1,721,068 research outputs found
Gambaran Tingkat Pengetahuan Mahasiswa Fakultas Kedokteran USU Semester 7 terhadap Hubungan Covid-19 dengan Penyakit Jantung
No full textLatar Belakang. Pada bulan Desember, 2019, serangkaian kasus pneumonia yang tidak diketahui penyebabnya muncul di Wuhan, Hubei, Cina dengan presentasi klinis sangat menyerupai virus pneumonia. Infeksi SARS-COV-2 dapat menimbulkan gejala ringan sampai berat. Penyakit pernapasan adalah manifestasi klinis yang paling sering terjadi pada penderita COVID-19, sedangkan keterlibatan kardiovaskular lebih jarang terjadi. Meskipun begitu, secara konsisten ditunjukkan bahwa adanya penyakit kardiovaskular yang sudah ada sebelumnya dan/atau terjadinya miocardial injury memiliki hubungan yang signifikan dengan timbulnya prognosis buruk pada pasien COVID-19. Dengan tingginya angka mortalitas dan morbiditas penyakit kardiovaskular pada pasien COVID-19, sehingga penting bagi kita semua terutama mahasiswa fakultas kedokteran untuk mengetahui dan memahami terkhusus tentang hubungan COVID-19 dengan penyakit jantung. Tujuan. Untuk mengetahui tingkat pengetahuan mahasiswa Fakultas Kedokteran Semester 7 Universitas Sumatera Utara terhadap hubungan COVID-19 dengan penyakit jantung. Metode Penelitian. Penelitian ini merupakan penelitian deskrptif dengan pendekatan cross sectional. Sampel diambil sebanyak 70 orang dengan metode proporsi binomunal dari populasi Mahasiswa FK Semester 7 USU yang telah memenuhi kriteria inklusi dan ekslusi. Data dianalisis dengan menggunakan aplikasi SPSS. Hasil. Dari 70 mahasiswa FK USU semeter 7 sebanyak 17 orang (24,3%) memiliki tingkat pengetahuan baik, 33 orang (47,1%) memiliki tingkat pengetahuan cukup, dan 20 orang (28,6%) memiliki tingkat pengetahuan kurang. Kesimpulan. Mahasiswa FK USU semester 7 memiliki tingkkat pengetahuan yang cuku terhadap hubungan COVID-19 dengan penyakit jantungBackground: In December 2019, a series of pneumonia cases of unknown cause emerged in Wuhan, Hubei, China represent a clinical manifestation resemble with those viral pneumonia. SARS-COV-2 infection can cause mild to severe symptoms. Respiratory disease is the most common clinical manifestation of patient with COVID-19, whereas cardiovascular involvement is less common. However, it has consistently been shown that the pre-existing cardiovascular disease and/or the occurrence of myocardial injury has a significant association with the incidence of poor prognosis in COVID-19 patients. With the high mortality and morbidity rates of cardiovascular disease in COVID-19 patients, it is important for all of us, particularly medical students, to know and understand the relationship between COVID-19 and cardiovascular disease. Objectives: To determine how the knowledge level of the 7th semester’s students of the Faculty of Medicine, University of North Sumatera about the relationship between COVID-19 and cardiovascular disease. Methods: This study was a descriptive study with cross-sectional approach. 70 students were taken by using the binomunal proportion method from the 7th semester’s students of the Faculty of Medicine, University of North Sumatera who were suitable with inclusion and exclusion criteria. Data were analyzed using the SPSS application. Result: From 70 students, it was obtained good knowledge level results on 17 students (24.3%), moderate knowledge level on 33 students (47.1%), and less knowledge level on 20 students (28.6%). Conclusion: The knowledge level of the 7th semester’s students of the Faculty of Medicine, University of North Sumatera were moderate105 HalamanSkripsi Sarjan
Prevalensi Gagal Jantung pada Pasien Sindroma Koroner Akut di RSUP Haji Adam Malik Medan Tahun 2016
No full textBackgrounds. Acute coronary syndromes is a major cardiovascular problem because it leads to hospital care and high mortality. Therefore, acute coronary syndromes often cause various complications. Heart failure is a complex clinical symptoms where the disruption of the heart's ability to pump blood in sufficient quantities to fulfill the peripheral tissue metabolic requirements and some other organs. Aims. This study aims to determine the prevalence of heart failure in patients with acute coronary syndrome in RSUP H. Adam Malik Medan in period of January to December 2016. Methods. This research is descriptive with cross sectional design. Sample was taken from patient of acute coronary syndrome at RSUP Haji Adam Malik Medan by consecutive sampling. The study was conducted by observing medical records of patients with acute coronary syndrome who had heart failure. All data which has been collected and grouped will be processed using Statistic Package for Social Science (SPSS) program, analyzed in descriptive way, and presented in tabular form. Results. The number of patients with acute coronary syndrome are 157 people, and 91 of them have heart failure. The prevalence of heart failure was 58% with total of 79.3% were men. 78% were > 50 years, 39% were diagnosed with NSTEMI, and 91,5% were having acute coronary syndrome for 50 tahun sebesar 78%, dengan klasifikasi diagnosis NSTEMI sebesar 39%, dan lama menderita sindroma koroner akut <5 tahun sebesar 91,5%. Kesimpulan. Pada penelitian ini, prevalensi gagal jantung sebesar 58% dan gagal jantung dipengaruhi oleh usia, jenis kelamin, klasifikasi diagnosis, dan lama menderita sindroma koroner akut.Skripsi Sarjan
Karakteristik Pasien Gagal Jantung Kongestif dengan Riwayat Rawat Inap Ulang di RSUP Haji Adam Malik Medan Tahun 2012
No full textRehospitalization is one of the prognostic factor of congestive heart
failure (CHF). In 2011, Based on NICOR in Europe, prevalence of rehospitalization
of congestive heart failure in a year was 18,43%. In Yogjakarta, prevalence of once
rehospitalization of congestive heart failure in a year was 52,21% and prevalence of more
than once rehospitalization of congestive heart failure in a year was 44.79%. There wasn’t a
current description of congestive heart failure patient with rehospitalization. to determine the characteristic of rehospitalized patient with congestive
heart failure in RSUP Haji Adam Malik Hospital during 2012.
Methods : this study is a descriptive study with cross sectional design. Data were
collected from medical record in Haji Adam Malik Hospital. 64 samples were
collected by total sampling. The prevalence of rehospitalization of CHF patient was 11,02% with
duration of rehospitalization were 11 days. The most common cause of CHF was
CAD (31,3%) and the most common cause of rehospitalization was pneumonia
(15,6%). The characteristic of rehospitalization of CHF patient were 41-60 years old
(50%), Male (59,4%), enterpriser (32,8%), Stage III (64,1%), outpatient (85,9%).
Conclusion : In further studies, recommended to analyzed factors associated with
rehospitalization of CHF.90 HalamanSkripsi Sarjan
Correlation of Mean Platelet Volume (MPV) And Immature Platelet Fraction (IPF) with Troponin I Levels in Acute Coronary Syndrome Patients
No full textBACKGROUND. Acute coronary syndrome is a leading cause of death
worldwide, with platelet activation playing a crucial role in the formation and
evolution of atherothrombosis. Platelet indices, such as Mean Platelet Volume
(MPV) and Immature Platelet Fraction (IPF), play a significant role as indicators
of platelet activation. Troponin I is a specific protein for myocardium and serves
as an ideal biomarker, providing crucial insights into the extent of myocardial
damage.
METHOD. This research is a cross-sectional study involving 52 acute coronary
syndrome patients undergoing treatment at H. Adam Malik Hospital, Medan, from
February 2023 to May 2023. Blood samples were taken upon admission, and
examinations for MPV, IPF, and Troponin I were conducted. The data were
analyzed using SPSS software, and the Spearman test was employed. A p-value
less than 0.05 was considered statistically significant.
RESULTS. Insignificant results and a very weak correlation were obtained,
between MPV and Troponin I with a p-value of 0.251 and a r-value of 0.162.
Similarly, there were insignificant results and a very weak correlation between
IPF and Troponin I, with a p-value of 0.090 and a r-value of 0.237. However, a
strong correlation was observed between MPV and IPF (r = 0.840) with a p-value
of less than 0.001.
CONCLUSION. The findings indicate insignificant results and a very weak
correlation between MPV and IPF values in relation to Troponin I levels in acute
coronary syndrome patients.124 PagesTesis Magiste
Hubungan Derajat Albuminuria dengan Beratnya Lesi Arteri Koroner pada Pasien Penyakit Jantung Koroner
No full textIntroduction : Coronary heart disease (CHD) is currently one of the major health
problems in the world. Corrective CHD is defined as the presence of minimal ≥
50% stenosis in a single coronary artery evidenced by an angiographic
examination. The degree of stenosis in the coronary artery can be seen by
angiographic action and is usually measured by a visual evaluation of the
presentation of the relative diameter reduction against the adjacent normal
segment. At this time, it is known that microalbuminuria is a picture of a thorough
and equitable process of endothelial damage glomelurus, retina and tunica intima
large blood vessels.
Aim : To determine the relationship of degree of albuminuria to the severity of
coronary artery narrowing based on angiography examination in patients with
CHD
Methods : A total of 58 patients of CHD inpatient RSUP H. Adam Malik Medan
who underwent angiography examination and has met the inclusion
criteria.Dilakukan data collection of complete blood laboratory, troponin T,
CKMB, mikroalbuminuria and angiography. Statistical analysis with chi square
correlation test
Results : Of the 58 subjects in which the subjects of normal grade
microalbuminuroa (10,7%) macroalbuminuria (0%) while in grade 1
microalbuminuria (1%) macroalbuminuria (6.7%), grade 2 microalbuminuria
(32.1%) macroalbuminuria (0%) And grade 2, 3 macroalbuminuria (46.7%). The
result of chi square test showed that there was a significant correlation between
microalbuminuria and degree of coronary artery lesion (p <0.001).
Conclusion : With elevated levels of microalbuminuria will be followed
increasing the degree of severity of coronary artery lesions. There was a
significant correlation between microalbuminuria and degree of coronary artery
lesion (p <0.001).Latar Belakang : Penyakit Jantung koroner ( PJK ) saat ini merupakan salah satu
masalah kesehatan utama di dunia. PJK bermakna didefinisikan sebagai adanya
stenosis ≥ 50 % minimal pada satu arteri koroner yang dibuktikan dari
pemeriksaan angiografi. Derajat stenosis pada arteri koroner dapat dilihat dengan
tindakan angiografi dan biasanya diukur dengan evaluasi visual dari presentasi
pengurangan diameter relatif terhadap segmen normal yang berdekatan. Pada saat
ini, diketahui bahwa mikroalbuminuria adalah gambaran dari proses menyeluruh
dan merata dari kerusakan endotel glomelurus, retina dan tunika intima pembuluh
darah besar.
Tujuan : Untuk mengetahui hubungan derajat albuminuria terhadap beratnya
penyempitan arteri koroner berdasarkan pemeriksaan angiografi pada pasien
penderita PJK
Metode : Sebanyak 58 pasien PJK rawat inap RSUP H. Adam Malik Medan
yang menjalani pemeriksaan angiografi dan telah memenuhi kriteria
inklusi.Dilakukan pendataan laboratorium darah lengkap, troponin T, CKMB,
mikroalbuminuria dan Angiografi. Analisa statistik dengan uji korelasi chi square
Hasil : Dari 58 subjek dimana subjek grade normal mikroalbuminuroa (10,7%)
makroalbuminuria (0%) sedangkan pada grade 1 mikroalbuminuria (1%)
makroalbuminuria (6,7%) , grade 2 mikroalbuminuria (32,1%) makroalbuminuria
(0%) dan grade 2, 3 makroalbuminuria (46,7%) . Hasil analisis dengan uji chi
square menunjukkan terdapat hubungan yang signifikan antara mikroalbuminuria
dengan derajat lesi arteri koroner (p<0,001).
Kesimpulan : Dengan peningkatan kadar Mikroalbuminuria akan diikuti
peningkatan derajat keparahan lesi arteri koroner. Didapatkan hubungan yang
signifikan antara mikroalbuminuria dengan derajat lesi arteri koroner (p<0,001).66 HalamanTesis Magiste
Hubungan Nilai Rasio Bun-Kreatinin dan Status Hemokonsentrasi Akhir Rawatan Pasien Gagal Jantung Akut Terhadap Kejadian Kardiovaskular Mayor (Kkvm) dalam Waktu 6 Bulan Setelah Pulang di Rumah Sakit Umum Pusat Haji Adam Malik Medan
No full text94 HalObjective: High BUN / creatinine ratio values have been known to be associated
with the incidence of death in patients with acute heart failure (ARF) who are
equipped with renal dysfunction. However, the clinical impact of a high BUN /
creatinine ratio at the end of treatment showed renal dysfunction, neurohormonal
hyperactivity and different responses to decongestion therapy not clear.
Hemoconcentration status has become a parameter that supports decongestion
therapy. This study aimed to see the relationship between the BUN/creatinine ratio
at the end of treatment and hemoconcentration status to Major Cardiovascular
Events (MACE) after 6 months at RSUP H. Adam Malik.
Methods: This study is a comparative analytical study with a retrospective cohort
method from July 2018 to March 2020. The total sample was 134 patients
diagnosed with acute heart failure at H. Adam Malik General Hospital who met
the inclusion and exclusion criteria. Each variable will be calculated p value, with
a p value <0.05 is considered statistically significant.
Results: The research subjects were 134 people consisting of 98 people (73.1%)
men and 36 people (10.7%) women. This study obtained a mean BUN/Cr ratio at
the end of treatment 19.27 ± 8.95 and hemodilution as much as 56.7% of the
sample. From the analysis with the comparative test, it was found that there were
significant differences between each sample group towards the MACE. From the
logistic regression analysis, it was found that the incidence of MACE in the high
BUN / Cr ratio group and hemodilution was 6 times higher than the low BUN / Cr
ratio group and hemoconcentration group.
Conclusion : High BUN/Cr ratio at the end of admission and hemodilution in acute
heart failure patients was associated with major cardiovascular events at 6 months.Tujuan : Nilai rasio BUN/Kreatinin yang tinggi telah diketahui berkaitan dengan
kejadian kematian pada pasien Gagal Jantung Akut (GJA) yang disertai disfungsi
ginjal.Tetapi dampak klinis dari rasio BUN/Kreatinin tinggi di akhir rawatan
menunjukkan disfungsi ginjal, hiperaktivitas neurohormonal dan respon berbeda
terhadap terapi dekongesti belum jelas. Status hemokonsentrasi telah menjadi
parameter keberhasilan terapi dekongesti. Penelitian ini ditujukan untuk
mengetahui hubungan antara rasio BUN/Kreatinin akhir rawatan dan status
hemokonsentrasi terhadap Kejadian Kardiovaskular Mayor (KKvM) setelah 6
bulan di RSUP H. Adam Malik.
Metode : Penelitian ini merupakan suatu studi analisif komparatif dengan metode
kohort retrospektif mulai Juli 2018 sampai Maret 2020. Jumlah sampel sebanyak
134 orang pasien yang didiagnosis dengan gagal jantung akut di RSUP H.Adam
Malik yang memenuhi kriteria inklusi dan eksklusi. Masing-masing variabel akan
dihitung nilai p, dengan nilai p <0,05 dianggap signifikan secara statistik.
Hasil : Subyek penelitian sebanyak 134 orang yang terdiri dari 98 orang (73,1%)
laki-laki dan 36 orang (10.7%) perempuan. Penelitian ini mendapatkan rerata rasio
BUN/Cr akhir rawatan 19,27 ± 8,95 dan hemodilusi sebanyak 56,7% sampel. Dari
analisis dengan uji komparatif didapati perbedaan bermakna antar tiap kelompok
sampel terhadap KKvM. Dari hasil analisis uji regresi logistik didapati kejadian
KKvM pada kelompok rasio BUN/Cr tinggi dan hemodilusi 6 kali lipat dibanding
kelompok rasio BUN/Cr rendah dan hemokonsentrasi.
Kesimpulan : Rasio BUN/Cr tinggi di akhir rawatan dan hemodilusi pada pasien
gagal jantung akut memiliki hubungan dengan Kejadian Kardiovaskular Mayor
dalam 6 bulan.Tesis Magiste
Tingginya Kadar Kreatinin Saat Masuk Sebagai Prediktor Kejadian Kardiovaskular Mayor (KKvM) Selama Rawatan Pasien Gagal Jantung Akut di Rumah Sakit Umum Pusat Haji Adam Malik Medan
No full textLatar Belakang : Gagal Jantung akut merupakan masalah kesehatan global
dengan angka morbiditas dan mortalitas yang cukup tinggi. Prognosis pasien
gagal jantung akut juga buruk baik jangka pendek maupun jangka panjang. Oleh
karena itu diperlukan identifikasi awal pasien yang beresiko tinggi untuk
mengalami kejadian kardiovaskular mayor (KKvM) selama rawatan dirumah sakit
agar prognosis menjadi lebih baik. Kadar kreatinin saat masuk dapat digunakan
sebagai prediktor KKvM pasien gagal jantung akut karena kreatinin merupakan
biomarker fungsi ginjal yang sederhana dan rutin diperiksa pada pasien gagal
jantung akut. Tujuan penelitian adalah untuk mengetahui apakah kreatinin dapat
digunakan sebagai prediktor KKvM pada pasien gagal jantung akut.
Metode : Penelitian ini merupakan penelitian kohort ambispektif terhadap 108
pasien gagal jantung akut yang dirawat di RSUP H. Adam Malik sejak Juli 2018
sampai Januari 2019. Titik potong kreatinin ditentukan dengan menggunakan
kurva ROC, kemudian dilakukan analisis bivariat dan multivariat untuk
menentukan prediktor KKVM selama rawatan.
Hasil : Dari 108 subyek penelitian, 24 (22,2%) subyek mengalami KKvM selama
rawatan. Subyek yang mengalami kematian sebanyak orang 20 orang (83,4%),
yang mengalami aritmia sebanyak 2 orang (8,3%) dan mengalami stroke sebanyak
2 orang (8,33%). Titik potong kreatinin yang bermakna berdasarkan kurva ROC
adalah ≥1,7 mg/dl. Dari hasil analisis bivariat diketahui bahwa umur, tekanan
darah sistolik, tekanan darah diastolik, denyut jantung, BMI, riwayat gagal
jantung sebelumnya, kreatinin, creatinine clearence, osmolalitas dan durasi QRS
bermakna sebagai prediktor KKvM. Sedangkan dari hasil analisis multivariat
didapatkan bahwa prediktor kuat terjadinya KKvM selama rawatan adalah
kreatinin (p=0,001 OR 18,31 CI 95% 3,313-101,178) bersama creatinine
clearence dan denyut jantung.
Kesimpulan : Kadar kreatinin saat masuk merupakan prediktor KKvM selama
rawatan pasien gagal jantung akut.Background : Acute heart failure (AHF) is a global problem with high morbidity
and mortality. Short term and long term prognosis for AHF is still poor. In order
to improve outcomes on high risk patient,we have to identify earlier risks of major
adverse cardiovascular events (MACE) during hospital admission. Serum
creatinine level can be used as a predictor in AHF patients because creatinine is a
simple renal function biomarker and routinely measured. The study aims to
determine whether creatinine can be used as a predictor of MACE in AHF
patients.
Method : This study is an ambispective cohort study of 108 patients on AHF
patinets treated in Haji Adam Malik General Hospital from July 2018 to January
2019. The cut off creatinine level was determined by using ROC curve, then
bivariat and multivariat analysis were applied to determine predictor of in hospital
major adverse cardiovascular events.
Result : From 108 subjects, 24 (22,2%) subjects experienced MACE during
treatment in hospital. Subjects died during treatment were 20 people (83,4%),
subjects with arythmia 2 people (8,3%) and subjects with stroke were 2 people
(8,3%). The cut off creatinine level was ≥1,7 mg/dl from ROC curve. From
bivariat analysis, age, systolic blood pressure, diastolic blood pressure, heart rate,
BMI, history of heart failure, creatinine, creatinine clearence, osmolality and QRS
duration were significant as MACE predictor. From multivariat analysis,
creatinine ≥1,7 mg/dl was a predictor of MACE during hospital admission
(p=0,001 OR 18,31 CI 95% 3,313-101,178) along with creatinine clearence and
heart rate.
Conclusion : The creatinine level at admission was a significant predictor of
MACE in AHF patients.76 HalamanTesis Magiste
Perbandingan Kadar Adiponektin Antara Angina Pektoris Stabil dengan Sindroma Koroner Akut
No full textBackground : Atherosclerosis is a basic mechanism in development of coronary artery disease. Inflammation has an important role in atherogenesis and its progression, such as in acute coronary syndrome (ACS). Adiponectin is an adipocytes-produced protein and shows a number protective effects include antiatherogenic, anti inflammation, and antithrombotic. Aim : To investigate whether level of adiponectin in ACS differ from stable angina pectoris (SAP). Materials and Methods: A cross sectional study was conducted to ACS and SAP patients who admitted and visit Dr.Pirngadi General Hospital and Haji Adam Malik Hospital in periods July – October, 2007. Anamnesis, physical examination, electrocardiography were performed and plasma level of adiponectin was measured. Adiponectin levels was compared between these two groups. Results: Of 17 patients with ACS and 17 patients with SAP, there is no difference in gender, age, smoking habit, hypertension, diabetes mellitus, bod mass indexI and lipid profiles. There are significant difference in adiponectin level between ACS and SAP groups (2,62 ± 1,00 µg/mL vs 3,84 ± 1,32 µg/mL ; p=0,005). Conclusion: Level of adiponectin in patients with SAP are higher than in patients with ACS.Latar belakang : Aterosklerosis merupakan dasar mekanisme utama timbulnya Penyakit Jantung Koroner. Inflammasi berperen penting pada aterogenesis dan perkembangannya, termasuk pada kejadian Sindroma Koroner Akut (SKA) . Adiponektin salah satu protein yang dihasilkan sel lemak, dapat dideteksi dalam sirkulasi, mempunyai efek protektif sebagai antiaterogenik, antiinflammasi dan antitrombotik. Tujuan : Untuk mengetahui apakah ada perbedaan kadar adiponektin pada penderita SKA dibandingkan dengan Angina Pektoris Stabil (APS). Bahan Dan Cara : Dilakukan penelitian potong lintang terhadap penderita SKA dan APS yang datang ke Rumah Sakit pada Juli-Oktober 2007. Dilakukan anamnesis, pemeriksaan fisik , elektrokardiografi, dan laboratorium termasuk kadar adiponektin. Kemudian dibandingkan kadar adiponektin antara kelompok APS dan SKA. Hasil : Didapatkan 17 penderita SKA dan 17 penderita APS, kedua kelompok hampir tidak berbeda dalam hal jenis kelamin, umur, merokok, hipertensi, diabetes mellitus, index massa tubuh, dan profil lipid. Terdapat perbedaan bermakna dalam hal kadar adiponektin antara kedua kelompok, dimana kadar adiponektin kelompok SKA lebih rendah daripada kelompok APS (2,62 ± 1,00 µg/ml vs 3,84 ± 1,32 µg/ml ; p=0,005 ). Kesimpulan : Kadar adiponektin pada penderita APS lebih tinggi dibandingkan pada penderita SKA.68 HalamanTesis Magiste
Karakteristik Pasien Gagal Jantung yang Dirawat Inap di RSUP. Haji Adam Malik Medan Tahun 2020-2021
No full textBackground. The 2018 Riskesdas data shows that the prevalence of heart disease in Indonesia is 1.5%. The prevalence of heart failure in Indonesia reaches 5% of the total population. This is a high number when compared to the prevalence in America and Europe, which is only 1-2%. Meanwhile, the prevalence of heart failure in Indonesia in 2013 was 0.13% or an estimated 229,696 people. North Sumatra Province has a proportion of 0.13% or around 11,622 people. Aim. To find out the characteristics of heart failure patients who are hospitalized at RSUP. Hajj Adam Malik Medan 2020-2021. Methods. This is the descriptive research through secondary data taken from the patient's medical records. The inclusion criteria for this study were patients recorded in the medical record who had heart failure and were hospitalized at the General Hospital. H. Adam Malik Medan in 2020-2021. Results. From this study obtained 99 samples. Each variable is processed and presented in the form of a frequency distribution table. Conclusion. Gender characteristics were 67 patients with a percentage of 67.7% male and 32 female patients with a percentage of 32.3%, the highest age of heart failure patients was in the age range of 56-65 years with 37 patients with a percentage of 37.4%, the most occupation of heart failure patients as self-employed as many as 42 patients with a percentage of 42.4%, ischemic heart disease is the most etiology of 45 patients with a percentage of 45.5%, history of previous disease as many as 98 patients with a percentage of 99%, dyspnea is the highest main complaint were 37 patients with a percentage of 37.4%, the most other co-morbidities with a total of 54 patients with a percentage of 54.5%, EKG is the most supporting examinations with a total of 99 patients with a percentage of 100%.94 HalamanSkripsi Sarjan
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