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"ABSTRAKBACKGROUND: The incidence lung tumors and mediastinum tumors are the main causes of death due to malignancies with 12,9% of all malignancy cases. Lung tumors are more common in developing countries. Biopsy of lung tumors and mediastinal tumors is a frequent and multidisciplinary action. The minimally invasive technique that is mostly done is percutaneus transthoracic needle aspiration biopsy (PTNAB). Research states that PTNAB is a safe, effective, and accurate procedure.OBJECTIVE: This study aimed to assess the effect of needle biopsy size on the success of biopsy and the incidence of pneumothorax in intrathoracal tumor patients in Hasan Sadikin General Hospital for the period 2014-2016.METHODS: This study is a clinical epidemiological study and observational analytic with a cross sectional study design involving 232 data of patients who met the inclusion criteria and did not meet the exclusion criteria. Matching is done because there are differences in the number of research subjects in each group. The total number of research subjects is 158 patient data. The test used is chi square.RESULTS: The results showed that PTNABs actions using large and small needles had a success rate of 73,4% and 49,4%, respectively, and were significantly different (p <0,05). The success rate of PTNABs actions is not significantly different from lung tumors and mediastinum. The success rate of PTNABs actions in mediastinal tumors using large and small needles was 92,3% and 50%, respectively, and was significantly different (p <0,05). The incidence of pneumothorax after PTNABs action is zero in both groups so analysis cannot be performed.CONCLUSION: This study concluded that the success of PTNABs actions using large-sized needles on small-sized needles differed significantly."

"Latar Belakang: Penegakkan diagnosis sedini dan setepat mungkin menjadi hal utama dalam penatalaksanaan kanker paru. Beberapa penelitian sebelumnya tentang biopsi transtorakal dengan panduan USG menunjukkan akurasi diagnosis yang cukup baik. USG dinilai sebagai modalitas radiologi yang mudah digunakan secara aman, bedside, real-time, mobile dan bebas pajanan radiasi. Saat ini di RSUP Persahabatan Jakarta belum terdapat penelitian tentang biopsi jarum halus transtorakal dengan panduan USG.Metode Penelitian:  Studi observasional dengan pendekatan potong lintang terhadap subjek dengan tumor paru atau tumor mediastinum yang dilakukan biopsi jarum halus transtorakal dengan panduan ultrasononografi toraks pada bulan April-September 2021. Pengambilan sampel dilakukan secara consecutive sampling. Peneliti melakukan observasi terhadap karakteristik lesi, karakteristik prosedur dan komplikasi. Diagnosis akhir berdasarkan hasil sitologi biopsi jarum halus transtorakal dengan panduan USG.Hasil Penelitian: Dari 46 subjek, rerata usia subjek adalah 52 tahun dan didominasi jenis kelamin laki-laki (69,6%) dan jenis tumor terbanyak adalah tumor paru (80,4%). Proporsi kepositifan sitologi biopsi jarum halus transtorakal dengan panduan USG toraks adalah 78,3%. Karakteristik lesi pada subjek dengan hasil sitologi TTNA positif antara lain memiliki rerata diameter lesi 9,61 ± 2,27 cm, lesi di anterosuperior paru (63,9%), memiliki gambaran ekogenitas hipoekoik heterogen (58,3%) dan memiliki kontak dengan pleura (77,8%). Karakteristik prosedur pada subjek dengan hasil sitologi TTNA positif antara lain dilakukan teknik aspirasi (77,8%), pengambilan TTNA sebanyak < 3 set (58,3%), rerata jumlah gelas objek yang terpakai adalah 15 ± 4 dan median kedalaman insersi adalah 4 (2 – 6) cm. Komplikasi pasca tindakan terjadi pada dua subjek yaitu hemoptisis (4%).Kesimpulan: Biopsi jarum halus transtorakal merupakan metode diagnostik yang invasif minimal dengan proporsi kepositifan yang tinggi (78,3%) dan angka komplikasi yang rendah (4%).

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Background: Treatment of multidrug-resistant tuberculosis (MDR-TB) using second-line drugs is known to have more side effects. Recent studies have shown concern about bedaquiline and delamanid that can cause a prolonged QT interval. This condition is a known risk factor for Torsades de Pointes, a lethal cardiac arrhythmia. This study sought to observe the condition among such patients treated in the study location.

Methods: This study was a prospective cohort study  of MDR-TB patients receiving bedaquilin in the outpatient clinic and inpatient ward of National Respiratory Referral Hospital Persahabatan, Jakarta, Indonesia between February 2020 to February 2021. Patients received 400 mg on week 0-2 (intensive phase) and followed by 200 mg 3 times per week (continuation phase) of bedaquiline. Sampling was carried out by consecutive sampling and data on subjects who met the inclusion criteria were taken from medical records.

Result: From a total of 71 subjects, all of them met the inclusion criteria. Prolonged QT interval was experienced in 18.3% patients. From eleven patients who experienced prolonged QT interval, two patients required hospitalization: one presented with nausea and gastric upset and one patient presented with dyspnea and palpitation. Prolonged QT interval occurred in initial phase and correlated with drug dosing. A mycobacterial culture conversion at month-6 was observed in those receiving multidrug regimens which include bedaquiline, quinolone, and clofazimine. There was a correlation between prolonged QT interval and hypocalemia. Treatment success rate was 46.5% without prolonged QT. Other outcomes included 4.2% died, 26.8% loss-to-follow up, and 4.1% treatment failed.

Conclusion: The use of bedaquiline MDR-TB appeared to be effective and safe across different settings, although the certainty of evidence was assessed as very low. Hypokalemia was correlated with the outcomes of patients receiving bedaquiline, particularly in those experienced prolonged QT interval."

"DISAIN. Biopsi aspirasi jarum dilakukan pada 35 penderita Osteosarkoma antara Januari 1996 sampai dengan Juli 1999. Hasilnya dibandingkan dengan biopsi terbuka (BT) dan kesimpulan Konferensi Patologi Klinik (CPC). OBJEKTIF. Mengetahui ketepatan diagnosis biopsi aspirasi jarum dalam hal adekuasi dan akurasi, serta sensitifitas dan spesifisitasnya pada osteosarkoma. LATAR BELAKANG. Sampai saat lni biopsi terbuka menjadi standar dalam mendiagnosis suatu neoplasma pada umumnya dan Osteosarkoma khususnya. Biopsi terbuka memberikan material yang memadai namun mempunyai keterbatasan, risiko dan komplikasi. Biopsi tertutup dengan aspirasi memberikan beberapa keuntungan dengan hasil yang cukup akurat dan memungkinkan penegakan diagnosis secara dini sehingga meningkatkan kualitas penatalaksanaan.

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DESIGN. Needle aspiration biopsies were performed on 35 patients with osteosarcoma between January 1996 and July 1999. The results were compared with open biopsy (BT) and clinical pathology conference (CPC) conclusions. OBJECTIVE. To know the accuracy of the diagnosis of needle aspiration biopsy in terms of adequacy and accuracy, as well as its sensitivity and specificity in osteosarcoma. BACKGROUND. Until now, open biopsies have become the standard in diagnosing a neoplasm in general and osteosarcoma in particular. Open biopsy provides adequate material but has limitations, risks and complications. Aspirational closed biopsy provides several advantages with fairly accurate results and allows for early establishment of diagnosis so as to improve the quality of management."

"Demam neutropenia merupakan efek samping yang sering terjadi setelah kemoterapi. Demam neutropenia dapat menyebabkan penundaan dosis kemoterapi sehingga dapat mengurangi efektivitas terapi. Kejadian demam neutropenia paskakemoterapi dapat dicegah dengan pemberian Granulocyte-colony Stimulating Factor (G-CSF). Regimen kemoterapi yang digunakan dapat memengaruhi kejadian demam neutropenia. Selain itu, usia, stadium kanker, riwayat kemoterapi dan kadar hemoglobin sebelum kemoterapi merupakan faktor risiko demam neutropenia paskakemoterapi.Penelitian ini bertujuan untuk mengetahui perbandingan kejadian demam neutropenia regimen TAC (dosetaksel, doksorubisin, siklofosfamid) dengan profilaksis primer G-CSF dan regimen FAC (fluorourasil, doksorubisin, siklofosfamid) pada pasien kanker payudara di RSUP Dr. Hasan Sadikin Bandung periode Januari 2017-Juni 2019.Desain penelitian adalah cross sectional uji dua populasi. Jumlah sampel sebanyak 61 regimen TAC dan 102 regimen FAC. Kejadian demam neutropenia dianalisis menggunakan chi-square.Hasil penelitian menunjukkan kejadian demam neutropenia paskakemoterapi lebih banyak terjadi pada regimen TAC dengan profilaksis primer G-CSF dibandingkan dengan regimen FAC. Kejadian demam neutropenia 12 kali lebih banyak terjadi pada regimen TAC dengan GCSF dibanding regimen FAC. Usia, stadium kemoterapi, riwayat kemoterapi dan kadar hemoglobin sebelum kemoterapi secara statistik tidak signifikan memengaruhi kejadian demam neutropenia paskakemoterapi.

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Febrile Neutropenia is a common side effect of chemotherapy. Febrile neutropenia can cause delayed chemo doses that can reduce the effectiveness of therapy. The incidence of febrile neutropenia can be prevented by administering Granulocyte-colony Stimulating Factor (G-CSF). The chemotherapy regimen can affect the incidence of febrile neutropenia. In addition, age, stage of cancer, history of chemotherapy and prechemotherapy hemoglobin level are risk factors for febrile neutropenia.This study aimed to compare the incidence of febrile neutropenia between TAC (docetaxel, doxorubicin, cyclophosphamide) regimen with G-CSF primary prophylaxis and FAC regimen (fluorouracil, doxorubicin, cyclophosphamide) in breast cancer patients at RSUP Dr. Hasan Sadikin Bandung period January 2017 - June 2019.The study design was cross sectional test of two populations. The sample consisted of 61 TAC regimen and 102 FAC regimen. The incidence of febrile neutropenia were analyzed using chi-square.The results showed that the incidence of post-chemotherapy febrile neutropenia is more common in TAC regimen with G-CSF primary prophylaxis than FAC regimen. The incidence of neutropenia is 12 times more common in TAC regimens with G-CSF than FAC regimen. Age, stage of chemotherapy, history of chemotherapy and pre-chemotherapy hemoglobin levels did not statistically significantly influence the incidence of febrile neutropenia."

"[ABSTRAKKecemasan merupakan hal yang sering dilaporkan ketika anak dihadapkan pada prosesoperasi. Penelitian ini bertujuan mengidentifikasi dampak penggunaan buku ceritabergambar terhadap kecemasan sebelum operasi. Design Penelitian adalah quasieksperiment:Post test-only non equivalen control group. Sampel penelitian adalah 34anak usia sekolah yang akan menjalani operasi, dipilih dengan teknik Consecutivesampling. Kelompok intervensi diberikan informasi dengan buku cerita bergambar dankelompok kontrol mendapatkan informasi rutin rumah sakit. Hasil penelitianmenunjukan anak yang mendapatkan persiapan dengan buku cerita bergambarmengalami kecemasan sebelum operasi lebih rendah (p=0,003). Penelitian inimerekomendasikan pemberian informasi dengan buku cerita bergambar sebagai salahsatu intervensi persiapan operasi

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ABSTRACTAnxiety is often reported among preoperative children. This study aimed to identify theimpact of story book on preoperative anxiety among school-age children. Researchdesign was quasi experiment: Post test -only non equivalent control group toward 34which were selected with consecutive sampling technique. Children on interventiongroup were prepared with pictured story book, while children on control group wereprepared with hospital routine information. The result showed that children whoseprepared with pictured story book experienced less preoperative anxiety (p=0,003). Thisresearch recommends pictured story book as one of interventions for preoperativepreparation;Anxiety is often reported among preoperative children. This study aimed to identify theimpact of story book on preoperative anxiety among school-age children. Researchdesign was quasi experiment: Post test -only non equivalent control group toward 34which were selected with consecutive sampling technique. Children on interventiongroup were prepared with pictured story book, while children on control group wereprepared with hospital routine information. The result showed that children whoseprepared with pictured story book experienced less preoperative anxiety (p=0,003). Thisresearch recommends pictured story book as one of interventions for preoperativepreparation., Anxiety is often reported among preoperative children. This study aimed to identify theimpact of story book on preoperative anxiety among school-age children. Researchdesign was quasi experiment: Post test -only non equivalent control group toward 34which were selected with consecutive sampling technique. Children on interventiongroup were prepared with pictured story book, while children on control group wereprepared with hospital routine information. The result showed that children whoseprepared with pictured story book experienced less preoperative anxiety (p=0,003). Thisresearch recommends pictured story book as one of interventions for preoperativepreparation.]"

"Latar Belakang: Transbronchial needle aspiration (TBNA) konvensional merupakan salah satu modalitas minimal invasif yang digunakan untuk diagnosis dan staging kanker paru serta tumor mediastinum terutama jika EBUS-TBNA tidak tersedia. Penelitian ini dilakukan untuk mengetahui tingkat kepositifan biopsi TBNA konvensional KGB paratrakeal kanan bawah (KGB 4R) dan subkarina (KGB 7) pada pasien kanker paru dan tumor mediastinum. Metode: Penelitian ini menggunakan desain potong lintang. Pengumpulan data dilakukan dengan cara observasi langsung pada pasien kanker paru atau tumor mediastinum yang menjalani TBNA konvensional pada KGB 4R dan/atau KGB 7 di RSUP Persahabatan Jakarta, Indonesia. Hasil Penelitian: Total 33 pasien menjalani tindakan TBNA konvensional. Hasil TBNA positif sebanyak 20 (60,6%) yang terdiri dari 18 kasus keganasan dan dua kasus infeksi M. Tuberculosis. Pada kasus adenokarsinoma 58,3% pemeriksaan mutasi EGFR menggunakan sediaan sitologi TBNA. Jarum 21 G memberikan hasil TBNA positif lebih banyak dibandingkan jarum 19 G (masing-masing 68,2% dan 45,5%). Kelompok 1-2 set TBNA menunjukkan hasil TBNA positif 55,6% sedangkan kelompok 3-4 set TBNA menunjukkan hasil TBNA positif 66,7%. Kelompok jiggling 10-14 tusukan menunjukkan hasil TBNA positif 70% sedangkan kelompok jiggling 15-20 tusukan menunjukkan hasil TBNA positif 56,5%. Kelenjar getah bening subkarina memberikan hasil TBNA positif lebih banyak dibandingkan KGB paratrakeal kanan bawah (masing-masing 75% dan 47,1%). Ukuran KGB < 30 mm memberikan hasil TBNA positif lebih sedikit dibandingkan ukuran KGB ≥ 30 mm (36,4% berbanding 53,8%). Kesimpulan: Jarum TBNA 21 G, pengambilan spesimen sitologi sebanyak 3-4 set TBNA, jumlah jiggling sebanyak 10-14 tusukan, KGB 7 dan KGB berukuran ≥ 30 mm memberikan hasil TBNA positif lebih banyak.

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Background: Minimally invasive conventional transbronchial needle aspiration (C-TBNA) is an alternative method for diagnosing and staging a lung cancer and mediastinal tumor when EBUS-TBNA is unavailable. This study was to determine the positivity level of C-TBNA biopsies in different techniques (repeated sets and jiggled) at the right lower paratracheal (station 4R) and subcarinal (station 7) lymph nodes in lung cancer and mediastinal tumor cases.

Methods: This cross-sectional study was carried out by direct observation of lung cancer and mediastinal tumor cases examined by using C-TBNA of the station 4R and/or 7 lymph nodes at Persahabatan Hospital Jakarta, Indonesia.

Results: A total of 33 patients underwent C-TBNA. Positive results were 20 (60.6%), of which 18 cases were malignancy and two cases were M. tuberculosis infection. In the case of adenocarcinoma, 58.3% showed EGFR mutations from cytological exam. The 21 G needle yielded more positive TBNA results than the 19 G needle (68.2% and 45.5%, respectively). Repeated 1-2 sets of TBNA showed 55.6% positive results while repeated 3-4 sets of TBNA showed 66.7% positive results. The 10-14 jiggled TBNA showed 70% positive results while the 15-20 jiggled TBNA showed 56,5% positive results. Station 7 lymph node TBNA received more positive TBNA results than station 4R lymph node (75% and 47.1%, respectively). Lymph nodes of size < 30 mm yielded less positive TBNA result than of size ≥ 30 mm (36.4% vs 53.8%).

Conclusion: Specimen collection using 21 G TBNA needle, by means of repeated 3-4 sets or 10-14 jiggled, done at station 7 lymph nodes, and at lymph nodes of size ≥ 30 mm were observed to yield more positive TBNA results."

"ABSTRAKTindakan kedokteran adalah persetujuan yang diberikan oleh pasien atau keluargaterdekat setelah mendapat penjelasan secara lengkap dan jelas mengenai tindakankedokteran yang akan dilakukan terhadap pasien. Skripsi ini membahas mengenaikelengkapan dan keakuratan pengisian informed consent tindakan medis berisikopasien rawat inap RSUP Dr. Hasan Sadikin Bandung periode bulan Desember2010. Desain yang digunakan dalam skripsi ini deskriftif dengan pendekatankuantitatif. Data yang diambil adalah semua formulir informed consent padarekam medis pasien rawat inap yang dilakukan tindakan medis berisiko sebanyak357 berkas.Hasil penelitian menunjukan bahwa proporsi kelengkapan pengisianinformed consent masih belum 100%.Atas hasil ini disarankan kepada manajemen rumah sakit untuk memberikanpembekalan kepada para dokter yang akan melaksanakan program spesialis,melakukan monitoring dan evaluasi terhadap pengisian informed consent,memberikan insentif and desinsentif kepada para dokter residen, dokter spesialisdan UPF berkaitan dengan hasil evaluasi.

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ABSTRACTMedical procedure is consent given by the patient or next of kin after a full andclear explanation of the medical procedure to be performed on patients. This paperdiscusses about the completeness and accuracy of filling the inpatients riskmedical procedure informed consent at RSUP Dr. Hasan sadikin Bandung periodfrom December 2010. Design used in this thesis with a descriptive quantitativeaproach. The data retrieved are all informed consent forms in about 357 medicalrecords of patient who performed the medical procedure. As a result of reseachshows that the proportion of completeness of informed consent is still not fillingto 100%. For this result suggested to the hospital management to provide adebriefing to the doctor who will carry out a specialist program, monitoring andevaluation of nformed consent filling, provide reward and punishment to theresidents, specialist and departemen related to the evaluation results."

"Latar belakang: Kasus baru kanker paru semakin bertambah dan mulai banyak dialami usia muda. Pendekatan skrining dalam upaya deteksi dini dilanjutkan tindakan diagnostik yang cepat dan akurat memberikan penderita memeroleh kualitas hidup yang lebih baik dalam perjalanan penyakitnya. Biopsi paru transtorakal menggunakan jarum halus dan core menghasilkan akurasi berkisar 85%-90% dengan keunggulan tindakan minimal invasif. Variasi akurasi diagnostik dan belum terdapat data proporsi hasil biopsi transtorakal di RS Persahabatan, membuat kami melakukan penelitian ini. Metode: Kami melakukan pencatatan data sampel periode Januari 2021-September 2023 pada bulan Januari-Februari 2024. Data yang dicatat yaitu karakteristik pasien keganasan rongga toraks belum tegak jenis yang dilakukan tindakan biopsi jarum halus dan core transtorakal dengan panduan CT scan. Sebanyak 765 pasien dalam periode tindakan didapatkan 563 pasien yang sesuai kriteria inklusi dan eksklusi. Data kemudian dianalisis untuk menilai kepositifan biopsi jarum halus dan core transtorakal serta faktor yang memengaruhinya. Hasil: Sejumlah 563 subjek terdiri atas laki-laki 67,9% dan perempuan 32,1%. Usia paling muda 18 tahun dan paling tua 88 tahun dengan median usia 56 tahun. Subjek dengan keluhan respirasi 83,7% dan nonrespirasi 16,3%. Perokok merupakan mayoritas subjek sebesar 58,4%. Lokasi target biopsi paling banyak di paru 75,3% sedangkan mediastinum 24,7%. Nilai HU kami kelompokkan menjadi ≥ 30 sebanyak 91,3% dan < 30 sebanyak 8,7%. Panjang minimal kedalaman tusuk 0,7 cm dan maksimal 11,21 cm dengan median 4,2 cm. Posisi saat tindakan biopsi yaitu terlentang 67,5%, tengkurap 24,5% dan lateral dekubitus 8%. Proporsi kepositifan biopsi jarum halus 80,8% sementara biopsi core 77,6%. Selanjutnya karakteristik tersebut kami lakukan analisis bivariat didapatkan nilai HU memengaruhi kepositifan biopsi jarum halus (p < 0,05). Kesimpulan: Proporsi biopsi jarum halus dan core transtorakal di RS Persahabatan sangat baik. Nilai HU memengaruhi kepositifan biopsi TTNA namun, tidak pada biopsi core. Kedalaman tusuk dan posisi bukan faktor yang memengaruhi kepositifan biopsi TTNA dan core.

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Background: New cases of lung cancer are increasing and are starting to occur at a young age. A screening approach in an effort for early detection followed by rapid and accurate diagnosis provides patients with a better quality of life throughout their disease. Transthoracic lung biopsy using a fine needle and core produces an accuracy of around 85%-90% with the advantage of being minimally invasive. Variations in diagnostic accuracy and no database availability yet on the proportion of transthoracic biopsy results at Persahabatan Hospital prompted us to conduct this research. Methods: We recorded data from January 2021-September 2023 in January-February 2024. The data recorded were the characteristics of patients with unconfirmed type thoracic cavity malignancies who underwent fine needle and transthoracic core biopsies CT scan guided. A total of 765 patients during the action period 563 patients met the inclusion and exclusion criteria. The data is then processed to assess the positivity of transthoracic fine needle and core biopsies and the factors that influence it. Result: A total of 563 subjects consisted of 67.9% men and 32.1% women. The youngest age is 18 years and the oldest is 88 years with a median age of 56 years. Subjects with respiratory complaints were 83.7% and non-respiratory 16.3%. Smokers constituted the majority of our subjects at 58.4%. The most common biopsy target locations were the lungs, 75.3%, while the mediastinum was 24.7%. Hounsfield units are divided into ≥ 30 as many as 91.3% and < 30 as many as 8.7%. The minimum length of the puncture depth is 0.7 cm and the maximum is 11.21 cm with 4.2 cm as the median. The position during the biopsy was supination 67.5%, prone 24.5%, and lateral decubitus 8%. The positive proportion of fine needle biopsy was 80.8% while core biopsy was 77.6%. We conducted a bivariate analysis of these characteristics and found that the HU value influenced the positivity of fine needle biopsy (p < 0.05). Conclusion: The proportion of fine needle and core transthoracic lung biopsies at Persahabatan Hospital is decent. The HU value influences the positivity of TTNA biopsy but not core biopsy. Puncture depth and position were not a factor influencing the positivity of TTNA and core biopsies."

"ABSTRAKLatar Belakang: Kanker tiroid merupakan keganasan endokrin yang paling sering ditemukan dan insidennya semakin meningkat. Meskipun metode biopsi aspirasi jarum halus memiliki sensitivitas yang baik dalam mendiagnosis nodul tiroid, sebanyak 10-40 masih memberikan hasil inkonklusif dalam penentuan keganasan. Hal ini sering merugikan pasien karena harus mengalami re-operasi apabila terdapat keganasan pada hasil histopatologi.Tujuan Penelitian: Mengetahui proporsi dan mendapatkan nilai diagnostik dari pemeriksaan mutasi BRAF, NRAS, dan promoter TERT pada spesimen BAJAH untuk meningkatkan akurasi diagnosis kanker tiroid.Metode Penelitian: Studi retrospektif dengan mengikutsertakan 50 pasien nodul tiroid yang memerlukan pembedahan. Spesimen diambil pada saat proses BAJAH atau pasca operasi. Deteksi mutasi BRAF, NRAS, dan promoter TERT menggunakan metode DNA sekuensing Sanger . Hasil mutasi akan dibandingkan dengan pemeriksaan baku emas histopatologi.Hasil: Dari 50 kasus yang ikut dalam analisis, terdapat 39 kasus 78 merupakan keganasan tiroid. Nilai proporsi mutasi BRAF, NRAS, dan pTERT berturut-turut sebesar 31 , 18 , dan 13 . Uji diagnostik mutasi BRAF menghasilkan sensitivitas, spesifisitas, nilai duga positif, dan nilai duga negatif berturut-turut 31 , 100 , 100 , 29 terhadap kanker tiroid. Untuk mutasi NRAS sebesar 18 , 100 . 100 , 26 . Sedangkan untuk mutasi pTERT sebesar 13 , 100 , 100 , 24 . Jika ketiga mutasi tersebut dikombinasikan, maka nilainya akan meningkat menjadi 49 , 100 , 100 , 35 . Kesimpulan: Pemeriksaan mutasi BRAF, NRAS dan promoter TERT pada kanker tiroid masing-masing memiliki spesifisitas yang tinggi. Jika ketiganya dikombinasikan maka akan meningkatkan sensitivitas untuk membantu dalam meningkatkan akurasi diagnosis keganasan tiroid.

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ABSTRACTBackground Thyroid cancer is the most common endocrine malignancy and it rsquo s incidence is on the rise. Although the fine needle aspiration biopsy FNAB has a good sensitivity in the diagnosis of thyroid nodules, as much as 10 40 still gives inconclusive results in malignant determination. This is often detrimental to patients having to undergo re surgery if there is a malignancy in the histopathologic outcome.Aim To establish the proportion and diagnostic value of BRAF, NRAS, and TERT promoter mutation detection on FNAB specimens to improve the accuracy of thyroid cancer diagnosis.Methods The retrospective study by involving 50 patients with thyroid nodules surgery. Specimens were taken during the FNAB or postoperative process. Detection of BRAF, NRAS, and TERT promoter mutation using DNA sequencing method Sanger . The mutation results will be compared with the histopathologic gold standard examination.Resuts Of the 50 cases involved in the analysis, there were 39 cases 78 of thyroid malignancies. The proportion of BRAF, NRAS, and pTERT mutations was 31 , 18 , and 13 , respectively. BRAF mutation diagnostic test results in sensitivity, specificity, positive predictive value, and negative predictive value were 31 , 100 , 100 , 29 respectively. For NRAS mutation were 18 , 100 . 100 , 26 . As for pTERT mutation were 13 , 100 , 100 , 24 . If the three mutations are combined, then the value will increase to 45 , 100 , 100 , 35 .Conclusion Detection mutations of BRAF, NRAS and TERT promoters in thyroid cancer have a high specificity. If all three are combined it will increase the sensitivity to improve the accuracy of the diagnosis in thyroid malignancy."

"Penanganan pasangan ingin anak membutuhkan kesabaran dari pihak medis maupun pasien di samping kemampuan mendiagnosa serta pengobatan yang terarah. RSUP Dr. Hasan Sadikin mempunyai kelompok kerja ART (Assisted Reproduktif Technology) dengan surat keputusan Direktur Nomor: Kp 01.01.1.2.231.P tanggal 20 Nopember 1995, untuk mengembangkan Tim Ahli Bayi Tabung di Seksi Infertilitas SMF Kebidanan dan Penyakit Kandungan. Kememapuan penangann pasangan infertil di RSUP Dr. Hasan Sadikin masih jauh dari memadai, karena keterbatasan sarana, sedangkan kebutuhan akan pelayanan ART sudah mendesak. Penelitian ini dilakukan dengan tujuan memperoleh gambaran trend pelayanan infertilitas di RSUP Dr. Hasan Sadikin dan memilih model strategis yang tepat untuk di terapkan. Penelitian ini adalah operasional riset yang dianalisis secara kuantitatif dan kualitatif. Hasil penelitian dari analisia situasi menggambarkan total jumlah kunjungan pelayanan mengalami penurunan sekitar 19,21% dan dari total jumlah kasus, 87% kasus usia di bawah 35 tahun potensi untuk ditangani tuntas dan 67% kasuss memerlukan tindakan ART, pada periode tahun 1993-1997. Hasil analisis metode Dekamposisi menggambarkan faktor trend kunjungan menurun, sehingga sulituntukmerencanakan sasaran jangka panjang, dan Indeks Musim.memperlihatkan peningkatan hanya pada bulan Januari, Maret, Mai, Juni, Nopember dan Desember, sehingga baru dapat mereucanakan sasaran jangka pendek di pelayananinfertilitas. Hasil analisis metode Delphi menggambarkan derajat pelaksanaan rendah, akselerasi pelayanan lamban, adanya factor pendorong dan penghambat pelaksanaan serta masalah keuangan sebagai faktor kekuatan, kelemahan, ancaman dan peluang Seksi Pelayanan Infertilitas. Hasil analisis matrike SPACE dalam memposisikan strategi sebagai langkah awal pemilihan model strategi, yaitu pada Kuadran I: Agresif adalah pertumbuhan dan perkembangan. Pada penelitian ini dibahas dua strategi alternatif untuk memilih model strategi yang tepat, yaitu strategi umum/bisnis dan strategi operasional. Untuk mengembangkan pelayanan infertilitas di RSUP Dr. Hasan Sadikin saat ini dipilih strategi operasional dengan sasaran elemen kunci pengembangan di bidang pemasaran, keuangan, produksi/operasi, riset dan pengembangan, sumber daya manusia serta konsisten dengan target lahir bayi tabung, sehingga. dapat disusun program kerja berdasarkan pendekatan legislatif, edukatif, ekonomi, administratif dan teknis.

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Managing couples wishing to have children needs patience from the medical services as well as the patient besides ability to diagnose and well planned medical treatment. Dr. Hasan Sadikin Provincial Hospital developed has an ART (Assisted Reproductive Technology) team work through the Director's Decree: Kp. 01.01.2. 231.P date 20'h November 1995. This Team of Experts of Test-tube Babies at the Infertility Division, Obstetrics and Gynecology Department is developing it capability in managing infertile couples at Dr. Hasan Sadikin Provincial Hospital, however it still far from adequate, due to limited facilities, while the need for ART services is already urgently field.

This is an operational research study, utilizing quantitative and qualitative analysis, aiming at obtaining the trend of the infertility service demand at Dr. Hasan Sadikin Provincial Hospital, and selecting a correct strategy model to be applied.

The situational analysis of this study revealed for that a period of 1993-1997 there was a decrease of around 19,21% in the total number of visits; in which, 87 % of the cases of those under 35 years of age and were potential for complete treatment, while 67% of the cases needed an ART management.

Analysis by decomposition method revealed that the trend factor decreased, so that it was difficult to plan for a long term target, and that the season Index showed an increase only in the months of January, March, May, June, November, and December, so that only a short term plan could be planned in the infertility services.

Analysis by the Delphi method revealed a low level of implementation, a slow acceleration of service, the presence of enchancing and delaying factors in the implementation, and also financial problems as factors of strength, weakness, threat, and opportunity in the infertility services.

Result of SPACE matrix analysis in positioning strategy as an initial step in the selection of a strategy model, is as follows Quadrant I: Aggressive is growth and development.

In this study two alternative strategies were analyzed to choose the right strategy model, i.e. general business strategy and operational strategy to develop the infertility services at Dr. Hasan Sadikin Provincial Hospital. At present the operational strategy was selection with the development key element as the target in the aspect of marketing, finance, production/operation, research and development, human resources, and consistent with the birth of test-tube babies as target, so as to allow the compilation of a working program based on a legislative, educative, economic, administrative, and technical approach."