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"ABSTRAKLuka kaki diabetik (LKD) merupakan komplikasi kronik diabetes yang meningkatkan mortalitas danmorbiditas, serta menurunkan kualitas hidup. Komplikasi makro dan mikrovaskular/mikrosirkulasimempunyai pengaruh besar terhadap kejadian LKD dan proses penyembuhannya. Kondisimikrosirkulasi dapat dinilai melalui pemeriksaan transcutaneous perfusion oxygen (TcPO2). Kondisimikrosirkulasi dipengaruhi oleh HbA1c, glukosa darah sewaktu, neuropati, fibrinogen, PAI-1,hsCRP, indeks MMP-9, indeks TcPO2, dan indeks TcPCO2, yang akan memengaruhi terbentuknyajaringan granulasi.Penelitian ini bertujuan untuk mengetahui peran HbA1c, GDS, neuropati, fibrinogen, PAI-1, hsCRP,indeks MMP-9, terhadap indeks TcPO2, indeks TcPCO2, dan indeks granulasi, serta mengetahuiperan serta indeks TcPO2 dan indeks TcPCO2 terhadap indeks granulasi pada luka kaki diabetik.Sebanyak 68 subjek LKD tanpa penyakit arteri perifer di RS dr. Cipto Mangukusumo dan beberaparumah sakit jejaring, pada Desember 2015?Desember 2016, diberikan perawatan standar dandipantau setiap minggu sebanyak 4 kali. Pada pemantauan ke-1, ke-2, dan ke-3, dilakukandokumentasi LKD, pengambilan darah vena sebanyak 7,7 mL untuk pemeriksaan fibrinogen, PAI-1,hsCRP, MMP-9, dan TIMP-1, darah arteri sebanyak 2 mL untuk pemeriksaan analisis gas darah,serta pemeriksaan TcPO2 dan TcPCO2 dengan menggunakan TCM TOSCA/CombiM monitoringsystems buatan Radiometer. Pada pemantauan ke-4, hanya dilakukan dokumentasi LKD.Pengukuran luas luka dan jaringan granulasi dinilai berdasarkan hasil dokumentasi fotografi denganmenggunakan program ImageJ. Penilaian neuropati menggunakan pemeriksaan interval RR dankecepatan hantar saraf. Data laboratorium lainnya diperoleh dari data sekunder rekam medis.Kemudian dilakukan analisis data dengan menggunakan path analysis (analisis lajur) pada datarepetitif dan SPSS pada data nonrepetitif.Berdasarkan analisis didapatkan hubungan antara peningkatan glukosa darah sewaktu, fibrinogen,dan PAI-1 dengan penurunan indeks TcPO2. Didapatkan juga hubungan antara beratnya neuropatimotorik dan sensorik, peningkatan glukosa darah sewaktu, fibrinogen, PAI-1, dan hsCRP denganpenurunan indeks granulasi. Tetapi, indeks granulasi tidak dipengaruhi oleh indeks TcPO2. IndeksTcPCO2 tidak memiliki hubungan terhadap semua variabel tersebut, kecuali hsCRP dan indeksTcPCO2 tidak memengaruhi indeks granulasi.Indeks TcPO2 pada LKD dipengaruhi oleh kadar glukosa darah sewaktu, fibrinogen, dan PAI-1,tetapi tidak memengaruhi tumbuhnya jaringan granulasi. Tumbuhnya jaringan granulasi dipengaruhioleh glukosa darah sewaktu, neuropati motorik dan sensorik, peningkatan kadar fibrinogen, PAI-1,dan hsCRP. Selain itu, indeks TcPCO2 tidak memengaruhi indeks granulasi

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ABSTRACTDiabetic foot wounds/ulcer (DFU) is chronic complication of diabetes, which increasesmortality and morbidity, and lower quality of life. Macro and microvascular/microcirculationcomplications has a great influence on DFU and healing process. Microcirculation condition canbe seen from transcutaneous perfusion oxygen (TcPO2). The growth of granulation tissue in thehealing process is determined by microcirculation condition, among others influenced byHbA1c, random blood glucose, neuropathy, fibrinogen, PAI-1, hsCRP, MMP-9 index, TcPO2index, and TcPCO2 index.This study aimed to investigatethe role of HbA1c, random blood glucose, sensory, motoric, andautonomy neuropathy, fibrinogen, PAI-1, hsCRP, MMP-9 index, TcPO2 index, TcPCO2 index,and granulation index, as well as the relationship between TcPO2 index, TcPCO2 index andgranulation index in diabetic foot wounds.As much as 68 subjects DFU without peripheral arterial disease, in Cipto MangunkusumoReferral National Hospital, on December 2015?December 2016, were given standardmanagementof diabetic foot ulcer and monitored once a week for four times. In the 1st, 2nd, and3rd monitoring, DFU was documented, then 7.7 mL of venous blood was taken for fibrinogen,PAI-1, hsCRP, MMP-9, and TIMP-1 examination, also 2 mL arterial blood for blood gasanalysis, and then examination of TcPO2 and TcPCO2was performed using TCM4TOSCA/CombiM monitoring systems made by Radiometer. In the 4th monitoring, only DFUwas documented. Wound and granulation size was measured through photographicdocumentation using ImageJ program. Neuropathy was diagnosed based on RR interval andnerve conduction velocity study. Other laboratory data were obtained from medical records. Thedata were analysed by path analysis for repetititive data and SPSS for nonrepetitive data.From analysis, there is a significant correlation between the increasing random blood glucose(RBG), fibrinogen, and PAI-1 with the decreasing of TcPO2, also found a significantrelationship between the severity of sensory and motoric neuropathy, the increasing levels ofRBG, fibrinogen, PAI-1, and hsCRP with the decreasing of granulation index. But, TcPO2 indexdoes not influence granulation index. TcPCO2 index does not have significant correlation withall these variables, except hsCRP. Moreover, TcPCO2 index also does not influence granulationindex.TcPO2 index of DFU is affected by RBG, fibrinogen, PAI-1, but does not affect the growth ofgranulation tissue. Granulation tissue?s growing is influenced by the sensory and motoricneuropathy, increased levels of fibrinogen, PAI-1, and hsCRP. Furthermore, TcPCO2 index doesnot influence granulation?s growth."

"Latar belakang: Skeling dan penghalusan akar (SPA) dapat mengubah komposisi bakteri patogen. Tujuan: Mengetahui efek klinis dan mikrobiologis (P. gingivalis, T. forsythia) setelah SPA pada periodontitis kronis poket 4-6 mm. Metode: Empat puluh tiga subjek diperiksa kedalaman poket, indeks pendarahan gingiva, sampel plak subgingiva, serta dilakukan SPA pada kunjungan awal, bulan kedua, ketiga, keenam. Hasil: Kedalaman poket, pendarahan gingiva, populasi P. gingivalis, T. forsythia menurun (p<0,05). Penurunan kedalaman poket tidak berhubungan dengan penurunan populasi P.g (p>0,05). Kesimpulan: SPA meningkatkan kondisi klinis dan mikrobiologis poket 4-6 mm. Perbaikan kondisi klinis berhubungan dengan penurunan kedua bakteri kecuali kedalaman poket dengan populasi P.gingivalis.

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Background: Scaling and root planing (SRP) can change the composition of bacterial pathogens.

Objective: To know the clinical and microbiological effects (P.gingivalis and T. forsythia) of SRP at 4-6 mm pocket depth of chronic periodontitis.

Method: Forty-three subject were performed with SRP on the initial visit, two, three, six month. Pocket depth, gingival bleeding index (PBI) and subgingival plaque samples were examined.

Result: (There is a) decrease in pocket depth, gingival bleeding index, populations of P. gingivalis and T. forsythia (p <0.05). The decrease in pocket depth was not associated with a decrease in the population of P.g (p >0.05).

Conclusion: SRP can improve clinical and microbiological condition in the treatment of chronic periodontitis with 4-6 mm pocket depth. The improvement of clinical condition is associated with the decreasing of bacteria population, except pocket depth is not associated with the P. gingivalis population."

"Introduction: Diabetic foot ulcer is one of the most severe complications in a patient with diabetes mellitus because it will lead to with amputation, which results in disability and death. Doppler ultrasound is an easily available and non-invasive modality for evaluating lower limb arteries and can detect the severity of blood flow disorders or peripheral arterial disease (PAD). WHO recommends the classification of perfusion, extent/size, depth/tissue loss, infection, and sensation (PEDIS) as a tool for establishing the diagnosis and helping determine the management of diabetic foot. This study aims to see the correlation of PEDIS scores in assessing impaired lower limb arterial flow with Doppler ultrasound in patients with diabetic foot ulcers. Method: This was a cross-sectional study with subjects who has diabetic foot ulcer treated in the Division of Vascular and Endovascular Surgery, Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The data of PEDIS scores and spectral ultrasound in the femoral artery, popliteal artery, dorsalis pedis artery, and posterior tibial artery were taken. Results: As many as 81 subjects participated in this study, with 52 people (64%) were male, 29 people (36%) were female, and an average age of 59.8 ± 10.5 years. Pedis cut-off scores were obtained using ROC (receiver operating characteristic) curves, with popliteal arteries scores of >10, dorsalis pedis arteries, and posterior tibial arteries scores of >8 had the best values as diagnostic tools compared to USG as reference standards."

"[Latar Belakang: Ulkus kaki diabetik terinfeksi merupakan kasus DM yang paling banyak dirawat di RS, berhubungan dengan morbiditas, mortalitas, biaya yang tinggi dan bersifat multifaktorial. Salah satu faktor yang berpengaruh adalah albumin. Belum ada penelitian yang secara langsung menghubungkan konsentrasi albumin serum awal perawatan dengan perbaikan klinis infeksi ulkus kaki diabetik. Belum ada batasan mengenai konsentrasi albumin yang dapatmempengaruhi perbaikan klinis infeksi ulkus kaki diabetik.Tujuan: Mendapatkan data mengenai konsentrasi albumin serum awal perawatan dan hubungannya dengan perbaikan klinis infeksi ulkus kaki diabetik.Metodologi: Penelitian dengan desain kohort prospektif terhadap 71 pasiendiabetes dengan ulkus kaki terinfeksi yang dirawat inap di RSUPNCM,RSPADGS atau RSP pada kurun waktu April-Agustus 2014. Diagnosis dan klasifikasi ulkus kaki diabetik terinfeksi menggunakan kriteria IDSA. Data klinis dan albumin serum diambil dalam 24 jam pertama perawatan dan diikuti dalam 21 hari perawatan dengan terapi standar untuk dilihat perbaikan klinis infeksi ulkus kaki diabetik. Perbedaan rerata konsentrasi albumin antara subjek yang mengalami perbaikan klinis infeksi dan yang tidak, diuji dengan uji t tidak berpasangan dengan batas kemaknaan p<0,05. Untuk analisis multivariat,digunakan analisis regresi logistik dengan koreksi terhadap variabel perancu. Kemudian dinilai kemampuan konsentrasi albumin serum dalam memprediksi perbaikan klinis dengan membuat kurva ROC dan menghitung AUC. Lalu ditentukan titik potong konsentrasi albumin serum dengan sensitifitas dan spesifisitas terbaik pada penelitian ini.Hasil: Rerata konsentrasi albumin pada kelompok yang tidak mengalami perbaikan klinis infeksi ulkus kaki diabetik dan yang perbaikan, masing-masing sebesar 2,47 (0,45) g/dL dan 2,94 (0,39) g/dL (p<0,001). Setelah penambahan variabel perancu, didapatkan adjusted OR untuk setiap penurunan konsentrasi albumin 0,5 g/dL adalah 4,81 (IK95% 1,80;10,07). Konsentrasi albumin kurangdari 2,66 g/dL dapat memprediksi bahwa ulkus kaki diabetik terinfeksi tidak akan mengalami perbaikan dalam 21 hari perawatan dengan sensitivitas 75% dan spesifisitas 69,6%.Kesimpulan: Terdapat hubungan antara konsentrasi albumin serum awal perawatan dengan perbaikan klinis infeksi ulkus kaki diabetik. Konsentrasi albumin serum kurang dari 2,66 g/dL dapat memprediksi ulkus kaki diabetik terinfeksi tidak akan membaik dengan sensitivitas 75% dan spesifisitas 69,6%., Background: Infected diabetic foot ulcer is the most common case of diabetes mellitus (DM) for hospitalization. It is associated with high morbidity, mortality, expensive cost of treatment and has multifactorial aspects. Albumin is considered as one of the factors associated with the disease. No studies have been conducted to demonstrate direct association between serum albumin level at early hospitalization and clinical improvement of diabetic foot ulcer infection. Moreover, no standardized value on albumin level has been set, particularly thatmay influence the clinical improvement of diabetic foot ulcer infection.Objective: To obtain data about serum albumin level at early hospitalization and to recognize its association with clinical improvement of diabetic foot ulcer infection.Methods: A prospective cohort study was conducted. The study evaluated 71 patients with infected diabetic foot ulcers who were hospitalized at Cipto Mangunkusumo Hospital, Gatot Soebroto Hospital or Persahabatan Hospital between April and August 2014. Diagnosis and classification of infected diabetic foot ulcers were made using the IDSA criteria. Clinical data and serum albumin level were obtained within the first 24 hours of hospitalization and the data werefollowed within 21 days of hospitalization with standard treatment in order to evaluate any clinical improvement of diabetic foot ulcer infection. Unpaired t test with significance value of p <0,05 was used to show the difference of the mean of serum albumin level between subjects with clinical improvement and without clinical improvement of diabetic foot ulcer infection. Afterwards, a logistic regression analysis with adjustment to the confounding variables was used. ROCcurve and AUC were used to analyze the capacity of serum albumin level in predicting clinical improvement. Then, a cut-off point of serum albumin level with the best sensitivity and specificity was determined to predict the clinical improvement of diabetic foot ulcer infection.Results: The mean of serum albumin concentration of the group with clinical improvement and without improvement were 2,47 (0,45) g / dL and 2,94 (0,39) g / dL (p <0,001) respectively. After adjusting the confounding variables, we found that serum albumin level had an adjusted OR of 4,81 (95% CI 1,80;10,07) for every decrease in albumin level of 0,5 g / dL. Serum albumin level of less than 2,66 g/dL had sensitivity of 75% and specificity of 69,6% in predicting that theinfected diabetic foot ulcers would not improve within 21 days of hospitalization.Conclusions: There is a association between serum albumin level at early hospitalization and clinical improvement of diabetic foot ulcer infection. Serum albumin level of less than 2,66 g/dL can predict that the infected diabetic foot ulcers will not improve with sensitivity of 75% and specificity of 69,6%.]"

"Disertasi ini membahas algoritme neuromuscular taping terhadap manifestasi klinis gangguan mikrosirkulasi pada kaki dabetik. Tahapan riset meliputi kajian literatur, faktor risiko neuropati kaki diabetik, uji diagnostik, standarisasi perawatan pencegahan neuropati kaki diabetik, standarisasi NMT FANI pada perawatan neuropati kaki diabetik dan pembentukan algoritme. Desain penelitian uji diagnostik dengan cross sectional, sedangkan uji efek NMT FANI terhadap kelembapan, suhu, kapiler lipatan kuku dan nyeri neuropati dengan desain eksperimental. Instrument menggunakan moisture meter skin, thermometer infrared, capiloroscopy, biothesiometer dan LANSS. Hasil uji diagnostik menunjukan moisture meter skin (sensitifitas, spesifisitas dan akurasi 74%); capilaroscopy (sensitifitas, spesifisitas dan akurasi 73%) baik dalam mendeteksi neuropati kaki diabetik. Uji thermograph menunjukan sensitifitas 73.07% dalam mendeteksi kelainan neuropati, spesifisitas 56.42% dan akurasi 59.03%. Uji thermometer gun menunjukan sensitifitas 56.66%, spesifisitas 53.67% dan akurasi 54.21% kurang baik dalam mendeteksi neuropati kaki diabetik. NMT FANI berpengaruh secara signifikan terhadap kelembapan kulit, kapiler lipatan kulit kuku dan derajat nyeri neuropati pada kaki diabetik (p value < 0.05), sedangkan pada suhu kaki tidak berpengaruh secara signifikan (p value > 0.05). Hasil akhir algoritme tersusun dari pengkajian awal dari hasil anamnesis faktor risiko, pemeriksaan fisik dan diagnostik serta tatalaksana NMT FANI. Indikator kelembapan kulit, perubahan struktur kapiler lipatan kuku kaki dan intervensi NMT FANI perlu dimasukan dalam tatalaksana kaki diabetik.

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This dissertation discusses the neuromuscular taping algorithm against the clinical manifestations of microcirculation disorders in the diabetic foot. The research stages included a review of literature, risk factors for neuropathy of diabetic foot, diagnostic tests, standardization of preventive treatment of diabetic foot neuropathy, standardization of NMT FANI in the treatment of diabetic foot neuropathy, and algorithm formation. The study design was a cross-sectional diagnostic test, while an experimental design was employed for the NMT FANI effect test on skin moisture, temperature, nail fold capillaries, and neuropathic pain. The instruments used were a skin moisture meter, infrared thermometer, capillaroscopy, biothesiometer, and LANSS. The diagnostic test results showed that the SC skin moisture meter (sensitivity, specificity, accuracy 74%) and capillaroscopy (sensitivity, specificity, accuracy 73%) were good at detecting diabetic foot neuropathy. The thermograph test shows a sensitivity of 73.07% in detecting neuropathic disorders, a specificity of 56.42% and an accuracy of 59.03%. The thermometer gun test showed a sensitivity of 56.66%, a specificity of 53.67%, and an accuracy of 54.21% that was not good at detecting diabetic foot neuropathy. NMT FANI had a significant effect on skin moisture, nail fold capillaries, and the degree of neuropathy pain in diabetic foot (p value < 0.05), while foot temperature did not significantly influence (p value > 0.05). The end result of the algorithm is composed of a preliminary assessment of the results of the history of risk factors, physical examination, diagnostic and management of NMT FANI. Indicators of skin moisture, changes in the capillary structure of the nail folds and NMT FANI interventions need to be included in the management of diabetic foot."

"Latar Belakang: Pasien DM dengan ulkus kaki lebih banyak yang mengalamidepresi dan memiliki kualitas hidup yang buruk. Dalam tatalaksana ulkus kaki diabetic perlu diperhatikan faktor psikososial karena diperkirakan dapat mempengaruhi penyembuhan luka melalui induksi gangguan keseimbangan neuroendokrin-imun. Beberapa penelitian mengenai pengaruh depresi pada proses penyembuhan ulkus diabetik telah dilakukan dengan hasil yang masih kontroversial. Tujuan: Mengetahui pengaruh depresi terhadap proses perbaikan infeksi ulkus kaki diabetik, serta tingkat depresi pada pasien ulkus kaki diabetik rawat inap. Metode: Observasional, kohort prospektif, terhadap 95 pasien ulkus kaki diabetic terinfeksi yang dirawat di RSCM dan RS jejaring dalam kurun waktu penelitian, terbagi 2 kelompok yaitu kelompok depresi dan kelompok tidak depresi. Data klinis, penilaian depresi, dan data laboratorium diambil saat pasien masuk rumah sakit kemudian dinilai perbaikan infeksi ulkus kaki diabetik dalam 21 hari masa perawatan. Dilakukan analisis bivariat dengan uji Chi-square berdasarkan batas kemaknaan (α) sebesar 5% dan analisis multivariat. Hasil: Dari 95 subyek penelitian, 38 orang (40%) masuk dalam kelompok tidak depresi, sedangkan kelompok depresi terdiri atas 57 orang (60%). Subyek perempuan jumlahnya dominan pada kelompok depresi (70%). Komorbid terbanyak adalah hipertensi, dengan angka komorbiditas dan penyakit kardivaskular lebih tinggi pada kelompok depresi. Malnutrisi dan obesitas juga lebih banyak pada kelompok depresi (64,9% dan 31,6%), demikian pula dengan kontrol glikemik yang buruk (73,7%). Sebagian besar pasien (73,7%) yang masuk dalam kelompok depresi memiliki depresi ringan. Pada kelompok depresi 40,4% mengalami perbaikan infeksi dalam 21 hari masa perawatan, sedangkan pada kelompok tidak depresi 68,4%. Simpulan: Depresi cenderung meningkatkan risiko atau kemungkinan tidak terjadinya perbaikan infeksi ulkus kaki diabetik, walaupun setelah dilakukan penyesuaian terhadap variabel perancu, hasil tersebut tidak bermakna secara statistik (adjusted OR 2,429 dengan IK 95% 0,890-6,632). Lebih banyak subjek dengan depresi sedang yang tidak mengalami perbaikan infeksi ulkus kaki diabetik dibandingkan dengan subjek dengan depresi ringan (93,3% dan 47,6%).

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Background: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial.

Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers.

Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis.

Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%.

Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%)."