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"Latar belakang: Argon Plasma Coagulation (APC) merupakan modalitas terapi yangbanyak digunakan untuk pengobatan kolitis radiasi pada pasien keganasan ginekologi,kolorektal dan urologi yang mendapatkan radioterapi di RSUPN-CM.Tujuan: Menilai hasil dari APC yang dilakukan pada penderita kolitis radiasi danfaktor perancunya.Metode: Penelitian deskriptif analitik dengan desain kohort retrospektif berdasarkandata dari rekam medis RSUPN-CM antara bulan April 2012 sampai dengan Oktober2019. Variabel yang dinilai meliputi umur, jenis kelamin, jenis keganasan, diabetesmelitus, hipertensi, dan status anemia, dengan luaran berupa keberhasilan APC.Pengujian kemaknaan statistik dilakukan sesuai dengan karakteristik data serta tujuanpenelitian, dengan p <0,05 dianggap bermakna. Juga dilakukan analisis multivariatuntuk melihat variabel perancu yang paling memengaruhi keberhasilan APC.Hasil: Sebanyak 180 pasien kolitis radiasi yang mendapatkan terapi APC memenuhikriteria penelitian dengan proporsi terbanyak berjenis kelamin perempuan sebesar89,4%, dan berusia >50 tahun sebanyak 83,9%. Sedangkan jenis tumor terbanyakadalah keganasan ginekologi sebanyak 88,9%. Sebanyak 81,3 % subyek mengalamikeberhasilan terapi APC. Nilai tengah frekuensi APC sebanyak 2 sesi dengan rentang1 sampai 12 sesi. Terdapat 180 subyek (100%) menderita anemia sebelum menjalaniAPC yang pertama. Kadar hemoglobin pada penderita APC meningkat denganmedian Hb sebelum APC pertama sebesar 8 g/dL (3-11 g/dL) menjadi 12 g/dL (10-14g/dL) sebelum APC terakhir. Sebanyak 59,2% subyek yang mengalami keberhasilanAPC tidak lagi menderita anemia setelah terapi APC, dengan perbaikan status anemiameningkat sebesar 1,628 kali lebih baik pada subyek yang mengalami keberhasilanAPC dibandingkan dengan subyek yang mengalami ketidakberhasilan terapi APC(p=0,017). Usia, jenis kelamin, jenis keganasan, hipertensi dan diabetes melitus bukanmerupakan faktor perancu terhadap status anemia pada keberhasilan APC.Kesimpulan: Terdapat perbaikan status anemia pada penderita kolitis radiasi yangmendapatkan terapi APC di RSUPN-CM.

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Background: Argon Plasma Coagulation (APC) is recently widely used in thetreatment of radiation colitis among patients with gynecology, colorectal andurology malignancy.Purpose: To measure the result of APC conducted on radiation colitis patients and itscounfounding factors.Methods: An analytic descriptive study with retrospective cohort design based onRSUPN-CM database between April 2012 until October 2019. Variables measuredwere age, gender, tumor types, diabetes melitus, hypertension, and anaemia, withefficacy of APC treatment as the outcome. Statistical tests conducted according tocharacteristics and the purpose of the study, with p value <0.05 consideredsignificant. Multivariate analysis was also conducted to evaluate which factorsinfluenced to the efficacy of APC therapy.Results: As much as 180 radiation colitis patients received APC treatment fulfilledinclusion criteria with characteristics female patients (89.4%), and age >50 years old(83.9%) were found in this study. Types of tumor were dominated by gynecologymalignancy (88.9%). As much as 81.3% subjects had successful APC treatment.Median number of efficacy of APC treatment in this study was 2 sessions. All of thesubjects had anaemia before the first APC treatment. There was improvement in Hblevel, median Hb before the first APC treatment was 8 g/dL (3-11 g/dL) and medianHb level before the last APC treatment was 12 g/dL (10-14 g/dL). As much as 59.2%subjects who had successful APC treatment were no longer anaemia after APCtreatment, with improvement of anaemia status was 1.628 times more likely insubjects who had successful APC treatment compared to subjects who did not havesuccessful APC treatment (p=0.017). Age, gender, malignancy types, hypertensiondan diabetes melitus were not confounding factors to anaemia status in successfulAPC treatment.Conclusion: There was improvement in anaemia status on radiation colitis patientsreceiving APC treatment in RSUPN-CM."

"Latar Belakang: Kolangitis akut merupakan penyakit dengan tingkat mortalitas tinggi sehingga diperlukan diagnosis dan tatalaksana segera. Tokyo Guidelines 2018 (TG18) sebagai modalitas diagnostik perlu dinilai sensitivitasnya. Serta prediktor mortalitas kolangitis akut di Indonesia masih belum pernah diteliti. Tujuan: Menilai performa diagnostik TG18 dan prediktor mortalitas pasien kolangitis akut dewasa di Indonesia.Metode: Studi kohort retrospektif dilakukan menggunakan rekam medis pasien kolangitis RSCM dari tahun 2019-2022. Perbandingan dengan baku emas ERCP dilakukan untuk TG18. Analisis bivariat dan multivariat dilakukan untuk menilai prediktor mortalitas. Hasil: Subjek penelitian 163 orang dengan 51,5% laki-laki dengan rerata usia 51,0 ±12,81 tahun. Tingkat mortalitas selama di rumah sakit mencapai 11,6%. Sensitivitas TG18 dengan ERCP adalah 84,05% (95%CI 77,51-89,31%). Prediktor mortalitas yang bermakna pada analisis univariat adalah TG18 derajat III (RR 13,846 (3,311-57,897), p<0,001), riwayat keganasan (RR 4,400 (1,525-12,687), p=0,006), pemilihan antibiotik tidak sesuai pedoman (RR 3,275 (1,366-7,851), p=0,008) dan kadar prokalsitonin ≥ 2.0 ng/mL (RR 2,440 (1,056-5,638), p=0,037). Pada analisis multivariat prediktor yang bermakna adalah TG18 derajat III (RR 10,670 (2,502-45,565), p=0,001), penggunaan antibiotik tidak sesuai pedoman (RR 2,923 (1,342-6,367), p=0,007), dan kadar prokalsitonin ≥2.0 ng/mL (RR 2,371 (1,183-4,753), p=0,015). Simpulan: Sensitivitas TG18 cukup tinggi sehingga bisa digunakan untuk membantu diagnosis kolangitis akut. Prediktor mortalitas kolangitis akut mencakup derajat III berdasarkan TG18, pengguaan antibiotik tidak sesuai pedoman, dan kadar prokalstionin ≥2.0 ng/mL.

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Background: Acute cholangitis is a disease with a high mortality rate that requires prompt diagnosis and treatment. Tokyo Guidelines 2018 (TG18) as a diagnostic modality need to be assessed for sensitivity. Predictors of acute cholangitis mortality in Indonesia are still unknown. Objective Assessing the diagnostic performance of TG18 and predictors of mortality in adult acute cholangitis patients in Indonesia.

Methods A retrospective cohort study was conducted using the medical records of RSCM cholangitis patients from 2019-2022. Comparisons with the ERCP gold standard were made for TG18. Bivariate and multivariate analyzes were performed to assess predictors of mortality.

Results The research subjects were 163 people with 51.5% male with a mean age of 51.0 ± 12.81 years. The mortality rate during hospitalization reached 11.6%. The sensitivity of TG18 with ERCP as the gold standard were 84.05% (95%CI 77.51-89.31%). Significant predictors of mortality in Univariate analysis was TG18 grade III (RR 13,846 (3,311-57,897), p<0,001), history of malignancy (RR 4,400 (1,525-12,687), p=0,006), the use of antibiotics did not comply with the guidelines (RR 3,275 (1,366-7,851), p=0,008) and procalcitonin level ≥ 2.0 ng/mL (RR 2,440 (1,056-5,638), p=0,037) In multivariate analysis the significant predictors were TG18 degree III (RR 10,670 (2,502-45,565), p=0,001), the use of antibiotics did not comply with the guidelines (RR 2,923 (1,342-6,367), p=0,007) and procalcitonin level ≥ 2.0 ng/mL (RR 2,371 (1,183-4,753), p=0,015).

Conclusions: The sensitivity of TG18 is high enough that it can be used to help diagnose acute cholangitis. Predictors of acute cholangitis mortality included grade III based on TG18, inappropriate use of antibiotics and procalcionine level  ≥ 2.0 ng/mL."

"Latar Belakang: Reseptor ACE2 tidak hanya terdapat pada paru-paru, tetapi juga pada saluran pencernaan yang memungkinkan terjadinya infeksi SARS-COV-2 pada enterosit, menimbulkan manifestasi klinis gastrointestinal, dan terdeteksinya RNA virus pada pemeriksaan swab anal. Studi lain di seluruh dunia menunjukkan hasil yang berbeda-beda serta belum didapatkan penelitian serupa di Indonesia. Tujuan: Penelitian ini bertujuan untuk mengetahui luaran klinis infeksi COVID- 19 pada pasien yang dilakukan swab anal, mendapatkan hubungan hasil pemeriksaan PCR SARS-CoV-2 swab anal dengan manifestasi klinis gastrointestinal dan derajat keparahan pada pasien COVID-19 di Indonesia. Metode: Merupakan cabang penelitian dari penelitian utama yang berjudul “Nilai RT-PCR Swab Anal untuk Diagnosis COVID-19 pada Orang Dewasa di Indonesia”. Penelitian ini merupakan studi analitik dengan desain potong lintang. Sampel penelitian merupakan pasien COVID-19 yang menjalani rawat inap di RSUPN dr. Cipto Mangunkusumo (RSCM), RS Mitra Keluarga Depok, RS Mitra Keluarga Kelapa Gading, dan RS Ciputra selama periode April 2020 sampai dengan Januari 2021. Dikumpulkan data demografi, manifestasi klinis, derajat keparahan, dan hasil swab anal PCR SARS-CoV-2.Hasil: 136 subjek penelitian dengan swab nasofaring positif dianalisis. 52 pasien (38,2%) dengan swab anal PCR SARS-CoV-2 positif dan 84 pasien (61,8%) dengan swab anal negatif. Manifestasi klinis saluran cerna tersering, yaitu: mual-muntah 69 pasien (50,7%), nafsu makan menurun sebanyak 62 pasien (45,6%), dan nyeri perut sebanyak 31 pasien (22,8). Terdapat 114 pasien (83,8%) tergolong dalam derajat ringan-sedang dan 22 pasien (16,2%) tergolong dalam berat-kritis. Terdapat hubungan yang bermakna secara proporsi statistik antara variabel hasil pemeriksaan PCR SARS-CoV-2 swab anal dengan manifestasi klinis gastrointestinal berupa keluhan diare atau mual-muntah (nilai p 0,031). Tidak terdapat hubungan yang bermakna secara proporsi statistik antara variabel hasil pemeriksaan PCR SARS-CoV-2 swab anal dengan derajat keparahan (nilai p 0,844).Simpulan: Terdapat hubungan antara hasil pemeriksaan PCR SARS-CoV-2 swab anal dengan manifestasi klinis gastrointestinal berupa keluhan diare atau mual- muntah dan tidak terdapat hubungan antara variabel hasil pemeriksaan PCR SARS- CoV-2 swab anal dengan derajat keparahan infeksi COVID-19.

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Background: ACE2 receptor is not only found in the lungs, but also in the digestive tract, which allows the occurrence of enterocyte infection, gastrointestinal clinical manifestations, and detection of viral RNA on anal swab PCR. Studies around the world show various results, yet there has been no similar study to be found in Indonesia.

Objective: This study aims to determine the clinical outcome of COVID-19 patients with gastrointestinal manifestations who were tested by anal swab, the relationship between anal swab PCR for SARS-CoV-2 test result with gastrointestinal clinical manifestations as well as the severity of COVID-19 patients in Indonesia.

Methods: This research is a branch of study titled. The Value of Anal Swab RT- PCR for COVID-19 Diagnosis in Adult Indonesian Patients. This is an analytical study with cross-sectional design. Samples were obtained from hospitalized COVID-19 patients at RSUPN dr. Cipto Mangunkusumo (RSCM), Mitra Keluarga Hospital Depok, Mitra Keluarga Kelapa Gading Hospital, and Ciputra Hospital from April 2020 to January 2021. Demographic data, clinical manifestations, severity, and SARS-CoV-2 PCR anal swab were collected.

Results: 136 subjects with positive nasopharyngeal swab were analyzed. Result showed that 52 patients (38.2%) had positive anal swabs PCR SARS-CoV-2 and 84 patients (61.8%) had negative anal swabs. Common gastrointestinal clinical manifestations were: nausea and vomiting in 69 patients (50.7%), anorexia in 62 patients (45.6%), and abdominal pain in 31 patients (22.8). There were 114 patients (83,8%) classified as mild-moderate and 22 patients (16,2%) as severe-critical. There was a statistically significant relationship between anal swab PCR for SARS- CoV-2 test result with gastrointestinal clinical manifestations (diarrhea or nausea- vomiting) (p value 0.031). There was no statistically significant relationship found between anal swab PCR for SARS-CoV-2 test result with the severity of COVID- 19 infection (p value 0.844).

Conclusions: There is a relationship between anal swab PCR SARS-CoV-2 test result with gastrointestinal clinical manifestations (diarrhea or nausea-vomiting) and there is no relationship between anal swab PCR SARS-CoV-2 test result with severity of COVID-19 infection."

"Latar Belakang. Coronavirus Disease-19 (COVID-19) sampai sekarang masih menjadi ancaman kesehatan global. Baku emas diagnosis COVID-19 adalah pemeriksaan RT-PCR dari sampel usap nasofaring. Pengambilan sampel dengan cara ini memiliki kekurangan seperti rasa tidak nyaman pada pasien, risiko perdarahan, dan risiko paparan pada tenaga medis. Saliva merupakan salah satu alternatif sampel yang bisa digunakan untuk tujuan ini. Tujuan. Mengetahui sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif, dan akurasi RTPCR saliva. Metode. Penelitian potong lintang pasien dewasa suspek COVID-19 pada April-Juni 2021 di instalasi gawat darurat rumah sakit Siloam Lippo Village. Pasien yang memenuhi syarat dan menyatakan setuju dilakukan pemeriksaan RT-PCR dari sampel usap nasofaring dan saliva. RTPCR dikerjakan dengan menilai gen N dan gen ORF1AB menggunakan alat Rotorgen QPlex-5Plus dengan batas positif CT Value < 40. Hasil. Sebanyak 126 pasien suspek COVID-19 yang eligible ikut penelitian selama periode studi. Enam pasien menolak mengikuti penelitian. Analisis akhir dikerjakan pada 120 pasien dengan proporsi laki-laki 42,5% dan median usia 50 tahun. Hasil RT-PCR positif ditemukan pada 69 (57,5%) sampel saliva dan 75 (62,5%) sampel usap nasofaring. Sensitivitas uji RT-PCR COVID19 dari sampel saliva adalah 86,67% (95% CI 76,84- 93,42), spesifisitasnya 91,11% (95% CI 78,78- 97,52). Nilai NDP yang didapat adalah 94,20% (95% CI 86,39-97,65) dan nilai NDN yang didapat 80,39% (95% CI 69,57-88,03). Akurasi yang didapat adalah 88,33% (95% CI 81,2093,47). Rerata CT value RT-PCR dari sampel saliva lebih tinggi dibandingkan sampel nasofaring, baik pada gen N (mean saliva 26,22 vs nasofaring 22,18; p= 0,01) maupun ORF1AB (mean saliva 26,39 vs nasofaring 23,24; p= 0,01). Simpulan. Saliva yang diambil dengan metode drooling merupakan sampel yang akurat untuk pemeriksaan RT-PCR COVID-19.

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Background. Coronavirus Disease-19 (COVID-19) is still a global health problem. Diagnostic gold standard for COVID-19 is RT-PCR of the nasopharyngeal swab specimen. However, this method has several issues such as patient’s discomfort, risk of bleeding, and risk of exposure to examiner. Saliva is a viable alternative sample for this examination. Aim. To find out the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of saliva RT-PCR. Method. Crossectional study in adult patient with suspect ofCOVID-19 during April-June 2021 in emergency unit Lippo Village Hospital. Eligible and agreed patient are examined with RT-PCR from nasopharyngeal swab and saliva. RT-PCR was done by targeting gene N and ORF1AB using Rotorgen QPlex-5-Plus with CT value cut off 40. Result. A total of 126 suspected COVID-19 cases were admitted to ER during study period. Six patients were disagree to join. Final analysis was carried out on 120 patients (42.5% male, media age 60). Positive RT-PCR was found in 69 (57.5%) saliva specimens and 75 (62.5%) nasopharyngeal specimens. Sensitivity of saliva specimens was 86.67% (95% CI 76.84- 93.42), with specificity of 91.11% (95% CI 78.78-97.52). NDP of saliva was 94.20% (95% CI 86.39-97.65) with NDN of 80.39% (95% CI 69.57-88.03). Saliva’s accuracy was 88.33% (95% CI 81.20-93.47). Mean CT value of saliva specimens was higher than nasopharyngeal specimens in both gene N (mean saliva 26.22 vs nasopharyngeal 22.18; p= 0.01) and ORF1AB (mean saliva 26.39 vs nasopharyngeal 23.24; p= 0.01). Conclusion. Saliva collected with drooling method is an accurate sample for COVID-19 RT-PCR."