Hasil Pencarian  ::  Simpan CSV :: Kembali

"Tesis ini membahas mengenai performa skor V-POSSUM sebagai prediktor mortalitas 30 hari pasca tindakan EVAR TEVAR pada pasien AAA dan TAA di RSUPN Cipto Mangunkusumo.Penelitian ini merupakan studi kohort retrospektif menggunakan data dari rekam medis. Data yang diambil sesuai variabel yang terdapat dalam sistem skoring dalam bentuk kategorik lalu diolah secara statistik untuk menguji validitas skor V-POSSUM. Hasil penelitian melibatkan 85 pasien yang memenuhi syarat penerimaan penelitian. Dari pengolahan data statistik diketahui bahwa skor fisiologis, risiko morbiditas, dan risiko mortalitas dapat digunakan sebagai model untuk memprediksi luaran kematian karena memiliki performa akurasi dan diskriminasi yang baik, sedangkan skor kepelikan operasi tidak dapat digunakan karena secara statistik tidak menunjukkan hal yang sama. Nilai P hasil perhitungan 'Goodnes of Fit Model' skor fisiologis, risiko morbiditas, risiko mortalitas masing-masing adalah 0.00, sedangkan skor kepelikan operasi 0.18 (>0.05). 'Area Under the Curve' (AUC) masing-masing adalah 94%, 93%, 93%, dengan titik potong masing-masing berada di angka 31, 68.8, dan 10.6. Sebagai kesimpulan adalah bahwa skor V-POSSUM memiliki akurasi dan diskriminasi yang baik bukan hanya pada skor risiko mortalitasnya saja, namun pada skor fisiologis dan skor risiko morbiditasnya.

---

This thesis discusses the performance of V-POSSUM score as a predictor of 30 days mortality after EVAR TEVAR in AAA and TAA patients at Cipto Mangunkusumo Hospital. This study is a retrospective cohort method using data from medical records. Data taken according to the variables contained in the scoring system in categorical form then processed statistically to test the validity of the V-POSSUM score. The results of the study involved 85 patients who met the research acceptance requirements. From the processing of statistical data it is known that physiological scores, morbidity risk, and mortality risk can be used as a model to predict the outcome of death because it has good performance in accuracy and discrimination, while the severity score of surgery cannot be used because it does not show the same result statistically. The P value calculated by the Goodnes of Fit Model physiological score, the morbidity risk, the mortality risk of each was 0.00, while the severity score of the operation was 0.18 (> 0.05). Area Under the Curve (AUC) are 94%, 93%, 93%, respectively, with points 31, 68.8 and 10.6. The conclusion is that the V-POSSUM score has good accuracy and discrimination not only on the mortality risk score, but also on the physiological score and the morbidity risk score."

"Adenoma hipofisis merupakan salah satu tumor primer intrakranial tersering yang sebagian dapat bersifat agresif dengan risiko rekurensi/regrowth yang lebih tinggi sehingga berdampak buruk pada kualitas hidup pasien. Identifikasi awal adenoma hipofisis yang agresif dapat membantu menentukan strategi tatalaksana dan follow-up untuk mencegah terjadinya rekurensi/regrowth. Penilaian aktivitas proliferasi dengan ekspresi Ki-67 pada adenoma hipofisis diharapkan dapat memprediksi terjadinya rekurensi/regrowth. Penelitian ini bertujuan untuk menilai ekspresi Ki-67 pada adenoma hipofisis yang mengalami rekurensi/regrowth dan yang tidak mengalami rekurensi/regrowth. Penelitian ini merupakan penelitian retrospektif analitik dengan desain potong lintang. Sampel berupa kasus adenoma hipofisis di Departemen Patologi Anatomik FKUI/RSCM tahun 2016-2020. Dilakukan pemeriksaan imunohistokimia Ki-67 dan penilaian persentase sel tumor yang terpulas positif. Analisis statistik dilakukan dengan uji komparatif numerik di antara dua kelompok tersebut. Nilai titik potong untuk prediksi rekurensi/regrowth ditentukan dengan analisis kurva receiving operator characteristic. Didapatkan 46 kasus adenoma hipofisis yang terdiri atas 23 kasus dengan rekurensi/regrowth dan 23 kasus tanpa rekurensi/regrowth. Rerata ekspresi Ki-67 pada kelompok yang mengalami rekurensi/regrowth lebih tinggi dibandingkan dengan kelompok yang tidak mengalami rekurensi/regrowth. (1,58% vs 0,88%, p=0,003). Nilai titik potong untuk yang direkomendasikan untuk prediksi rekurensi/regrowth sebesar 1,37%. Ekspresi Ki-67 yang lebih tinggi berhubungan dengan rekurensi/regrowth pada adenoma hipofisis.

---

Pituitary adenoma is one of the most common primary intracranial tumor that some can behave aggresively with higher reccurrence/regrowth risk and have bad impact to patient’s quality of life. Early identification of aggressive pituitary adenoma can help for deciding aggressive treatment strategies and strict follow-up to prevent recurrence/regrowth. Proliferation assesment using Ki-67 expression is expected to be one of the predictor of tumor recurrence/regrowth. This study aims to evaluate Ki-67 expression in pituitary adenoma with recurrence/regrowth and without recurrence/regrowth. This is an analytic retrospective study with cross sectional study design including specimens diagnosed as pituitary adenoma recorded in archives of Anatomical Pathology Departement FMUI/CMH from 2016-2020. Ki-67 immunostaining was conducted and Ki-67 expression in percentage was evaluated. Data was analyzed statistically to evaluate Ki-67 expression. Cut-off point to predict recurrence/regrowth was determined using receiving operator charasteristic curve analysis. Forty-six cases were selected, consisted of 23 cases with recurrence/regrowth and 23 cases without recurrence/regrowth. There was higher expression of Ki-67 in adenoma with recurrence/regrowth than adenoma without recurrence/regrowth (1,58% vs 0,88%, p=0,03). Recommended cut off value to predict recurrence/regrowth in this study was 1,37%. Higher Ki-67 expression was associated with recurrence/regrowth in pituitary adenoma."

"This atlas is a detailed guide to the imaging appearances of gliomas following treatment with neurosurgery, radiation therapy, and chemotherapy. Normal and pathological findings are displayed in detailed MR images that illustrate the potential modifications due to treatment. Particular emphasis is placed on characteristic appearances on the newer functional MR imaging techniques, including MR spectroscopy, diffusion-weighted imaging, and perfusion imaging. These techniques are revolutionizing neuroradiology by going beyond the demonstration of macroscopic alterations to the depiction of preceding metabolic changes at the cellular and subcellular level, thereby allowing earlier and more specific diagnosis. A key section comprising some 40 clinical cases and more than 500 illustrations offers an invaluable clinical and research tool not only for neuroradiologists but also for neurosurgeons, radiotherapists, and medical oncologists."

"Stroke yang disebabkan karena gangguan perfusi otak merupakan penyebab utama disabilitas dan kematian di seluruh dunia. Komplikasi stroke dengan angka mortalitas tinggi yaitu edema luas akibat infark arteri serebri media/middle cerebral artery (MCA) maligna yang kemudian diikuti deteriorasi neurologis cepat dan berujung pada luaran yang buruk dengan angka kematian sebesar 80%. Kraniektomi dekompresi sebagai tatalaksana infark MCA maligna diketahui dapat meningkatkan probabilitas keselamatan hingga lebih dari 80%. Penelitian ini bertujuan untuk mengetahui angka kesintasan dan kualitas hidup pasien infark MCA maligna 1, 3, 6, dan 12 bulan pasca-operasi kraniektomi dekompresi di Indonesia, hubungan luaran dengan terapi reperfusi pendahulu, dan menganalisis faktor-faktor yang telah diketahui dapat mempengaruhi luaran, yaitu usia, waktu pembedahan, dan diameter anteroposterior kraniektomi. Penelitian ini bersifat kohort retrospektif melalui pengambilan data rekam medis pasien infark MCA maligna yang dilakukan tindakan kraniektomi dekompresi di Rumah Sakit Umum Pusat dr. Cipto Mangunkusumo (RSCM), Rumah Sakit Umum Pusat (RSUP) Fatmawati, dan Rumah Sakit Pusat Otak Nasional Prof. Dr. dr. Mahar Mardjono Jakarta (RS PON) pada tahun 2017-2022. Sebanyak 39 subjek masuk dalam kriteria inklusi. Dari seluruh subjek, sebanyak 51,3% subjek berusia <60 tahun, 48,7% dioperasi dalam waktu pembedahan <48 jam, 76,6% memiliki diameter kraniektomi 12-14 cm, dan 38,5% subjek mendapatkan terapi reperfusi pendahulu sebelum operasi. Dari hasil penelitian didapatkan 12 penyintas yang hidup pada akhir follow-up. Angka kesintasan pada bulan pertama sebesar 55% yang kemudian turun menjadi 36% pada 12 bulan follow-up (Kaplan-Meier). Dari 27 subjek yang meninggal, 17 subjek meninggal dalam bulan pertama perawatan pasca-operasi di rumah sakit (rentang 1-20 hari), sedangkan sisanya meninggal di luar perawatan rumah sakit. Penyebab tertinggi kematian yang diketahui yaitu infeksi. Dari 12 penyintas, 58% memiliki luaran fungsional yang buruk (modified Rankin scale 4-5) pada akhir follow-up. Tidak didapatkan adanya perbedaan signifikan angka kesintasan (p 0,779, log rank test) maupun luaran fungsional (p 0,929, Mann- Whitney test) pada kelompok yang mendapatkan terapi reperfusi maupun tidak. Dari analisis bivariat diketahui bahwa faktor usia, waktu pembedahan, dan diameter kraniektomi tidak berhubungan signifikan dengan kesintasan maupun luaran fungsional. Dari analisis multivariat dengan melibatkan faktor-faktor tambahan di luar faktor tersebut, diketahui jenis kelamin berhubungan signifikan terhadap luaran fungsional (p 0,032) sedangkan skor National Institutes of Health Stroke Scale (NIHSS) pra-operasi berhubungan secara signifikan dengan kesintasan (p 0,028) dan luaran fungsional (p 0,004). Dari penelitian ini diketahui bahwa angka kesintasan 12 bulan pasien infark MCA Universitas Indonesia viii maligna yang dilakukan kraniektomi dekompresi yaitu sebesar 36% dan mayoritas penyintas memiliki luaran fungsional buruk. Perlu dilakukan penelitian lebih lanjut dengan menyertakan kelompok kontrol pasien infark MCA maligna yang tidak dilakukan kraniektomi dekompresi namun mendapatkan terapi konservatif maksimal agar dapat diketahui manfaat operasi melalui perbandingan luaran kedua kelompok tersebut.

---

Stroke caused by impaired brain perfusion is a major cause of disability and death worldwide. Stroke complication with high mortality rate is extensive edema due to malignant middle cerebral artery (MCA) infarction which is followed by rapid neurological deterioration and leads to poor outcomes with a mortality rate of 80%. Decompressive hemicraniectomy as a treatment for malignant MCA infarction has been known to increase the probability of survival by more than 80%. This study aims to determine the survival rate and functional outcome of patients with malignant MCA infarction in 1, 3, 6, and 12 months after decompressive hemicraniectomy in Indonesia, analyse impacts of prior reperfusion therapy to outcomes, and also analyse factors that are already known to affect outcome from literatures, which are age, timing of surgery, and anteroposterior craniectomy diameter. This study was a retrospective cohort by collecting medical record data of malignant MCA infarction patients who underwent decompressive hemicraniectomy at Cipto Mangunkusumo National General Hospital, Fatmawati General Hospital, and Mahar Mardjono Jakarta National Brain Center Hospital from 2017-2022. A total of 39 subjects were included, 51.3% of them were aged <60 years, 48.7% were operated within <48 hours of onset, 76.6% had a craniectomy diameter of 12-14 cm, and 38.5% received reperfusion therapy prior to surgery. Results of the study, 12 subjects survived at the end of follow-up. The survival rate at the first month was 55% which then decreased to 36% at 12 months follow-up (Kaplan-Meier). Of the 27 subjects who died, 17 subjects died within the first month of post-operative care in the hospital (interval 1-20 days), with infection as the leading cause of death, while the rest died outside of hospital care. Of the 12 survivors, 58% had poor functional outcomes (modified Rankin scale 4-5). There was no significant difference in survival rate (p 0.779, log rank test) and functional outcome (p 0.929, Mann-Whitney test) in the group receiving reperfusion therapy or not. From the bivariate analysis, it was found that age, timing of surgery, and craniectomy diameter were not significantly related to survival or functional outcome. From the multivariate analysis including other additional factors, it was found that sex was significantly related to functional outcome (p 0.032) while the pre-operative National Institutes of Health Stroke Scale (NIHSS) score was significantly related to survival (p 0.028) and functional outcome (p 0.004). From this study, it is known that the 12-month survival rate of malignant MCA infarction patients who underwent decompressive hemicraniectomy was 36% and the majority of survivors had poor functional outcomes. Further research is needed by including a control group of patients with malignant MCA infarction who did not undergo decompressive hemicraniectomy Universitas Indonesia x but received maximum conservative therapy in order to know the benefits of surgery by comparing the outcomes of the two groups."

"ABSTRACTBackground: resistive index (RI) is highly utilised to assess the graft function using Doppler ultrasonography. The RI has been shown as the best ultrasound parameter to assess kidney allograft dysfunction. Several studies have established the role of the RI as a predictor of transplant failure. However, these studies were using RI measurement in the later stages post transplantation. The present study has conducted to identify the association between early RI measurement and early graft function represented as delayed graft function (DGF) and immediate graft function (IGF), as well as long-term graft survival. Methods: an evidence based clinical review of studies published before May 2018 was conducted from Medline, Science Direct, EMBASE and Cochrane databases. Studies on early measurement of RI whereby the primary or secondary goals of the study related to graft function and/or graft survival were included. Studies using late RI measurement and without RI value groups were excluded. The Mantzel Haenzel method was used to analyse pooled risk ratio and 95% confidence interval, while the heterogeneity of the study was calculated through I2 value. Data analysis was performed using Review Manager 5.3. Results: nine studies with a total of 1802 patients who had undergone a kidney transplant were analysed. DGF was found in 19% (193/1015) of the low RI group and in 42.8% (337/787) of the high RI group (RR 2.04 (95% CI 1.72 - 2.41), p < 0.00001, I2 = 28%). IGF was found in 39.5% (62/157) of the low RI group and in 10.5% (28/268) of the high RI group (RR 0.26 (95% CI 0.17 0.40), p < 0.00001, I2 = 0%). Long term graft survival, with follow up between 60 144 months, was found in 83% (701/845) of the low RI group and in 69.4% (395/569) of the high RI group (RR 0.82 (95% CI 0.72 0.93), p = 0.002, I2 = 63%). Conclusion: the results of this study emphasise the association between early measurement of RI and early graft function, and longterm graft survival. An elevated RI provides the chance of recognizing the patients with poor longterm prognosis, from the first moment after kidney transplant."

"Penyakit Tuberkulosis di Indonesia merupakan salah satu dari 10 besar penyebab kematian dan agen infeksi utama. Penyebaran penyakit TB dapat dicegah dengan memberikan tes TB dini untuk individu dengan indikasi penyakit TB, seperti individu dari negara dengan kasus TB tinggi, orang yang tinggal atau bekerja di lingkungan berisiko tinggi, petugas kesehatan yang merawat pasien dengan risiko tinggi. Penyakit TBC dapat diketahui dengan TB Skin Test (TST) dan TB Blood Test. Kegagalan pengobatan terjadi ketika seorang individu gagal untuk pulih dari pengobatan lini pertama yang diberikan kepada individu TB aktif. Pada skripsi ini disusun model matematika dengan membagi total populasi  menjadi enam kompartemen berdasarkan status kesehatannya. Digunakan data pertambahan kasus TB Indonesia per-triwulan tahun 2017-2021 serta beberapa metode seperti pembentukan Basic Reproduction Number (R0) menggunakan metode NGM, menentukan dan analisis titik bebas penyakit dan endemik dengan pendekatan Van den Driessche, Castillo-Chavez dan Song, serta kajian analitik dengan analisis elastisitas dan sensitivitas serta simulasi autonomous.

---

Tuberculosis in Indonesia is one of the top 10 causes of death and a major infectious agent. The spread of TB disease can be prevented by providing early TB testing for individuals with indications of TB disease, such as individuals from countries with high TB cases, people living or working in high-risk environments, health workers who care for high-risk patients. TB disease can be identified by means of the TB Skin Test (TST) and the TB Blood Test. Treatment failure occurs when an individual fails to recover from the first-line treatment given to an individual with active TB. In this thesis is constructed a mathematical model by dividing the total population into six compartments based on their health status. The use of data on the increase in Indonesia TB cases per quartely 2017-2021 as well as several methods such as the formation of R0 or Basic Reproduction Number using the NGM or Next Generation Matrix method, determine and analyze disease and endemic points with the Van den Driessche approach, Castillo-Chavez and Song, as well as analytical studies with elasticity and sensitivity analysis as well as autonomous simulation."

"The aim of this book is to provide insight into the principles of operation of the cerebral cortex. These principles are key to understanding how we, as humans, function. There have been few previous attempts to set out some of the important principles of operation of the cortex, and this book is pioneering. The book goes beyond separate connectional neuroanatomical, neurophysiological, neuroimaging, neuropsychiatric, and computational neuroscience approaches, by combining evidence from all these areas to formulate hypotheses about how and what the cerebral cortex computes. As clear hypotheses are needed in this most important area of 21st century science, how our brains work, I have formulated a set of hypotheses about the principles of cortical operation to guide thinking and future research. The book focusses on the principles of operation of the cerebral cortex, because at this time it is possible to propose and describe many principles, and many are likely to stand the test of time, and provide a foundation for further developments, even if some need to be changed. In this context, I have not attempted to produce an overall theory of operation of the cerebral cortex, because at this stage of our understanding, such a theory would be incorrect or incomplete. However, many of the principles described will provide the foundations for more complete theories of the operation of the cerebral cortex. This book is intended to provide a foundation for future understanding, and it is hoped that future work will develop and add to these principles of operation of the cerebral cortex. The book includes Appendices on the operation of many of the neuronal networks described in the book, together with simulation software written in Matlab."