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Abstrak :
ABSTRAK
Ulkus kaki diabetik mengakibatkan mortalitas yang semakin meningkat terutama pasca amputasi, beban yang signifikan pada pembiayaan kesehatan dan menyebabkan hilangnya produktivitas. Penelitian ini bertujuan untuk mengetahui efektivitas terapi kombinasi dari laserpunktur dan perawatan luka konvensional dibandingkan dengan laserpunktur sham dan perawatan luka konvensional terhadap penyembuhan ulkus kaki diabetik. Uji klinis acak tersamar ganda dengan pembanding dilakukan terhadap 36 pasien yang dialokasikan ke dalam kelompok kasus atau kelompok kontrol. Tindakan laserpunktur dilakukan pada titik LI4 Hegu, ST36 Zusanli, SP6 Sanyinjiao, dan KI3 Taixi bilateral serta penyinaran pada ulkus dua kali seminggu, selama empat minggu. Rerata ukuran ulkus kaki diabetik sebagai keluaran primer diukur setiap minggu. Hasil penelitian menunjukkan perbedaan yang bermakna antara penurunan luas luka akhir di kelompok laserpunktur dan perawatan luka konvensional dengan kelompok laserpunktur sham dan perawatan luka konvensional (p=0,006). Dapat disimpulkan bahwa terapi kombinasi laserpunktur dan perawatan luka konvensional efektif mempercepat penyembuhan ulkus kaki diabetik dengan frekuensi terapi dua kali seminggu. ABSTRACT
Diabetic foot ulcers result in mortality is increasing, especially after the amputation, a significant burden on health financing and lead to loss of productivity. This study aims to determine the effectiveness of the combination therapy between laserpuncture and conventional wound care compared with sham laserpuncture and conventional wound treatment for healing diabetic foot ulcers. Double-blind randomized clinical trial with a control carried out on 36 patients allocated to the case group or control group. Laserpuncture actions performed on LI4 point Hegu, Zusanli ST36, SP6 Sanyinjiao and Taixi KI3 bilateral as well as exposure to ulcers twice a week, for four weeks. The mean size of diabetic foot ulcers as the primary output is measured every week. The results showed a significant difference between the reduction in wound area at the end of the group laserpuncture and conventional wound care compare with laserpuncture sham group and conventional wound treatment (p = 0.006). It can be concluded that the combination therapy laserpuncture and conventional wound care effectively accelerate the healing of diabetic foot ulcers with frequency therapy twice a week.;Diabetic foot ulcers result in mortality is increasing, especially after the amputation, a significant burden on health financing and lead to loss of productivity. This study aims to determine the effectiveness of the combination therapy between laserpuncture and conventional wound care compared with sham laserpuncture and conventional wound treatment for healing diabetic foot ulcers. Double-blind randomized clinical trial with a control carried out on 36 patients allocated to the case group or control group. Laserpuncture actions performed on LI4 point Hegu, Zusanli ST36, SP6 Sanyinjiao and Taixi KI3 bilateral as well as exposure to ulcers twice a week, for four weeks. The mean size of diabetic foot ulcers as the primary output is measured every week. The results showed a significant difference between the reduction in wound area at the end of the group laserpuncture and conventional wound care compare with laserpuncture sham group and conventional wound treatment (p = 0.006). It can be concluded that the combination therapy laserpuncture and conventional wound care effectively accelerate the healing of diabetic foot ulcers with frequency therapy twice a week.;Diabetic foot ulcers result in mortality is increasing, especially after the amputation, a significant burden on health financing and lead to loss of productivity. This study aims to determine the effectiveness of the combination therapy between laserpuncture and conventional wound care compared with sham laserpuncture and conventional wound treatment for healing diabetic foot ulcers. Double-blind randomized clinical trial with a control carried out on 36 patients allocated to the case group or control group. Laserpuncture actions performed on LI4 point Hegu, Zusanli ST36, SP6 Sanyinjiao and Taixi KI3 bilateral as well as exposure to ulcers twice a week, for four weeks. The mean size of diabetic foot ulcers as the primary output is measured every week. The results showed a significant difference between the reduction in wound area at the end of the group laserpuncture and conventional wound care compare with laserpuncture sham group and conventional wound treatment (p = 0.006). It can be concluded that the combination therapy laserpuncture and conventional wound care effectively accelerate the healing of diabetic foot ulcers with frequency therapy twice a week.

Abstrak :
ABSTRAK
Latar belakang dan tujuan : Nodul tiroid banyak ditemukan pada populasi dewasa. Kebanyakan merupakan lesi jinak yang tidak memerlukan tindakan lanjutan, namun 7-15% dapat ganas. Modalitas paling sensitif untuk evaluasi adalah ultrasonografi (USG), namun untuk memastikan jenis nodul tetap diperlukan diagnosis invasif dengan lini pertama yaitu pemeriksaan sitopatologi dengan fine needle aspiration biopsy (FNAB). Saat ini berkembang elastografi untuk menilai kekakuan jaringan, dengan teori semakin ganas nodul maka semakin padat jaringan dan elastisitas berkurang. Elastografi kualitatif menggunakan skoring dengan kriteria Rago berdasarkan warna nodul yang semakin gelap dengan meningkatnya kepadatan. Diharapkan elastografi dapat menjadi tambahan untuk evaluasi nodul tiroid. Tujuan penelitian untuk mengetahui kesesuaian antara pemeriksaan strain elastografi kualitatif kriteria Rago dengan hasil sitopatologi. Metode : Uji kesesuaian menggunakan data primer elastografi nodul tiroid berdasarkan sistem skoring Rago dengan hasil sitopatologi berdasarkan klasifikasi Bethesda, dengan desain potong lintang (cross sectional), di RSCM bulan Juli-Agustus 2018. Subjek penelitian adalah 39 nodul yang dikategorikan menjadi benign, intermediate, dan malignant. Analisis statistik menggunakan uji McNemar dan Kappa. Hasil : Didapatkan kesesuaian antara hasil strain elastografi dengan FNAB dengan hasil McNemar test p=0,214, nilai Kappa R=0,52 dan p=0,000. Kesimpulan : Terdapat kesesuaian antara elastografi menggunakan sistem skoring kategori Rago dengan sitopatologi dengan tingkat kesesuaian moderate sehingga elastografi dapat menjadi pemeriksaan tambahan untuk evaluasi nodul tiroid.

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ABSTRACT
Introduction : Thyroid nodule is common condition in adult populations, which mostly are benign. Nevertheless, malignancy can be found in 7-15% nodules. The most sensitive modality to evaluate thyroid nodule is ultrasonography (USG), although invasive examination is still necessary to confirm benignity or malignancy with first line is cytopathology with fine needle aspiration biopsy (FNAB). Elastography is developed to asses tissue elasticity, with theory that higher malignancy the cells are denser and elasticity is decreasing. In qualitative elastography there is Rago scoring system criteria based on colors appearing in nodules which darker as nodule grows denser. Elastography may become additional examination to evaluate thyroid nodules. The objective of this research is to acknowledge the concordance between qualitative strain elastography and cytopathology result. Methods : This research is suitability test using primary data of thyroid nodules elastography and cytopathology results in RSCM between July to August 2018. The design is cross sectional. The subjects are 39 nodules and every nodule is grouped into three categories which is benign, intermediate, and malignant. Statistical analysis is performed using McNemar and Kappa test. Result : Concordance can be found between scoring system strain elastography with FNAB results with McNemar test p=0,214, Kappa R=0,52 and p=0,000. Conclusion : There is concordance between scoring system strain elastography using Rago criteria with FNAB results with moderate level of agreement. Thus, elastography can be used as additional examination to evaluate thyroid nodules.

Abstrak :
Pendahuluan. Adenoma pituitari atau pituitary neuroendocrine tumor (PitNET) meliputi 10% hingga 15% dari seluruh tumor intrakranial. Sekitar 30%-40% pasien adenoma pituitari membutuhkan tatalaksana pembedahan. Dari pasien yang dilakukan operasi tersebut sekitar 25%-40% memiliki luaran yang kurang baik seperti menginvasi secara lokal, resisten terhadap terapi konvensional, memiliki tingkat rekurensi yang tinggi serta dapat mengalami metastasis. Tujuan penelitian ini untuk mengetahui apakah faktor-faktor klinikopatologi tertentu yaitu ukuran adenoma, tipe/ subtipe adenoma, sifat invasif, sifat proliferatif (Ki-67, mitosis, dan p53), dan grade adenoma mempengaruhi luaran yang agresif pada adenoma pituitari pasca operasi. Metode. Penelitian ini merupakan studi meta analisis dengan menggunakan sumber data elektronik maupun pencarian manual. Studi-studi yang disertakan adalah studi observasional. Pemilihan studi didasarkan pada strategi penelusuran literatur sesuai panduan PRISMA dan kriteria eligibilitas yang telah ditentukan sebelumnya. Variabel bebas yang dinilai antara lain ukuran adenoma, tipe/ subtipe, sifat invasif, sifat proliferatif, ki-67, tingkat mitosis, p53, dan grade. Luaran yang dinilai adalah agresivitas pasca operasi yang terdiri atas rekurensi atau progresi. Penilaian kualitas dan risiko bias pada tiap studi terpilih mengunakan perangkat Newcastle Ottawa Scale. Analisis data dilakukan baik secara kualitatif maupun kuantitatif. Semua tahapan dalam penelitian ini dilakukan oleh setidaknya 2 peneliti. Hasil. Dari 736 studi awal yang terjaring terdapat 10 studi terpilih. Jumlah subjek penelitian 2727 orang dengan 632 orang kasus. Durasi pemantauan berkisar antara 3 hingga 11 tahun. Seluruh studi memiliki kualitas sedang hingga baik. Meta analisis dilakukan pada masing-masing variabel bebas terhadap agresivitas adenoma pituitari pasca operasi dengan hasil ukuran adenoma ≥10mm dengan <10mm OR 1,79 (CI 1,29-2,48), tipe kortikotrof dengan non kortikotrof OR 1,91 (CI 1,41-2,58), sifat invasif dengan non invasif OR 3,67 (CI 1,95-6,90), sifat proliferatif dengan non proliferatif OR 4,78 (CI 3,61-6,32), Ki-67 ≥ 3% dengan < 3% OR 4,13 (CI 2,94-5,81), tingkat mitosis > 2 dengan ≤2 OR 3,91 (CI 2,74-5,57), p53 positif dengan negatif OR 1,92 (CI 1,28-2,90), dan grade 2b dengan non 2b OR 4,56 (CI 3,0-6,91). Simpulan. Faktor-faktor klinikopatologi tertentu yaitu ukuran adenoma, tipe/ subtipe adenoma, sifat invasif, sifat proliferatif (Ki-67, mitosis, dan p53), dan grade adenoma mempengaruhi luaran yang agresif pada adenoma pituitari pasca operasi. ......Introduction. Pituitary adenoma/ pituitary neuroendocrine tumor (PitNET) comprise of 10% up to 15% of intracranial tumor. About 30%-40% of pituitary adenoma patients need surgery. For those who have undergone surgery about 25%- 40% will have bad outcomes like locally invasive, resistant to conventional treatment, high rate of recurrence, and malignant tendency. The aim of this study was to determine whether certain clinicopathologic factors consisting of size, type/ subtype, invasiveness, proliferative (ki-67, mitotic rate, and p53), and grade influenced the aggressive outcome of post-operative pituitary adenoma. Methods. This meta-analysis study used electronic and manual data source. Included studies were observational studies. Study selection was based to literature searching strategy according to PRISMA guideline and predetermined eligibility criteria. Independent variables reviewed were size, type/ subtype, invasiveness, proliferative, ki-67, mitotic rate, p53, and grade. Outcome reviewed were postoperative aggressiveness comprised of recurrence or progressive. Quality and risk of bias assessment to each study included were based on Newcastle Ottawa Scale. Data analysis was carried out both qualitatively and quantitatively. All stages in this study were carried out by at least 2 reviewers. Results. Of the 736 initial studies, 10 were selected. The number of research subjects were 2727 people with 632 cases. The duration of monitoring ranged from 3 to 11 years. All studies had moderate to good quality. Meta-analysis were carried out on each independent variable on the aggressiveness of post-operative pituitary adenoma with the results were size ≥10mm vs <10mm OR 1,79 (CI 1,29-2,48), corticotroph vs non-corticotroph OR 1,91 (CI 1,41-2,58), invasive vs non-invasive OR 3,67 (CI 1,95-6,90), proliferative vs non proliferative OR 4,78(CI 3,61-6,32), Ki-67 ≥ 3% vs < 3% OR 4,13 (CI 2,94-5,81), mitotic rate > 2 vs ≤2 OR 3,91 (CI 2,74-5,57), p53 positive vs negative OR 1,92 (CI1,28-2,90), and grade 2b vs non 2b OR 4,56 (CI 3,0-6,91). Conclusions. Certain clinicopathologic factors consisting of size, type/ subtype, invasiveness, proliferative (ki-67, mitotic rate, and p53), and grade influenced the aggressive outcome of post-operative pituitary adenoma.