Alamat Redaksi
Gedung KALBE
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E-mail: cdk.redaksi@yahoo.co.id
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Nomor Ijin
151/SK/DITJEN PPG/STT/1976 Tanggal 3 Juli 1976
Penerbit
Kalbe Farma
Pencetak
PT. Temprint
Susunan Redaksi
Ketua Pengarah
Dr. Boenjamin Setiawan, PhD
Pemimpin Umum
Dr. Erik Tapan
Ketua Penyunting
Dr. Budi Riyanto W.
Manajer Bisnis
Nofa, S.Si, Apt.
Dewan Redaksi
Prof. Dr. Sjahbanar Soebianto Zahir, MSc.
Dr. Michael Buyung Nugroho
Dr. Karta Sadana
Dr. Sujitno Fadli
Drs. Sie Djohan, Apt.
Ferry Sandra, Ph.D.
Budhi H. Simon, Ph.D.
Tata Usaha
Dodi Sumarna
CDK 172/vol.36 no.6/September - Oktober 2009
397
ISSN: 0125-913 X
http://www.kalbe.co.id/cdk
ENGLISH SUMMARY
Cephalgia among
Obstructive Sleep Apnea
Patients in Sleep
Laboratory, Mitra
Kemayoran Hospital,
Jakarta
Maula Gaharu*, Andreas Prasadja**
* Neurologist, WIN Pain Clinic,Kelapa Gading, Jakarta
** Physician, Sleep Technologist, Sleep Disorder
Clinic RS Mitra Kemayoran, Jakarta
Background
Cephalgia and sleep disorders are closely
related; especially in Obstructive Sleep Apnea
(OSA)
Objective
To evaluate frequency of cephalgia among
Obstructive Sleep Apnea patients
Method
A cross-sectional study was done on sleep
disorder patients in sleep laboratory Mitra
Kemayoran Hospital Jakarta, from January
until Desember 2007.
Result
There were 65 patients, only 4 has no OSA
based on PSG examination; 21.3% were
mild, 23.0% moderate and 55.7% severe
OSA. Men consisted of 98.4%. Mostly
more than 45 years of age (57.4% - mean
43.86 Ø 13.87 years).
Mean Body Mass Index (BMI) 26.53 (SD
5.14). Mean neck circumference 44.84 cm
(SD 7.99). Mean Apnea Hypopnea Index
(AHI) 38.90 (SD 25.55) and lowest Oxygen
saturation 72.40% (SD 11.17). Fourty-two
people had OSA and cephalgia (68.9%) with
mean AHI 43.25 (SD 25.28), BMI 26.99 (SD
5.52), neck circumference 45.92 cm (SD 8.18)
and oxygen saturation 71.69 (SD 11.50).
Conclusion
Cephalgia often followed sleep disorder OSA;
this co-morbidity warrants better management.
Keyword: Cephalgia, Obstructive Sleep
Apnea (OSA)
CDK 2009; 36(6) : 399-402
Abstract
Myasthenia gravis (MG) is an acquired
autoimmune disorder characterized clinically
by weakness of skeletal muscles and fatiga-
bility on exercise. Weakness increases during
the day and improves with rest. Extraocular
muscle (EOM) weakness or ptosis is present
initially in 50% of patients and 90% occurs
during the course of illness.
AChE inhibitors and immunomodulating
therapies are the mainstays of treatment. In
mild form, AChE inhibitors are used. Impor-
tant risk factors for poor prognosis include
age older than 40 years, a progressive disease,
and thymoma.
Key words : myasthenia - immunology
diagnosis treatment - prognosis
CDK 2009; 36(6) : 413-416
Abstract
Rabies is an acute viral infection affecting
central nervous system with 100% mortal-
ity. Rabies is a vaccine-preventable zoonotic
disease, and safe and effective vaccines are
available, but it remains a major health problem
in Asia, Africa, South America. In Indonesia
rabies cases are reported from almost all
provinces. Lack of vaccine and immuno-
globulin availability and its cost make the
majority did not get proper treatments.
Mortality is reported approximately 55,000 /
year, mostly men (7 : 3), 30-50 % are children
under 15 years. The most common biting
animals are dogs (90 %), mostly in lower
extremities.
Incubation period varies from 7 days to
more than one year, mostly 1 3 months.
Virus reaches central nerve system through
peripheral nerves, multiplies in brain neuron
and moves to motoric and autonomic nerve
systems. Clinical manifestations comprises 4
stages : prodromal, acute neurologic symptoms,
central nerve system impairments, coma.
Most patients show furious state, some show
paralytic type. Death is due to cardiorespi-
ratory failure. Diagnosis mostly based on
very specific clinical presentations. Other
examinations are viral isolation, RT-PCR,
rapid fluorescent antibody test, histopatho-
logic examination.
Management include patient isolation, early
wound treatment, tetanus toxoid/ immu-
noglobulin, antibiotics, anti rabies vaccine, anti
rabies immunoglobulin, symptomatic and
supportive treatments, treatments of compli-
cations. Early and proper treatments can give
100 % survival rate, but if virus has reached
central nervous system mortality is 100 %.
Prevention measures are control in animals
and wild dogs, animals vaccination, pre-
exposure vaccination for high risk people,
including travellers to endemic areas.
Key words: Rabies, furious, paralytic, mortality.
CDK 2009; 36(6) : 417-421
Myasthenia Gravis:
Current Review
Rizaldy Pinzon
Department of Neurology, Bethesda Hospital,
Yogyakarta, Indonesia
Rabies : Diagnosis
and Management
Carta A. Gunawan
Dept. of Internal Medicine
Faculty of Medicine, Mulawarman University/A.
Wahab Sjahranie General Hospital
Samarinda, East Kalimantan, Indonesia
398
CDK 172/vol.36 no.6/September - Oktober 2009
Redaksi Kehormatan
Prof. Drg. Siti Wuryan A Prayitno, SKM, MScD, PhD
Bagian Periodontologi, Fakultas Kedokteran Gigi Universitas Indonesia, Jakarta
Prof. Dr. Abdul Muthalib, SpPD KHOM
Divisi Hematologi Onkologi Medik
Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia/
RSUPN Dr. Cipto Mangunkusumo, Jakarta
Prof. Dr. Djoko Widodo, SpPD-KPTI
Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonsia/
RSUPN Dr. Cipto Mangunkusumo, Jakarta
Prof. DR. Dr. Charles Surjadi, MPH
Pusat Penelitian Kesehatan Unika Atma Jaya Jakarta
Prof. DR. Dr. H. Azis Rani, SpPD, KGEH
Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia/
RSUPN Dr. Cipto Mangunkusumo, Jakarta
Prof. DR. Dr. Sidartawan Soegondo, SpPD, KEMD, FACE
Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia/
RSUPN Dr. Cipto Mangunkusumo, Jakarta
DR. Dr. Abidin Widjanarko, SpPD-KHOM
Fakultas Kedokteran Universitas Indonesia/RS Kanker Dharmais, Jakarta
DR. Dr. med. Abraham Simatupang, MKes
Bagian Farmakologi, Fakultas Kedokteran Universitas Kristen Indonesia, Jakarta
Prof. Dr. Sarah S. Waraouw, SpA(K)
Dekan Fakultas Kedokteran Universitas Sam Ratulangi, Manado
Prof. DR. Dr. Rully M.A. Roesli, SpPD-KGH
Bagian Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Padjadjaran/
RSUP Dr. Hasan Sadikin, Bandung
Dr. Aucky Hinting, PhD, SpAnd
Bagian Biomedik Fakultas Kedokteran Universitas Airlangga Surabaya
DR. Dr. Yoga Yuniadi, SpJP
Departemen Kardiologi dan Kedokteran Vaskular FKUI/
Pusat Jantung Nasional Harapan Kita, Jakarta
Prof. DR. Dra. Arini Setiawati
Bagian Farmakologi Fakultas Kedokteran Universitas Indonesia, Jakarta
Prof. Dr. Faisal Yunus, PhD, SpP(K)
Departemen Pulmonologi & Ilmu Kedokteran Respirasi Fakultas Kedokteran
Universitas Indonesia/SMF Paru RS Persahabatan, Jakarta
Prof. DR. Dr. Rianto Setiabudy, SpFK
Bagian Farmakologi Fakultas Kedokteran Universitas Indonesia, Jakarta
Dr. R.M. Nugroho Abikusno, MSc., DrPH
Fakultas Kedokteran Universitas Trisakti, Jakarta
Prof. DR. Dr. Wimpie Pangkahila, SpAnd, FAACS
Fakultas KedokteranUniversitas Udayana Denpasar, Bali
Prof. DR. Dr. Ignatius Riwanto, SpB(K)
Bagian Bedah Fakultas Kedokteran Universitas Diponegoro/
RS Dr. Kariadi, Semarang
Dr. Tony Setiabudhi, SpKJ, PhD
Universitas Trisakti/ Pusat Kajian Nasional Masalah Lanjut Usia, Jakarta
Prof. DR. Samsuridjal Djauzi, SpPD, KAI
Sub Dept. Alergi-Imunologi, Dept. Ilmu Penyakit Dalam Fakultas Kedokteran
Universitas Indonesia/RSUPN Dr. Cipto Mangunkusumo, Jakarta
Dr. Prijo Sidipratomo, SpRad(K)
Departemen Radiologi FKUI/RSUPN Dr. Cipto Mangunkusumo, Jakarta
Prof. DR. Dr. Johan S. Masjhur, SpPD-KEMD, SpKN
Departemen Kedokteran Nuklir Fakultas Kedokteran Universitas Padjadjaran/
RSUP Dr. Hasan Sadikin, Bandung
Dr. Hendro Susilo, SpS(K)
Dept. Neurologi Fakultas Kedokteran Universitas Airlangga/RS Dr. Soetomo,
Surabaya
Prof. DR. Dr. Darwin Karyadi, SpGK
Institut Pertanian Bogor, Bogor, Jawa Barat
Dr. Ike Sri Redjeki, SpAn KIC, M.Kes
Bagian Anestesiologi & Reanimasi Fakultas Kedokteran Universitas Padjadjaran/
RSUP Dr. Hasan Sadikin, Bandung