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Abstrak :
Latar belakang : Kejadian jatuh yang tinggi pada usia lanjut berhubungan erat dengan penurunan kekuatan otot. Seiring bertambahnya usia terjadi sarkopenia dimana massa otot berkurang sebesar 1-2% setiap tahun dan menyebabkan penurunan kekuatan otot sebesar 3%. Vitamin D mempunyai aksi biologis pada otot sehingga menjadi salah satu modalitas terapi sarkopenia. Walaupun peran vitamin D pada kekuatan otot masih kontroversial, namun studi sebelumnya menunjukkan analog vitamin D (alfacalcidol) dapat meningkatkan kekuatan otot dengan memakai luaran kekuatan otot ekstremitas bawah. Tujuan : Menentukan pengaruh alfacalcidol terhadap kekuatan otot ekstremitas atas yang diukur dengan pemeriksaan kekuatan genggam tangan pada perempuan usia lanjut Indonesia. Metode : Studi ini merupakan uji klinis acak tersamar ganda yang dilakukan selama bulan April-September 2012 di poliklinik Geriatri RS. Cipto Mangunkusumo, Jakarta. Subjek penelitian adalah perempuan berusia ≥ 60 tahun dengan kekuatan genggam tangan £ 22 kg yang diukur dengan dinamometer. Subjek dirandomisasi dalam dua kelompok yaitu kelompok yang menerima alfalcalcidol 1x0,5 mg dan kelompok kontrol menerima plasebo. Masing-masing kelompok mendapat kalsium laktat 500 mg dan diamati selama 90 hari. Pada akhir penelitian dilakukan pemeriksaan kekuatan genggam tangan. Hasil : Sebanyak 122 subjek direkrut, namun terdapat 27 subjek yang mempunyai kriteria eksklusi sehingga randomisasi membagi 95 subjek masing-masing 47 subjek pada kelompok alfacalcidol dan 48 subjek pada kelompok plasebo. Sebanyak 88 subjek menyelesaikan penelitian hingga akhir (7 drop out) dan dianalisis dengan uji Mann Whitney. Terdapat perbedaan peningkatan kekuatan otot yang bermakna antara kelompok alfacalcidol dibanding kelompok plasebo (15,50 kg vs. 13,75 kg ; p= 0,003). Kesimpulan: Analog vitamin D (alfacalcidol) dapat meningkatkan kekuatan otot perempuan usia lanjut Indonesia yang mempunyai kekuatan genggam tangan yang rendah dibandingkan pemberian plasebo.

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Background : The age-related increase in falls is strongly associated with a decline in muscle strength. Sarcopenia develops in concomitant with aging, where muscle mass decrease 1-2% annually, lead to 3% reduction in muscle strength. Vitamin D was known to have a biological action on muscle, so it was used as one of the therapy for sarcopenia. Although the role of vitamin D on muscle strength was still controversial, previous studies in vitamin D analog (alfacalcidol) reveal a promising effect in lower extremity muscle strength. Objective : To determine the effect of alfacalcidol on upper extremities muscle strength in elderly ambulatory Indonesian women. Methods : This was a randomized, double-blind clinical trial, which was conducted at Geriatrics Outpatient Clinic of Cipto Mangunkusumo General Hospital Jakarta, during April to September of 2012. The study subject consists of elderly women (aged ≥60 years old) with handgrip strength of ≤ 22 kg, measured with a handheld dynamometer. Subject was then randomized to two groups, one receiving alfacalcidol 1x0.5 mcg and the other receiving identically packaged placebo. Each group also received 500mg calcium lactate daily and then was observed for 12 weeks. At the end of the observation period, a second measurement of handgrip by using handheld dynamometer was performed. Outcome : A total 122 subjects were enrolled in this study. There were 95 subjects fulfilled the eligible criteria consist of 47 subjects receiving alfacalcidol and 48 subjects as a control. A number of 88 subjects were able to complete the intervention period and then the results were analyzed with Mann Whitney test. The study showed a significant increase of muscle strength in the intervention group compared to placebo (15.50 kg vs. 13.75 kg; p = 0.003). Conclusion : Daily doses of 0.5 mg alfacalcidol significantly improved muscle strength in elderly Indonesian women with low handgrip strength compared to placebo.

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[ABSTRAK
Latar belakang: Berdasarkan data riskesdas 2013, prevalensi batu saluran kemih di Indonesia adalah 0,6 persen. Batu saluran kemih disebabkan oleh beberapa faktor; lingkungan kerja panas dan BJ Urin. Sebagian pekerja dapur RS X Tangerang mengeluh lingkungan kerja yang panas berlebihan sehingga berkeringat dan data medical check up tahun 2014 tidak ada pemeriksaan urin sehingga gambaran status kesehatan pekerja akibat lingkungan panas tidak dapat diketahui. Penelitian ini bertujuan untuk mengetahui hubungan lingkungan kerja panas dengan kristalisasi urin pada pekerja dapur RS X Tangerang. Metode: Rancangan penelitian yang digunakan adalah kros seksional. Pengumpulan data dilakukan di RS X Tangerang dari bulan Januari sampai Maret 2015, dengan menggunakan kuesioner, wawancara, pemeriksaan tanda vital responden sebelum dan sesudah kerja, pemeriksaan urinalisa sebelum dan sesudah kerja serta pengukuran suhu lingkungan kerja dengan menggunakan alat area heat stress monitor Quest Stemp 36 dan perhitungannya berdasarkan Indeks Suhu Bola Basah. Berdasarkan metode total populasi dan setelah mempertimbangkan faktor eklusi dan inklusi didapatkan sampel sebanyak 105 orang. Hasil: Prevalensi kristal urin ditemukan sebesar 6,7% pada pemeriksaan urin sebelum kerja dan 10,5% sesudah kerja. Lingkungan kerja panas tidak mempunyai hubungan yang bermakna dengan terjadinya kristalisasi urin pada pekerja (p=0,316). BJ urin mempunyai hubungan yang bermakna dengan terjadinya kristalisasi urin (p<0,05), dimana risiko untuk terjadinya kristalisasi urin meningkat 1,8 kali sesudah kerja. Faktor risiko lain seperti umur, jenis kelamin, riwayat penyakit, Indeks Masa Tubuh, kebiasaan makan dan minum, masa kerja, lama kerja, dan jenis pekerjaan tidak terdapat hubungan yang bermakna (p>0,05). Kesimpulan: Lingkungan kerja panas dan faktor risiko lainnya tidak berhubungan dengan terjadinya kristalisasi urin pada pekerja di bagian dapur RS X Tangerang. BJ Urin responden berhubungan dengan terjadinya kristalisasi urin baik pada pemeriksaan urin sebelum dan sesudah kerja, Ini berarti sebelum kerja responden sudah dehidrasi, mungkin karena kurang minum atau paparan panas sebelumnya. Ditambah lingkungan kerja panas kepekatan urin meningkat, karenanya dianjurkan pekerja mengkonsumsi cairan minimal dua liter perhari.

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ABSTRACT
Background: According to 2013 Riskesdas data, the prevalence of urinary tract calculus in Indonesia is 0.6%. Several factors like temperature of working environment and urine specific gravity contribute to the formation of urinary tract calculus. Some of kitchen workers in the hospital X Tangerang complain about their hot working environment which caused them to sweat excessively and medical check-ups data in 2014, there was no urine examination so that an overview of health status of workers due to hot environment can‟t be obtained.This study aims to determine the relationship between hot working environment and urine crystallization on the kitchen workers of hospital X Tangerang Methods: The research used a cross-sectional design. Data collection was done in Hospital X Tangerang from January to March 2015 using questionnaire, interview, and vital signs examination of the respondents before and after work, urine examination before and after work. Environment temperature was measured using area heat stress monitor Quest Stemp 36 and the calculation was done based on WBGT (Wet Bulb Globe Temperature Index). Using total population methods after considering the inclusion and exclusion factors, we acquired 105 people as samples. Result: The prevalence of urinary crystals was 6. 7% on urine samples before work and 10.5% after work. The relationship between hot working environment and the formation of crystals in the urine was not significant in the kitchen workers (p>0.316). Urine specific gravity has a significant relationship to the formation of crystals in the urine (p<0.05) in which the risk of the crystals formation increase 1,8 time after work. The other risk factors such as age, sex, hospital sheet, body mass index, eating and drinking habits, tenure, long working, and type of work showed no significant relationship (p>0.05). Conclusion: Hot working environment and the other risk factors are not related to urine crystallization in the kitchen workers of Hospital X Tangerang. Urine specific gravity is related to the formation of crystals in the urine before and after work. This means, before working respondents already dehydrated, probably due to lack of drinking or heat exposure before. Hot working environment increases urine concentration. It‟s recommended for workers to consume at least two liters of fluid perday., Background: According to 2013 Riskesdas data, the prevalence of urinary tract calculus in Indonesia is 0.6%. Several factors like temperature of working environment and urine specific gravity contribute to the formation of urinary tract calculus. Some of kitchen workers in the hospital X Tangerang complain about their hot working environment which caused them to sweat excessively and medical check-ups data in 2014, there was no urine examination so that an overview of health status of workers due to hot environment can‟t be obtained.This study aims to determine the relationship between hot working environment and urine crystallization on the kitchen workers of hospital X Tangerang Methods: The research used a cross-sectional design. Data collection was done in Hospital X Tangerang from January to March 2015 using questionnaire, interview, and vital signs examination of the respondents before and after work, urine examination before and after work. Environment temperature was measured using area heat stress monitor Quest Stemp 36 and the calculation was done based on WBGT (Wet Bulb Globe Temperature Index). Using total population methods after considering the inclusion and exclusion factors, we acquired 105 people as samples. Result: The prevalence of urinary crystals was 6. 7% on urine samples before work and 10.5% after work. The relationship between hot working environment and the formation of crystals in the urine was not significant in the kitchen workers (p>0.316). Urine specific gravity has a significant relationship to the formation of crystals in the urine (p<0.05) in which the risk of the crystals formation increase 1,8 time after work. The other risk factors such as age, sex, hospital sheet, body mass index, eating and drinking habits, tenure, long working, and type of work showed no significant relationship (p>0.05). Conclusion: Hot working environment and the other risk factors are not related to urine crystallization in the kitchen workers of Hospital X Tangerang. Urine specific gravity is related to the formation of crystals in the urine before and after work. This means, before working respondents already dehydrated, probably due to lack of drinking or heat exposure before. Hot working environment increases urine concentration. It‟s recommended for workers to consume at least two liters of fluid perday.]

Abstrak :
[ABSTRAK
Status hidrasi dipengaruhi oleh banyak faktor termasuk usia. Perubahan fisiologis yang terjadi pada lansia yaitu penurunan sensasi rasa haus, penurunan sekresi aldosteron, dan penurunan fungsi luhur dapat menyebabkan peningkatan risiko dehidrasi pada lansia. Penelitian analitik observasional dengan metode potong lintang telah dilakukan di rumah binaan lansia Atmabrata, Cilincing Jakarta Utara, dengan tujuan untuk menilai status hidrasi pada lansia dan faktor-faktor yang berhubungan yaitu asupan cairan dan aktivitas fisik. Lima puluh sembilan subjek berhasil menyelesaikan protokol penelitian. Hasil penelitian menunjukkan bahwa 27,1% lansia mengalami dehidrasi dengan menggunakan indikator berat jenis urin dan 49,2% lansia tidak terhidrasi dengan baik dengan menggunakan indikator warna urin. Rerata asupan cairan subjek adalah 1327,97 ± 407,75 mL, dan terdapat 72,9% subjek dengan aktivitas fisik rendah. Tidak terdapat hubungan antara status hidrasi dengan asupan cairan (p>0,05), dan sebaliknya terdapat hubungan yang bermakna antara berat jenis urin dengan tingkat aktivitas fisik (p <0,001).

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ABSTRACT
Hydration status can be affected among others by age. Dehydration risk is higher in the elderly. Physiological changes such as decreasing sensation of thirst, decreasing secretion of aldosterone and impaired cognitive fuction could be the causes of dehydration among elderly. Analytic observational by using cross sectional study design conducted in Atmabrata nursing home, Cilincing North Jakarta has been done to asses hydration status in the elderly and its related factors, i.e fluid intake and physical activity. Fifty nine subjects accomplished the study protocol. Based on the urine specific gravity measure, it shows that 27.1% elderly was dehydrated and by using urine color chart, it shows that 49.2% elderly was not hydrated properly. The fluid intake average of the subject was 1327.97 ± 407.75 mL, and there was 72.9% subject with low physical activity. There was no significant association between hydration status and fluid intake (p>0.05). There was significant association between urine specific gravity status and level physical activity (p<0.001)., Hydration status can be affected among others by age. Dehydration risk is higher in the elderly. Physiological changes such as decreasing sensation of thirst, decreasing secretion of aldosterone and impaired cognitive fuction could be the causes of dehydration among elderly. Analytic observational by using cross sectional study design conducted in Atmabrata nursing home, Cilincing North Jakarta has been done to asses hydration status in the elderly and its related factors, i.e fluid intake and physical activity. Fifty nine subjects accomplished the study protocol. Based on the urine specific gravity measure, it shows that 27.1% elderly was dehydrated and by using urine color chart, it shows that 49.2% elderly was not hydrated properly. The fluid intake average of the subject was 1327.97 ± 407.75 mL, and there was 72.9% subject with low physical activity. There was no significant association between hydration status and fluid intake (p>0.05). There was significant association between urine specific gravity status and level physical activity (p<0.001).]

Abstrak :
ABSTRAK Nelayan merupakan pekerjaan yang memiliki banyak risiko kesehatan namun masih belum terlalu diperhatikan. Lama kerja nelayan lebih panjang dari lama kerja normal serta waktu bekerja yang berbeda yaitu pada malam hari. Jika hipertensi tidak ditangani secara tepat maka dapat menyebabkan terjadinya komplikasi yang lebih serius seperti serangan jantung mendadak yang dapat terjadi kapan saja ketika para nelayan tersebut sedang melakukan pekerjaannya ditengah laut. Tujuan penelitian ini adalah diketahuinya masalah peningkatan tekanan darah pada nelayan tradisional dan pengaruhnya dengan faktor pekerjaan dalam hal ini lama kerja guna meningkatkan derajat kesehatan pada nelayan di Pelabuhan Merak Banten.Penelitian ini menggunakan disain kasus kontrol, dimana dilakukan pemeriksaan tekanan darah serta wawancara terhadap responden. Pengambilan sampel menggunakan teknik consecutive sampling. Jumlah sampel dalam penelitian sebanyak 120 orang yang terdiri dari 60 kasus dan 60 kontrol. Hasil penelitian didapatkan adanya pengaruh lama kerja dengan kejadian peningkatan tekanan darah pada nelayan tradisional di Pelabuhan Merak Banten OR =1,2;p=0,023 . Faktor lain yang memiliki pengaruh signifikan terhadap kejadian peningkatan tekanan darah yaitu faktor asupan garam OR=4,5;p=0,000 dan kualitas tidur OR=4,2;p=0,001 . Faktor yang tidak memiliki pengaruh signifikan yaitu faktor asupan lemak OR=4,5;p=0,053 , riwayat keluarga OR=4,97;p=0,035 , status gizi OR=0,73;p=0,610 dan aktifitas fisik OR=3,72;p=0,008 .Hasil analisis multivariat didapatkan faktor yang paling dominan yang mempengaruhi kejadian peningkatan tekanan darah yaitu faktor faktor asupan garam OR=4,5;p= 0,000 , dan kualitas tidur OR=4,2;p=0,001 . Lama kerja panjang memiliki risiko 1,2x lipat lebih besar terhadap kejadian peningkatan tekanan darah pada nelayan tradisional. Diperlukan penyuluhan mengenai hipertensi dan faktor ndash; faktor yang mempengaruhinya untuk mencegah komplikasi lebih lanjut. Kata kunci : Hipertensi, Peningkatan tekanan darah Nelayan, Jam kerja panjang.

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ABSTRACT Fisherman is a job that has many health risks but still not too concerned. The length of work of the fishermen is longer than the normal length of work and the different working hours at night. If hypertension is not handled properly it can lead to more serious complications such as sudden cardiac arrest that can occur anytime when the fishermen are doing their work in the middle of the sea. The purpose of this study is to know the problem of increasing blood pressure in traditional fishermen and its influence with the work factor in this case the length of work in order to improve the degree of health to the fishermen in the Port Merak Banten.This study used case control design, where the blood pressure was tested and interviews of the respondents. Sampling using consecutive sampling technique. The number of samples in the study were 120 people consisting of 60 cases and 60 controls. The result of the research shows that there is influence of working duration with the incidence of blood pressure increase in traditional fisherman at Merak Port of Banten OR 1,2 p 0,023 . Other factors that have a significant influence on the incidence of increased blood pressure are salt intake factor OR 4.5, p 0,000 and sleep quality OR 4,2 p 0.001 . Factors that did not have significant influence were fat intake factor OR 4,5, p 0,053 , family history OR 4,97 p 0,035 , nutritional status OR 0,73 p 0,610 and Physical activity OR 3,72 p 0,008 .The result of multivariate analysis showed that the most dominant factors influencing the incidence of blood pressure increase were salt intake factor OR 4,5, p 0,000 , and sleep quality OR 4,2 p 0,001 . Longer labor has a 1.2 fold greater risk of increased blood pressure in traditional fishermen. There is a need for counseling on hypertension and the factors that influence it to prevent further complications. Keywords Hypertension, Increased blood pressure, Fisherman, Long working hours.

Abstrak :
Pendahuluan Karsinoma nasofaring (KNF) merupakan jenis keganasan yang unik dengan distribusi geografis dan etnis tertentu. Daerah Cina Selatan dan Asia Tenggara memiliki insidens kejadian yang tinggi. Indonesia memiliki insidens 5,66 kasus per 100.000 penduduk per tahun. Salah satu penyebab kematian pasien dengan keganasan adalah trombosis. Kadar soluble Platelet-selectin (sP-selectin) yang tinggi dalam plasma, hasil dari aktivasi sel-sel endotel dan trombosit, adalah prediktor kejadian trombosis.

Tujuan Mengetahui kadar sP-selectin pada berbagai stadium karsinoma nasofaring dan korelasinya dengan hitung trombosit.

Metode Dilakukan studi potong lintang pada 60 kasus karsinoma nasofaring yang baru terdiagnosis di Rumah Sakit Cipto Mangunkusumo pada periode Maret hingga November 2012. Kadar sP-selectin diukur dengan teknik Enzyme Linked Immunosorbent Assay.

Hasil Rerata usia adalah 43,9 tahun dengan rasio laki-laki terhadap perempuan 3:1. Jenis patologi terbanyak adalah karsinoma tidak berdiferensiasi (83,3%). Sepuluh persen pasien mengalami trombositosis. Median kadar sP-selectin adalah 45,73 ng/mL dengan rentang interkuartil: 42,02-57,66 ng/mL. Secara statistik terdapat perbedaan kadar sP-selectin diantara stadium IVC dengan stadium lainnya (stadium IVB, p = 0,001 dan kelompok stadium I-IVA, p < 0,001). Hitung trombosit tidak berkorelasi dengan sP-selectin (r: 0,185; p = 0,158).

Simpulan Terdapat perbedaan kadar sP-selectin pada berbagai stadium karsinoma nasofaring. Hitung trombosit tidak berkorelasi dengan kadar sP-selectin. ......Background Nasopharyngeal carcinoma (NPC) is an unique malignancy because of its geographical and ethnic patterns. South China and South East Asia have the highest incidence, while in Indonesia is about 5.66 cases per 100,000 populations per year. Thrombosis is one of the complications of malignancy. High plasma levels of soluble Platelet-Selectin (sP-selectin) produced by activated endothelial cells and platelets, are predictive of thrombosis.

Objective To measure sP-selectin levels in various stages of nasopharyngeal carcinoma and its correlation with platelet count.

Methods This was a cross sectional study including 60 patients with newly diagnosed nasopharyngeal carcinoma at Cipto Mangunkusumo Hospital, Jakarta, Indonesia in period of April to November 2012. Soluble P-selectin levels in various stages of NPC measured with Enzyme Linked Immunosorbent Assay was compared and correlated with platelets count.

Results From 60 patients of NPC, the mean age was 43.9 years with ratio of men to women was 3:1. The most prevalence histopathology was undifferentiated carcinoma (83.3%). Ten percent of the patients had thrombocytosis. The median level of sP-selectin was 45.73 ng/mL (inter quartile range: 42.02-57.66). Soluble P-selectin levels were statistically significantly higher among patients with stage IVC than other stages (with stage IVB, p = 0.001 and with group of stage I-IVA, p < 0.001). There was no correlation between platelet count and sP-selectin levels (r = 0.185; p = 0.158).

Conclusion There were different levels of sP-selectin between various stages of nasopharyngeal carcinoma. There was no correlation between platelets count and sP-selectin levels.

Abstrak :
Pengemudi bis antar kota adalah profesi yang bertanggung jawab terhadap keselamatan banyak jiwa, tidak hanya para penumpang yang dibawanya namun juga para pengguna jalan yang lain. Untuk itu dibutuhkan stamina dan kondisi fisik yang prima agar mereka dapat bekerja dengan baik. Sementara cara kerja yang cukup melelahkan serta beberapa perilaku kurang baik yang banyak dilakukan oleh para pengemudi bis antar kota ini membuat mereka rentan terkena gangguan kesehatan antara lain hipertensi. Hasil skrining kesehatan pada pengemudi bis antar kota yang dilakukan pada bulan Juli 2015 di terminal Poris Plawad Tangerang didapatkan kejadian hipertensi sebesar 25 %. Tujuan penelitian ini adalah diketahuinya masalah hipertensi dan hubungannya dengan faktor pekerjaan serta faktor lain pada pengemudi bis antar kota di terminal Poris Plawad Tangerang. Penelitian ini menggunakan metode potong lintang, dimana dilakukan pengukuran tekanan darah serta wawancara terhadap responden. Dari penelitian yang dilakukan terhadap 84 responden, didapatkan prevalensi hipertensi sebesar 57,1 %, dan terdapat hubungan yang bermakna antara Indeks Masa Tubuh berlebih dengan kejadian hipertensi pada pengemudi bis antar kota di terminal Poris Plawad Tangerang ini. Dimana pengemudi dengan indeks masa tubuh berlebih memiliki risiko sebesar 16 kali untuk terkena hipertensi dibandingkan dengan pengemudi dengan indeks masa tubuh normal. ......Inter city bus driver is a profession that is responsible for the safety of many people, not only his passengers but also other road users. It requires good performance so that they can work well and safely. Exhausting way of working as well as some bad behavior which is mostly done by this inter city bus drivers have made them susceptible to health problems such as hypertension or other cardiovascular diseases. The results of inter city bus drivers’s health screening in Poris Plawad bus station Tangerang held on July 2015 found the prevalence of hypertension is 25 %. The purpose of this study is to determine hypertension problems and it relations with work related and other factors among the inter city bus drivers in Poris Plawad Bus Station Tangerang. This study using cross sectional method, with examination of respondent’s blood pressure and also some interviews for collecting other data. From 84 respondents it was found that the prevalence of hypertension was 57,1% and there was a significant relationship between body mass index and hypertension, which is the drivers with overweight had 16 times risk to have hypertension compare with them with normal weight.

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Pendahuluan. Berbagai panduan menganjurkan hemodialisis HD tiga kali seminggu. Di Indonesia pasien dengan hemodialisis dua kali seminggu lebih banyak ditemukan. Perlu dilakukan penelitian untuk mengetahui gambaran klinis dan kualitas hidup pada pasien yang menjalani hemodialisis dua kali seminggu dibandingkan tiga kali seminggu. Metode. Merupakan studi potong lintang pada pasien yang menjalani HD dua dan tiga kali seminggu di RS Cipto Mangunkusumo dan beberapa RS swasta. Dilakukan pemeriksaan laboratorium dan penilaian kualitas hidup dengan menggunakan Kidney Disease Quality of Life KDQOL-SF 36. Hasil. Didapatkan 80 subjek dengan kelompok usia >50 tahun lebih banyak ditemukan. Secara bermakna lebih tinggi pada kelompok HD dua kali yaitu Interdialytic Weight Gain IDWG 4,91 SB 1,52 dan 3,82 SB 1,28 p=0,002. albumin 4,05 SB 0,26 dan 3,86 SB 0,48 p=0,027, saturasi transferin 25,5 12,0-274,0 dan 21,95 5,8-84,2 p=0,004, kadar fosfat 5,82 SB 1,68 dan 5,82 SB 1,68 p=0,026. Kadar TIBC 235,20 SB 55,72 dan 273,73 SB 58,29 p=0,004 pada kelompok tiga kali HD secara bermakna lebih tinggi. Pada kelompok HD dua kali seminggu 68 mencapai Kt/V>1,8, 93,3 yang HD tiga kali seminggu mencapai Kt/V>1,2. Kualitas hidup antara kedua kelompok tidak berbeda bermakna baik pada Physical Componet Score PCS p=0,227, Mental Component Score MCS p=0,247 dan Kidney Disease Component Score KDCS p=0,889. Simpulan. Didapatkan secara bermakna lebih tinggi pada kelompok HD dua kali seminggu pada pemeriksaan IDWG, albumin, saturasi transferin, fosfat, sedangkan TIBC lebih tinggi pada kelompok HD tiga kali seminggu. Kualitas hidup kedua kelompok tidak berbeda bermakna. ...... Introduction. Many guidelines recommend hemodialysis HD three times a week. In Indonesia there are more patients undergoing hemodialysis twice a week. It is necessary to investigate the clinical features and the quality of life in patients undergoing hemodialysis twice a week. Method. A cross sectional study in patients undergoing HD two and three times weekly at Cipto Mangunkusumo Hospital and some private hospitals. Laboratory examination and assessment of quality of life by using Kidney Disease Quality of Life KDQOL SF 36. Results. There were 80 subjects with age group 50 years is more common. Significantly higher in group HD twice a week were Interdialytic Weight Gain IDWG 4.91 SB 1.52 and 3.82 SB 1.28 p 0.002. 4,05 albumin SB 0.26 and 3.86 SB 0.48 p 0.027, transferrin saturation 25.5 12.0 to 274.0 and 21.95 5.8 to 84.2 p 0.004, the phosphate level 5.82 SB 1.68 and 5.82 SB 1.68 p 0.026. The TIBC level 235.20 55.72 SB and 273.73 58.29 SB p 0.004 was significantly higher in group HD thrice a week. In twice a week HD group 68 reached Kt V 1.8, 93.3 of HD thrice a week achieved Kt V 1.2. Quality of life between the two groups was not significant either on Physical Componet Score PCS p 0.227, Mental Component Score MCS p 0.247 and Kidney Disease Component Score KDCS p 0.889. Conclusion. There were significantly higher in group HD twice a week on examination IDWG, albumin, transferrin saturation and phosphate levels, whereas the TIBC was higher in group HD three times a week. Quality of life of the two groups was not significant difference.

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ABSTRAK
Latar Belakang: Tingkat kesesuaian pemeriksaan biopsi perkolonoskopi merupakan salah satu ukuran kualitas dari suatu tindakan kolonoskopi sehingga perlu diidentifikasi.Tujuan: Mengetahui tingkat kesesuaian tindakan biopsi perkolonoskopi dibandingkan dengan pemeriksaan histopatologi secara pembedahan.Metode: Studi potong lintang ini menggunakan rekam medik pasien tumor kolon yang telah melakukan pemeriksaan histopatologi secara biopsi perkolonoskopi dan dikonfirmasi dengan pemeriksaan histopatologi secara pembedahan di PESC RSPUN dr. Cipto Mangunkusumo dalam periode 1 Januari 2006-31 Desember 2015. Tingkat kesesuaian dicari dengan menggunakan uji komparatif kesesuaian kategorik, sehingga didapatkan nilai kappa.Hasil: Terdapat 48 subjek pada penelitian ini. Diagnosis utama tindakan biopsi perkolonoskopi pada kasus tumor kolon adalah massa rektosigmoid sebanyak 12 pasien 25 , hasil histopatologi terbanyak pada biopsi secara pembedahan adalah adenokarsinoma kolon bediferensiasi baik sebanyak 28 pasien 58,3 , topografi terbanyak pada kasus tumor kolon adalah C.18.9 pada kolon dengan lokasi yang tidak spesifik sebanyak 21 pasien 43,7 dan morfologi adenokarsinoma sebanyak 46 pasien 95,8 . Pada penelitian ini kasus suspek ganas kami masukkan kedalam kelompok histopatologi jinak. Dari 48 kasus, 37 77,1 kasus ganas menjadi ganas, 10 20,8 kasus jinak menjadi ganas, dan 1 2,1 kasus jinak tetap menjadi jinak. Pada penelitian ini didapatkan perhitungan kesesuaian nyata sebesar 79 , kesesuaian karena peluang sebesar 77 , kesesuaian bukan karena peluang sebesar 2 , potensi kesesuaian bukan karena peluang sebesar 23 , tingkat kesesuaian murni nilai kappa sebesar 0,134.Simpulan: Tingkat kesesuaian pemeriksaan histopatologi secara biopsi perkolonoskopi dibandingkan dengan pemeriksaan histopatologi secara pembedahan di PESC RSCM tahun 2006-2015 adalah kurang baik. Nilai kappa dipengaruhi oleh prevalensi, pada kasus jarang seperti pada penelitian ini nilai kappa yang rendah tidak selalu mencerminkan rendahnya kesesuaian secara keseluruhan.

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ABSTRACT
Background Level of agreement comparison between biopsy per colonoscopy examination is used to measure of the quality of a colonoscopy examination and needed to be identifiedAim To identify level of agreement comparison between histopathologic examination of biopsy per colonoscopy and histopathologic examination per surgicalMethods A cross sectional study using medical records from patients with colon tumor who had undergone histopathologic examination with biopsy per colonoscopy and then confirmed by surgical procedure in PESC RSPUN dr. Cipto Mangunkusumo between 1st January, 2006 31st December, 2015. Level of agreement calculated using comparative agreement category test in order to obtain the value of kappa.Result There are 48 subjects in this study. The first diagnosis from per colonoscopy biopsy examination was rectosigmoid mass as much as 12 25 patients. The top histopathologic result from biopsy per surgery was adenocarcinoma with good differentiated as much as 28 patients 58,3 , top topography result in the case of colon tumors was C.18.9 the colon with no specific location as much as 21 patients 43.7 , and top morphology was adenocarcinoma as much as 46 patients 95,8 . We were put in histopathologic suspected malignancy cases in benign cases. From 48 cases, 37 77,1 malignancy cases become malignancy, 10 20,8 benign cases become malignancy, and 1 2,1 benign cases become benign. Level of real agreement was 79 , level of agreement by chance was 77 , level of agreement not by chance was 23 , kappa value was 0,134. Conclusion The level of agreement comparison between histopathologic examination of biopsy per colonoscopy compared with histopathologic examination per surgical at PESC RSCM between 2006 2015 period was not good, kappa value was influenced by the prevalence, in rare cases such as in this study lower kappa value do not always reflect low overall level of agreement

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[ABSTRAK
Pola sirkadian tekanan darah (TD) adalah gambaran TD 24 jam berupa kurva TD yang meningkat pada pagi hari, menurun pada siang / sore hari dan terendah pada malam hari / waktu tidur. 24 hours Ambulatory Blood Pressure Monitoring (24 hrs ABPM) merupakan alat pengukur TD yang lebih akurat dan dapat memperlihatkan pola sirkadian TD 24 jam. Turunnya TD 10 - 20% pada malam hari disebut dipper, jika turun < 10% disebut nondipper. Meningkatnya TD 24 jam dan nondipper merupakan faktor risiko morbiditas dan mortalitas kardiovaskular. Prevalensi hipertensi dan nondipper pada Penyakit Ginjal Kronik Stadium 5 dalam Terapi Dialisis (PGK 5D) masih sangat tinggi. Faktor utama penyebab hipertensi pada PGK 5D adalah menurunnya Laju Filtrasi Glomerulus (LFG) dan meningkatnya cairan ekstraselular. Transplantasi ginjal akan memperbaiki TD dan nondipper dengan membaiknya LFG, meningkatnya produksi urin dan menurunnya cairan ekstraseluler. Namun demikian satu bulan Pasca Transplantasi Ginjal kebutuhan dosis obat imunosupresan masih cukup tinggi yang dapat mengakibatkan hambatan penurunan TD. Tujuan : Mengetahui perbedaan pola sirkadian TD, data dipper / nondipper dan rerata TD 24 jam pada pasien PGK Pra dan satu bulan Pasca Transplantasi Ginjal. Metode Penelitian : Studi Pre experimental dengan before and after design. Subjek penelitian pasien PGK 5D / Pra Transplantasi Ginjal berusia 18 ? 60 tahun, dilakukan di RSCM pada bulan Oktober sampai dengan Desember 2014. Jumlah subjek sebanyak 15 orang. Dilakukan pengumpulan urin 24 jam, pemeriksaan LFG, pengukuran TD 24 jam dengan 24 hrs ABPM, Pra dan satu bulan Pasca Transplantasi Ginjal. Analisis statistik dengan uji McNemar dan uji t dependen. Hasil : Terdapat 12 subjek nondipper dan 3 subjek dipper pada pasien PGK Pra Transplantasi Ginjal. Satu bulan Pasca Transplantasi Ginjal seluruh subjek (15 orang) memperlihatkan keadaan nondipper. Uji McNemar tidak dapat dilakukan karena seluruh subjek PGK satu bulan Pasca Transplantasi Ginjal nondipper (homogen). Terdapat penurunan rerata TD sistolik 24 jam pasien PGK satu bulan Pasca Transplantasi Ginjal yang tidak signifikan (p > 0,05) dan penurunan rerata TD diastolik 24 jam yang signifikan (p < 0,05). Simpulan : Belum terdapat perbaikan nondipper pada pasien satu bulan Pasca Transplantasi Ginjal. Terdapat penurunan rerata TD sistolik 24 jam yang tidak signifikan dan penurunan rerata TD diastolik 24 jam yang signifikan pada pasien satu bulan Pasca Transplantasi Ginjal.

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ABSTRACT
The circadian pattern of blood pressure (BP) is a 24 hours blood pressure (24hrs BP) curve which increases in the morning, decreases in the afternoon/evening and the lowest state is at night/bedtime. 24 hrs Ambulatory Blood Pressure Monitoring (ABPM) is a BP measuring device that is accurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20% at night is called as a dipper, while less than 10% is called as a nondipper. The increasing of 24 hrs BP and nondipper are the risk factor for cardiovascular morbidity and mortality. The prevalence of hypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis (CKD 5D) are still very high. The main factors causing hypertension in CKD 5D are decreased Glomerular Filtration Rate (GFR) and increased extracellular fluid. Kidney transplantation will improve BP and nondipper by GFR improvement, increases urine production and decreases extracellular fluid. However, one month after kidney transplantation, the dose of immunosuppressant drugs is relatively high, which is an obstacle to decrease BP. Aim: To determine differences in the circadian pattern of BP, the data of dipper and nondipper, and the mean of 24 hrs BP in CKD before, and one month after kidney transplantation. Methods: Design of the study is before and after design. Subjects of the study were patients with CKD 5D before kidney transplantation, aged 18-60 years, were conducted in Cipto Mangunkusumo Hospital during October to December 2014. 15 subjects were included in the study. 24 hrs urine collection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in all subjects, before and one month after kidney transplantation. McNemar test and t dependent test were used in statistical analysis. Results: Before kidney transplantation, 12 of 15 subjects were nondippers while the others 3 subjects were dippers. After kidney transplantation, all subjects (15 patients) were nondippers. McNemar test can not be used because all subjects one month after kidney transplantation were nondippers (homogeneous). The decreasing of the mean of 24 hrs systolic BP was found in all CKD one month after kidney transplantation, but statistically not significant (p>0.05), while decreasing of the mean of 24 hrs diastolic BP was statistically significant (p<0.05). Conclusion: There were still no improvement in nondipper patients one month after kidney transplantation. There were a decrease in the mean of 24 hrs systolic BP but statistically not significant and a decrease in the mean of 24 hrs diastolic BP which is statistically significant in patients one month after kidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours blood pressure (24hrs BP) curve which increases in the morning, decreases in the afternoon/evening and the lowest state is at night/bedtime. 24 hrs Ambulatory Blood Pressure Monitoring (ABPM) is a BP measuring device that is accurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20% at night is called as a dipper, while less than 10% is called as a nondipper. The increasing of 24 hrs BP and nondipper are the risk factor for cardiovascular morbidity and mortality. The prevalence of hypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis (CKD 5D) are still very high. The main factors causing hypertension in CKD 5D are decreased Glomerular Filtration Rate (GFR) and increased extracellular fluid. Kidney transplantation will improve BP and nondipper by GFR improvement, increases urine production and decreases extracellular fluid. However, one month after kidney transplantation, the dose of immunosuppressant drugs is relatively high, which is an obstacle to decrease BP. Aim: To determine differences in the circadian pattern of BP, the data of dipper and nondipper, and the mean of 24 hrs BP in CKD before, and one month after kidney transplantation. Methods: Design of the study is before and after design. Subjects of the study were patients with CKD 5D before kidney transplantation, aged 18-60 years, were conducted in Cipto Mangunkusumo Hospital during October to December 2014. 15 subjects were included in the study. 24 hrs urine collection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in all subjects, before and one month after kidney transplantation. McNemar test and t dependent test were used in statistical analysis. Results: Before kidney transplantation, 12 of 15 subjects were nondippers while the others 3 subjects were dippers. After kidney transplantation, all subjects (15 patients) were nondippers. McNemar test can not be used because all subjects one month after kidney transplantation were nondippers (homogeneous). The decreasing of the mean of 24 hrs systolic BP was found in all CKD one month after kidney transplantation, but statistically not significant (p>0.05), while decreasing of the mean of 24 hrs diastolic BP was statistically significant (p<0.05). Conclusion: There were still no improvement in nondipper patients one month after kidney transplantation. There were a decrease in the mean of 24 hrs systolic BP but statistically not significant and a decrease in the mean of 24 hrs diastolic BP which is statistically significant in patients one month after kidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours blood pressure (24hrs BP) curve which increases in the morning, decreases in the afternoon/evening and the lowest state is at night/bedtime. 24 hrs Ambulatory Blood Pressure Monitoring (ABPM) is a BP measuring device that is accurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20% at night is called as a dipper, while less than 10% is called as a nondipper. The increasing of 24 hrs BP and nondipper are the risk factor for cardiovascular morbidity and mortality. The prevalence of hypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis (CKD 5D) are still very high. The main factors causing hypertension in CKD 5D are decreased Glomerular Filtration Rate (GFR) and increased extracellular fluid. Kidney transplantation will improve BP and nondipper by GFR improvement, increases urine production and decreases extracellular fluid. However, one month after kidney transplantation, the dose of immunosuppressant drugs is relatively high, which is an obstacle to decrease BP. Aim: To determine differences in the circadian pattern of BP, the data of dipper and nondipper, and the mean of 24 hrs BP in CKD before, and one month after kidney transplantation. Methods: Design of the study is before and after design. Subjects of the study were patients with CKD 5D before kidney transplantation, aged 18-60 years, were conducted in Cipto Mangunkusumo Hospital during October to December 2014. 15 subjects were included in the study. 24 hrs urine collection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in all subjects, before and one month after kidney transplantation. McNemar test and t dependent test were used in statistical analysis. Results: Before kidney transplantation, 12 of 15 subjects were nondippers while the others 3 subjects were dippers. After kidney transplantation, all subjects (15 patients) were nondippers. McNemar test can not be used because all subjects one month after kidney transplantation were nondippers (homogeneous). The decreasing of the mean of 24 hrs systolic BP was found in all CKD one month after kidney transplantation, but statistically not significant (p>0.05), while decreasing of the mean of 24 hrs diastolic BP was statistically significant (p<0.05). Conclusion: There were still no improvement in nondipper patients one month after kidney transplantation. There were a decrease in the mean of 24 hrs systolic BP but statistically not significant and a decrease in the mean of 24 hrs diastolic BP which is statistically significant in patients one month after kidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours blood pressure (24hrs BP) curve which increases in the morning, decreases in the afternoon/evening and the lowest state is at night/bedtime. 24 hrs Ambulatory Blood Pressure Monitoring (ABPM) is a BP measuring device that is accurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20% at night is called as a dipper, while less than 10% is called as a nondipper. The increasing of 24 hrs BP and nondipper are the risk factor for cardiovascular morbidity and mortality. The prevalence of hypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis (CKD 5D) are still very high. The main factors causing hypertension in CKD 5D are decreased Glomerular Filtration Rate (GFR) and increased extracellular fluid. Kidney transplantation will improve BP and nondipper by GFR improvement, increases urine production and decreases extracellular fluid. However, one month after kidney transplantation, the dose of immunosuppressant drugs is relatively high, which is an obstacle to decrease BP. Aim: To determine differences in the circadian pattern of BP, the data of dipper and nondipper, and the mean of 24 hrs BP in CKD before, and one month after kidney transplantation. Methods: Design of the study is before and after design. Subjects of the study were patients with CKD 5D before kidney transplantation, aged 18-60 years, were conducted in Cipto Mangunkusumo Hospital during October to December 2014. 15 subjects were included in the study. 24 hrs urine collection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in all subjects, before and one month after kidney transplantation. McNemar test and t dependent test were used in statistical analysis. Results: Before kidney transplantation, 12 of 15 subjects were nondippers while the others 3 subjects were dippers. After kidney transplantation, all subjects (15 patients) were nondippers. McNemar test can not be used because all subjects one month after kidney transplantation were nondippers (homogeneous). The decreasing of the mean of 24 hrs systolic BP was found in all CKD one month after kidney transplantation, but statistically not significant (p>0.05), while decreasing of the mean of 24 hrs diastolic BP was statistically significant (p<0.05). Conclusion: There were still no improvement in nondipper patients one month after kidney transplantation. There were a decrease in the mean of 24 hrs systolic BP but statistically not significant and a decrease in the mean of 24 hrs diastolic BP which is statistically significant in patients one month after kidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours blood pressure (24hrs BP) curve which increases in the morning, decreases in the afternoon/evening and the lowest state is at night/bedtime. 24 hrs Ambulatory Blood Pressure Monitoring (ABPM) is a BP measuring device that is accurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20% at night is called as a dipper, while less than 10% is called as a nondipper. The increasing of 24 hrs BP and nondipper are the risk factor for cardiovascular morbidity and mortality. The prevalence of hypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis (CKD 5D) are still very high. The main factors causing hypertension in CKD 5D are decreased Glomerular Filtration Rate (GFR) and increased extracellular fluid. Kidney transplantation will improve BP and nondipper by GFR improvement, increases urine production and decreases extracellular fluid. However, one month after kidney transplantation, the dose of immunosuppressant drugs is relatively high, which is an obstacle to decrease BP. Aim: To determine differences in the circadian pattern of BP, the data of dipper and nondipper, and the mean of 24 hrs BP in CKD before, and one month after kidney transplantation. Methods: Design of the study is before and after design. Subjects of the study were patients with CKD 5D before kidney transplantation, aged 18-60 years, were conducted in Cipto Mangunkusumo Hospital during October to December 2014. 15 subjects were included in the study. 24 hrs urine collection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in all subjects, before and one month after kidney transplantation. McNemar test and t dependent test were used in statistical analysis. Results: Before kidney transplantation, 12 of 15 subjects were nondippers while the others 3 subjects were dippers. After kidney transplantation, all subjects (15 patients) were nondippers. McNemar test can not be used because all subjects one month after kidney transplantation were nondippers (homogeneous). The decreasing of the mean of 24 hrs systolic BP was found in all CKD one month after kidney transplantation, but statistically not significant (p>0.05), while decreasing of the mean of 24 hrs diastolic BP was statistically significant (p<0.05). Conclusion: There were still no improvement in nondipper patients one month after kidney transplantation. There were a decrease in the mean of 24 hrs systolic BP but statistically not significant and a decrease in the mean of 24 hrs diastolic BP which is statistically significant in patients one month after kidney􀀃transplantation., Background: The circadian pattern of blood pressure (BP) is a 24 hours blood pressure (24hrs BP) curve which increases in the morning, decreases in the afternoon/evening and the lowest state is at night/bedtime. 24 hrs Ambulatory Blood Pressure Monitoring (ABPM) is a BP measuring device that is accurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20% at night is called as a dipper, while less than 10% is called as a nondipper. The increasing of 24 hrs BP and nondipper are the risk factor for cardiovascular morbidity and mortality. The prevalence of hypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis (CKD 5D) are still very high. The main factors causing hypertension in CKD 5D are decreased Glomerular Filtration Rate (GFR) and increased extracellular fluid. Kidney transplantation will improve BP and nondipper by GFR improvement, increases urine production and decreases extracellular fluid. However, one month after kidney transplantation, the dose of immunosuppressant drugs is relatively high, which is an obstacle to decrease BP. Aim: To determine differences in the circadian pattern of BP, the data of dipper and nondipper, and the mean of 24 hrs BP in CKD before, and one month after kidney transplantation. Methods: Design of the study is before and after design. Subjects of the study were patients with CKD 5D before kidney transplantation, aged 18-60 years, were conducted in Cipto Mangunkusumo Hospital during October to December 2014. 15 subjects were included in the study. 24 hrs urine collection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in all subjects, before and one month after kidney transplantation. McNemar test and t dependent test were used in statistical analysis. Results: Before kidney transplantation, 12 of 15 subjects were nondippers while the others 3 subjects were dippers. After kidney transplantation, all subjects (15 patients) were nondippers. McNemar test can not be used because all subjects one month after kidney transplantation were nondippers (homogeneous). The decreasing of the mean of 24 hrs systolic BP was found in all CKD one month after kidney transplantation, but statistically not significant (p>0.05), while decreasing of the mean of 24 hrs diastolic BP was statistically significant (p<0.05). Conclusion: There were still no improvement in nondipper patients one month after kidney transplantation. There were a decrease in the mean of 24 hrs systolic BP but statistically not significant and a decrease in the mean of 24 hrs diastolic BP which is statistically significant in patients one month after kidney􀀃transplantation.]

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[ABSTRAK
Latar Belakang: Terapi antiretroviral (ARV) terbukti secara efektif dapat menekan replikasi HIV. Pengukuran viral load (VL) merupakan prediktor yang lebih baik dibanding kriteria klinis atau imunologis untuk menilai kegagalan atau keberhasilan terapi ARV. Karena keterbatasan sumber daya, maka pemeriksaan VL tidak selalu mudah untuk diakses oleh pasien HIV yang mendapat terapi ARV sehingga perlu untuk diketahui faktor-faktor pada pasien yang dapat memprediksi terjadinya kegagalan virologis. Tujuan: Mengetahui faktor prediktor kegagalan virologis pada pasien HIV yang mendapat terapi ARV lini pertama sesuai paduan ARV terbaru di Indonesia. Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien HIV rawat jalan dewasa di RSCM yang mulai terapi ARV lini pertama selama periode Januari 2011-Juni 2014. Pasien HIV yang mempunyai data VL 6-9 bulan setelah mulai terapi ARV dengan kepatuhan berobat baik dimasukkan sebagai subjek penelitian. Kegagalan virologis dinyatakan sebagai nilai VL ≥ 400 kopi/mL setelah minimal 6 bulan terapi ARV dengan kepatuhan berobat baik. Paduan ARV yang digunakan terdiri dari dua NNRTI (salah satu dari TDF/AZT/d4T ditambah 3TC) dengan satu NNRTI (NVP atau EFV). Usia, faktor risiko penularan HIV, stadium klinis HIV menurut WHO, ko-infeksi TB, indeks massa tubuh, kadar hemoglobin, dan jumlah CD4 awal terapi serta basis paduan terapi ARV merupakan variabel yang diteliti pada penelitian ini. Hasil: Terdapat 197 pasien sebagai subjek penelitian ini. Kegagalan virologis didapatkan pada 21 pasien (10,7%). Semua variabel yang diteliti belum terbukti dapat memprediksi kegagalan virologis pada pasien HIV yang mendapat terapi ARV lini pertama dengan adherens baik. Terdapat peningkatan risiko kegagalan virologis pada pasien dengan usia yang lebih muda, faktor risiko penasun, stadium klinis lanjut, adanya ko-infeksi TB, dan paduan ARV TDF+3TC+NVP tetapi tidak bermakna secara statistik.!! Simpulan: Dari variabel yang diteliti, tidak didapatkan variabel yang terbukti sebagai prediktor awal kegagalan virologis pada pasien HIV yang mendapat terapi ARV lini pertama dengan adherens baik.

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ABSTRACT
Background: Antiretroviral therapy (ART) effectively suppress HIV replication. Viral load (VL) measurement is better predictor than clinical or immunological criteria to evaluate failure or success of ART. However, in the country with limited resources, VL measurement is not easily accessible by HIV patients receiving ARV therapy therefore it is necessary to know which factors in the patients that can predict virological failure. Objectives: To know early predictive factor of virological failure in HIV patients receiving recent first line ARV therapy regimen in Indonesia Methods: This study was a retrospective cohort study among adult HIV patients in Out-patient Clinic of Cipto Mangunkusumo General Hospital that started ARV therapy during periode January 2011-June 2014. HIV patients with good adherence that have VL data 6-9 months after initiation of ARV therapy were included in this study. Virological failure was defined as VL ≥ 400 copies/mL after minimum of 6 months therapy with good adherence. ARV regimen used in this study consist of two NRTI (one of TDF/AZT/d4T plus 3TC) combined with one NNRTI (NVP or EFV). Age, risk factor for HIV infection, HIV clinical stage, HIV- TB co-infection, baseline CD4 value, hemoglobin level, body mass index, and ARV therapy regimen at the time of initiation were among the variables that analyzed in this study. Results: There are 197 patients as subjects in this study. Virological failure was found in 21 patients (10,7%). All the variables included in this study can not predict virological failure in HIV patients receiving first line ART with good adherence. There is increase risk of virological failure in patients with younger age, IDU as risk factor for HIV infection, late clinical stage, TB co-infection, and ARV regimen TDF+3TC+NVP but not reaching statistically significant. Conclusion: There is no variable in this study proved to be early predictive factor for virological failure in HIV patients receiving first line ART with good adherence.;Background: Antiretroviral therapy (ART) effectively suppress HIV replication. Viral load (VL) measurement is better predictor than clinical or immunological criteria to evaluate failure or success of ART. However, in the country with limited resources, VL measurement is not easily accessible by HIV patients receiving ARV therapy therefore it is necessary to know which factors in the patients that can predict virological failure. Objectives: To know early predictive factor of virological failure in HIV patients receiving recent first line ARV therapy regimen in Indonesia Methods: This study was a retrospective cohort study among adult HIV patients in Out-patient Clinic of Cipto Mangunkusumo General Hospital that started ARV therapy during periode January 2011-June 2014. HIV patients with good adherence that have VL data 6-9 months after initiation of ARV therapy were included in this study. Virological failure was defined as VL ≥ 400 copies/mL after minimum of 6 months therapy with good adherence. ARV regimen used in this study consist of two NRTI (one of TDF/AZT/d4T plus 3TC) combined with one NNRTI (NVP or EFV). Age, risk factor for HIV infection, HIV clinical stage, HIV- TB co-infection, baseline CD4 value, hemoglobin level, body mass index, and ARV therapy regimen at the time of initiation were among the variables that analyzed in this study. Results: There are 197 patients as subjects in this study. Virological failure was found in 21 patients (10,7%). All the variables included in this study can not predict virological failure in HIV patients receiving first line ART with good adherence. There is increase risk of virological failure in patients with younger age, IDU as risk factor for HIV infection, late clinical stage, TB co-infection, and ARV regimen TDF+3TC+NVP but not reaching statistically significant. Conclusion: There is no variable in this study proved to be early predictive factor for virological failure in HIV patients receiving first line ART with good adherence., Background: Antiretroviral therapy (ART) effectively suppress HIV replication. Viral load (VL) measurement is better predictor than clinical or immunological criteria to evaluate failure or success of ART. However, in the country with limited resources, VL measurement is not easily accessible by HIV patients receiving ARV therapy therefore it is necessary to know which factors in the patients that can predict virological failure. Objectives: To know early predictive factor of virological failure in HIV patients receiving recent first line ARV therapy regimen in Indonesia Methods: This study was a retrospective cohort study among adult HIV patients in Out-patient Clinic of Cipto Mangunkusumo General Hospital that started ARV therapy during periode January 2011-June 2014. HIV patients with good adherence that have VL data 6-9 months after initiation of ARV therapy were included in this study. Virological failure was defined as VL ≥ 400 copies/mL after minimum of 6 months therapy with good adherence. ARV regimen used in this study consist of two NRTI (one of TDF/AZT/d4T plus 3TC) combined with one NNRTI (NVP or EFV). Age, risk factor for HIV infection, HIV clinical stage, HIV- TB co-infection, baseline CD4 value, hemoglobin level, body mass index, and ARV therapy regimen at the time of initiation were among the variables that analyzed in this study. Results: There are 197 patients as subjects in this study. Virological failure was found in 21 patients (10,7%). All the variables included in this study can not predict virological failure in HIV patients receiving first line ART with good adherence. There is increase risk of virological failure in patients with younger age, IDU as risk factor for HIV infection, late clinical stage, TB co-infection, and ARV regimen TDF+3TC+NVP but not reaching statistically significant. Conclusion: There is no variable in this study proved to be early predictive factor for virological failure in HIV patients receiving first line ART with good adherence.]