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Faresa Hilda

Perbandingan laser fotokoagulasi panretinal 532 nm durasi 20 ms dosistunggal dan 100 ms dosis tunggal serta terbagi terhadap ketebalan makula sentral : Pada severe non-proliferative diabetic retinopathy dan non-high risk proliferative diabetic retinopathy = Comparison of 532 nm panretinal laser photocoagulation of 20 ms duration single session and 100 ms duration single session and multiple session toward central macular thickness

"ABSTRAK

Tujuan tesis ini adalah mengetahui pengaruh laser fotokoagulasi panretinal 532 nm durasi 20 ms dosis tunggal, 100 ms dosis tunggal dan 100 ms-3 sesi terhadap ketebalan makula sentral (KMS). Desain penelitian adalah uji klinis acak terkontrol tersamar ganda. Tiga puluh tiga mata yang memenuhi kriteria inklusi dirandomisasi untuk mendapatkan laser 20 ms dosis tunggal atau 100 ms dosis tunggal atau 100 ms-3 sesi. Keluaran primer adalah KMS yang diukur menggunakan time-domain Optical Coherence Tomography pada baseline, 4 minggu dan 8 minggu pasca laser. Analisis hasil didapatkan rerata ( + SE) KMS baseline kelompok 100 ms, 20 ms dan 100 ms-3 sesi berturut-turut adalah 212,18 + 12,18 µm; 199,18 + 12,18 µm; 215,36 + 12,18 µm. Empat minggu pasca laser, KMS berturut-turut meningkat menjadi 232,09 + 18,63 µm; 206,27 + 18,63 µm; 254,09 + 18,63 µm. Delapan minggu pasca laser, KMS meningkat pada kelompok 100 ms dan 20 ms (237,90 + 17,47 µm; 208,27 + 17,47 µm), namun menurun pada kelompok 100 ms-3sesi (252,36 + 17,47 µm).

ABSTRACT
The purpose of this study was to determine the effect of panretinal laser photocoagulation 532 nm of 20 ms duration single session (SS), 100 ms SS and 100 ms (3 session) toward central macular thickness (CMT). The study design was a double-blind, randomized controlled clinical trial. Thirty-three subjects who met inclusion criteria were randomized to receive 20 ms SS laser or 100 ms SS or 100 ms (3 session). Primary output was CMT, measured by time-domain Optical Coherence Tomography at baseline, 4 weeks and 8 weeks post-laser. Results showed mean ( + SE) CMT at baseline from 100 ms SS group, 20 ms SS and 100 ms-3 session were 212.18 + 12.18 μm; 199.18 + 12.18 μm; 215.36 + 12.18 μm respectively. Four weeks after laser, CMT was increased to 232.09 + 18.63 μm; 206.27 + 18.63 μm; 254.09 + 18.63 μm respectively. Eight weeks post laser, CMT was increased in 100 ms SS and 20 ms SS (237.90 + 17.47 μm; 208.27 + 17.47 μm), but decreased 100 ms-3session group (252.36 + 17.47 μm)."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015

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Faresa Hilda

Perbandingan laser fotokoagulasi panretinal 532 NM durasi 20 MS dosis tunggal dan100 MS dosis tunggal serta terbagi terhadap ketebalan makula sentral (pada severe non-proliferative diabetic retinopathy dan non-high risk proliferative diabetic retinopathy) = Comparison of 532 NM panretinal laser photocoagulation of 20 MS duration single session and 100 MS duration single session and multiple session toward central macular thickness (in severe non-proliferative diabetic retinopathy and non-high risk proliferative diabetic retinopathy)

"Tujuan tesis ini adalah mengetahui pengaruh laser fotokoagulasi panretinal 532 nm durasi 20 ms dosis tunggal, 100 ms dosis tunggal dan 100 ms-3 sesi terhadap ketebalan makula sentral (KMS). Desain penelitian adalah uji klinis acak terkontrol tersamar ganda. Tiga puluh tiga mata yang memenuhi kriteria inklusi dirandomisasi untuk mendapatkan laser 20 ms dosis tunggal atau 100 ms dosis tunggal atau 100 ms-3 sesi. Keluaran primer adalah KMS yang diukur menggunakan time-domain Optical Coherence Tomography pada baseline, 4 minggu dan 8 minggu pasca laser. Analisis hasil didapatkan rerata ( + SE) KMS baseline kelompok 100 ms, 20 ms dan 100 ms-3 sesi berturut-turut adalah 212,18 + 12,18 μm; 199,18 + 12,18 μm; 215,36 + 12,18 μm. Empat minggu pasca laser, KMS berturut-turut meningkat menjadi 232,09 + 18,63 μm; 206,27 + 18,63 μm; 254,09 + 18,63 μm. Delapan minggu pasca laser, KMS meningkat pada kelompok 100 ms dan 20 ms (237,90 + 17,47 μm; 208,27 + 17,47 μm), namun menurun pada kelompok 100 ms-3sesi (252,36 + 17,47 μm).

The purpose of this study was to determine the effect of panretinal laser photocoagulation 532 nm of 20 ms duration single session (SS), 100 ms SS and 100 ms (3 session) toward central macular thickness (CMT). The study design was a double-blind, randomized controlled clinical trial. Thirty-three subjects who met inclusion criteria were randomized to receive 20 ms SS laser or 100 ms SS or 100 ms (3 session). Primary output was CMT, measured by time-domain Optical Coherence Tomography at baseline, 4 weeks and 8 weeks post-laser. Results showed mean ( + SE) CMT at baseline from 100 ms SS group, 20 ms SS and 100 ms-3 session were 212.18 + 12.18 μm; 199.18 + 12.18 μm; 215.36 + 12.18 μm respectively. Four weeks after laser, CMT was increased to 232.09 + 18.63 μm; 206.27 + 18.63 μm; 254.09 + 18.63 μm respectively. Eight weeks post laser, CMT was increased in 100 ms SS and 20 ms SS (237.90 + 17.47 μm; 208.27 + 17.47 μm), but decreased 100 ms-3session group (252.36 + 17.47 μm)."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015

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Kshetra Rinaldhy

Perbandingan luaran jangka panjang pasien penyakit hirschsprung pasca transanal endorectal pull-through dan prosedur duhamel modifikasi = Long term outcome comparison after transanal endorectal pull through and modified duhamel in hirschsprung disease

"Transanal Endorectal Pull-Through (TEPT) dan prosedur Duhamel modifikasi (Martin atau Adang) merupakan teknik operasi penanganan Penyakit Hirschsprung (PH). Penelitian ini bertujuan untuk mengetahui luaran jangka panjang pada pasien PH pasca operasi TEPT dan prosedur Duhamel modifikasi di Rumah Sakit Cipto Mangunkusumo. Luaran jangka panjang yang dievaluasi adalah gejala komplikasi konstipasi, fecal soiling, inkontinensia, dan enterokolitis. Penelitian ini menggunakan rancangan analitik cross sectional. Hasil penelitian menunjukkan angka keberhasilan tanpa gejala komplikasi pasca operasi TEPT lebih tinggi dibanding pasca prosedur Duhamel. Didapatkan angka kejadian yang lebih rendah pada seluruh luaran komplikasi terutama konstipasi pada pasien pasca operasi TEPT dibanding pasca prosedur Duhamel modifikasi. Evaluasi jangka panjang menunjukkan operasi satu tahap TEPT secara umum lebih baik dibanding Duhamel modifikasi.

Transanal Endorectal Pull-Through (TEPT) and Duhamel procedure (Martin or Adang modification) are surgical technique for Hirschprung Disease. The aim of this study was to evaluate the long-term outcome of TEPT and Duhamel procedure in Cipto Mangunkusumo Hospital. This long-term outcome includes constipation, fecal soiling, incontinensia, and enterocolitis. This study use a cross sectional study design. As a results, success rate without symptoms of postoperative complications on TEPT was higher than Duhamel procedure and incidence of complication, especially constipation, on TEPT was lower than Duhamel procedure. In general, long-term outcome of TEPT is better than Duhamel procedure."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014

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Adiel Amaris Syah

Kualitas hidup pasien penyakit buerger pasca pengobatan dan faktor faktor yang mempengaruhinya = The Post therapy quality of life of patients with buerger's disease and its related factors

"Berdasarkan data Kementerian Kesehatan Indonesia6, pada tahun 2010, 43,3% dari seluruh perokok mulai merokok pada rentang usia 14-19 tahun. Fakta ini mengindikasikan peningkatan prevalensi penyakit-penyakit pembuluh darah di masa yang akan datang, termasuk Buerger's disease (Penyakit Buerger). Sehubungan dengan peningkatan prevalensi tersebut, perlu dilakukan penelitian tentang faktor-faktor yang mempengaruhi kualitas hidup pasien dengan Penyakit Buerger, terutama faktor sosioekonomi dengan tujuan agar pelayanan terhadap pasien dan kepuasan pasien terhadap terapi dapat ditingkatkan. Metode penelitian adalah studi potong lintang. Pada hasil ditemukan hubungan bermakna antara faktor usia dengan indeks gejala pasca tatalaksana (p<0,05 ; uji t tidak berpasangan). Kesimpulan yang didapatkan bahwa secara keseluruhan tidak ditemukan hubungan bermakna antara faktor sosioekonomi dengan kualitas hidup, kecuali faktor usia dengan indeks gejala pasca tatalaksana.

Based on the data from the Ministry of Health of Indonesia, in 2010, 43.3% of all smokers start smoking at the age range from 14 to 19 years old. This fact indicates an increased prevalence of vascular diseases in the future, including Buerger's disease. Regarding to the increased prevalence a research futher about factors that affect the quality of life of the patient with Buerger's Disease need to be performed, particularly on the socioeconomic factor which purposed for better medical service and increase treatment satisfactory of the patients. The research method is cross-sectional study. As the result, significant correlations is found in the correlation of the age factor and post-therapy symptoms index (p<0,05 : t-unpaired test). The conclusion found is relatively no significant correlation between the socioeconomic factor and the quality of life, except the correlation of the age factor and the post therapy symptoms index."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014

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Wahyu Rathariwibowo

Faktor risiko yang berhubungan dengan kondisi kritis iskemia tungkai pada pasien penyakit arteri perifer = Risk factors related to critical limb ischemia in perifer artery disease's patient

"Kondisi kritis iskemia tungkai merupakan manifestasi dan stadium akhir penyakit arteri perifer (PAP) yang dapat meningkatkan risiko morbiditas dan mortalitas yang tinggi bagi penderitanya. Dengan demikian perlu dilakukan penelitian tentang faktor-faktor yang berhubungan dengan kondisi kritis iskemia tungkai pada penderita PAP. Beberapa faktor tersebut diantaranya faktor usia, jenis kelamin, penyakit diabetes mellitus, hipertensi, kebiasaan merokok dan penyakit chronic kidney disease dengan tujuan agar pencegahan dan pelayanan terhadap pasien penderita PAP dapat ditingkatkan. Metode penelitian adalah studi potong lintang.

Hasil penelitian dengan analisis regresi logistik biner menunjukkan kejadian kondisi kritis iskemia tungkai pada penderita PAP berhubungan secara signifikan oleh faktor diabetes mellitus (OR=3,5; 95% CI=1,431-8,533), hipertensi (OR=2,62; 95% CI=1,064-6,442), dan kebiasaan merokok (OR=2,92; 95% CI=1,059-8,035). Usia, jenis kelamin, dan chronic kidney disease tidak berhubungan signifikan terhadap kondisi kritis iskemia tungkai pada penderita PAP.

Critical limb ischemia is the manifestation dan the last stage of perifer artery disease (PAD) which improves high risk of morbidity and mortality for its patient. Thus its needed to perform a research about factors related to critical limb ischemia in perifer artery disease’s patients, including age, gender, diabetes mellitus, hypertension, smoking habit, and chronic kidney disease in purpose to increase prevention and treatment satisfactory of PAD’s patients. The research method is cross-sectional study.
The result with binary logistic regression analysis shows that critical limb ischemia in PAD's patients significantly related by diabetes mellitus (OR=3,5; 95% CI=1,431-8,533), hypertension (OR=2,62; 95% CI=1,064-6,442), and smoking habit (OR=2,92; 95% CI=1,059-8,035). Age, gender, and chronic kidney disease are not significantly related to critical limb ischemia in PAD’s patients."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014

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Valery Ivanov Arwadi

Morbiditas dan Mortalitas Tumor Parotis Ganas di RSUPNCM serta Faktor Prognosis yang Berhubungan = Morbidity and Mortality of Malignant Parotid Gland Tumor in Cipto Mangunkusumo Hospital and Related Prognostic Factors

"Latar belakang: tumor kelenjar liur merupakan tumor yang jarang pada keganasan kepala leher. Histopatologinya sangat heterogen demikian juga kejadian dan klinik epidemiologinya. Perbedaan karakteristik dari tumor parotis di banyak pusat kesehatan memengaruhi survival rate.

Metode: penelitian ini adalah uji retrospektif analitik dengan uji kesintasan. Data didapatkan dari rekam medik pasien tumor parotis ganas yang dirawat di RSUPNCM periode Januari 2005 sampai Desember 2011.

Hasil: ada 75 kasus tumor parotis ganas. Laki-laki lebih banyak dibandingkan perempuan, dengan umur rata-rata 50 tahun. Delapan puluh persen ditemukan dalam stadium klinis lanjut. Mukoepidermoid karsinoma merupakan histopatologi yang paling sering ditemukan. Pembedahan merupakan terapi pilihan utama. Enam puluh persen kasus ditemukan penurunan indeks masa tubuh (IMT). Komplikasi tersering adalah paralisis nervus fasialis sekitar 30,7%. Mortalitas dalam 1 tahun didapati sebesar 25,3%. Rekurensi ditemukan sebesar 17,3%. Analisis bivariat antara tatalaksana dengan morbiditas menunjukkan signifikan dengan nilai p=0.001, dan dalam hubungannya dengan mortalitas didapati signifikan dengan tatalaksana, sedangkan stadium klinis dan histopatologi tidak. Histopatologi signifikan dalam hubungannya dengan rekurensi. Pada analisis multivariat antara stadium klinis I-II dengan status nutrisi dan mortalitas menunjukkan hubungan yang signifikan dengan nilai p = 0.006. Terdapat hubungan signifikan antara tatalaksana dengan survival rate, sedangkan untuk jenis kelamin, usia, histopatologi dan stadium klinis tidak ditemukan hubungan yang signifikan. Disease free survival untuk kasus keganasan ini adalah 61,5%.

Kesimpulan: karakteristik tumor parotis ganas di RSUPNCM tidak berbeda dengan yang ditemukan pada literatur, hubungan yang signifikan ditemukan antara histopatologi dan tatalaksana sebagai faktor prognosis survival rate.

Background: salivary gland tumor is a rare case found in head and neck tumor. The histopathology is very heterogeneous, as well as the incident and clinical epidemiology. Different characteristics of parotid gland tumor in many health centers affecting survival rate.
Method: This is a survival study with retrospective analytical method. Data is obtained from medical record in Cipto Mangunkusumo Hospital in period of January 2005 to December 2011.
Results: There are 75 patients with malignant parotid gland tumor. Male is affected more than female, the mean age is 50 years old. 80% of cases found are in late stage. Mucoepidermoid carcinoma is the most frequent histopathology found. Surgery remains the treatment of choice. 60% patients experienced a decreased of body mass index. Postoperative complication such as facial nerve paralysis occurred in 30.7%. One year mortality is found in 25.3% cases. Recurrence is found in 17,3%. Bivariate analysis between clinical management and morbidity has a significant correlation with p=0,001, and significant also found between clinical management with mortality but not for tumor stage and histopathology. Histopathology found significant in correlation with recurrence. Multivariate analysis between nutritional status and tumor stage showed significancy with p = 0.006 in stage I-II. There is significant relationship between clinical management and survival rate, but there is no significancy between sex, age, histopathology, and tumor stage. Disease Free Survival is among 61,5%.
Conclusion: malignant parotid gland tumor in Cipto Mangunkusumo Hospital contributes the same characteristics with those found in publications. There is significant relationship between variables from survival analysis of prognostic factors."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015

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Cut Putri Samira

Perbandingan ketebalan kornea dan morfologi sel endotel penderita miopia sedang pada pemakaian harian lensa kontak lunak hidrogel konvensional (nelfilcon a) terhadap silikon hidrogel (lotrafilcon b): penelitian pendahuluan = Comparison of corneal thickness and endothelial cell morphology in myopic patients with daily wear hydrogel (nelfilcon a) and silicon hydrogel (lotrafilcon b): contact lenses a pilot study

"[ABSTRAK

Tujuan: Untuk mengevaluasi perbandingan ketebalan kornea dan morfologi sel endotel penderita miopia sedang dengan pemakaian harian lensa kontak lunak hidrogel konvensional (nelfilcon A) terhadap silikon hidrogel (lotrafilcon B) selama 1 bulan.

Metode: Penelitian ini merupakan uji klinis tersamar tunggal pada 17 pasien (34 mata) dengan miopia sedang yang dibagi secara acak untuk memakai lensa kontak lunak nelfilcon A atau Lotrafilcon B. Ketebalan kornea sentral (CCT), Coefficient of variation (CV), dan persentase sel heksagonal (6A) diukur menggunakan mikroskop spekuler non-con robo Konan sebelum penelitian (pre-fitting), 1 minggu serta 1 bulan setelah pemakaian lensa kontak lunak. Pasien juga dievaluasi mengenai adanya efek samping subyektif dan komplikasi selama memakai lensa kontak.

Hasil: Terdapat 64,7% subyek dengan riwayat pemakaian lensa kontak lunak sebelumnya, dimana 52,9% diantaranya adalah pemakai hidrogel konvensional yang tidak teratur. Setelah evaluasi 1 bulan, tidak didapatkan perbedaan yang bermakna antara pemakai Nelfilcon A dengan Lotrafilcon B dalam hal: ketebalan kornea sentral (p=0,285; uji Mann Whitney), CV (p=0,587; uji t tidak berpasangan), dan 6A (p=0,353; uji t tidak berpasangan). Analisis general linear model terhadap waktu pengukuran mendapatkan perbedaan yang bermakna pada seluru subyek meliputi penurunan CCT (p=0,001) dan CV (p=0,001), serta peningkatan 6A (p=0,022) pada test within subject effect.

Simpulan: Tidak terdapat perbedaan CCT, CV, dan 6A yang bermakna secara statistik antara pada pemakaian harian lensa kontak lunak Lotrafilcon B dan Nelficon A. Pasien dengan riwayat penggunaan lensa kontak sebelumnya mendapatkan manfaat dengan pemakaian nelfilcon A dan lotrafilcon B dalam hal perbaikan hipoksia jaringan berupa: penurunan ketebalan kornea dan perbaikan morfologi sel endotel.

ABSTRACT

Objective: To compare corneal thickness and endothelial cell morphology in myopic patients wearing 1 month hydrogel conventional and silicon hydrogel contact lenses in daily wear.

Methods: This is a prospective, single blind, randomized study. Seventeen (34 eyes) myopic patients were randomly assigned to wearing either nelfilcon A or lotrafilcon B. Central corneal thickness (CCT), Coefficient of variation (CV), and percentage of six-sided cell (6A) were examined using specular microscope non-con robo Konan. Changes in CCT, CV, and 6A were evaluated before contact lenses fitting as well as 1 week and 1 month after the treatment. Patients were also evaluated for any subjective side effects and complications during the treatment period.

Results: There were 64,7% subjects with history of contact lens weares and 52,9% of them was hydrogel wearers. After 1 month daily wear of nelfilcon A and lotrafilcon B, no statistically differences changes in CCT (p=0,285; Mann Whitney test), CV (p=0,587; unpaired t test) dan 6A (p=0,353; unpaired t test). General linear model analysis in follow up evaluation with test of within subject effect revealed decreased CCT(p=0,001) and CV (p=0,001), also increased 6A (p=0,022) in all subjects.

Conclusions: There were no statistically difference CCT, CV, and 6A between daily wear of nelfilcon A and lotrafilcon B. Subjects with history of contact lens weares gained advantages in oxygen availability, which is decrease in corneal thickness and improvement of endothelial cell morphology., Objective: To compare corneal thickness and endothelial cell morphology in myopic patients wearing 1 month hydrogel conventional and silicon hydrogel contact lenses in daily wear.

2015

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Radhita Fatma Kamil

Manfaat skor APACHE II, MPI, dan ARPI sebagai penentu On Demand Relaparotomy = Benefits of APACHE II, MPI, and ARPI as determinants of On Demand Relaparotomy

"[ABSTRAK

Pendahuluan: Keputusan relaparotomi yang terlambat menambah morbiditas dan mortalitas. Keputusan on demand relaparotomy bersifat subjektif dari klinis, sehingga diperlukan pemeriksaan diagnostik tambahan dan alat untuk menentukan keputusan secara tepat, yaitu sistem skor. Metode penelitian: kasus kontrol dengan menggunakan 32 kasus on demand relaparotomy dan 64 kasus laparotomi, secara retrospektif. Hasil penelitian: Analisis perbedaan dua kelompok menunjukkan bahwa skor APACHE II tidak mempunyai perbedaan bermakna (p=0,144) sedangkan skor MPI dan ARPI mempunyai perbedaan yang bermakna (p<0,0001). Dari kurva ROC didaptkan APACHE II mempunyai AUC 59,2% dengan cut off point 10, MPI mempunyai AUC 86,4% dengan cut off point 20 dan ARPI mempunyai AUC 77,6% dengan cut off point 10. Kesimpulan: MPI dan ARPI bermanfaat sebagai penentu on demand relaparotomy.ABSTRACT Background: Delayed decision to do relaparotomy add morbidity and mortality. The decision to do on demand relaparotomy is subjective based on the clinical nature, therefore, it is necessary to have an examination and additional diagnostic and tools to determine the correct decisions, that is the scoring system. Methods: this is a case-control using 32 cases of on demand relaparotomy and 64 cases of laparotomy, retrospectively. Results: The analysis of the two groups showed that APACHE II has no significant difference (P = 0.114) while the MPI and ARPI has significant difference (P <0.0001) and on ROC curve obtained APACHE II had AUC of 59.2% with a cut-off point of 10, MPI had AUC of 86.4% with a cut-off point of 20 and ARPI had AUC of 77.6% with a cut-off point of 10.
Conclusion: MPI and ARPI can be used as determinants on demand relaparotomy. ;Background: Delayed decision to do relaparotomy add morbidity and mortality. The decision to do on demand relaparotomy is subjective based on the clinical nature, therefore, it is necessary to have an examination and additional diagnostic and tools to determine the correct decisions, that is the scoring system. Methods: this is a case-control using 32 cases of on demand relaparotomy and 64 cases of laparotomy, retrospectively. Results: The analysis of the two groups showed that APACHE II has no significant difference (P = 0.114) while the MPI and ARPI has significant difference (P <0.0001) and on ROC curve obtained APACHE II had AUC of 59.2% with a cut-off point of 10, MPI had AUC of 86.4% with a cut-off point of 20 and ARPI had AUC of 77.6% with a cut-off point of 10.
Conclusion: MPI and ARPI can be used as determinants on demand relaparotomy. ;Background: Delayed decision to do relaparotomy add morbidity and mortality. The decision to do on demand relaparotomy is subjective based on the clinical nature, therefore, it is necessary to have an examination and additional diagnostic and tools to determine the correct decisions, that is the scoring system. Methods: this is a case-control using 32 cases of on demand relaparotomy and 64 cases of laparotomy, retrospectively. Results: The analysis of the two groups showed that APACHE II has no significant difference (P = 0.114) while the MPI and ARPI has significant difference (P <0.0001) and on ROC curve obtained APACHE II had AUC of 59.2% with a cut-off point of 10, MPI had AUC of 86.4% with a cut-off point of 20 and ARPI had AUC of 77.6% with a cut-off point of 10.
Conclusion: MPI and ARPI can be used as determinants on demand relaparotomy. ;Background: Delayed decision to do relaparotomy add morbidity and mortality. The decision to do on demand relaparotomy is subjective based on the clinical nature, therefore, it is necessary to have an examination and additional diagnostic and tools to determine the correct decisions, that is the scoring system. Methods: this is a case-control using 32 cases of on demand relaparotomy and 64 cases of laparotomy, retrospectively. Results: The analysis of the two groups showed that APACHE II has no significant difference (P = 0.114) while the MPI and ARPI has significant difference (P <0.0001) and on ROC curve obtained APACHE II had AUC of 59.2% with a cut-off point of 10, MPI had AUC of 86.4% with a cut-off point of 20 and ARPI had AUC of 77.6% with a cut-off point of 10.
Conclusion: MPI and ARPI can be used as determinants on demand relaparotomy. , Background: Delayed decision to do relaparotomy add morbidity and mortality. The decision to do on demand relaparotomy is subjective based on the clinical nature, therefore, it is necessary to have an examination and additional diagnostic and tools to determine the correct decisions, that is the scoring system. Methods: this is a case-control using 32 cases of on demand relaparotomy and 64 cases of laparotomy, retrospectively. Results: The analysis of the two groups showed that APACHE II has no significant difference (P = 0.114) while the MPI and ARPI has significant difference (P <0.0001) and on ROC curve obtained APACHE II had AUC of 59.2% with a cut-off point of 10, MPI had AUC of 86.4% with a cut-off point of 20 and ARPI had AUC of 77.6% with a cut-off point of 10.
Conclusion: MPI and ARPI can be used as determinants on demand relaparotomy. ]"

Fakultas Kedokteran Universitas Indonesia, 2015

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Budhi Arifin Noor

Pengaruh eksisi tangensial dini terhadap kadar prokalsitonin pasien luka bakar berat = The influence of early tangential excision to the level of procalcitonin serum in patients with severe burns

"[ABSTRAK
Luka bakar menyebabkan terbentuknya eskar. Endotoksin bakteri pada eskar dan mediator inflamasi yang terbentuk saat lisis eskar menyebabkan sepsis. Eksisi tangensial dini merupakan upaya menurunkan risiko sepsis melalui pembuangan eskar. Prokalsitonin (PCT) adalah penanda inflamasi yang baik pada sepsis yang akan menurun kadarnya dengan tatalaksana yang adekuat.
Sampai saat ini belum ada penelitian yang menghubungkan eksisi dini dengan PCT. Penelitian ini bertujuan untuk mengetahui pengaruh tindakan eksisi tangensial dini terhadap kadar PCT serum pasien luka bakar berat. Desain penelitian ini adalah analitik observasional pre and post intervention study. Besar sampel yang digunakan adalah empat puluh. Data PCT diambil dari data sekunder yaitu dari rekam medis kemudian dianalisis menggunakan uji Wilcoxon. Didapati perbedaan bermakna antara PCT sebelum operasi dengan PCT sesudah operasi (2,78 (0,09-50,62) vs 1,31 (0,02-83,14), p < 0,005).
ABSTRACT Burn trauma caused cell death with the formation of eschar. Bacteria endotoxins and inflammation mediators that are formed when eskar was lysis cause sepsis. Early tangential excision is the efforts to decrease the risk of sepsis by disposing the eschar. Procalcitonin (PCT) is a good biomarker of sepsis that will decreased with the proper treatment. Until now, there hasn?t been any research linked early excision with PCT. The aim of this research is to know the influence of early tangential excision to the level of PCT serum on severe burn patients. The study design was observational analytic pre and post interventional study. The sample size was forty. PCT data were taken from medical records then analyzed using the Wilcoxon test. There were significant differences between preoperative PCT to postoperative PCT (2.78 (0.09 to 50.62) vs 1.31 (0.02 to 83.14), respectively, p<0.005).;Burn trauma caused cell death with the formation of eschar. Bacteria endotoxins and inflammation mediators that are formed when eskar was lysis cause sepsis. Early tangential excision is the efforts to decrease the risk of sepsis by disposing the eschar. Procalcitonin (PCT) is a good biomarker of sepsis that will decreased with the proper treatment. Until now, there hasn?t been any research linked early excision with PCT. The aim of this research is to know the influence of early tangential excision to the level of PCT serum on severe burn patients. The study design was observational analytic pre and post interventional study. The sample size was forty. PCT data were taken from medical records then analyzed using the Wilcoxon test. There were significant differences between preoperative PCT to postoperative PCT (2.78 (0.09 to 50.62) vs 1.31 (0.02 to 83.14), respectively, p<0.005)., Burn trauma caused cell death with the formation of eschar. Bacteria endotoxins and inflammation mediators that are formed when eskar was lysis cause sepsis. Early tangential excision is the efforts to decrease the risk of sepsis by disposing the eschar. Procalcitonin (PCT) is a good biomarker of sepsis that will decreased with the proper treatment. Until now, there hasn’t been any research linked early excision with PCT. The aim of this research is to know the influence of early tangential excision to the level of PCT serum on severe burn patients. The study design was observational analytic pre and post interventional study. The sample size was forty. PCT data were taken from medical records then analyzed using the Wilcoxon test. There were significant differences between preoperative PCT to postoperative PCT (2.78 (0.09 to 50.62) vs 1.31 (0.02 to 83.14), respectively, p<0.005).]"

Fakultas Kedokteran Universitas Indonesia, 2015

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Mo Tualeka

Hubungan kesesuaian antibiotika empiris dengan hasil kultur terhadap ketahanan hidup pasien perforasi tukak peptik di RSUPN Dr. Cipto Mangunkusumo Jakarta = Relationship of suitability of empiric antibiotics with culture results to the survival of perforated peptic ulcer patients in Dr. Cipto Mangunkusumo Hospital Jakarta

"ABSTRAK
Latar Belakang: Mortalitas pasien perforasi tukak peptik (PTP) masih stabil pada
angka 20-50% dimana penyebab terbanyak adalah sepsis. Tantangan ini memicu para
ahli bedah untuk meneliti faktor-faktor yang berhubungan dengan mortalitas dan
morbiditas penyakit ini. Selain pembedahan untuk kontrol infeksi, antibiotika
preoperatif diketahui menurunkan angka mortalitas. Penelitian ini bertujuan
mengetahui hubungan kesesuaian antibiotika empiris dengan hasil kultur sensitifitas
antibiotika terhadap ketahanan hidup 30 hari pasien perforasi tukak peptik di RSUPN
Dr Cipto Mangunkusumo (RSCM) Jakarta. Metode: Studi kohort terhadap pasien
PTP sejak Januari 2012 hingga Agustus 2015 di Departemen Bedah FKUI/RSCM
Jakarta, dimana PTP akibat keganasan dan trauma tembus dieksklusikan. Pola kuman
dan antibiotika pada pasien PTP disajikan sebagai studi pendahuluan. Hasil: dari 45
pasien yang didapat, angka mortalitas pasien PTP di RSCM sebesar 31,1% dan
ketahanan hidup sebesar 68,9%. Pola kuman pada pasien PTP adalah Escherichia coli
sebagai kuman Gram negatif terbanyak (35,85%) dan Streptococcus alfahemolytic
sebagai kuman Gram positif terbanyak (15,09%). Antibiotika lini kedua yang sesuai
untuk pasien PTP adalah Sulbactam/Ampicillin.
Tidak terdapat hubungan antara skor
Boey dan ketahan hidup, namun syok preoperatif memengaruhi ketahanan hidup
(nilai OR 14,67). Begitu juga dengan komorbiditas memengaruhi ketahanan hidup
sebesar 10,54 kali. Lama persiapan operasi tidak bermakna terhadap ketahanan hidup,
sedangkan durasi operasi memengaruhi ketahanan hidup sebesar 7,5 kali. Antibiotika
empiris yang sesuai dengan hasil kultur memengaruhi ketahanan hidup sebesar 12,57
kali. Kesimpulan: Pemberian antibiotika empiris yang tepat terbukti berhubungan
dengan ketahanan hidup pasien perforasi tukak peptik.;
ABSTRACT
Background: Mortality of patients with peptic ulcer perforation (PUP) was stable at
20-50%, which is the most common cause is sepsis. This challenge prompted the
surgeon to examine the factors associated with mortality and morbidity of this
disease. In addition to surgery to control infection, preoperative antibiotics are
known to reduce mortality. This study aims to determine the suitability of empiric
antibiotics relationship with antibiotic sensitivity culture results to the 30 days
survival of perforated peptic ulcer patients in Dr Cipto Mangunkusumo General
Hospital (RSCM) in Jakarta. Methods: A cohort study of patients PUP since January
2012 to August 2015 at Department of Surgery Faculty of medicine/RSCM Jakarta,
where PUP due to malignancy and penetrating trauma were excluded. Patterns of
bacteria and antibiotics in PUP patients presented as a preliminary study. Results:
45 patients were obtained, the mortality rate of patients in RSCM PUP by 31.1% and
amounted to 68.9% survival. Patterns of bacteria in a patient PUP is Escherichia
coli as most Gram-negative bacteria (35.85%) and Streptococcus alfahemolytic as
most Gram-positive bacteria (15.09%). The second line antibiotics are appropriate
for the PUP patients is sulbactam/ampicillin. There was no relationship between
Boey?s score and survivability, but the preoperative shock affect survival (OR 14.67).
Likewise with comorbidities affecting the survival of 10.54 times. Time to surgery on
survival was not significant, while the duration of surgery affecting the survival of 7.5
times. Empiric antibiotics in accordance with the culture results affects survival of
12.57 times. Conclusion: The provision of appropriate empiric antibiotic shown to be
associated with survival in patients with peptic ulcer perforation. ;Background: Mortality of patients with peptic ulcer perforation (PUP) was stable at
20-50%, which is the most common cause is sepsis. This challenge prompted the
surgeon to examine the factors associated with mortality and morbidity of this
disease. In addition to surgery to control infection, preoperative antibiotics are
known to reduce mortality. This study aims to determine the suitability of empiric
antibiotics relationship with antibiotic sensitivity culture results to the 30 days
survival of perforated peptic ulcer patients in Dr Cipto Mangunkusumo General
Hospital (RSCM) in Jakarta. Methods: A cohort study of patients PUP since January
2012 to August 2015 at Department of Surgery Faculty of medicine/RSCM Jakarta,
where PUP due to malignancy and penetrating trauma were excluded. Patterns of
bacteria and antibiotics in PUP patients presented as a preliminary study. Results:
45 patients were obtained, the mortality rate of patients in RSCM PUP by 31.1% and
amounted to 68.9% survival. Patterns of bacteria in a patient PUP is Escherichia
coli as most Gram-negative bacteria (35.85%) and Streptococcus alfahemolytic as
most Gram-positive bacteria (15.09%). The second line antibiotics are appropriate
for the PUP patients is sulbactam/ampicillin. There was no relationship between
Boey?s score and survivability, but the preoperative shock affect survival (OR 14.67).
Likewise with comorbidities affecting the survival of 10.54 times. Time to surgery on
survival was not significant, while the duration of surgery affecting the survival of 7.5
times. Empiric antibiotics in accordance with the culture results affects survival of
12.57 times. Conclusion: The provision of appropriate empiric antibiotic shown to be
associated with survival in patients with peptic ulcer perforation.;Background: Mortality of patients with peptic ulcer perforation (PUP) was stable at
20-50%, which is the most common cause is sepsis. This challenge prompted the
surgeon to examine the factors associated with mortality and morbidity of this
disease. In addition to surgery to control infection, preoperative antibiotics are
known to reduce mortality. This study aims to determine the suitability of empiric
antibiotics relationship with antibiotic sensitivity culture results to the 30 days
survival of perforated peptic ulcer patients in Dr Cipto Mangunkusumo General
Hospital (RSCM) in Jakarta. Methods: A cohort study of patients PUP since January
2012 to August 2015 at Department of Surgery Faculty of medicine/RSCM Jakarta,
where PUP due to malignancy and penetrating trauma were excluded. Patterns of
bacteria and antibiotics in PUP patients presented as a preliminary study. Results:
45 patients were obtained, the mortality rate of patients in RSCM PUP by 31.1% and
amounted to 68.9% survival. Patterns of bacteria in a patient PUP is Escherichia
coli as most Gram-negative bacteria (35.85%) and Streptococcus alfahemolytic as
most Gram-positive bacteria (15.09%). The second line antibiotics are appropriate
for the PUP patients is sulbactam/ampicillin. There was no relationship between
Boey?s score and survivability, but the preoperative shock affect survival (OR 14.67).
Likewise with comorbidities affecting the survival of 10.54 times. Time to surgery on
survival was not significant, while the duration of surgery affecting the survival of 7.5
times. Empiric antibiotics in accordance with the culture results affects survival of
12.57 times. Conclusion: The provision of appropriate empiric antibiotic shown to be
associated with survival in patients with peptic ulcer perforation."

2015

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