Vol. 21 No. 2, Page 47-78

January 1, 2002

Influence of fasting during Ramadhan on clinical status of type-2 Diabetic patients

By Yosephine*, Rajaselvam**, Artati**, Inestia**, Nailahj**, Adi Hidayat**

        Fasting during Ramadan represents a recurring annual event in the life of a Muslim. A Muslim is required to abstain from any oral intake for an average of 13 h daily during this month. Therefore we conducted a study on 57 type 2 diabetic patients to observe the clinical effects of fasting. Patients who fasted in the month of Ramadan were recruited to the study before Ramadan and were asked to note any episodes that might indicate hypoglicemia. Non-fasting blood sugar levels were measured before and during Ramadan using capilliray blood samples. Before fasting the mean non-fasting blood sugar level was 194,05 ± 84,70 mg/dl and 200,40 ± 89,03 mg/dl for the month of Ramadan. There was no statistically significant difference between the mean before and during Ramadan. No statistically siginificant changes of hypoglicemic episodes during Ramadan. Base on these findings, it was concluded that for most type 2 diabetic patients, is not a contra indication to fasting in Ramadan. They did like their normal counterparts during fasting and could be encouraged to do so provided they are clinically stable.

Language : Indonesia

Occupational health and safety profile of a men’s underwear factory in Jakarta

By Rina K. Kusumaratna

The objective of this study was to determine the extent of occupational health and safety practices in the garment manufacturing industry. The method was a descriptive cross-sectional study. The study was conducted at factory “X” in South Jakarta. The survey instrument used closed-ended questionnaire adopted from ILO/RI Ministry of Manpower, which focused on health and safety hazards, workplace ergonomics, as well as work site sound, dust and light threshold values. The 34 respondents interviewed were company management, field supervisors and sampled workers. Main product of the factory was men underwear such as Underpants/pantray and Sleeveless/undershirt. Type of work was office work and production work. Company management provided social and health coverage for workers. Sanitation, health and safety facilities were available in the factory. Inadequate lighting, high temperature, cotton and string dust were potential hazard found in the workplace. The workers rarely used personal protective equipment. Prevalence of respiratory disease among workers was 25%. Most employees adopted non-ergonomic posture during working at 4 worksite units. Workers complained of low back pain and dizziness was 30%. It is recommended that health promotion should focus on the use of protective equipment for disease prevention. Workplace facilities should fulfill standard ergonomic criteria.

Language : English

Detection and management of dysfunctional uterine bleeding

By Maria Magdalena Tan

Dysfunctional uterine bleeding is best defined as vaginal bleeding without an apparent organic cause in a patient who is not taking the oral contraceptive pill. It is important to exclude the abnormal bleeding associated with contraceptive pill ingestion as the evaluation and treatment of this is different from that of patients with DUB. Dysfunctional uterine bleeding is a very common problem during the two extremes of a female’s reproductive life. This is due to the frequent anovulatory cycles during this time. Dysfunctional uterine bleeding is a diagnosis by exclusion. It may present with any abnormal pattern of uterine bleeding although most commonly it is bleeding which is excessive, either in amount, duration or frequency. Finland had demonstrated that in the first 2 years after menarche, 55-82% of cycles was anovulatory. However, some of these girls may still have regular menstrual bleeding. It has been postulated that the group of adolescents with DUB may be due to a delayed maturation of normal negative feedback cyclically. The underlying etiology of this problem in the adolescent age group is thought to be anovulation secondary to hypothalamic-pituitary dysfunction. Unopposed fluctuating levels of estrogen result in unregulated endometrial growth with irregular shedding leading to bleeding episodes of varying severity. The bleeding pattern is heavy, prolonged and irregular bleeding. The management of DUB depends on the severity of the bleeding and the gynecological age of the girl.

Language : English

Adavantage of Enhanced external counterpulsation (EECP) for ischaemic heart disease patients

By Sutopo Widjaja

Ischemic heart disease (IHD) is one of the most attractive diseases in the world. The management of IHD can be categorized into invasive and non-invasive. Enhanced external counterpulsation (EECP) is a non-invasive, outpatient measure, aimed at reducing angina attack by enhancing the decrease blood supply to myocardium due to narrowing or closure of coronary arteries. The basic concept of EECP was derived from the United States. Clinical trial were conducted in the USA since 1962, modified and improved further by Chinese scientists. Till now the results of multicenter trial showed that EECP is beneficial for reducing angina attack in IHD patients that cannot be controlled by medication or failed after invasive measures. The effectiveness of EECP has been objectively evaluated by (1) thallium stress test, (2) treadmill, (3) post EECP major adverse cardiovascular events, (MACE) evaluation, (4) colour Doppler imaging dan duplex ultrasonography, and (5) nitrogen-13 (13N) ammonia positron emission tomography (PET). The success rate ranged 74 – 81 % and the benefit lasts 5 years. Reports from other studies showed EECP is useful for ischemic stroke, renal ischemic disease and erectile dysfunction. The rate of D/S ratio not less than 1.2 is the absolute condition that EECP treatment will give optimal benefit, although some reports it between 1.5 - 2.0.

Language : Indonesia

Istanbul Protocol for management of torture victims

By A. Prayitno

        Even though Human Rights and International Humanitarian Law has consistently forbid all forms of torture, ill treatment is still practiced in almost all countries in the world today. In 1997 ill treatment has been reported in 117 countries done by police and security forces. In the last two decades much has been studied on torture and its effects, but no international guidelines has been available until the issuance of the Istanbul Protocol. The protocol principles include minimal standards so that countries are able to compile effective torture document. This protocol has been compiled for 23 years and consists of analysis, research, and document compilation of more than 75 experts in the field of law, health, and human rights representing 40 organizations and institutions from 15 countries. Definition of torture of the 1975 Tokyo Declaration of the World Medical Association, is a deliberate, systematic and inhumane act that causes physical and mental burden on an individual or persons done individually or as ordered by authority to force people to provide information, admittance or for other reasons.

Language : Indonesia

Relation between mental disturbance and hip fracture in older persons

By Suharko Kasran

Hip fracture is a leading health problem in the elderly. Increased rsik fracture may be attributable to reduced bone mass, reduced quality of bone, or factors associated with trauma and falling. Hip fractures have become the international barometer of osteoporosis since they are strongly related to low bone mineral density. The most prevalent mental health problem of elderly people is depression. And depression is the risk factor most frequently associated with suicide. Studies have suggested the relation between mental distress and low bone density. Depresssed women had a 40% increased rate of fracture compared with non-drepressed women Increasing age is associated with increasing apathy, psychomotor retardation, schizophrenia and cognitive function. The use of psychotropic drugs may increase the risk of falling and consequently the risk of hip fracture. The adverse effect of mental distress on risk of hip fracture may act through several mechanisms. Medication induce dizziness and increase risk of falling. Another possible mechanism may be an increased level of cortisol and neglecting health behaviour.

Language : Indonesia