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Akurasi Pemeriksaan Ct Scan Toraks dalam Menegakkan Diagnosis Tuberkulosis Paru pada Pasien Hiv dengan Foto Toraks Normal
No full textPendahuluan: Pemeriksaan foto toraks adalah pemeriksaan awal untuk menegakkan TB paru. Pada kenyataannya foto toraks yang normal bahkan dapat terjadi pada pasien HIV dengan gejala TB paru, hal ini disebabkan karena foto toraks menampilkan rekonstruksi 2 dimensi dan sulit mendeteksi masalah yang berada di area belakang jantung. CT scan sendiri dapat mendeteksi masalah yang berada di area belakang jantung karena tampilan rekonstruksi dibuat 3 dimensi selain itu CT scan juga sangat memungkinkan melihat kelainan yang masih minimal. Oleh karena itu dirasa penting untuk menilai akurasi pemeriksaan CT scan toraks dalam menegakkan diagnosis tuberkulosis paru pada pasien HIV yang memiliki gejala TB paru (batuk, sesak napas, nyeri dada, penurunan berat badan, keringat malam, demam) dengan gambaran foto toraks normal. Metode: Desain penelitian ini adalah penelitian cross sectional dengan reference standar uji sputum geneXpert. Sampel yang digunakan yaitu 40 orang pasien HIV dengan gejala klinis TB paru tetapi foto toraks normal. Hasil: Sensitivitas CT scan dalam menegakkan diagnosis tuberkulosis pada pasien HIV dengan gejala TB tetapi memiliki foto toraks normal adalah sebesar 100%, spesifisitas sebesar 55,56%, nilai prediksi positif sebesar 20%, nilai prediksi negatif sebesar 100%. Tingkat akurasi uji diagnostik dengan menggunakan metode kurva ROC (Area Under the Curve (AUC)) bernilai 0,778. Tingkat akurasi prediksi klasifikasi CT scan berdasarkan geneXpert, dengan menggunakan metode regresi logistik (binary logistic regression) berdasarkan data 40 pasien adalah sebesar 60%. Kesimpulan: CT scan toraks dapat direkomendasikan untuk menyatakan tidak adanya TB pada pasien HIV yang memiliki gejala TB dimana bila CT scan menyatakan kesan TB negatif maka dapat disimpulkan pasien tidak menderita TB. Hal ini diperlukan pada sentra sentra yang tidak ada pemeriksaan geneXpert. Pemeriksaan geneXpert tidak bisa menegakkan TB extraparu sedangkan CT scan mampu menegakkan masalah TB extraparu. Sehingga sangat penting dilakukan CT scan untuk menegakkan masalah diagnosis TB extraparu.Introduction: Chest x-ray is an initial examination in diagnosing tuberculosis, but the fact is normal chest x-ray often happened in HIV positive patient with tuberculosis clinical signs, because chest x-ray only shows 2 dimensional reconstruction and difficult to see the area behind the cardiac, while CT scan can show it because it shows 3 dimensional reconstruction. Therefore, it is important to evaluate the accuracy of chest CT scan compare to geneXpert in diagnosing tuberculosis on HIV positive patients who have tuberculosis clinical signs such as cough, dyspnea, chest pain, weight decrease, night sweat, fever with normal chest x-ray. Methods: The study design is cross sectional with standard reference sputum test by geneXpert. We use 40 HIV positive patients with tuberculosis clinical signs but normal chest x-ray as the samples. Results: The sensitivity of CT scan in diagnosing tuberculosis in HIV positive patients with normal chest x-ray is 100%, the specificity is 55,56%, the positive predictive value is 20%, and the negative predictive value is 100%. The accuracy of the diagnostic tool by ROC curve method (Area Under the Curve (AUC)) is 0,778 (good). The predictive accuracy of CT scan than geneXpert, by using binary logistic regression method is 60%. Conclusion: Chest CT-scan can be recommended to distinguish tuberculosis on HIV positive patients with tuberculosis clinical signs but normal chest x-ray. This diagnostic tool is valuable on every health center that has no geneXpert examination. Chest CT-scan also can diagnose extrap ulmonary tuberculosis while geneXpert not.79 HalamanTesis Magiste
Hubungan Indeks Massa Tubuh dengan Volume Visceral dan Subcutaneous Adipose Tissue pada Pasien yang Dilakukan CT SCAN Abdomen di RSUP H. Adam Malik Medan
No full textBackground: Visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT),
and excess body mass index act as cardiometabolic risk factors. Measurement of
body mass index only describes the state of the ratio of body weight to height in
general. An abdominal CT scan is the gold standard in the examination of VAT and
SAT volumes.
Objective: To analyze the correlation between BMJ and VAT and SAT in patients
that performed CT scans of the abdomen.
Methods: A cross-sectional study on patients who underwent CT scans of the
abdominal region at the Radiology Department of the H. Adam Malik Central
General Hospital Medan from July to August 2022. Data were collected in the form
of an examination of height, weight, body mass index, and volume of VAT and SAT
of patients that performed CT scans of the abdominal region at the 14 level.
Measurement of VAT and SAT volumes using 3D smart segmentation. BMl
measurement results were correlated with VAT and SAT volumes using statistical
software.
Results: Of the 60 patients studied, the number of samples was 51. 7% male. The
mean age was 49.3 ± 12.18 years with an average BMI of25.58 kg/m2. The average
VAT volume value is 678,13 ± 436,09 cm3 and the average SAT volume is 1.708,76
± 1.068,99 cm3
. There is a significant positive correlation between BMI and VAT
(r=0.687) and BMJ and SAT (r=0.669) with p<0.001.
Conclusion: There is a moderate positive correlation between BMI with VAT and
BMJ with SAT in patients who underwent CT scans of the abdomen.82 HalamanTesis Magiste
Korelasi Optic Nerve Sheath Diameter dengan Rotterdam CT Score dan Skala Koma Glasgow pada Pasien Cedera Kepala di RSUP H. Adam Malik Medan
Get PDFBackground: Head injury is one of the causes of morbidity and mortality throughout the
world. Increased intracranial pressure (ICP) is one of the fatal events resulting from head
injury. The gold standard examination for diagnosing elevated ICP, namely external
ventricular drainage (EVD), is highly invasive, not available in the initial assessment, and
is contraindicated in patients with coagulopathy. Measuring optic nerve sheath diameter
(ONSD) has recently emerged as an alternative, non-invasive method of ICP monitoring.
Based on initial CT scan findings, the Rotterdam CT Score (RCTS) is used to assess the
severity and prognosis of head injury. A high Rotterdam CT Score is associated with a
higher mortality rate and this has been proven in various studies.
Objective: To analyze the correlation between ONSD with RCTS and GCS.
Methods: Cross-sectional study of head injury patients who underwent non-contrast head
CT scans at the Radiology Departement of RSUP H. Adam Malik, Medan from May 1st,
2022 to April 30th, 2023 who met the inclusion criteria. Then ONSD and RCTS
measurements were carried out on non-contrast head CT scans by 2 examiners. The GCS
score is obtained from the patient's medical record.
Results: From 42 patients studied, the number of male samples was 61.9%. The mean
age is 36.33 ± 12.47 years with the largest age group being 18 – 30 years. The mean
ONSD was 6.26 ± 0.80 mm. The median score of RCTS was 3(1-6) and GCS was 14 (3
– 15). There is a significant strong positive correlation between ONSD and RCTS (r =
0.747) and a moderate negative correlation between ONSD and GCS (r = -0.476) with
p<0.05.
Conclusion: There is a strong positive correlation between ONSD and RCTS and a
moderate negative correlation between ONSD and GCS.92 HalamanTesis Magiste
Hubungan Hipertensi dengan Kalsifikasi Arkus Aorta pada Foto Toraks Pasien Stroke Iskemik di RSUP. H. Adam Malik Medan
No full textIntroduction: Fatty liver is a broad term for a condition in which there is an increase triglyceride level in hepatocyte. In Indonesia there is not much research about this condition. Fatty liver is a major health problem in West countries, and is slowly increasing in Asian countries. For many individual with fatty liver, have no specific complaint or can have no symptoms at all.
Objective: Analyzed the relationship between fatty liver images on abdominal CT scans with dyslipidemia.
Methods: This study is an observational analytic study with a case – control type of research with the aim of knowing the relationship between CT scan images of fatty liver and dsylipidemia. The data in this study were all medical records who went to the Radiology Department for abdominal CT Scan at the Haji Adam Malik General Hospital for a period of one year from January 1st, 2020 to December 31st 2020.
Results: The subjects on the abdominal CT scan results with fatty liver and high triglyceride is 5 peoples out of 12 (41.7%). The test results obtained p value = 0.,688 (p>0,05), in other words there is no significant relationship between fatty liver and high triglyceride level.
Conclusion: No significant relationship was found between the incidence of fatty liver and the incidence of dyslipidemia.82 HalamanTesis Magiste
Ketepatan Pemeriksaan Terpadu Sitologi Biopsi Aspirasi Jarum Halus (Si-bajah) dan Ultrasonografi pada Nodul Tiroid di RSUP H. Adam Malik Medan
No full textThyroid nodules are a common problem and only small presentage are neoplasms (5-10%). Fine needle aspiration biopsy (FNAB) is a preoperative method and to select the patients who need surgery for neoplastic disorders or medicamentosa. Ultrasonography (USG) can be perform as guiding for FNAB so that the needle can be insert precisely to the lesion. Ultrsonography significantly increased the sensitivity and specificity of FNAB in thyroid nodules. This study has been done descriptively using cross-sectional methods to evaluate the accuracy of FNAB and USG in thyroid nodules at the RSUP Adam Malik Medan, and the histopathology are the gold standart for diagnosis. All the patients with thyroid nodules ≥ 2 cm are perform FNAB and USG, and the then FNAB are perform once more. The smears are stained with Giemsa. The FNAB diagnosis had a sensitivity of 13,0% (1/8) and specificity of 100,0% (26/26). The diagnostic accuracy of FNAB and USG are higher than only FNAB, with sensitivity of 25,0% (2/8) and specificity of 100,0% (26/26).
Conclusion
In conclusion, this study showed that USG increased the diagnostic accuracy value of FNAB in thyroid nodules ≥ 2 cm, especially benign lesions.Pembesaran nodul tiroid merupakan keadaan yang biasa ditemukan dan hanya sebagian kecil saja yang merupakan neoplasma (5-10%). Sitologi biopsi aspirasi jarum halus (Si-BAJAH) merupakan metode pemeriksaan prabedah dan untuk memilih pasien yang memerlukan tindakan pembedahan pada kelainan neoplasma atau pengobatan (medikamentosa). Ultrasonografi (USG) dapat dipergunakan sebagai pengarah pada Si-BAJAH, agar jarum biopsi dapat lebih jelas dan akurat diinsersikan ke lesi yang dicurigakan. Ultrasonografi secara signifikan meningkatkan sensitivitas dan spesifitas daripada Si-BAJAH pada nodul tiroid dibandingkan jika hanya dengan Si-BAJAH. Penelitian ini merupakan penelitian deskriptif dengan rancangan potong lintang untuk menilai ketepatan pemeriksaan Si-BAJAH dan USG pada nodul tiroid di RSUP Adam Malik Medan, dan pemeriksaan histopatologi sebagai baku emasnya. Semua penderita dengan nodul tiroid ukuran ≥ 2 cm dilakukan biopsi aspirasi dan USG, kemudian dilakukan biopsi aspirasi ulang. Hapusan dicat dengan larutan Giemsa. Hasil pengukuran mendapati sensitifitas Si-BAJAH mencapai 13,0% (1/8) dan spesifisitas 100,0% (26/26). Akurasi diagnostik Si-BAJAH dan USG pada nodul tiroid lebih tinggi dibandingkan jika hanya dengan Si-BAJAH, dimana sensitifitas mencapai 25% (2/8) dan spesifisitas 100,0% (26/26)
Kesimpulan
Kesimpulan dari penelitian ini adalah pemeriksaan USG meningkatkan nilai akurasi diagnostik Si-BAJAH pada nodul tiroid dengan ukuran ≥ 2 cm, terutama pada lesi jinak.64 HalamanTesis Magiste
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Gambaran Biopsi Jarum Abram dengan Tuntunan Ultrasonografi dalam Mendiagnosis Penyebab Efusi Pleura Ganas
No full textLatar Belakang: Penyakit keganasan yang melibatkan pleura merupakan penyebab paling umum ketiga dari efusi pleura eksudatif setelah tuberkulosis dan parapneumoni. Efusi pleura ganas merupakan temuan klinis yang penting karena merupakan manifestasi pertama dari keganasan yang mendasari penyakit tersebut. Tersedianya data yang sangat terbatas mengenai aspek klinis, radiologis, dan etiologis efusi pleura ganas di Indonesia menjadi dasar penelitian ini dilakukan.
Metode Penelitian: Penelitian ini merupakan suatu penelitian deskriptif dengan pendekatan cross sectional pada 28 pasien yang telah dilakukan biopsi pleura jarum Abram dengan tuntunan USG untuk menentukan lokasi pengambilan sampel yang tepat agar dapat mengetahui etiologi dari efusi pleura ganas tersebut.
Hasil: Dari hasil penelitian diperoleh gambaran paling banyak adalah berjenis kelamin laki-laki, dengan usia lebih dari 40 tahun, perokok, tidak memiliki riwayat keganasan di keluarga, letak efusi pleura di sisi kanan, dengan luas moderate, hasil sitologi cairan pleura dan biopsi pleura tidak ganas.Background : Malignant disease involving the pleura is the second most common cause of exudative pleural effusion next to tubercular and parapneumonic effusions. Malignant pleural effusion is an important clinical entity because sometimes it may be the first manifestation of an underlying malignancy. There are very limited data regarding clinical, radiological and etiological aspects of malignant pleural effusion from Indonesia, and this is the purpose of this research.
Methods : This study was a descriptive study using cross sectional in 28 patients who had been carried out by Abram needle pleural biopsy with ultrasound guidance to determine the location of taking the right sample. It can be seen the etiology for this malignant pleural effusion.
Results : The results of the most research are male, with age more than 40 years, smokers, no history of malignancy in the family, location of pleural effusion on the right side, with moderate size, results of pleural fluid cytology and not malignant pleural biopsy98 HalamanTesis Magiste
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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