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"[ABSTRAKLatar Belakang: Kualitas hidup dan fertilitas merupakan isu yang ingin ditangani pada kasus amenorhea primer, dan kedua masalah ini menjadi alasan utama pasien mencari pengobatan. Penundaan diagnosis dan tatalaksana dapat mempengaruhi masa depan jangka panjang pasien. Walaupun prevalensi amenorhea primer sangat jarang (<0.1%), belum didapatkan data di senter pelayanan rawat jalan poliklinik Endokrinologi-Reproduksi RSCM. Tujuan: Meneliti karakteristik pasien amenorhea primer yang ditemui di poliklinik endokrinologi RSCM selama tahun 2014. Metode: Telaah retrospektif rekam medik dengan desain studi deskriptif kategorik terhadap pasien amenore primer yang berobat jalan di poliklinik imunoendokrinologi-reproduksi RSCM selama tahun 2014. Hasil dan simpulan: Terdapat 57 subyek penelitian. Selama 1 tahun terdapat 74% kasus baru dan 26% kasus lama, mayoritas kasus rujukan (79%) dengan karakteristik: Usia pada awal kontrol 22 ± 5.9 tahun. Keluhan utama yang tersering ditemukan adalah belum menstruasi (91.2%). Keluhan penyerta lain berupa gangguan pertumbuhan seks sekunder (8.7%). Sebanyak 93% tidak memiliki riwayat operasi dan obatan. Setengah populasi (50%) pasien tidak pernah mengalami perdarahan haid. Indeks massa tubuh pasien sebesar 20.77±3.5 kg/m2. Sebanyak 22.8% pasien amenore primer berperawakan kecil, serta 56.14% pasien amenore primer tidak memiliki pertumbuhan seks sekunder. Sebanyak 98.3% pasien tanpa hirsutisme, pembesaran tiroid, galaktore atau massa inguinal. Sebanyak 68.5 % dengan genitalia eksterna normal. Sebanyak 56.2% pasien dengan hipoplasi uterus, dan 49.1% dengan hipoplasi ovarium. Amenore primer hipergonadotropin-hipogonadisme adalah profil lab yang tersering ditemukan (33.33%). Dari gambaran kariotipe tersering 38% adalah 46XX. Etiologi dasar pada yang tersering adalah disgenesis gonad (36.8%), diikuti kelainan pembentukan duktus muller (28.07%) dan kelainan sentral (15.79%). Tatalaksana yang dilakukan terhadap kasus amenore primer berupa, induksi haid 42.1% dengan terapi hormonal. Pasien yang mendapat terapi hormonal, 24.56% mengalami perdarahan sela; Pada 28% mengalami perubahan klasifikasi Tanner. Operasi penyesuaian jender dilakukan pada 5 kasus (11%).

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ABSTRACTBackground : Quality of life and fertility are the two main issues to be handled in cases of primary amenorhea, as they become the main reasons for patients to seek medical care. Delay in diagnosis and treatment may affect the patient in the long term. Prevalence of primary amenorrhea is very rare (<0.1%) and there is minimal data on our reproductive endocrinology clinic at RSCM. Aim: To study the characteristics of primary amenorrhea patients at the reproductive endocrinology outpatient clinic during 2014. Methods: retrospective medical record review with cathegorical descriptive study to patients at reproductive-imunoendocrinology outpatient clinic during 2014. Results and conclusion: There were 57 study subjects. During 1 year there wer e74% new cases and 26% old cases with majority of referred casess(79%) with characteristics as such. Age at first control was 22 ± 5.9 years old. The most frequent chief complaint were no menstruation (91.2%). Other frequent complaint were disorder of secondary sex characteristics (8.7%). As much as 93% did not have history of surgery nor medication. Half of the cases (50%) never had menstruation. Body mass index mean was 20.77±3.5 kg/m2. As much as 22.8% patients were short-statured with 56.14% with no signs of secondary sex characteristics growth. Mostly (99.3%) patients had no hirsutism, thyroid enlargement nor inguinal. Normal external genitalia was found at 68.5% cases. 56.2% patient had uterus hipoplasia, and 49.1% with hipoplasia of the ovaries. Most often laboratory profile found was hypergonadotropin-hypogonadism (33.3%). Most frequent karyotpe were 46XX (38%). Most frequent etiology of primary amenorrhe in this study is gonadal dygenesis (36.8%) and mullerian dysgenesis/agenesis, and central disorders (15.79%). Most frequent etiology found was gonadal dysgenesis (36.8%), mullerian dysgenesis (28.07%) and central disorder (15.79%). Hormonal therapy was the most frequent treatment (42.1%). on patient with hormones, 24.6% had breakthrough bleeding, 28% had Tanner stage changes, and 11% had gender change. ;Background : Quality of life and fertility are the two main issues to be handled in cases of primary amenorhea, as they become the main reasons for patients to seek medical care. Delay in diagnosis and treatment may affect the patient in the long term. Prevalence of primary amenorrhea is very rare (<0.1%) and there is minimal data on our reproductive endocrinology clinic at RSCM. Aim: To study the characteristics of primary amenorrhea patients at the reproductive endocrinology outpatient clinic during 2014. Methods: retrospective medical record review with cathegorical descriptive study to patients at reproductive-imunoendocrinology outpatient clinic during 2014. Results and conclusion: There were 57 study subjects. During 1 year there wer e74% new cases and 26% old cases with majority of referred casess(79%) with characteristics as such. Age at first control was 22 ± 5.9 years old. The most frequent chief complaint were no menstruation (91.2%). Other frequent complaint were disorder of secondary sex characteristics (8.7%). As much as 93% did not have history of surgery nor medication. Half of the cases (50%) never had menstruation. Body mass index mean was 20.77±3.5 kg/m2. As much as 22.8% patients were short-statured with 56.14% with no signs of secondary sex characteristics growth. Mostly (99.3%) patients had no hirsutism, thyroid enlargement nor inguinal. Normal external genitalia was found at 68.5% cases. 56.2% patient had uterus hipoplasia, and 49.1% with hipoplasia of the ovaries. Most often laboratory profile found was hypergonadotropin-hypogonadism (33.3%). Most frequent karyotpe were 46XX (38%). Most frequent etiology of primary amenorrhe in this study is gonadal dygenesis (36.8%) and mullerian dysgenesis/agenesis, and central disorders (15.79%). Most frequent etiology found was gonadal dysgenesis (36.8%), mullerian dysgenesis (28.07%) and central disorder (15.79%). Hormonal therapy was the most frequent treatment (42.1%). on patient with hormones, 24.6% had breakthrough bleeding, 28% had Tanner stage changes, and 11% had gender change. , Background : Quality of life and fertility are the two main issues to be handled in cases of primary amenorhea, as they become the main reasons for patients to seek medical care. Delay in diagnosis and treatment may affect the patient in the long term. Prevalence of primary amenorrhea is very rare (<0.1%) and there is minimal data on our reproductive endocrinology clinic at RSCM. Aim: To study the characteristics of primary amenorrhea patients at the reproductive endocrinology outpatient clinic during 2014. Methods: retrospective medical record review with cathegorical descriptive study to patients at reproductive-imunoendocrinology outpatient clinic during 2014. Results and conclusion: There were 57 study subjects. During 1 year there wer e74% new cases and 26% old cases with majority of referred casess(79%) with characteristics as such. Age at first control was 22 ± 5.9 years old. The most frequent chief complaint were no menstruation (91.2%). Other frequent complaint were disorder of secondary sex characteristics (8.7%). As much as 93% did not have history of surgery nor medication. Half of the cases (50%) never had menstruation. Body mass index mean was 20.77±3.5 kg/m2. As much as 22.8% patients were short-statured with 56.14% with no signs of secondary sex characteristics growth. Mostly (99.3%) patients had no hirsutism, thyroid enlargement nor inguinal. Normal external genitalia was found at 68.5% cases. 56.2% patient had uterus hipoplasia, and 49.1% with hipoplasia of the ovaries. Most often laboratory profile found was hypergonadotropin-hypogonadism (33.3%). Most frequent karyotpe were 46XX (38%). Most frequent etiology of primary amenorrhe in this study is gonadal dygenesis (36.8%) and mullerian dysgenesis/agenesis, and central disorders (15.79%). Most frequent etiology found was gonadal dysgenesis (36.8%), mullerian dysgenesis (28.07%) and central disorder (15.79%). Hormonal therapy was the most frequent treatment (42.1%). on patient with hormones, 24.6% had breakthrough bleeding, 28% had Tanner stage changes, and 11% had gender change. ]"

"Latar Belakang: Insidens postdural puncture headache menggunakan jarum spinal ukuran kecil belum pernah diteliti di RSUPNCM. Saat ini di tempat kami jarum spinal yang tersedia yaitu jarum spinal Quincke ukuran 25G, 26G, dan 27G. Metode: Penelitian observasional ini dilakukan secara prospektif untuk mencari insidens postdural puncture headache sampai 72 jam pasca-anestesia spinal. Faktor-faktor risiko yang berhubungan dengan pasien dan prosedur dihubungkan dengan PDPH dan dilakukan analisis regresi linear terhadap faktor-faktor tersebut. Hasil: Insidens postdural puncture headache pasca-anestesia spinal sebesar 6,6%. Kelompok usia <50 tahun memiliki kemungkinan 3 kali PDPH dibanding kelompok umur lebih tua. Jarum spinal 25G/26G Quincke memiliki kemungkinan 2 kali risiko MPDPH dibandingkan jarum 27G. Kesimpulan: Insidens postdural puncture headache setelah anesthesia spinal di RSUPNCM tidak berbeda dengan hasil laporan di tempat lain.

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Background : Incidence of postdural puncture headache using small spinal needles was not yet investigated in RSUPNCM. In our centre we use Quincke spinal needle sizes 25G, 26G, and 27G.

Methods : The incidence of postdural puncture headache was prospectively investigated until 72 hours after spinal anesthesia in 440 patients at RSUPNCM. Patient and procedure related factors were recorded and submitted to multiple logistic regression analysis to determine the relationship of these factors to postdural puncture headcahe.

Results: The incidence of postdural puncture headache after spinal anesthesia were 6,6%. The age <50 years old is identified increase three times for PDPH compare to older. Larger needles Quincke (25G/26G) is identified increase twice for PDPH compare to 27G.

Conclusion : The incidence of postdural puncture headache after spinal anesthesia at RSUPNCM is comparable to those reported elsewhere."

"ABSTRAKLatar Belakang. Penyakit jantung koroner PJK merupakan penyakit dengan prevalensi yang cukup tinggi di masyarakat umum maupun masyarakat pekerja. Berbagai studi mengindikasikan penyakit jantung koroner berhubungan dengan kerja gilir. Penelitian ini bertujuan untuk mengetahui pengaruh kerja gilir terhadap insidensi risiko sedang-tinggi PJK pada pekerja laki-laki perusahaan manufaktur di Bogor sejak tahun 2011 hingga 2016.Metode. Penelitian ini merupakan penelitian kohort retrospektif dalam periode lima tahun menggunakan metode Nelson-Aalen untuk analisis hazard function. Risiko PJK dinilai berdasarkan Skor Risiko Framingham.Hasil. Tingkat insidens risiko sedang-tinggi PJK pada pekerja gilir adalah 103/1.000 orang-tahun, berbeda secara bermakna dengan tingkat insidens pekerja non gilir yaitu 68/1.000 orang-tahun RR=1,5; IK 95 =1,001-2,304 . Hazard function kumulatif pekerja gilir untuk memiliki risiko sedang-tinggi PJK di tahun kelima lebih besar dibandingkan dengan pekerja non gilir HR=1,51.

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ABSTRACT

Background. Coronary heart disease CHD is a disease with a high prevalence in the general population and workers. Studies have indicated that coronary heart disease is associated with shift work. This study is aimed to determine the effect of shift work on the incidence of intermediate high risk CHD among male workers at manufacturing company in Bogor from 2011 to 2016.Method. This is a retrospective cohort study in five year period using Nelson Aalen method for hazard function analysis. Risk of CHD is assessed based on Framingham Risk Score.Result. The intermediate high risk CHD incidence rate of shift workers was 103 1,000 person year, significantly different from the incidence rate of non shift workers which was 68 1.000 person year RR 1.5 95 CI 1.001 2.304 . Cumulative hazard function of shift workers to have an intermediate high risk CHD in the fifth year was greater than that of non shift workers HR 1.51 . Workers with length of employment ge 14 years had greater cumulative hazard function than workers with length of employment ."

"Sepsis memiliki angka kematian yang cukup tinggi di seluruh dunia. Hal ini disebabkan sebagian besar oleh karena penegakan diagnostik, pemantauan, dan tatalaksana yang tidak adekuat. Mortalitas dan morbiditas sepsis masih dalam banyak penelitian di seluruh dunia. Penyebab terbanyak adalah keadaan imunoparalisis pada sepsis. Penelitian ini bertujuan untuk melihat kejadian, gambaran klinis imunoparalisis pada sepsis klinis anak.Penelitian ini dengan desain deskriptif, dimana subjek di IGD, PICU, dan ruang rawat anak RSCM usia 1 bulan ndash; 18 tahun dengan diagnosis sepsis klinis yang memilki 2/lebih dari 4 kriteria: 1 takikardia; 2 takipnu; 3 hipo/hipertermia; 4 leukositosis/leukopenia, dengan bukti infeksi berupa prokalstionin 0,5 ng/mL dan/atau dijumpai pertumbuhan kuman pada kultur. Setelah orangtua subjek mengisi informed consent, pasien dilakukan pemeriksaan darah rutin, analisa gas darah, prokalsitonin, kultur darah, dan darah diambil untuk pemeriksaan TNF alfa ex vivo. Pemeriksaan TNF alfa ex vivo dilakukan dengan menstimulasi darah segar dengan lipopolisakarida salmonella serotipe abortus equii 500 pg/mL yang kemudian akan dilakukan inkubasi pada suhu 370C selama 4 jam dan disentrifugasi 1000XG selama 5 menit, dilakukan pemeriksaan TNF alfa dengan metode ELISA. Subjek dikatakan imunoparalisis jika didapati hasil TNF alfa ex vivo < 200 pg/mL.Hasil penelitian menunjukkan angka kejadian imunoparalisis 12 17,1 dari 70 subjek terdiagnosa sepsis klinis. Proporsi laki:perempuan 1,4:1. Status gizi kurang n=8/66,7 lebih banyak didapati pada imunoparalisis sepsis klinis. Fokus infeksi tersering adalah infeksi pada sistem hematologi, nefrologi dan respirasi. Subjek demam 5 41,7 , takikardia 3 25 , takipnu 3 25 dari 12 subjek imunoparalisis pada sepsis klinis anak Untuk pemeriksaan laboratorium, prokalsitonin >2,0 ng/mL dan jumlah leukosit > 11.000/mm3 lebih sering dijumpai.Simpulan: angka kejadian imunoparalisis pada sepsis klinis anak di RSCM 17,1 . Gambaran pasien imnoparalisis pada sepsis klinis yang memiliki persentase besar adalah gizi kurang; pasien dengan fokus infeksi hematologi, nefrologi, dan respirasi; prokalsitonin ge; 2 ng/mL; dan leukosit ge; 11.000/mm3

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Mortality in sepsis is high worldwide. It is caused by the diagnostic, monitoring, and inadequate therapeutic. Mortality and morbidity in sepsis is still in research. Immunoparalysis is a leading cause of mortality and morbidity of sepsis. The objectives of this study were investigating incidence, clinical characteristics immunoparalysis in clinically sepsis.Design of study was descriptive. The subjets were children age 1 month-18 years from emergency room, PICU, and pediatric ward with clinically sepsis following ge; 2 of 4 criterias: 1 tachycardia; 2 tachypnea; 3 hypo/hyperthermia; 4 leucocytosis/leucopenia, with proven infection such as procalcitonin 0.5 ng/mL with/without positive culture. After informed consent was filled, subjects were examined blood sample, procalcitonin, blood culture, and TNF alpha ex vivo. Whole blood was stimulated with lipopolysaccharides salmonella serotype abotrtus equii, incubated in 37 0C for 4 hours, centrifugated 1000XG for 5 minutes, and examined for TNF alpha with ELISA. Subjects was defined imunoparalysis with TNF alpha ex vivo < 200 pg/mL.We found the incidence of immunoparalysis was 12 17.1 of 70 clinically sepsis subjects. Malnourished status n=8/66.7 was higher frequency. The large numbers for focus of infection were hematologic, nephrologic, and respiratory system. Subjects had fever 5 41,7 , tachycardia 3 25 , and tachypnea 3 25 from 12 imunoparalysis clinically sepsis subject. Laboratorium findings showed procalcitonin > 2.0 pg/mL 8 66,7 subjects and leucocyte > 11.000/mm3 6 50 subjects.Conclusion: The incidence of imunnoparalysed sepsis was 17.1 . Profile of pediatric clinically sepsis had a big number in malnourished status, focus infectious on hematology, nephrology, and respitarory with laboratorium findings showed procalcitonin > 2.0 ng/mL and leococyte > 11.000/mm3 had a high numbers in immunoparalysed clinically sepsis."

"Latar Belakang. Infeksi sitomegalovirus (CMV) merupakan infeksi oportunistik tersering yang menjadi penyulit pascatransplantasi hati anak. Infeksi CMV aktif pascatransplantasi hati diperkirakan terjadi tidak hanya karena faktor serologi donor dan resipien, tetapi juga karena nilai Pediatric End-stage Liver Disease (PELD) atau Model for End-stage Liver Disease (MELD), penggunaan kombinasi imunosupresan, dan klinis rejeksi yang pernah dialami.Metode. Penelitian ini menggunakan desain kasus kontrol pada pasien anak yang telah menjalani transplantasi hati selama satu tahun atau lebih sejak tahun 2010 hingga tahun 2022di RSCM dengan stratifikasi risiko menengah. Sumber data diperoleh dari rekam medis dan hasil pemeriksaan polymerase chain reaction (PCR) CMV di Laboratorium Mikrobiologi Klinik FKUI. Hubungan antarvariabel dianalisis dengan menggunakan Fisher’s exact test dan t-test untuk dua populasi independen. Nilai p < 0,05 dianggap bermakna secara statistik pada analisis bivariat.Hasil. Insidens CMV aktif pascatransplantasi hati pada periode satu tahun pertama adalah 26,7%. Kesintasan kumulatif bebas infeksi CMV aktif pada bulan ke-12 adalah 73,3% dan incidence rate tertinggi pada bulan ke-3. Tidak ditemukan perbedaan yang bermakna secara statistik pada nilai PELD/MELD antara kelompok CMV aktif dan kelompok non-CMV aktif (IK 95% -5,24-3,14, p = 0,61). Penggunaan kombinasi imunosupresan dan klinis rejeksi yang pernah dialami sebelumnya tidak berhubungan dengan terjadinya infeksi CMV aktif (RO 1,50, IK 95% 0,33-6,68, p = 0,72; dan RO 1,36, IK 95% 0,36-5,10, p = 0,65). Post-hoc power dari masing-masing uji hipotesis yang digunakan adalah 50-76%.Kesimpulan. Insidens infeksi CMV aktif pascatransplantasi hati anak pada periode satu tahun pertama pada subjek dengan stratifikasi risiko menengah adalah 26,7%. Nilai PELD/MELD, penggunaan kombinasi imunosupresan, dan klinis rejeksi yang pernah dialami tidak berhubungan dengan risiko infeksi CMV aktif pascatransplantasi hati. Namun, power penelitian ini rendah sehingga dibutuhkan penelitian lanjutan dengan desain prospektif dan mengikutsertakan subjek yang lebih besar.

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Background. Cytomegalovirus (CMV) infection is the most common opportunistic infection after pediatric liver transplantation. Active CMV infection after liver transplantation was considered to be affected not only by serology status of recipient and donor, but also by Pediatric End-stage Liver Disease (PELD) score or Model for End-stage Liver Disease (MELD) score, combination of immunosuppressive agents, and previous clinically rejection.

Method. Case control study was designed in this study, and children who experienced liver transplantation beyond one year from 2010 to 2022 at RSCM with moderate risk stratification were included in this study. Source data was obtained from medical record and polymerase chain reaction (PCR) CMV in Clinical Microbiology Laboratory Faculty of Medicine University of Indonesia. Analysis of two variables was explained using Fisher’s exact test and t-test for two independent population. A p value < 0.05 was considered to be statistically significant in bivariate analysis.

Result. Incidence of active CMV infection after liver transplantation within first one year was 26.7%. Cumulative survival of free CMV infection at 12th month was 73.3% and the highest incidence rate was in the first 3 months. There was no statistically significant difference between PELD/MELD score in active CMV group and not-active-CMV group (CI 95% -5.24-3.14, p = 0.61). Combination of immunosuppressive agents and previous cellular rejection were not associated with active CMV infection (OR 1.50, CI 95% 0.33-6.68, p = 0.72; and OR 1.36, CI 95% 0.36-5.10, p = 0.65). Post-hoc power of each hypothesis test was 50-76%.

Conclusion. Incidence of active CMV infection within first year after pediatric liver transplantation among moderate risk stratification group was 26.7%. PELD/MELD score, combination of immunosuppressive agents, and previous clinically rejection were not associated with risk of active CMV infection. However, this study was underpower that further studies need to be conducted with a prospective design and enrolled more participants."