JAMBI MEDICAL JOURNAL "Jurnal Kedokteran dan Kesehatan"
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THE BENEFITS OF LI-ESWT THERAPY IN ORGANIC ERECTILE DYSFUNCTION WITH CHRONIC RENAL FAILURE: A CASE REPORT
Get PDFErectile dysfunction (ED) is a common type of male sexual dysfunction that has a negative impact on the quality of life. Erectile dysfunction is common in men and the incidence increases with age. Erectile dysfunction can be caused by organic disorders, such as hormonal disorders and metabolic disorders. In this case report, the authors report the case of a man who developed chronic renal failure with multiple metabolic disorders and hypogonadism. This case report described the benefits of Low Intensity Extracorporeal Shockwave Therapy (Li-ESWT) therapy in patients who less responsive after receiving phosphodiesterase type 5 inhibitor (PDE-5 inhibitor) therapy, tadalafil as first-line therapy for erectile dysfunction. This case report was evaluated using the International Index of Erectile Function-5 (IIEF-5) questionnaire and Erection Hardness Score (EHS) score as a description of erection quality with Peak Systolic Velocity (PSV) parameters from the results of penile Color Doppler Ultrasonography (CDUS) during flaccid and Vascular Endothelial Growth Factor (VEGF) parameters as angiogenesis factors. In this case report, the patient experienced improvements in erection quality, PSV parameters, and VEGF parameters after receiving Li‑ESWT therapy
AGE-RELATED FACTORS OF EPILEPSY AND ITS IMPACT ON QUALITY OF LIFE: A CROSS-SECTIONAL STUDY IN BETHESDA HOSPITAL YOGYAKARTA
Get PDFIntroduction: Epilepsy is a neurological disorder that negatively impacts quality of life (QOL). There are limited studies on the QOL of people living with epilepsy in Indonesia. Aim: The purpose of this study was to evaluate the association between age-related factors (age, age at onset, and duration of epilepsy) and QOL.
Methods: This cross sectional study was conducted in the Department of Neurology, Bethesda Hospital, Yogyakarta, Indonesia from November 2017 to February 2018. Patients with epilepsy aged 18 years and above were recruited in the study. QOL was measured using the Short Form 8 (SF-8).
Results: A total of 27 patients were eligible for the study. The QOL of patients aged ≥ 60 years was significantly lower in the following aspects: physical functioning (42.44±8.243), general health (40.04±7.641), role emotional (39.60±7.638), mental health (43.50±10.347), and mental component score (42.04±10.282). Patients with age at onset ≥ 55 years had significant effects in lower role emotional (40.54±7.245) and mental component score (42.98±10.155). There was no significant difference in the QOL scores and duration of epilepsy.
Conclusion: This study demonstrated that age and age at onset influence the QOL in patients with epilepsy.
Keywords: Epilepsy, age-related factors, quality of life, Short Form 8 Health Survey
PERBANDINGAN SKOR IQ (Intellectual Question) PADA ANAK STUNTING DAN NORMAL
Get PDFABSTRAKIntroduction: Stunting is a condition in which a child experiences malnutrition or a lack of nutritional intake that lasts a long time (chronic) so that the child becomes short for his age. This situation will naturally result in stunted growth development if left unceasing, and will also affect the quality of his future, especially his intelligence. The incidence of stunting in South Sumatra Province is 26.9%. This figure is of course very high and needs serious attention, given that several theories state that stunting that persists in children over 2 years will have a major impact on children's health.Methods: This research uses observational analytic research method with unmatching case control design. The study was conducted in three sub-districts in Palembang City, and conducted in August - October 2019 with 150 samples. Data were analyzed by bivariate using chi square analysis.Results: this study shows that short / stunting children who get an average IQ score of upwards are 64% and those who get an average IQ score below 36%. Whereas the non-stunted children who get an average IQ score above are 72% and those who get an average IQ score below are 28% (p = 0,000, OR: 4.57 (95% CI: 2,1733 -9,6873).Conclusion: there is a significant difference in the scores of IQs of stunting and normal children (p=0,000). Children who suffer from stunting are 4.5 times more likely to get below average intelligence compared to children who are not stunting.Keywords: Stunting, Intellectual QuestionABSTRAKPendahuluan: Stunting merupakansuatu kondisi di mana anak mengalami malnutrisi atau kurangnya asupan gizi yang berlangsung lama (kronis) sehingga mengakibatkan anak menjadi pendek untuk seusianya. Keadaaan ini tentu saja akan mengakibatkan terhambatnya perkembangan pertumbuhan jika dibiarkan terus menerus, dan juga akan mempengaruhi kualitas masa depannya khususnya kecerdasannya. Angka kejadian stunting di Provinsi Sumatra Selatan sebesar 26.9 % Angka ini tentu saja sangat tinggi dan perlu mendapat perhatian serius, mengingat beberapa teori menyebutkan bahwa stunting yang menetap pada anak di atas 2 tahun akan berdampak besar pada kesehatan anak.Metode: Penelitian ini menggunakan metode penelitian analitik observasional dengan desain unmatching case control. Penelitian dilakukan di tiga kecamatan di Kota Palembang yaitu Kecamatan Seberang Ulu I, Seberang Ulu II dan Sukarame dan dilaksanakan pada bulan Agustus – Oktober 2019 dengan 150 sampel. Data dianalisis dengan bivariate menggunakan analisis chi square.Hasil: penelitian ini menunjukkan bahwa Anak yang pendek/stunting yang mendapatkan nilai IQ rata-rata ke atas adalah sebesar 64% dan yang mendapatkan nilai skor IQ rata-rata ke bawah sebesar 36%. Sedangkan pada anak yang tidak stunting yang mendapatkan nilai skor IQ rata-rata ke atas adalah 72% dan yang mendapat nilai IQ rata-rata ke bawah adalah 28% (p = 0.000, OR:4,57 (95% CI:2,1733-9,6873).Kesimpulan: ada perbedaan signifikan nilai skor IQ anak yang stunting dan normal (p=0,000). Anak yang menderita stunting kemungkinan 4,5 kali mendapatkan kecerdasan rata-rata ke bawah dibandingkan dengan anak yang tidak stunting.Kata Kunci : Stunting, Kecerdasan intelektua
KETAHANAN HIDUP PASIEN KANKER SERVIKS BERDASARKAN STADIUM KANKER
Get PDFABSTRACT Background : Cervical cancer is the most common malignancy of the reproductive system and causes many deaths in women. One of the prognostic factors causing cervical cancer death is clinical stage. The purpose of this research is to determine the probability of 3-year survival of cervical cancer patients based on the stage of cancer.Methods : An analytical study with a retrospective cohort design using 274 medical records of cervical cancer patients for the period 2014-2016 in the Dr. Mohammad Hoesin Hospital in Palembang. Each patient's data was followed by its development for 3 years, starting from the time the patient was first diagnosed with cervical cancer and determined the stage of cancer (clinical staging).Results : This study found that the probability of survival for 3 years for stage I was around 80%, stage II was around 70%, stage III was around 60%, and stage IV was around 40%. The median survival for stage IV is 24 months.Conclusion : This research proves that the earlier the stage of cancer, the 3-year survival will increase.Keywords: cervical cancer, stage, survival
ABSTRAK
Latar belakang : Kanker serviks merupakan penyakit keganasan sistem reproduksi paling umum dan banyak menyebabkan kematian pada wanita. Salah satu faktor prognostik penyebab kematian kanker serviks adalah stadium kanker. Tujuan penelitan ini adalah untuk mengetahui probabilitas ketahanan hidup 3 tahun pasien kanker serviks berdasarkan stadium kanker.
Metode : Studi analitik dengan desain kohort retrospektif dengan menggunakan 274 catatan rekam medis pasien kanker serviks periode tahun 2014-2016 di RSUP. Dr. Mohammad Hoesin Palembang. Masing- masing data pasien tersebut diikuti perkembangannya selama 3 tahun, dimulai sejak pasien pertama kali didiagnosis kanker serviks dan ditetapkan stadium kankernya (clinical staging).
Hasil : Penelitian ini mendapatkan bahwa probabilitas ketahanan hidup 3 tahun untuk stadium I sekitar 80%, stadium II sekitar 70%, stadium III sekitar 60%, dan stadium IV sekitar 40%. Median ketahanan hidup untuk stadium IV adalah 24 bulan.
Kesimpulan : Penelitian ini membuktikan bahwa semakin awal stadium kanker serviks maka ketahanan hidup 3 tahun akan semakin meningkat.
Kata Kunci : kanker serviks, stadium, ketahanan hidu
EFEKTIVITAS EKSTRAK DAUN JERUK PURUT (Citrus hystrix) SEBAGAI INSEKTISIDA ALAMI TERHADAP KECOAK AMERIKA (Periplaneta americana) DENGAN METODE SEMPROT
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Cockroach control can be done in various ways one of which is spraying insecticide. Natural insecticides are less dangerous than conventional insecticides. This study aimed to determined the effectiveness of kaffir lime leaf extract (Citrus hystrix) as a natural insecticide against cockroach americana (Periplaneta americana) with spray method.
This research was an experimental study with a post-test only control group designed design. The sample in this study was 60 cockroaches, the sample was divided into 6 groups: negative control (aquades), positive control (transflutrin 0.06%) and and 4 test groups with concentrations of kaffir lime leaf extract (20%, 40%, 60% , and 80%) each group consisted of 10 cockroaches. Phytochemical tests were carried out to determine the content of secondary metabolites in extracts of kaffir lime leaves.
Positive phytochemical test results containing flavonoids, alkaloids and essential oils. Based on probit analysis, it is known that the LC50 value = 58.5%; LC95 = 85.1%. The time of death of LT50 is fastest at a concentration of 60% (3,036 hours) and LT95 is the fastest at a concentration of 80% (5,960 hours). Anova test analysis results showed that the positive control group had no significant difference with kaffir lime leaf extract concentration of 80%
Kaffir lime leaf extract has an insecticide effect, the higher the concentration of kaffir lime leaf extract, the more number of dead cockroaches and the longer the observation time, the number of cockroaches death will also increase.
Keywords: American cockroach, kaffir lime leaf extract, cockroach death
Abstrak
Pengendalian kecoa dapat dilakukan dengan berbagai cara salah satunya penyemprotan insektisida. Insektisida alami kurang berbahaya dibanding insektisida konvensional. Penelitian ini bertujuan untuk mengetahui efektifitas ekstrak daun jeruk purut (Citrus hystrix) sebagai insektisida alami terhadap kecoak americana (Periplaneta americana) dengan metode semprot.
Jenis penelitian ini adalah penelitian eksperimental dengan rancangan post-test only control group designed. Sampel dalam penelitian ini adalah 60 ekor kecoak, sampel dibagi menjadi 6 kelompok yaitu kontrol negatif (aquades), kontrol positif (transflutrin 0,06%) dan dan 4 kelompok uji dengan konsentrasi ekstrak daun jeruk purut (20%, 40%, 60%, dan 80%) masing-masing kelompok terdiri dari 10 ekor kecoak. Uji fitokimia dilakukan untuk mengetahui kandungan senyawa metabolit sekunder pada ekstrak daun jeruk purut.
Hasil uji fitokimia positif mengandung flavonoid, alkaloid dan minyak atsiri. Berdasarkan analisis probit, diketahui nilai LC50 = 58,5%; LC95 = 85,1%. Waktu kematian LT50 paling cepat pada konsentrasi 60% (3,036 jam) dan LT95 paling cepat pada konsentrasi 80% (5,960 jam). Hasil analisis uji anova menunjukkan bahwa kelompok kontrol positif tidak terdapat perbedaan yang signifikan dengan ekstrak daun jeruk purut konsentrasi 80%
Ekstrak daun jeruk purut memiliki efek insektisida, semakin tinggi konsentrasi ekstrak daun jeruk purut maka jumlah kecoak yang mati semakin banyak dan semakin lama waktu pengamatan, maka jumlah kecoak yang mati juga akan semakin banyak.
Kata kunci : kecoak amerika, ekstrak daun jeruk purut, kematian kecoa
Studi Kualitas Hidup Pekerja Komuter Pengguna KRL Commuter line dan Busway Transjakarta dari Bogor ke Jakarta
Get PDFBackground: Many studies have concluded that commuting activities have an impact on the quality of life of commuters on both physical, mental / psychological, health, and social / environmental aspects of commuting. The purpose of this study was to determine the quality of life of commuting workers of busway Transjakartaand train commuter linemodes of transportation from Bogor to Jakarta and what factors which influenced it.
Methods:This study was conducted using cross sectional design with WHO Quality of Life BREF questionnaire. Analysis with univariate and bivariate with Chi square.
Results: The result showed the respondents had used train commuter line for ≥ 4 years (50.6%) while busway Transjakartauser workers <4 years were 52.5% with frequency ten times a week for train commuter line(72.4%) The quality of life of user commuter line and busway Transjakara is categorized by percentage of 57.1% and 70%.
Conclusion:The psychological and environmental domains have the highest scores on both mode transportation while the physical domain has the lowest score. Bivariate analysis revealed the quality of life in train commuter line workers affected by income and psychological conditions. While the worker busway Transjakarta usersaffected by type of work
Keywords: Quality of Life, WHOQOL BREF, Worker Commuter, Busway Transjakarta, Train Commuter lin
KORELASI MASA LEMAK DAN LEMAK VISERAL DENGAN KADAR LEPTIN SERUM PADA REMAJA OVERWEIGHT DAN OBESITAS
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Background:The prevalence of adolescent obesity (15-18 years) in Indonesia continues to increase. The results of basic health research in 2013 showed the prevalence of adolescent obesity from 1.4% in 2010 increase to 7.3% in 2013. The condition of obesity will affect leptin secretion which plays a role in influencing food intake by controlling appetite in the hypothalamus and brain stem. Objective: This study aims to determine the description, differences, and correlations of the fat mass, visceral fat, and serum leptin levels in the group of adolescents who are overweight and obese. Design: This study was conducted by analytic survey method with cross sectional approachment. The sample consisted of 60 people aged above 18 years state as students of the Faculty of Medicine and Health Sciences Jambi University who were overweight and obese. Analyze data from the examination of fat mass, visceral fat, and serum leptin using the Pearson Correlation test and for the characteristics of FKIK Unja students aged above 18 years with BMI ≥23 will be analyze distributively. Results: The analysis showed significant results p = 0.000 and a high correlation of r = 0.719 between fat mass with leptin levels where the fat mass is directly proportional to leptin levels. The analysis showed that the results were not significant with p = 0.338 and did not correlate r = -0.126 between visceral fat and leptin levels. Conclusions: From this study obtained a body composition profile, leptin level profile and food intake data in overweight and obese adolescents, which will be used as initial screening to make lifestyle modifications and healthy behavior in overweight and obese adolescents so that in the future they will not be a risk factor for metabolic syndrome
KEY WORDS: Obesity; Overweight; Fat mass; Visceral fat; Leptin
ABSTRAK
Latar belakang: Prevalensi obesitas remaja di Indonesia terus meningkat. Hal ini dapat berdampak buruk terhadap kesehatan karena obesitas berkaitan dengan noncommunicable diseases (penyakit-penyakit tidak menular). Keadaan obesitas yang ditandai dengan meningkatnya massa lemak dan lemak viseral akan mempengaruhi sekresi leptin dan menyebabkan terjadi resistensi leptin, dimana kondisi hiperleptinemia pada obesitas menjadi faktor risiko independen terhadap penyakit kardiovaskuler.
Tujuan: Penelitian ini bertujuan untuk mengetahui korelasi masa lemak dan lemak viseral dengan kadar leptin pada remaja yang mengalami overweight dan obesitas
Metode: Penelitian ini dilakukan dengan metode survey analitik dengan pendekatan cross sectional. Sampel berjumlah 60 orang remaja overweight dan obesitas dengan usia 17- 25 Analisa data hasil pemeriksaan massa lemak, lemak viseral, dan leptin serum menggunakan uji Korelasi Pearson dan untuk karakteristik mahasiswa FKIK Unja usia >18 tahun dengan IMT ≥23 akan dianalisis distributifnya. Hasil: Analisis menunjukkan hasil yang signifikan p = 0.000 serta korelasi r = 0,719 yang tinggi antara massa lemak dengan kadar leptin dimana massa lemak berbanding lurus dengan kadar leptin. Analisis menunjukkan hasil yang tidak signifikan dengan p = 0.338 serta tidak berkorelasi r = -0,126 antara lemak viseral dengan kadar leptin. kesimpulan: Dari penelitian ini didapatkan profil komposisi tubuh, profil kadar leptin dan data asupan makanan pada remaja yang overweight dan obesitas, yang akan dijadikan skrining awal untuk melakukan modifikasi gaya hidup dan perilaku hidup sehat pada remaja overweight dan obesitas sehingga kedepan tidak menjadi faktor risiko terkena sindroma metabolik.
KATA KUNCI: Obesitas; Overweight; Masa lemak; Lemak viseral; Lepti
PERBEDAAN TINGKAT PENGETAHUAN DAN SIKAP IBU HAMIL TENTANG TOKSOPLASMOSIS
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Background: Toxoplasmosis is an infection caused by protozoan Toxoplasma gondii which has complex life cycle in warm-blooded organisms, including human as intermediate hosts and cats as definitive hosts. This infection transmits through orofecal, blood transfusion, organ transplantation from infected donors and vertically from mothers to the fetus per placenta. High rate of seroprevalency among pregnant women shows the importance of educating pregnant women about toxoplasmosis and the preventive behaviours. This study purpose is to determine the differences of knowledge levels and behaviours about toxoplasmosis between pregnant women in Kemiling Primary Health Care and obstetric clinic in Bandar Lampung.
Methods: This is a descriptive-analytic study with cross-sectional approachment using questionairs as the instrument of the study. The number of subjects in this study is 106 pregnant women. Statistic analysis that is used is Chi Square Test.
Results: The good knowledge levels and behaviours in Kemiling Primary Health Care is 22,6% while in the obstetric clinic it reached 75,5%. As the result of bivariate analysis, the p value is 0,001.
Conclusions: In conclusion, there is a significant difference of knowledge levels and behaviours about toxoplasmosis between pregnant women in Kemiling Primary Health Care and obstetric clinic in Bandar Lampung.
Keywords : behaviour, knowledge, pregnant women, toxoplasmosis, Toxoplasma gondii
ABSTRAK
Latar Belakang: Toksoplasmosis adalah penyakit infeksi yang disebabkan oleh protozoa Toxoplasma gondii yang memiliki siklus hidup kompleks pada organisme berdarah panas, termasuk manusia sebagai hospes perantara dan kucing sebagai hospes definitif. Infeksi ini menular secara orofekal, transfusi darah, transplantasi organ dari pendonor yang positif terinfeksi atau juga terjadi pada saat kehamilan dari ibu ke janin melalui plasenta. Tingginya tingkat prevalensi toksoplasmosis pada ibu hamil menunjukkan pentingnya edukasi bagi ibu hamil untuk meningkatkan pengetahuannya tentang toksoplasmosis dan perilaku pencegahannya. Tujuan dari penelitian ini adalah mengetahui perbedaan tingkat pengetahuan dan sikap ibu hamil tentang toksoplasmosis di Puskesmas Kemiling dan klinik spesialis di Bandar Lampung.
Metode: Penelitian ini bersifat deskriptif analitik dengan pendekatan cross-sectional dengan menggunakan kuesioner sebagai instrument penelitian. Jumlah subjek pada penelitian ini yaitu sejumlah 106 ibu hamil. Analisis statistik yang digunakan adalah Uji Chi Square.
Hasil: Tingkat pengetahuan dan sikap yang baik sebesar 22,6% di Puskesmas Kemiling dan sebesar 75,5% di klinik spesialis kandungan di Bandar Lampung. Hasil analisis bivariat didapatkan p value sebesar 0,001.
Kesimpulan: Terdapat perbedaan tingkat pengetahuan dan sikap ibu hamil tentang toksoplasmosis di Puskesmas Kemiling dan klinik spesialis kandungan di Bandar Lampung.
Kata Kunci : ibu hamil, pengetahuan, sikap, toksoplasmosis, Toxoplasma gondi
Hubungan antara Asupan Makronutrien dan Status Nutrisi Dengan Kekuatan Otot Pada Lansia di Panti Werdha Jakarta
Get PDFBackground: The decrease of muscle mass and strength in elderly people will affect the functional capacity and increase the risk of sarcopenia. One factor that can affect the loss of muscle mass and strength in elderly is the decrease in nutrition intake i.e macronutrient especially protein and branched chain amino acids (BCAA). The aim of this study is to examine the association between muscle strength intake with macronutrient intake and nutritional status in elderly people.
Methods: The methodology of this research is a cross-sectional study with 52 elderly people from April-May 2016. Macronutrient intake is obtained from 2x24 hours food records. Anthropometric measurement is performed by using Seca electrodigital scale and knee height caliper. Blood sampling to measure prealbumin was performed after the subjects fasted for ± 8 hours, and muscle strength was measured with a Jamar’s handgrip dynamometer.
Results: The results show significant possitive correlation between handgrip strength with energy intake( r=0,32 dan p=0,02) and carbohydrate intake (r=0,46 dan p=0,01). However, fat intake, protein intake, BCAA intake, serum prealbumin, and BMI have no correlation with handgrip strength.
Conclusion: This study concludes that energy intake, especially from carbohydrate intake, can affect muscle strength in elderly.
Keywords: macronutrient intake, nutritional status, serum prealbumin, muscle strengh
KEMAMPUAN CLINICAL REASONING PADA UJIAN OSCE MAHASISWA KEDOKTERAN TAHUN KETIGA
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Background : Clinical reasoning is one of the clinical skill competencies that must be owned by a doctor so it needs to be studied and tested. The OSCE is one method of assessment that can be used to assess the achievement of clinical reasoning. OSCE in the third year at Faculty of Medicine Islamic University of Indonesia (FM IUI) has been using clinical case OSCE so that can be used to assess clinical reasoning skill in addition to others clinical skills such as physical examination and clinical procedural skills. This study aimed to evaluate the clinical reasoning skills of students in the third year of the OSCE exam at FM IUI.
Methods : The cross sectional study method was used in this study. OSCE test result semesters 5 and 6 of the academic year 2015/2016 collected. Clinical reasoning skills of students in OSCE obtained from the score of the diagnosis ability in clinical case OSCE station. The difference between clinical reasoning skill on each OSCE station and its correlation with the written test on the corresponding block were analyzed.
Results: There is differences between clinical reasoning skill in OSCE stations semester 5 and 6. There was no relationship between the score clinical reasoning skills at the OSCE with written test achievement on the corresponding block.
Conclusion: The clinical reasoning skills on the OSCE semesters 5 and 6 do not illustrate the clinical reasoning skills of third-year medical students in this study. This study supports the need for further development of the assessment of clinical reasoning skills on the OSCE for medical students.
Keywords : clinical reasoning, OSCE, medical student
ABSTRAK
Latar Belakang: Penalaran klinis atau clinical reasoning merupakan salah satu kompetensi keterampilan klinis yang harus dimiliki oleh seorang dokter sehingga perlu dipelajari dan diujikan. OSCE merupakan salah satu metode assessment yang dapat digunakan untuk menilai pencapaian clinical reasoning. OSCE pada tahun ketiga di FK UII telah menggunakan kasus klinis untuk dapat juga menilai clinical reasoning disamping keterampilan klinis yang lain seperti pemeriksaan fisik dan tindakan prosedural. Penelitian ini bertujuan mengevaluasi kemampuan clinical reasoning mahasiswa kedokteran pada ujian OSCE tahun ketiga di FK UII.
Metode : Metode yang digunakan adalah cross sectional dari hasil ujian OSCE semester 5 dan 6 tahun akademik 2015/2016. Kemampuan clinical reasoning mahasiswa pada ujian OSCE didapatkan dari nilai kemampuan menegakkan diagnosis pada stasion OSCE yang berupa manajemen kasus klinis. Nilai OSCE direkap pada semua mahasiswa yang mengikuti ujian pada periode tersebut. Analisis dilakukan dengan melihat perbedaan kemampuan clinical reasoning antar station OSCE dan menilai korelasinya dengan ujian tulis pada blok yang bersesuain .
Hasil: Terdapat perbedaan kemampuan clinical reasoning antar stasion OSCE baik di semester ke 5 maupun ke 6. Tidak terdapat hubungan antara nilai kemampuan diagnosis pada ujian OSCE dengan pencapaian nilai ujian tulis blok yang berkaitan dengan konten OSCE yang diujikan.
Kesimpulan: Kemampuan diagnosis pada ujian OSCE semester 5 dan 6 tidak menggambarkan kemampuan clinical reasoning mahasiswa tahun ketiga pada penelitian ini. Diperlukan evaluasi dan pengembangan lebih lanjut mengenai penilaian dan pencapaian kemampuan clinical reasoning pada ujian OSCE bagi mahasiswa kedokteran.
Kata kunci : clinical reasoning, OSCE, mahasiswa kedoktera