HUBUNGAN HBA1C DENGAN TRIGLISERIDA, LDL-K DAN APO B PADA PENDERITA DM DENGAN KOMPLIKASI JANTUNG KORONER

Background: Glycated hemoglobin (HbA1C) can reflect cumulative blood glucose in period of 2-3 months. Dyslipidemia in diabetes have characteristics by increased levels of triglycerides (TG), low density lipoprotein cholesterol (LDL-C) and decreased high density lipoprotein cholesterol (HDL-C). LDL-C is a lipoprotein proatherogenic, and each LDL-C has apolipoprotein B (apo B) which is an atherogenic particles. Increased HbA1C, TG, LDL-C and apo B in DM facilitate the occurrence of coronary heart disease (CHD). Objective: To determine whether there are any correlations of HbA1C level with TG, LDL-C and apo B in diabetic patients with CHD complications. Methods of research: A cross-sectional study was performed on thirty diabetic patients with CHD complications. HbA1C level test was done by ion-exchange HPLC method, TG and LDL-C levels were using colorimetric enzymatic method and apo B level using immunoturbidimetry method. Statistical analysis between the variables were analyzed using Pearson correlation test. Results: The HbA1C level <7% by 6 respondents (20%) and HbA1C ≥7% by 24 respondents (80%). The mean of HbA1C level is 8,72%, TG is 182,54 mg/dl, LDL-C is 110,64 mg/dl and apo B is 111,88 mg/dl. The relationship between HbA1C with TG has r=0.375, p=0.021, HbA1C with LDL-C has r=0.283, p=0.650 and HbA1C with apo B has r=0.574, p=0.000. Conclusion: The HbA1C levels showed a moderate positive correlation with TG levels, HbA1C levels showed a strong positive correlation with apo B levels but there is no correlation with LDL-C levels. Keywords: DM, CAD, HbA1C, TG, LDL-C, a

Determinants of coronary heart disease among adults: a case-control study

Background According to recent World Health Organization data, coronary heart disease (CHD) remains the leading cause of death worldwide. Although the risk factors of this disease are well known, the strength of these factors varies in different populations. The aim of the study was to assess the determinants of CHD in Indonesian adults aged 25 years and over. Methods A case–control study was carried out involving 592 subjects aged 25 years and over (444 controls and 148 cases). Participants were interviewed using validated questionnaires. Physical examinations and supporting examinations were conducted. The Chi square test, Fisher’s exact test, and independent t test were used to analyze the data. To determine independent predictors of CHD, the odds ratio (OR) was determined via the multiple logistic regressions test. Results The CHD subjects (case group) showed higher blood sugar and systolic pressure than non-CHD subjects (controls), with mean fasting blood sugar of 92.53±27.05 mg/dL vs 88.29 ±23.43 mg/dL (p=0.038), 2-hour postprandial blood sugar of 133.15±65.09 mg/dL vs 120.87±44.60 mg/dL (p=0.000), and systolic blood pressure of 89±27.62 mmHg vs 129.98±10.58 mmHg (p=0.002). The logistic regression analysis in the case group showed that higher education (college) had a 2.32-fold greater effect (95% CI. 1.01-5.35) on CHD incidence compared to the control group. Conclusions This study has demonstrated that the most frequent risk factor for CVD in adults aged 25 years and over is higher education. Control and prevention of CHD need to be done with regular control of blood sugar levels and blood pressure to stabilize them within normal limits

Prediktor Sindrom Metabolik : Studi Kohor Prospektif Selama Enam Tahun di Bogor, Indonesia

Abstract The prevalence of metabolic syndrome (MS) in the world is between 20-25%, whereas in Indonesia 23.34%, is higher in men (26.2%) than in women (21.4%). SM is predicted to cause a two-fold increase in the risk of heart disease and five-fold in type 2 diabetes mellitus. There are no data on MS incidents in Indonesia. The aim of this study was to determine MS predictor and hazard rate from predictor factors during the six-years follow up in Bogor city. This study is a sub sample of data “Cohort Study of Non Communicable Disease Risk Factors” in Bogor City conducted in 2017. The sample taken is respondents who meet the criteria of MS in accordance with NCEP/ATP III. A total of 4,215 samples that were MS free at baseline were analyzed. Data were collected by interview, physical measurement and laboratory examination every two years during the six year follow-up (2011-2017). Bivariate analysis was performed to obtain a significant p value, followed by multivariate analysis with cox regression to see the hazard rate (HR). The result is the incidence of MS was 56 person years per 10.000 population, during 6 yeras observation. After adjusting for age, the MS were women with predictor or HR 4.78 (95% CI 1.11 – 20.56) and carbohydrate intake with HR 2.99 (95% CI 1.28 – 6.98). Women was main predictors of MS after controlling carbohydrate intake among people aged 25 years and above.To control of carbohydrate intake among women is a priority of MS control programs in community. Predictors for the incidence of SM women at risk were 4.78 times compared to men and carbohydrate consumption was 2.99 times. Abstrak Prevalensi sindrom metabolik (SM) di dunia antara 20-25%, sedangkan di Indonesia 23,34%, lebih tinggi pada laki-laki (26,2%) dibandingkan pada perempuan (21,4%). SM diprediksi menyebabkan kenaikan dua kali lipat risiko terjadinya penyakit jantung dan lima kali lipat pada penyakit diabetes melitus tipe 2. Belum ada data insiden SM di Indonesia. Tujuan penelitian untuk menentukan variabel prediksi responden SM dan mendapatkan hazard rate dari faktor prediktor selama follow up enam tahun di Kota Bogor. Penelitian ini merupakan sub sampel data “Studi Kohor Faktor Risiko Penyakit Tidak Menular” di Kota Bogor yang dilakukan pada tahun 2017. Sampel yang diambil adalah responden yang memenuhi kriteria SM sesuai NCEP/ATP III. Sebanyak 4.215 sampel yang bebas SM saat baseline, dianalisis. Data dikumpulkan dengan metode wawancara, pengukuran fisik dan pemeriksaan laboratorium setiap dua tahun selama follow up enam 6 tahun (2011-2017). Analisis bivariat dilakukan untuk mendapatkan nilai p yang bermakna, dilanjutkan dengan analisis multivariat dengan regresi cox untuk melihat hazard rate (HR). Hasil penelitian menunjukkan insiden SM sebesar 56 per 10.000 penduduk selama enam tahun pengamatan. Setelah di disesuaikan dengan umur maka HR atau prediktor SM adalah perempuan 4,78 (95% CI 1,11 – 20,56) dengan p = 0,03 dan asupan karbohidrat 2,99 (95% CI 1,28 – 6,98) dengan p = 0,01. Wanita dan asupan karbohidrat adalah prediktor untuk SM pada responden berusia 25 tahun ke atas. Kontrol asupan karbohidrat pada wanita merupakan prioritas program pengendalian sindrom metabolik di masyarakat. Prediktor untuk kejadian SM wanita berisiko sebesar 4,78 kali dibanding dengan laki laki dan komsumsi karbohidrat 2,99 kali

Penanganan Balita Gizi Buruk di Puskesmas Provinsi Banten, Jawa Barat, Kalimantan Barat, dan Nusa Tenggara Timur

Abstrak Masalah balita gizi buruk cenderung menurun pada tahun 2018, namun di beberapa daerah kasus gizi buruk meningkat menjadi KLB. Salah satu penanganannya melalui pemulihan di puskesmas. Tujuan penelitian ini untuk mengetahui sejauh mana penanganan gizi buruk dilakukan oleh tenaga kesehatan puskesmas dan kader posyandu. Desain penelitian menggunakan pendekatan mix methods, berlokasi di Kalimantan Barat, Banten, Jawa Barat dan Nusa Tenggara Timur. Dua kabupaten dipilih dari masing-masing provinsi, selanjutnya dari tiap kabupaten diambil satu puskesmas yang banyak kasus gizi buruk. Informan penelitian adalah Tenaga Pelaksana Gizi (TPG) puskesmas dan kader posyandu. Data yang dikumpulkan meliputi pelayanan gizi dan kesehatan, makanan terapi, dan penyuluhan serta peranan kader. Cara pengumpulan data dengan wawancara, in-depth interview dan diskusi kelompok terarah. Analisis data kuantitatif disajikan secara deskriptif dan kualitatif dengan content analysis. Hasil penelitian menunjukkan sebagian besar puskesmas di daerah penelitian menangani gizi buruk dengan cara rawat jalan. Belum semua TPG puskesmas mendapat pelatihan gizi buruk, hanya sebagian puskesmas menggunakan makanan terapi sedangkan lainnya menggunakan makanan tambahan yang tidak sesuai dengan pedoman. Dukungan sebagian kader dalam penanganan gizi buruk di puskesmas berupa penemuan kasus gizi buruk dan merujuknya, membagikan PMT ke rumah balita. Penanganan balita gizi buruk di puskesmas belum optimal karena tidak didukung dengan ketersediaan input berupa makanan terapi dan belum semua TPG mendapat pelatihan gizi buruk. Pelatihan gizi buruk untuk tenaga puskesmas perlu ditingkatkan dan sistem pengadaan makanan terapi di daerah perlu diperbaiki, agar kualitas pelayanan gizi buruk menjadi lebih baik. Kata kunci: gizi buruk, TPG, PMT, sistem pengadaan, pelayanan kesehatan Abstract The problem of severe malnutrition children under five years old tends to decline in 2018. One of the treatment measures was through recovery at the health center. The purpose of this study was to evaluate the extent to which severe malnutrition children was handled by health center nutrition officer and posyandu cadre. Mix methods approach was used as research design and the study was located in West Kalimantan, Banten, West Java and East Nusa Tenggara Provinces. Two districts were chosen, then one health center from each district was selected based on the highest severe malnutrition cases. The informants were nutrition officer of health center and posyandu cadres. The data collected were nutrition and health services, therapeutic food, counseling, and the role of cadres. Data was collected through interview, in-depth interview, and focus group discussion. Quantitative data analysis was presented descriptively and qualitative data was presented with content analysis.The majority of health centers handled severe malnutrition children in outpatient treatment setting. Not all nutrition officer of health centre have received training in handling severe malnutrition. Only some health centers used therapeutic food while others used supplementary foods that was not recommended. The support of cadre was seen in the form of finding cases of malnutrition and distributing supplementary food to the malnourished children’s homes. The handling of malnourished children in health centers was not optimal, because it was not supported by the availability of therapeutic food and not all nutrition officer have been trained. For recommendations, nutrition training for health center staff needs to be increased and the system for provision therapeutic food in the regions needs to be improved in order to improve the quality of nutrition services. Keywords: severe malnutrition, health center nutrition officer, mix methods, indepth interview, content analysi

Psychological distress and dyslipidemia in adult women: A 6-years follow up study in Bogor City, Indonesia

BACKGROUND Dyslipidemia is of global occurrence, with a prevalence 30% or higher in several countries, including Indonesia. One risk factor of dyslipidemia is physical or mental stress, that is more frequent in women. This study aimed at investigating the association between psychological distress and dyslipidemia in adult women. METHODS This observational longitudinal study involved 1850 women aged 25 years and older at baseline. Dyslipidemia was determined from the ratio of low- density lipoprotein to high-density lipoprotein. Psychological distress was determined using the 20-item self-reporting questionnaire. Data analysis was by Cox regression for calculating the hazard ratio of the incidence of dyslipidemia as predicted by the psychological distress. RESULTS Among the 1474 participants without dyslipidemia at baseline, 545 (36.9%) developed dyslipidemia during 6 years of monitoring, while 93 (6.3%) had a history of psychological distress. There was a significant association between psychological distress and dyslipidemia (HR = 3.08; 95% CI: 2.33- 4.07). Cox regression revealed that the association was still found to be significant after a further adjustment for the variables of age, BMI, menopause, smoking status, physical activity, and carbohydrate and fat intakes (HR=2.8; 95% CI: 2.10 - 3.77). CONCLUSIONS Dyslipidemia incidence was high among adult women in Bogor. Women with psychological distress had higher incidence rates of dyslipidemia than women without psychological distress. Psychological distress in women was statistically significantly associated with incidence rate of dyslipidemia. This finding highlights the importance of the need for a dyslipidemia- reduction program in women through prevention and control of psychological distress

Korelasi Hemoglobin A1c dengan Hemoglobin dan Laju Filtrasi Glomerulus Penderita Diabetes dengan dan tanpa Komplikasi Gagal Ginjal Kronik di Bogor

Diabetes mellitus type 2 (T2DM) is a chronic disease and can cause complications, one of which is decreased kidney function. Anemia is a complication of T2DM, especially if it is accompanied by renal disorders. The aim of this study was to show the relationship between HbA1c and hemoglobin (Hb), hematocrit (HCT), creatinine, and glomerular filtration rate (GFR) in T2DM respondents with and without complications of chronic renal failure (CRF). This study used a subset of the Non-Communicable Diseases cohort data set by the Center for Public Health Efforts in Central Bogor sub-district, Bogor City. The research design was an analytic observational study. Respondents were all T2DM with complete data as much as 303 people. The respondents diagnosed based on the results of previous blood sugar tests. The inclusion criteria were people with T2DM who had complete data (HBA1c, Hb, HCT, and creatinine). Bivariate analysis between the dependent variable (T2DM with or without CRF) and the independent variable (HbA1c, Hb, HCT, creatinine, and LFG) used the Spearman correlation. The results showed a strong positive correlation between HbA1c and Hb (r = 0,66, p&lt;0,05) and HCT (r = 0,67, p&lt;0,05)in T2DM respondents with CRF, but there is no correlation between HbA1c and creatinine and LFG. In T2DM without CRF there is a weak positive correlation between HbA1c and Hb (r = 0,26, p&lt;0,05) and HCT (r = 0,21, p&lt;0,05), a negative correlation between HbA1c and creatinine (r = -0,29, p&lt;0,05), and there is a weak positive correlation between HbA1c and LFG (r = 0,24, p&lt;0,05 ). The conclusion is that controlling blood sugar by examining HbA1c levels shows a strong positive correlation with Hb levels and HCT in T2DM with CRF and a weak negative correlation with LFG in T2DM without CRF. This difference is not in accordance with the existing theory Abstrak&nbsp; Diabetes melitus tipe 2 (DMT2) merupakan penyakit kronik dan dapat menimbulkan komplikasi, salah satunya adalah penurunan fungsi ginjal. Anemia merupakan komplikasi DMT2 khususnya jika disertai gangguan renal. Tujuan penelitian ini menunjukkan hubungan hemoglobin A1c (HbA1c) dengan hemoglobin (Hb), hematokrit (HCT), kreatinin, dan laju filtrasi glomerulus (LFG) pada responden DMT2 dengan dan tanpa komplikasi gagal ginjal kronik (GGK). Penelitian ini menggunakan subset data kohor penyakit tidak menular (PTM) yang dilakukan oleh Puslitbang Upaya Kesehatan Masyarakat di Kecamatan Bogor Tengah, Kota Bogor. Desain penelitian adalah studi observasional analitik. Responden adalah semua penderita DMT2 dengan data lengkap sebanyak 303 orang yang didiagnosis berdasarkan hasil pemeriksaan gula darah sebelumnya. Kriteria inklusi adalah penderita DMT2 yang memiliki data lengkap (HbA1c, Hb, HCT, dan kreatinin). Analisis bivariat antara variabel dependen (DMT2 dengan atau tanpa GGK) dengan variabel independen (HbA1c, Hb, HCT, kreatinin dan LFG) mengunakan korelasi Spearman. Hasil penelitian menunjukkan pada responden DMT2 dengan GGK terdapat korelasi positif yang kuat antara HbA1c dengan Hb (r = 0,66, p&lt;0,05) dan HCT (r = 0,67, p&lt;.0,05). Sedangkan HbA1c dengan kreatin dan LFG tidak terdapat korelasi. Pada DMT2 tanpa GGK terdapat korelasi positif lemah antara HbA1c dengan Hb (r = 0,26, p&lt;0,05 ) dan HCT (r = 0,21, p&lt;0,05), terjadi korelasi negatif antara HbA1c dengan kreatinin sebesar (r = -0,29, p&lt;0,05), dan terdapat korelasi positif lemah antara HbA1c dengan LFG ( r = 0,24, p&lt;0,05 ). Simpulan yang dapat diambil adalah pengontrolan gula darah dengan pemeriksaan kadar HbA1c menunjukkan korelasi positif yang kuat dengan kadar Hb dan HCT pada DMT2 dengan GGK dan korelasi negatif lemah dengan LFG pada DMT2 tanpa GGK. Perbedaan tersebut belum sesuai teori yang ada

Gambaran Gangguan Fungsi Ginjal Kasus Baru Penderita Diabetes Melitus, Jantung Koroner, dan Strok pada Studi Kohor di Bogor Indonesia

One of the adverse effect of prolonged patients with diabetes mellitus (DM), coronary heart disease (CHD), and stroke was the emerge of chronic kidney disease (CKD) and it would be burden of the economic. The prognosis of CKD in new cases of DM, CHD, and stroke during followed up in Cohort Study Noncommunicable Disease Risk Factor in Bogor was not yet known. Aim to study was to obtain to CKD profile in DM, CHD, stroke, and comorbid incidences during Cohort Study Noncommunicable Disease Risk Factor. This article has been result of cross sectional further analysis of secondary data on 370 new cases of DM, CHD, and stroke that who were examined for blood creatinine levels and calculated eGFR on 2018 and 2019. DM was diagnosed from fasting glucose ≥126 mg/dl or post prandial glucose ≥200mg/dl. CHD was diagnosed by ECG examination and validated by cardiologist and stroke was diagnosed by anamnesis by a neurologist. The main variable is eGFR as an indicator of CKD which is the result of CKP-epi calculation based on creatinine levels in the blood. Other variables are age, sex, type of disease (DM, CHD, and stroke). Data were analyzed using chi-square test. The results showed that average age patients with CKD on new cases of DM, CHD, stroke, and comorbid in Bogor were 48.2 ± 8.6 years old. Proportions CKD on new cases of DM, CHD, strok and comorbid were 59.5%, 56.7%, 66.7% and 50.0%. CKD was higher in older woman than others. The prevalence of CKD was found very high in subjects with stroke, DM, CHD, and comorbid. So, it is necessary to prevent complications by early diagnosis of NCD with regular monitoring of kidney function by creatinine level test and avoid using drugs that caused kidney damage. Abstrak Salah satu komplikasi buruk dari penderita diabetes melitus (DM), penyakit jantung koroner (PJK), dan strok yang berkepanjangan adalah munculnya gangguan fungsi ginjal dan akan membebani ekonomi bagi penderitanya. Gambaran prognosis gangguan fungsi ginjal pada insiden DM, PJK, dan strok selama pemantauan Studi Kohor Faktor Risiko PTM (FRPTM) Bogor belum diketahui. Tujuan penelitian untuk mendapatkan gambaran gangguan fungsi ginjal pada kasus baru DM, PJK, dan strok yang muncul selama pemantauan Studi Kohor FRPTM. Artikel ini merupakan hasil analisis lanjut secara potong lintang dari data sekunder kasus baru (insiden) DM, PJK, dan strok pada Studi Kohor FRPTM sebanyak 370 subjek yang diperiksa kadar kreatinin darah dan dihitung eLFG pada tahun 2018 dan 2019. DM didiagnosis dari kadar gula darah puasa ≥126 mg/dl atau post prandial ≥200mg/dl. PJK dari hasil pemeriksaan EKG dan validasi dokter spesialis jantung dan strok hasil anamnesis oleh spesialis saraf dan sudah mengalami rawat jalan. Variabel utama adalah eLFG merupakan indikator terjadinya gangguan fungsi ginjal yang merupakan hasil hitung kadar kreatinin dalam darah dengan CKD-epi. Variabel lain adalah umur, jenis kelamin, jenis penyakit (DM, PJK, dan strok). Data dianalisis dengan uji chi-square. Hasil menunjukkan temuan gangguan fungsi ginjal pada penderita DM, PJK, strok, dan komorbid di Bogor berumur 48,2 ± 8,6 tahun dan proporsi masing-masing 59,5%, 56,7%, 66,7%, dan 50%. Subjek yang mengalami gangguan fungsi ginjal menunjukkan lebih banyak pada umur lebih tua dan perempuan. Tingginya proporsi gangguan fungsi ginjal pada penderita strok, DM, PJK, dan komorbid diperlukan pencegahan komplikasi sejak awal terdiagnosis PTM dengan memantau fungsi ginjal dengan pemeriksaan kadar kreatinin secara teratur, serta menghindari penggunaan obat yang menimbulkan kerusakan ginjal

Hubungan Antara HbA1c Dengan LDL-K dan Albuminuria pada Penderita DM dengan Riwayat Komplikasi Jantung Koroner

The prevalence of Diabetes Mellitus (DM) globally is elevated continually. Poor blood glucose control to diabetes patients caused both macrovascular complications (ex.coronary heart disease/CHD) and  microvascular complications (ex.nephropathy). Blood glucose controlled is need to be done in every 3 months regularly using HbA1C as a diabetic parameter, regarding to the high risk mortality of the complications. Low density lipoprotein cholesterol (LDL-C) is dyslipidemia  characteristics and LDL-C is a lipoprotein proatherogenic. Albuminuria test is also needed as an early marker of micro and macrovascular disorders, which reflects the general process of endothelial damages (vascular dysfunction).The aim of this study is to prove any relationship between HbA1C levels with LDL-C and albuminuria levels in diabetic patients with history of coronary heart complications.This study is performed an analytical observational study with cross sectional approach. Thirty diabetic patients with any history of CHD complications were enrolled, then laboratory analysis of HbA1C by ion exchange HPLC, LDL-C levels were using colorimetric enzymatic method and albuminuria test with  the photometric method. Differences between variables were analyzed using by Spearman correlation-testHbA1C levels in 10 patients (33,3 %) are &lt;7% and in 19 patients are ≥ 7% (66,7 % ). LDL-C (&lt;100mg/dl) in 13 patients (43,3%), LDL-C (≥100mg/dl) in 17 patients (56,7%), Normoalbuminuria (&lt; 20 mg/L ) in 11 patients (36.7%), albuminuria (≥20 mg/L) in 19 patients (63,3%).There is a moderate positive relationship between HbA1C and LDL-C levels (r=0.385, p=0.014) and a positive strong relationship between HbA1C and albuminuria levels (r=0.52, p=0.004).Conclusions: The higher HbA1C levels, the higher LDL-C and albuminuria levels would be

Efficacy and safety of artemisinin-naphthoquine <it>versus</it> dihydroartemisinin-piperaquine in adult patients with uncomplicated malaria: a multi-centre study in Indonesia

<p>Abstract</p> <p>Background</p> <p>A practical and simple regimen for all malaria species is needed towards malaria elimination in Indonesia. It is worth to compare the efficacy and safety of a single dose of artemisinin-naphthoquine (AN) with a three-day regimen of dihydroartemisinin-piperaquine (DHP), the existing programme drug, in adults with uncomplicated symptomatic malaria.</p> <p>Methods</p> <p>This is a phase III, randomized, open label using sealed envelopes, multi-centre, comparative study between a single dose of AN and a three-day dose of DHP in Jayapura and Maumere. The modified WHO inclusion and exclusion criteria for efficacy study were used in this trial. A total of 401 eligible adult malaria subjects were hospitalized for three days and randomly treated with AN four tablets single dose on day 0 or DHP three to four tablets single daily dose for three days, and followed for 42 days for physical examination, thick and thin smears microscopy, and other necessary tests. The efficacy of drug was assessed by polymerase chain reaction (PCR) uncorrected and corrected.</p> <p>Results</p> <p>There were 153 <it>Plasmodium falciparum</it>, 158 <it>Plasmodium vivax</it> and 90 <it>P. falciparum/P. vivax</it> malaria<it>.</it> Mean of fever clearance times were similar, 13.0 ± 10.3 hours in AN and 11.3 ± 7.3 hours in DHP groups. The mean of parasite clearance times were longer in AN compared with DHP (28.0 ± 11.7 hours <it>vs</it> 25.5 ± 12.2 hours, p = 0.04). There were only 12 PCR-corrected <it>P. falciparum</it> late treatment failures: seven in AN and five in DHP groups. The PCR uncorrected and corrected on day −42 of adequate clinical and parasitological responses for treatment of any malaria were 93.7% (95% Cl: 90.3–97.2) and 96.3% (95% Cl: 93.6–99.0) in AN, 96.3% (95% Cl: 93.5–99.0) and 97.3% (95% Cl: 95.0–99.6) in DHP groups. Few and mild adverse events were reported. All the abnormal haematology and blood chemistry values had no clinical abnormality.</p> <p>Conclusion</p> <p>AN and DHP are confirmed very effective, safe and tolerate for treatment of any malaria. Both drugs are promising for multiple first-line therapy policies in Indonesia.</p