Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
ABSTRAK
Latar Belakang. Kejadian aterosklerosis, dilaporkan lebih sering pada pasien lupus eritematosus sitemik (LES) dibandingkan individu tanpa LES, salah satunya adalah penyakit arteri perifer (PAP). Klorokuin diduga memiliki efek protektif terhadap kejadian PAP melalui penekanan kadar sitokin proinflamasi dan efek menurunkan kadar kolesterol, namun beberapa penelitian lain menunjukkan bahwa klorokuin meningkatkan kadar sitokin proinflamasi. Hingga saat ini, penelitian mengenai pengaruh klorokuin belum pernah dilakukan pada populasi pasien LES di Indonesia.

Tujuan Penelitian. Mengetahui pengaruh klorokuin terhadap kejadian PAP pada pasien LES wanita berusia 40 tahun ke bawah.

Metode Penelitian. Studi kasus kontrol dilakukan terhadap pasien LES wanita berusia 40 tahun ke bawah di RS Cipto Mangunkusumo selama Juni-Agustus 2012 yang tidak menderita diabetes melitus ataupun hipertensi sebelum diagnosis LES ditegakkan. Pasien dengan penyakit autoimun selain LES dan gagal ginjal kronik dieksklusi dari penelitian. Pengaruh klorokuin terhadap PAP pada pasien LES dinyatakan dalam odds ratio (OR). Peran variabel perancu dinilai pada analisis regresi logistik berjenjang sehingga didapatkan adjusted OR.

Hasil Penelitian. Dari 18 subjek yang menderita PAP (kelompok kasus), sebanyak 8 (44,4 %) menggunakan klorokuin dan dari 72 subjek yang tidak menderita PAP (kelompok kontrol), 20 (27,8 %) di antaranya menggunakan klorokuin. Setelah dilakukan adjustment terhadap variabel perancu (usia, lama menderita sakit, dislipidemia, dan aktivitas penyakit), tidak didapatkan hubungan yang bermakna antara penggunaaan klorokuin dengan kejadian PAP pada pasien LES wanita berusia di bawah 40 tahun (adjusted OR 2,44; IK95 % 0,76 sampai 7,87).

Simpulan. Pengaruh klorokuin terhadap kejadian PAP pada pasien LES wanita berusia 40 tahun ke bawah belum dapat disimpulkan pada penelitian ini.

---

ABSTRACT
Background. Atherosclerosis is enhanced in systemic lupus erythematosus (SLE) compared to general population, one of which is peripheral arterial disease (PAD). Chloroquine has protective effects in peripheral arterial disease through the suppression of proinflamatory cytokine levels and lipid lowering effect, although other studies have shown the increasing of cytokine levels by chloroquine. To date, no studies have ever been performed to investigate the effect of chloroquine on peripheral arterial disease in Indonesian lupus patients.

Aims. To investigate the effects of chloroquine on peripheral arterial disease in patients with systemic lupus erythematosus aged forty-year-old and below.

Methods. A case control study including female lupus patients aged forty year-old and younger in Cipto Mangunkusumo Hospital between June-August 2012, who do not suffer from diabetes mellitus and/or hypertension before the diagnosis of lupus is confirmed. Patients with other autoimmune disease than lupus and/or with chronic kidney disease were excluded from the study. Effect of chloroquine on peripheral arterial disease in lupus patients is expressed in odds ratio (OR). The role of confounding factors analyzed with multiple logistic regression to estimate the adjusted OR.

Results. Eight (44.4 %) of the total 18 subjects contracting PAD (case group) and 20 (27.8 %) of the total 72 subjects without PAD (control group) were using chloroquine. After adjustments towards confounding factors (age, disease duration, dyslipidemia, and disease activity) were completed, the results showed there was no considerable relation between the use of chloroquine and PAD case in female SLE patients aged below forty-year-old (adjusted OR 2.44; 95 % CI 0.76 to 7.87). Conclusion. The effect of chloroquine usage on PAD case in female SLE patients aged forty-year-old and below can not be concluded from this study.

Abstrak :
ABSTRAK
Latar Belakang. Terdapat gangguan sistem imun pada sepsis. Fase awal ditandai dengan hiperinflamasi, sedangkan fase lanjut ditandai dengan imunosupresi. Kematian kumulatif lebih banyak pada fase lanjut. Saat ini belum terdapat penelitian yang secara khusus meneliti faktor prognostik mortalitas sepsis fase lanjut dan mengembangkan model prediksi mortalitasnya. Tujuan. Mengetahui faktor prognostik mortalitas sepsis berat fase lanjut di ICU dan mengembangkan sistem skor untuk memprediksi mortalitas. Metode. Penelitian kohort retrospektif dilakukan pada pasien dewasa yang mengalami sepsis berat di ICU RSCM pada periode Oktober 2011 – November 2012 dan masih bertahan setelah > 72 jam diagnosis sepsis ditegakkan di ICU. Tujuh faktor prognostik diidentifikasi saat diagnosis sepsis berat ditegakkan di ICU. Prediktor independen diidentifikasi dengan analisis Cox’s proportional hazard. Prediktor yang bermakna secara statistik dikuantifikasi dalam model prediksi. Kalibrasi model dinilai dengan uji Hosmer-Lemeshow dan kemampuan diskriminasi dinilai dari area under curve (AUC) dari receiver operating curve. Hasil. Subjek penelitian terdiri atas 220 pasien. Mortalitas 28 hari sepsis berat fase lanjut adalah 40%. Faktor prognostik yang bermakna adalah alasan masuk ICU (medis (HR 2,75; IK95%:1,56-4,84), pembedahan emergensi (HR 1,96; IK95%:0,99 – 3,90), indeks komorbiditas Charlson > 2 (HR 2,07; IK95%:1,32- 3,23), dan skor MSOFA > 4 (HR 2,84; IK95%:1,54-5,24). Model prediksi memiliki kemampuan diskriminasi yang baik (AUC 0,844) dan kalibrasi yang baik (uji Hosmer-Lemeshow p 0,674). Berdasarkan model tersebut risiko mortalitas dapat dibagi menjadi rendah (skor 0, mortalitas 5,4%), sedang (skor 1 – 2,5, mortalitas 20,6%), dan tinggi (skor > 2,5, mortalitas 73,6%). Simpulan. Alasan masuk medis dan pembedahan emergensi, indeks komorbiditas Charlson > 2, dan skor MSOFA > 4 merupakan faktor prognostik mortalitas sepsis berat fase lanjut di ICU RSCM. Sebuah model telah dikembangkan untuk memprediksi dan mengklasifikasikan risiko mortalitas.

---

ABSTRACT
Background. Immune system derrangement occurs during the course of sepsis, characterized by hyperinflamation in early phase and hypoinflamation and immunosupression in late phase. The number of patient die during late phase is larger than early phase. Until now, there is no study specifically addressing prognostic factors of mortality from late sepsis and developing a mortality prediction model. Aim. To determine prognostic factors of mortality from late phase of severe sepsis in ICU and to develop scoring system to predict mortality. Method. A retrospective cohort study was conducted to identify prognostic factors associated with mortality. Adult patients admitted to ICU during November 2011 until October 2012 who developed severe sepsis and still alive for minimum 72 hours were included in this study. Seven predefined prognostic factors were indentified at the onset of severe sepsis in ICU. Cox’s proportional hazard ratio was used to identify independent prognostic factors. Each independent factors was quantified to develop a prediction model. Calibration of the model was tested by Hosmer-Lemeshow, and its discrimination ability was calculated from area under receiver operating curve. Result. Subjects consist of 220 patients. Twenty eight-day mortality was 40%. Significant prognostic factors indentified were admission source (medical (HR 2.75; CI95%: 1.56 – 4.84), emergency surgery (HR 1.96; CI95%:0.99 – 3.90), Charlson comorbidity index > 2(HR 2.07; CI95%:1.32 – 3.23), and MSOFA score > 4 (HR 2.84; CI95% : 1.54 – 5.24). Prediction model developed has good discrimination ability (AUC 0.844) and good calibration (Hosmer-Lemeshow test p 0.674). Based on the model mortality risk can be classified as low (score 0, mortality 5.4%), moderate (score 1 – 2.5, mortality 20.6%), and high (score > 2.5, mortality 73.6%). Conclusion. Medical and emergency surgery admission, Charlson comorbidity index > 2, and MSOFA score > 4 were prognostic factors of mortality from late phase of severe sepsis in ICU at Dr.Cipto Mangunkusumo general hospital. A model has been developed to predict and classify mortality risk.

Abstrak :
ABSTRAK
Luka kaki diabetik (LKD) merupakan komplikasi kronik diabetes yang meningkatkan mortalitas dan morbiditas, serta menurunkan kualitas hidup. Komplikasi makro dan mikrovaskular/mikrosirkulasi mempunyai pengaruh besar terhadap kejadian LKD dan proses penyembuhannya. Kondisi mikrosirkulasi dapat dinilai melalui pemeriksaan transcutaneous perfusion oxygen (TcPO2). Kondisi mikrosirkulasi dipengaruhi oleh HbA1c, glukosa darah sewaktu, neuropati, fibrinogen, PAI-1, hsCRP, indeks MMP-9, indeks TcPO2, dan indeks TcPCO2, yang akan memengaruhi terbentuknya jaringan granulasi. Penelitian ini bertujuan untuk mengetahui peran HbA1c, GDS, neuropati, fibrinogen, PAI-1, hsCRP, indeks MMP-9, terhadap indeks TcPO2, indeks TcPCO2, dan indeks granulasi, serta mengetahui peran serta indeks TcPO2 dan indeks TcPCO2 terhadap indeks granulasi pada luka kaki diabetik. Sebanyak 68 subjek LKD tanpa penyakit arteri perifer di RS dr. Cipto Mangukusumo dan beberapa rumah sakit jejaring, pada Desember 2015?Desember 2016, diberikan perawatan standar dan dipantau setiap minggu sebanyak 4 kali. Pada pemantauan ke-1, ke-2, dan ke-3, dilakukan dokumentasi LKD, pengambilan darah vena sebanyak 7,7 mL untuk pemeriksaan fibrinogen, PAI-1, hsCRP, MMP-9, dan TIMP-1, darah arteri sebanyak 2 mL untuk pemeriksaan analisis gas darah, serta pemeriksaan TcPO2 dan TcPCO2 dengan menggunakan TCM TOSCA/CombiM monitoring systems buatan Radiometer. Pada pemantauan ke-4, hanya dilakukan dokumentasi LKD. Pengukuran luas luka dan jaringan granulasi dinilai berdasarkan hasil dokumentasi fotografi dengan menggunakan program ImageJ. Penilaian neuropati menggunakan pemeriksaan interval RR dan kecepatan hantar saraf. Data laboratorium lainnya diperoleh dari data sekunder rekam medis. Kemudian dilakukan analisis data dengan menggunakan path analysis (analisis lajur) pada data repetitif dan SPSS pada data nonrepetitif. Berdasarkan analisis didapatkan hubungan antara peningkatan glukosa darah sewaktu, fibrinogen, dan PAI-1 dengan penurunan indeks TcPO2. Didapatkan juga hubungan antara beratnya neuropati motorik dan sensorik, peningkatan glukosa darah sewaktu, fibrinogen, PAI-1, dan hsCRP dengan penurunan indeks granulasi. Tetapi, indeks granulasi tidak dipengaruhi oleh indeks TcPO2. Indeks TcPCO2 tidak memiliki hubungan terhadap semua variabel tersebut, kecuali hsCRP dan indeks TcPCO2 tidak memengaruhi indeks granulasi. Indeks TcPO2 pada LKD dipengaruhi oleh kadar glukosa darah sewaktu, fibrinogen, dan PAI-1, tetapi tidak memengaruhi tumbuhnya jaringan granulasi. Tumbuhnya jaringan granulasi dipengaruhi oleh glukosa darah sewaktu, neuropati motorik dan sensorik, peningkatan kadar fibrinogen, PAI-1, dan hsCRP. Selain itu, indeks TcPCO2 tidak memengaruhi indeks granulasi

---

ABSTRACT
Diabetic foot wounds/ulcer (DFU) is chronic complication of diabetes, which increases mortality and morbidity, and lower quality of life. Macro and microvascular/microcirculation complications has a great influence on DFU and healing process. Microcirculation condition can be seen from transcutaneous perfusion oxygen (TcPO2). The growth of granulation tissue in the healing process is determined by microcirculation condition, among others influenced by HbA1c, random blood glucose, neuropathy, fibrinogen, PAI-1, hsCRP, MMP-9 index, TcPO2 index, and TcPCO2 index. This study aimed to investigatethe role of HbA1c, random blood glucose, sensory, motoric, and autonomy neuropathy, fibrinogen, PAI-1, hsCRP, MMP-9 index, TcPO2 index, TcPCO2 index, and granulation index, as well as the relationship between TcPO2 index, TcPCO2 index and granulation index in diabetic foot wounds. As much as 68 subjects DFU without peripheral arterial disease, in Cipto Mangunkusumo Referral National Hospital, on December 2015?December 2016, were given standard managementof diabetic foot ulcer and monitored once a week for four times. In the 1st, 2nd, and 3rd monitoring, DFU was documented, then 7.7 mL of venous blood was taken for fibrinogen, PAI-1, hsCRP, MMP-9, and TIMP-1 examination, also 2 mL arterial blood for blood gas analysis, and then examination of TcPO2 and TcPCO2was performed using TCM4 TOSCA/CombiM monitoring systems made by Radiometer. In the 4th monitoring, only DFU was documented. Wound and granulation size was measured through photographic documentation using ImageJ program. Neuropathy was diagnosed based on RR interval and nerve conduction velocity study. Other laboratory data were obtained from medical records. The data were analysed by path analysis for repetititive data and SPSS for nonrepetitive data. From analysis, there is a significant correlation between the increasing random blood glucose (RBG), fibrinogen, and PAI-1 with the decreasing of TcPO2, also found a significant relationship between the severity of sensory and motoric neuropathy, the increasing levels of RBG, fibrinogen, PAI-1, and hsCRP with the decreasing of granulation index. But, TcPO2 index does not influence granulation index. TcPCO2 index does not have significant correlation with all these variables, except hsCRP. Moreover, TcPCO2 index also does not influence granulation index. TcPO2 index of DFU is affected by RBG, fibrinogen, PAI-1, but does not affect the growth of granulation tissue. Granulation tissue?s growing is influenced by the sensory and motoric neuropathy, increased levels of fibrinogen, PAI-1, and hsCRP. Furthermore, TcPCO2 index does not influence granulation?s growth.