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"Latar Belakang: Penyakit Graves paling banyak diderita anak hipertiroid dengan akibat tumbuh kembang anak terganggu. Metode pengobatan optimal hipertiroid Graves saat ini masih dalam perdebatan. ATD masih digunakan oleh sebagian besar tenaga kesehatan. Relaps dengan ATD dapat mencapai 83% dengan pengobatan ATD. Pengalihan metode terapi salah satunya berdasarkan relaps. Pengalihan terapi saat awal dari ATD ke metode pengobatan lain pada anak yang diprediksi relaps akan menghemat waktu dan biaya serta meningkatkan potensi tumbuh kembang anak. Tujuan: Mengetahui insidens relaps hipertiroid Graves anak dan hubungannya terhadap kadar awal FT4 serta karakteristik usia dan jenis kelamin penderita. Metode: Penelitian bersifat kohort retrospektif dengan menelusuri data rekam medis pasien berusia 1-18 tahun mulai Januari 2000 hingga Juni 2013 di RS Cipto Mangunkusumo, RS Hermina Jatinegara, Bekasi dan Podomoro. Data ditabulasi untuk mendapatkan insiden relaps, median kadar awal FT4, median usia dan jenis kelamin penderita relaps. Analisis statistik dilakukan untuk mencari pengaruh kadar awal FT4 terhadap insiden relaps. Hasil: Penelitian dilakukan terhadap 25 subjek dengan 12 anak mengalami relaps. Kadar awal FT4 terhadap insiden relaps ditemukan tidak bermakna secara statistik (p=0,64) namun kelompok relaps cenderung memiliki kadar awal FT4 lebih tinggi. Relaps dialami lebih banyak oleh anak perempuan (3:1) dengan median usia 10,9 tahun. Penelitian ini mendapatkan hasil lain yaitu durasi eutiroid berbeda bermakna terhadap insiden relaps (p=0,002). Simpulan: Insiden relaps hipertiroid Graves anak 12/25 dengan kadar awal FT4 tidak bermakna secara statistik walau terdapat kecenderungan kadar awal FT4 lebih tinggi pada kelompok relaps. Relaps lebih banyak dialami anak perempuan (3:1) dengan median usia 10,9 tahun.

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Background: Graves disease is most common causes in children with hyperthyroidism which affect growth and development. Optimal initial treatment method of hyperthyroid Graves in children is still under debate. Anti-thyroid drug (ATD) is still used as the initial treatment by the majority of health workers. Relapse can reach 83% with ATD treatment; and relapse is one of the causes to adjust therapeutic method. Alteration of initial ATD therapy to other treatment methods, in children who predicted relapse, will save time and costs as well as potentiate children’s growth and development.

Aim: To investigate the incidence of Graves hyperthyroidism relapse and its relationship to the initial FT4 levels, as well as age and gender characteristics of patients.

Method: This study is a retrospective cohort by investigate medical records of patients aged 1-18 years from January 2000 to June 2013 at Cipto Mangunkusumo hospital, Hermina Jatinegara Bekasi and Podomoro Hospital. Data were tabulated to obtain the incidence of relapse, the median of initial FT4 levels, the median of age, and sex of relapse patient. Statistical analysis was performed to find the effect of initial FT4 levels on the incidence of relapse.

Result: The study was conducted on 25 subjects with 12 children experienced a relapse. Initial FT4 levels of relapse patients was found statistically insignificant (p=0,64), but the relapse group tended to have higher levels of initial FT4. Relapse is predominant in girls (3:1), with median age of 10.9 years. This study found that duration of euthyroid differ significantly in the incidence of relapse (p=0,002).

Conclusion: The incidence of hyperthyroid Graves relapse in children is 12/25 with inital FT4 levels were not statistically significant although there was tendency initial FT4 levels were higher in relapse group. Girls experienced more relapses (3:1) with median age of 10.9 years."

"[ABSTRAKLatar Belakang: Kusta merupakan penyakit infeksi penyebab neuropati perifer paling sering. Neuropati otonom merupakan salah satu neuropati perifer yang perlu dideteksi dini dengan pemeriksaan sederhana untuk mencegah kecacatan lebih lanjut karena memiliki gejala subklinis. Tujuan: Menguji sensitivitas dan spesifisitas pemeriksaan Stimulated Skin Wrinkle (SSW) terhadap Sudoscan dalam mendeteksi neuropati otonom pada kusta multibasiler. Metode penelitian: Penelitian menggunakan uji diagnostik pemeriksaan SSW terhadap Sudoscan pada penderita kusta multibasiler yang telah didiagnosis di poliklinik Kulit dan Kelamin RS Cipto Mangunkusumo, Jakarta. Penelitian dilakukan selama tiga bulan (Maret-Mei 2015). Anamnesis, pemeriksaan fisik, SSW dengan krim Eutectic mixture of local anesthetic (EMLA), dan Sudoscan dilakukan pada setiap subjek penelitian. Hasil dianalisis untuk mendapatkan nilai sensitivitas dan spesifisitas. Hasil: Diperoleh 70 subyek penelitian. Prevalensi gangguan otonom berdasarkan pemeriksaan SSW, Sudoscan dan klinis berturut-turut sebesar 64.3%, 32.9% dan 85.7%. Berdasarkan kurva ROC pemeriksaan SSW terhadap Sudoscan, didapatkan nilai AUC sebesar 0,779. Setelah diuji dengan tabel 2x2 didapatkan nilai sensitivitas 95.7%, spesifisitas 51.1%, nilai prediksi positif 48.9% dan nilai prediksi negatif 96%. Kesimpulan: Pemeriksaan SSW dapat menjadi pemeriksaan penyaring yang sederhana dalam mendeteksi neuropati otonom pada kusta tipe multibasiler, dengan sensitivitas yang tinggi.

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ABSTRACTBackground: Leprosy is the commonest infectious disease causes peripheral neuropathy. Autonomic neuropathy is a peripheral neuropathy that is important to detect with a simple examination to prevent further disability because the subclinical manifestation. Objective: Examine the sensitivity and specificity of Stimulated Skin Wrinkle (SSW) examination against Sudoscan to detect autonomic neuropathy in multibacillary leprosy. Method: The study consists of diagnostic test of SSW examination upon Sudoscan among multibacillary leprosy patients previously diagnosed in the Dermatology & Venerealogy Clinic in Cipto Mangunkusumo Hospital, Jakarta. The study was conducted in three months (March-May 2015). History, physical examination, SSW with Eutectic mixture of local anesthetic (EMLA) cream, and Sudoscan was performed upon every subject. Results are analyzed to obtain sensitivity and specificity level. Results: There are 70 subjects participated. Prevalence of autonomic disturbance by SSW, Sudoscan and clinical are 64.3%, 32.9% and 85.7% respectively. Based on ROC curve of the SSW examination against Sudoscan, the obtained AUC value is 0.779. After testing with chi-square, the following values were obtained: sensitivity 95.7%, specificity 51.1%, positive predictive value 48.9%, and negative predictive value 96%. Conclusion: SSW examination is a simple screening test that can detect autonomic neuropathy among multibacillary leprosy, with high sensitivity.;Background: Leprosy is the commonest infectious disease causes peripheral neuropathy. Autonomic neuropathy is a peripheral neuropathy that is important to detect with a simple examination to prevent further disability because the subclinical manifestation. Objective: Examine the sensitivity and specificity of Stimulated Skin Wrinkle (SSW) examination against Sudoscan to detect autonomic neuropathy in multibacillary leprosy. Method: The study consists of diagnostic test of SSW examination upon Sudoscan among multibacillary leprosy patients previously diagnosed in the Dermatology & Venerealogy Clinic in Cipto Mangunkusumo Hospital, Jakarta. The study was conducted in three months (March-May 2015). History, physical examination, SSW with Eutectic mixture of local anesthetic (EMLA) cream, and Sudoscan was performed upon every subject. Results are analyzed to obtain sensitivity and specificity level. Results: There are 70 subjects participated. Prevalence of autonomic disturbance by SSW, Sudoscan and clinical are 64.3%, 32.9% and 85.7% respectively. Based on ROC curve of the SSW examination against Sudoscan, the obtained AUC value is 0.779. After testing with chi-square, the following values were obtained: sensitivity 95.7%, specificity 51.1%, positive predictive value 48.9%, and negative predictive value 96%. Conclusion: SSW examination is a simple screening test that can detect autonomic neuropathy among multibacillary leprosy, with high sensitivity., Background: Leprosy is the commonest infectious disease causes peripheral neuropathy. Autonomic neuropathy is a peripheral neuropathy that is important to detect with a simple examination to prevent further disability because the subclinical manifestation. Objective: Examine the sensitivity and specificity of Stimulated Skin Wrinkle (SSW) examination against Sudoscan to detect autonomic neuropathy in multibacillary leprosy. Method: The study consists of diagnostic test of SSW examination upon Sudoscan among multibacillary leprosy patients previously diagnosed in the Dermatology & Venerealogy Clinic in Cipto Mangunkusumo Hospital, Jakarta. The study was conducted in three months (March-May 2015). History, physical examination, SSW with Eutectic mixture of local anesthetic (EMLA) cream, and Sudoscan was performed upon every subject. Results are analyzed to obtain sensitivity and specificity level. Results: There are 70 subjects participated. Prevalence of autonomic disturbance by SSW, Sudoscan and clinical are 64.3%, 32.9% and 85.7% respectively. Based on ROC curve of the SSW examination against Sudoscan, the obtained AUC value is 0.779. After testing with chi-square, the following values were obtained: sensitivity 95.7%, specificity 51.1%, positive predictive value 48.9%, and negative predictive value 96%. Conclusion: SSW examination is a simple screening test that can detect autonomic neuropathy among multibacillary leprosy, with high sensitivity.]"

"Latar Belakang: Dosen, tenaga kependidikan, dan staf lainnya di perguruan tinggi seringkali menghadapi beban kerja yang besar dalam melaksanakan pekerjaannya. Beban kerja yang besar dapat mengarah ke pengabaian perilaku sehat seperti istirahat yang cukup, olahraga, makan teratur, dan pengelolaan stress. Kebiasaan kurang sehat tersebut dapat menyebabkan gangguan keseimbangan otonom sebagai regulator fungsi organ internal yang kemudian mengarah ke kondisi patologis seperti gangguan metabolik, salah satunya pada regulasi glukosa darah.  Studi ini mengeksplorasi hubungan antara status fungsional sistem saraf otonom berdasarkan Index of Regulation System Activity (IRSA) sebagai salah satu alat ukur status fungsional sistem saraf otonom yang praktis digunakan dan faktor-faktor lainnya terhadap glukosa darah puasa pada pegawai perguruan tinggi sehingga dapat menyajikan pendekatan baru dalam mendeteksi risiko gangguan metabolisme glukosa. Metode: Penelitian ini menggunakan desain observasional potong lintang pada karyawan Fakultas X, Universitas Y. Pengambilan data melibatkan pengukuran IRSA dan profil glukosa darah dari data sekunder pemeriksaan kesehatan tahun 2022. Analisis statistik menggunakan metode univariat, bivariat, dan multivariat untuk menilai hubungan antara variabel studi. Hasil: Hasil pemeriksaan IRSA didapatkan sebanyak 151 pegawai (67,4%) memiliki status fungsional kondisi prenosologis-premorbid, 48 pegawai (21,4%) pada status fungsional fisiologis normal, dan 25 pegawai (11,2%) pada status fungsional kegagalan adaptasi. Pada pemeriksaan glukosa darah puasa, didapatkan 36 pegawai (16,1%) memiliki glukosa darah puasa ≥ 100 mg/dL. Status fungsional kegagalan adaptasi (p=0,001; OR=26,43; 95% CI = 3,10-225,25) dan juga status fungsional prenosologis-premorbid (p=0,001 OR=9,78; 95% CI = 1,29-74,08) memiliki hubungan yang bermakna dengan glukosa darah puasa. Kesimpulan: Pekerja  dengan IRSA abnormal memiliki kecenderungan lebih besar memiliki glukosa darah puasa ≥ 100 mg/dL jika dibandingkan dengan pegawai dengan status fungsional IRSA fisiologis normal. Diperlukan tidak lanjut dari hasil pemeriksaan kesehatan secara berkesinambungan dan holistik baik untuk individu maupun kelompok yang disesuaikan dengan karakteristik dan resiko sasaran demi kesehatan serta produktivitas pekerja.

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Background: Faculty members, educational staff, and other university personnel often face significant workloads in performing their duties. Work overload can lead to unhealthy behaviors and stress which can disturb the autonomic balance. These unhealthy habits can disturb the autonomic balance leading to pathological conditions such as metabolic disorders, including blood glucose metabolism. This study aims to find the relationship between the functional status of the autonomic nervous system based on the Index of Regulation System Activity (IRSA) to fasting blood glucose (FBG) levels in university employees. Method: This observational cross-sectional study used the secondary data of university employees medical checkups (MCU) in 2022 with total sample of 242 people. Variables included were IRSA from Heart Rate Variability (HRV) examination, FBG level, and other sociodemographic profiles. The MCU was conducted in the university hospital. Results: The examination results of IRSA indicated that 151 employees (67.4%) had a prenosologic-premorbid functional status and 25 employees (11.2%) had a failure of adaptation functional status. FBG examination revealed that 36 employees (16.1%) had FBG levels of ≥ 100 mg/dl. Failure of adaptation functional status had a significant relationship with FBG (p=0.003; OR=26.43; 95% CI = 3.10-225.25), as well as prenosological-premorbid functional status (p=0.03; OR=9.78; 95% CI = 1.29-74.08). Conclusion: Employees with abnormal IRSA were more likely to have FBG levels ≥ 100 mg/dL compared to those with normal physiological functional status. Ongoing and holistic monitoring of health examination outcomes is essential, catered to the specific characteristics and risk profiles of both individual and group targets, aiming to maintain and enhance worker health and productivity."

"Beban kompleks ventrikel prematur (KVP) memiliki tiga jenis ritme sirkadian, yaitu tipe cepat, tipe lambat, dan tipe independen. Nukleus suprakiasmatikus merupakan bagian dari hipotalamus dan berperan sebagai pusat yang mengatur ritme sirkadian tubuh. Nukleus suprakiasmatikus berhubungan dengan sumbu hipotalamus-pituitari-adrenal (HPA), sistem saraf autonom, dan aspek psikologis. Hubungan ketiga sistem ini dengan ritme sirkadian beban KVP belum diketahui. Oleh karena itu, perlu dilakukan penelitian untuk menganalisis hubungan sumbu HPA, sistem saraf autonom, dan aspek psikologis dengan ritme sirkadian beban KVP. Studi observasional potong lintang ini merekrut subjek penelitian di RS Jantung dan Pembuluh Darah Harapan Kita, RSUD Pakuhaji, dan RS Bun. Waktu penelitian adalah dari Juli 2022 sampai Desember 2022. Kriteria inklusi adalah pasien KVP idiopatik dengan beban ≥ 5%. Sebanyak 23 subjek KVP tipe-cepat, 20 subjek KVP tipe-lambat, 22 pasien KVP tipe-independen, dan 5 subjek kontrol diikutsertakan pada penelitian. Setiap subjek menjalani pemeriksaan Holter 24 jam untuk evaluasi beban KVP dan heart rate variability, mengumpulkan saliva untuk pemeriksaan kortisol dan norepinefrin pada pukul 06:00–07:00, 10:00–11:00, dan 22:00–23:00, serta mencatat skala kesehatan subjektif. Selanjutnya, dilakukan analisis univariat dan regresi linier multipel untuk menganalisis hubungan antara ritme sirkadian variabel independen dan ritme sirkadian beban KVP. Hasil pemeriksaan Holter menunjukkan bahwa rerata beban KVP idiopatik tipe-cepat adalah 15,7%; tipe-lambat 8,4%; dan tipe-independen 13,6%. Regresi liner multipel menunjukkan bahwa tingginya beban KVP idiopatik-tipe-cepat berhubungan dengan kadar kortisol yang lebih tinggi dan tonus sistem saraf parasimpatis yang lebih rendah. Di samping itu, tingginya beban KVP idiopatik-tipe-lambat berkaitan dengan kadar kortisol dan tonus sistem saraf simpatis yang lebih rendah atau tonus sistem saraf parasimpatis yang lebih tinggi. Sementara itu, pada KVP idiopatik-tipe-independen tingginya beban KVP berhubungan dengan kadar kortisol dan tonus sistem saraf simpatis yang lebih tinggi atau tonus sistem saraf parasimpatis yang lebih rendah serta skala kesehatan subjektif yang lebih rendah. Disimpulkan bahwa pola sirkadian beban KVP idiopatik tipe cepat, lambat, dan independen masing-masing berhubungan secara khas dengan sumbu HPA, sistem saraf autonom dan mekanisme psikologis. Penilaian tipe ritme sirkadian KVP idiopatik perlu dilakukan secara rutin mengingat perbedaan mekanisme yang mendasarinya dan kemungkinan perbedaan pada prognosisnya.

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Recent data show that premature ventricular complex (PVC) burden exhibits one of the three circadian patterns, namely fast-type, slow-type, and independent-type PVC. The suprachiasmatic nucleus is part of the hypothalamus and serves as the center of circadian rhythm regulation. The suprachiasmatic nucleus is related to the hypothalamus-pituitary-adrenal (HPA) axis, the autonomic nervous system, and psychological aspects. The relationship between these three systems and the circadian rhythm of PVC is unknown. Therefore, it is important to evaluate the relationship between the HPA axis, the autonomic nervous system, and psychological aspects with the circadian rhythm of PVC burden. This cross-sectional observational study recruited 23 fast-, 20 slow-, and 22 independent-type idiopathic PVC subjects, as well as 5 control subjects. Each subject underwent a 24-hour Holter to examine PVC burden and heart rate variability, collected saliva for cortisol and norepinephrine level measurement at 6–7 am, 10–11 am, and 10–11 pm, and recorded their self-rated health scales. Furthermore, univariate and multiple linear regression were conducted to investigate the associations between circadian rhythms of the independent variables and circadian rhythms of PVC burden. The results of the Holter monitor showed that the average PVC burden was 15.7%, 8.4%, and 13.6% respectively in fast-, slow-, and independent-type idiopathic PVCs. Multiple linear regression showed that the high burden of fast-type idiopathic PVC was assosciated with higher cortisol levels and lower parasympathetic nervous system tone. On the other hand, the high burden of slow-type idiopathic PVC was associated with lower cortisol levels and lower sympathetic nervous system tone. Meanwhile, in independent-type idiopathic PVC, the high burden was associated with higher cortisol levels and sympathetic nervous system tone as well as lower self-rated health scales. The results of this study indicate that each circadian pattern of idiopathic PVC burden is uniquely related to the HPA axis, the autonomic nervous system and psychological mechanisms. Assessment of idiopathic PVC circadian rhythm types needs to be carried out routinely considering the differences in the underlying mechanisms and the possible differences in the prognosis."

"Penggunaan komputer atau Visual Display Terminal VDT bertujuan meningkatkan efisiensi dan efektifitas kerja, disisi lain peningkatan intensitas pekerja dengan komputer dapat berpengaruh pada kesehatan antara lain menimbulkan stres kerja. Penelitian ini bertujuan dibuktikannya perbedaan stres kerja dengan gangguan otonom pada pegawai pengguna VDT dan non pengguna VDT di Instansi Pemerintah.Penelitian ini menggunakan desain comparative cross sectional dengan 224 orang responden yang dipilih melalui cluster random sampling. Pengukuran stres kerja dengan gangguan otonom menggunakan kuesioner Survey Diagnostic Stress SDS dan pengukuran Heart Rate Variability HRV . SDS digunakan untuk mendiagnosis stres kerja sedangkan HRV digunakan untuk mendiagnosis gangguan otonom. Dari 224 responden didapatkan prevalensi stres kerja dengan gangguan otonom pada pengguna VDT yaitu 19,1 dan prevalensi stres kerja dengan gangguan otonom pada non pengguna VDT yaitu 7,3 . Pengguna VDT mempunyai risiko lebih tinggi 2,99 kali untuk mengalami terjadinya stres kerja dengan gangguan otonom dibandingkan dengan non pengguna VDT OR = 2,99; 95 CI=1,27 ndash; 7,04 . Faktor faktor determinan yang berhubungan bermakna dengan stres kerja dengan gangguan otonom yaitu konflik peran p = 0,017; OR.adj = 3,96;95 CI = 1,28 -12,30 , tanggung jawab personal p = 0,022; OR.adj = 3,79; 95 CI = 1,28 -11,82 dan pengguna VDT p = 0,027; OR.adj = 2,37; 95 CI = 1,12 - 6,66 . Pegawai pada Instansi Pemerintah yang bekerja menggunakan VDT memiliki risiko lebih tinggi untuk mengalami stres kerja dengan gangguan otonom dibandingkan pegawai non pengguna VDT.

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The use of computer or Visual Display Terminal VDT is aimed at improving working efficiency and effectiveness, however, the increasing use of computer among workers can also affects their health, one of which is causing job stress. This study is aimed at proving the difference between job stress with autonomic disorder among VDT users and non VDT users at Central Goverment Institutions.This study used a comparative cross sectional design with 224 respondents selected through cluster random sampling. Job stress with autonomic disorder is measured by Stress Diagnostic Survey SDS questionnaire and Heart Rate Variability HRV . SDS is used to diagnose job stres while HRV is used to diagnose autonomic disorder. Out of the 224 respondents, the prevalence of job stress with autonomic disorder among VDT users is 19.1 and prevalence of job stress with autonomic disorder among non VDT users is 7.3 . VDT users have a higher risk 2.99 times to experience job stress with autonomic disorder compared to the non VDT users OR 2.99 95 CI 1.27 ndash 7.04. Determinant factors which have significant correlation with job stress with autonomic disorder are role conflict p 0.017 OR.adj 3.96 95 CI 1.28 12.30 , personel responsibility p 0.022 OR.adj 3.79 95 CI 1.28 11.82 and VDT users p 0.027 OR.adj 2.37 95 CI 1.12 ndash 6.66 .Workers at Government Institutions working with VDT have a higher risk to experience job stress with autonomic disorder compared to the non VDT users. Keywords Job stres with autonomic disorder VDT Survey Diagnostic Stres Heart Rate Variability."

"Otitis media supuratif kronik (OMSK) merupakan salah satu gangguan telinga yang sering menimpa anak dan dapat menyebabkan gangguan pendengaran dan penurunan kualitas hidup, serta banyak komplikasi. Kondisi yang terkait dengan OMSK di antaranya alergi, hipertrofi adenoid, dan refluks laringofaring (RLF). Refluks laringofaring pada anak belum banyak dipelajari di Indonesia, dan diagnosis RLF berdasarkan Instrumen Tanda dan Gejala Refluks belum banyak dipelajari. Kejadian RLF juga dikaitkan dengan gangguan saraf autonom, akibat gangguan nervus vagus yang dapat menyebabkan refluksat lambung naik ke nasofaring dan mencapai muara tuba.Penelitian ini bertujuan untuk mengetahui hubungan RLF dengan OMSK tipe aman aktif yang dibahas desain 1 penelitian, yaitu studi kasus kontrol yang menganalisis alergi, hipertrofi adenoid, dan RLF sebagai faktor risiko OMSK tipe aman aktif. Desain kedua penelitian adalah studi kasus kontrol untuk mengetahui hubungan gangguan saraf autonom dengan kejadian RLF. Desain ketiga penelitian merupakan kohort retrospektif untuk mengetahui hubungan RLF dengan gangguan fungsi tuba. Penelitian dilaksanakan Mei 2023–Juni 2024, menyertakan 39 subjek OMSK tipe aman aktif dan 39 subjek kontrol dari pasien Poliklinik THT-KL RSCM, dan direkrut secara consecutive sampling. Subjek juga akan diperiksa kondisi RLF dan gangguan saraf autonom.Hasil penelitian menunjukkan bahwa anak dengan RLF terbukti berisiko 5,59x lebih tinggi untuk terkena OMSK tipe aman aktif (OR: 5,59; 95%CI: 1,247–25,049; p = 0,025). Alergi (OR: 1,433; 95%CI: 0,343–5,981; p = 0,622) dan hipertrofi adenoid (OR: 1,178; 95%CI: 0,584–2,378; p = 0,646) tidak terbukti bermakna secara statistik sebagai faktor risiko OMSK tipe aman aktif. Gangguan saraf autonom juga belum terbukti secara statistik sebagai faktor risiko RLF (OR: 1,086; 95%CI: 0,444– 2,650; p = 0,856). Refluks laringofaring juga tidak terbukti menjadi faktor risiko gangguan fungsi tuba (RR: 1,558; 95%CI: 0,594–4,087; p = 0,367). Dapat disimpulkan bahwa RLF merupakan faktor risiko utama OMSK tipe aman aktif pada anak. Pepsin dan derajat keasaman dari refluksat RLF pada telinga tengah dapat berperan dalam kerusakan telinga tengah.

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Chronic suppurative otitis media (CSOM) is a prevalent ear disorder in children that can lead to hearing impairment, a decline in quality of life, and various complications. Conditions associated with CSOM include allergy, adenoid hypertrophy, and laryngopharyngeal reflux (LPR). The incidence of LPR in children has not been extensively studied in Indonesia, and diagnosis of LPR based on Reflux Symptom and Sign Instrument is yet to be studied. LPR has also been linked to autonomic nervous system dysfunction, as disturbances in the vagus nerve can result in the reflux of gastric contents into the nasopharynx and the opening of the Eustachian tube.

This study aims to investigate the relationship between LPR and active benign type CSOM with the first design being a case-control study that analyzes allergy, adenoid hypertrophy, and LPR as risk factors for active benign type CSOM. The second design, also a case-control study, is to determine the association between autonomic nervous system dysfunction and the occurrence of LPR. The third study design employs a retrospective cohort study to assess the relationship between LPR and Eustachian tube function disorders. The research is conducted from May 2023 to June 2024, including 39 subjects with active benign type CSOM and 39 control subjects from the ENT-HN Polyclinic of RSCM, recruited through consecutive sampling. Subjects will also be evaluated for the presence of LPR and autonomic nervous system dysfunction.

The results indicated that children with LPR were at a 5.59-fold increased risk of developing active safe type CSOM (OR: 5.59; 95% CI: 1.247–25.049; p = 0.025). Allergy (OR: 1.433; 95% CI: 0.343–5.981; p = 0.622) and adenoid hypertrophy (OR: 1.178; 95% CI: 0.584–2.378; p = 0.646) were not found to be statistically significant risk factors for active safe type CSOM. Additionally, autonomic nervous system dysfunction did not show statistical significance as a risk factor for LPR (OR: 1.086; 95% CI: 0.444–2.650; p = 0.856). LPR also did not appear to be a risk factor for Eustachian tube dysfunction (RR: 1.558; 95% CI: 0.594–4.087; p = 0.367). It can be concluded that LPR is a primary risk factor for active safe type CSOM in children. The presence of pepsin and the acidity level of the LPR refluxate in the middle ear may contribute to middle ear damage."

"Hipertiroidisme adalah suatu kondisi di mana kelenjar tiroid menghasilkan terlalu banyak hormon tiroid sehingga metabolisme menjadi lebih cepat dan menimbulkan berbagai gejala seperti penurunan berat badan, palpitasi, dan kecemasan. Metimazol (MMI) dan propiltiourasil (PTU) adalah dua obat yang umum digunakan dalam pengobatan hipertiroidisme. Tujuan dari penelitian ini adalah untuk menganalisis efektivitas-biaya MMI dibandingkan dengan PTU pada pasien hipertiroid rawat jalan di Rumah Sakit Umum Pusat Fatmawati pada tahun 2017–2022. Penelitian observasional ini menggunakan desain studi cross-sectional dengan teknik pengambilan data secara retrospektif. Pasien yang memenuhi kriteria inklusi berjumlah 140 pasien dan dibagi menjadi dua kelompok, yaitu 70 pasien menggunakan terapi metimazol dan 70 pasien menggunakan terapi propiltiourasil. Terapi dinyatakan efektif jika pasien memperoleh kadar T4 bebas (fT4) normal, yaitu < 1,76 ng/dL setelah menggunakan terapi selama 3 bulan. Terdapat perbedaan yang bermakna antara efektivitas MMI dan PTU, yakni 77,1% dan 60% (p = 0,045). Komponen biaya yang digunakan adalah total biaya langsung medis. Nilai Rasio Inkremental Efektivitas-Biaya (RIEB) yang diperoleh adalah Rp15.516/% efektivitas, yang artinya dibutuhkan tambahan biaya sebesar Rp15.516 untuk setiap peningkatan 1% pasien hipertiroid yang mencapai kadar fT4 normal jika ingin berpindah dari terapi propiltiourasil ke metimazol.

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Hyperthyroidism is a condition in which the thyroid gland produces an excessive amount of thyroid hormones, leading to an accelerated metabolism and various symptoms such as weight loss, palpitations, and anxiety. Methimazole (MMI) and propylthiouracil (PTU) are two commonly used drugs in the treatment of hyperthyroidism. The aim of this study was to analyze the cost-effectiveness of MMI compared to PTU in outpatient hyperthyroid patients at Fatmawati General Hospital from 2017 to 2022. This observational study employed a cross-sectional design with data collected retrospectively. A total of 140 patients who met the inclusion criteria were divided into two groups: 70 patients receiving methimazole therapy and 70 patients receiving propylthiouracil therapy. Therapy was considered effective if patients achieved a normal free T4 (fT4) level, i.e., < 1.76 ng/dL, after three months of treatment. There was a significant difference in effectiveness between MMI and PTU, namely 77.1% and 60% (p = 0.045), respectively. The cost components considered were the total direct medical costs. The calculated Incremental Cost-Effectiveness Ratio (ICER) was Rp15,516/% effectiveness, indicating that an additional cost of Rp15,516 was required to achieve a 1% increase in hyperthyroid patients who achieved normal fT4 levels when switching from propylthiouracil to methimazole therapy."

"Hipertiroidisme merupakan salah satu masalah kesehatan yang sering terjadi di area perkotaan. Salah satu jenis pengobatan hipertiroidisme adalah dengan tindakan pembedahan yang berpotensi menimbulkan gejala ketidaknyamanan leher. Tujuan penulisan ini adalah untuk menjelaskan konsep dasar keperawatan kesehatan masyarakat perkotaan khususnya penyakit hipertiroid, menerapkan asuhan keperawatan dari pengkajian sampai evaluasi pada pasien dengan hipertiroid pasca tiroidektomi, dan menganalisis evidence-based practice yang sudah dilakukan. Hasil penerapan evidence-based practice berupa latihan peregangan leher pada pasien pasca tiroidektomi terbukti efektif dalam mengurangi gejala ketidaknyamanan leher pasca pembedahan. Rekomendasi penulisan ini ialah agar perawat perlu mengajarkan latihan peregangan leher pada pasien pasca tiroidektomi untuk mengurangi gejala ketidaknyamanan leher.

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Hyperthyroidism is one of the health problems that often occur in urban areas. One of the treatments of hyperthyroidism is a surgery that potentially cause symptoms of neck discomfort. This paper aimed to explain the basic concepts of public health nursing in particular urban with hyperthyroid, to implement nursing care from assessment to evaluation in patients who had undergone thyroid surgery, and analyze evidence-based practice that has been done. The results of evidence-based practice application of neck stretching exercises in patients who had undergone thyroid surgery had effectively reduced postoperative neck symptoms discomfort after thyroid surgery. Recommendation of this paper is that nurses need to teach stretching exercises in patients with post thyroidectomy to reduce neck discomfort symptoms"

"Penyakit Graves merupakan penyakit autoimun pada kelenjar tiroid dengan manifestasi berbagai sistem organ, termasuk sistem kardiovaskular akibat hipertiroid. Pada pasien hipertiroid terjadi peningkatan fungsi sistolik ventrikel kiri dibandingkan populasi normal. Beberapa penelitian tentang kadar hormon tiroid mendapatkan hasil yang berbeda-beda. Hipotesis pada penelitian ini adalah peningkatan kadar hormon tiroid akan diikuti peningkatan fungsi ventrikel kiri.TujuanDiketahui korelasi kadar tiroksin bebas dan fraksi ejeksi ventrikel kiri pada pasien Graves yang belum diobati.MetodePada penelitian potong lintang ini digunakan kadar tiroksin bebas sebagai parameter hormon tiroid dan fraksi ejeksi ventrikel kiri (LVEF) menurut cara Simpson yang dimodifikasi dengan ekokardiografi sebagai parameter fungsi sistolik ventrikel kiri. Kadar tiroksin bebas diperiksa di laboratorium sedangkan fraksi ejeksi ventrikel kiri cara Simpson dinilai dengan alat ekokardiografi.HasilDidapatkan 10 pasien, 7 laki-laki dan 3 perempuan, dengan usia 18-52 tahun. Lama gejala dirasakan pasien 2-12 bulan. Pada pasien didapatkan rerata kadar fT4 5,75 (SB 0,96) ngldL dan rerata fraksi ejeksi ventrikel kiri 70,57 (SB 4,50) %. Didapatkan koefisien korelasi positif antara kadar tiroksin bebas dan fraksi ejeksi ventrikel kiri (r=0,711, p=0,021) pada pasien Graves yang belum diobatiKesimpulanPada penelitian ini didapatkan korelasi positif kuat antara kadar tiroksin bebas (fT4) dan fraksi ejeksi ventrikel kiri (LVEF) pada pasien Grave yang belum mendapat pengobatan.

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Graves' disease is an autoimmune disease of thyroid gland which can be manifested in many organ system, especially cardiovascular system due to hyperthyroid. Hyperthyroid patients have a higher left ventricular systolic function than normal. Several studies of correlation between thyroid hormone level and cardiac function have showed different results. The hypotesis tested in this study is the increasing thyroid level will followed by the increase of left ventricular systolic function in Graves' disease.

Objective

To determine the correlation between thyroid hormone level and left ventricular ejection fraction in newly diagnosed Graves' patients.

Methods

In this cross-sectional study, we use the free thyrosine level as a parameter of thyroid hormon and use left ventricular ejection fraction as a parameter of left ventricular systolic function. Free thyroxine level was measured in the laboratory and the LVEF were assessed by Simpson's methods of echocardiography study.

Results

Ten patients (7 men and 3 women; age 18-52 years old) were studied. Their average of ff4 was 5.75 (SD 0.96) ngldL and their average of LVEF was 70.57 (SD 4.50) %. There was positive correlation coefficient between free thyroxine level and left ventricular ejection fraction (r=0.711, p=0.021) in newly diagnosed Graves' patients.

Conclusion

In this study there was strong positive correlation between free thyroxine (fT4) and left ventricular ejection fraction (LVEF) in newly diagnosed Graves' patients."

"Penelitian analisis kadar merkuri dalam rambut dengan gangguan fungsi sistem saraf pusat bagi pekerja pertambangan emas, dilakukan untuk dapat memberikan referensi terkait dampak penggunaan merkuri dan penanggulangannya bagi kesehatan masyarakat. Penelitian ini menggunakan metode cross sectional dengan menganalisis data sekunder dari Kementerian Kesehatan terhadap 119 sampel. Hasil pengukuran kadar merkuri dalam rambut pekerja, didapatkan 77,9% berada diatas normal, angka Nilai Indeks Pajanan Biologi yang dipersyarakatkan ≤ 3μg/g (ACGIH, 2005). Analisis kadar merkuri dalam rambut dengan gangguan fungsi sistem saraf pusat, secara perhitungan statistik menunjukan tidak ada hubungan signifikan, namun pekerja dengan kadar merkuri tinggi berisiko 3,12 kali,CI 95% (0,67 - 14,36) terhadap gangguan fungsi sistem saraf pusat. Analisis berbagai faktor konfounding, yaitu: Lama paparan, konsumsi sayur-buah, konsumsi ikan, penggunaan pestisida dan atau insektisida dan kebiasaan merokok, berdasarkan perhitungan statistik, hanya penggunaan pestisida secara konstan mempunyai hubungan diantara keduanya dan berisiko 3,97 kali, CI 95% (1,51 - 10,43) terhadap gangguan fungsi sistem saraf pusat. Hasil analisis multivariat, didapatkan responden dengan kadar merkuri dalam rambut tinggi, mempunyai risiko 2,82 kali lebih besar dengan CI 95% (0,595-13,379) untuk mengalami gangguan fungsi sistem saraf pusat setelah dikontrol variabel penggunaan pestisida. Pencegahan dan pengendalian dampak kesehatan akibat penggunaan merkuri perlu melibatkan berbagai pihak baik pemerintah, swasta dan masyarakat, melalui program eliminasi, subtitusi, pengendalian teknis dan administrasi.

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Research into the analysis of mercury levels in hair with impaired central nervous system function for gold mining workers, was conducted to provide a reference to the impact of mercury use and its prevention for public health. The method in this research use cross sectional design. This research used secondary data from Ministry of Health, with 119 miners as samples.

The results of the measurement of mercury in the hair of workers, obtained 77.9% above normal, Biology Exposure Index value ≤ 3μg / g (ACGIH, 2005). Analysis of mercury levels in the hair with impaired function of the central nervous system, the statistical calculation showed no significant relationship, but workers with high mercury levels risked 3.12 times, 95% CI (0.67 - 14.36) against impaired functioning of the nervous system center. Analysis of various confounding factors, namely: Length of exposure, consumption of fruits, fish consumption, pesticide and or insecticide use and smoking habits, based on statistical calculations, only the use of pesticides has a constant relationship between them and 3.97 times risk, 95% (1.51 - 10.43) against impaired functioning of the central nervous system.

The result of multivariate analysis, obtained by respondent with high mercury in hair, had 2.82 times greater risk with 95% CI (0,595-13,379) for impaired function of central nervous system after controlled variable of pesticide usage. Prevention and control of health impacts due to the use of mercury should involve various parties, government, private and public, through elimination, substitution, technical and administrative control programs."