Hasil Pencarian  ::  Simpan CSV :: Kembali

"Latar Belakang: Major Adverse Cardiac Events (MACE) merupakan penyebab utama meningkatnya morbiditas dan mortalitas pada pasien sindrom koroner akut (SKA). Skor prediksi MACE merupakan model yang dapat memprediksi prognosis untuk terjadinya MACE berdasarkan faktor risiko yang dimiliki oleh pasien SKA. Tujuan: Untuk membuat skor prediksi sederhana, mudah dikalkulasi dan aplikatif, yang mampu mengidentifikasi pasien SKA dengan risiko terjadinya MACE. Metode: Dilakukan penelitian kohort retrospektif pada 1002 subyek pasien SKA yang dirawat di intensive coronary care unit RSCM dalam periode waktu Januari 2010 - Desember 2013. Dilakukan evaluasi terhadap faktor risiko jenis kelamin, usia, riwayat keluarga penyakit jantung koroner, diabetes, hemoglobin, leukosit, kreatinin, asam urat, enzim jantung, tekanan darah sistolik, denyut jantung, henti jantung, deviasi segmen ST dan kelas killip. Hasil: Major Adverse Cardiac Events didapatkan pada 112 subyek (9,21%), faktor prediktor jenis kelamin wanita, leukosit, kreatinin, asam urat, enzim jantung, tekanan darah sistolik, denyut jantung, henti jantung dan kelas killip pada analisis multivariat mempergunakan regresi logistik didapatkan berhubungan bermakna dengan MACE dengan RR (95% IK) masing-masing 2.66 (1.35-5.25), 2.06 (1.02-4.16), 2.84 (1.43-5.66), 3.79 (1.90-7.54), 3.26 (1.51-7.05), 3.48 (1.57-7.70), 2.46 (1.20-5.01), 42.04 (18.90-93.51), dan 6.31 (3.19-12.50) serta didapatkan akurasi prediksi yang baik dengan nilai area under curve 0,95, 95% IK, 0,93-0,97. Kesimpulan: Pada pasien SKA didapatkan probabilitas MACE sebesar 3,6% bagi yang memiliki skor total 0-6 dan 83,5% bagi yang memiliki skor > 6 berdasarkan faktor-faktor prediktor jenis kelamin wanita (skor 1), leukositosis (skor 1), peningkatan kreatinin (skor 1), hiperurisemia (skor 2), peningkatan enzim jantung (skor 1), hipotensi (skor 2), takikardi (skor 1), henti jantung (skor 5) dan kelas killip III-IV (skor 3).

---

Background: Major Adverse Cardiac Events (MACE) have been known as the cause of increasing morbidity and mortality among acute coronary syndrome (ACS) patients. Prediction score have been used as prognostic to prediction MACE based on risk factor in ACS patients.

Aim: To develop a simple risk score, easily calculated and applicability that can identifies ACS patients with risk for MACE.

Methods: A cohort retrospective study involving 1002 ACS patients in intensive coronary care unit RSCM from January 2010 through December 2013. Sex, age, family history, diabetes, hemoglobin, leucocyte, creatinine, uric acid, cardiac enzyme, systolic blood pressure, heart rate, cardiac arrest, deviation ST segment and killip class as risk factor for MACE was assessed.

Results: Major Adverse Cardiac Events was found in 112 (9,21%) of ACS patients, predictor factor woman, leucocyte, creatinine, uric acid, cardiac enzyme, systolic blood pressure, heart rate, cardiac arrest and killip class in multivariate logistic regression analysis were associated with MACE in ACS patients with (RR 95% CI) 2.66 (1.35-5.25), 2.06 (1.02-4.16), 2.84 (1.43-5.66), 3.79 (1.90-7.54), 3.26 (1.51-7.05), 3.48 (1.57-7.70), 2.46 (1.20-5.01), 42.04 (18.90-93.51), and 6.31 (3.19-12.50) respectively, and the best predictive accuracy for MACE was obtained by area under curve 0,95, 95% CI, 0,93-0,97.

Conclusions: In ACS patients we found probability MACE was 3,6% in patients with total score 0-6 and 83,5% for who have total score > 6 based on predictor factor woman (score 1), leukocytosis (score 1), elevated creatinine level (score 1), hyperuricemia (score 2), elevated cardiac enzyme (score 1), hypotension (score 2), tachycardia (score 1), cardiac arrest (score 5) and killip class III-IV (score 3)."

"Latar belakang. Kondisi iskemia pada penyakit jantung koroner (PJK) berkorelasi dengan disfungsi sistem saraf otonom. Revaskularisasi melalui percutaneous coronary intervention (PCI) dapat mengembalikan keseimbangan fungsi saraf otonom dan memperbaiki prognosis. Di sisi lain, perasaan cemas yang muncul menjelang prosedur PCI, dapat memicu hiperaktivitas simpatis. Tujuan penelitian ini adalah untuk mengetahui pengaruh ansietas terhadap perbaikan heart rate variability (HRV), sebuah teknik non-invasif untuk mengevaluasi aktivitas sistem saraf otonom; setelah tindakan PCI. Metode. Studi dengan desain potong lintang, korelasi pretest-posttest; melibatkan 44 subjek dengan PJK stabil yang menjalani PCI elektif di Pelayanan Jantung Terpadu, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo. Pengukuran HRV dilakukan sebelum PCI, kemudian diulang pasca tindakan PCI. Ansietas dinilai menggunakan kuesioner hospital anxiety depression score (HADS). Pengolahan data serta analisis statistik dilakukan dengan bantuan software SPSS 20.0. Hasil. Sebanyak 54,5% subjek mengalami ansietas saat akan menjalani PCI. Pada kelompok tanpa ansietas, ditemukan perbaikan signifikan pada parameter HRV sebelum-setelah PCI; yaitu SDNN [standard deviation of normal to normal intervals] (Median = 26,19 vs. Median = 39,60 ; Z = -3,621 ; p < 0,001) dan parameter RMSSD [root mean square of the successive differences] (Median = 21,90 vs. Median = 30,99; Z = -2,501; p = 0,012). Sementara itu, tidak didapatkan perbaikan bermakna parameter HRV sebelum-setelah PCI, pada kelompok ansietas. Terdapat perbedaan bermakna pada kenaikan nilai SDNN antara kelompok tanpa ansietas dibandingkan dengan kelompok ansietas ansietas (Median = 9,11 vs. Median = 2,83 ; U = 154,00 ; p = 0,043). Simpulan. Ansietas yang terjadi sebelum PCI elektif dapat menghambat perbaikan HRV pasca tindakan sehingga mempengaruhi prognosis penyakit. Diperlukan penelitian lanjutan mengenai peranan terapi ansietas menjelang PCI dihubungkan dengan luaran klinis serta prognosis pasca PCI.

---

Background. Chronic ischemic condition in coronary artery disease (CAD) was associated with autonomic dysfunction. Percutaneous coronary intervention (PCI) could restore perfusion so that improving autonomic balance and disease prognosis. On the other hand, pre-PCI anxiety was known to produce sympathetic hyperactivity. The aim of this study was to determine whether pre-PCI anxiety may influence heart rate variability (HRV) improvement, a noninvasive technique for the evaluation of the autonomic nervous system activity; after successful PCI.

Methods. A cross sectional studies, pretest-posttest correlation; enclose 44 patients with stable CAD undergoing PCI in Integrated Heart Service, Cipto Mangunkusumo National Hospital. HRV measurement was done before and after PCI. Anxiety symptoms was collected using hospital anxiety depression score (HADS) questionnaires. Data input and statistical analysis was carried out using SPSS 20.0 for Windows.

Results. As many as 54.5% stable CAD patients undergoing elective PCI experienced anxiety symptoms. In the anxiety group, there were significant post-PCI improvement of SDNN [standard deviation of normal to normal intervals] (Median = 26.19 vs. Median = 39.60; Z = -3.621; p < 0.001) and RMSSD [root mean square of the successive differences] (Median = 21.90 vs. Median = 30.99; Z = -2.501; p = 0.012). Post-procedure HRV improvement was not significant in patients with anxiety symptoms. There was significant difference of the SDNN improvement between non-anxiety and anxiety patients (Median = 9.11 vs. Median = 2.83; U = 154.00; p = 0.043).

Conclusions. Pre-PCI anxiety may affect HRV improvement after revascularization thus influence disease prognosis. Further studies are needed to determine the impact of pre-PCI anxiety treatment on cardiac outcomes."

"Adanya perubahan sosial ekonomi, diduga sejalan dengan meningkatnya prevalensi stres psikologis dengan manifestasi ldinis psikis maupun somatis. Keluhan somatis yang bersamaan dengan kelainan psilds yang terbanyak adalah dispepsi non ulkus, dibanding keluhan dari organ lain. Sampai saat ini belum ada kesepakatan tentang patofisiologi terapi DNU dan pengaruh faktor psikologis terhadap DNU khususnya keasaman lambung. Sementara ini banyak pendapat asam lambung pada DNU adalah normal. Dengan mengetahui keasaman cairan lambung pada DNU dengan gangguan psikosomatik maka dapat diupayakan pendekatan terapi yang rasional. Metoda: penelitian dilakukan dengan uji potong lintang dan sampel total. Dikenakan kriteria inklusi dan ekslusi. Dilakukan anamnesa umum dan khusus untuk psikologisnya, pemeriksaan fisik, laboratorik, endoskopi dan keasaman cairan lambung.

---

The existence of socio-economic changes is suspected to be in line with the increasing prevalence of psychological stress with psychological and somatic manifestations. The most common somatic complaints associated with psilds disorders are non-ulcer dyspepsies, compared to complaints from other organs. Until now, there has been no agreement on the pathophysiology of DNU therapy and the influence of psychological factors on DNU, especially gastric acidity. Meanwhile, many people think that gastric acid in DNU is normal. By knowing the acidity of gastric juice in DNU with psychosomatic disorders, a rational therapeutic approach can be sought. Method: The research was carried out by cross-cutting test and total samples. Subject to inclusion and exclusion criteria. General and specific anamnesis is carried out for the psychological, physical, laboratory, endoscopy and acidity examination gastric fluid."

"Latar Belakang. Salah satu penyebab kematian pada sindrom koroner akut adalah terjadinya komplikasi yang dikenal dengan major adverse cardiac event MACE . Terdapat beberapa prediktor terjadinya MACE pada pasien SKA, diantaranya adalah faktor psikologis yaitu depresi dan ansietas. Saat ini, depresi dan ansietas belum mendapat banyak perhatian padahal memiliki peran penting dalam pengobatan SKA dan prognosisnya. Tujuan. Mengetahui hubungan antara depresi dan ansietas dengan major adverse cardiac event dalam 7 hari pada pasien SKA. Metode. Studi dengan desain kohort prospektif untuk meneliti hubungan antara depresi dan ansietas dengan MACE dalam 7 hari pasien SKA, dengan menggunakan kuisioner HADS pada pasien SKA yang menjalani perawatan di ICCU, Rawat Inap Gedung A RSCM pada bulan Januari ndash; Mei 2018. Analisis bivariat dilakukan untuk menghitung risk ratio RR terjadinya MACE dalam 7 hari pada kelompok depresi dan ansietas dengan menggunakan SPSS. Hasil. Didapatkan jumlah subjek yang memenuhi kriteria inklusi sebanyak 114 orang. depresi didapatkan pada 7 subjek, ansietas didapatkan pada 28,95 subjek, dan MACE didapatkan pada 9,6 subjek. Pada kelompok depesi, MACE 7 hari terjadi pada 12,5 subjek. Pada kelompok Ansietas, MACE 7 hari terjadi pada 21,2 subjek. Pada analisis bivariat didapatkan ansietas meningkatkan risiko terjadinya MACE dalam 7 hari pada pasien SKA, dengan risiko relatif RR sebesar 4,2 IK 1,34 ndash; 13,7. Kesimpulan. Proporsi depresi pada pasien SKA di RSCM sebesar 7 dan proporsi ansietas pada pasien SKA di RSCM sebesar 28,95 . Ansietas pada pasien SKA merupakan prediktor independen terjadinya MACE dalam 7 hari dan meningkatkan risiko terjadinya MACE 7 hari.

---

Background. One of the causes of death in acute coronary syndrome is the occurrence of a complication known as major adverse cardiac event MACE. There are several predictors of the occurrence of MACE in patients with ACS, including psychological factors such as depression and anxiety. Currently, depression and anxiety have not received much attention when it has an important role in the treatment of ACS and its prognosis.

Objective. To determine the association between depression and anxiety with major adverse cardiac event within 7 days in patients with acute coronary syndrome.

Method. Study with prospective cohort design to examine the association between depression and anxiety with MACE within 7 days of ACS patients, using HADS questionnaires on ACS patients undergoing treatment at ICCU, Hospitalization RSCM in January May 2018. Bivariate analysis was performed to calculate the risk ratio RR of MACE occurrence within 7 days in the depression and anxiety group using SPSS.

Results. Obtained number of subjects who meet the inclusion criteria of 114 people. depression was obtained in 7 of subjects, Anxiety was obtained in 28,95 of subjects, and MACE was obtained in 9.6 of subjects. In the depression group, MACE 7 days occurred in 12.5 of subjects. In the Anxiety group, MACE 7 days occurred in 21,2 of subjects. In bivariate analysis, anxiety increased the risk of MACE within 7 days in patients with ACS, with relative risk RR of 4,2 IK 1,34 ndash 13,7.

Conclusion. The proportion of depression in patients with SKA in RSCM was 7 and the proportion of anxiety in ACS patients in RSCM was 28,95. Anxiety in patients with ACS is an independent predictor of MACE within 7 days and increases the risk of a 7 day MACE. "

"Pendahuluan. Berbagai panduan menganjurkan hemodialisis HD tiga kali seminggu. Di Indonesia pasien dengan hemodialisis dua kali seminggu lebih banyak ditemukan. Perlu dilakukan penelitian untuk mengetahui gambaran klinis dan kualitas hidup pada pasien yang menjalani hemodialisis dua kali seminggu dibandingkan tiga kali seminggu. Metode. Merupakan studi potong lintang pada pasien yang menjalani HD dua dan tiga kali seminggu di RS Cipto Mangunkusumo dan beberapa RS swasta. Dilakukan pemeriksaan laboratorium dan penilaian kualitas hidup dengan menggunakan Kidney Disease Quality of Life KDQOL-SF 36. Hasil. Didapatkan 80 subjek dengan kelompok usia >50 tahun lebih banyak ditemukan. Secara bermakna lebih tinggi pada kelompok HD dua kali yaitu Interdialytic Weight Gain IDWG 4,91 SB 1,52 dan 3,82 SB 1,28 p=0,002. albumin 4,05 SB 0,26 dan 3,86 SB 0,48 p=0,027, saturasi transferin 25,5 12,0-274,0 dan 21,95 5,8-84,2 p=0,004, kadar fosfat 5,82 SB 1,68 dan 5,82 SB 1,68 p=0,026. Kadar TIBC 235,20 SB 55,72 dan 273,73 SB 58,29 p=0,004 pada kelompok tiga kali HD secara bermakna lebih tinggi. Pada kelompok HD dua kali seminggu 68 mencapai Kt/V>1,8, 93,3 yang HD tiga kali seminggu mencapai Kt/V>1,2. Kualitas hidup antara kedua kelompok tidak berbeda bermakna baik pada Physical Componet Score PCS p=0,227, Mental Component Score MCS p=0,247 dan Kidney Disease Component Score KDCS p=0,889. Simpulan. Didapatkan secara bermakna lebih tinggi pada kelompok HD dua kali seminggu pada pemeriksaan IDWG, albumin, saturasi transferin, fosfat, sedangkan TIBC lebih tinggi pada kelompok HD tiga kali seminggu. Kualitas hidup kedua kelompok tidak berbeda bermakna.

---

Introduction. Many guidelines recommend hemodialysis HD three times a week. In Indonesia there are more patients undergoing hemodialysis twice a week. It is necessary to investigate the clinical features and the quality of life in patients undergoing hemodialysis twice a week.

Method. A cross sectional study in patients undergoing HD two and three times weekly at Cipto Mangunkusumo Hospital and some private hospitals. Laboratory examination and assessment of quality of life by using Kidney Disease Quality of Life KDQOL SF 36.

Results. There were 80 subjects with age group 50 years is more common. Significantly higher in group HD twice a week were Interdialytic Weight Gain IDWG 4.91 SB 1.52 and 3.82 SB 1.28 p 0.002. 4,05 albumin SB 0.26 and 3.86 SB 0.48 p 0.027, transferrin saturation 25.5 12.0 to 274.0 and 21.95 5.8 to 84.2 p 0.004, the phosphate level 5.82 SB 1.68 and 5.82 SB 1.68 p 0.026. The TIBC level 235.20 55.72 SB and 273.73 58.29 SB p 0.004 was significantly higher in group HD thrice a week. In twice a week HD group 68 reached Kt V 1.8, 93.3 of HD thrice a week achieved Kt V 1.2. Quality of life between the two groups was not significant either on Physical Componet Score PCS p 0.227, Mental Component Score MCS p 0.247 and Kidney Disease Component Score KDCS p 0.889.

Conclusion. There were significantly higher in group HD twice a week on examination IDWG, albumin, transferrin saturation and phosphate levels, whereas the TIBC was higher in group HD three times a week. Quality of life of the two groups was not significant difference."

"[ABSTRAKLatar Belakang. Pendekatan holistik di bidang Psikosomatik menekankan faktor spiritualitas dan dukungan pada sisi spiritualitas dapat meningkatkan pelayanan serta memperbaiki kondisi psikologis pada pasien. Selama prosedur hemodialisis respon inflamasi akan meningkat dibuktikan dengan peningkatan konsentrasi interleukin-6 (IL- 6). Aspek spiritual yang dapat menurunkan respon inflamasi masih perlu diteliti.Tujuan. Untuk mengetahui gambaran aspek spiritual pasien yang menjalani hemodialisis kronik dan untuk mengetahui korelasi aspek spiritual dengan kadar IL-6 serum pada pasien yang menjalani hemodialisis kronik.Metode. Penelitian ini merupakan studi cross sectional dilakukan pada 51 pasien hemodialisis kronik di unit Hemodialisis RSUP. H. Adam Malik dan RSU. Dr. Pirngadi Medan mulai bulan Juli-Agustus 2014. Pemeriksaan kadar IL-6 serum diukur dengan metode quantitative enzyme-linked immunosorbent assay (ELISA) dilakukan pengambilan sampel darah dan pengukuran spiritual dilakukan dengan pengisian kuesioner FACIT Sp-12 pada pagi hari 30 menit sebelum hemodialisis berlangsung.Hasil. Skor subskala meaning (makna) 10.67 (SB 2.66), peace (damai) 9.63 (SB 2.19) dan faith (iman) 11.47 (SB 2.91). Nilai median kadar IL-6 serum pada penelitian ini adalah adalah 5,63 (1,48-28,88) pg/mL. Nilai median FACIT Sp-12 adalah 30,00 (18-48). Hasil uji korelasi antara tingkat spiritual dengan kadar IL-6 serum menunjukkan koefisien korelasi -0,330 dengan nilai p = 0,018 yang secara statistik menunjukkan korelasi negatif yang lemah.Simpulan. Spiritual pada pasien hemodialisis kronik tinggi. Terdapat korelasi negatif yang lemah antara aspek spiritual dengan kadar IL-6 pada pasien hemodialisis kronik.

---

ABSTRACTBackground: Holistic approach in psychosomatic focus on spirituality factor and spiritual support is expected to improve services and psychological condition of the patients. Inflammatory response during haemodialysis procedure hence increased with the evidence of increasing level of serum interleukin-6 (IL-6). Further research is still needed to see the spiritual factors that can decrease the inflammatory factors.Objective: To assess spiritual aspect of chronic haemodialysis patients and to assess correlation between serum IL-6 level and spiritual aspect in chronic haemodialysis patients.Methods: Cross sectional study on 51 chronic haemodialysis patients at RSUP. H. Adam Malik and RSU dr. Pirngadi Medan between July-August 2014. Serum IL-6 was measured using quantitative enzyme-linked immunosorbent assay (ELISA) methods. Blood samples and spiritual aspect assessment by handing out FACITSp-12 questionnaire to patients were taken in the morning, 30 minutes before haemodialysis.Results: . Subscale meaning 10.67 (SB 2.66), peace 9.63 (SB 2.19) and faith 11.47 (SB 2.91). Median serum IL-6 level is 5,63 ( 1,48-28,88 ) pg/mL. Median FACIT Sp-12 is 30,00 (18-48). Correlation test between serum IL-6 level and spiritual aspect have shown statistically weak negative correlation (correlation coefficient -0,330, p = 0.018).Conclusion: spirituality level in chronic hemodialysis patients are higher. Weak negative correlation between serum IL-6 level and spiritual level on chronic haemodialysis patients was found in this study.;Background: Holistic approach in psychosomatic focus on spirituality factor and spiritual support is expected to improve services and psychological condition of the patients. Inflammatory response during haemodialysis procedure hence increased with the evidence of increasing level of serum interleukin-6 (IL-6). Further research is still needed to see the spiritual factors that can decrease the inflammatory factors.Objective: To assess spiritual aspect of chronic haemodialysis patients and to assess correlation between serum IL-6 level and spiritual aspect in chronic haemodialysis patients.Methods: Cross sectional study on 51 chronic haemodialysis patients at RSUP. H. Adam Malik and RSU dr. Pirngadi Medan between July-August 2014. Serum IL-6 was measured using quantitative enzyme-linked immunosorbent assay (ELISA) methods. Blood samples and spiritual aspect assessment by handing out FACITSp-12 questionnaire to patients were taken in the morning, 30 minutes before haemodialysis.Results: . Subscale meaning 10.67 (SB 2.66), peace 9.63 (SB 2.19) and faith 11.47 (SB 2.91). Median serum IL-6 level is 5,63 ( 1,48-28,88 ) pg/mL. Median FACIT Sp-12 is 30,00 (18-48). Correlation test between serum IL-6 level and spiritual aspect have shown statistically weak negative correlation (correlation coefficient -0,330, p = 0.018).Conclusion: spirituality level in chronic hemodialysis patients are higher. Weak negative correlation between serum IL-6 level and spiritual level on chronic haemodialysis patients was found in this study., Background: Holistic approach in psychosomatic focus on spirituality factor and spiritual support is expected to improve services and psychological condition of the patients. Inflammatory response during haemodialysis procedure hence increased with the evidence of increasing level of serum interleukin-6 (IL-6). Further research is still needed to see the spiritual factors that can decrease the inflammatory factors.Objective: To assess spiritual aspect of chronic haemodialysis patients and to assess correlation between serum IL-6 level and spiritual aspect in chronic haemodialysis patients.Methods: Cross sectional study on 51 chronic haemodialysis patients at RSUP. H. Adam Malik and RSU dr. Pirngadi Medan between July-August 2014. Serum IL-6 was measured using quantitative enzyme-linked immunosorbent assay (ELISA) methods. Blood samples and spiritual aspect assessment by handing out FACITSp-12 questionnaire to patients were taken in the morning, 30 minutes before haemodialysis.Results: . Subscale meaning 10.67 (SB 2.66), peace 9.63 (SB 2.19) and faith 11.47 (SB 2.91). Median serum IL-6 level is 5,63 ( 1,48-28,88 ) pg/mL. Median FACIT Sp-12 is 30,00 (18-48). Correlation test between serum IL-6 level and spiritual aspect have shown statistically weak negative correlation (correlation coefficient -0,330, p = 0.018).Conclusion: spirituality level in chronic hemodialysis patients are higher. Weak negative correlation between serum IL-6 level and spiritual level on chronic haemodialysis patients was found in this study.]"

"Latar Belakang. Artritis Reumatoid AR merupakan penyakit kronik, sistemik. Depresi sering menyertai pasien AR sebanyak 20-30 . Derajat aktivitas penyakit AR dapat mempengaruhi terjadinya depresi. Tujuan. Mengetahui prevalensi depresi pada pasien AR dan mengetahui hubungan antara derajat aktivitas penyakit dengan depresi pada pasien AR. Metode. Penelitian ini merupakan studi potong lintang yang dilakukan dengan memeriksa pasien AR di poliklinik rematologi RSCM yang memenuhi kriteria inklusi dengan consecutive sampling selama periode Januari sampai Maret 2017. Pasien dinilai derajat aktivitas penyakitnya dengan menggunakan DAS 28 dan diminta untuk mengisi kuesioner BDI. Analasis statistik dilakukan dengan menggunakan metode chi-square. Hasil Penelitian. Pada studi ini, didapatkan hasil bahwa prevalensi depresi pada pasien AR di RSCM adalah 35,9 dengan interval kepercayaan 95 sebesar 30 ndash; 42 . Derajat aktivitas penyakit memiliki hubungan yang bermakna dengan depresi pada pasien AR. p = 0,001. Kesimpulan. Prevalensi kejadian depresi pada pasien AR di RSCM pada adalah sebesar 35,9 . Derajat aktivitas penyakit memiliki hubungan yang bermakna dengan depresi pada pasien AR.

---

Background. Rheumatoid Arthritis RA is a chronic, systemic disease that cause synovial inflammation and progressive destruction to cartilages and deformities. Prevalence of depression in RA patients is 20 to 30 . Disease activity is considered to have relation with depression.

Objective. To identify the prevalence of depression in RA patients and to identify association between disease activity index and depression in RA patients.

Method. A cross sectional study of 145 RA patients that fulfilled the inclusion and exclusion criteria was held in Rheumatology Outpatient Clinic at RSCM from January to March 2017. Evaluation of DAS 28 and BDI was done to the patients. Chi square method was used to analyse the statistic.

Results. The prevalence of depression in RA patients at RSCM is 35,9 with 95 confidence of interval 30 42 . There is significant relation between disease activity with depression in rheumatoid arthritis patient p 0,001.

Conclusion. The prevalence of depression in RA patients at RSCM is 35,9 . There is significant relation between disease activity with depression in RA patients. "

"ABSTRAKLatar Belakang: Muatan besi berlebih adalah kondisi yang akan terjadi pada penderita thalassemia yang bergantung transfusi. Muatan besi berlebih yang terjadi progresif akan menimbulkan kerusakan organ akibat toksisitas besi. Banyak ditemukan kelainan tulang pada penderita thalassemia seperti perawakan pendek, facies cooley atau fraktur spontan, tetapi sampai saat ini hanya sedikit penelitian yang secara khusus mencari efek toksisitas besi di tulang pada penderita thalassemia dewasa.Tujuan: Mengetahui peran toksisitas besi pada penurunan densitas tulang penderita thalassemia dewasa yang bergantung transfusiMetode: Studi potong lintang dilakukan terhadap penderita thalassemia mayor dan intermedia dewasa yang mendapat transfusi rutin di RSUPNCM Jakarta dari Agustus sampai Oktober 2016. Dilakukan pemeriksaan kadar besi yaitu saturasi transferrin ST dan ferritin serum, pemeriksaan Dual X-ray Absorbtiometry DXA untuk menilai densitas masa tulang BMD dan rontgen pelvis untuk menilai indeks femoral Singh. Analisis dilakukan untuk mengetahui korelasi antara ST atau ferritin dengan nilai BMD, korelasi antara indeks femoral Singh dengan BMD dan pencarian titik potong ST atau ferritin untuk membedakan densitas tulang rendah dan normal pada penderita thalassemia mayor dan intermedia dewasa dengan menggunakan receiver operating curve ROC .Hasil: Sebanyak 60 penderita usia 18-68 tahun, 32 adalah penderita thalassemia mayor dan 68 adalah penderita intermedia dewasa yang mendapat transfusi minimal sekali tiap bulan dengan rerata Hb pre-transfusi sebesar 8.08mg/dL. Sebanyak 68 penderita memiliki densitas tulang rendah. Didapatkan nilai median ST 86 20-112 , median dari rerata nilai ferritin setahun yaitu 3881 ng/mL 645-15437ng/mL , median nilai BMD terendah -1.1 -5.7- -2.6 . Didapatkan korelasi negatif secara bermakna antara ST dengan nilai BMD r=-0.329, nilai p=0.01 , namun tidak didapatkan korelasi yang bermakna antara ferritin dengan nilai BMD r=-0.088, nilai p=0.504 serta tidak ditemukan korelasi yang bermakna antara indeks femoral Singh dengan BMD r=0.273, nilai p= 0.038 . Kurva ROC, nilai ST didapatkan area dibawah kurva AUC 0.727 dengan titik potong ST 89.5 untuk membedakan densitas tulang rendah dan normal Kesimpulan: Kejadian densitas tulang rendah pada penderita thalassemia adalah sebesar 68 . Terdapat korelasi terbalik yang signifikan antara ST dan nilai BMD dengan nilai titik potong ST 89.5 untuk membedakan densitas tulang rendah dan normal pada thalassemia dewasa"

---

""ABSTRACT"Background Iron overload is a complication experienced by transfusion dependent thalassemia TDT patients. Progressive iron accumulation results in tissue damage referred as iron toxicity. Bone deformities complication such as short stature, cooley rsquo s face and fracture are also commonly found among TDT patients but only few studies has been conducted to evaluate the effect of direct iron toxicity in bone among such population.Objective To determine the role of iron toxicity in low bone mass density among transfusion dependent thalassemia patients.Methods Cross sectional study conducted among major and intermedia thalassemia patients whom regularly received blood transfusion in CiptoMangunkusumo Central Hospital Jakarta between August to October 2016. Level of transferrin saturation TS and ferritin were measured as indicator of body iron level while dual x ray absorptiometry were measured to evaluate bone mass density BMD and pelvic X ray to evaluate Singh femoral index. Statistical analysis were conducted to evaluate correlation between TS or ferritin to BMD, correlation between Singh index and BMD and to determine the best cutoff value of TS or ferritin to differentiate between normal to low bone mass density among TDT patients using receiver operating curve ROC Results Total of 60 patients between 18 68 years old, 32 were thalassemia major patients, 68 were transfusion dependent thalassemia intermedia patients. Mean pre transfusion HB were 8.08mg dL, and as much as 68 subjects had low bone density. Median value of TS was 86 20 112 , median value of ferritin was 3881ng mL 645 15437ng mL , median value of the lowest BMD score was 1.1 5.7 2.6 . Significant reverse correlation between BMD score and TS was found r 0.329 p value 0.01 but no correlation with ferritin r 0.088, p value 0.504 nor correlation to Singh femoral index r 0.273, p value 0.038 . ROC curve analysis showed with area under the curve AUC 0,727, the best cutoff TS to differentiate normal to low bone density was 89.5 Conclusion Low bone mass density is a common complication of thalassemia major and transfusion dependent thalassemia intermedia. Reverse correlation between BMD score and TS with cutoff value of TS 89.5 to to differentiate normal to low bone density"

"ABSTRAKLatar belakang Major adverse cardiovascular events (MACE) masih menjadi target yang dicegah dalam tata laksana sindroma koroner akut (SKA). Rasio netrofil-limfosit (RNL) terkait dengan dampak atau prognosis pada pasien dengan penyakit ini. Kondisi psikologis berperan sebelum, selama dan setelah infark. Psikoterapi suportif singkat (PSS) ditujukan untuk membangun kepercayaan diri, mengurangi cemas dan memperbaiki mekanisme koping terhadap penyakit ini.Tujuan Penelitian ini bertujuan membandingkan pengaruh PSS terhadap MACE, RNL dan gejala psikis pada pasien SKA yang dirawat di Intensive Cardiac Care Unit (ICCU).Metode Penelitian ini merupakan uji klinis random tidak tersamar ganda untuk membandingkan kelompok yang mendapat intervensi PSS dengan kontrol pada pasien SKA yang dirawat di ICCU RSUPN Cipto Mangunkusumo mulai 18 April hingga 30 Juli 2019 terhadap MACE, RNL dan gejala psikis. Intervensi PSS berlangsung 5 sesi selama rawatan di ICCU, kelompok PSS dan kontrol akan difollow-up pada saat sebelum pulang rawatan terhadap MACE (fatal aritmia, infark miokard rekuren, syok kardiogenik dan kematian), RNL dan gejala psikis yang diukur menggunakan inventori Hospital Anxiety Depression Scale (HADS). Data dianalisis menggunakan uji Chi square dan t tidak berpasangan untuk distribusi normal dan uji Fisher dan Mann-Whitney untuk yang tidak terdistribusi normal.Hasil Hasil menunjukkan kelompok PSS terdapat 32 pasien, dan kontrol sejumlah 35 pasien. Median usia sebesar 55 (32-86) tahun. Proporsi lelaki sebesar 74,6%. Rerata lama rawatan ICCU yaitu 5 (2-13) hari. Tidak ada kejadian MACE, namun insiden major adverse event lain (stroke) 3,13% pada PSS dan 5,71% pada kontrol. Rerata RNL kelompok PSS sebesar 3,35(2,26) dan kontrol 3,63(1,79), p 0,346 (95% KI -1,27-0,71). Delta rerata RNL 1,49, p 0,098 (95% KI -0,69 - 3,67); tanpa CHF 3,87(5,48), 0,33(2,54) pada kontrol, p 0,007 d 0,79; tanpa CAD 3,88(4,55), 0,84(2,51) pada kontrol, p 0,014, d 0,77. Rerata skor HAD-Ansietas kelompok PSS sebesar 4,63(3,52) dan kontrol 4,31(2,62), p 0,874 (95% KI -1,19 - 1,82). Delta rerata skor HAD-Ansietas sebesar -0,01, p 0,988 (95% KI -1,74-1,71). Rerata skor HAD-Depresi kelompok PSS sebesar 4,91 (2,63) dan kontrol 4,37 (3,05), p 0,447 (95% KI -0,86 - 1,93). Delta rerata skor HAD-Depresi sebesar 1,62, p 0,149 (95% KI -0,17 -3,41); dengan CHF 1,73(3,58), -1,27(2,8) pada kontrol, p 0,041, d 0,86; dengan CAD 2,08(3,4), -0,8(3,3) pada kontrol, p 0,035, d 0,80.

---

ABSTRACTBackground Major adverse cardiovascular events (MACE) is still the preventive target in management acute coronary syndrome (ACS). Neutrophil-lymphocyte ratio (NLR) is regarded to the impact or prognosis in this patients. Psychological conditions play a role before, during and after infarction. Brief supportive psychotherapy (BSP) is stressed in terms of building confidence, reduce anxiety and improve coping mechanisms of this illness.Aim The present study aims to compare influence of BSP on MACE, NLR, and psychological symptom in ACS patients to control one in ICCU.Method The study is a double opened clinical randomized study which was compared with controls before and after intervention to observe the influence of BSP on the patients with ACS who were treated in ICCU of RSUPN Cipto Mangunkusumo - Jakarta in April, 18th to July, 30th 2019 on MACE, NLR and psychological symptom. The BSP intervention was about 5 sessions as long as inpatient in ICCU, the BSP group and the control ones would be followed by the end of the day in ICCU for the MACE (fatal arrhythmias, recurrent myocardial infarction, cardiogenic shock, and death), NLR, and psychological symptom which it was measured with hospital anxiety depression scale (HADS) inventory. Data were analyzed with Chi square and independent t-test for normally distributed data and Fisher and Mann-Whitney test for abnormally ones.Results The study results showed 32 patients in brief supportive psychotherapy group and 35 patients in control one. The median age was 55(32 - 86) years old. The male proportion was 74,6%. The median length of stay in ICCU was 5(2-13) days. There was no MACE, but incident of other major adverse event (stroke) 3,13% in BSP and 5,71% in control. The mean NLR was 3,35(2,26) in BSP group and 3,63(1,79) in control one, p 0,346 (95% CI -1,27 - 0,71). The mean delta of NLR was 1,49, p 0,098 (95% CI -0,69 - 3,67); without CHF 3,87(5,48), 0,33(2,54) in control group, p 0,007 d 0,79; without CAD 3,88(4,55), 0,84(2,51) in control one, p 0,014, d 0,77. The mean of HAD-Anxiety score was 4,63(3,52) in BSP group and 4,31(2,62) in control one, p 0,874 (95% CI -1,19 -1,82). The mean delta of HAD-Anxiety score was -0,01, p 0,988 (95% CI -1,74 - 1,71). The mean of HAD-Depression score was 4,91(2,63) in BSP group and 4,37(3,05) in control one, p 0,447 (95% CI -0,86 - 1,93). The mean delta of HAD-Depression score was 1,62, p 0,149 (95% CI -0,17 - 3,41); with CHF 1,73(3,58), -1,27(2,8) in control group, p 0,041, d 0,86; with CAD 2,08(3,4), -0,8(3,3) in control one, p 0,035, d 0,80. Conclusions There was no MACE, but stroke incident lower in BSP than control one. There was influence of BSP on NLR in ACS patients without CHF or CAD, and psychological symptom in ACS ones with CHF or CAD."