residual urine will be measured after 6 hours. The result is normal if residual urine <200 ml. PPUR management is done simultaneously with catheter application, prostaglandin, antibiotics and hydration 2-3 L/day. Good clinical examination and management during prolonged second stage of labor, bladder emptying and perineal ruptur management are needed in preventing post partum urinary retention.

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