Medica Hospitalia : Journal of Clinical Medicine http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh <p style="background-color: transparent; box-sizing: border-box; color: rgba(0, 0, 0, 0.87); font-family: &amp;quot; noto sans&amp;quot;,-apple-system,blinkmacsystemfont,&amp;quot;segoe ui&amp;quot;,&amp;quot;roboto&amp;quot;,&amp;quot;oxygen-sans&amp;quot;,&amp;quot;ubuntu&amp;quot;,&amp;quot;cantarell&amp;quot;,&amp;quot;helvetica neue&amp;quot;,sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; line-height: 25px; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px; margin: 0px 0px 20px 0px;">Medica Hospitalia: <em style="box-sizing: border-box;">Journal of Clinical Medicine</em>&nbsp;(P-ISSN: <a style="background-color: transparent; box-sizing: border-box; color: #007ab2;" title="p-ISSN" href="http://u.lipi.go.id/1436428853" target="_blank" rel="noopener">2301-4369</a>; e-ISSN: <a style="background-color: transparent; box-sizing: border-box; color: #007ab2;" href="http://u.lipi.go.id/1562578179" target="_blank" rel="noopener">2685-7898</a> ) adalah jurnal ilmiah yang diterbitkan RSUP Dr Kariadi dan menerima artikel ilmiah dalam bahasa Indonesia dan bahasa Inggris yang diharapkan dapat menjadi media untuk menyampaikan temuan dan inovasi ilmiah dibidang kedokteran atau kesehatan kepada para praktisi dan akedemisi di bidang kesehatan dan kedokteran.</p> <p style="background-color: transparent; box-sizing: border-box; color: rgba(0, 0, 0, 0.87); font-family: &amp;quot; noto sans&amp;quot;,-apple-system,blinkmacsystemfont,&amp;quot;segoe ui&amp;quot;,&amp;quot;roboto&amp;quot;,&amp;quot;oxygen-sans&amp;quot;,&amp;quot;ubuntu&amp;quot;,&amp;quot;cantarell&amp;quot;,&amp;quot;helvetica neue&amp;quot;,sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; line-height: 25px; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px; margin: 20px 0px 20px 0px;">Medica Hospitalia: <em style="box-sizing: border-box;">Journal of Clinical Medicine</em>&nbsp; merupakan jurnal kesehatan&nbsp; &nbsp;mengenai berbagai aspek yang berkaitan dengan bidang kedokteran/ kesehatan yang berbasis klinis khususnya Rumah Sakit.</p> <p style="background-color: transparent; box-sizing: border-box; color: rgba(0, 0, 0, 0.87); font-family: &amp;quot; noto sans&amp;quot;,-apple-system,blinkmacsystemfont,&amp;quot;segoe ui&amp;quot;,&amp;quot;roboto&amp;quot;,&amp;quot;oxygen-sans&amp;quot;,&amp;quot;ubuntu&amp;quot;,&amp;quot;cantarell&amp;quot;,&amp;quot;helvetica neue&amp;quot;,sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; line-height: 25px; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px; margin: 20px 0px 0px 0px;"><span style="background-color: transparent; box-sizing: border-box; color: #000000; cursor: text; display: inline; float: none; font-size: 14px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">Medica Hospitalia: </span><em style="background-color: transparent; box-sizing: border-box; color: #000000; cursor: text; font-size: 14px; font-style: italic; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; outline-color: transparent; outline-style: none; outline-width: 0px; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">Journal of Clinical Medicine</em><span style="background-color: transparent; box-sizing: border-box; color: #000000; cursor: text; display: inline; float: none; font-family: &amp;quot; noto sans&amp;quot;,arial,helvetica,sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;"> sudah terindeks </span><a style="background-color: transparent; box-sizing: border-box; color: #007ab2; font-size: 14px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: underline; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;" title="Google Scholar" href="https://scholar.google.co.id/citations?hl=id&amp;user=r_-HSA0AAAAJ" target="_blank" rel="noopener">Google Scholar</a></p> <p>&nbsp;DOI&nbsp;Medica Hospitalia: <em>Journal of Clinical Medicine : <a href="doi.org/10.36408/mhjcm" target="_blank" rel="noopener">http://doi.org/10.36408/mhjcm&nbsp; </a>&nbsp;</em></p> RSUP Dr. Kariadi en-US Medica Hospitalia : Journal of Clinical Medicine 2301-4369 <p><strong>PEMBERITAHUAN HAK CIPTA</strong></p> <ul> <li><strong>Hak Cipta</strong>:</li> </ul> <p>Penulis yang mempublikasikan naskahnya pada Medica Hospitalia: <em>Journal of Clinical Medicine</em> menyetujui ketentuan berikut:</p> <ol> <li>Hak cipta pada setiap artikel adalah milik penulis, begitu juga dengan hak untuk mempatenkan. 2. Penulis mengakui bahwa Medica Hospitalia: <em>Journal of Clinical Medicine</em> berhak sebagai yang mempublikasikan pertama kali.</li> <li>Penulis dapat memasukan tulisan secara terpisah, mengatur distribusi non-ekskulif dari naskah yang telah terbit di jurnal ini kedalam versi yang lain (misal: dikirim ke respository institusi penulis, publikasi kedalam buku, dll), dengan mengakui bahwa naskah telah terbit pertama kali pada Medica Hospitalia: <em>Journal of Clinical Medicine</em></li> </ol> <ul> <li><strong>Lisensi</strong> :</li> </ul> <p>Medica Hospitalia: <em>Journal of Clinical Medicine</em> didiseminasikan berdasarkan ketentuan lisensi Creative Commons Atribusi-NonKomersial 4.0 Internasional. Lisensi ini mengizinkan setiap orang untuk menyalin dan menyebarluaskan kembali materi ini dalam bentuk atau format apapun, menggubah, mengubah, dan membuat turunan dari materi ini untuk kepentingan apapun. Anda tidak dapat menggunakan materi ini untuk kepentingan komersial. Anda harus mencantumkan nama yang sesuai, mencantumkan tautan terhadap lisensi, dan menyatakan bahwa telah ada perubahan yang dilakukan. Anda dapat melakukan hal ini dengan cara yang sesuai, namun tidak mengisyaratkan bahwa pemberi lisensi mendukung Anda atau penggunaan Anda.</p> Status Kesehatan Rongga Mulut Wanita Suku Osing http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/386 <p><strong>Latar belakang</strong></p> <p>Kualitas hidup manusia ditentukan oleh tingkat sosiodemografi, status kesehatan umum dan rongga mulut yang saling berkaitan. Ras dan suku menentukan genetika dalam merespon keradangan, kerentanan jaringan rongga mulut terhadap bakteri atau injuri, meregulasi hormon reproduksi, dan sindrom menopause. Akan tetapi hubungan faktor tersebut masih &nbsp;belum banyak terungkap, khususnya pada Suku Osing. Suku Osing merupakan salah satu suku yang masih memegang kuat adat istiadat.Tujuan penelitian ini adalah untuk mengetahui status kesehatan rongga mulut wanita suku Osing.</p> <p><strong>Metode </strong></p> <p>Penelitian observasional dengan desain <em>cross sectional</em>.Subyek penelitian dikelompokan menjadi kelompok usia produktif dan menopause. Pada subyek penelitian dilakukan pemeriksaan status kesehatan rongga mulut meliputi jumlah gigi yang tersisa di rongga mulut, indeks periodontal, karies dan kebersihan rongga mulut. Semua data dikategorikan kemudian akan dilakukan uji korelasi non parametric (p?0,05).</p> <p><strong>Hasil</strong></p> <p>Kelompok wanita usia menopause pada penelitian ini sudah mengalami menopause dalam kurun waktu 5-10 tahun.Jumlah gigi wanita usia menopause lebih sedikit dibanding wanita usia produksif (p?0,05). Wanita usia menopause lebih banyak menderita penyakit periodontal yang bersifat <em>irreversible</em> (2,65 ± 0,35) daripada wanita usia produktif (1,16 ± 0,27). Indeks karies kelompok wanita usia menopause (D=166, M=570) lebih tinggi dibanding wanita usia produktif (D=247, M=162). Akan tetapi, kedua kelompok ini mempunyai tingkat kebersihan mulut yang sama. Selain itu terdapat hubungan antara tingkat kebersihan mulut, penyakit periodontal, karies dan lamanya menopause (R&gt;0,3).</p> <p><strong>Simpulan</strong></p> <p>Status kesehatan rongga mulut wanita usia menopause suku Osing di Desa Kemiren, Kecamatan Glagah, Banyuwangi lebih buruk dibanding wanita usia produktif. Akan tetapi, perlu penelitian lebih lanjut mengenai faktor-faktor yang mempengaruhi status kesehatan rongga mulut tersebut.</p> <p>&nbsp;</p> <p><strong>Background</strong></p> <p>Social-demography, health status, and oral health specify a quality life, which all of them are correlated. Races and ethnic assign genetic aspect, especially in inflammation respond, oral tissue susceptibility to bacterial infection and injuries, hormone regulation, and menopause syndrome. However, the relationships are unexplored yet, especially in osingese. Osingese is one of ethnic which hold the customs strongly. The objective of this study was to know the oral health status of Osingese Women.</p> <p><strong>Method </strong></p> <p>This study was observational with a cross-sectional design. The subjects were classified into productive and menopause age. All of the subjects were examined their oral health, including remain teeth, periodontal index, caries index, and oral hygiene index. All of the data were categorized and analyzed by non-parametric correlation analysis (p?0.05).</p> <p><strong>Result </strong></p> <p>Menopause aged group experienced menopause period about 5-10 years. The number of teeth of the menopause group was less than productive group (p?0.05). The menopause group more sustained irreversible periodontal diseases (2.65 ± 0.35) than the productive group (1.16 ± 0.27). Caries index in the menopause group (D=166, M=570) was higher than the productive group (D=247, M=162). However, their oral hygiene index was the same. Moreover, there presented the relationship between oral hygiene, caries index, periodontal index, and menopause status (R&gt;0.3).</p> <p><strong>Conclusion</strong></p> <p>Oral health status menopause aged osingese women was poorer than the productive group. However, it needed further study to investigate the other factor influencing oral health status.</p> <p><strong>Keywords:</strong> caries, periodontal disease, oral hygiene, menopause, Osingese</p> Agustin Wulan Suci Dharmayanti Suhartini Suhartini Banun Kusumawardani ##submission.copyrightStatement## 2019-11-20 2019-11-20 6 2 71 79 10.36408/mhjcm.v6i2.386 Penentuan Intravitalitas Gantung berdasarkan Gambaran Histopatologis Otak Besar Mencit Balb/c http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/387 <p><strong>Latar Belakang : </strong>Asfiksia merupakan salah satu mekanisme kematian yang dapat terjadi akibat gantung. Otak merupakan salah satu organ penting yang dinilai dalam otopsi kasus gantung. Secara makroskopis tidaklah mudah membedakan temuan asfiksia pada otak yang terjadi antemortem dan perimortem. Adanya temuan asfiksia pada pemeriksaan mikrokopis dapat menentukan intravitalitas gantung. Penelitian ini bertujuan untuk mengetahui penentuan intravitalitas gantung berdasarkan gambaran histopatologis otakbesar mencit Balb/c.</p> <p><strong>Metode : </strong>Penelitian eksperimental ini menggunakan <em>post test only with control group design </em>yang telah memenuhi kelayakan etik dengan sampel berjumlah 18 mencit Balb/c jantan yang dibagi menjadi tiga kelompok yaitu kelompok kontrol yang tidak diberi perlakuan, kelompok antemortem yang digantung saat masih hidup, kelompok perimortem yang digantung 15 menit setelah mati. Pada kelompok pelakuan mencit digantung selama 1 jam dengan tali yang ditambahkan beban 50 gram. Penilaian gambaran histopatologi otak besar berdasarkan reaksi inflamasi dan perdarahan.</p> <p><strong>Hasil : </strong>Pada kelompok kontrol hampir tidak terdapat inflamasi dan perdarahan, pada kelompok antemortem terdapat inflamasi sedang hingga berat dan perdarahan berat, pada kelompok perimortem terdapat inflamasi dan perdarahan ringan hingga sedang. Pada uji <em>Kruskal Wallis</em> didapatkan perbedaan bermakna pada semua kelompok (p&lt;0,05). Pada Uji <em>Man Whitney</em> didapatkan perbedaan yang bermakna pada parameter inflamasi dan perdarahan antara kelompok kontrol dengan kelompok antemortem dan perimortem, antara kelompok antemortem dan perimortem (p&lt;0,05).</p> <p><strong>Simpulan : </strong>Intravitalitas Gantung dapat ditentukan berdasarkan gambaran histopatologis otak besar mencit Balb/c dimana reaksi inflamasi dan perdarahan berat didapatkan pada kelompok antemortem.</p> <p><strong><em>Kata Kunci: </em></strong><em>gantung,</em><em> histopatologi</em><em>s</em><em>, </em><em>intravital,</em> <em>otak besar</em></p> <p><em>&nbsp;</em></p> <p><strong><em>Hanging Intravitality Determination based on Cerebrum Histopathological </em></strong><strong><em>Features</em></strong><strong><em> in Balb/c Mice</em></strong></p> <p><strong><em>Abstract</em></strong></p> <p><strong><em>Background</em></strong><em>: Asphyxia is one of the death mechanisms that can occur due to hanging. The brain is one of the important organs autops</em><em>ied in </em><em>a hanging</em><em>-related death </em><em>case. Macroscopically</em><em>,</em><em> it is</em><em> challenging</em><em> to distinguish </em><em>between </em><em>asphyxi</em><em>ated b</em><em>rain</em><em>s </em><em>occu</em><em>ring</em><em> antemortem and </em><em>those occurring </em><em>perimortem. The presence of asphyxia on micro-examination can </em><em>help </em><em>determin</em><em>ing</em><em> the hanging</em> <em>intravitality. </em><em>This study aims </em><em>to determine hanging intravitality</em> <em>based on </em><em>cereberum </em><em>histopathological </em><em>features</em> <em>in </em><em>mice Balb/c</em><em> mice.</em></p> <p><strong><em>Method:</em></strong><em> This </em><em>is a </em><em>post test only experimental </em><em>study</em><em> with control group </em><em>examining </em><em>18 male Balb/c mice</em> <em>in three groups involving </em><em>untreated control group, antemortem group hanged</em><em> during</em><em> alive, perimortem group hanged 15 minutes after death. In the treatment group</em><em>s,</em><em> mice were hanged with 50 grams </em><em>load </em><em>for 1 hour.</em><em> Determination of h</em><em>istopathological </em><em>features</em><em> is based on inflammatory and bleeding reactions. </em><em>&nbsp;</em></p> <p><strong><em>Results</em></strong><em>:</em> <em>Nearly no</em><em> inflammation and bleeding</em><em> was found</em> <em>i</em><em>n the control group, moderate to severe inflammation and heavy bleeding</em><em> was found</em><em> in the antemortem group, mild to moderate inflammation and bleeding</em><em> was found</em><em> in the perimortem group. The Kruskal Wallis test </em><em>showed</em><em> significant differences in all groups (p &lt;0.05). The Man Whitney test found significant differences in the inflammatory and bleeding parameters between the control group and the antemortem and perimortem groups</em><em>;</em><em> between the antemortem and perimortem groups (p &lt;0.05).</em></p> <p><strong><em>Conclusion</em></strong><em>: </em><em>T</em><em>he cerebrum histopathological </em><em>features</em><em> of the Balb/c mice </em><em>can indicate h</em><em>anging</em> <em>intravitality</em><em> in which t</em><em>he antemortem group</em><em> shows</em><em> inflammatory reactions and heavy bleeding.</em></p> <p><strong><em>Keywords</em></strong><em>: hanging, histopathological, intravital, cerebrum</em></p> Raja Al Fath Widya Iswara Sigid Kirana Lintang Bhima Intarniati Nur Rohmah ##submission.copyrightStatement## 2019-11-20 2019-11-20 6 2 80 85 10.36408/mhjcm.v6i2.387 Hubungan Kadar HbA1c Dan Rasio TG/HDL Dengan Cystatin-C Serum Pada Pasien Diabetes Melitus Tipe 2 http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/388 <p><strong>Latar belakang:</strong> Diabetes melitus (DM)&nbsp; tipe 2 dapat menyebabkan komplikasi salah satunya nefropati. Kontrol glikemik yang dinilai dengan HbA1c dan dislipidemia yang dinilai dengan rasio trigliserida/<em>high density lipoprotein </em>(TG/HDL) diduga berhubungan dengan komplikasi nefropati. <em>Cystatin C </em>merupakan petanda yang dapat menilai kerusakan fungsi ginjal dini. Hubungan kadar HbA1c dan rasio TG/HDL dengan <em>Cystatin C </em>pada pasien DM tipe 2 belum diketahui dengan jelas.</p> <p><strong>Tujuan: </strong>Mengetahui hubungan antara kadar HbA1c dan rasio TG/HDL dengan <em>Cystatin C</em> pada pasien diabetes melitus tipe 2.</p> <p><strong>Metode: </strong>Penelitian observasional analitik dengan pendekatan belah lintang dilakukan pada bulan April - Juni 2019 melibatkan 34 pasien DM tipe 2 di Puskesmas Karang Ayu yang memenuhi kriteria inklusi dan ekslusi. Pemeriksaan kadar HbA1c menggunakan metode HPLC, rasio TG/HDL dihitung dengan perbandingan TG dengan HDL yang diperiksa menggunakan alat kimia klinik otomatis, kadar <em>Cystatin C</em> menggunakan metode ELISA. Uji statistik menggunakan korelasi <em>Spearman.</em> <em>p</em> &lt; 0,05 dianggap signifikan.&nbsp;</p> <p><strong>Hasil:</strong> Rerata±SD kadar HbA1c adalah 8,21±1,65. Median (minimum-maksimum) rasio TG/HDL dan <em>Cystatin C</em> berturut-turut adalah 3,65(1,3–9,7), 0,72(0,46 – 1,22) mg/L. Korelasi HbA1c dengan <em>Cystatin C</em> dan rasio TG/HDL dengan <em>Cystatin C</em> berturut-turut adalah (r = 0,505; <em>p</em> = 0,002) dan (r = 0,471; <em>p</em> = 0,005).</p> <p><strong>Simpulan:</strong> Terdapat hubungan positif sedang bermakna antara kadar HbA1c dengan <em>Cystatin C</em>&nbsp; dan rasio TG/HDL dengan <em>Cystatin C </em>pada pasien diabetes melitus tipe 2.</p> <p><strong>Kata kunci: </strong>HbA1c, rasio TG/HDL, <em>Cystatin C</em>, DM.</p> <p>&nbsp;</p> <p><strong>The correlation of HbA1c and TG/HDL ratio with serum cystatin C in type 2 diabetes patients</strong></p> <p>&nbsp;</p> <p><strong><em>Background</em></strong><strong><em>:</em></strong> <em>Type 2 diabetes mellitus (DM) can cause </em><em>chronic </em><em>complications such as nephropathy. Glycemic control assessed with HbA1c and dyslipidemia assessed by the </em><em>tryglyceride/high density lipoprotein (</em><em>TG / HDL</em><em>)</em><em> ratio is thought to be associated with complications of nephropathy. Cystatin C is a marker that can assess early kidney function damage. Relationship between HbA1c levels and TG / HDL ratio with Cystatin C in type 2 DM patients</em><em> is not clearly known.</em></p> <p><strong><em>Objective:</em></strong><em> to investigate the correlation of </em><em>HbA1c and TG/HDL ratio with Cystatin C </em><em>&nbsp;in a</em><em>cute </em><em>type 2 diabetes mellitus patients</em><em>.</em></p> <p><strong><em>Method</em></strong><strong><em>s: </em></strong><em>A</em><em>nalytic </em><em>o</em><em>bservational study with cross sectional approac</em><em>h was conducted in </em><em>April</em><em>-</em><em>June </em><em>2019 involving 34 </em><em>type 2 diabetes mellitus</em> <em>patients at the </em><em>Karang Ayu Puskesmas</em><em> who were screened according to the inclusion and exclusion criteria. The level of </em><em>HbA1c</em><em> were measured by the </em><em>HPLC</em><em> method, </em><em>TG/HDL ratio</em> <em>was measured by </em><em>automatic chemistry</em><em> analyzer</em> <em>and </em><em>Cystatin C</em><em> was measured by ELISA method. Statistical analysis used Spearman Correlation Test. </em><em>p &lt;0.05 was considered significant.</em></p> <p><strong><em>Results:</em></strong><em> The mean ± SD HbA1c level was 8.21 ± 1.65. The median (minimum-maximum) ratio of TG / HDL and Cystatin C were 3.65 (1.3–9.7), 0.72 (0.46 - 1.22) mg / L, respectively. Correlation of HbA1c with Cystatin C and the ratio of TG / HDL with Cystatin C respectively (r = 0.505; p = 0.002) and (r = 0.471; p = 0.005).</em></p> <p><strong><em>Conclusions:</em></strong><em> There are significant moderate positive correlation between </em><em>HbA1c</em><em> with&nbsp; </em><em>Cystatin C</em><em> and </em><em>TG/HDL ratio with Cystatin C in type 2 diabetes mellitus patients</em><em>. </em></p> <p><strong><em>Keywords : HbA1c, TG/HDL ratio, Cystatin C, Type 2 Diabetes mellitus.</em></strong></p> Hadian Widyatmojo Indranila Kustarini Samsuria Ria Triwardhani ##submission.copyrightStatement## 2019-11-20 2019-11-20 6 2 86 91 10.36408/mhjcm.v6i2.388 Terapi Kombinasi Diabetic Self Management Education (DSME) Dengan Senam Kaki Diabetik Terhadap Ankle Brachial Index (ABI) Pada Penderita Diabetes Tipe II http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/389 <p><strong>Latar belakang</strong>: Diabetes melitus tipe II merupakan salah satu penyakit tidak menular yang dapat menyebabkan kematian dan memiliki risiko tinggi terjadi komplikasi. Penatalaksanaan empat pilar diabetes tipe II meliputi edukasi, terapi gizi medis, latihan jasmani dan intervensi non &nbsp;farmakologi. Salah satu penanganan non-farmakologi yang sering dilakukan adalah &nbsp;&nbsp;<em>Diabetic Self Management Education</em> (DSME) dan senam kaki diabetik, tetapi kombinasi keduanya belum pernah di teliti. Gabungan beberapa terapi disebut terapi kombinasi. &nbsp;Penelitian ini bertujuan untuk mengetahui pengaruh terapi kombinasi DSME dan senam kaki terhadap <em>Ankle Brachial Index</em> (ABI) pada penderita diabetes tipe II.</p> <p><strong>Metode: </strong>Desain penelitian adalah penelitian Experimental dengan rancangan<em> pretest-posttest control group</em> <em>design</em>. Kelompok intervensi di beri terapi kombinasi DSME dengan senam kaki dan kelompok kontrol dengan pemberian <em>Range of Motion </em>(ROM). Teknik <em>sampling non-probability</em> dengan metode <em>consecutive sampling</em> dengan &nbsp;48 responden yang terbagi dalam 2 kelompok.</p> <p><strong>Hasil</strong> Rerata ABI kelompok Intervensi dan Kontrol sebelum perlakuan adalah 0,84 mmHg dan 0,82 mmHg, sedangkan setelah perlakuan adalah 1,09 mmHg dan 0,89 mmHg. Uji <em>independent</em> <em>t test</em> menunjukkan nilai <em>p</em> <em>value</em> 0,000 berarti ada perbedaan rerata selisih ABI kedua kelompok.</p> <p><strong>Kesimpulan</strong> kombinasi <em>Diabetic Self Management Education</em> (DSME) dengan senam kaki efektif dalam peningkatan <em>Ankle Brachial Index</em> (ABI) pada penderita diabetes tipe II.</p> <p>Kata kunci : Diabetes Melitus, <em>Diabetic Self Management Education</em> (DSME), senam kaki diabetik, <em>Ankle Brachial Index</em>.</p> <p>&nbsp;</p> <p><strong>COMBINATION THERAPY OF </strong><strong>DIABETIC SELF MANAGEMENT EDUCATION (DSME) </strong><strong>WITH DIABETIC FOOT EXERCISE TOWARDS </strong><strong>ANKLE BRACHIAL INDEX (ABI) </strong><strong>ON PATIENTS DIABETIC TYPE II </strong></p> <p><strong>Background</strong>: Type II diabetes mellitus is a non-infectious disease which cause death and have a high risk complications. Management of 4 pillars of type II diabetes includes education, medical nutrition therapy, physical exercise and non pharmacological interventions. One of the non-pharmacological treatments is the combination of Diabetic Self Management Education (DSME) and diabetic foot exercises. Study aims is to determine&nbsp; effect of a combination of Diabetic Self Management Education (DSME) with diabetic foot exercises on Ankle Brachial Index (ABI) in type II diabetics patients.</p> <p><strong>Method: R</strong>esearch design &nbsp;was Quasy Experimental with pretest-posttest control group design. Intervention group was 24 patients type II diabetic with therapy combination of DSME and foot exercises, the control group was given &nbsp;Range of Motion (ROM) as therapy.</p> <p><strong>Results</strong>: Mean of ABI intervention and control group before treatment are 0.84 mmHg and 0.82 mmHg, while after treatment are 1.09 mmHg and 0,89 mmHg &nbsp;Independent t test shows p value 0.000, that there is a differences of mean of ABI both group. It can be concluded that combination of DSME with foot exercises is effective to increase &nbsp;Ankle Brachial Index (ABI) at patients type II diabetics.</p> <p>Keywords: Diabetes Melitus, Diabetic Self Management Education (DSME), diabetic foot exercises, Ankle Brachial Index.</p> <p>&nbsp;</p> Diyah Fatmasari Rastia Ningsih Tri Johan Agus Yuswanto ##submission.copyrightStatement## 2019-11-25 2019-11-25 6 2 92 99 10.36408/mhjcm.v6i2.389 Manifestasi Klinik Gangguan Neurologis Terkait HIV http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/390 <p><strong>Latar Belakang</strong>: Komplikasi neurologis terjadi pada lebih dari 40% pasien dengan infeksi HIV. Kelainan neurologis yang terkait dengan infeksi HIV meliputi infeksi sistem saraf pusat, neoplasma, komplikasi vaskular, neuropati perifer, dan miopati.Penelitian ini bertujuan untuk mengetahui manifestasi klinis gangguan neurologis terkait HIV pada pasien terdiagnosis HIV yang dirawat di RSUP Dr. Kariadi Semarang tanggal 1 Januari 2014- 31 Desember 2016.&nbsp;</p> <p><strong>Metode</strong>: Penelitian ini adalah studi deskriptif retrospektif observasional yang dilakukan di Rumah Sakit Umum Dr. Kariadi, Semarang, Jawa Tengah. Data diambil dari Rekam medis, dianalisis manifestasi neurologis terkait HIV.</p> <p><strong>Hasil</strong>: Subyek adalah 115 pasien dengan HIV-AIDS, 64 laki-laki (56%) dan 51 perempuan (44%). Usia rata-rata 32,06 tahun (4 sampai 68 tahun). Dari 115 kasus, 40 subyek (34,78%) memiliki manifestasi neurologis terkait HIV. Manifestasi neurologis terkait HIV meliputi toksoplasmosis otak (60%), meningoencephalitis(20%), st non hemoragik (5%),abses serebral (5%) dan vertigo (5%).</p> <p><strong>Kesimpulan</strong>. Infeksi HIV dan kaitannya dengan tingkat keparahan imunodefisiensi bertanggung jawab atas sejumlah besar gangguan neurologis. Analisis faktor risiko serta status imunitas harus dilakukan pada semua pasien dengan gangguan neurologis untuk tujuan penyaringan hiv.</p> <p>Kata kunci: HIV, AIDS, Kelainan neurologis</p> <p>&nbsp;</p> <p><strong>Background</strong>: Neurologic complications occur in more than 40% of patients with&nbsp;<a href="http://emedicine.medscape.com/article/211316-overview">HIV infection</a>.&nbsp;Neurologic disorders associated with HIV infection include central nervous system infections, neoplasms, vascular complications, peripheral neuropathies, and myopathies. This study was aimed to identify clinical manifestation of HIV-associated neurologic disorders in Patients with AIDS treated in Dr. Kariadi General Hospital from 1 January 2014 to 31 December 2016.</p> <p><strong>Methods</strong>: This is a descriptive retrospective observational study conducted in neurology clinic,Dr. Kariadi General Hospital, Semarang,between 1 January 2014 and 31 December 2016.Each patient”s medical record was studied in detail and then analyzed specifically in regard to the clinical manifestation of HIV-associated neurologic disorders.</p> <p><strong>Results</strong>: One hundred fifteen patients were included, 64 males (56%) and 51 females (44%). The average age was 32,06 years (4 to 68 years). Of the 115 cases, 40 (34,78 %) had neurologic manifestation.The manifestation include brain toxoplasmosis (60%), meningoencephalitis (20%), non hemorragic stroke (5%),cerebral abces (5%) and vertigo (5%).</p> <p><strong>Conclusions</strong>. HIV infection and their association with the severity of immunodeficiency is responsible for a large number of neurologic disorders. Analysis of risk factors as well as imunnological status should be made in all patients with neurologic disorders for the purpose of hiv screening.</p> <p>Keywords: HIV, AIDS, neurologic disorders</p> Rahmayanti Rahmayanti Retnaningsih Retnaningsih Muchlis AU Achsan Udji Sofro ##submission.copyrightStatement## 2019-11-25 2019-11-25 6 2 100 106 10.36408/mhjcm.v6i2.390 Hubungan Kebisingan Dengan Gangguan Pendengaran Dan Kejiwaan Para Pekerja Terpapar Bising http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/391 <p><strong>Latar belakang:</strong> Kebisingan di tempat kerja seringkali menjadi problem bagi tenaga kerja. Paparan bising dapat menyebabkan gangguan auditori yaitu noise-induced hearing loss (NIHL) dan gangguan non auditori berupa gangguan kejiwaan seperti depresi, kecemasan serta stress.</p> <p><strong>Tujuan:</strong> Untuk mengetahui hubungan antara kebisingan terhadap kejadian gangguan pendengaran dan kejiwaan pada pekerja terpapar bising.</p> <p><strong>Metode: </strong>Penelitian ini bersifat deskriptif analitik dengan design belah lintang. Tingkat kebisingan diukur dengan menggunakan alat sound level meter (SLM), gangguan pendengaran dinilai dari hasil audiometri, gangguan kejiwaan dinilai dari jawaban kuesioner Depression Anxiety Stress Scale 42 (DASS 42) dari WHO. Analisis data dengan uji chi square.</p> <p><strong>Hasil : </strong>Data yang didapatkan dari 326 sampel menunjukkan bahwa 179 (54.9%) subjek mempunyai masa kerja lebih dari 10 tahun dan 147 (45.1%) subjek mempunyai masa kerja kurang dari 10 tahun. Sebanyak 51 (15.6%) pekerja mengalami NIHL dan 154 (47.2%) pekerja mengalami gangguan jiwa. Terdapat hubungan antara lama paparan bising (P= 0.000) dan intensitas kebisingan (P= 0.022) terhadap kejadian NIHL, dan intensitas kebisingan terhadap derajat keparahan depresi (P= 0.007)</p> <p><strong>Kes</strong><strong>impulan: </strong>Lama paparan dan intensitas bising berhubungan dengan gangguan pendengaran sedangkan intensitas bising berhubungan dengan derajat keparahan depresi. Dibandingkan dengan intensitas bising, lama paparan bising mempunyai hubungan yang lebih besar terhadap kejadian NIHL.</p> <p><strong>Kata kunci :</strong> Kebisingan, NIHL, depresi, ansietas, stres</p> <p>&nbsp;</p> <p><strong>Background:</strong> Noise can raise significant issues in the workplaces. It can affect either auditory disturbance called Noise Induce Hearing Loss (NIHL) or non-auditory disturbance involving psychiatric disorders such as depression, anxiety and stress.</p> <p><strong>Objective:</strong> To examine the relationship between noise in the workplace and the incidence of hearing impairment and psychiatric disorders.</p> <p><strong>Method: </strong>The study design is analitic desciptive with cross-sectional approach. The noise level was measured with sound-level-metre (SLM), hearing disorders was assessed with audiometric and psychiatric disorder was assessed with Depression Anxiety Stress Scale 42 (DASS 42). The data were analized with chi square.</p> <p><strong>Results :</strong> A total of 326 workers were sampled during this study showing that&nbsp; 179 (54.9%) workers have worked over 10 years and 179 (54.9%) workers have worked less than 10 years. It was found that 51 (15.6%) workers suffered from NHIL and 154 (47.2%) workers suffered from mental disorders. A significant relationship was found between the incidence of NIHL and years of noise exposure (P= 0.000) and noise intensity (P= 0.022). A significant relationship was found between noise intensity and depression severity (P= 0.007)</p> <p><strong>Conclusion:</strong> The years of noise exposure and noise intensity were related to haring disorders. The noise intensity were related to the depression severity. In comparison with noise intensity, a stronger relationship was found between years of noise exposure and the incidence of NIHL.</p> <p><strong>Keywords :</strong> Noise, NIHL, depression, anxiety, stress</p> Rohmatullah Subekti Muyassaroh Muyassaroh Zulfikar Naftali ##submission.copyrightStatement## 2019-11-25 2019-11-25 6 2 107 111 10.36408/mhjcm.v6i2.391 Perbandingan Efektivitas Patient-Controlled Analgesia (PCA) Fentanil, PCA Morfin dan Tramadol Intravena sebagai Analgetik Pasca Operasi Modified Radical Mastectomy http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/392 <p><strong><em>Background : </em></strong><em>Modified Radical Mastectomy often accompanied by moderate to severe post-operative pain. Some patients who received intermitten analgesic combination of tramadol and ketorolac still complaining of pain. PCA is a new method of analgesic administration. The use of PCA fentanyl and PCA morphine is expected to be more effective in the management of MRM post-operative pain.</em></p> <p><strong><em>The aim of study</em></strong><em> : This study aims to determine the effectivity, side effects and patient satisfaction level between intravenous PCA fentanyl, PCA morphine and tramadol as an analgesic for post-operative MRM.</em></p> <p><strong><em>Methods</em></strong><em> : Double-blind clinical trial of 36 patients who were scheduled to undergo MRMfulfilled this study criteria. After general anesthesia, the patients were divided into 3 groups of post-operative analgesic treatment: 1) PCA fentanyl group with fentanyl loading dose 50 mcg, demand dose 20 mcg, 10 min interval lockout, 70 mcg/hour dose limit, infusion background 30 mcg/hour; 2) PCA group morphine with morphine loading dose 4 mg, demand dose 1 mg, 10 minute interval lockout, 6 mg/hour limit dose, no background infusion; 3) tramadol group who received intravenous tramadol 100 mg/8 hours. Periodic assessment of NRS score, RASS score, vital signs, side effects and patient satisfaction levels during first 24 hours post-operative. Data analyzed with Shapiro-Wilk followed by Kruskal-Wallis or One Way ANOVA, were considered significant if </em>p<em>&lt;0.05. </em></p> <p><strong><em>Result</em></strong><em> : PCA fentanyl is the most effective, followed by PCA morphine then tramadol. PCA fentanyl and PCA morphineRASS score are lower than tramadol</em>(p=0,000)<em>. Drugs side effects are nausea,vomiting and dizziness which not statistically significant. PCA fentanyl provides the highest patient satisfaction level, while there is no significant differences between PCA morphine and tramadol</em>(p=0,009)<em>. Blood pressure, respiratory rate and pulse rate PCA fentanyl and PCA morphine is significantly lower than tramadol group.</em></p> <p><strong><em>Conclusion :</em></strong><em>PCA fentanyl and PCA morphine are more effective than tramadol. PCA fentanyl providesthe highest patient satisfaction level. Drugs side effects are nausea, vomiting and </em><em>dizziness which not statistically significant.</em></p> <p><strong><em>Keyword : </em></strong><em>MRM,</em><em>PCA fentanil, PCA morfin, tramadol, effectivity, side effects, patient satisfaction level</em></p> <p>&nbsp;</p> <p><strong>Latar Belakang :</strong> Operasi <em>Modified Radical Mastectomy </em>menimbulkan nyeri derajat sedang hingga berat pasca operasi. Sebagian pasien yang mendapat kombinasi anagetik tramadol dan ketorolak secara berkala, masih mengeluh nyeri. PCA merupakan metode baru pemberian analgetik. Penggunaan PCA fentanil dan PCA morfin diharapkan dapat lebih efektif dalam mengatasi nyeri pasca operasi MRM.</p> <p><strong>Tujuan</strong><strong> : </strong>Penelitian ini bertujuan untuk mengetahui perbandingan efektivitas, efek samping dan tingkat kepuasan pasien antara penggunaan PCA fentanil, PCA morfin dan tramadol intravena sebagai analgetik pasca operasi MRM.</p> <p><strong>Metode :</strong>Dilakukan uji klinis tersamar ganda terhadap 36 pasien rencana operasi MRM yang memenuhi kriteria penelitian. Setelah dilakukan anestesi umum, pasien dibagi dalam 3 kelompok perlakuan pemberian analgetik pasca operasi: 1) kelompok PCA fentanil dengan fentanil<em>loading dose </em>50 mcg, <em>demand dose </em>20 mcg, <em>lockout interval</em> 10 menit, <em>limit</em><em> dose</em>70 mcg/jam, <em>background infusion </em>30 mcg/jam; 2) kelompok PCA morfin denganmorfin <em>loading dose </em>4 mg, <em>demand dose </em>1 mg, <em>lockout interval</em> 10 menit, <em>limit</em><em> dose</em>6 mg/jam, tanpa <em>background infusion</em><em>; </em>3)kelompok tramadol yang mendapat tramadol intravena 100 mg/8jam. Dilakukan penilaian berkala skor NRS, RASS, tanda vital, efek samping dan tingkat kepuasan pasien selama 24 jam pasca operasi. Data dianalisa dengan <em>Shapiro-Wilk</em> dilanjutkan <em>Kruskal-Wallis</em> atau <em>One wayANOVA</em>, dianggap bermakna bila p&lt; 0,05.</p> <p><strong>Hasil :</strong>Efektivitas terbaik pada PCA fentanil, diikuti PCA morfin lalu tramadol. Skor RASS PCA fentanil dan PCA morfin lebih rendah dari tramadol (p=0,000). Terdapat efek samping mual, muntah dan <em>dizziness</em> yang secara statistik tidak berbeda bermakna. Tingkat kepuasan pasien tertinggi pada kelompok PCA fentanil, sedangkan antara kelompok PCA morfin dan tramadol tidak berbeda bermakna(p=0,009). Tekanan darah, laju napas dan laju nadi kelompok PCA fentanil dan PCA morfin lebih rendah daripada tramadol.</p> <p><strong>Simpulan:</strong>PCA fentanil dan PCA morfin lebih efektif dibandingkan tramadol. PCA fentanil memberikan tingkat kepuasan pasien yang lebih tinggi dibanding PCA morfin dan tramadol. Terdapat efek samping mual, muntah dan <em>dizziness</em> namun secara statistik tidak berbeda bermakna</p> <p><em><strong>Kata Kunci : </strong>MRM, PCA fentanil, PCA morfin, tramadol, efektivitas, efek samping, tingkat kepuasan pasien</em></p> Widya Istanto Nurcahyo Arie Faishal Madjan Ibnu Siena Samdani ##submission.copyrightStatement## 2019-11-25 2019-11-25 6 2 112 124 10.36408/mhjcm.v6i2.392 Pengaruh Perawatan Paliatif Terhadap Peningkatan Kualitas Hidup Penderita Karsinoma Nasofaring Stadium Lanjut di RSUP Dr. Kariadi Semarang http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/393 <p><strong>Background:</strong> Palliative care can improve the quality of life for patients with end stage nasopharyngeal carcinoma (NPC). Palliative care includes handling nutrition, relieving pain and reducing the severity of symptoms from the disease, side effects of therapy or other complaints. It also improve psychological, social and spiritual aspects. The purpose of this study was to analyze the effect of palliative care on improving the quality of life for end stage NPC patients.</p> <p><strong>Methods:</strong> Observational cohort study in 15-70 years old NPC patients included in the screening criteria for palliative care (total score 4). The sample was divided into 2 groups, 20 sampels per group. Quality of life was assessed with modified Gill scale questionnaire. Data was analyzed with t test.</p> <p><strong>Results:</strong> The quality of life of NPC patients increased after palliative care (score 31,8 to 35,6). Decreased in groups without palliative care (score 33,0 to 30,9). Statistical analysis found significant differences between before and after palliative care (p = 0.055).</p> <p><strong>Conclusion</strong>: Palliative care improves the quality of life for end stage NPC patients.</p> <p><strong>Key word</strong>: Quality of life, Palliative care, Nasopharyngeal carcinoma</p> <p>&nbsp;</p> <p><strong>Latar belakang :</strong> Perawatan paliatif dapat meningkatkan kualitas hidup penderita karsinoma nasofaring (KNF) stadium lanjut. Perawatan paliatif meliputi penanganan nutrisi, menghilangkan nyeri dan mengurangi keparahan gejala yang timbul akibat penyakit tersebut ataupun akibat efek samping terapi atau keluhan lain yang tidak lagi responsif terhadap terapi kuratif, serta mengupayakan&nbsp; perbaikan&nbsp; dalam&nbsp; aspek psikologis, sosial dan spiritual. Tujuan penelitian ini adalah menganalisis pengaruh perawatan paliatif terhadap peningkatan kualitas hidup penderita KNF stadium lanjut.</p> <p><strong>Metode :</strong> Penelitian kohort observasional pada penderita KNF stadium lanjut usia 15 – 70 tahun yang masuk dalam kriteria penapisan perawatan paliatif (total skor 4). Sampel dibagi menjadi 2 kelompok yaitu kelompok perlakuan dan kelompok kontrol. Besar sampel ditentukan sebanyak 20 tiap kelompok. Kualitas hidup dinilai dengan kuesioner modifikasi skala mc Gill. Analisis data dengan Uji t test.</p> <p><strong>Hasil : </strong>Kualitas hidup penderita KNF meningkat setelah dilakukan perawatan paliatif (skor 31,8 menjadi 35,6). Menurun pada kelompok tanpa perawatan paliatif (skor 33,0 menjadi 30,9). Analisis statistik didapatkan perbedaan bermakna antara sebelum dan sesudah dilakukan perawatan paliatif p=0,055.&nbsp;</p> <p><strong>Simpulan : </strong>Perawatan paliatif meningkatkan kualitas hidup penderita KNF stadium lanjut.</p> <p><strong>Key word : </strong>Kualitas hidup, Perawatan paliatif, Karsinoma Nasofaring</p> Muyassaroh Muyassaroh Tri Lestari ##submission.copyrightStatement## 2019-11-25 2019-11-25 6 2 125 130 10.36408/mhjcm.v6i2.393 Late Presentation of Arrhythmogenic Right Ventricular Cardiomyopathy : Role of Non Invasive Modalities for The Diagnosis http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/394 <p><strong>Background : </strong>Arrhythmogenic right ventricular cardiomyopathy(ARVC) is an inherited myocardial disease affecting predominantly young people and manifests as sustained ventricular tachycardia, sudden cardiac death (SCD) or heart failure. However, its first manifestation in older patients is infrequent. Diagnosis of ARVC remains a clinical challenge and need further investigation. Our case report investigated role of non invasive modalities for diagnosis of ARVC patient.</p> <p><strong>Case Presentation : </strong>A 65 year old man was admitted to the hospital with symptoms of palpitationand near syncope. An Electrocardiogram (ECG) showed a sustained VT with LBBB morphology and inferior axis. The patient was cardioverted to sinus rhytm with a single 100J shock. Postcardioversion ECG showed an epsilon wave in right precordial leads. Echocardiography revealed extensive RV enlargement and reduce function. Our patient had three major (RV aneurysm, epsilon wave and T wave inversion) and one minor criteria (sustained LBBB type-VT with inferior axis)making the diagnosis of ARVC definite according to the revised Task Forced Criteria.</p> <p><strong>Conclusion: </strong>ARVC may have a very late presentation and this diagnosis should be considered as a potential cause of sustained VT of RV origin among the elderly. ECG and echocardiography as non invasive modalities have an important role for the diagnosis of patients with suspected ARVC.</p> <p><strong>Keywords :</strong>Arrhythmogenic right ventricular cardiomyopathy,ventricular tachycardia, sudden cardiac death, diagnosis.</p> Safir Sungkar Mochamad Arif Nugroho ##submission.copyrightStatement## 2019-11-25 2019-11-25 6 2 131 136 10.36408/mhjcm.v6i2.394 Ketogenic Diet for Treatment 2-Year 9 Month Old Boy With Intractable Epilepsy http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/395 <p><strong>Background:</strong>The ketogenic diet (KD) is a high-fat, low-carbohydrate, and normal-protein diet that has been used for the treatment of medically refractory childhood epilepsy since the 1920s.The KD includes 80% fat, 15% protein, and 5% carbohydrate; the ratio of fat to carbohydrate plus protein ranges from 2:1 to 4:1.The purpose of the case report was to learn benefits and factors that influence the administration of the ketogenic diet in intractable epilepsy.</p> <p><strong>Case:</strong>A 2-years 9 months old boy since 3 month of age the child begins seizure. Five month the child was diagnosed with epilepsy received one type of anti epileptic drug (AED). Seven months of age the child began control in outpatient clinic Neurology Department of Dr. Kariadi Hospital with a diagnosis of general epilepsy, were given 2 type of AEDs. Since10 month of age the child was given 3 type of AEDs. The child still often seizure, at 15 months was diagnosed intractable epilepsyand at 29monthof age, was programed to have long term EEG and KD during hospitalization.</p> <p><strong>Conclusion:</strong>The administration of KD in 2-years9 months old boy with intractable epilepsyshowed benefits in reducing the frequency of seizures.</p> <p>Key word : <strong><em>Ketogenic Diet, </em></strong><strong><em>Intractable Epilepsy</em></strong><strong><em>, Child</em></strong></p> I Made Ananta Wijaya Alifiani Hikmah Putranti Maria Mexitalia ##submission.copyrightStatement## 2019-11-25 2019-11-25 6 2 137 142 10.36408/mhjcm.v6i2.395 Stent angioplasti pada anak hipertensi akibat stenosis arteri renalis di RSUP dr. Kariadi http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/396 <p><strong>Background :</strong></p> <p>Renal artery stenosis (RAS) causes 5-10% of all secondary hypertension (HT) in children. Percutaneous transluminal angioplasty (PTA) has proven beneficial for adult patients, but for a children there are varying result. This paper is to report the management of PTA in HT children due to RAS in Dr. Kariadi Hospital.</p> <p><strong>Case report:</strong></p> <p>Nine years 8 months boy with stage II HT since 4 years old, in a good nutritional status, complaints headaches, no family history of hypertension. Treatment with of nifedipine, captopril, valsartan and furosemide has not improved. Four months ago, the patient was treated by the Children's Nephrology and Radiology Division in Dr. Kariadi Hospital for 4 days. initial blood pressure 150/100 mmHg (stage II HT), normal eye examination, heart and kidney function, the angiographic results obtained severe right middle renal artery stenosis.teh stenosis reduced by PTA with dilated balloons up to 30%. One day after the procedure, blood pressure decreased to stage I HT, no complication involved, and the patient was discharged on day 4, with nifedipine, valsartan to control HT and aspilet as anti platelet aggregation. Evaluation 4 months after PTA obtained normal blood pressure.</p> <p><strong>Discussion</strong>: HT renovascular children e.c. unilateral RAS performed by PTA has a good prognosis. Unilateral RASre-stenosis rates are less than 30%. Anti-hypertensive therapy is needed after ballooning or angioplasty stents. PTA in Dr. Kariadi Hospital can managed patient to make blood pressure normal.</p> <p><strong>Conclusion</strong>: PTA management is an option in children with HT renovasculere.c SAR. Dr. Kariadi Hospital can be a referral&nbsp; to manage the case.</p> <p><strong>Keywords</strong>: pediatric hypertension, RAS, PTA, Dr. Kariadi Hospital</p> <p>&nbsp;</p> <p><strong>Latar belakang : </strong></p> <p>Stenosis arteri renalis (SAR) menyebabkan 5-10%&nbsp; dari seluruh hipertensi (HT) sekunder pada anak. <em>Percutaneous transluminal angioplasty</em> (PTA) terbukti bermanfaat untuk pasien dewasa, namun pada anak hasilnya bervariasi. Tujuan makalah ini melaporkan tatalaksana PTA pada anak HT akibat SAR di RSUP dr Kariadi.</p> <p><strong>Laporan kasus : </strong>Anak laki laki 9 tahun 8 bulan dengan HTderajatII sejak usia 4 tahun, status gizi baik, keluhan kadang-2 sakit kepala, tidak ada riwayat keluarga hipertensi. Pengobatan nifedipin, kaptopril, valsartan dan furosemid belum membaik.&nbsp;</p> <p>Empat bulan yang lalu pasien di rawat oleh Divisi Nefrologi Anak dan Radiologi di RSUP dr Kariadi selama 4 hari. Tekanan darah saat masuk 150/100 mmHg, pemeriksaan mata, fungsi ginjal dan jantung normal, Hasil angiografi didapatkan stenosis berat arteri renalis kanan pertengahan, dilanjutkan PTA dengan stent post dilatasi dengan balon, stenosis mejadi 30%. Satu hari paska tindakan, tekanan darah menurun menjadi HT derajat I, tidak ada kelainan dan dipulangkan pada hari ke 4, mendapat nifedipin, valsartan dan aspilet sebagai anti agregasi trombosit. Evaluasi 4 bulan paska PTA didapatkan tekanan darah normal.</p> <p><strong>Pembahasan : </strong>HT renovaskuler anak <em>e.c.</em>SAR unilateral yang dilakukan PTA mempunyai prognosis baik. Angka re-stenosis SAR unilateral kurang dari 30%. Terapi anti-hipertensi diperlukan setelah pemasangan balon atau stent angioplasti. PTA di RSUP dr Kariadi berhasil membuat tekanan darah menjadi normal.</p> <p><strong>Kesimpulan :</strong>Manajemen PTA merupakan pilihan pada anak dengan HT renovaskuler <em>e.c</em> SAR. RSUP dr Kariadi dapat menjadi rujukan dalam tatalaksana kasus tersebut.</p> <p><strong>Kata kunci : </strong>hipertensi anak, SAR, PTA, RSUP dr Kariadi</p> Muhammad Heru Muryawan Antonius Gunawan Santoso Omega Mellyana ##submission.copyrightStatement## 2019-11-25 2019-11-25 6 2 143 145 10.36408/mhjcm.v6i2.396 Glycogen Rich Clear Cell Carcinoma Pada Payudara http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/397 <p><strong>Background</strong>: <em>Glycogen rich clear cell carcinoma</em> is a rare neoplasm of the breast, with the incidence of 1.4-3% of all breast cancers. The tumour has distinct morphology, different from that of common breast cancers. <em>Glycogen rich clear cell carcinomas</em> are members of a heterogeneous group of neoplasms, including signet-ring, secretory and lipid-rich carcinomas of the breast. In general, clear cell breast carcinoma tends to follow an aggressive clinical course.</p> <p><strong>Case report</strong>: To present a case of a 47 years old woman suffering from breast mass in the upper outer quadrant of her right breast. On macroscopic examination, the biopsy tumor sized 2x1.5x0.5 cm and solid with brown and white.</p> <p><strong>Discussion</strong><strong>: </strong>Microscopic examination showed breast tissue composed of tumor cells arranged in nets, trabeculae and singly dispersed. Tumor cells are moderately pleomorphic, have sharply defined border and polygonal contours. Cytoplasm is clear in more than 90% of cells and finely granular in few cells. Nuclei are hyperchromatic with clumped chromatin and prominent nucleoli. Occasional mitosis is also observed. Special stain (PAS Staining): Intracytoplasmic PAS positivity in tumor cells are variable. Immunohistochemistry ER (+) positive &gt;20-50%, PR (+) positive &lt;20%, HER2 (-) negative. The patient was diagnosed with <em>glycogen rich clear cell carcinoma.</em></p> <p><strong>Conclusion:</strong> <em>Glycogen rich clear cell carcinoma</em> of the breast is rare. Its clinical feature is rather aggressive and varies depending on special characteristics such as low grade.</p> <p><strong>Keywords</strong>: Glycogen rich clear cell carcinoma, breast carcinoma, PAS staining</p> <p>&nbsp;</p> <p><strong>Latar belakang:</strong> <em>Glycogen rich clear cell carcinoma</em> adalah kanker payudara yang jarang, dengan insidensi 1.4-3% dari semua kanker payudara. Tumor memiliki morfologi yang berbeda dari kanker payudara pada umunya. <em>Glycogen rich clear cell carcinoma</em> merupakan neoplasma heterogen yang termasuk karsinoma payudara signet-ring, sekretori dan kaya lipid. Secara umum, <em>carcinoma</em> ini cenderung mengikuti perjalanan klinis yang agresif.</p> <p><strong>Tujuan:</strong></p> <p><strong>Laporan Kasus:</strong> Dilakukan pemeriksaan makroskopis jaringan tumor dari seorang perempuan berusia 47 tahun dengan massa payudara kanan di kuadran luar atas. Tumor biopsi berukuran 2x1.5x0.5 cm, komposisi padat, berwarna coklat dan putih. Dilakukan pemeriksaan histopatologi, imunohistokimia dan histokimia pewarnaan khusus PAS <em>(Periodic Acid Schiff)</em>.</p> <p><strong>Pembahasan:</strong> Pemeriksaan mikroskopis menunjukkan jaringan payudara dengan sel-sel tumor yang tersusun dalam jaring, trabekula dan tersebar tunggal. Sel-sel tumor cukup pleomorfik, hiperkromatik, kromatin kasar dan nucleoli prominent, mitosis dapat ditemukan, sitoplasma jernih lebih dari 90% sel dan granular halus dalam beberapa sel, memiliki garis batas dan beberapa bentuk poligon yang jelas. Hasil histokimia PAS (+) positif, Immunohistokimia ER (+) positif &gt; 20-50% pada sel-sel tumor, PR (+) positif &lt; 20%, HER2 (-) negatif. Dari hasil pemeriksaan tersebut, pasien didiagnosis <em>Glycogen rich clear cell carcinoma.</em></p> <p><strong>Kesimpulan:</strong> <em>Glycogen rich clear cell carcinoma</em> pada payudara adalah tumor yang jarang, perilaku klinisnya dilaporkan agak agresif sejauh ini, sangat bervariasi tergantung pada karakteristik khusus seperti tingkat rendah.</p> <p><strong>Kata kunci</strong>: <em>Glycogen rich clear cell carcinoma</em>, karsinoma payudara, pewarnaan PAS.</p> Finot Finot Dik Puspasari Siti Amarwati ##submission.copyrightStatement## 2019-11-25 2019-11-25 6 2 146 149 10.36408/mhjcm.v6i2.397