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"Background: graves disease (GD) is the most common condition of thyrotoxicosis. The management of GD is initiated with the administration of antithyroid drugs; however, it requires a long time to achieve remission. In reality more than 50% of patients who had remission may be at risk for relapse after the drug is stopped. This study aimed to evaluate the role of clinical factors such as smoking habit, degree of ophtalmopathy, degree of thyroid enlargement; genetic factors such as CTLA 4 gene on nucleotide 49 at codon 17 of exon 1, CTLA 4 gene of promotor -318, TSHR gene polymorphism rs2268458 of intron 1; and immunological factors such as regulatory T cells (Treg) and thyroid receptor antibody (TRAb); that affecting the relapse of patients with Graves disease in Indonesia. Methods: this was a case control study, that compared 72 subjects who had relapse and 72 subjects without relapse at 12 months after cessation of antithyroid treatment, who met the inclusion criteria. Genetic polymorphism examination was performed using PCR-RFLP. The number of regulatory T cells was counted using flow cytometry analysis and ELISA was used to measure TRAb. The logistic regression was used since the dependent variables were categorical variables. Results: the analysis of this study demonstrated that there was a correlation between relapse of disease and family factors (p=0.008), age at diagnosis (p=0.021), 2nd degree of Graves ophthalmopathy (p=0.001), enlarged thyroid gland, which exceeded the lateral edge of the sternocleidomastoid muscles (p=0.040), duration of remission period (p=0.029), GG genotype of CTLA 4 gene on the nucleotide 49 at codon 17 of exon 1 (p=0.016), CC genotype of TSHR gene on the rs2268458 of intron 1 (p=0.003), the number of regulatory T cells (p=0.001) and TRAb levels (p=0.002). Conclusion: genetic polymorphisms of CTLA 4 gene on the nucleotide 49 at codon 17 of exon 1, TSHR gene SNP rs2268458 of intron 1, number of regulatory T cells and TRAb levels play a role as risk factors for relapse in patients with Graves disease."

"Background: the risk of Non Alcoholic Fatty Liver Disease (NAFLD) is increasing in patients with type 2 diabetes. Prevalence and factors related to the increased risk of NAFLD in diabetic patients in Indonesia has never been studied before. Data regarding the profile of fibrosis in the population has also been unknown. This study aimed to identify the difference on the profile of diabetic patients with and without NAFLD as well as the degree of fibrosis.Methods: the study was conducted using a cross sectional method in type 2 diabetic patients who were treated at the outpatient clinic of endocrinology and metabolic division in Cipto Mangunkusumo Hospital. Sampling was done consecutively. Collected data comprised of age, duration of diabetes, body mass index (BMI), waist circumference, HDL, triglyceride, and HbA1C levels. Abdominal ultrasonography was conducted for all patients to determine the presence of NAFLD. Patients with NAFLD were subsequently underwent transient elastography in order to assess their degree of liver fibrosis. Chi-square or Fishers Exact tests were used for bivariate analysis and logistic regression was used for multivariate analysis.Results: as many as 186 patients were analyzed in the study and 84 patients (45.2%) were demonstrated to have NAFLD. Transient elastography examinations were carried out in 68 patients and 17 patients (25.0%) were found with severe fibrosis. Univariate analysis showed significant differences on BMI (PR=1.878; 95%CI= 1.296 2.721; p<0.001) and waist circumference (PR=2.368; 95%CI= 1.117 5.017; p=0.018) between patients with and without NAFLD. However, the multivariate test showed that BMI was the only factor that had a significance difference between both groups (OR=2.989; 95%CI=1.625-5.499; p<0.001).Conclusion: prevalence of NAFLD among type 2 diabetic patients in Cipto Mangunkusumo Hospital has reached 45.2% and 25.0% among them had severe fibrosis. BMI is the only factor found to be associated with the occurrence of NAFLD."

"ABSTRACTBackground: non alcoholic fatty liver disease (NAFLD) is known to be associated with some metabolic disorders. Recent studies suggested the role of uric acid in NAFLD through oxidative stress and inflammatory process. This study is aimed to evaluate the association between serum uric acid and NAFLD. Methods: a systematic literature review was conducted using Pubmed and Cochrane library. The quality of all studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). All data were analyzed using REVIEW MANAGER 5.3. Results: eleven studies from America and Asia involving 100,275 subjects were included. The pooled adjusted OR for NAFLD was 1.92 (95% CI: 1.66-2.23; p<0.00001). Subgroup analyses were done based on study design, gender, non-diabetic subjects, non-obese subjects. All subgroup analyses showed statistically significant adjusted OR and most of which having low to moderate heterogeneity. Two studies revealed relationship between increased serum uric acid levels and severity of NAFLD. No publication bias was observed. Conclusion: our study demonstrated association between serum uric acid level and NAFLD. This finding brings a new insight of uric acid in clinical practice. Increased in serum uric acid levels might serve as a trigger for physician to screen for NAFLD."

"Organisasi sebagai sebuah sistem yang terbuka akan selalu dipengaruhi oleh lingkungan ekstemal dan lingkungan internal. Karena itu, setiap organisasi hams selalu menyesuaikan diri terhadap kondisi tersebut dan selalu peka terhadap perubahan apa yang sedang terjadi. Perubahan organisasi yang disebabkan akibat pengaruh faktor-faktor internal dan eksternal harus terencana dan dipersiapkan secara bail( dan menyeluruh oleh pihak-pihak terkait.Ladokgi TNI AL R.E.Martadinata merupakan organisasi yang melaksanakan tugas pokok dibidang kesehatan gigi dan mulut dinas pasien TNI AL. Selain itu, Ladokgi TNI AL REM juga memberikan pelayanan kesehatan gigi dan mulut bagi masyarakat umum dalam rangka memperoleh dana tambahan bagi subsudi silang pasien dinas TNI AL. Adanya persaingan saat ini dan masa mendatang menuntut Ladokgi TNI AL untuk menentukan strategi apa yang tepat untuk menghadapi kondisi tersebut. Strategi tersebut kemudian diimplementasikan pada organisasi yaitu pada struktur organisasi Ladokgi yang saat ini masih belum ada kejelasan pengesahan dari pusat. Maka, penelitian ini dilakukan untuk mendapatkan posisi Ladokgi TNI AL REM saat ini dihadapkan berbagai faktor ekstemal dan internal yang mempengaruhi dan strategi untuk menghadapinya.Penelitian dilakukan dengan pendekatan kualitatif menggunakan Matriks TOWS (Treaths - Opportunitiess -- Weaknesses - Strengths) dan Analisis CPM ( Competitive Profile Matrix) dalam sebuah kelompok diskusi atau CDMG ( Conssensus Decision Making Group) yang beranggotakan pars pimpinan Ladokgi TNI AL REM.Hasil Matriks TOWS diperoleh bahwa posisi Ladokgi TNI AL REM herada pada kuadran 4 yaitu Future Quadrant dengan rekomendasi strategi yaitu divesifikasi yang masih terkait, pengembangan pasar, pengembangan produk, integrasi vertikal dan penetrasi pasar.. Hasil analisis CPM, posisi relatif Ladokgi TNI AL REM berada dibawah RSGM UI dan RSGM Trisakti dan diatas RSGM Dr.Moestopo dan Lakesgilut. Kelemahan Ladokgi dibanding RSGM UI dan RSGM Trisakti berada pada pengenalan nama dan lokasi/akses sehingga strateginya lebih menekankan pada faktor kelemahan tersebut.Strategi yang diperoleh selanjutnya diimpelementasi kedalam struktur organisasi sebagai usulan rancangan perubahan struktur Ladokgi TNI AL REM yang meliputi pembentukan RSGM sebagai strategi divesifikasi; penambahan bagian pemasaran pads struktur sebagai strategi penetrasi pasar, pengembangan pasar dan produk ; pembentukan klinik gigi satelit untuk mempermudah akses ke Ladokgi TNI AL REM sekaligus sebagai sarana pengenalan nama, integrasi, pengembangan pasar dan produk.Dari penelitian ini disarankan Ladokgi TNI AL REM meninjau ulang usulan struktur organisasi untuk disesuaikan dengan strategi, memanfaatkan kekuatan pada pembagian kerja dan fasilitas yang dimiliki serta dukungan anggaran pemerintah untuk meraih peluang banyaknya pangsa pasar dan melakukan evaluasi 1 audit internal terus menerus terhadap kinerja dan mutu pelayanan untuk mengatasi ancaman persaingan dan tuntutan masyarakat akan mutu pelayanan kesehatan gigi dan mulut.

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Organization as an open system will always he influenced by internal and external environment. As a consequence, every organization has to adapt and be sensitive to this condition. Organizational change as a result of influence internal and external factors have to be planned and prepared well and throughout by related parties.

The Institute of Dentistry R.E.Martadinata at Indonesian Navy (Ladokgi TNI AL RE.Martadinata) is an organization that provide oral and dental health care for members of the Indonesian Navy and their families. Also, Ladokgi TNI AL REM gives public services to obtain additional fund to subsidize internal patient. For present and future period, competition of oral and dental health care providers force Ladokgi TNI AL REM to determine strategy to face the competition. The Strategy will be implemented to organization in structure Ladokgi which there is no clarity until this time. So, this research has been done to get position of Ladokgi TM AL REM with various external and internal factors and what is the strategy.

The research has been done according to qualitative with TOWS ( Treaths - Opportunities - Weaknesses - Strengths ) Matrix and CPM (Competitive Profile Matrix) analysis in a discussion group or CDMG ( Conssensus Decision Making Group) from all member head of Ladokgi TNI AL REM.

The result of TOWS Matrix is Ladokgi TM AL REM position at kuadran 4, Future Quadrant. Rekomendations of strategic in Future Quadrant are consentric diversification, market and product development, integration and market penetration. The result of CPM analysis is position relative Ladokgi TNI AL REM under RSGM UI and RSGM Trisakti and above RSGM Dr. Moestopo and Lakesgilut. The Weaknesses of Ladokgi TNI AL REM compared to RSGM UI and RSGM Trisakti at name recognition and location or acces. So, its strategy more is emphasizing at weaknesses factor.

Implementation strategy to structure as a recommendation of design changing structure organization Ladokgi TNI AL REM. It consists are making of RSGM as strategy of diversification ; marketing division as strategy market penetration, market and product development ; satellite clinic as acces to Ladokgi and also as strategy of market and product development and name recognition.

This research suggests that Ladokgi TNI AL REM has to evaluate its organizational structure to adapt with the strategy, use the strength aspects in division of labor, their facilities and use government support budget to reach opportunities in the market, to internally audit of service quality and performance continuously to increase the number of consumer."