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"ABSTRAK Severe gingival enlargement (GE) is one of the most commonly observed adverse effects in patients who have undergone renal transplants due to the use of cyclosporine A. Objectives: We aimed to gain more insight into the prevalence of GE in patients with renal transplants. Methods: We searched the PubMed and Web of Science databases for relevant studies from January 1990 to January 2018. Using random effects models, we calculated summary incidence rates and 95% confidence intervals (CIs). Results: A total of 595 patients from 10 studies were included. Patients using cyclosporine A with or without any other drugs had a 62.6% (95% CI, 41.9% until 79.5%) incidence of GE. Subgroup analysis according to diagnostic criteria showed that the incidence of GE was lower when using well defined diagnostic criteria or scoring system. The incidence of GE was 88.2% (95% CI, 80.9% until 93.0%) in patients using cyclosporine A with nifedipine. Cyclosporine A without nifedipine was associated with a significantly decreased risk of GE incidence when compared with the combination of cyclosporine A and nifedipine (odds ratio:0.198, 95% CI, 0.083 until 0.473, P < 0.001). Conclusions: It is important for all clinicians to know the effects of the aforementioned drugs and the treatment options. "

"PURPOSE: To clarify the risk factors for complications after diverting ileostomy closure in patients who have undergone rectal cancer surgery.METHODS: The study group comprised 240 patients who underwent a diverting ileostomy at the time of lower anterior resection or internal anal sphincter resection, in our department, between 2004 and 2015. Univariate and multivariate analyses of 18 variables were performed to establish which of these are risk factors for postoperative complications.RESULTS: The most common complications were intestinal obstruction and wound infection. Univariate analysis showed that an age of 72 years or older (p = 0.0028), an interval between surgery and closure of 6 months or longer (p = 0.0049), and an operation time of 145 min or longer (p = 0.0293) were significant risk factors for postoperative complications. Multivariate analysis showed that age (odds ratio, 3.4236; p = 0.0025), the interval between surgery and closure (odds ratio, 3.4780; p = 0.0039), and operation time (odds 2.5179; p = 0.0260) were independent risk factors.CONCLUSIONS: Age, interval between surgery and closure, and operation time were independent risk factors for postoperative complications after diverting ileostomy closure. Thus, temporary ileostomy closure should be performed within 6 months after surgery for rectal cancer."

"Latar Belakang: Disfungsi ereksi (DE) adalah salah satu penyakit sering ditemukan pada mereka yang menderita penyakit ginjal stadium akhir (ESRD). Meskipun transplantasi ginjal memperbaiki masalah ini pada beberapa pasien, sebanyak 20 hingga 50% penerimanya terus menderita DE. Sampai saat ini, literatur mengenai efek transplantasi ginjal terhadap DE masih kontroversial. Mayoritas penelitian menunjukkan bahwa pasien mendapatkan kembali fungsi ereksi setelah transplantasi ginjal, sedangkan penelitian lain menunjukkan efek minimal transplantasi terhadap status DE. Kami melakukan tinjauan sistematis untuk merangkum efek transplantasi ginjal terhadap status DE.Metode: Pencarian literatur sistematis di PubMed, Cochrane, dan Scopus, dilakukan pada bulan April 2020 dengan menggunakan kata bebas dan istilah MeSH. Kami memasukkan semua penelitian prospektif yang menyelidiki skor IIEF sebelum dan sesudah transplantasi pada penerima transplantasi ginjal dengan DE.Hasil: Pencarian database awal di PubMed dan Google Scholar menghasilkan 4.052 makalah. 42 makalah dipertimbangkan untuk analisis teks lengkap. Dari 42 teks lengkap yang dicari, empat diantaranya dimasukkan dalam tinjauan sistematis. Sebanyak 152 dari 230 subjek menunjukkan peningkatan fungsi ereksi melalui skor IIEF-5 setelah transplantasi ginjal. Meta-analisis yang dilakukan terhadap skor IIEF dan kadar Testosteron menunjukkan perbedaan yang signifikan sebelum dan sesudah transplantasi.Kesimpulan: Temuan kami telah mengkonfirmasi bahwa transplantasi ginjal meningkatkan fungsi ereksi. Dengan demikian, peningkatan signifikan dalam skor testosteron dan IIEF pasca transplantasi terbukti secara statistik dalam penelitian ini. Namun, karena jumlah penelitian yang ada terbatas, bukti yang ada pun terbatas. Penelitian lebih lanjut dengan metodologi yang lebih baik dan ukuran sampel yang lebih besar diperlukan untuk menyelidiki pengaruh transplantasi ginjal pada fungsi ereksi.

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Introduction: Erectile dysfunction (ED) is a major health burden worldwide frequently found in those with end-stage renal disease (ESRD) Although renal transplant improves the problem in some patients, as many as 20 to 50% of recipients continue to suffer ED. To this date, literature regarding the effect of kidney transplantation on ED has been contradictory. Majority of studies have shown that patients regain erectile function following renal transplant, whereas other studies showed minimal effect of transplantation on the status of ED.1,2 We did a systematic review to summarize the effects of kidney transplantation on the status of ED.

Methods: A systematic literature search on PubMed, Cochrane, and Scopus, were carried out in April 2020 by using both free words and MeSH terms. We included all prospective studies investigating the pre- and post-transplant IIEF scores of renal transplant recipients with ED.

Results: The initial database search on PubMed and Google Scholar produced 4,052 papers. 42 papers were considered for full-text analysis. Out of 42 full texts sought, four were included in the systematic review. A total of 152 out of 230 subjects showed improvement of erectile function by means of IIEF-5 score after renal transplantation. Meta-analysis performed on IIEF score and Testosterone level show significant differences pre and post-transplantation.

Conclusion: Our findings have confirmed that renal transplantation improves erectile function. Thus, significant improvement in testosterone and IIEF score post- transplantation were proven statistically in this study. However, as there were only a limited number of studies, the evidence is limited. Further studies with better methodology and larger sample size are needed to investigate the effect of renal transplantation on erectile function."

"Pendahuluan: Dalam memberikan panduan pencitraan pada nefrolitotomi perkutan (PCNL), ultrasonografi telah menjadi alternatif panduan dalam PCNL bebas sinar-x yang akan mengurangi radiasi baik pada pasien maupun operator. Meta-analisis ini menilai literatur secara kritis dengan membandingkan keamanan dan kemanjuran PCNL bebas sinar-x dan PCNL yang dipandu fluoroskopi dengan sub-analisis dalam posisi terlentang dan tengkurap. Metode: Pencarian literatur secara sistematis dilakukan menggunakan Wiley Library, Clinicalkey, dan Pubmed. Studi yang membandingkan fluoroskopi dan PCNL bebas sinar-x hingga Agustus 2020 disertakan. Hasil yang diukur termasuk tingkat bebas batu, waktu operasi, perdarahan, komplikasi, dan lama rawat rumah sakit. Meta-analisis dilakukan pada setiap hasil. Hasil: Dari 283 artikel yang teridentifikasi dari skrining, tujuh artikel dimasukkan ke dalam analisis kuantitatif dan kualitatif. Tingkat bebas batu (p=0,50), waktu operasi (p=0,83), perdarahan (p=0,41), komplikasi (p=0,20), dan lama rawat inap (p=0,27) pada kedua kelompok secara statistik tidak berbeda. Dalam sub-analisis, ditemukan bahwa komplikasi dan perdarahan signifikan secara statistik pada kelompok rawan, p=0,05 dengan OR 0,17 (95%CI 0,03-1,00) dan p=0,02 dengan OR 0,52 (95%CI 0,30-0,92) masing-masing. Kesimpulan: Bukti yang mendukung pendekatan pencitraan yang lebih baik masih terbatas saat ini. Namun, sebagai pendekatan alternatif untuk PCNL dengan ultrasonografi bebas x-ray, hal ini menawarkan keamanan yang lebih baik pada posisi tengkurap dan keamanan yang sebanding pada kelompok terlentang. Efikasi antara kedua kelompok ditemukan sebanding baik dalam sub-analisis terlentang dan tengkurap.

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Introduction: There are imaging guidances used for percutaneous nephrolithotomy (PCNL), Ultrasonography has been an alternative for guidance in x-ray free PCNL that would reduce radiation both in patients and operators. This meta-analysis critically appraises the literature comparing the safety and efficacy of x-ray free and fluoroscopy-guided PCNL with sub-analysis in supine and prone position.

Method: A systematic literature search using Wiley Library, Clinicalkey, and Pubmed. Studies comparing fluoroscopy and x-ray free PCNL up to August, 2020 were included. The outcome measured included the stone-free rate, operative time, bleeding, complication, and hospital length. Meta-analysis was conducted for each of the outcomes.

Result: Of 283 articles identified from screening, seven were included in quantitative and qualitative analysis. The stone-free rate (p=0.50), operative time (p=0.83), bleeding (p=0.41), complication (p=0.20), and hospital length of stay (p=0.27) in both groups statistically indifferent. In sub-analysis, we found that complication and bleeding statistically significant in prone group, p=0.05 with OR 0.17 (95%CI 0.03-1.00) and p=0.02 with OR 0.52 (95%CI 0.30-0.92) respectively.

Conclusion: Evidence supporting a better imaging approach remains limited at present. However, as an alternative approach for x-ray free ultrasound-guided PCNL, it offers better safety in prone positio and comparable safety in supine group. The efficacy between both groups found comparable both in supine and prone sub-analysis."

"Latar Belakang. Penyalahgunaan zat merupakan masalah global yang berkembang dengan angka kekambuhan yang cukup tinggi. Undang undang no 35 tahun 2009 mewajibkan semua penyalahguna zat untuk mengikuti rehabilitasi, namun terdapat perbedaan pendapat terkait efektifitas terapi berdasarkan keinginan untuk mengikuti rehabilitasi. Faktor yang turut berperan dalam keberhasilan rehabilitasi adalah tingkat kesiapan untuk berubah yang terlihat dari motivasinya. Implikasi UU no 35 dapat dilihat melalui perbedaan tingkat motivasi dan hubungannya dengan karakteristik serta mekanisme koping dari individu yang telah menjalani rehabilitasi berdasarkan keinginannya. Metode. Potong lintang melibatkan 100 orang penyalahguna zat yang telah mengikuti rehabilitasi selama periode bulan Juli-September 2014 di Balai Besar Rehabilitasi BNN. Pengukuran tingkat motivasi dengan instrumen University of Rhode Island Change Assessment Scale (URICA) dan mekanisme koping diukur dengan instrumen Brief-Coping Orientation to Problem Experienced (Brief-COPE). Hasil. Tidak terdapat perbedaan yang bermakna pada tingkat motivasi antara penyalahguna zat yang mengikuti rehabilitasi secara sukarela dengan yang tidak sukarela setelah mengikuti proses terapi rehabilitasi. Terdapat hubungan antara tingkat motivasi dengan mekanisme koping (nilai p 0.001). Mekanisme koping yang digunakan pada subyek dalam penelitian berupa emotion-focus koping dan skor mekanisme koping yang terbanyak pada tingkat sedang. Simpulan. Tidak terdapat perbedaan tingkat motivasi pada penyalahguna zat yang telah menjalani rehabilitasi berdasarkan keinginan.

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Background. Substance abuse is a growing global problem at a fairly high recurrence rate. Indonesia narcotics law no 35 in 2009 requires compulsory treatment for people with drug dependence, nevertheless there are many differences in opinions regarding the effectiveness of therapy based on the willingness to participate. Factors that contribute to the outcomes of rehabilitation s the readiness to change seen by motivation. The implications of the Law No. 35 can be seen through motivational level differences and its relationship with the characteristics and coping mechanisms of substance abusers who have undergone a rehabilitation based on the willingness to be rehabilitated. Method. A crosssectional involving 100 substance abusers who have undergone a rehabilitation program during the period July-September 2014 at BNN rehabilitation center. Motivation level measurement by University of Rhode Island Change Assessment Scale (URICA) instrument and coping mechanism by Brief-Coping Orientation to Problems Experienced (Brief-COPE) instrument. Result. There is no significant differences of motivational level between voluntary and compulsary substance abuser. There is a relationship between the level of motivation with coping mechanisms (p-value 0.001). Coping mechanisms used by the subject is emotionfocused coping with the highest score is at moderate level. Conclusion.There is no difference of motivational level among substance abusers who have undergone a rehabilitation program based on the willingness."

"The subject of the book is advanced statistical analyses for quantitative research synthesis (meta-analysis), and selected practical issues relating to research synthesis. Specifically the book describes multivariate analyses for several indices commonly used in meta-analysis (e.g., correlations, effect sizes, proportions and/or odds ratios), will outline how to do power analysis for meta-analysis (again for each of the different kinds of study outcome indices), and examines issues around research quality and research design and their roles in synthesis. For each of the statistical topics we will examine the different possible statistical models (i.e., fixed, random, and mixed models) that could be adopted by a researcher. "

"Modern meta-analyses do more than combine the effect sizes of a series of similar studies. Meta-analyses are currently increasingly applied for any analysis beyond the primary analysis of studies, and for the analysis of big data. This 26-chapter book was written for nonmathematical professionals of medical and health care, in the first place, but, in addition, for anyone involved in any field involving scientific research. The authors have published over twenty innovative meta-analyses from the turn of the century till now. This edition will review the current state of the art, and will use for that purpose the methodological aspects of the authors' own publications, in addition to other relevant methodological issues from the literature.Are there alternative works in the field? Yes, there are, particularly in the field of psychology. Psychologists have invented meta-analyses in 1970, and have continuously updated methodologies. Although very interesting, their work, just like the whole discipline of psychology, is rather explorative in nature, and so is their focus to meta-analysis. Then, there is the field of epidemiologists. Many of them are from the school of angry young men, who publish shocking news all the time, and JAMA and other publishers are happy to publish it. The reality is, of course, that things are usually not as bad as they seem. Finally, some textbooks, written by professional statisticians, tend to use software programs with miserable menu programs and requiring lots of syntax to be learnt. This is prohibitive to clinical and other health professionals."

"Hidrosefalus yang terjadi pada seseorang dapat disebabkan oleh adanya perdarahan di dalam otak yang akhirnya menumpuk dan menekan otak dan perlu dilakukan operasi VP-Shunt. Gejala yang timbul dari penyakit ini dapat menimbulkan pasien penurunan kesadaran atau perubahan pada tingkat kesadaran dan perubahan fungsi kognitif yang dapat menyebabkan pasien gelisah. Penanganan pasien yang gelisah di ruang Instalasi Gawat Darurat (IGD) dan di Intensive Care Unit (ICU) ialah berupa pemasangan Physical restraint di setiap ekstremitas. Penggunaan Physical restraint dalam jangka panjang dapat menimbulkan komplikasi neurovascular di ekstremitas. Seperti edema, kemerahan, mati rasa, keterbatasan gerak, peningkatan nyeri suhu, perubahan warna, dan kerusakan saraf. Sehingga, perlu adanya pemantauan pada anggota gerak yang terpasang Physical restraint. Metode dalam karya ilmiah ini dengan case study pada praktik klinik keperawatan kegawatdaruratan di RSUI. Pasien kelolaan adalah Tn. F berusia 69 tahun dengan diagnosis Pasca VP-Shunt atas indikasi hidrosefalus karena adanya perdarahan intraserebral dan intravaskuler di otak. Dan pasien dilakukan pemantauan pada anggota gerak yang terpasang Physical restrain selama perawatan. Didapatkan hasil tidak adanya komplikasi yang terjadi pada bagian ekstremitas pasien. Perawat dapat menggunakan pemantauan ini untuk mencegah terjadinya komplikasi neurovascular di ekstremitas.

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Hydrocephalus that occurs in a person can be caused by bleeding in the brain which eventually builds up and presses on the brain and requires VP-Shunt surgery. Symptoms arising from this disease can cause the patient to lose consciousness and changes in cognitive function which can cause the patient to become restless. Handling anxious patients in the Emergency Room (IGD) and Intensive Care Unit (ICU) is in the form of physical restraints on each extremity. Long-term use of physical restraints can cause neurovascular complications in the extremities. Such as oedema, redness, numbness, limited movement, increased pain, temperature, discoloration, and nerve damage. So, it is necessary to monitor the limbs that are attached to physical restraints. The method in this scientific work is a case study on emergency nursing clinical practice at RSUI. The patient managed is Mr. F is 69 years old with a diagnosis of Pasca-VP-Shunt for indications of hydrocephalus due to intracerebral and intravascular bleeding in the brain. And patients are monitored on the limbs that are attached to physical restraints during treatment. The results showed that there were no complications occurring in the patient's extremities. Nurses can use this monitoring to prevent neurovascular complications in the extremities."

"Tulisan ini membahas dan melaporkan ruptura uteri saat kehamilan dan persalinan pada kasus pasca miomektomi perlaparoskopi. Laporan kasus kejadian ruptur uterus pada pasien yang sebelumnya mengalami laparoskopi operatif miomektomi miom intramural Æ 3.5 cm, yang 6 bulan kemudian mengalami kehamilan. Tidak ada gejala ke arah ruptura uteri saat kehamilan namun pada saat usia gestasi 34 minggu, pasien mengalami gejala ruptura uteri. Pada saat laparotomi; ditemukan fetus 2100 gram mati, dan robekan jaringan 5 cm pada sikatriks bekas miomektomi. Pada pasien yang mengalami miomektomi per laparoskopi khususnya miom intramural mempunyai risiko ruptura uteri pada saat persalinan. (Med J Indones 2004; 14: 113-6)

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Following laparoscopic myomectomy, uterine rupture during pregnancy or delivery in the area of the scar is a very rare but dangerous complication. Individual cases of uterine rupture during pregnancy are described in the literature. Case report of uterine rupture during delivery in a patient who had previously undergone laparoscopic myomectomy. In the case presented here, the patient conceived 6 months after an 3.5 cm intramural myoma, had been laparoscopically removed. No symptoms suggesting uterine rupture were observed during the pregnancy, but in the first stage of delivery the condition of the patient deteriorated and symptoms of oligaemic shock developed. A laparotomy was performed, which showed the presence of 2100 gr fresh dead fetus in the abdominal cavity and ruptured uterine muscle in the scarred area about 5 cm. In patients who have previously undergone a laparoscopic myomectomy, there is some risk of uterine rupture at delivery. This is also the case where unappropriate suturing of the uterine muscle had been required. (Med J Indones 2004; 14: 113-6)"