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"Diabetes melitus merupakan penyakit kronik dengan tingkat morbiditas dan mortalitas yang tinggi. Salah satu komplikasi yang ditakuti adalah kaki diabetik. Berdasarkan data di RSCM pada tahun 2011 sebanyak 1,3% dari pasien kaki diabetik harus menjalani amputasi. Borkosky dkk (2013) menunjukkan tingginya insidens re-amputasi pada pasien kaki diabetik sebesar 19,8%. Amputasi berulang membutuhkan biaya pengobatan yang tidak murah, selain itu dapat meningkatkan morbiditas dan mortalitas pasien. Oleh karena itu diperlukan suatu penelitian untuk mengetahui faktor-faktor risiko terjadinya re-amputasi pada pasien kaki diabetik. Penelitian ini adalah deskriptif analitik, didapatkan adanya kecenderungan penurunan jumlah kasus amputasi kaki diabetik di RSCM dari tahun 2009-2015. Level amputasi terbanyak yang dilakukan pada pasien kaki diabetik adalah amputasi minor pada level Ray. Trauma, neuropati perifer, nilai ABI ≤0,9, dan kadar HbA1c ≥7% merupakan faktor risiko terjadinya re-amputasi pada pasien kaki diabetik. trauma merupakan faktor risiko terbesar terjadinya reamputasi pada pasien kaki diabetik (p=0,000; OR 73,842; 95%CI 19,236-283,457). Jika semua faktor risiko tersebut dimiliki oleh pasien maka risiko kumulatif untuk dilakukan re-amputasi sebesar 100%.

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Diabetic mellitus is one of chronic diseases with high morbidity and mortality. One of complications of diabetic mellitus is foot diabetic. Based on data in Cipto Mangunkusumo General hospital, in 2011, prevalence of amputation for foot diabetic patients was 1,3%. Borkosky et al (2013) showed high incidence of reamputation among foot diabetic patients 19,8%. Re-amputation is highly cost and can increase morbidity and mortality in diabetic patients. Thus research needs to be done to find out risk factors of re-amputation among foot diabetic patients.

This research showed that foot diabetic amputation cases in RSCM had been decreased from 2009-2015. The most common amputation level was Ray amputation. Foot trauma, peripheral neuropathy, ABI score ≤0,9 and HbA1c level ≥7% are risk factors for re-amputation in foot diabetic patients. Foot trauma was the biggest risk factor for re-amputation in foot diabetic patients (p=0,000; OR 73,842; 95% CI 19,236-283,457). The cummulative risk factor for re-amputation for those who have all the risk factors is 100%."

"ABSTRAKLuka kaki diabetik merupakan komplikasi diabetes yang menyebabkan tingginya angka amputasi. Luka kaki diabetik membutuhkan perawatan yang efektif dan efisien untuk mecegah perluasan infeksi dan memperbaiki kerusakan jaringan. Tujuan penulisan karya ilmiah ini adalah untuk menganalisis keefektifan balutan luka modern dalam perawatan luka kaki diabetik. Metodologi yang digunakan adalah studi kasus. Hasil analisis yang didapat bahwa terdapat perbaikan pada kondisi luka berupa berkurangnya jaringan nekrotik sebanyak 75% , jumlah eksudat berkurang 80%, dan lingkungan disekitar luka tampak lembab. Studi kasus ini merekomendasikan agar perawatan luka dengan menggunakan balutan modern jenis hydrogel dapat diimplementasikan pada perawatan luka kaki diabetik untuk mempercepat proses penyembuhan luka.

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ABSTRACT

Diabetic foot ulcer is a complication of diabetes which causes high amputation rates. Diabetic foot ulcer requires effective and efficient treatment to prevent the spread of infection and repair damaged tissue. The purpose of writing this scientific paper is to analyze the effectiveness of modern dressing Hydrogel in the treatment of diabetic foot ulcer. The methodology used is a case study. The results of the analysis found that there was an improvement in the condition of the wound in the form of 75% reduction in necrotic tissue, the amount of exudate was reduced by 80%, and the environment around the wound looked moist. This case study recommends that wound care using modern dressing hydrogel can be implemented for treatment of diabetic foot ulcer to promote the wound healing process."

"Telehealth nursing adalah layanan berbasis teknologi informasi yang diharapkan dapat menjadi sarana untuk mempermudah komunikasi antara pasien dan perawat dalam merawat luka terutama pada saat kondisi pandemi COVID-19. Penelitian ini bertujuan untuk mengetahui efektifitas telehealth nursing terhadap penyembuhan ulkus kaki diabetik. Desain penelitian menggunakan quasi eksperimen dengan pre-post test with control group. Jumlah responden dalam penelitian ini sebanyak 46 orang diperoleh melalui teknik consecutive sampling. Kelompok eksperimen diberikan telehealth nursing yang berisi kombinasi edukasi dan monitoring perawatan luka mandiri dan kelompok kontrol diberikan edukasi dan perawatan luka secara langsung di klinik luka. Penyembuhan luka diukur dengan menggunakan Bates Jensen Wound Assessment Tool (BWAT). Hasil penelitian menunjukkan bahwa telehealth nursing memiliki efektifitas yang signifikan yaitu sebesar p=0,873 (α>0.05) pada proses penyembuhan luka. telehealth nursing adalah pilihan terbaik dalam merawat ulkus kaki diabetik pada pasien yang mengalami kesulitan atau dengan kondisi yang tidak memungkinkan untuk perawatan luka secara langsung ke layanan kesehatan.

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Telehealth nursing as an information technology-based service is expected to be a means to facilitate communication between patients and nurses in caring for wounds, especially during the COVID-19 pandemic. This study aims to identify the effectiveness of telehealth nursing in healing diabetic foot ulcers.This study was a quasi-experimental with a pre-post test with a control group. The study was conducted on 46 people using consecutive sampling. The intervention group was given telehealth nursing which contained a combination of education and self manage wound care monitoring and the control group was given education and wound care at the wound clinic. Wound healing was measured using the Bates Jensen Wound Assessment Tool (BWAT). The results showed that telehealth nursing had significant effectiveness of p=0.873 (α>0.05) in the wound healing process. telehealth nursing is the best choice in treating diabetic foot ulcers in patients who have difficulty or with conditions that do not allow direct wound care to health services."

"Luka diabetes merupakan komplikasi mikrovaskular yang sering dikeluhkan oleh pasien diabetes melitus (DM) tipe 2. Vaskularisasi berperan penting dalam penyembuhan luka, yang aktivitasnya diperantarai aktivitas hypoxia-inducible factor 1-alpha (HIF-1α) dan vascular endothelial growth factor (VEGF). Belum ada studi klinis yang mengevaluasi aktivitas HIF-1α dan VEGF pada manusia, khususnya pasien DM tipe 2 yang mengalami luka kaki diabetes. Tujuan penelitian adalah untuk mengevaluasi vaskularisasi jaringan, HIF-1α, dan VEGF pada luka kaki diabetes yang menjalani amputasi dan non-amputasi.Studi potong lintang dilakukan di Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo (RSCM) pada tahun 2020–2021. Subjek penelitian adalah pasien luka kaki diabetik yang dilakukan debridemen/amputasi. Kemudian diambil jaringan viabel tepi luka untuk diperiksa vaskularisasi jaringan (densitas mikrovaskular), ekspresi VEGF, serta area granulasi, di Departemen Patologi Anatomi FKUI-RSCM. Konsentrasi HIF-1α jaringan dikuantifikasi di Departemen Biokimia dan Biologi Molekuler FKUI-RSCM. Data numerik yang diperoleh diuji normalitasnya dengan uji Saphiro-Wilk. Data distribusi normal dianalisis dengan uji t tidak berpasangan. Dilakukan uji regresi logistik bila terdapat > 2 variabel independen dengan nilai p < 0,25.Dari 67 subjek terdapat 30 pasien amputasi dan 34 pasien debridemen yang dianalisis. Proporsi subjek laki-laki pada kelompok amputasi lebih tinggi dibandingkan kelompok debridemen (p = 0,041). Tidak terdapat perbedaan bermakna pada status gizi, usia, kejadian hipertensi, gagal ginjal, dan status merokok antar kedua kelompok. Profil glikemik, hematologi rutin, penanda inflamasi, kadar elektrolit, penanda fungsi hati, fungsi ginjal tidak berhubungan dengan tindakan pasien, kecuali kadar albumin. Pada analisis bivariat, kadar albumin lebih tinggi pada kelompok debridemen 2,53/0,49 dibandingkan amputasi 2,94/0,51, p = 0,002. Kelompok amputasi memiliki nilai median HIF-1α 5,77 (0,55–53,47) pg/mg protein yang jauh lebih rendah dibandingkan kelompok debridemen 26,56 (2,23–211,12) pg/mg protein (p = 0,001). Hal serupa juga ditemukan pada nilai VEGF (p < 0,001). Pasien dengan HIF-1α < 8,8065 pg/mg protein, MVD < 68,7%, VEGF < 30,443%, dan area granulasi < 33,2802% memiliki aOR 11,116 (IK 95% 1,441–85,752), 10,934 (IK 95% 1,604–74,55), 7,973 (IK 95% 1,301–48,86), 15,589 (IK 95% 1,39–174,867) untuk mengalami amputasi. Kepadatan mikrovaskular, konsentrasi HIF-1α, ekspresi VEGF, dan area jaringan granulasi lebih banyak pada pasien non-amputasi. Pasien dengan penurunan jumlah parameter tersebut memiliki risiko lebih tinggi untuk mendapat tindakan amputasi.

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Diabetic wounds are microvascular complications often complained by people with type 2 diabetes mellitus (DM). Tissue vascularization plays an essential role in wound healing, whose activity is mediated by the activity of hypoxia-inducible factor 1-alpha (HIF-1α) and vascular endothelial growth factor (VEGF). However, no clinical studies evaluate its activity in humans, especially in type 2 diabetes mellitus patients who have diabetic foot ulcers. This study attempts to evaluate whether there are differences in tissue vascularization, HIF-1 α, and VEGF in diabetic foot wounds that received amputation and non-amputation procedures.

A cross-sectional study was conducted at the Cipto Mangunkusumo National Central General Hospital (RSCM) in 2020–2021. Diabetic foot wound patients who received debridement/amputation were included in this study. Viable tissue at the wound edges was taken. The expression of VEGF, microvascular density, and area of granulated tissue were evaluated in the Department of Pathology and Anatomy, FKUI-RSCM. HIF-1 levels in tissue were quantified at the Department of Biochemistry and Molecular Biology FKUI-RSCM. All numerical data were tested for normality by the Shapiro-Wilk test. Variables with normally distributed data were analyzed by unpaired t-test. A logistic regression test was performed if there were more than two independent variables with a p-value < 0.25.

This study included 67 patients. There were 30 amputees, and 34 debridement patients included in the data analysis. The proportion of male patients in the amputation group was found to be higher than the debridement group (p = 0.041). There were no differences in nutritional status, age, the incidence of hypertension, kidney failure, and smoking status between the two groups. The glycemic profile, routine haematological findings, markers of inflammation, electrolyte levels, markers of liver function, and markers of kidney function were not found to be related to the patient's condition, except for albumin levels. In bivariate analysis, albumin levels were found to be higher in the debridement group [2.53 (0.49)] than in the amputee [2.94 (0.51)], p = 0.002. The amputee group had a median HIF-1α value of 5,77 (0,55–53,47) pg/mg protein, which was much lower than the debridement group of 26,56 (2,23–211,12) pg/mg protein (p = 0.001). Similar condition was also found in the VEGF value (p < 0.001). Patients with HIF-1α < 8.8065 pg/mg protein, MVD < 68.7%, VEGF < 30.443%, and granulation area < 33.2802% had risk odds of 11.116 (95% CI 1.441–85.752), 10.934 (95% CI 1.604–74.55), 7,973 (95% CI 1.301–48.86), 15.589 (95% CI 1.39–174.867) for amputation. Microvascular density, HIF-1α levels, VEGF expression, and granulation tissue area were higher in non-amputated patients. Patients with a decrease in these parameters have a higher risk of amputation."

"Prevalensi penderita diabetes melitus dari tahun-ketahun semakin meningkat. Salah satu komplikasi yang sering dikaitkan dengan diabetes melitus adalah luka kaki diabetik. Infeksi luka yang tidak tertangani akan berkembang menjadi sepsis dan meningkatkan risiko kematian. Peran perawat sebagai pemberi asuhan, edukator, maupun konselor dalam mencegah terjadinya sepsis sangat penting. Salah satu intervensi keperawatan dalam upaya mencegah sepsis adalah dengan perawatan luka. Perawatan luka yang tepat akan membantu mempercepat penyembuhan luka dan mencegah komplikasi lebih lanjut. Selain perawatan luka berbagai faktor dapat meningkatkan risiko terjadinya sepsis perlu dikendalikan. Tujuan penulisan karya ilmiah ini adalah untuk menganalisis pemberian asuhan keperawatan pada pasien dengan luka kaki diabetik untuk mencegah terjadinya sepsis. Dengan hasil adanya perbaikan pada kondisi luka dan tidak terjadi kondisi sepsis. Studi kasus ini menunjukkan pemberian asuhan keperawatan secara komprehensif memiliki peranan dalam mencegah terjadinya sepsis.

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The prevalence of people with diabetes mellitus from year to year is increasing. One of the complications often associated with diabetes mellitus is diabetic foot ulcer. Untreated wound infection will develop into sepsis and increase the risk of death. The role of nurses as caregivers, educators, and counselors in preventing sepsis is very important. One of the nursing interventions in an effort to prevent sepsis is wound care. Proper wound care will help speed wound healing and prevent further complications. In addition to wound care, various factors can increase the risk of sepsis need to be controlled. The purpose of writing this scientific paper is to analyze the provision of nursing care in patients with diabetic foot ulcer to prevent sepsis. With the result of an improvement in the condition of the wound and no sepsis condition occurs. This case study shows that providing comprehensive nursing care has a role in preventing sepsis."

"Dengan mengetahui patogenesis terjadinya tukak diabetik, maka masalah KD yang mempunyai gambaran sangat Iuas dapat dilakukan usaha pencegahan yang tepat agar tidak terjadi tukak. Aspek neuropati berperan besar dalam terjadinya tukak, sedangkan aspek vaskular lebih berperan dalam usaha revaskularisasi dan penyembuhan tukak yang sudah terjadi. Kelainan vaskular yang didapat sebagai komplikasi dari penyakit DM rnasih tetap merupakan suatu tantangan ilmu hedah, seorang ahli bedah sebaiknya mengetahui pertumbuhan patologik apa yang terjadi pada dinding pembuluh darah seorang pasien DM, untuk dapat merencanakan suatu perawatan I tindakan bedah yang paling menguntungkan pasien.

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By knowing the pathogenesis of diabetic ulcers, KD problems that have a very good picture can be prevented so that ulcers do not occur. The neuropathy aspect plays a big role in the occurrence of ulcers, while the vascular aspect plays a greater role in the efforts to revascularize and heal ulcers that have occurred. Vascular abnormalities acquired as a complication of fixed DM disease is a scientific challenge, a surgeon should know what pathological growths occur in the walls of a DM patient's blood vessels, to be able to plan a treatment I surgical procedure that is most beneficial to the patient."

"[ABSTRAKLatar Belakang: Pasien DM dengan ulkus kaki lebih banyak yang mengalamidepresi dan memiliki kualitas hidup yang buruk. Dalam tatalaksana ulkus kaki diabetic perlu diperhatikan faktor psikososial karena diperkirakan dapat mempengaruhi penyembuhan luka melalui induksi gangguan keseimbangan neuroendokrin-imun. Beberapa penelitian mengenai pengaruh depresi pada proses penyembuhan ulkus diabetik telah dilakukan dengan hasil yang masih kontroversial.Tujuan: Mengetahui pengaruh depresi terhadap proses perbaikan infeksi ulkus kaki diabetik, serta tingkat depresi pada pasien ulkus kaki diabetik rawat inap.Metode: Observasional, kohort prospektif, terhadap 95 pasien ulkus kaki diabetic terinfeksi yang dirawat di RSCM dan RS jejaring dalam kurun waktu penelitian, terbagi 2 kelompok yaitu kelompok depresi dan kelompok tidak depresi. Data klinis, penilaian depresi, dan data laboratorium diambil saat pasien masuk rumah sakit kemudian dinilai perbaikan infeksi ulkus kaki diabetik dalam 21 hari masa perawatan. Dilakukan analisis bivariat dengan uji Chi-square berdasarkan batas kemaknaan (α) sebesar 5% dan analisis multivariat.Hasil: Dari 95 subyek penelitian, 38 orang (40%) masuk dalam kelompok tidak depresi, sedangkan kelompok depresi terdiri atas 57 orang (60%). Subyek perempuan jumlahnya dominan pada kelompok depresi (70%). Komorbid terbanyak adalah hipertensi, dengan angka komorbiditas dan penyakit kardivaskular lebih tinggi pada kelompok depresi. Malnutrisi dan obesitas juga lebih banyak pada kelompok depresi (64,9% dan 31,6%), demikian pula dengan kontrol glikemik yang buruk (73,7%). Sebagian besar pasien (73,7%) yang masuk dalam kelompok depresi memiliki depresi ringan. Pada kelompok depresi 40,4% mengalami perbaikan infeksi dalam 21 hari masa perawatan, sedangkan pada kelompok tidak depresi 68,4%.Simpulan: Depresi cenderung meningkatkan risiko atau kemungkinan tidak terjadinya perbaikan infeksi ulkus kaki diabetik, walaupun setelah dilakukan penyesuaian terhadap variabel perancu, hasil tersebut tidak bermakna secara statistik (adjusted OR 2,429 dengan IK 95% 0,890-6,632). Lebih banyak subjek dengan depresi sedang yang tidak mengalami perbaikan infeksi ulkus kaki diabetik dibandingkan dengan subjek dengan depresi ringan (93,3% dan 47,6%).

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ABSTRACTBackground: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial.Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers.Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis.Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%.Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%).;Background: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial.Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers.Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis.Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%.Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%).;Background: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial.Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers.Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis.Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%.Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%)., Background: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial.Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers.Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis.Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%.Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%).]"

"ABSTRAKPendahuluan:Modifikasi dari kriteria klinis infeksi menurut International Disease Society of America dan International Working Group on Diabetic Foot (IDSA-IWGDF) diperlukan untuk mengevaluasi infeksi pada ulkus kaki diabetik setelah pengobatan. Prokalsitonin (PCT), penanda infeksi yang spesifik untuk infeksi bakteri diketahui bermanfaat dalam menegakkan diagnosis infeksi pada ulkus kaki diabetik. Namun, peranannya dalam menentukan ada tidaknya infeksi pada ulkus kaki diabetik setelah pengobatan belum diketahui, begitu juga nilai tambahnya terhadap penanda klinis infeksi. Penelitian ini dilakukan untuk menentukan kemampuan penanda klinis infeksi menurut IDSA-IWGDF yang dimodifikasi dan PCT dalam mengevaluasi masih ada atau tidaknya infeksi pada ulkus kaki diabetik setelah pengobatan.Metode:Dilakukan studi potong lintang berbasis riset diagnostik pada penyandang diabetes dengan ulkus kaki terinfeksi yang sedang mendapatkan pengobatan dan perawatan di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta pada kurun waktu Oktober 2011-April 2012. Pasien yang sudah memenuhi kriteria inklusi dan eksklusi penelitian dilakukan penilaian infeksi pada ulkus menggunakan kriteria klinis infeksi menurut IDSA-IWGDF yang dimodifikasi (eritema, edema, nyeri, dan panas) dan pemeriksaan PCT. Kemudian dinilai kemampuannya dalam mengevaluasi masih ada atau tidaknya infeksi pada ulkus kaki diabetik setelah pengobatan dengan membuat kurva ROC dan menghitung AUC. Lalu ditentukan titik potong dengan sensitivitas dan spesifisitas terbaik pada penelitian ini yang dibandingkan dengan baku emas berupa pemeriksaan bakteri secara kuantitatif dari kultur jaringan ulkus.Hasil:Dari 47 subjek yang diteliti, terdapat 41 subjek dengan ulkus kaki diabetik yang masih terinfeksi berdasarkan pemeriksaan bakteri secara kuantitatif dari kultur jaringan ulkus. Penanda klinis infeksi menurut IDSA-IWGDF yang dimodifikasi memilki kemampuan prediksi yang baik dalam menentukan masih ada atau tidaknya infeksi pada ulkus kaki diabetik setelah pengobatan dengan AUC: 0,744 (IK 95% 0,576-0,912) dengan titik potong bila ditemukan ≥2 tanda klinis infeksi (Sn: 41,46%; Sp: 100%; NPP: 100%, NPN: 20%). Sedangkan, untuk prokalsitonin didapatkan AUC: 0,642 (IK 95% 0,404-0,880).Simpulan:Kriteria klinis infeksi menurut IDSA-IWGDF yang dimodifikasi memiliki kemampuan yang baik untuk menentukan masih ada atau tidaknya infeksi pada ulkus kaki diabetik setelah pengobatan. Belum didapatkan manfaat prokalsitonin dalam mengevaluasi masih ada atau tidaknya infeksi pada ulkus kaki diabetik setelah pengobatan."

"ABSTRAKLatar belakang. Diabetes mellitus DM merupakan salah satu penyakit kronis yang komplikasinya masih menjadi masalah besar di Indonesia. Salah satu komplikasi DM yang paling sering dan sering berakhir dengan kecacatan adalah kaki diabetik. Angka amputasi di Indonesia khususnya di RSUPN dr. Cipto Mangunkusumo RSCM masih cukup tinggi dibandingkan dengan negara lain di Asia. Salah satu faktor predisposisi amputasi kaki diabetik adalah perfusi jaringan yang dapat diukur dengan ankle brachial index ABI . Studi sebelumnya menunjukkan hubungan signifikan antara ABI dengan kejadian amputasi. Penelitian ini bertujuan untuk mengetahui hubungan nilai ABI dengan besarnya risiko terjadinya amputasi minor dan mayor pada penderita kaki diabetic dalam populasi kami.Metode. Kami melakukan studi retrospektif pada 84 subjek dengan kaki diabetik yang diamputasi di RSCM selama periode 1 Januari 2013 sampai dengan 31 Desember 2014. Karakteristik subjek dan vaskular termasuk diantaranya ABI dianalisa secara statistik.Hasil. Kami dapatkan sepsis dengan adjusted OR 95 CI : 0,023 0,004 sampai 0,157 dan nilai ABI yang memiliki adjusted OR 95 CI : 2,89 1,33 sampai 6,29 merupakan variabel yang bermakna dengan kejadian amputasi pada pasien kaki diabetik.Kesimpulan. Subjek dengan nilai ABI 1,3 secara independen.

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AbstractBackgroundhr>ABSTRACT. Diabetes mellitus is one of the chronic diseases in which the complication is still a major problem in Indonesia. One of the most frequent complications of diabetes mellitus and often ends up with a disability is diabetic foot. The number of amputation in Indonesia, especially in dr. Cipto Mangunkusumo Hospital RSCM is quite high compared to other countries in Asia. One of predisposing factors of diabetic foot amputation is the tissue perfusion that can be measured by the ankle brachial index ABI . All the studies carried out abroad and in RSCM show a significant relationship between ABI and the incidence of amputation. This study aims to determine the relationship of ABI score with the magnitude of minor and major amputation risks in patients with diabetic foot.Method. The retrospective study was conducted in 84 patients with diabetic foot that were amputated at the RSCM during the period of January 1, 2013 to December 31, 2014. Samples were taken consecutively. Statistical analysis is done to find out a relationship between predisposing factors with the incidence of minor and major amputations in patients with diabetic foot. Chi Square test or Fisher, as well as multivariate analysis using logistic regression is used. The significance if p was "

"ABSTRAKDiabetes melitus DM merupakan suatu epidemik global. Obesitas merupakan faktor risiko tersering pada terjadinya DM tipe 2. Salah satu komplikasi yang sering dialami oleh penderita DM ialah kaki diabetik. Pada pasien DM dengan obesitas dan kaki diabetik, terapi medik gizi penting untuk mencapai target berat badan, menjaga kadar glikemik, serta mencegah komplikasi DM. Selain itu pemberian nutrisi yang adekuat juga penting untuk mendukung penyembuhan luka. Pasien pada serial kasus ini berusia antara 41 ndash;59 tahun dengan dengan proporsi yang sama antara laki-laki dan perempuan. Keempat pasien memiliki status gizi obes dengan IMT sebesar 26-54,4 kg/m2. Awitan DM pada keempat pasien diketahui bervariasi antara 1-13 tahun. Terapi medik gizi diberikan sesuai dengan klinis, hasil laboratorium, dan asupan terakhir masing-masing pasien. Dari hasil pemantauan didapatkan bahwa dengan terapi nutrisi yang diberikan terjadi penurunan berat badan sebesar 3,2-4,8 kg 3,2-5,8 dan penurunan nilai HbA1c sebanyak 0,3-0,7. Selain itu juga didapatkan ukuran luka yang mengecil dan gejala neuropati berkurang. Pada pasien DM tipe 2 dengan obesitas dan kaki diabetik, terapi medik gizi yang adekuat berkaitan dengan penurunan berat badan, perbaikan kontrol glikemik, dan penyembuhan luka yang baik.

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ABSTRACT<>br>Diabetes mellitus is now a global epidemic. Obesity is a common risk factor in the occurrence of type 2 diabetes. One of the complications that are often experienced by people with diabetes is diabetic foot. In diabetic patients with obesity and diabetic foot, medical nutrition therapy is important to achieve targeted body weight, maintain glycemic levels, and prevent diabetes complications. Good nutrition is also essential for wound healing. This case series consists of four patients who are between 41-59 years old and obese with BMI of 26-54.4 kg/m2. The onset of DM in all four patients is known to vary between 1-13 years. Nutritional therapy is given in accordance with the clinical, laboratory outcomes, and patients' daily intake. It was found that medical nutrition therapy can lead to weight loss of 3.2-4.8 kg (3.2-5.8%) and decreased HbA1c by 0.3-0.7%. It was also observed that the wound size and neuropathy symptoms are reduced. Adequate medical nutrition therapy in type 2 DM patients with obesity and diabetic foot is associated with weight loss, improved glycemic control, and good wound healing."