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Abstrak :
Penelitian mendapatkan gambaran "faktor-faktor berhubungan dengan Selfcare Behavior anak usia sekolah dengan talasemia mayor". Penelitian merupakan penelitian cross sectional. Hipotesa yang dibuktikan adalah "Adanya hubungan antara Pengetahuan, Dukungan Sosial, Status Kesehatan, Usia, Jenis Kelamin, Lamanya Sakit dengan Selfcare behavior Anak Usia Sekolah dengan Talasemia Mayor". Sampel penelitian adalah pasien usia sekolah dengan talasemia mayor di RSUPN. Dr. Cipto Mangunkusumo Jakarta, sejumlah 131 pasien. Instrumen berupa instrument pengetahuan, dukungan sosial, status kesehatan dan instrument selfcare behavior. Hasil menunjukkan ada hubungan antara pengetahuan, dukungan sosial dengan selfcare behavior, dengan pengetahuan yang paling dominan. Penelitian ini merekomendasikan untuk meningkatkan pendidikan kesehatan tentang talasemia.

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This research to gain the description on "Analysis of Factors That Corelate With Talasemia's Selfcare Bahavior School Age Children With Major Thalassemia at RSUPN. Dr. Cipto Mangukusumo Jakarta 2010". The design of this research was descriptive correlation with cross sectional method. The proven in this research was the relationship between knowledge, social support, health condition, age, gender, long illness with thalassemia's selfcare behavior. The sample were 131 school age patiens with major thalassemia. In the research used to instrument about knowledge, social support, health condition and thalasemia's selfcare behavior. The result indicated that knowledge and social support had significant correlation with thalassemia's selfcare behavior. This research recommend to improve health education about thalassemia.

Abstrak :
[ABSTRAK
Gangguan depresi mayor merupakan suatu gangguan kejiwaan ditandai dengan kemurungan, ketiadaan gairah hidup, perasaan tidak berguna dan putus asa dan mengalami minimal empat dari gejala berikut yaitu perubahan berat badan dan nafsu makan, perubahan tidur dan aktivitas, tidak ada energi, rasa bersalah, masalah dalam berfikir dan membuat keputusan, berfikir berulang tentang kematian dan bunuh diri tampa riwayat episode manik, campuran atau hipomanik, sekurang-kurangnya telah dirasakan selama 2 minggu. Survei kesehatan mental dunia pada 17 negara menemukan sekitar 1 dari 20 orang dilaporkan menderita episode depresi setiap tahunnya, paling sering terjadi adalah gangguan depresi mayor. Pengobatan dengan farmakoterapi golongan antidepresan hanya menunjukkan efektifitas 60-70% disertai efek samping yang serius sehingga berbagai modalitas terapi dikembangkan, salah satunya akupunktur. Penelitian ini bertujuan untuk mengetahui efektivitas terapi kombinasi akupunktur dengan antidepresan dibandingkan kombinasi akupunktur sham dengan antidepresan terhadap perubahan skor Hamilton Rating Scale for Depression (HAM-D 17) pada penderita gangguan depresi mayor. Uji klinis acak tersamar tunggal dilakukan pada 48 pasien gangguan depresi mayor dialokasikan ke dalam kelompok kombinasi akupunktur dengan antidepresan dan kelompok kombinasi akupunktur sham dengan antidepresan. Penilaian kemajuan terapi digunakan skor HAM-D 17. Hasil penelitian menunjukkan rerata skor HAM-D 17 pada kelompok kasus sebelum terapi 22,2±3,38 dan setelah terapi ke-12 turun menjadi 7,3±2,64. Sedangkan pada kelompok kontrol rerata skor HAM-D 17 sebelum terapi 21,4±3,10 dan setelah terapi ke-12 turun menjadi 9,3±3,33. Terdapat perbedaan bermakna antara selisih rerata penurunan skor HAM-D 17 sebelum dan setelah 12 kali terapi pada kelompok kasus 14,9±2,45 dibandingan dengan kelompok kontrol 12,2±4,30 (p<0,005). Terapi kombinasi akupunktur dengan antidepresan lebih efektif mengurangi gejala gangguan depresi mayor dibandingkan kombinasi akupunktur sham dengan antidepresan.

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ABSTRACT
Major depressive disorder is a psychiatric disorder that is characterized at least four of the following symptoms, loss of weight and appetite, sleep disturbance and loss of interest of activity, low energy level, guilt, difficulty concentrating and making decisions, recurrent death or suicide, without a history of manic episodes, mixed or hypomanic. These sings and symptoms have been felt at least for 2 weeks. The mental health survey conducted in 17 countries found that about 1 in 20 people are reported to suffer from a depressive episode each year and most are major depressive disorder. The effectiveness of antidepressant medication only 60-70% with serious side effects, so that various therapeutic modalities developed, one of which is acupuncture. This study aims to determine the effectiveness of combination therapy of acupuncture with antidepressants compared to combination of sham acupuncture with antidepressants in patients with major depressive disorder and the outcome was the score Hamilton Rating Scale for Depression (HAM-D 17). Single-blind randomized clinical trial conducted in 48 patients with major depressive disorder and the patients were allocated into two groups, intervention (acupuncture with antidepressants) and control (sham acupuncture with antidepressant). The mean of HAM-D 17 score in the intervention group before treatment was 22,2±3,38 and after treatment was 7,3±2,64. The mean of HAM-D 17 score in control group before treatment was 21,4±3,10 and after treatment was 9,3±3,33. There was significant differences between intervention and control group before and after 12 times of therapy in the mean decrease of score on HAM-D 1714.9±2.45 to12.2±4.30 (p<0.005). A combination of acupuncture therapy with antidepressants is more effective in reducing the symptoms of major depressive disorder compared to sham acupuncture combination with antidepressants, Major depressive disorder is a psychiatric disorder that is characterized at least four of the following symptoms, loss of weight and appetite, sleep disturbance and loss of interest of activity, low energy level, guilt, difficulty concentrating and making decisions, recurrent death or suicide, without a history of manic episodes, mixed or hypomanic. These sings and symptoms have been felt at least for 2 weeks. The mental health survey conducted in 17 countries found that about 1 in 20 people are reported to suffer from a depressive episode each year and most are major depressive disorder. The effectiveness of antidepressant medication only 60-70% with serious side effects, so that various therapeutic modalities developed, one of which is acupuncture. This study aims to determine the effectiveness of combination therapy of acupuncture with antidepressants compared to combination of sham acupuncture with antidepressants in patients with major depressive disorder and the outcome was the score Hamilton Rating Scale for Depression (HAM-D 17). Single-blind randomized clinical trial conducted in 48 patients with major depressive disorder and the patients were allocated into two groups, intervention (acupuncture with antidepressants) and control (sham acupuncture with antidepressant). The mean of HAM-D 17 score in the intervention group before treatment was 22,2±3,38 and after treatment was 7,3±2,64. The mean of HAM-D 17 score in control group before treatment was 21,4±3,10 and after treatment was 9,3±3,33. There was significant differences between intervention and control group before and after 12 times of therapy in the mean decrease of score on HAM-D 1714.9±2.45 to12.2±4.30 (p<0.005). A combination of acupuncture therapy with antidepressants is more effective in reducing the symptoms of major depressive disorder compared to sham acupuncture combination with antidepressants]

Abstrak :
ABSTRAK
Latar belakang: Kardiomiopati akibat kelebihan besi masih merupakan penyebab kematian utama pada pasien thalassemia b mayor. Kardiomipati akibat kelebihan besi merupakan penyakit yang reversibel dengan pemberian kelasi besi yang ditandai dengan gejala awal gangguan diastolik. Amino-terminal pro-brain natriuretic peptide NT-proBNP merupakan biomarker yang sensitif dalam mendeteksi disfungsi diastolik.Tujuan: Mengevaluasi nilai diagnostik NT-proBNP dalam mendeteksi hemosiderosis jantung yang dinilai dengan MRI T2 jantung.Metode: Enam puluh delapan pasien dengan thalassemia b mayor usia 10-18 tahun tanpa gejala gagal jantung menjalani pemeriksaan NT-proBNP saat sebelum transfusi darah. Semua subyek diperiksa MRI T2 Jantung dalam kurun waktu maksimal 3 bulan median 19 hari . Pasien kemudian dibagi menjadi kelompok hemosiderosis jantung MRI T2 jantung 20 ms .Hasil: Dari 68 pasien, didapatkan rasio lelaki : perempuan sebesar 1: 1,1 dengan usia median 14,1 tahun rentang : 10-17,8 tahun . Kadar NT-proBNP tidak berbeda bermakna antara kelompok hemosiderosis jantung dan tidak hemosiderosis jantung p-0,233 . Uji diagnosis NT-proBNP dengan nilai titik potong 160 pg/mL menghasilkan nilai sensitivitas, spesifisitas, nilai duga postif, dan nilai duga negatif secara berurutan sebesar 38,46 , 58,1 , 17,8 , dan 50 .Simpulan: Pengukuran NT-proBNP tidak dapat digunakan untuk mendeteksi hemosiderosis jantung pada anak. ABSTRACT
Background Iron induced cardiomyopathy remains the leading cause of mortality in patients with thalassemia b major. Iron deposition related cardiomiopathy, which may be reversible through iron chelation, is characterized by early diastolic dysnfunction. Amino terminal pro brain natriuretic peptide NT proBNP is a sensitive biomarker of diastolic dysfunction.Aim To evaluate the diagnostic value of NT proBNP as a surrogate marker of iron overload examined with MRI T2 .Methods sixty eight b thalassemia major patients 10 18 years with no signs of heart failure underwent NT proBNP measurement before routine transfusion. All subjects were prospectively performed cardiac MRI T2 examination within three months median 19 days . Patients were divided as cardiac hemosiderosis cardiac MRI T2 20 ms Result Of 68 patients, the male to female ratio was 1 1,1 and the median age was 14.1 years range 10 17.8 years . NT proBNP levels were not different between hemosiderosis and non hemosiderosis p 0,233 . Diagnosis test using cut off value of 160 pg mL resulted in sensitivity of 38.46 , specificity of 58.1 , positive predictive value of 17.8 , and negative predictive value of 50 .Conclusion NT proBNP cannot be used to detect cardiac hemosiderosis in adolescent.

Abstrak :
Penelitian ini bertujuan untuk mengetahui keluhan subjektif mata kering dan gangguan komponen air mata (lipid, akuos, mucin) pada pasien thalassemia mayor dengan riwayat transfusi darah jangka panjang, serta menganalisis hubungan antara kadar feritin serum, durasi, dan frekuensi transfusi darah dengan masing-masing parameter penilaian komponen lapisan air mata. Penelitian ini merupakan studi potong lintang (cross sectional) pada pasien thalassemia mayor yang sudah berusia dan mengalami transfusi darah selama minimal 10 tahun. Penilaian mata kering terdiri dari pengisian kuesioner OSDI untuk menilai keluhan subjektif, pemeriksaan biomikroskopi lampu celah dan nilai tear break up time (TBUT) untuk menilai tingkat keparahan mata kering, pemeriksaan Schirmer basal, Ferning, dan sitologi impressi konjungtiva untuk menghitung jumlah sel goblet. Data perhitungan tingkat keparahan mata kering, nilai uji Schirmer basal, TBUT, dan jumlah sel goblet dianalisis dan dicari hubungannya dengan kadar feritin serum, durasi dan frekuensi transfusi. Pada 77 subyek, mata kering terjadi sebanyak 14.3%, penurunan nilai TBUT (39%), nilai Schirmer basal (37.7%), nilai Ferning (24.7%), dan jumlah sel goblet (45.5%). Tidak terdapat perbedaan bermakna antara tingkat keparahan mata kering, nilai TBUT, nilai Schirmer basal, nilai Ferning, dan jumlah sel goblet dengan kadar feritin serum, durasi, dan frekuensi transfusi. Namun, terdapat hubungan yang bermakna antara tingkat keparahan mata kering dan usia (p = 0.014), serta nilai TBUT (p = 0.012) dan Schirmer (p = 0.014) dengan jenis kelamin. Penelitian ini memperlihatkan 14.3% subyek thalassemia mayor mengalami mata kering berdasarkan kriteria DEWS 2007. Kejadian mata kering pada thalassemia mayor tidak dipengaruhi oleh faktor transfusi dan kadar feritin serum, melainkan dipengaruhi oleh usia dan jenis kelamin. ......This study is aimed to understand subjective complaints for dry eyes and disruption of component of tear fluid (lipid, aqueous, mucin) in patients with major thalassemia with a history of long-term blood transfusions and to analyse the correlation between serum ferritin level, duration and frequency of blood transfusion. This study is a cross-sectional study. The subject of this study is patients with major thalassemia age minimum of 10 years old and have had blood transfusion for at least 10 years. OSDI questionnaire, slit-lamp biomicroscopy examination, tear break up time (TBUT), and basal Schirmer test was used to assess dry eyes severity. Ferning and conjunctiva impression cytology examination was used to assess mucin quality and count the amount of goblet cells. The correlation analysis between the result of these assessments and serum ferritin level and duration and frequency of blood transfusion was done. In 77 subjects, the prevalence of dry eyes is 14.3%. There is a decrease in TBUT (39%), basal Schirmer (37.7%), Ferning (24.7%), and goblet cells (45.5%). There is no significant correlation between dry eyes severity and TBUT, basal Schirmer, Ferning, and the amount of goblet cells with serum ferritin level, duration, and frequency of blood transfusion. There is a significant correlation between dry eyes severity and patient s age (p = 0.014); TBUT (p = 0.012), as well as, Schirmer (p = 0.014) with sex. This study showed that 14.3% of patients with major thalassemia suffer from dry eyes with severity level grade 2 according to DEWS 2007. The incidence of dry eyes is not influenced by transfusion and serum ferritin level but is influenced by age and sex.

Abstrak :
ABSTRAK
Lama transfusi darah pada talasemia mayor menyebabkan hemosiderosis. Penelitian ini untuk mengetahui dampak lama pemberian PRC terhadap hemosiderosis kulit, endokrin, jantung, tulang, hati dan limfa, serta saluran pencernaan pada anak dengan talasemia mayor di Ruang Melati 2 RSUD Dr.Moewardi Surakarta. Penelitian kuantitatif, metode deskriptif analisis dengan pendekatan cross sectional. Sampel 35 anak, usia 3-17 tahun, dalam 4 kategori transfusi darah 1-5 tahun, >5-9 tahun, >9-13 tahun, dan >13-17 tahun. Penelitian dilakukan selama 2 bulan, Mei sampai Juni 2010, dengan wawancara, pemeriksaan fisik, dan observasi. Analisis data menggunakan uji ANOVA. Ada perbedaan hemosiderosis keseluruhan organ diantara keempat kategori lama transfusi darah (p=0,05). Ada perbedaan hemosiderosis pada kulit (p=0,000), endokrin (p=0,032), tulang (p=0,015), hati dan limfa (p=0,000). Hemosiderosis dapat terjadi pada beberapa organ maupun seluruh organ tubuh. Rekomendasi untuk perawat yaitu mengantisipasi hemosiderosis dan memberikan perawatan sesuai dengan kondisi hemosiderosis anak talasemia mayor.

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Abstract
Duration of blood transfusion resulted hemosiderosis. This study to known duration of PRC transfusion effect for hemosiderosis of skin, endocrine, heart, bone, hepar and lien, and tractus digestivus in children with major thalassemia at Melati 2 ward of Dr.Moewardi Hospital in Surakarta 2010. This study was kuantitative researched, analized descriptived method, cross sectional approached. Sample of 35 children, at the age range of 3 to 17 years in 4 groups were transfusion 1-5 years, >5-9 years, >9-13 years, and >13-17 years. This study did two months, Mei until June 2010 with interviewed, physical examinated, and observated. Data analized with ANOVA test. There was statistical difference between 4 groups transfusion prolonged for hemosiderosis (p=0,05). There were statistical difference were skin (p=0,000), endocrine (p=0,032), bone (p=0,015), hepar and lien (p=0,000). Hemosiderosis could occur at several body organs or all organs. Rekomendation for nurses, nurses should anticipate hemosiderosis and taken care for each organ of hemosiderosis.

Abstrak :
ABSTRAK
Indonesia tergolong dalam negara sabuk thalassemia yang memiliki prevalensi thalassemia yang tinggi. Thalassemia β mayor dan β-HbE merupakan dua jenis thalassemia yang paling banyak ditemukan di Indonesia. Studi-studi sebelumnya menemukan bahwa thalassemia menyebabkan gangguan pertumbuhan, di antaranya berupa perawakan pendek dan abnormalitas proporsi tubuh. Belum ada penelitian di Indonesia yang mencari perbedaan kejadian perawakan pendek dan proporsi tubuh antara anak thalassemia β mayor, β-HbE, dan normal usia prepubertal. Penelitian ini dilakukan dengan desain potong-lintang dengan menyertakan sampel berusia 5-12 tahun sebanyak 130 orang. Prevalensi perawakan pendek pada anak thalassemia β mayor ditemukan sebesar 34,0, pada anak thalassemia β-HbE sebesar 24,3, dan pada anak normal sebesar 9,4. Tidak terdapat perbedaan rasio segmen atas terhadap segmen bawah pada anak thalassemia β mayor, β-HbE, dan kontrol. Rerata rasio rentang lengan terhadap tinggi badan lebih pendek pada anak thalassemia β mayor dan β-HbE dibanding pada anak normal. Jenis kelasi, usia diagnosis, durasi sakit, frekuensi transfusi, rerata Hb pretransfusi dalam 6 bulan terakhir, dan rerata ferritin dalam 6 bulan terakhir tidak berbeda antara anak thalassemia yang pendek dan yang tidak pendek.

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ABSTRACT
Indonesia belongs to thalassemia belt countries which has high prevalence of thalassemia. major and HbE thalassemia are the two most common types of thalassemia found in Indonesia. Previous studies have found that thalassemia causes growth disorders, including short stature and abnormalities of body proportions. There have been no studies in Indonesia that looked for differences in the incidence of short stature and body proportion between β major and β-HbE thalassemia and normal children in prepubertal age. This research was conducted as cross sectional study towards 130 children with age of 5 12. The prevalence of short stature was found to be 34.0 in major thalassemia, 24.3 in HbE thalassemia, and 9.4 in normal children. There was no difference in upper segment to lower segment ratio between major and HbE thalassemia and control. Arm range to stature ratio is shorter in β major and β-HbE thalassemia than control. Types of chelating agent, age of diagnosis, duration of sickness, frequency of transfusion, mean pretransfusion Hb in the last 6 months, and mean ferritin in the last 6 months did not differ between short and not short thalassemia children.

Abstrak :
Tindakan aborsi merupakan tindakan kriminal di Indonesia, akan tertapi terdapat pengecualian dalam pelaksanaannya apabila terdapat indikasi kedaruratan medis atau kehamilan terjadi akibat perkosaan. Talasemia merupakan penyakit genetik kelainan sel darah merah. Talasemia mayor merupakan keadaan klinis talasemia yang paling berat karena pengidapnya membutuhkan transfusi darah seumur hidup. Penelitian ini mengkaji permasalahan pengaturan tindakan penghentian kehamilan di Indonesia, pengaturan dan penanganan pasien pengidap talasemia mayor, serta menganalisis tindakan penghentian kehamilan terhadap janin pengidap talasemia mayor. penelitian ini merupakan penelitian yuridis-normatif yang bersifat deskriptif dengan mengkaji data sekunder yang diperoleh dari bahan hukum, serta data primer melalui wawancara narasumber, dengan metode analisis data kualitatif. Simpulan dari penelitian ini adalah pengaturan mengenai aborsi atas indikasi kedaruratan medis sebenarnya mengakomodir kasus terminasi kehamilan terhadap janin pengidap talasemia mayor setelah dilakukannya prenatal diagnosis, namun dalam pelaksanaannya, dokter kandungan di Indonesia memilih untuk mengikuti hati nuraninya dan menolak untuk melakukan terminasi kehamilan terhadap janin pengidap talasemia mayor. Perlu adanya pengaturan lebih detail mengenai batas usia kehamilan serta penyakit apa saja yang termasuk sebagai hal kedaruratan medis sebagai pengecualian diperbolehkan dilakukannya tindakan aborsi. ......Termination of pregnancy is illegal in Indonesia, but there are exceptions in its implementation if there are indications of a medical emergency or pregnancy due to rape. Thalassemia is a genetic disease of red blood cell disorders. Thalassemia major is the most severe clinical condition of thalassemia because the sufferer requires blood transfusion for life. This study examines the problems of regulating termination of pregnancy in Indonesia, the regulation and management patients with thalassemia major, and analyzing the termination of pregnancy for fetuses with thalassemia major. This research is a descriptive-juridical-normative research by examining secondary data obtained from legal materials, as well as primary data through interviewing sources, using qualitative data analysis methods. The conclusion of this study is that the regulation of abortion for medical emergency situation is sufficient to acommodates cases of termination of pregnancy for fetuses with thalassemia major after prenatal diagnosis, but in practice, obstetricians in Indonesia choose to follow their conscience and refuse to terminate pregnancy for fetuses with major thalassemia. . There needs to be a more detailed regulation regarding the age limit for pregnancy and what diseases are included as medical emergencies as an exception to the permissible act of abortion.

Abstrak :
Malnutrisi sering ditemukan pada anak dengan pasca pembedahan dan berhubungan dengan luaran sepsis atau infeksi luka operasi. Penelitian observasional analitik ini bertujuan mengetahui pengaruh malnutrisi terhadap luaran pasien pasca pembedahan dengan mengukur penurunan kadar RBP pada hari pertama dan kelima pasca pembedahan. Dilakukan pengukuran kadar RBP, kortisol, CRP pada hari pertama dan kelima pasca pembedahan, luaran infeksi dinilai berdasarkan skor ASEPSIS. Hasil penelitiaan ini menunjukkan penurunan RBP, peningkatan CRP, usia dan skor ASA berturut-turut memberikan risiko 4,4;3,3;1,2 dan 1,3 kali terjadinya infeksi luka operasi pada pasien pasca pembedahan mayor, namun tidak didapatkan perbedaan yang bermakna. ......Malnutrition is often found in children with post-surgery and associated with poor outcomes such as sepsis or surgical wound infections. This analytic observational study aims to determine the effects of malnutrition on the outcomes of patients after surgery by measuring the decrease in Retinol Binding Protein (RBP) levels on the first and fifth day post-surgery. We measured levels of RBP, cortisol, CRP in the first and fifth day post-surgery and infection outcomes were evaluated according to ASEPSIS score. The results of this study showed a decrease in RBP, an increase in CRP, age and ASA score consecutively provide risk 4.4; 3.3, 1.2 and 1.3 times for occurrence of surgical wound infections in patients after major surgery, but there were no statistically differences.