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"ABSTRAKBackground: the correlation between diabetes mellitus (DM) and Multi-Drug-Resistant Tuberculosis (MDR-TB) has never been studied among patients with tuberculosis (TB) in Indonesia, while DM has been identified to alter immune response and pharmacokinetics of TB medications that may lead to a failure of TB treatment and develop MDR-TB. Our study aimed to analyze the influence of diabetes mellitus on the development of MDR-TB. Methods: a retrospective cohort study was carried out on 356 TB patients at the Provincial Lung Clinics and Sardjito Hospital, Yogyakarta, Indonesia between 2010 and 2014. Diagnosis of MDR-TB was established based on GeneXpert or drug sensitivity testing, while DM was determined based on the criteria in the National Guidelines. Demographic, epidemiological and outcome variables were collected. Odds ratios and 95% confidence intervals (95% CI) were analyzed using simple logistic regression. Results: among 356 TB patients, 23 patients were with binomial TB-DM, while 333 patients did not suffered from DM. Patients with TB-DM presented a 6.8-fold (95% CI:2.0-23.7, p=0.003) higher risk of developing MDR-TB. Individuals with TB-DM had a 4.4-fold (95% CI:1.5-12.9, p=0.008) greater chance to have positive sputum smear by the second month of treatment indicating a delay in the resolution of the tuberculosis infection. Conclusion: there was a significant correlation between diabetes mellitus and MDR-TB development. Therefore, it is suggested that clinicians at all levels of health care service should conduct any kind of screening test for MDR-TB in such group of patients. Further prospective cohort study is needed to confirm the findings of this preliminary study."

"Latar belakang: Gangguan fungsi ginjal pada tahap awal sangat jarang diketahui karena belum memunculkan tanda dan gejala. Saat gangguan fungsi ginjal berkembang progresif dan muncul penyakit ginjal terminal hingga hemodialisis akan menyebabkan status kesehatan jemaah haji menjadi risiko tinggi dan dapat menjadi tidak memenuhi syarat istithaah. Perlu dilakukan evaluasi lebih awal dengan mengetahui faktor risiko yang berhubungan dengan gangguan fungsi ginjal seperti obesitas sentral untuk mendapatkan upaya pencegahan dan intervensi yang lebih menguntungkan. Tujuan: Mengetahui prevalensi gangguan fungsi ginjal dan hubungan obesitas sentral dengan gangguan gangguan fungsi ginjal pada jemaah haji penderita DM tipe 2. Metode: Penelitian ini menggunakan desain cross sectional terhadap 2.106 jemaah haji yang menderita DM tipe 2. Subyek diperoleh dari data sekunder Siskohatkes Shar'i Puskeshaji Kemenkes RI tahun 1438 H / 2017 M. Semua subyek dilakukan pemeriksaan kesehatan di puskesmas atau rumah sakit rujukan. Estimasi nilai LFG menggunakan persamaan CKD EPI untuk menentukan fungsi ginjal. Obesitas sentral ditentukan menggunakan indeks lemak visceral. Analisis menggunakan regresi logistik multivariat. Hasil: Nilai rata-rata estimasi LFG 78,63 ml/menit/1,72 m2. Prevalensi gangguan fungsi ginjal pada jemaah haji yang menderita DM tipe 2 sebesar 39,55%. Prevalensi gangguan fungsi ginjal pada Jemaah haji penderita DM tipe 2 dengan obesitas sentral adalah 29,17%. Obesitas sentral berhubungan signifikan secara statistik dengan gangguan fungsi ginjal pada jemaah haji penderita DM tipe 2. Nilai adjusted OR sebesar 1,45 (95% CI 1,19-1,77). Kesimpulan: Prevalensi gangguan fungsi ginjal pada jemaah haji yang menderita DM tipe 2 sebesar 39,55%. Obesitas sentral berhubungan secara signifikan dengan gangguan fungsi ginjal pada jemaah haji yang menderita DM tipe 2.

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Background: Impaired renal function in the early stages often not raised signs and symptoms. End-stage renal disease with hemodialysis will cause Indonesian pilgrims in high risk health status and does not meet istithaah requirements. Early detection of risk factors such as central obesity might be directed to benefit prevention dan intervention.

Objective: to estimate the prevalence of renal function impairment in type 2 DM and the association of central obesity with renal function impairment among Indonesian pilgrim with type 2 DM based on Siskohatkes shar'i 1438 H / 2017 M.

Methods: This cross sectional studi consisted of 2.106 Indonesian pilgrims with type 2 DM. The data was obtained from Siskohatkes 2017 of Pilgrimage Health Center, Ministry of Health. The variable data analyzed were creatinin serum, anthropometric, age, gender, smoking, family history of end-stage renal disease, blood pressure, HDL, LDL, trigliserida and uric acid. Renal function impairment was defined according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation to estimate Glomerulus Filtration Rate (eGFR). Central obesity was determined using visceral adiposity index (VAI). Multivariable logistic regression was used to analyze the association of central obesity and renal function impairment.

Result: The prevalence of renal function impairment in Indonesia pilgrim with type 2 DM was 39,55%. The mean of eGFR was 78,63 ml/min/1,72 m2. Central obesity was associated with renal function impairment (adjusted OR = 1,45; 95% CI 1,19-1,77).

Conclusion: The prevalence of renal function impairment in Indonesia pilgrim with type 2 DM was 39,55%. Central obesity was associated with renal function impairment."

"Perkembangan global yang terjadi saat ini menyebabkan Indonesia khususnya di daerah perkotaan mendapat pengaruh dari luar seperti pengaruh pola makan gaya barat yang mengandung makanan-makanan instan yang banyak mengandung kadar gula tinggi, kolesterol, zat pengawet, dan zat-zat campuran lainnya. Hal tersebut mengakibatkan masyarakat perkotaan semakin rentan penyakit yaitu salah satunya diabetes mellitus (DM) yang disebabkan pola makan yang tidak baik tersebut. Diabetes mellitus ini juga banyak diderita di salah satu kota di Indonesia yaitu Depok dengan salah satu kelurahannya yaitu Cisalak Pasar khususnya di RW 05. Oleh karena itu, penulis membina salah satu keluarga yang menderita DM di RW 05 yaitu di RT 01 dengan diagnosa keperawatan ketidakefektifan manajemen kesehatan diri pada keluarga Bpk M dengan DM. Intervensi unggulan untuk mengatasi diagnosa keperawatan tersebut yaitu manajemen diet. Evaluasi dari intervensi unggulan ini yaitu dengan manajemen diet yang baik, maka kadar glukosa darah dapat terkontrol dengan baik pula.

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Global development is being on today make Indonesia especially urban areas got outside influences such as the influence of western style diet that containing instant foods that contain lots of high sugar levels, cholesterol, preservatives, and other mixed substances. This resulted make more vulnerable diseases on urban communities, that is diabetes mellitus (DM). Diabetes mellitus also suffered in one of the cities in Indonesia, that is Depok with one of the urban village Cisalak Pasar especially in RW 05. Therefore, the authors caring one of the family who suffer from diabetes is in RT 05 RW 01 with a nursing diagnosis ineffective self health management at the Mr. M’s family with DM. The best interventions to resolves that nursing diagnoses is dietary management. Evaluation from this intervention is if the people have a good dietary management, so the blood glucose levels can be controlled."

"Diabetes mellitus adalah kondisi terjadinya peningkatan kadar gula darah yang disebabkan gangguan sekresi atau fungsi insulin yang terjadi minimal dalam 2 kali pemeriksaan. Pada klien DM tipe 2 masalah psikososial yang muncul adalah ansietas. Penyebab ansietas pada klien DM tipe 2 disebabkan kare informasi yang salah tentang penyakit DM, masalah psikosomatik yang telah ada sebelumnya atau kekawatiran adanya komplikasi dari DM. Ansietas adalah kondisi yang perasaan tidak nyaman atau kekhawatiran yang samar yang dialami oleh seseorang. Intervensi keperawatan ansietas pada klien dengan DM tipe 2 adalah tehnik relaksasi nafas dalam dan hypnosis lima jari yang dimodifikasi dengan aspek spiritual. Tehnik relaksasi nafas dalam dan hypnosis lima jari yang dimodifikasi dengan aspek spiritual dapat menurunkan ansietas pada klien DM tipe 2. Pada pasien DM tipe 2 yang mengalami ansietas dapat dilakukan tehnik relaksasi nafas dalam. Hypnosis lima jari yang dimodifikasi aspek spiritual dapat dilakukan pada klien dengan latar belakang spiritual yang kuat.

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Diabetes mellitus is a condition increased blood sugar levels due to impaired insulin secretion or function that occurs at least 2 times in the examination. DM client appears on both physical and psychosocial problems. Psychosocial issues that arise in client with type 2 DM is Anxiety. Anxiety causes of diabetes mellitus due to misinformation about diabetes disease, psychosomatic problems that have been there before or concerns the complications of diabetes.

Anxiety is a condition that uncomfortable feeling faint or concerns experienced by someone. previously. Anxiety nursing interventions to clients with type 2 diabetes mellitus is a breath of relaxation techniques and five fingers hypnosis in a modified with a spiritual aspect.

Deep breathing relaxation techniques and five fingers hypnosis are modified with the spiritual aspects can reduce anxiety in type 2 diabetes. clients with type 2 diabetes who experience anxiety can do deep breathing relaxation. Hypnosis five fingers are modified with the spiritual aspect can be used on the client with a strong spiritual background."

"To determine the differences in mean plasma values of von willebrand factor and platelet agregation in type 2 DM patient with or without peripheral artirial disease...."

"ABSTRAKPenyakit degeneratif merupakan sebuah fenomena yang terjadi di daerah perkotaan. Salah satunya adalah penyakit diabetes melitus pada usia dewasa. Karya Ilmiah Akhir ini memberikan gambaran tentang asuhan keperawatan keluarga yang dilaksanakan pada keluarga Ibu M dengan masalah keperawatan ketidakefektifan pemeliharaan kesehatan terkait diabetes melitus pada ibu M. Implementasi yang telah dilakukan terdiri dari implementasi yang bersifat kognitif, afektif, dan psikomotor dengan pendekatan lima tugas kesehatan keluarga. Intervensi yang menjadi unggulan untuk menurunkan kadar gula darah pada ibu M yaitu olahraga berupa jalan kaki. Hasil evaluasi menunjukkan bahwa terjadi penurunan kadar gula darah setelah rutin melakukan jalan kaki. Hasil pemeriksaan gula darah sebelum dan setelah melakukan jalan kaki yaitu 316 mg/dl dan 265 mg/dl.

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ABSTRACT

Degenerative disease is a phenomenon that occurs in urban areas. One of them is diabetes mellitus in adulthood. This Final Scientific Paper provides an overview of family nursing care undertaken in family nursing to Ibu M with problems related to ineffectiveness health maintenance of diabetes mellitus in the family of Ibu M. Implementations consist of the implementation of cognitive, affective, and psychomotor task with five family health approaches. Seeded intervention to decrease blood glucose levels of Ibu M is walking exercise. Evaluation results showed that blood sugar levels decreased after walking exercise routinely. The results of blood glucose tests before and after walking exercise are 316 mg/ dl and 265 mg/ dl."

"Background: thyroid dysfunction is more likely to occur in diabetes mellitus patients than general population. Until now, no study has been done to find prevalence of hypothyroidism and hyperthyroidism in Indonesian diabetics. This study aimed to find the proportion and characteristics of thyroid dysfunction in Indonesian type 2 diabetes mellitus patients. Methods: a cross-sectional study was conducted in Endocrine and Diabetes Polyclinic, Department of Internal Medicine, Cipto Mangunkusumo Hospital from July to September 2015. This study include type 2 diabetes mellitus patients, age ≥ 18 year-old, willing to undergo thyroid laboratory testing. In this study, hypothyroidism defined as TSH more than 4.0 mIU/L, while hyperthyroidism is defined as TSH less than 0.4 mIU/L with eCLIA. Results: from 364 subjects who were recruited from Endocrine and Diabetes Polyclinic, Cipto Mangunkusumo Hospital, 303 subjects underwent this study until analysis. Two hundred and three (273) subjects (90.1%) were euthyroid, 7 subjects (2.31%) were hyperthyroid, and 23 subjects (7.59%) were hypothyroid. Majority of the patients had subclinical hypothyroidism (56.5% based on Zulewski and Billewicz Score and 65.2% based on fT4 laboratory result), while 42.9% and 71.4% subjects had clinical hyperthyroidism based on clinical appearance and fT4 laboratory result respectively. Conclusion: proportion of hypothyroidism was 7.59% and hyperthyroidism was 2.31%, while the proportion of total thyroid dysfunction was 9.9% among diabetics. It is suggested that screening for thyroid dyscfunction can be done in high risk condition as a part of comprehensive management in type 2 diabetes mellitus patients."

"Indonesia merupakan negara terbanyak keempat kematian akibat diabetes Mellitus dan penyakit jantung diantara negara-negara Asia Tenggara. Penelitian dengan desain studi cross sectional ini bertujuan untuk mengetahui gambaran biaya akibat sakit serta kualitas hidup pasien diabetes mellitus tipe 2 dengan penyakit jantung dengan sampel 110 orang di RSUD Dr.M.Yunus Bengkulu. Rata-rata biaya pasien akibat sakit diabetes mellitus tipe 2 dengan penyakit jantung selama setahun adalah Rp. 6.081.572 dimana komposisi biaya langsung adalah (81,54%) dan biaya tidak langsung (18,46%). Proporsi terbesar adalah biaya obat (37,05%). Faktor-faktor yang mempengaruhi biaya akibat penyakit tersebut adalah Lama Hari Rawat (LHR) dan jenis pekerjaan sedangkan faktor yang mempengaruhi kualitas hidup pasien adalah Lama/durasi sakit. Disarankan agar RSUD.dr.M.Yunus Bengkulu menyusun clinical pathway dan formularium rumah sakit. Pemerintah perlu merevisi formularium nasional dengan memperhatikan kondisi lokal dan mengembangkan program peningkatan kualitas hidup pasien.

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Indonesia is the fourth most deaths due diabetes mellitus and heart disease among south Asia countries. This study with cross-sectional design is aiming to describing the cost of illness and quality of life of patients with type 2 diabetes mellitus with heart disease in dr.M.Yunus public hospital. Number of samples was110 patients. The annual cost of illness due to type 2 diabetes mellitus with heart disease perpatient was Rp. 6,081,572, with direct cost is reached (81.54%) and indirect cost (18.46%). The largest proportion of the cost was drug (37.05%). Factors that affect COI were Length of Stay (LOS) and the type of work, and factor affect quality of life was duration of illness. It is recommended that dr.M.Yunus Public Hospital Bengkulu should prepare clinical pathways and hospital formulary. The central government needs to revise national formulary with considering variability of country situation and develop program to improve quality of DM patient."

"ABSTRAK Latar belakang : Prevalens diabetes melitus (DM) terus meningkat di negaraberkembang yang merupakan negara endemis tuberkulosis (TB). Diabetes melitusmeningkatkan risiko infeksi, hambatan konversi sputum dan kegagalanpengobatan TB. Penelitian ini bertujuan menganalisis faktor-faktor yangmempengaruhi konversi sputum Basil Tahan Asam (BTA) mikroskopik padaakhir bulan kedua pengobatan TB pada pasien TB paru kasus baru dengan DM.Metode : Penelitian kohort retrospektif ini dilaksanakan di RSUP Perahabatanterhadap pasien-pasien TB paru BTA positif kasus baru dengan DM yang berobatpada periode Juli 2012 sampai Juni 2015. Hubungan faktor risiko dengan konversisputum BTA mikroskopik dianalisis dengan analisis bivariat dan multivariat.Hasil penelitian: Proporsi kegagalan konversi sputum BTA mikroskopik padapasien TB paru kasus baru dengan DM adalah 43,04%, sedangkan pada pasientanpa DM 22,75% (p<0,001, KI95% 0,11-0,30) dan risiko relatif (RR) kegagalankonversi 1,89 kali lebih tinggi pada kelompok DM. Faktor risiko yang meningkatbermakna pada pasien gagal konversi adalah kadar kepositifan sputum BTAsebelum terapi (p=0,021), HbA1c (p=0,014), GDP (p=0,047), GD 2jam PP(p=0,030) dan kavitas pada foto toraks (p=0,033) sedangkan albumin serum lebihrendah bermakna (p=0,013). Analisis multivariat mendapatkan faktor risikoterkuat untuk kegagalan konversi sputum adalah kadar albumin serum yangrendah (p=0,046, aOR 0,464, KI95% 0,218-0,986), tingkat kepositifan sputumBTA mikroskopik sebelum terapi yang tinggi (p=0,009, aOR 2,313, KI95%1,230-4,349) dan kadar HbA1c yang tinggi (p=0,018, aOR 1,298, KI 95% 1,047-1,610).Kesimpulan: Tingkat kepositifan sputum BTA sebelum terapi yang tinggi, statuskontrol DM yang tidak baik, kavitas pada foto toraks dan kadar albumin serumyang rendah meningkatkan risiko kegagalan konversi sputum BTA pada pasienTB dengan DM.ABSTRACT Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients."