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Ihsanul Rajasa
Hubungan antara HOMA-β dan C-Peptide saat Admisi dengan Luaran Buruk Perawatan pada Pasien Terkonfirmasi COVID-19 yang Dirawat di RSUPN Dr. Cipto Mangunkusumo = The Relationship between HOMA-β and C-Peptide during Admission with Poor Outcomes Among Hospitalized Patients with Confirmed COVID-19 in RSUPN Dr. Cipto Mangunkusumo Hospital
"Latar Belakang. Banyak faktor yang memengaruhi derajat berat infeksi dan mortalitas dari infeksi Corona Virus Disease 2019 (COVID-19). COVID-19 menyebabkan kerusakan sel beta pankreas, namun sampai saat ini mekanisme kerusakan ini belum banyak diketahui. Metode untuk menilai fungsi sekresi dari sel beta pankreas adalah Homeostatic Model Assessment- β (HOMA-β) dan C-peptide. Tujuan. Mengetahui hubungan antara HOMA-β dan C-peptide saat admisi dengan luaran buruk pada pasien terkonfirmasi COVID-19 yang dirawat inap. Metode. Penelitian ini merupakan studi kohort retrospektif yang dilakukan di Rumah Sakit Cipto Mangunkusumo (RSCM). Pasien terkonfirmasi COVID-19 (derajat ringan/sedang) berusia > 18 tahun, yang dirawat inap di RSCM Kiara dalam periode waktu September 2020 – Maret 2021, dengan HbA1c <6,5% serta tanpa riwayat diabetes sebelumnya, menjalani pemeriksaan HOMA-β dan C-Peptide. Ditentukan nilai titik potong keduanya untuk kemudian dilihat hubungannya dengan luaran buruk selama perawatan tersebut. Hasil. Dari 232 subyek yang memenuhi kriteria, terdapat 10(4,3%) subyek dengan luaran buruk. Median HOMA-β pada luaran buruk adalah 70,28% (RIK 32,25 – 132,11), sementara itu pada luaran baik adalah 121,6% (RIK 82,39 – 174,23). Median C-peptide pada luaran buruk dan baik berturut-turut adalah 2059 (RIK 1508 – 2762) dan 1647 (RIK 1107 – 2461). Nilai titik potong HOMA-β 80%, dengan AUC 0,702 (IK 95% 0,526-0,879) menunjukkan sensitifitas 60% dan spesifisitas 71,4%. Nilai Hazard Ratio (HR) dari HOMA-β <80 adalah 4,660 (p=0,017). Nilai titik potong C-peptide tidak dapat ditentukan karena AUC 0,555. Kesimpulan. Terdapat hubungan antara nilai HOMA-β saat admisi dengan luaran buruk selama perawatan pada pasien terkonfirmasi COVID-19, namun hubungan C-Peptide tidak didapatkan kemaknaannya dengan luaran buruk selama perawatan. Kata Kunci. COVID-19, C-Peptide, HOMA-β, Luaran buruk.
Background. Many factors affect the severity of infection and mortality of Corona Virus Disease 2019 (COVID-19) infection. COVID-19 virus linked to pancreatic beta cells damage, yet the mechanism is still unclear. A method to assess the secretory function of pancreatic beta cells is based on Homeostatic Model Assessment- (HOMA-β) and C-peptide. Aim. Determine the relationship between HOMA-β and C-peptide values during admission in hospitalized confirmed COVID-19 patients with poor outcomes. Method. This is a retrospective cohort study conducted at Cipto Mangunkusumo Hospital (RSCM). Patients with confirmed COVID-19 (mild/moderate) who were hospitalized at the RSCM Kiara Hospital during the period September 2020 – March 2021, with HbA1c <6.5%, and without history of diabetes underwent HOMA-β and C-Peptide examination. The cut-off point for both was evaluated, furthermore the relationship with poor outcomes during hospitalization was assessed. Result. From 232 subjects met the inclusion and exclusion criteria, there were 10 (4.3%) subjects with poor outcomes. Median of HOMA-β in poor outcome group was 70.28% (IQR 32.25 – 132.11) while in good outcome group was 121.6% (IQR 82.39 – 174.23). The median of C-peptide on poor and good outcome were 2059 (IQR 1508 – 2762) vs. 1647 (IQR 1107 – 2461), respectively. The HOMA-β cut- off point was 80% showed AUC 0.702 (95% CI 0.526-0.879), with sensitivity 60% and specificity 71.4%. The Hazard Ratio (HR) of HOMA-β value <80% was 4.660 (p=0.017). The C-peptide cut-off point could not be determined because the AUC was 0.555. Conclusion. There is a significant relationship between the HOMA-β during admission and the poor outcome of hospitalized patients with confirmed COVID- 19 yet there is no significant relationship between C-Peptide and poor outcome."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tugas Akhir  Universitas Indonesia Library
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Barus, Nadya R V
Hubungan antara Parameter Obesitas dengan Luaran Buruk selama Perawatan Pasien COVID-19 Terkonfirmasi Derajat Ringan-Sedang = Association between Obesity Parameters and Poor Outcomes in Hospitalized Patients with Confirmed Mild to Moderate COVID-19
"Latar Belakang. Obesitas merupakan faktor risiko luaran buruk pada pasien COVID-19. Sampai saat ini studi penilaian hubungan parameter obesitas berupa nilai lemak viseral, lingkar pinggang (LP), indeks massa tubuh (IMT), dan persentase lemak tubuh secara bersamaan dengan luaran COVID-19 menggunakan metode sederhana berupa bioimpedance analyzer (BIA) masih terbatas. Keempat variabel tersebut akan dinilai kemampuannya untuk memprediksi luaran buruk selama perawatan pasien COVID-19.
Metode. Penelitian ini merupakan kohort prospektif dari 261 pasien COVID-19 ringan-sedang di RSUPN Cipto Mangunkusumo rawat inap sejak Desember 2020 hingga Maret 2021. Pasien dilakukan pemeriksaan BIA, LP, dan IMT saat admisi. Dilakukan analisis multivariat regresi logistik untuk menilai kemampuan nilai lemak viseral, persentase massa tubuh, IMT dan LP untuk memprediksi luaran buruk komposit yang mencakup ARDS dan mortalitas.
Hasil. Didapatkan median nilai lemak viseral 10 (setara 100 cm2 ), lingkar pinggang 93 cm, IMT 26,1 kg/m2 , dan persentase lemak tubuh 31,5%. Berdasarkan multivariat regresi logistik, lingkar pinggang secara statistik bermakna sebagai faktor yang berpengaruh terhadap luaran buruk pada pasien COVID-19 [RR 1,04 (IK 95% 1,01-1,08)] bersama dengan derajat COVID-19 [RR 4,3 (IK 95% 1,9- 9,9)], skor NEWS [RR 5,8 (IK 95% 1,1-31)] saat admisi, dan komorbiditas [RR 2,7 (IK 95% 1,1-6,3)].
Kesimpulan. Luaran buruk COVID-19 selama perawatan pasien COVID-19 terkonfirmasi dapat dipengaruhi oleh lingkar pinggang.
Background. Obesity is a risk factor for adverse outcomes in COVID-19 patients. Until now, studies on assessing the relationship between obesity parameters in the form of visceral fat, waist circumference (WC), body mass index (BMI), and body fat percentage simultaneously with COVID-19 outcomes using a simple method such as bioimpedance analyzer (BIA) are still limited. The four variables will be assessed for their ability to predict adverse outcomes during the treatment of COVID-19 patients.
Method. This study is a prospective cohort of 261 mild-moderate COVID-19 subjects at Cipto Mangunkusumo General Hospital who were hospitalized from December 2020 to March 2021. Patients underwent BIA, WC, and BMI examinations upon admission. Multivariate logistic regression analysis was performed to assess the ability of visceral fat, body mass percentage, BMI, and WC to predict poor composite outcomes, including ARDS and mortality.
Results. The median value of visceral fat was 10 (equivalent to 100 cm2 ), WC was 93 cm, BMI was 26.1 kg/m2 , and body fat percentage was 31.5%. Based on multivariate logistic regression, WC was statistically significant as a factor influencing poor outcomes in COVID-19 patients [RR 1.04 (95% CI 1.01-1.08)] along with COVID-19 degree of severity [RR 4.3 (95% CI 1.9-9.9)], NEWS score [RR 5.8 (95% CI 1.1-31)] at admission, and comorbidities [RR 2.7 (95% CI 1.1) - 6.3)].
Conclusion. During the hospitalization of confirmed COVID-19 patients, poor outcomes can be affected by waist circumference."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tesis Membership  Universitas Indonesia Library
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Ermi Wahyu Haryani
Peran Rasio Neutrofil-Limfosit, Monosit-Limfosit, dan Trombosit-Limfosit terhadap Luaran Klinis Pasien Terkonfirmasi COVID-19 di RSUPN dr Cipto Mangunkusumo Jakarta = The Role of Neutrophil-Lymphocyte, Monocyte-Lymphocyte, and Platelet-Lymphocyte Ratios in The Clinical Outcome of Patients Confirmed for COVID-19 at dr. Cipto Mangunkusumo hospital Jakarta
"Coronavirus Disease 2019 (COVID-19) merupakan penyakit multisistemik yang melibatkan kaskade imunologi, inflamasi, dan koagulasi. Biomarker di sirkulasi yang dapat memberikan informasi mengenai kondisi inflamasi dan status imun dapat digunakan dalam mendiagnosis dan menilai prognosis pasien COVID-19. Parameter hematologi rutin, mudah dilakukan, biaya terjangkau dan cepat, sehingga diharapkan dapat memberikan informasi awal sistem imun pasien yang dapat dihubungkan dengan outcome penyakit. Nilai RNL, RML dan RTL dapat mendeteksi dini kecurigaan perburukan kondisi pasien COVID-19. Penelitian ini menggunakan desain nested case-control yang melibatkan 206 data subjek yang terdiri atas 141 subjek luaran baik dan 65 subjek luaran buruk. Dijumpai perbedaan bermakna nilai RNL, RML dan RTL antara kelompok luaran baik dan buruk. Nilai titik potong optimal RNL, RML dan RTL berturut-turut adalah ≥5,43; ≥0,46 dan ≥196,34 untuk mendiskriminasi luaran buruk. Area Under Curve (AUC) untuk RNL adalah 0,825 (0,766-0,884), sensitivitas 76,9%, spesifisitas 73,8%; AUC RML 0,763 (0,692-0,833), sensitivitas 73,8%, spesifisitas 68,1% dan AUC RTL 0,617 (0,528-0,705), sensitivitas 63,1%, spesifisitas 60,3%. Usia >30 tahun (OR=2,59; IK95% 1,34-5,02), adanya komorbid (OR=2,21; IK95% 1,28-3,81), RNL ≥5,43 (OR=4,60; IK95% 2,07-10,26) dan RML ≥0,46 (OR=2,09; IK95% 0,93-4,67) berhubungan dengan luaran buruk pasien COVID-19.
Coronavirus Disease 2019 (COVID-19) is a multisystemic disease involving immunologic, inflammatory, and coagulation cascades. Biomarkers in circulation which can provide information on inflammatory conditions and immune status can be used in diagnosing and assessing the prognosis of COVID-19 patients. Hematology parameters are routinely performed, easy, affordable and fast, so it can provide preliminary information on the patient's immune system that linked to disease outcomes. NLR, MLR and TLR values can detect early suspicion of worsening conditions of COVID-19 patients. This study used a nested case-control design involving 206 subjects data consisting of 141 subjects with good outcomes and 65 subjects poor outcomes. A significant difference was found in the values of NLR, MLR and TLR between the two groups. The optimal cut-off point values of NLR, MLR and TLR were ≥5.43; ≥0.46 and ≥196.34, respectively, to discriminate against poor outcomes. The Area Under Curve (AUC) for NLR was 0.825 (0.66-0.884), sensitivity 76.9%, specificity 73.8%; MLR was 0.763 (0.692-0.833), sensitivity 73.8%, specificity 68.1% and TLR was 0.617 (0.528-0.705), sensitivity 63.1%, specificity 60.3%. Age >30 years (OR=2.59; 95% CI 1.34-5.02), presence of comorbidities (OR=2.21; 95% CI 1.28-3.81), NLR ≥5.43 (OR=4.60; 95% CI 2.07-10.26) and MLR ≥0.46 (OR=2.09; 95% CI 0.93-4.67) were associated with poor outcomes of COVID-19 patients."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Tugas Akhir  Universitas Indonesia Library
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Selvi Nafisa Shahab
Prevalensi dan Faktor Risiko Kolonisasi Bakteri Resistan Multiobat pada Pasien saat Admisi Rawat Inap di RSUPN dr. Cipto Mangunkusumo = Prevalence and Risk Factors of Multidrug-Resistant Bacteria Colonization in Patients on Admission in Dr. Cipto Mangunkusumo Hospital
"Latar Belakang: Bakteri resistan multiobat (MDR) dapat dibawa oleh pasien yang baru masuk perawatan inap dan menjadi sumber penyebaran di rumah sakit hingga menyebabkan. Namun, pemeriksaan deteksi bakteri MDR pada awal perawatan belum menjadi standar. Oleh karena itu, dilakukan pengembangan media cair selektif yang digunakan dalam kultur bakteri untuk mengetahui prevalensi kolonisasi bakteri MDR pada pasien saat admisi rawat inap di Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo (RSCM).
Metode: Untuk mengembangkan media cair selektif, dilakukan uji stabilitas cakram carbapenem. Cakram carbapenem yang paling stabil digunakan untuk suplementasi media cair untuk bakteri batang Gram negatif resistan carbapenem (CR-GNB). Media cair selektif yang digunakan adalah tryptic soy broth (TSB) yang ditambahkan cakram antibiotik yang sesuai dengan bakteri resistan yang akan diperiksa. Media kemudian menjalani uji limit deteksi dan uji spesifisitas. Saat admisi rawat inap, subjek menjalani pengambilan spesimen dan pengisian kuesioner. Spesimen skrining yang digunakan adalah swab tenggorok, swab pusar, swab rektal, swab nasal, dan swab ketiak.
Hasil Penelitian: Berdasarkan hasil uji stabilitas, cakram imipenem adalah yang paling stabil. Media cair selektif yang digunakan untuk CR-GNB, Enterobacterales penghasil beta-lactamase spektrum luas (ESBL-PE), dan Staphylococcus aureus resistan methicillin (MRSA) adalah TSB dengan vancomycin-imipenem (limit deteksi < 1,5×10-1 CFU/mL), vancomycin-cefotaxime (limit deteksi < 1,5×10-1 CFU/mL), dan cefoxitin (limit deteksi 1,5×100 CFU/mL), berurutan. Dari 100 pasien yang diikutsertakan dalam penelitian, prevalensi kolonisasi bakteri MDR saat admisi rawat inap adalah 63%. Faktor yang berhubungan dengan kolonisasi bakteri MDR adalah riwayat penggunaan alat medis invasif dan komorbiditas, sedangkan faktor yang berhubungan dengan kolonisasi CR-GNB adalah riwayat penggunaan antibiotik.
Kesimpulan: Prevalensi kolonisasi bakteri MDR pada pasien saat admisi rawat inap di RSCM tahun 2022 adalah 63% yang berhubungan dengan riwayat penggunaan alat medis invasif dan komorbiditas.
Background: Multidrug-resistant (MDR) bacteria could be carried by newly admitted patients and become a source of spread in the hospital amd causing infections. However, the detection of MDR bacteria on admission has not been a standard. Therefore, we developed selective liquid media to culture MDR bacteria to get the prevalence of MDR bacteria colonization in patients on admission in Dr. Cipto Mangunkusumo Hospital.
Method: To develop selective liquid media, we performed carbapenem disc stability testing. The most stable carbapenem disc was used to supplement the liquid media in detecting carbapenem-resistant Gram-negative bacilli (CR-GNB). Selective liquid media used for the detection was tryptic soy broth (TSB) with added antibiotics based on the target bacteria. We performed a limit detection test and specificity test on the developed media. While admitted to the hospital, we took samples from subjects and interviewed them to fill out a questionnaire. The specimens used for this study were throat swabs, navel swabs, rectal swabs, nasal swabs, and armpit swabs.
Results: Based on the stability test, imipenem disc was the most stable. Selective media used for CR-GNB, extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE), and methicillin-resistant Staphylococcus aureus (MRSA) were TSB with vancomycin-imipenem (detection limit < 1,5×10-1 CFU/mL), vancomycin-cefotaxime (detection limit < 1,5×10-1 CFU/mL), dan cefoxitin (detection limit 1,5×100 CFU/mL), respectively. Of 100 patients included in the study,the prevalence of MDR bacteria colonization on admission was 63%. Factors associated with MDR bacteria colonization were the recent use of invasive medical devices and comorbidity, while a factor associated with CR-GNB colonization was the recent use of antibiotics.
Conclusion: Prevalence of MDR bacteria colonization in patients on admission in Dr. Cipto Mangunkusumo Hospital in 2022 was 63% and was associated with the recent use of invasive medical devices and comorbidity."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tugas Akhir  Universitas Indonesia Library
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Felicia Erika Jahja
Hubungan Derajat Keparahan Infeksi Covid-19 Terhadap Kesesuaian Kapasitas Kerja Fisik Dan Faktor Yang Memengaruhi Pada Tenaga Kesehatan Di RSUPN Dr. Cipto Mangunkusumo = The Relationship between Degree of Severity of COVID-19 Infection and Physical Activity Fitness Among Healthcare Worker in RSUPN Dr. Cipto Mangunkusumo
"Kapasitas kerja fisik merupakan hasil jarak tempuh yang dilakukan oleh pasien dalam pemeriksaan 6MWT. Pasien dengan pekerjaan tertentu memiliki estimasi kebutuhan METs minimum untuk melakukan pekerjaan. Pasien dengan infeksi COVID-19 derajat berat diduga dapat menjadi salah satu faktor yang memengaruhi kesesuaian kapasitas kerja fisik. Tujuan dari studi ini mengetahui hubungan antara derajat keparahan infeksi COVID-19 terhadap kesesuaian kapasitas kerja fisik pada tenaga kesehatan di RSUPN Dr. Cipto Mangunkusumo. Penelitian menggunakan desain studi potong lintang pada tenaga kesehatan di RSUPN Dr. Cipto Mangunkusumo. Populasi penelitian merupakan data pegawai yang terinfeksi COVID-19 pada bulan Juni-Juli 2021 dan melakukan pemeriksaan kapasitas kerja fisik pada periode September-November 2021. Pengolahan data dilakukan dengan menghimpun data secara bertahap dari rekam medis, dikelompokkan dan dilakukan uji analisis bivariat. Penentuan kesesuaian kapasitas fisik dilakukan dengan membandingkan antara hasil pemeriksaan kapasitas kerja fisik dengan estimasi kebutuhan METs minimum pekerja. Dari 102 pegawai terdapat 81 pegawai yang mengalami ketidaksesuaian kapasitas kerja fisik. Sebagian besar pegawai yang memiliki ketidaksesuaian kapasitas kerja fisik berasal dari kelompok infeksi derajat ringan (83,9%). Tidak ditemukan adanya hubungan yang bermakna (p>0,05) antara usia, jenis kelamin, IMT, gejala sisa, penyakit penyerta dan derajat keparahan terjadap kapasitas kerja fisik pada tenaga kesehatan di RSUPN Dr. Cipto Mangunkusumo
Functional capacity is the result of 6MWT distance examination. Patients with a particular job have an estimated minimum functional capacity. Patients with severe covid-19 infection are thought to be one of the factors affecting the suitability of physical activity fitness. Purpose of this study to know the relationship between severity of COVID-19 infection and physical activity fitness among healthcare worker in RSUPN Dr. Cipto Mangunkusumo.A cross-sectional study obtained data among healthcare personnel who has COVID-19 infection from June to July 2021, and undergone physical activity test between September to November 2021. Data processing is carried out by collecting data from medical records and then grouped, then bivariate analysis test is carried out. Determination of the suitability of physical activity fitness is carried out by comparing the results of the functional capacity examination with the estimated minimum METs needs of workers. A total of 102 employees, there were 81 employees who unsuitable for physical activity fitness. Most of the employees who had unsuitability of physical activity fitness came from the mild infection group (83.9%). There is no significant relationship (p>0.05) between age, gender, BMI, sequelae, comorbidities and degree of severity of COVID-19 infection and activity fitness among healthcare workers at RSUPN Dr. Cipto Mangunkusumo"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tesis Membership  Universitas Indonesia Library
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Agung Wiretno Putro
Hubungan antara gangguan depresi dengan kualitas hidup, stresor psikososial, dan tingkat kontrol asma pada pasien asma di RSUPN Dr. Cipto Mangunkusumo = Relationship between depressive disorder and quality of life psychosocial stressors level of asthma control in asthmatic patients at Dr. Cipto Mangunkusumo Hospital
"[ABSTRAK
Latar Belakang: Pasien asma dengan tingkat kontrol yang buruk dan adanya
komorbiditas seperti gangguan depresi dan stres psikososial akan memengaruhi
kualitas hidup pasien asma serta meningkatkan beban dan biaya ekonomi yang
harus ditanggung oleh pasien dan keluarganya. Untuk itu perlu diketahui
hubungan antara gangguan depresi dengan kualitas hidup, stresor psikososial, dan
tingkat kontrol asma pada pasien asma.
Metode: Penelitian cross-sectional deskriptif-analitik pada 37 pasien asma yang
memiliki gangguan depresi dan 37 pasien asma yang tidak memiliki gangguan
depresi di Poliklinik Alergi dan Imunologi RSUPN Dr. Cipto Mangunkusumo
Jakarta menggunakan Structured Clinical Interview for DSM IV Disorder(SCID)1,
instrumen World Health Organization Quality Of Life (WHOQOL)-BREF,
instrumen stresor psikososialHolmes & Rahe, dan kuesioner Ashtma Control Test
(ACT).
Hasil: Terdapat hubungan antara ada tidaknya gangguan depresi pada pasien asma
dengan skor kualitas hidup berdasarkan kesehatan fisik (p < 0,001), skor kualitas
hidup berdasarkan kesehatan psikologis (p < 0,001), skor kualitas hidup
berdasarkan relasi sosial (p = 0,023), skor kualitas hidup berdasarkan lingkungan
(p = 0,022), stresor psikososial (OR 3,85; p = 0,005), dan tingkat kontrol asma (p
= 0,001).
Simpulan: Pasien asma yang memiliki gangguan depresi cenderung memiliki
skor kualitas hidup yang lebih rendah pada domain kesehatan fisik, kesehatan
psikologis, relasi sosial, dan lingkungan dibandingkan pasien asma yang tidak
memiliki gangguan depresi. Pasien asma yang mengalami stresor psikososial yang
tinggi berisiko 3,8 kali untuk memiliki gangguan depresi. Pasien asma yang
memiliki gangguan depresi cenderung memiliki skor tingkat kontrol asma yang lebih rendah dibandingkan pasien asma yang tidak memiliki gangguan depresi. ABSTRACT Background: Asthmatic patients with poor control level and the presence of
comorbid disorders such as depression and psychosocial stress will affect the
quality of life of asthmatic patients and increases the burden and economic costs
for patient and his family. We investigated the correlation between depressive
disorders, quality of life, psychosocial stressors, and level of asthma control in
asthmatic patients.
Methods: The study was cross-sectional descriptive-analytic in 37 asthmatic
patients with depressive disorder and 37 asthmatic patients without depressive
disorder in the Allergy and Immunology Clinic RSUPN Dr. Cipto
Mangunkusumo using the Structured Clinical Interview for DSM-IV Disorder
(SCID)-1, World Health Organization Quality of Life (WHOQOL)-BREF
questionnaire, Holmes & Rahe psychosocial stressors questionnaire, and Ashtma
Control Test (ACT) questionnaire.
Results: There is arelation between the presence of depressive disorders and
lower quality of life scores based on physical health (p <0.001), quality of life
scores based on psychological health (p <0.001), quality of life scores based on
social relations (p = 0.023), quality of life scores based on the environment (p =
0.022), psychosocial stressors (OR 3.85; p = 0.005), and the level of asthma
control (p = 0.001) in asthmatic patients.
Conclusion: Asthmatic patients with depressive disorders tend to have lower
quality of life score in all domains (physical health, psychological health, social
relationships, and environment) than asthmatic patients without depressive
disorders. Asthmaticpatients who have psychosocial stressors have risk 3.8 times
higher to have depressive disorders. Asthmatic patients with depressive disorders tend to have lower level of asthma control scores than asthmatic patients without depressive disorders.;Background: Asthmatic patients with poor control level and the presence of
comorbid disorders such as depression and psychosocial stress will affect the
quality of life of asthmatic patients and increases the burden and economic costs
for patient and his family. We investigated the correlation between depressive
disorders, quality of life, psychosocial stressors, and level of asthma control in
asthmatic patients.
Methods: The study was cross-sectional descriptive-analytic in 37 asthmatic
patients with depressive disorder and 37 asthmatic patients without depressive
disorder in the Allergy and Immunology Clinic RSUPN Dr. Cipto
Mangunkusumo using the Structured Clinical Interview for DSM-IV Disorder
(SCID)-1, World Health Organization Quality of Life (WHOQOL)-BREF
questionnaire, Holmes & Rahe psychosocial stressors questionnaire, and Ashtma
Control Test (ACT) questionnaire.
Results: There is arelation between the presence of depressive disorders and
lower quality of life scores based on physical health (p <0.001), quality of life
scores based on psychological health (p <0.001), quality of life scores based on
social relations (p = 0.023), quality of life scores based on the environment (p =
0.022), psychosocial stressors (OR 3.85; p = 0.005), and the level of asthma
control (p = 0.001) in asthmatic patients.
Conclusion: Asthmatic patients with depressive disorders tend to have lower
quality of life score in all domains (physical health, psychological health, social
relationships, and environment) than asthmatic patients without depressive
disorders. Asthmaticpatients who have psychosocial stressors have risk 3.8 times
higher to have depressive disorders. Asthmatic patients with depressive disorders tend to have lower level of asthma control scores than asthmatic patients without depressive disorders.;Background: Asthmatic patients with poor control level and the presence of
comorbid disorders such as depression and psychosocial stress will affect the
quality of life of asthmatic patients and increases the burden and economic costs
for patient and his family. We investigated the correlation between depressive
disorders, quality of life, psychosocial stressors, and level of asthma control in
asthmatic patients.
Methods: The study was cross-sectional descriptive-analytic in 37 asthmatic
patients with depressive disorder and 37 asthmatic patients without depressive
disorder in the Allergy and Immunology Clinic RSUPN Dr. Cipto
Mangunkusumo using the Structured Clinical Interview for DSM-IV Disorder
(SCID)-1, World Health Organization Quality of Life (WHOQOL)-BREF
questionnaire, Holmes & Rahe psychosocial stressors questionnaire, and Ashtma
Control Test (ACT) questionnaire.
Results: There is arelation between the presence of depressive disorders and
lower quality of life scores based on physical health (p <0.001), quality of life
scores based on psychological health (p <0.001), quality of life scores based on
social relations (p = 0.023), quality of life scores based on the environment (p =
0.022), psychosocial stressors (OR 3.85; p = 0.005), and the level of asthma
control (p = 0.001) in asthmatic patients.
Conclusion: Asthmatic patients with depressive disorders tend to have lower
quality of life score in all domains (physical health, psychological health, social
relationships, and environment) than asthmatic patients without depressive
disorders. Asthmaticpatients who have psychosocial stressors have risk 3.8 times
higher to have depressive disorders. Asthmatic patients with depressive disorders tend to have lower level of asthma control scores than asthmatic patients without depressive disorders., Background: Asthmatic patients with poor control level and the presence of
comorbid disorders such as depression and psychosocial stress will affect the
quality of life of asthmatic patients and increases the burden and economic costs
for patient and his family. We investigated the correlation between depressive
disorders, quality of life, psychosocial stressors, and level of asthma control in
asthmatic patients.
Methods: The study was cross-sectional descriptive-analytic in 37 asthmatic
patients with depressive disorder and 37 asthmatic patients without depressive
disorder in the Allergy and Immunology Clinic RSUPN Dr. Cipto
Mangunkusumo using the Structured Clinical Interview for DSM-IV Disorder
(SCID)-1, World Health Organization Quality of Life (WHOQOL)-BREF
questionnaire, Holmes & Rahe psychosocial stressors questionnaire, and Ashtma
Control Test (ACT) questionnaire.
Results: There is arelation between the presence of depressive disorders and
lower quality of life scores based on physical health (p <0.001), quality of life
scores based on psychological health (p <0.001), quality of life scores based on
social relations (p = 0.023), quality of life scores based on the environment (p =
0.022), psychosocial stressors (OR 3.85; p = 0.005), and the level of asthma
control (p = 0.001) in asthmatic patients.
Conclusion: Asthmatic patients with depressive disorders tend to have lower
quality of life score in all domains (physical health, psychological health, social
relationships, and environment) than asthmatic patients without depressive
disorders. Asthmaticpatients who have psychosocial stressors have risk 3.8 times
higher to have depressive disorders. Asthmatic patients with depressive disorders tend to have lower level of asthma control scores than asthmatic patients without depressive disorders.]"
Fakultas Kedokteran Universitas Indonesia, 2015
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Elvia AS
Faktor Prediktor Acute Kidney Injury pada Pasien COVID-19 yang dirawat dI ICU RSUPN dr. Cipto Mangunkusumo Jakarta = Predictor Factors of Acute Kidney Injury in Patients COVID-19 at the ICU RSUPN dr. Cipto Mangunkusumo Jakarta
"Latar Belakang : Insiden Acute Kidney Injury (AKI) pada pasien coronavirus disease 2019 (COVID-19) yang dirawat di Intensive Care Unit (ICU) yang dilaporkan dari berbagai penelitian adalah 23% sampai dengan 81% dengan mortalitas yang makin tinggi dengan semakin tingginya serum kreatinin. Terdapat perbedaan komorbiditas yang mendasari populasi yang diperiksa, serta variasi dalam praktik dan metode diagnosis dan pelaporan AKI. Evaluasi dini pemantauan fungsi hati, ginjal, serta parameter hematologi, sangat penting untuk memprediksi perkembangan COVID-19. Berdasarkan hal diatas perlu diketahui variabel apa yang dapat mempengaruhi terjadinya AKI.
Tujuan : Tujuan penelitian ini adalah menganalisis insiden AKI pada pasien COVID-19 yang dirawat di ICU RSCM dan menganalisis pengaruh umur, jenis kelamin, komorbid, kreatinin, ureum, trombosit, leukosit, nilai Neutrophil Lymphocyte Ratio (NLR), C- Reactive Protein (CRP), obat vasoaktif dan obat nefrotoksik terhadap angka kejadian AKI pada pasien COVID-19 yang dirawat di ICU RSCM.
Metode : Penelitian ini merupakan studi observasional retrospektif dengan desain case control study. Data yang digunakan adalah data sekunder dari rekam medis pasien COVID-19 yang dirawat di ICU RSCM. Kriteria penerimaan adalah pasien dengan usia
≥ 18 tahun dan terkonfirmasi COVID-19 dengan RT-PCR positif. Kriteria penolakan adalah pasien dengan riwayat transplantasi ginjal, dan pasien Chronic Kidney Disease (CKD) gagal ginjal yang menjalani dialisis. Kriteria pengeluaran adalah pasien dengan data rekam medis yang tidak lengkap.
Hasil : Dari 370 pasien yang terkonfirmasi COVID-19 yang dirawat di ICU RSCM, 152 pasien memenuhi kriteria inklusi dari 148 subjek yang direncanakan. Hasil analisis bivariat didapatkan usia, komorbid, ureum, kreatinin dan obat vasoaktif mempunyai perbedaan bermakna terhadap angka kejadian AKI. Setelah dilakukan analisis multivariat regresi logistik didapatkan komorbid (odd ratio 2,917; 95 % confidence interval, 1,377 – 6,179; p value 0,005) dan obat vasoaktif (odd ratio 2,635; 1,226 – 5,667, p value 0,013) merupakan faktor prediktor AKI pada pasien COVID-19 yang dirawat di ICU RSUPN dr. Cipto Mangunkusumo Jakarta.
Kesimpulan : Insiden AKI pada pasien COVID-19 yang dirawat di ICU RSUPN Dr. Cipto Mangunkusumo Jakarta adalah 30,9%. Komorbid dan obat vasoaktif merupakan faktor prediktor AKI pada pasien COVID-19 yang dirawat di ICU RSUPN dr Cipto Mangunkusumo Jakarta.
Background: The incidence of Acute Kidney Injury (AKI) in COVID-19 patients treated in the Intensive Care Unit (ICU) reported from various studies is 23% to 81%, with higher mortality with higher serum creatinine. There are differences in the underlying comorbidities of the populations examined, as well as variations in practice and methods of diagnosing and reporting AKI. Early evaluation and monitoring of liver and kidney function, as well as hematological parameters, is very important to predict the development of COVID-19. By examining the predictor factors for the incidence of AKI in COVID-19 patients treated in the RSCM ICU, were there any predictor factors that were different from previous studies.
Purpose: The aim of this study was to analyze the incidence of AKI in COVID-19 patients treated at the RSCM ICU and to analyze the effect of age, gender, comorbidities, creatinine, urea, platelets, leukocytes, Neutrophil Lymphocyte Ratio (NLR), CRP, vasoactive drugs, and nephrotoxic drugs on the incidence of AKI in COVID-19 patients treated in the RSCM ICU.
Methods: This research is a retrospective observational study with a case-control study design. The data to be used is secondary data from the medical records of COVID-19 patients treated in the RSCM ICU. The acceptance criteria are patients aged ≥ 18 years and confirmed COVID-19 by positive RT-PCR. The criteria for rejection were patients with a history of kidney transplantation, and CKD patients undergoing dialysis. The exclusion criteria were patients with incomplete medical record data.
Results: Of the 370 patients with confirmed COVID-19 who were treated at the RSCM ICU, 152 patients met the inclusion criteria of the 148 planned subjects. The results of bivariate analysis showed that age, comorbidities, urea, creatinine, and vasoactive drugs had significant differences in the incidence of AKI. After multivariate logistic regression analysis, we found comorbid (OR 2.917; 95% CI, 1.377 – 6.179; p value 0.005) and vasoactive drugs (OR 2.635; 1.226 – 5.667, p value 0.013) is a predictor factor for AKI in COVID-19 patients treated at the ICU RSUPN Dr. Cipto Mangunkusumo Jakarta.
Conclusion: Incidence of AKI in COVID-19 patients treated at ICU RSUPN Dr. Cipto Mangunkusumo Jakarta is 30.9%. Co-morbidities and vasoactive drugs are predictors of AKI in COVID-19 patients treated at the ICU RSUPN Dr. Cipto Mangunkusumo Jakarta."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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Nani Oktavia
Leptin dan Skor Mortalitas 4C sebagai Prediktor Luaran Buruk Pasien COVID 19 Terkonfirmasi Selama Perawatan = Leptin and ISARIC 4C Mortality Score to Predict Poor Outcomes in Hospitalized Patients with Confirmed COVID-19
"Latar belakang: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) adalah virus menyebabkan infeksi saluran pernafasan dan memiliki manifestasi klinis ringan sampai berat serta dapat menyebabkan kematian. Tingginya angka morbiditas dan mortalitas akibat infeksi COVID 19 menyebabkan diperlukannya stratifikasi resiko terhadap pasien saat masuk ke rumah sakit serta prediktor terjadinya luaran buruk pada pasien. Tujuan: Mengetahui kemampuan skor mortalitas 4C dan kadar leptin dalam memprediksi luaran buruk pasien COVID 19 terkonfirmasi selama perawatan. Metode: Penelitian ini merupakan kohort prospektif dari 375 pasien COVID-19 yang dirawat di RSUPN Cipto Mangunkusumo sejak November 2020 hingga April 2021. Pasien dilakukan pemeriksaan fisik, CRP, Ureum  serta pemeriksaan kadar leptin saat admisi. Dilakukan analisis multivariat regresi logistik untuk menilai kemampuan skor mortalitas 4C dan leptin untuk memprediksi luaran buruk komposit yang mencakup ARDS dan mortalitas. Analisis korelasi dan regresi linier dengan STATA 15. Hasil: Dari analisis data pada 375 pasien didapatkan skor mortalitas 4C dapat memprediksi luaran buruk pasien COVID 19 selama rawat inap dengan area under curve (AUC) 0,68 (IK 0,61-0,75) dan titik potong skor mortalitas 4C adalah 6. Dari analisis multivariat didapatkan leptin tidak dapat memprediksi luaran buruk pasien COVID 19 selama rawat inap dengan area under curve (AUC) 0,52 (IK 0,44-0,60). Kesimpulan: Skor mortalitas 4C mampu memprediksi luaran buruk pasien COVID 19 terkonfirmasi selama perawatan sedangkan leptin tidak mampu menjadi prediktor luaran buruk pasien COVID 19 selama perawatan.
Background:  The high morbidity and mortality rates due to COVID-19 infection require risk stratification for patients when admitted to the hospital as well as predictors of poor patient outcomes. While obesity has been reported to be associated with poor outcomes, the role of leptin, a proinflammatory cytokines released by the adipose tissue, has never been assessed. Objective: To determine the ability of the leptin levels and 4C mortality score to predict poor outcomes in confirmed COVID-19 patients. Method: This study is a prospective cohort of 375 COVID-19 patients treated at Cipto Mangunkusumo National Referal Hospital from November 2020 to April 2021, as part of the CARAMEL study. Subjects who were 18 years old and above and had confirmed COVID-19 status through COVID-19 polymerase chain reaction (PCR) from oropharyngeal swabs were included. Subjects when admitted to the hospital required non-invasive ventilation, mechanical ventilation, ECMO and those who refused to participate in the study were excluded. A multivariate logistic regression analysis was performed to assess the ability of the 4C mortality score and leptin to predict composite adverse outcomes, including ARDS and mortality. Results: Our study observed that while the 4C mortality score could predict poor outcomes for COVID-19 patients during hospitalization with an AUC of 0.68 (CI 0.61-0.75), leptin levels could not predict poor outcomes [(AUC of 0.52 (CI 0.44-0.60)]. Conclusion: Leptin levels were not associated with the development of poor outcomes in hospitalised Covid-19 patients."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2024
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Avy Retno Handayani
Hubungan Antara Ketebalan Lidah Dengan Cormack Lehane Grading Pada Pasien Rsupn Dr Cipto Mangunkusumo = Connection Between Tongue Thickness and Cormack Lehane Grading in Patients in Dr. Cipto Mangunkusumo General Hospital
"Latar belakang: Patensi jalan napas merupakan hal paling penting dalam manajemen pasien di dalam kamar operasi maupun di luar kamar operasi. Kegagalan ataupun keterlambatan dalam manajemen jalan napas akan membawa dampak yang buruk terhadap morbiditas maupun mortalitas pasien. Prediksi kesulitan jalan napas dapat dilakukan dengan penilaian klinis maupun pemeriksaan penunjang. Cormack-Lehane grading telah lama digunakan sebagai prediksi kesulitan laringoskopi melalui visualisasi laring. Menurut penelitian yang sudah dilakukan oleh W Yao dan Bin Wang, dikatakan ukuran lebar lidah diatas 6.0 cm dapat menjadi prediksi terjadinya kesulitan intubasi. Salah satu faktor yang menyebabkan kesulitan intubasi adalah kesulitan laringoskopi yang ditandai dengan Cormack Lehane Grading ≥ 3. Penelitian ini bertujuan untuk mencari apakah terdapat hubungan ukuran lebar lidah dengan kesulitan laringoskopi yang ditandai dengan Cormack Lehane Grading.
Metode: Penelitian observasional prospektif dengan desain cross sectional ini dilakukan di Instalasi Bedah Pusat, CCC, dan Kirana RSUPN Cipto Mangunkusumo pada bulan Juli sampai September 2022. Populasi subjek adalah pasien yang akan menjalani pembedahan dengan pembiusan total dan menggunakan ETT. Ketebalan lidah diukur dengan menggunakan ultrasonografi. Penilaian Cormack Lehane Grading dilakukan melalui visualisasi laring pada saat laringoskopi dan sebelum dilakukan intubasi endotrakeal.
Hasil: Kelompok subjek dengan karakteristik sulit intubasi berdasarkan Cormack Lehane Grading (≥3) terbukti memiliki rerata ketebalan lidah yang lebih tebal dibandingkan kelompok mudah intubasi. Kelompok sulit intubasi juga terbukti memiliki Modified Mallampati Score yang lebih tinggi.
Kesimpulan: Ketebalan lidah dan Modified Mallampati Score berhubungan dengan sulit intubasi berdasarkan Cormack Lehane grading, sehingga dapat digunakan sebagai prediktor kesulitan jalan napas.
Background: Airway patency is a critical variable to maintain, either in perioperative or emergency setting. Failure or delay in airway management is associated with life-threatening complications. Prediction of difficult airway management can be done through bedside clinical examination and/or further investigations. Cormack Lehane grading has long been known as a parameter to assess difficult airway by visualization of the larynx. According to W Yao and Bin Wang, tongue thickness > 6.0 cm may be a predictor of difficult airway. One of the factors associated with difficult-to-intubate patients is difficult laryngoscopy as indicated by Cormack Lehane grading ≥ 3. This study aimed to investigate the correlation between tongue thickness and difficult laryngoscopy assessed through Cormack Lehane Grading.
Methods: This prospective observational study was conducted in Central Surgery Unit, CCC, and Kirana Unit of Cipto Mangunkusumo General Hospital in the period of July to September 2022. This study involved patients undergoing surgical interventions with general anesthesia and endotracheal intubation. Tongue thickness of each subject was assessed by ultrasonography. The assessment of Cormack Lehane grading in each subject was conducted through visualization of the larynx during laryngoscopy and prior to tracheal intubation.
Results: Difficult-to-intubate group characterized by Cormack Lehane grading ≥3 was associated with thicker tongue and higher Modified Mallampati score.
Conclusion: Tongue thickness and modified Mallampati score were associated with difficult laryngoscopy and endotracheal intubation based on Cormack Lehane grading. Therefore, tongue thickness may serve as a potential predictor of difficult airway."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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Anggreni Wiyono
Faktor-faktor yang berhubungan dengan lama rawat pra bedah pasien tumor yang dirawat di kelas III Irna A RSUPN dr. Cipto Mangunkusumo = Factors which are related to pre operative length of stay for hospitalized tumor patients in the third class of IRNA A wards dr. Cipto Mangunkusumo Hospital
"Memanjangnya lama rawat pra bedah pada pasien bedah secara umum dan pasien bedah tumor secara khusus merupakan masalah inefisiensi bagi rumah sakit. Di samping itu bagi pasien memanjangnya lama rawat ini menyebabkan bertambahnya biaya yang harus dikeluarkan sehingga kepuasan terhadap rumah sakit akan berkurang. Masalah ini melatarbelakangi penulis melakukan penelitian untuk mengetahui faktor-faktor yang yang berpengaruh terhadap lama rawat pra bedah pasien tumor tersebut.
Penelitian dilakukan pada sampel .yang terdiri dari 71 kasus pasien bedah tumor yang dirawat di IRNA A kelas 3 pads bulan Januari sampai pertengahan Februari dan bulan Juni 1996. Pada seluruh sampel dilakukan operasi di Instalasi Bedah Pusat RSUPN Dr. Cipto Mangunkusumo.
Penelitian ini merupakan penelitian deskriptif analitis dengan desain "cross sectional". Data sekunder diarnbil dari data rekam medis yang terdapat di IRNA A sebelum pasien dipulangkan. Selain itu juga dilakukan pengecekan di IBP pada saat pasien dioperasi.
Variabel bebas yang diteliti ialah kondisi medis pasien, jenis tindakan yang direncanakan, pemeriksaan penunjang yang dilaksanakan, keterlibatan dengan sub bagian lain, dan penundaan operasi. Variabel terikat ialah larva rawat pra bedah, yang terdiri dari 2 bagian, yaitu lama persiapan operasi dan lama menunggu jadwal operasi.
Hasil yang diperoleh pada penelitian ini adalah sebagai berikut :
Rata-rata lama rawat pra bedah pada keseluruhan sampel ialah 19,28 hari. Pada pasien dengan kondisi 1 tindakan medis berat ialah 24,92 hari, sedangkan pada pasien dengan kondisi 1 tindakan medis sedang ialah 11,47 hari.
Kesimpulan utama yang diperoleh adalah sebagai berikut :
1. Terdapat 4 faktor yang berhubungan dengan lama rawat pra bedah pada pasien secara keseluruhan , yaitu kondisi medis, jenis tindakan, keterlibatan sub bagian lain.
2. Faktor yang tidak berpengaruh terhadap lama rawat pra bedah pada keseluruhan sampel ialah pemeriksaan penunjang.
Saran yang diajukan oleh peneliti adalah sebagai berikut :
1. Membuat suatu alur pasien dari poliklinik bedah tumor sampai ke Instalasi Bedah Pusat, di mana pasien baru dapat dimasukkan ke IRNA A jika operasi sudah teijadwal. Pada keadaan ini tempat tidur di IRNA A sudah disiapkan. Alur ini diutamakan untuk pasien dengaan kondisi sedang, atau pasien yang tidak terlalu kompleks (dipakai pola dari SMF THT dan SMF Bedah Anak sebagai model).
2. Mengadakan upaya untuk menambah efisiensi dan utilisasi di Instalasi Bedah Pusat dengan mengacu pada hasil penelitian Duta Liana, 1966 dengan judul Analisis Faktor Faktor yang Berhubungan dengan Keterlambatan atau Pembatalan Operasi di Instalasi Bedah Pusat Rumah Sakit Dr. Cipto Mangunkusumo.
Efficiency is one of the most important parts in hospital management. Pre operative length of stay is a specific indicator for hospital efficiency. The increasing of length of stay causes the increasing cost which has to be born by patients and dissatisfaction among them.
This study was performed to 71 cases in hospitalized tumor patients to be operated in the third class of IRNA A in Cipto Mangunkusumo Hospital, from January until the middle of February and June 1996. This is a descriptive analytic study with the cross sectional design and based on the secondary data from the medical records in IRNA A wards after the surgeries.
The independent variables are : 1) The condition of the patients. 2) The type of the surgeries which are planned by the surgeons. 3) The waiting periods for the results of the laboratory tests or the waiting list for X ray tests in Radiology Department. 4) The consultations to other divisions. 5) Delayed or cancelled of the surgery. The dependent variables are the pre operative length of stay which is divided into 2 components, preparations time and waiting time for the surgeries.
The results of this study are: I) The average of pre operative length stay for all cases are 19.28 days. In the severe conditions are 24.92 days and in moderate cases 10.6 days.
The conclusions of the study are: There are relationships between condition of the patients, type of the surgeries, consultation to other divisions and delayed or cancelled of the surgeries. There is no relationship between waiting of the results of the laboratory tests or waiting lists for the radiology tests and pre operative length of stay.
The writer suggest that 1) The admission management has to be improved Surgeons should make the operation schedules in surgery room before patients are hospitalized. 2) Efficiency and utilization of the surgery department have to be increased, especially the delayed of the surgeries which caused by surgeries team not being on time (based on study of Liana, 1966)"
Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 1996
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