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Hubungan Tingkat Stres dan Intensitas Dismenore pada Mahasiswi di Sebuah Fakultas Kedokteran di Jakarta
No full text Dismenore merupakan salah satu gangguan ginekologis yang paling sering dialami perempuan. Salah satu faktor yang dapat meningkatkan risiko terjadinya dismenore adalah stres. Penelitian potong lintang dilakukan terhadap mahasiswi Fakultas Kedokteran Universitas Katolik Indonesia Atma Jaya angkatan 2015- 2017 (n=228). Penelitian dilakukan Januari-Februari 2018. Tingkat stres ditentukan menggunakan kuesioner Depression Anxiety Stress Scale (DASS). Intensitas dismenore ditentukan dengan kuesioner Visual Analogue Scale (VAS) dan Verbal Multidimensional Scoring system (VMS). Persentase responden yang mengalami stres adalah 32,9%. Persentase responden yang mengalami dismenore adalah 68,9% (VAS) dan 63,2% (VMS). Hasil penelitian menunjukkan bahwa terdapat hubungan yang bermakna antara tingkat stres dan intensitas dismenore (p<0,001) dengan korelasi cukup, baik berdasarkan VAS (koefisien korelasi=0,327) maupun VMS (koefisien korelasi=0,323). Kesimpulan penelitian ini adalah terdapat hubungan yang bermakna antara tingkat stres dan intensitas dismenore pada mahasiswi Fakultas Kedokteran Universitas Katolik Indonesia Atma Jaya angkatan 2015-2017. Kata kunci: Stres, dismenore, mahasiswi kedokteran. The Association between Stress Level and Dysmenorrhea Intensity among Female Students in One Medical Faculty in Jakarta Abstract Dysmenorrhea is one of the most common gynecological disorders. One factor that can increase the risk of dysmenorrhea is stress. A cross sectional study was conducted on female medical students of Atma Jaya Catholic University of Indonesia class of 2015-2017 (n=228). Stress level was determined by Depression Anxiety Stress Scale (DASS) questionnaire. Dysmenorrhea intensity was determined by Visual Analogue Scale (VAS) and Verbal Multidimensional Scoring system (VMS) questionnaire. There were 32,9% respondents experienced stress. Respondents who experienced dysmenorrhea were 68,9% (VAS) and 63,2% (VMS). The result showed there was significant association between stress level and dysmenorrhea intensity (p<0,001), either based on VAS (correlation coefficient=0,327) or VMS (correlation coefficient=0,323). The conclusion is there was significant association between stress level and dysmenorrhea intensity among female medical students of Atma Jaya Catholic University of Indonesia class of 2015-2017. Keywords: Stress, dysmenorrhea, female medical students. 
Peran Komponen Inflamasi Akibat Insersi Alat Kontrasepsi dalam Rahim dan Hubungannya dengan Peningkatan Kadar Glikodelin A
No full textAlat kontrasepsi dalam rahim (AKDR) terdiri atas AKDR lippes loop (LL), AKDR copper T (CuT) dan AKDR LNG. AKDR LL terbuat dari polietilen, harganya murah, dan dapat dipakai seumur hidup, namun karena faktor ekonomi, produksi AKDR LL dihentikan dan diganti dengan AKDR copper T (CuT). AKDR CuT meningkatkan sintesis glikodelin A (GdA) yaitu protein yang dihasilkan sel epitel endometrium dan mempunyai efek inhibisi fertilisasi. AKDR CuT merusak lapisan epitel permukaan dan kelenjar endometrium yang menghambat kembalinya kesuburan setelah AKDR dilepas terutama setelah pemakaian lama. Reaksi inflamasi akibat penggunaan AKDR CuT dan AKDR LL ditandai dengan komponen inflamasi yaitu makrofag, TNF-α, dan PGI-2. Dampak AKDR LL terhadap sel endometrium belum diketahui. Bila AKDR LL tidak merusak sel endometrium, diharapkan sel epitel endometrium menghasilkan GdA lebih tinggi sehingga AKDR LL yang sudah lama ditinggalkan dapat digunakan kembali. Komponen inflamasi yang diduga berhubungan dengan kenaikan kadar GdA adalah makrofag tipe 1 (M-1) yang diidentifikasi dari protein cluster of differentiation-38 (CD-38+), makrofag tipe 2 (M-2) yang diidentifikasi dari protein early growth response-2 (EGR-2) dan mediator lain yaitu TNF-α, IL-4, dan prostaglandin I-2 (PGI-2). Faktor-faktor yang memengaruhi peningkatan GdA adalah epigenetik, HCG, relaksin, estrogen, progesteron, ovalbumin, dan AKDR. Inflamasi mengakibatkan masuknya monosit dari sirkulasi darah ke lapisan epitel dan stroma kemudian berubah menjadi makrofag yang mempunyai kemampuan fagositosis. Komponen inflamasi yang berhubungan dengan kenaikan kadar GdA adalah M-1, M-2, TNF-α, IL-4, dan PGI-2. M-2 dan TNF-α merupakan penyebab kenaikan GdA di endometrium. Kata kunci: AKDR, glikodelin, makrofag, TNF-α, IL-4, PGI-2. Role of Inflammation Components of Contraception Insersion in Uterus and Its Association with The Increase of Glycodelin A Abstract Intrauterine device (IUD) consist of lippes loop IUD (LL), copper T (CuT) and polyetilen+levonorgestrel (LNG). LL IUD is made of polyethylene, cheap, and can be use for lifetime. However, because of economic factor, LL IUD production had been stopped and being replaced with CuT IUD. CuT IUD increases glycodelin A (GdA) synthesis, which is protein that produced by endometrium epithelial cell and has fertility inhibition effect. CuT IUD damages the surface epithelial lining and endometrial glands which inhibit the return of fertility after the IUD is released, especially after prolonged use. Inflammatory reactions due to CuT IUD and LL IUD are characterized by inflammatory components, namely macrophages, TNF-α, and PGI-2. The impact of LL IUD on endometrial cells has not been known yet. If the LL IUD does not damage endometrial cells, it is expected that endometrial epithelial cells will produce the higher GdA so that the long-abandoned LL IUD can be used. The inflammatory component that is thought to be associated with increased levels of GdA is macrophages type 1 (M-1) identified from protein cluster of differentiation-38 (CD-38+), macrophages type 2 (M-2) identified from protein early growth response- 2 (EGR-2) and other mediators namely TNF-α, IL-4, and prostaglandin I-2 (PGI-2). The factors that influence the increase of GdA are epigenetics, HCG, relaxin, estrogen, progesterone, ovalbumin, and IUDs. The result of inflammation is the entry of monocytes from the blood circulation to the epithelial and stromal layers and then changes to macrophages that have phagocytic abilities. The inflammatory component associated with increased levels of GdA are M-1, M-2, TNF-α, IL-4, and PGI-2. M-2 and TNF-α are the causes of the increase GdA in the endometrium. Keywords: IUD, glycodelin, macrophage, TNF-α, IL-4, PGI-2. 
Reminder System as a Strategy to Improve Patient’s Adherence on Medical Appointment
No full textMedical appointment non-adherence affects health outcomes and costs. Evidences have shownthat nearly 40% patients did not adhere to their treatment, fail to keep appointments or follow doctor’srecommendations. Sending reminders via e-mail and text message is one common intervention to enhancepatient’s adherence. The aim of the study is to provide an effective reminder system to improve patient’sadherence on medical appointment. Using the input-process-output-outcome scheme, we developed areminder system through web-based and mobile phone application. This reminder system facilitates thecommunication between patient and clinic staff. We tested this application among programmers and patientsin a primary clinic. The reminder system was applicable to be used by medical staff in a primary clinic. Patientscould easily download the application and put in appointment schedule; while clinic staff could check andset reminder system for patients. This reminder system is useful for patient to set medical appointment andto be reminded of their appointment one week, three days, and one day before. The reminder used emailnotification and SMS gateway to increase the effectiveness. Keywords: reminder system, patient’s adherence; medical appointment. Sistem Pengingat sebagai Sebuah Strategi untuk MeningkatkanKepatuhan Pasien terhadap Perjanjian Konsultasi Medis AbstrakKetidakpatuhan terhadap perjanjian konsultasi medis dapat memengaruhi luaran kesehatan dan biaya.Bukti ilmiah menunjukkan bahwa 40% pasien yang tidak patuh terhadap pengobatannya, gagal mengikutiperjanjian medis atau instruksi dokter. Mengirimkan pengingat melalui surat elektronik dan pesan merupakansalah satu intervensi umum untuk meningkatkan kepatuhan pasien. Studi ini bertujuan untuk menyediakansistem pengingat yang efektif dalam meningkatkan kepatuhan pasien terhadap perjanjian konsultasi medis.Dengan menggunakan skema input-proses-output-outcome, peneliti mengembangkan sistem pengingatberbasis situs web dan aplikasi telepon genggam. Sistem pengingat tersebut menjembatani komunikasi antarapasien dan staf klinik. Peneliti menguji coba aplikasi ini pada ahli pemrograman dan pasien di klinik. Sistemtersebut dapat digunakan oleh staf medis di klinik layanan primer. Pasien dapat mengunduh aplikasi denganmudah dan memasukkan jadwal perjanjian dan petugas klinik dapat mengecek serta menetapkan sistempengingat kepada pasien. Sistem pengingat bermanfaat bagi pasien untuk menentukan jadwal konsultasidan mengingatkan perjanjian satu minggu, tiga hari, dan satu hari sebelum jadwal. Sistem ini memanfaatkannotifikasi surat elektronik dan pesan singkat telepon untuk meningkatkan efektivitas. Kata kunci: sistem pengingat, kepatuhan pasien, perjanjian medis
Prolonged QTc Interval in Rat after Long-term High-Intensity Interval Training and Detraining
No full textLong-term exercise induces cardiac remodelling known as exercise-induced ventricle hypertrophy and accompanied by electrical remodelling that can be recorded by ECG. This study aimed at recognizing electrocardiographic changes in rats undergoing long-term high-intensity interval exercise followed by a period of detraining. This study conducted at the Laboratory of the Biochemistry and Molecular Biology Department, FMUI from November 2014-January 2015. Four groups of young adults male wistar rats (100-200gBW) were randomly selected. Group 1 and 2 were assigned as control group for ECG recording on week (4 and 8) and (12 and 16) respectively. Group 3 was given 4 weeks of intensive training, followed by 4 weeks of detraining, while group 4 was given 12 weeks of intensive training followed by 4 weeks of detraining. ECG examination was performed at the end of each period of training or detraining and compared to control group of the same period of age. P wave in the exercising group was significantly increased (p<0.05), PR interval was decreased in group 4 after detraining (p<0.05). QRS amplitude was increased although not significantly different compared to control group. However, a significant persistent prolonged QTc interval was observed in the exercising group (62.76+4.03 ms and 64.24+3.78 ms) compared to control group (48.88+2.15 ms and 47.33+3.43 ms). Detraining did not restore QTc interval (57.81+1.96 ms and 61.16+5.02 ms) vs (48.93+2.40 ms and 48.13+1.66 ms). In conclusion, cardiac remodelling after long-term high intensity interval training causes ventricular hypertrophy with persistent repolarization disturbances after a period of detraining, indicated by an increase in QRS amplitude and a significant prolonged QTc interval
Faktor-faktor yang Berhubungan dengan Kesintasan Pasien Kanker Serviks yang Ditatalaksana dengan Histerektomi Radikal dan Limfadenektomi
No full textKanker serviks adalah penyakit keganasan ke-4 tersering di dunia dan kedua di Indonesia. Kesintasanpasien kanker serviks merupakan ukuran kualitas layanan. Penelitian ini bertujuan untuk mengetahui faktor-faktoryang berhubungan dengan kesintasan pasien kanker serviks yang ditatalaksana dengan histerektomi radikal danlimfadenektomi. Penelitian dengan desain kohort retrospektif ini dilakukan di RSUPN dr. Cipto Mangunkusumopada bulan Agustus 2015 - Agustus 2016. Subjek adalah pasien kanker serviks stadium awal yang dilakukanhisterektomi radikal dan limfadenektomi pada bulan Januari 2011-Desember 2013. Variabel yang diteliti adalahstadium, histopatologi, ukuran tumor, diferensiasi tumor, invasi stroma, limfovaskular dan parametrium, kelenjarlimfe pelvis, batas sayatan dan hubungannya dengan kesintasan. Data diolah dengan SPSS versi 20 dan dianalisisdengan uji chi square, uji regresi cox metode stepwise, dan Kaplan Meier. Diperoleh 123 subjek kanker serviksnamun data yang dapat dianalisis adalah 50 pasien. Proporsi kesintasan subjek dengan keganasan serviks dalam7 tahun 2 bulan masa observasi maksimum 75%; tahun pertama 90% dan tahun ketiga 88%. Stadium, ukuran dandiferensiasi tumor, histopatologi, kelenjar limfe pelvis, batas sayatan, invasi limfovaskular dan parametrium tidakberhubungan dengan kesintasan namun invasi stroma dan terapi radiasi berhubungan dengan kesintasan. Faktorfaktoryang berhubungan dengan kesintasan adalah invasi stroma <2/3 bagian yang merepresentasikan ukurrantumor dan terapi radiasi yang diperlukan pada pasien risiko tinggi pasca bedah (memberikan kesintasan lebihbaik). Perlu dilakukan penelitian lebih lanjut untuk mengetahui faktor prognostik lain pada pasien kanker serviksstadium awal seperti ekspresi faktor stem cells (SOX4, NANOG dan OCT4). Kata kunci: kanker serviks, kesintasan, histerektomi radikal, limfadenektomi. Factors Associated with Survival Rate of Cervical Cancer Patients Treatedby Radical Hysterectomy and LymphadenectomyAbstractCervical cancer is the 4th most comkon cancer in the world and ranked 2nd in Indonesia. The survivalrate of cervical cancer patients is the parameter of quality of care. This study was intended to determinefactors associated with survival rate of cervical cancer patients treated by radical hysterectomy andlymphadenectomy. This retrospective cohort study was conducted in Cipto Mangunkusumo Hospital onAugust 2015 – August 2016. Subjects were early stage cervical cancer patients who underwent radicalhysterectomy and lymphadenectomy on January 2011 – December 2013. Analyzed variables were cancerstages, histopathology, tumour size, tumor differentiation, stromal invasion, lymphovascular and parametrium,pelvic lymph nodes, surgical margin, and its association with survival rate. Data were analyzed with SPSSversion 20 by using chi-square test, stepwise cox-regression test, and Kaplan-Meier test. Of all 123 subjectswith cervical cancer, only 50 subjects were eligible to be analyzed further. The survival rate of cervical cancerpatients within 7 years and 2 months with maximum observation were 75%; 1-year survival rate was 90%and 3-year survival rate 88%. Stages, size, and tumour differentiation, histopathology, pelvic lymph nodes,surgical margin, lymphovascular invasion and parametrium were not associated with survival rate. However,stromal invasion and radiotherapy were associated with survival rate. In conclusion, factors associatedwith survival rate are stromal invasion with less than two-third area which represents the tumour size andradiotherapy which is needed for high-risk patients post-surgery (better survival rate). Further studies areneeded to determine other prognostic factors in early stages cervical cancer patients such as the expressionof stem cell factors (SOX4, NANOG, and OCT 4). Keywords: cervical cancer, survival rate, radical hysterectomy, lymphadenectomy
Validation of Metacognitive Awareness Inventory in Academic Stage of Undergraduate Medical Education
No full textMedical students are expected to improve critical thinking, clinical reasoning and problem solving skills. These cognitive attributes need to be supported with metacognitive skills. Students with better metacognitive ability will be able to synergize their learning with self-reflection strategies to achieve learning target. One of the tools to assess students’ metacognitive skills is Metacognition Awareness Inventory (MAI). This study is aimed to validate Indonesian MAI in the academic stage of undergraduate medical education and was done on May-June 2014 at faculty of medicine Universitas Malahayati Bandar Lampung. This study used cross-sectional design consisted of 3 stages: language adaptation, pilot study and validation study. Validation study involved 1200 medical students. Factor analysis was conducted to identify factors of MAI. Language adaptation and pilot study produced Indonesian MAI which contains the same number of items. There were 757 MAI questionnaires eligible for analysis. Extraction of the 51-item MAI using principal component analysis (PCA) produced 5 factors which were cognitive preparation, supervision, management, strategy and evaluation. The Cronbach alpha value for the whole Indonesian MAI was 0.904. Indonesian MAI complies to construct validity criteria, specifically content validity and internal consistency. MAI is useful as an instrument to assess metacognitive ability in the academic stage of undergraduate medical education
Procalcitonin Levels in Elderly Compare with Non Elderly Patients with Gram Negative Bacteremia
No full text High level of procalcitonin can be used to diagnose gram negative bacteremia. In elderly, there is a decline in the immune system that can affect the body’s response to infection. This study was conducted to investigate difference of procalcitonin levels between elderly and non-elderly patients. Retrospective study was conducted at Dr. Cipto Mangunkusumo General Hospital (RSCM) from December 2013 to January 2018. Patients with gram negative bacteremia age of >18 years were included in this study. Patients were categorized into two groups: non-elderly (<60 years) and elderly patients (≥60 years). Chi-Square test is used to analyze categorical variables, Mann Whitney test is used to analyze nonparametric variables. The study enrolled 247 gram negative bacteremia patients, consisting of 142 (57.5%) women and 105 (42.5%) men. There were no significant differences in sex, complete blood count, liver function test and microorganisms in both groups. The three most common of microorganisms were Klebsiella pneumoniae, Acinetobacter baumannii and Escherichia coli. Bacteremia Salmonella species were found only in non-elderly group. Concentrations of ureum (p=0.027), creatinine (p=0.049) were significantly higher in the elderly group than in the non-elderly group. Procalcitonin concentrations were significantly higher in the non-elderly group compared with the elderly group (p=0.005). Elderly patients with gram negative bacteremia have decline in kidney function and lower procalcitonin levels compared with non-elderly patients. 
Solitary Fibrous Tumor: A Retrospective Study on Histopathologic Features and Immunohistochemistry Staining at Cipto Mangunkusumo Hospital
No full textSolitary fibrous tumor (SFT), is a rare mesenchymal spindle cell tumor and its biological behavior is hard to predict. There is no characteristic clinical manifestation and morphologic features showed broad spectrum, so often diagnosed as other spindle cell mesenchymal tumor, benign or malignant. In most cases, immunohistochemistry staining (IHC) is needed to diagnose SFT. The aim of this retrospective study is to see demographic data, histopathological features and the importance of IHC staining diagnosis of SFT. Secondary data was obtained from Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia in 2010-2016. There were 35 samples included in this review; most are male (20 cases) aged <55 years old. Thirty one cases were in the extrapleural site and most of the tumor is less than 5 cm in diameter. There are 20 cases of cellular SFT while the other is fibrous SFT. Commonly, cellular SFT shows moderate cellularity and pleiomorphism. Fibrous SFT are well circumscribed and without necrosis. There are only 3 cases of malignant SFT which is located in intra-abdominal and orbit. Generally, SFT is benign, small, and well circumscribed. Most of the cases are cellular than fibrous; mild to moderate nuclear pleiomorphism, mitotic activity low, and without necrotic. Features of malignant SFT are hypercellularity, moderate to high nuclear pleiomorphism, mitotic >4/10 high power field (HPF) and necrosis. Most SFT are benign, some may recurrence and metastasize.  
Effectiveness of Influenza Vaccination in Preventing Acute Asthma Exacerbations in Adult Patient
No full textAcute respiratory tract infection is a major cause of acute exacerbations in asthma. One example of viral respiratory tract infection is influenza caused by influenza virus. Administering influenza vaccine to asthmatic patients is expected to protect them from acute asthma exacerbations caused by influenza virus.The purpose of this case study is to determine the effectiveness of influenza vaccines in protecting the patients from acute exacerbations of asthma in adults. Literature search was conducted in the Pubmed database, EBSCO, Clinical Key, Google Scholar, and Science Direct to identify relevant articles. Literature search was done on March 30th, 2015. There were two selected articles that met the criterias and fully accessible for further review. Both articles had good validity and showed that there was no significant effect of influenza vaccination against acute asthma exacerbations. Number Needed to Treat (NNT) value from one of the articles showed no significancy. Influenza vaccination does not have significant protective effect against acute asthma exacerbations in adults
The Difference in Length of Stay, Quality of Life, and Cost Effectiveness of Care for Geriatric Patients in Acute Care for Elderly Dr. Cipto Mangunkusumo National Hospital Before and After National Health Insurance Program Implementation
No full textGeriatric population with special characteristics tend to have longer average length of stay. The aim of the study is to evaluate the implementation of NHIP (national health insurance program) system according to length of stay, quality adjusted life days (QALD) and cost effectiveness of care in Cipto Mangunkusumo National Hospital (CMNH). This is a retrospective cohort study with historical control. The subjects were geriatric patients with geriatrics giants on July to December 2013 (non NHIP) and January to June 2014 (NHIP). We used independent t-test to compare two means of length of stay and QALD. The characteristics were similar between 100 subjects in non NHIP group and 125 subjects in NHIP group. The median of age was 70 (60-86) dan 68 (60-85) years old respectively. There was no significant difference between length of stay in non NHIP, median 12(2-76) days and NHIP group, median 12(2-59) days, p= 0.974. As for QALD, there was also no significant difference between non NHIP, median 0.812 (-3.1–24.37) and NHIP group, median 0.000 (-7.37–22.43), p= 0.256. The median cost spent was Rp 19.961.000 (Rp2.57–Rp100 millions) in non NHIP and Rp 20.832.000 (Rp3.067-Rp100 millions) in NHIP group. Incremental cost effectiveness ratio (ICER) scheme showed NHIP is more expensive Rp1.500.000 to have 0.91 shorter days than non NHIP system. For QALD, the cost was cheaper Rp3.484.887 to have 0,25 QALD lower than non NHIP. There was no significant difference in length of stay and quality of life of patients who admitted in CMNH with CGA approach before and after NHIP implementation