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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 13 Documents
Search results for , issue "Vol 8, No 2 (2020): Vol 8, No. 2 (2020): Agustus" : 13 Documents clear
Flutter Atrium Tipikal Menyerupai Blok Atrioventrikuler Derajat Tinggi Agustinus Vincent; Sitti Rahmah Mahafuddin
eJournal Kedokteran Indonesia Vol 8, No 2 (2020): Vol 8, No. 2 (2020): Agustus
Publisher : Faculty of Medicine Universitas Indonesia

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Flutter atrium adalah jenis takiaritmia atrium yang paling sering dijumpai setelah atrial fibrilasi. Flutter atrium adalah bentuk takiaritmia berupa denyut atrium yang meningkat dan teratur, akibat aktivitas listrik atrium berlebihan ditandai dengan denyut atrial rerata 250 - 350 kali per menit. Risiko flutter atrium dikaitkan dengan berbagai kondisi medis tertentu dan hanya 2% kasus flutter atrium yang dapat timbul spontan. 90% kasus flutter atrium merupakan jenis tipikal dengan anticlockwise re-entry. Dilaporkan seorang laki-laki, 61 tahun dengan flutter atrium tipikal clockwise re-entry disertai pola disosiasi atrioventrikuler yang nyata dan bervariasi tanpa gambaran gelombang P sinusoid/gigi gergaji yang khas, sehingga hasil elektrokardiografi (EKG) pasien awalnya dianggap sebagai blok atrioventrikuler derajat tinggi. Gelombang P yang sinusoid khas flutter atrium baru terlihat jelas setelah pemberian salbutamol dan teofilin. Flutter atrium berhasil kembali menjadi irama sinus setelah salbutamol dan teofilin dihentikan dilanjutkan dengan pemberian digoksin. Disimpulkan bahwa diagnosis flutter atrium dapat didiagnosis hanya berdasarkan EKG sehingga untuk penatalaksaan kasus di runah sakit diperlukan pengalaman dan pemahaman komprehensif mengenai patofisiologi takiaritmia dan EKG. Typical Atrial Flutter Mimicking High Degree Atrioventricular Block Atrial flutter is one of the most common types of atrial tachyarrhythmias after atrial fibrillation. Atrial flutter is a form of tachyarrhythmias with a regular and increased atrial pulses, due to the activity of excessive atrial electrical activity characterized by an atrial pulse averaging 250 to 350 times per minute. The risk of atrial flutter always associated with a variety of certain medical conditions and only 2% of cases of atrial flutter can occur spontaneously. 90% of cases of atrial flutter are typical atrial flutter with anticlockwise re-entry. Here we present, a 61 years old male with a typical clockwise re-entry atrial flutter presenting a promienent and varied atrioventricular dissociation pattern without showing a sinusoidal / typical sawtooth P wave image, hence the patient’s electrocardiographic results were initially regarded as a high degree atrioventricular block. A typical sinusoid P waves of atrial flutter were then observed after administration of salbutamol and theophylline. In the end, the atrial flutter was succesfully converted into sinus rhythm after cessation of salbutamol and theophylline and administration of digoxin. In conclusion, the diagnosis of atrial flutter based solely on electrocardiography is a challenge that requires experience and a comprehensive understanding of the pathophysiology of the tachyarrhythmia and electrocardiography.
The Effect of Near-work Activity Time to The Incidence of Myopia in Children Triana Hardianti Gunardi; Julie Dewi Barliana; Andi Arus Victor; Angky Budianti
eJournal Kedokteran Indonesia Vol 8, No 2 (2020): Vol 8, No. 2 (2020): Agustus
Publisher : Faculty of Medicine Universitas Indonesia

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Myopia has been a global problem leading to visual impairment and blinding complications with associated factors including time spent outdoor and near-work activity time. Excessive near-work activities are inevitable in children nowadays. However, the association between near-work activity time and myopia are still inconsistent between studies. The aim of this study is to review whether excessive near-work activities is associated with myopia incidence. A literature search on six different database (Pubmed, Cochrane Library, Scopus, Clinical Key, Google Scholar, and EBSCOhost). Articles matched with inclusion criteria were appraised using Therapeutic Study Critical Appraisal Tool by CEEBM, University of Oxford. Three cohort trials were obtained from the literature search. Incidence of myopia and the hazard ratio (HR) in Ku et al, Tsai et al, and You et al are 27.7%, HR 1.31 (95% CI 1.03-1.68) for &ge;2 hours/day cram school attendance; 25.2% HR 1.12 (95%CI 1.02-1.22) for &ge;5 hours/week after-school program; 16% HR 1.05 (0.96-1.16) for &ge;2.95 &plusmn; 1.72 hours/day near work time, respectively. The protective factor pointed out by the studies was outdoor time. Tsai et al showed HR 0.90 (95%CI 0.82-0.99, p<0.001) for &ge;30 minute time spent on outdoor activities after school on weekdays; and Ku et al showed a protective dose-response relationship (p<0.001) between increased outdoor activity time and myopia. Near-work activity is a strong risk factor candidate for myopia incidence, while outdoor activity is a strong protective candidate. Hubungan Aktivitas Jarak Dekat terhadap Insidens Miopia pada Anak Miopia merupakan penyakit mata terbanyak yang dapat mengakibatkan kebutaan. Faktor yang berpengaruh antara lain aktivitas luar ruangan dan aktivitas jarak dekat. Pada era milenial olahraga luar ruangan jarang dilakukan dan aktivitas jarak dekat sangat melekat dengan kehidupan sehari-hari. Studi ini bertujuan untuk meninjau hubungan aktivitas jarak dekat dengan insidens miopia. Pencarian melalui enam basis data ilmiah (Pubmed, Cochrane Library, Scopus, Clinical Key, Google Scholar, and EBSCOhost) menghasilkan tiga studi kohort yang selanjutnya ditelaah menggunakan Therapeutic Study Critical Appraisal Tool by CEEBM, University of Oxford. Insidens miopia dan hazard ratio (HR) aktivitas jarak dekat pada Ku et al, Tsai et al, dan You et al adalah 27,7%, HR 1,31 (95% CI 1,03-1,68) untuk &ge;2 jam/hari les akademik; 25,2% HR 1,12 (95% CI 1,02-1,22) untuk &ge;5 jam/minggu program akademik; 16% HR 1,05 (0,96-1,16) untuk &ge;2,95 &plusmn; 1,72 jam/hari aktivitas jarak dekat. Aktivitas luar ruangan merupakan faktor protektif terhadap insidens miopia dengan HR 0,90 (95% CI 0,82-0,99, p<0,001) untuk &ge;30 menit kegiatan luar ruangan pada hari kerja. Terdapat hubungan dosis-respons protektif (p<0,001) antara aktivitas luar ruangan dan miopia. Aktivitas jarak dekat merupakan faktor risiko kuat untuk miopia sedangkan aktivitas luar ruangan merupakan faktor protektif.
Multicenter Management of Breast Cancer in Indonesia: Ten Years of Experience Soehartati Gondhowiardjo; Ratnawati Soediro; Vito Filbert Jayalie; Zubairi Djoerban; Nurjati Chairani Siregar; Evert D.C. Poetiray
eJournal Kedokteran Indonesia Vol 8, No 2 (2020): Vol 8, No. 2 (2020): Agustus
Publisher : Faculty of Medicine Universitas Indonesia

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In Indonesia, despite the increasing incidence, there is a gap in breast cancer patients profile, tumor characteristics and management as well as the follow up. This study aims to provide the profile and 10-year-experience in managing breast cancer. This was a cohort retrospective study conducted in all patients admitted to Department of Radiotherapy dr. Cipto Mangunkusumo National Hospital and Jakarta Breast Center from 2001 to 2010. Outcomes measured were patients&rsquo; profiles, disease stage at diagnosis, and treatment regimens which were collected from medical records to establish survival analysis and prognostic factors. In total, out of the 1,289 patients admitted during the period, follow-up was conducted in 933 breast cancer patients with a median follow-up of 26 months (0-130 months). The mean age of incidence was less than 50 years old. Most patients were pre-menopausal, not obese, breastfed their children and without a family history of cancer. Most common tumor profiles were invasive ductal (69%) grade II (28%) without lymph node involvement and positive hormone receptors. The survival of patients was higher in early stages. Multimodalities management were used for most patients, but overall compliance was only 46.2%. Five year survival was greater in patients with algorithm-based therapy and with high adherence. Despite the advancement of breast cancer screening and early therapy, more than 50% of breast cancer patients in Indonesia came at a later stage of breast cancer. Multimodalities treatment have become useful in managing breast cancer in various stages. Manajemen Multisenter Kanker Payudara di Indonesia: Pengalaman Sepuluh Tahun Di Indonesia, terdapat kesenjangan dalam tatalaksana pasien kanker payudara yang berdasarkan karakteristik tumor, manajemen yang diberikan serta tindak lanjut. Penelitian ini bertujuan untuk memberikan data profil dan pengalaman 10 tahun dalam mengelola kanker payudara di Indonesia. Penelitian ini merupakan penelitian retrospektif kohort yang dilakukan pada semua pasien kanker payudara di Departemen Radioterapi RSUPN dr. Cipto Mangunkusumo dan Jakarta Breast Centre dari tahun 2001 hingga 2010. Hasil yang diukur adalah profil pasien, tahap diagnosa, regimen terapi yang dikumpulkan dari rekam medis sehingga membentuk sebuah analisis survival dan faktor prognostik. Dari total 1.289 pasien di RSUPNCM pada periode tersebut, tindak lanjut dilakukan pada 933 pasien kanker payudara dengan rata-rata tindak lanjut 26 bulan (0-130 bulan) dengan usia rata-rata pasien kurang dari 50 tahun. Sebagian besar pasien memiliki kriteria premenopause, tidak obesitas, menyusui dan tanpa riwayat keluarga dengan kanker. Profil tumor yang paling umum ditemukan adalah duktal invasif (69%) grade II (28%) tanpa keterlibatan kelenjar getah bening dan reseptor hormon positif. Kelangsungan hidup pasien lebih tinggi pada tahap awal. Manajemen multimodalitas digunakan untuk kebanyakan pasien, tetapi kepatuhan keseluruhan hanya 46,2%. Kelangsungan hidup 5 tahun lebih besar pada pasien dengan terapi berbasis algoritma dan kepatuhan tinggi. Terlepas dari kemajuan skrining kanker payudara dan terapi dini, lebih dari 50% pasien kanker payudara di Indonesia datang dengan stadium lanjut. Tata laksana multimodal bermanfaat pada penanganan kanker payudara dalam berbagai tahap.
Burnout Syndrome among General Practitioners in A Tertiary Referral Center Ayu Hutami Syarif; Hafidz Nur Ichwan; Anita Meisita; Mururul Aisyi; Rahajeng Dewantari
eJournal Kedokteran Indonesia Vol 8, No 2 (2020): Vol 8, No. 2 (2020): Agustus
Publisher : Faculty of Medicine Universitas Indonesia

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Many demanding jobs, such as medical professionals are the targets of burnout syndrome. Although burnout syndrome was frequently reported in many studies abroad, Indonesia lacks the relevant data specifically burnout syndrome in the hospital staff. This study aimed to determine burnout syndrome in a tertiary referral center and its associated factors. This was a cross-sectional study involving general practitioners who worked in a tertiary referral hospital. The questionnaire used the Maslach Burnout Inventory (MBI). This study was performed in a tertiary referral hospital in Jakarta, from March to April 2019. The data were analyzed using univariate and bivariate analysis and compared with the chi-square test or Fisher test. Results: The total participants were 31 doctors; 25 of them were female, while half of them worked in the hospital at under 30 years (n=16). Most of them were married (n=20) and had a shift in the clinical unit (n=23). The majority of them worked longer than others (n=24) and earned a lower level of monthly salary (n=19). As many as 12 physicians in this institution were detected to be burnout. Medical doctors who suffered from burnout are marked with female (n=10), young age (n=10), marriage (n=9), longer working hours (n=11), low salary (n=7), and less working experience (n=6). Bivariate analysis showed age significantly associate with burnout syndrome (P-value=0.010). Burnout syndrome was found among medical doctors in a tertiary referral center with age as the only significant associating factor. Kejadian Burnout Syndrome pada Dokter Umum di Sebuah Rumah Sakit Rujukan Tertier Sindrom Burnout banyak ditemukan pada profesi tertentu seperti dokter. Meskipun demikian, data mengenai angka kejadian Sindrom Burnout belum banyak dilaporkan di Indonesia, khususnya pada profesi dokter umum yang bertugas di rumah sakit rujukan tersier. Penelitian ini dilakukan untuk menentukan angka kejadian dan faktor yang berpengaruh terhadap Sindrom Burnout pada dokter umum rumah sakit rujukan tersier. Studi potong lintang ini melibatkan 31 dokter umum sebagai responden penelitian. Studi ini dilakukan di sebuah rumah sakit rujukan tersier di Jakarta, pada bulan Maret-April 2019. Pengambilan data primer menggunakan kuesioner Maslach Burnout Inventory (MBI) untuk menentukan kejadian Sindrom Burnout. Data dianalisa dengan analisa univariat (data sosiodemografi) dan bivariat. Analisa bivariat dilakukan untuk melihat hubungan antara variabel karakteristik sosiodemografi terhadap kejadian Sindrom Burnout dengan menggunakan chi-square test atau fisher test. Hasil : Responden sebagian besar merupakan wanita (n=25), yang telah menikah (n=20), bekerja di unit pelayanan (n=23), bekerja lebih dari 60 jam (n=24), dan berpenghasilan di bawah 10 juta (n=19). Sebanyak 12 dokter umum mengalami Sindrom Burnout. Sindrom Burnout pada dokter umum ditandai dengan perempuan (n=10), usia yang lebih muda (n=10), telah menikah (n=9), jam kerja yang lebih lama (n=11), penghasilan yang lebih rendah (n=7), dan pengalaman kerja yang lebih sedikit (n=6). Analisis bivariat menunjukkan usia berhubungan secara signifikan terhadap kejadian Sindrom Burnout (P-value= 0,010). Sindrom burnout dialami oleh dokter umum yang bekerja di rumah sakit rujukan tersier. Usia merupakan satu-satunya faktor yang berhubungan dengan sindrom burnout.
Next-Generation Sequencing pada Kanker Paru Hana Khairina Putri Faisal; Jamal Zaini; Faisal Yunus
eJournal Kedokteran Indonesia Vol 8, No 2 (2020): Vol 8, No. 2 (2020): Agustus
Publisher : Faculty of Medicine Universitas Indonesia

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Kanker merupakan penyakit genetik, oleh sebab itu, tata laksana kanker didasarkan pada kelainan atau mutasi genetik yang terjadi pada masing-masing pasien kanker. Next-generation sequencing (NGS) adalah teknologi sekuensing gen dengan sensitivitas dan spesifisitas tinggi, yang dikembangkan untuk mendeteksi lebih dari satu kelainan genetik secara bersamaan dalam sekali pemeriksaan. Teknologi NGS tidak memerlukan banyak materi genetik untuk menghasilkan data besar. Diagnosis kanker paru ditegakkan berdasarkan temuan histolopatologi pada sediaan biopsi yang umumnya diperoleh melalui prosedur bronkoskopi. Sediaan biopsi dari bronkoskopi relatif sedikit sehingga pemeriksaan mutasi genetik yang dapat dilakukan hanya terbatas pada mutasi yang sering (hotspot). Oleh sebab itu, teknologi NGS dapat menjadi metode yang lebih sesuai untuk mengetahui profil mutasi pasien agar tata laksana kanker paru dengan prinsip precision medicine dapat diterapkan. Next-Generation Sequencing in Lung Cancer Cancer is a genetic disease, hence, it is understandable that cancer management should be based on genetic alterations of each cancer patients. Next-generation sequencing is a high-sensitivity and specificity technology developed to detect multiple gene alterations in a single test that requires only a little amount of genetic materials and yet may generate big data. Lung cancer diagnosis is still based on histopathological findings on a limited biopsy specimen obtained during bronchoscopy. Consequently, genetic detection in lung cancer is often limited to hotspot mutations. Therefore, NGS can be a suitable method for genetic mutation profiling in order to apply precision medicine principle in lung cancer management.
Potential Transmission of Cryptosporidium sp. in Ciliwung River Water, Jakarta Meita Mahardianti; Agnes Kurniawan; Ika Puspa Sari
eJournal Kedokteran Indonesia Vol 8, No 2 (2020): Vol 8, No. 2 (2020): Agustus
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Cryptosporidium sp. is an intracellular protozoa parasite that causes diarrhea. Contaminated water supply with Cryptosporidium oocyst may cause diarrhea outbreak. Inadequate wastewater treatment facilities in Jakarta become the main cause of water contamination, even in the river that was designated for the clean water reservoir. This study aims to evaluate the Cryptosporidium sp. existence in Ciliwung river water. This study used seven samples of Ciliwung river water and was conducted in Parasitology Laboratory, Faculty of Medicine Universitas Indonesia in 2018. Microscopic examination using modified Ziehl-Neelsen (mZN), Auramine Phenol staining (AF), Immunofluorescent Assay (IFA) and Polymerase Chain Reaction (PCR) was performed to detect Cryptosporidium oocyst. Oocyst enumeration was done by the IFA method. Assessment of oocyst viability was performed by the addition of 4&rsquo;-6-diamidino-2-phenylindole (DAPI) solution to the IFA method. The results showed that Cryptosporidium oocyst found upstream and downstream of Ciliwung river water. Contamination of Cryptosporidium oocysts shows higher contamination in the downstream river. Assessment of the viability of Cryptosporidium sp. oocyst showed that Cryptosporidium oocysts in the downstream Ciliwung river water are viable, suggesting that oocysts are infectious. It can be concluded that upstream and downstream of Ciliwung river water are contaminated with Cryptosporidium sp. and potential as a source of cryptosporidiosis infection. Potensi Transmisi Cryptosporodium sp di Sungai Ciliwung Jakarta Cryptosporidium sp. adalah protozoa intraseluler penyebab diare. Sumber air yang terkontaminasi ookista Cryptosporidium dapat menyebabkan wabah diare. Minimnya fasilitas pengolahan air limbah di Jakarta mengakibatkan pencemaran yang terjadi di badan-badan air, bahkan badan sungai yang diperuntukkan sebagai bahan baku air bersih telah tercemar. Tujuan penelitian ini adalah untuk mengevaluasi keberadaan Cryptosporidium sp. pada air sungai Ciliwung. Penelitiian dilakukan di Laboratorium Parasitologi Fakultas Kedokteran Universitas Indonesia pada tahun 2018. Pada penelitian ini digunakan 7 sampel air sungai Ciliwung. Pemeriksaan dilakukan dengan metode mikroskopis pewarnaan modifikasi Ziehl Neelsen (mZN), auramin fenol (AF), Immunofluorescent Assay (IFA) dan metode molekuler Polymerase Chain Reaction (PCR) untuk deteksi ookista Cryptosporidium. Enumerasi ookista dilakukan dengan metode IFA. Penilaian terhadap viabilitas ookista, dilakukan dengan penambahan larutan 4&rsquo;-6-diamidino-2-phenylindole (DAPI) pada metode IFA. Hasil penelitian menunjukkan bahwa ookista Cryptosporidium sp. ditemukan pada aliran sungai Ciliwung bagian hulu dan hilir. Kontaminasi ookista Cryptosporidium menunjukkan kontaminasi lebih tinggi pada bagian hilir. Penilaian viabilitas ookista Cryptosporidium sp. menunjukkan ookista Cryptosporidium pada air sungai Ciliwung bagian hilir bersifat viabel, menunjukkan bahwa ookista bersifat infeksius. Kesimpulan yang diperoleh adalah air sungai Ciliwung bagian hilir dan hulu terkontaminasi oleh Cryptosporidium sp. dan berpotensi sebagai sumber infeksi kriptosporidiosis.
Preliminary Study of Newborn Screening for Congenital Hypothyroidism and Congenital Adrenal Hyperplasia in Indonesia Aman B Pulungan; Frida Soesanti; Agustini Utari; Niken Pritayati; Madarina Julia; Diadra Annisa; Attika A. Andarie; I Wayan Bikin
eJournal Kedokteran Indonesia Vol 8, No 2 (2020): Vol 8, No. 2 (2020): Agustus
Publisher : Faculty of Medicine Universitas Indonesia

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Newborn screening (NBS) is an effective public health policy to detect congenital disorders. In 2014, Indonesia marked its pivotal step by launching a national NBS program for congenital hypothyroidism (CH). The expansion of NBS program is expected. This study aimed to evaluate the feasibility and recall rates of NBS for CH and congenital adrenal hyperplasia (CAH). A preliminary study was conducted in 5 cities in Indonesia from October 2015 to January 2016. All newborns aged 2-5 days with gestational age &ge;36 weeks were included in the study. Identity, gender, and age at the time of testing, and gestational age were recorded. The heel prick dried blood samples were taken and transported to the appointed standardized laboratories for TSH and 17-OHP testing. Samples were tested using immunoassay. A positive screen test prompted recalling for confirmatory testing and referral to pediatric endocrinologists. Out of 1226 patients, 1126 were screened for TSH while 1188 were tested for 17-OHP. The median age was 2 (2-5) days. The recall rate for CH was 1/1167 (0.09%). The patient was recalled and was found to be a true positive case. Out of 1188 patients who were screened for CAH, 8 had positive results (0.71%). After recalling, only 3 patients screened for CAH came for confirmatory testing, and 2 were found true positives. High rates of CH and CAH in Indonesia indicate the need of mandatory NBS program. CAH screening results in high false positive values; hence, second tier screening should be considered. Government support, good partnership with health services, and increased society awareness are of importance. Studi Preliminer Skrining Hipotiroid Kongenital dan Hiperplasia Adrenal Kongenital pada Bayi Baru Lahir di Indonesia Skrining bayi baru lahir (newborn screening/NBS) adalah kebijakan kesehatan masyarakat yang efektif dalam mendeteksi penyakit kongenital. Pada tahun 2014, Indonesia meluncurkan program NBS nasional untuk mendeteksi hipotiroid kongenital (HK). Penelitian ini bertujuan untuk mengevaluasi kelayakan dan recall rate program NBS untuk HK dan hiperplasia adrenal kongenital (HAK). Penelitian ini dilakukan di 5 kota di Indonesia pada bulan Oktober 2015 hingga Januari 2016. Subjek penelitian adalah neonatus berusia 2-5 hari dengan usia kehamilan &ge;36 minggu. Data identitas, jenis kelamin, usia saat skrining, dan usia kehamilan dikumpulkan. Sampel darah kering yang diambil dengan heel prick diuji TSH dan 17-OHP. menggunakan immunoassay. Jika hasil positif, maka subjek dipanggil kembali untuk uji konfirmasi dan rujukan ke spesialis endokrinologi anak. Dari 1226 subjek, 1126 diuji untuk TSH dan 1188 diuji 17-OHP. Median usia 2 (2-5) hari. Recall rate untuk HK 1/1167 (0,09%). Subjek dipanggil kembali dan memiliki hasil uji konfirmasi positif. Dari 1188 subjek yang diskrining untuk HAK, 8 memiliki positif (0,71%). Hanya 3 subjek yang datang untuk uji konfirmasi dan 2 subjek positif. Tingginya angka HK dan HAK di Indonesia mengindikasikan kebutuhan akan program NBS nasional. Skrining HAK memiliki nilai positif palsu yang tinggi, sehingga skrining lapis kedua perlu dipertimbangkan. Dukungan pemerintah, kerja sama yang baik dengan layanan kesehatan, dan peningkatan kesadaran masyarakat penting untuk mendukung suksesnya program ini.
Status Koagulasi Pasien Cedera Kepala Sedang Berdasarkan Tromboelastografi dan Hemostasis Konvensional Hanif G. Tobing; Martin Susanto; Syaiful Ichwan; Wismaji Sadewo; Ina S. Timan; Affan Priyambodo; Renindra A. Aman; Samsul Ashari; David Tandian; Mohammad Saekhu; Setyo W. Nugroho
eJournal Kedokteran Indonesia Vol 8, No 2 (2020): Vol 8, No. 2 (2020): Agustus
Publisher : Faculty of Medicine Universitas Indonesia

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Pasien cedera kepala paling banyak di RSUPN dr. Cipto Mangunkusumo (RSCM), Jakarta adalah cedera kepala sedang (CKS) dan kelainan koagulasi dapat memperburuk luaran pasien cedera kepala. Untuk mengetahui status koagulasi dan luaran pada pasien CKS di RSCM dilakukan studi kohort prospektif pada bulan Oktober 2019 &ndash; Januari 2020 dengan subjek 20 pasien CKS. Dilakukan pemeriksaan hemostasis konvensional (trombosit, PT, APTT) dan viskoelastisitas darah menggunakan tromboelastografi (TEG). Dari pemeriksaan konvensional didapatkan gangguan koagulasi pada 5% pasien sedangkan dari pemeriksaan TEG diperoleh 60% subjek dengan gangguan koagulasi (55% hiperkoagulasi dan 5% hipokoagulasi). Median lama rawat inap adalah 7 (3-27) hari dan tidak didapatkan mortalitas. Tidak didapatkan perbedaan bermakna antara pemeriksaan hemostasis konvensional dengan TEG (uji Fisher, p>0,999) serta antara status TEG dengan lama rawat inap (Uji Mann-Whitney, p=0,243). Dari parameter TEG (R time, K time, alpha angle, dan MA) tidak didapatkan perbedaan bermakna dengan lama rawat (uji Mann Whitney dan korelasi Spearman). Terdapat perbedaan bermakna antara parameter TEG, yaitu R time (p<0,001) dan alpha angle (p=0,028) dengan hasil CT scan. Disimpulkan, hiperkoagulasi merupakan kelainan koagulasi yang paling sering pada pasien CKS. Coagulation Status of Patients with Moderate Traumatic Brain Injury Based on Thromboelastography and Conventional Haemostasis Test It is known that the majority of traumatic brain injury (TBI) patients in Cipto Mangunkusumo Hospital, Jakarta (RSCM) are comprised of moderate TBI. This prospective cohort study was done in RSCM to evaluate the coagulation status profile of 20 patients with moderate TBI using conventional hemostatic test (platelet count, PT, APTT) and blood viscoelasticity using thromboelastography (TEG) from October 2019 &ndash; January 2020. From conventional test, coagulopathy were detected in 5% patients, while from the TEG, coagulopathy were detected in 60% patients (55% hypercoagulopathy and 5% hypocoagulopathy). The outcome of the patients were evaluate using length of stay (LOS) which is 7 days (3-27 days) and mortality (no mortality found in this study). From statistical analysis, the conventional test result and TEG test are not significantly correlated (p>0.999). Thromboelastography test result are not significantly correlated with LOS (p=0.243). From each parameter of TEG (R time, K time, alpha angle, and MA) are not correlated with LOS (Mann Whitney test and Spearman&rsquo;s correlation test). We found that 2 parameters of TEG, R time (p<0,001) and alpha angle (p=0,028) are significantly correlated with CT scan. In conclusion, hypercoagulopathy is the most coagulation abnormality that occurred in moderate TBI.
The Similarity Between Chinese-Indonesian, Sundanese and Bataknese Based on Facial and Nasal Index Alberta Karolina; Andri A. Rusman; Yoni Fuadah Syukriani
eJournal Kedokteran Indonesia Vol 8, No 2 (2020): Vol 8, No. 2 (2020): Agustus
Publisher : Faculty of Medicine Universitas Indonesia

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Identification plays a vital role in forensic medicine to determine personal identity. There is a possibility that facial index (FI) and nasal index (NI) are different between Chinese-Indonesian, Sundanese, and Bataknese, three important ethnic groups in Indonesia. The study aim is to determine the similarity between the three ethnicities based on FI and NI. A cross-sectional study was conducted in Bandung City in May-July 2018. Subjects were collected randomly from 21-50 years old adults, 64 people from each group. Morphometric analysis of the face and nose was conducted to produce FI and NI. Results showed that all groups were predominantly hyperleptoprosop, having a very long-narrow face (FI > 93). All males and Sundanese females are predominantly hyperleptorrhine, having a very long-narrow nose (NI 40-55). The Chinese-Indonesian female is predominantly chamaerrhine, having a short-broad nose (NI 85-99.9). The Bataknese females are predominantly hyperchamaerrhine, having a very short-broad nose (NI > 58). The hierarchical clustering analysis showed a close similarity between Chinese-Indonesian and Sundanese groups compared they are with Bataknese. This finding is consistent with the South-East Asian migration theory. The result could be used to support comparative identification in situations when forensic anthropology is a critical choice to estimate ethnic affiliation. Kemiripan Antara Suku Tionghoa-Indonesia, Sunda, serta Batak Berdasarkan Indeks Fasial dan Nasal Identifikasi berperan penting dalam kedokteran forensik untuk menentukan identitas personal. Ada kemungkinan perbedaan indeks wajah (FI) dan indeks hidung (NI) antar kelompok Cina-Indonesia, Sunda, dan Batak, sebagai tiga kelompok etnis penting di Indonesia. Penelitian ini bertujuan menentukan kemiripan di antara ketiga kelompok tersebut berdasarkan FI dan NI. Penelitian cross-sectional dilakukan di Kota Bandung bulan Mei-Juli 2018. Subjek diambil secara acak dari orang dewasa (21-50 tahun), 64 orang dari setiap kelompok. Analisis morfometri dilakukan untuk menghasilkan FI dan NI. Hasil menunjukkan seluruh populasi umumnya hyperleptoprosop, memiliki wajah sangat panjang dan sempit (FI > 93). Perempuan Sunda dan seluruh laki-laki umumnya hyperleptorrhine, yaitu hidung sempit (NI 40-55). Perempuan Cina- Indonesia umumnya chamaerrhine, yaitu hidung lebar dan pendek (NI 85-99,9). Perempuan Batak umumnya hyperchamaerrhine, yaitu hidung sangat lebar dan pendek (NI > 58). Analisis kluster hirarki menunjukkan kelompok Tionghoa-Indonesia memiliki kemiripan lebih dekat dengan kelompok Sunda dibandingkan dengan kelompok Batak. Hasil ini konsisten dengan teori migrasi di Asia Tenggara. Hasil ini dapat digunakan untuk identifikasi komparatif jenazah korban dalam situasi yang membutuhkan metode antropologi forensik untuk estimasi kelompok etnis.
Penentuan Tingkat Kedaruratan Bedah Adenoma Hipofisis Melalui Stratifikasi Prabedah di Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo Renindra Ananda Aman; Aryandhito Widhi Nugroho
eJournal Kedokteran Indonesia Vol 8, No 2 (2020): Vol 8, No. 2 (2020): Agustus
Publisher : Faculty of Medicine Universitas Indonesia

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Abstract

Adenoma hipofisis menyebabkan defisit neurologis yang memerlukan tata laksana tepat. Belum ada standar baku penetapan tingkat kedaruratan bedah untuk adenoma hipofisis. Penelitian ini bertujuan mengetahui distribusi tingkat kedaruratan bedah pengangkatan tumor melalui operasi trans-sfenoid pada pasien adenoma hipofisis. Penelitian retrospektif berbasis rekam medik dilakukan pada 50 pasien adenoma hipofisis yang menjalani operasi pengangkatan tumor dengan teknik trans-sfenoid di Departemen Bedah Saraf FKUI-RSUPNCM pada tahun 2018-2019. Proporsi pasien yang menjalani operasi elektif dan dipercepat dibandingkan dengan stratifikasi risiko prabedah menurut tingkat kedaruratan bedah A/B/C/D. Proporsi pasien yang menjalani operasi elektif dan dipercepat adalah 86% dan 14%, sedangkan proporsi tingkat kedaruratan bedah adalah 54% (A), 36% (B), 8% (C), dan 2% (D). Median hari waktu tunggu menuju operasi [min-max] adalah 77,6 (4-549) hari (A); 45,4 (7-258) hari (B); 71 (8-140) hari (C); dan 99 hari (D); tidak terdapat perbedaan bermakna. Terdapat ketidaksesuaian proporsi antara pasien kategori dipercepat/elektif dan tingkat kedaruratan bedah A/B/C/D serta tidak ada perbedaan waktu tunggu menuju operasi pada keempat kelompok risiko operasi A/B/C/D. Diperlukan penelitian lebih lanjut untuk menetapkan manfaat stratifikasi risiko prabedah tumor hipofisis terhadap luaran pasien pasca operasi pengangkatan tumor melalui operasi trans-sfenoid. Determination of Surgical Emergency Levels of Pituitary Adenoma Patients Through Pre-Surgical Stratification at the dr. Cipto Mangunkusumo National Hospital Pituitary adenomas may cause neurological deficits that require prompt management. There is no standard for determining the level of surgical emergencies for pituitary adenomas. The author aims to know the distribution of pituitary adenomas surgically removed through trans-sphenoid surgery. This medical record-based retrospective study was conducted on 50 pituitary adenoma patients who underwent trans-sphenoidal surgery at the Department of Neurosurgery, dr. Cipto Mangunkusumo National Hospital in 2018-2019. The proportion of patients undergoing elective and urgent surgery is compared with pre-surgical risk stratification according to the level of A/B/C/D surgical emergencies. The proportions of patients who underwent elective and urgent surgery were 86% and 14% respectively, while the proportion of surgical emergencies for each group was 54% (A), 36% (B), 8% (C), and 2% (D). The median waiting time to surgery [min-max] for each group is 77.6 (4-549) days (A); 45.4 (7-258) days (B); 71 (8-140) days (C); and 99 days (D); no significant difference were found. There was a large discrepancy in the proportion between patients included in the urgent/elective category and the level of emergency A/B/C/D surgery. Furthermore, there is no difference in waiting time for surgery between the four risk groups for A/B/C/D. Further research is needed to establish the benefits of preoperative risk stratification of pituitary adenoma in terms of patient outcomes after trans-sphenoid surgery.

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