Pidato Ratna Akbari

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135);( 128, 143);( 113, 150);( 103, 150);( 92, 157);( 85, 161);( 77, 161);(
45, 164);( 59, 143);( 25, 135);( 5, 126);( 5, 100);( 0, 81);( 0, 56
);( 7, 42);( 14, 35)}}
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{\shp{\*\shpinst
36, 3);( 25, 7);( 18, 10);( 3, 25);( 0, 32);( 10, 39);( 14, 28
);( 21, 25);( 25, 21);( 39, 14);( 60, 14)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}

{\shp{\*\shpinst
0, 7);( 0, 18);( 21, 18);( 28, 22);( 36, 22);( 51, 35);(
);( 56, 51);( 54, 47);( 54, 51);( 56, 51)}}
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{\shp{\*\shpinst
7, 0);( 0, 10);( 7, 14);( 14, 21);( 18, 28);( 18, 50);(
);( 7, 68)}}
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{\shp{\*\shpinst
32, 46);( 38, 43);( 45, 32);( 49, 25);( 52, 14);( 56, 3);(
);( 46, 24);( 24, 46);( 0, 43);( 3, 43);( 0, 43)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0);(
46, 36
27);(
14, 57
53);(
42, 0
37);(
67, 17);( 60, 7);( 26, 28);( 36, 28);( 7, 0);( 10, 3);( 7, 3
);( 7, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
45, 61);( 49, 46);( 38, 46);( 31, 43);( 20, 32);( 8, 23);( 14, 12
);( 13, 0);( 13, 3);( 13, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
3, 21);( 0, 28);( 0, 61);( 6, 68);( 16, 64);( 13, 54);( 9, 46
);( 9, 39);( 13, 32);( 13, 28);( 23, 18);( 31, 14);( 34, 10);( 31,
14);( 34, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
27, 0);( 31, 3);( 34, 3);( 34, 7);( 38, 7);( 38, 10);( 41, 14
);( 41, 17);( 45, 21);( 45, 25);( 41, 28);( 41, 32);( 38, 36);( 38,
39);( 34, 43);( 27, 43);( 23, 46);( 13, 46);( 9, 43);( 7, 43);(
7, 39);( 3, 39);( 3, 36);( 0, 32);( 0, 14);( 3, 14);( 3, 10
)}}
{\shp{\*\shpinst
3, 7);( 0, 10);( 9, 18);( 9, 14);( 13, 14);( 13, 10);( 20, 10
)}}
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{\shp{\*\shpinst
18, 3);( 14, 0);( 0, 0);( 0, 10);( 7, 10);( 10, 14);( 10, 18
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{\shp{\*\shpinst
10, 0);( 7, 0);( 0, 10);( 3, 10);( 3, 18);( 0, 21)}}
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{\shp{\*\shpinst

17, 17);( 21, 14);( 21, 7);( 25, 3);( 10, 0);( 10, 7);( 7, 7
);( 7, 10);( 0, 10);( 3, 10);( 0, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
16, 17);( 20, 14);( 23, 14);( 16, 3);( 13, 3);( 13, 7);( 9, 7
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0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
13, 25);( 13, 10);( 10, 10);( 10, 0);( 10, 3);( 10, 0)}}
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{\shp{\*\shpinst
3, 25);( 14, 21);( 14, 10);( 16, 10);( 14, 10);( 16, 10)}}
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{\shp{\*\shpinst
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{\shp{\*\shpinst
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{\shp{\*\shpinst
92, 14)}}
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{\shp{\*\shpinst
53, 7)}}
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{\shp{\*\shpinst
{\sp{\sn pVerticies}{\sv 8; 5;( 7, 0);( 0, 3);( 32, 75);(
10, 0)}}
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{\shp{\*\shpinst
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0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 50)}}
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{\shp{\*\shpinst
{\sp{\sn pVerticies}{\sv 8;31;( 56, 59);( 74, 26);( 101, 0);(
43, 72);(
80, 17);(
60,
0);(
141,
5);(
159, 8);( 176, 5);( 212, 12);( 241, 26);( 251, 37);( 258, 55);( 268, 87
);( 299, 75);( 308, 131);( 305, 138);( 305, 152);( 297, 170);( 287, 188);( 283,
210);( 279, 224);( 272, 239);( 254, 266);( 236, 277);( 201, 275);( 153, 309);(
136, 313);( 92, 264);( 43, 261);( 16, 216);( 21, 170);( 0, 117);( 6, 88
)}}
{\shp{\*\shpinst
46, 10);( 32, 18);( 17, 28);( 7, 43);( 0, 61);( 10, 64);( 28, 25
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{\shp{\*\shpinst
0, 4);( 0, 18);( 16, 15);( 34, 15);( 49, 18);( 63, 25);( 74, 33
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0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
7, 0);( 0, 10);( 14, 21);( 25, 35);( 32, 39);( 32, 46);( 39, 61
);( 39, 75);( 35, 82);( 35, 90);( 28, 104);( 17, 122);( 17, 125);( 17,
122);( 17, 125)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
67, 75);( 70, 68);( 81, 54);( 88, 39);( 96, 21);( 96, 0);( 85, 0
);( 81, 21);( 78, 36);( 70, 50);( 63, 61);( 56, 64);( 52, 68);( 46,
72);( 39, 75);( 25, 79);( 7, 79);( 0, 82);( 7, 79);( 3, 79);(
0, 82)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
116, 21);( 105, 14);( 81, 32);( 67, 35);( 56, 35);( 25, 24);( 24, 23
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0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
83, 104);( 87, 90);( 34, 83);( 17, 47);( 16, 0);( 16, 3);( 16, 0
)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst

3, 50);( 0, 64);( 0, 82);( 3, 100);( 10, 118);( 21, 111);( 14, 97
);( 10, 79);( 10, 64);( 14, 53);( 21, 39);( 28, 28);( 38, 17);( 52,
10);( 56, 7);( 52, 10);( 56, 10);( 56, 7)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
103, 25);( 101, 0);( 130, 34);( 138, 48);( 152, 63);( 159, 77);( 159, 95
);( 156, 106);( 148, 117);( 148, 127);( 145, 135);( 141, 145);( 130, 156);( 120,
156);( 112, 160);( 102, 160);( 96, 167);( 81, 174);( 74, 174);( 52, 163);(
45, 156);( 34, 153);( 28, 149);( 21, 145);( 10, 135);( 7, 124);( 7, 106
);( 0, 95);( 0, 70);( 3, 63);( 10, 55);( 14, 48)}}
65535}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
10, 14);( 7, 25);( 0, 32);( 10, 39);( 16, 28);( 20, 25);( 23, 17
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0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 2);( 0, 17);( 10, 13);( 16, 13);( 38, 24);( 42, 31);( 49, 45
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{\shp{\*\shpinst
7, 0);( 0, 10);( 25, 18);( 19, 50);( 10, 68);( 7, 68);( 10, 68
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{\shp{\*\shpinst
43, 43);( 46, 32);( 53, 25);( 53, 14);( 57, 3);( 43, 0);( 43, 10
);( 39, 21);( 36, 28);( 32, 32);( 23, 41);( 12, 45);( 0, 43);( 3,
43);( 0, 43)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
32, 32);( 43, 32);( 53, 28);( 60, 21);( 67, 17);( 60, 7);( 53, 14
);( 46, 17);( 28, 17);( 25, 14);( 17, 10);( 7, 0);( 10, 3);( 7,
0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}

{\shp{\*\shpinst
18, 46);( 25, 54);( 31, 57);( 42, 57);( 45, 46);( 38, 46);( 28, 43
);( 14, 28);( 14, 21);( 10, 10);( 10, 0);( 10, 3);( 10, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
17, 68);( 28, 64);( 20, 43);( 21, 22);( 46, 14);( 46, 10);( 46, 14
);( 46, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
18, 0);( 32, 0);( 32, 3);( 36, 3);( 39, 7);( 39, 10);( 42, 14
);( 45, 18);( 45, 28);( 42, 32);( 42, 36);( 39, 39);( 39, 43);( 32,
43);( 28, 46);( 14, 46);( 14, 43);( 10, 43);( 7, 39);( 3, 39);(
3, 28);( 0, 25);( 0, 14);( 3, 14);( 3, 10)}}
{\shp{\*\shpinst

10, 21);( 10, 17);( 14, 13);( 21, 13);( 18, 13);( 21, 13)}}
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{\shp{\*\shpinst
14, 3);( 14, 0);( 0, 0);( 0, 10);( 7, 10);( 7, 14);(
);( 10, 17);( 14, 21);( 10, 17);( 14, 21)}}
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{\shp{\*\shpinst
13, 10);( 9, 7);( 9, 3);( 6, 0);( 2, 0);( 0, 10);(
)}}
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{\shp{\*\shpinst
13, 17);( 16, 14);( 16, 10);( 20, 7);( 20, 3);( 10, 0);(
);( 7, 7);( 3, 10);( 0, 10);( 3, 10);( 0, 10)}}
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13);(
7);(
10, 14
17);(
0, 21
17);(
10, 7

{\shp{\*\shpinst
10, 17);( 21, 17);( 25, 14);( 28, 14);( 21, 3);( 17, 3);( 17, 7
);( 14, 7);( 14, 3);( 10, 3);( 7, 0);( 10, 3);( 10, 0);( 7,
0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
10, 21);( 17, 25);( 17, 10);( 14, 10);( 14, 7);( 10, 7);( 10, 0
);( 10, 3);( 10, 0)}}
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{\shp{\*\shpinst
3, 7);( 3, 10);( 0, 14);( 0, 17);( 3, 21);( 3, 25);( 14, 21
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0, 90)}}
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{\shp{\*\shpinst
0, 54)}}
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{\shp{\*\shpinst
184, 13);( 237, 0);( 259, 52);( 266, 70);( 283, 84);( 294, 95);( 305, 117
);( 305, 156);( 298, 174);( 287, 189);( 283, 210);( 280, 228);( 274, 243);( 251,
272);( 239, 271);( 203, 279);( 152, 315);( 132, 303);( 92, 268);( 45, 250);(
20, 228);( 22, 174);( 0, 137);( 11, 73)}}
{\shp{\*\shpinst
0, 67);( 10, 70);( 21, 56);( 27, 45);( 38, 34);( 49, 27);( 77, 20
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0, 6);( 0, 20);( 36, 20);( 52, 24);( 63, 28);( 78, 35);( 85, 46
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49, 57);( 42, 33);( 31, 10);( 7, 0);( 0, 10);( 34, 40);( 23, 20
);( 38, 57);( 38, 79);( 34, 86);( 27, 104);( 16, 118);( 16, 122);( 16,
118);( 16, 122)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
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91, 0);( 80, 0);( 74, 30);( 78, 40);( 56, 64);( 49, 72);( 42, 72
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{\shp{\*\shpinst
117, 21);( 110, 10);( 75, 40);( 35, 44);( 10, 0);( 7, 0);( 10, 0
);( 7, 0)}}
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{\shp{\*\shpinst
83, 100);( 87, 90);( 69, 86);( 56, 79);( 45, 72);( 34, 61);( 27, 50
);( 23, 36);( 20, 17);( 20, 3);( 16, 0);( 20, 3);( 20, 0);( 16,
0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
22, 118);( 33, 115);( 20, 63);( 17, 41);( 69, 10);( 69, 7);( 69, 10
);( 69, 7)}}
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{\shp{\*\shpinst
105, 4);( 126, 15);( 132, 22);( 136, 30);( 139, 40);( 150, 48);( 154, 51
);( 161, 62);( 161, 87);( 135, 128);( 162, 95);( 143, 130);( 139, 138);( 132,
145);( 126, 148);( 115, 148);( 105, 152);( 74, 166);( 111, 162);( 65, 163);(
41, 128);( 25, 152);( 9, 112);( 11, 78);( 0, 86);( 1, 69);( 0, 43
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{\shp{\*\shpinst
0, 45);( 14, 48);( 21, 26);( 42, 20);( 63, 23);( 60, 23);( 63, 23
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50, 14);( 43, 7);( 36, 3);( 25, 0);( 0, 0);( 3, 14);( 28, 14
);( 43, 21);( 46, 28);( 52, 35);( 52, 43);( 56, 46);( 52, 43);( 56,
46)}}
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{\shp{\*\shpinst
32, 32);( 28, 25);( 25, 14);( 18, 7);( 7, 0);( 0, 10);( 14, 25
);( 18, 28);( 21, 35);( 21, 43);( 18, 50);( 14, 57);( 10, 68);( 7,
72);( 10, 68);( 7, 68);( 7, 72)}}
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41, 39);( 49, 28);( 52, 21);( 56, 10);( 56, 0);( 41, 0);( 41, 17
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39)}}
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{\shp{\*\shpinst
67, 17);( 60, 7);( 33, 32);( 28, 20);( 7, 0);( 10, 3);( 10, 0
);( 7, 0)}}
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48, 61);( 48, 46);( 21, 47);( 14, 20);( 12, 0);( 12, 3);( 12, 0
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6, 18);( 0, 36);( 0, 46);( 2, 57);( 6, 68);( 16, 61);( 13, 54
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26, 0);( 34, 0);( 34, 3);( 38, 3);( 38, 10);( 42, 10);( 45, 14
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46);( 16, 43);( 13, 43);( 13, 39);( 6, 39);( 3, 36);( 3, 25);(
0, 21);( 0, 14);( 3, 14);( 3, 10)}}
{\shp{\*\shpinst
2, 3);( 0, 7);( 0, 14);( 6, 17);( 9, 14);( 20, 14);( 16, 14
);( 20, 14)}}
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17, 3);( 14, 3);( 14, 0);( 0, 0);( 3, 14);( 10, 14);(
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{\shp{\*\shpinst
17, 10);( 7, 0);( 0, 10);( 3, 14);( 3, 21);( 0, 25);(
);( 0, 21);( 0, 25)}}
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25, 7);( 25, 0);( 10, 0);( 10, 7);( 3, 7);( 0, 10);(
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7);(
10, 17
21);(
3, 21
14);(
3, 7

10, 14);( 21, 14);( 25, 10);( 28, 10);( 17, 3);( 10, 3);(
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{\shp{\*\shpinst
3, 17);( 7, 21);( 9, 25);( 13, 25);( 16, 14);( 13, 10);(
);( 9, 0);( 9, 3);( 9, 0)}}
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{\shp{\*\shpinst
0, 14);( 3, 17);( 3, 25);( 13, 17);( 13, 10);( 16, 10);(
);( 16, 10);( 16, 7)}}
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10);(
10, 0
14);(
9, 10
10);(
16, 7
0);(

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{\shp{\*\shpinst
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);( 156, 57);( 159, 64);( 159, 82);( 153, 93);( 150, 104);( 146, 115);( 146,
122);( 143, 133);( 135, 140);( 114, 151);( 103, 151);( 92, 158);( 86, 161);(
83, 161);( 72, 165);( 57, 158);( 43, 143);( 36, 143);( 25, 140);( 8, 125
);( 6, 102);( 1, 82);( 0, 54);( 0, 46)}}
{\shp{\*\shpinst
24, 7);( 16, 10);( 2, 25);( 0, 32);( 9, 39);( 13, 32);( 20, 25
);( 24, 17);( 31, 14);( 42, 14);( 52, 14);( 63, 14);( 60, 14);( 63,
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38, 7);( 27, 3);( 16, 3);( 5, 0);( 0, 3);( 0, 14);( 23, 14
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32, 46);( 43, 39);( 46, 32);( 50, 21);( 53, 10);( 56, 0);( 43, 0
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44, 61);( 48, 50);( 17, 40);( 15, 32);( 13, 0);( 13, 3);( 13, 0
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13, 68);( 23, 61);( 20, 53);( 16, 43);( 16, 35);( 20, 32);( 20, 25
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{\shp{\*\shpinst
25, 3);( 32, 0);( 60, 0);( 67, 7);( 70, 10);( 74, 14);( 74, 18
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61);( 77, 64);( 77, 68);( 74, 75);( 70, 75);( 67, 79);( 56, 79);(
50, 82);( 50, 86);( 36, 86);( 32, 82);( 28, 82);( 25, 75);( 14, 75
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27, 7);( 24, 3);( 16, 3);( 13, 0);( 0, 0);( 3, 14);( 16, 14
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28);( 27, 32)}}
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{\shp{\*\shpinst

21, 14);( 17, 7);( 14, 3);( 7, 0);( 0, 10);( 3, 14);( 7, 14
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25, 25);( 28, 17);( 32, 14);( 32, 7);( 36, 0);( 21, 0);( 21, 10
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21)}}
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{\shp{\*\shpinst
28, 21);( 31, 17);( 38, 14);( 31, 3);( 28, 7);( 25, 7);( 21, 10
);( 18, 7);( 14, 7);( 10, 3);( 7, 0);( 3, 0);( 7, 0);( 3,
0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
7, 25);( 10, 28);( 14, 32);( 21, 35);( 28, 35);( 28, 25);( 25, 21
);( 21, 21);( 17, 17);( 14, 14);( 14, 0);( 14, 3);( 14, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
3, 10);( 3, 18);( 0, 21);( 0, 28);( 3, 36);( 3, 39);( 18, 36
);( 14, 32);( 14, 18);( 18, 14);( 21, 14);( 28, 7);( 25, 10);( 28,
7)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
14, 3);( 18, 3);( 20, 7);( 20, 10);( 24, 10);( 24, 14);( 20, 17
);( 20, 25);( 14, 25);( 14, 28);( 10, 28);( 10, 25);( 3, 25);( 3,
21);( 0, 21);( 0, 7)}}
{\shp{\*\shpinst
3, 7);( 0, 7);( 14, 14);( 14, 10);( 18, 10);( 14, 10);( 18, 10
)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}

{\shp{\*\shpinst
9, 0);( 0, 0);( 3, 10);( 7, 14);( 7, 17);( 7, 14);(
)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 10);( 0, 14);( 0, 10);( 0, 14)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
13, 10);( 13, 7);( 16, 3);( 16, 0);( 7, 0);( 0, 3);(
);( 3, 0);( 0, 3)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
14, 10);( 7, 3);( 10, 3);( 7, 3);( 3, 0);( 7, 3);(
);( 3, 0)}}
3);(
7, 17
0);(
10);(
7, 0
14);(
7, 0
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
3, 10);( 7, 14);( 10, 14);( 14, 17);( 14, 0);( 14, 3);( 14, 0
)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
3, 7);( 0, 7);( 0, 17);( 3, 17);( 14, 14);( 14, 10);( 14, 14
);( 14, 10);( 17, 10);( 14, 10);( 17, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 50)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst

35, 35)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
49, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
32, 7)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
9, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}

{\shp{\*\shpinst
3, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 28)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
74, 42);( 56, 42);( 43, 45);( 21, 52);( 10, 52);( 0, 42)}}
{\shp{\*\shpinst
35, 0);( 21, 3);( 10, 10);( 0, 25);( 10, 32);( 17, 21);( 28, 17
);( 35, 14);( 46, 14);( 53, 17);( 63, 21);( 70, 32);( 81, 39);( 88,
28);( 81, 43);( 113, 57);( 92, 32)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
39, 28);( 53, 24);( 63, 20);( 77, 20);( 81, 24);( 88, 10);( 75, 12
);( 74, 0);( 50, 10);( 35, 13);( 25, 17);( 17, 17);( 14, 13);( 10,
6);( 10, 13);( 0, 6);( 0, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
50, 3);( 60, 7);( 67, 17);( 77, 25);( 43, 25);( 21, 32);( 7, 32
);( 0, 25)}}
{\shp{\*\shpinst
0, 36);( 10, 44);( 34, 12);( 61, 30);( 81, 54);( 88, 44);( 81, 54
);( 113, 69);( 92, 44)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
17, 30);( 28, 30);( 39, 27);( 53, 23);( 63, 19);( 74, 19);( 77, 23
);( 81, 23);( 88, 12);( 64, 0);( 47, 20);( 14, 16);( 14, 12);( 10,
9);( 10, 12);( 0, 5);( 0, 12)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
74, 42);( 56, 42);( 43, 45);( 32, 49);( 7, 49);( 3, 45);( 0, 42
)}}
{\shp{\*\shpinst
57, 3);( 46, 0);( 35, 0);( 21, 3);( 10, 7);( 0, 17);( 10, 28
);( 17, 17);( 28, 10);( 46, 10);( 53, 14);( 63, 17);( 81, 35);( 88,
25);( 81, 35);( 113, 50);( 92, 25)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
10, 30);( 41, 32);( 41, 20);( 81, 23);( 88, 12);( 67, 0);( 38, 20
);( 17, 19);( 17, 16);( 14, 16);( 14, 12);( 10, 9);( 10, 16);( 0,
5);( 0, 12)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
15, 34);( 33, 44);( 49, 47);( 60, 51);( 67, 51);( 74, 47);( 78, 44
);( 78, 40)}}
{\shp{\*\shpinst
106, 35);( 113, 28);( 103, 14);( 92, 7);( 81, 3);( 67, 7);( 56, 10
);( 46, 14);( 25, 35);( 32, 46);( 25, 35);( 0, 61);( 32, 46)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
74, 16);( 63, 16);( 42, 9);( 16, 0);( 14, 9);( 0, 9);( 7, 23
);( 10, 20);( 25, 20);( 38, 23);( 49, 27);( 78, 25);( 82, 35);( 92,
9);( 88, 5);( 92, 9);( 92, 5);( 88, 5)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}

{\shp{\*\shpinst
34, 42);( 49, 45);( 60, 49);( 74, 49);( 78, 45);( 78, 42)}}
{\shp{\*\shpinst
60, 30);( 70, 30);( 78, 26);( 88, 30);( 96, 37);( 106, 44);( 113, 37
);( 80, 0);( 55, 14);( 25, 44);( 32, 55);( 25, 44);( 0, 70);( 32,
55)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
52, 12);( 40, 7);( 12, 0);( 0, 8);( 7, 19);( 10, 19);( 17, 15
);( 25, 15);( 38, 19);( 49, 23);( 63, 26);( 74, 26);( 77, 23);( 85,
19);( 88, 15);( 92, 8);( 88, 1);( 92, 8);( 92, 5);( 88, 1)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst

15, 34);( 33, 44);( 49, 47);( 74, 47);( 78, 44);( 78, 40)}}
{\shp{\*\shpinst
60, 28);( 70, 24);( 88, 24);( 106, 42);( 113, 31);( 82, 0);(
);( 25, 38);( 32, 49);( 25, 38);( 0, 64);( 32, 49)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 17);( 7, 28);( 38, 28);( 49, 32);( 63, 35);( 77, 35);(
);( 92, 17);( 88, 10);( 92, 17);( 92, 14);( 88, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
44);(
31);(
53, 12
0);(
88, 24
43)}}
{\shp{\*\shpinst
98, 10);( 96, 10);( 98, 0);( 96, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
91, 32);( 91, 17);( 94, 32);( 116, 25);( 94, 17)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 28);( 2, 28);( 0, 39);( 2, 39)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
28, 0);( 28, 14);( 25, 0);( 0, 7);( 25, 14)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}

{\shp{\*\shpinst
0, 136)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 7)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
18, 17)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 7)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 7)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
18, 17)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
14, 14)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
9,
0);(
0, 10);(
0,
7);(

42, 54);( 42, 50);( 45, 43);( 45, 39);( 42, 32);( 38, 25);( 34, 14
);( 27, 7);( 21, 0);( 14, 7);( 7, 17);( 3, 28);( 0, 36);( 0,
46);( 3, 57);( 10, 64)}}
{\shp{\*\shpinst
20, 54);( 20, 57);( 5, 72);( 3, 79);( 5, 90);( 16, 80);( 32, 70
);( 31, 54);( 31, 43);( 27, 32);( 20, 21);( 5, 7);( 0, 7);( 5,
7);( 3, 0);( 0, 7)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
32, 7);( 26, 0);( 19, 7);( 5, 28);( 5, 50);( 8, 61);( 15, 72
);( 30, 82);( 32, 82);( 30, 82);( 32, 82)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
70, 50);( 77, 40);( 99, 18);( 109, 14);( 38, 0);( 15, 25);( 0, 90
);( 36, 108);( 42, 112);( 45, 119)}}
{\shp{\*\shpinst
0, 115);( 14, 115);( 14, 97);( 18, 75);( 21, 61);( 28, 46);( 36, 36
);( 46, 25);( 57, 17);( 63, 10);( 63, 0);( 63, 10);( 81, 3);( 63,
0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
46, 28);( 52, 25);( 60, 21);( 67, 21);( 74, 17);( 95, 17);( 113, 21
);( 116, 10);( 91, 6);( 58, 0);( 39, 21);( 32, 25);( 25, 32);( 21,
39);( 14, 50);( 7, 68);( 3, 93);( 7, 100);( 3, 93);( 0, 100);(
7, 100)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
3, 0);( 0, 10);( 37, 25);( 21, 18);( 49, 43);( 60, 36);( 49, 43
);( 60, 50);( 60, 36)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
21, 15);( 36, 11);( 53, 8);( 74, 4);( 150, 0);( 231, 21);( 283, 80
);( 215, 94);( 143, 93);( 77, 72);( 51, 58);( 20, 56)}}
{\shp{\*\shpinst
76, 15);( 60, 19);( 42, 22);( 13, 29);( 2, 40);( 0, 44);( 0, 51
);( 2, 55);( 68, 0);( 231, 37);( 285, 101);( 289, 91);( 289, 101);( 303,
101);( 292, 91)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
{\sp{\sn pVerticies}{\sv 8; 4;( 3, 21);( 134, 10);( 134, 0);( 0, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
32, 28);( 53, 39);( 80, 44);( 131, 68);( 155, 64);( 152, 53);( 122, 50
);( 30, 25);( 10, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
156, 16);( 100, 41);( 112, 20);( 57, 56);( 41, 66);( 10, 98)}}
{\shp{\*\shpinst
450, 10);( 453, 0);( 450, 10);( 467, 10);( 453, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
169, 28);( 284, 14);( 366, 34);( 459, 104);( 466, 93);( 385, 28);( 272, 0
);( 169, 17);( 99, 27);( 49, 61);( 7, 114);( 13, 125);( 7, 114);( 0,
125);( 13, 125)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst

32, 68);( 46, 61);( 90, 39);( 171, 10);( 219, 0);( 272, 39);( 255, 100
);( 233, 115);( 223, 118);( 208, 122);( 197, 125);( 184, 129);( 170, 133);( 110,
130);( 42, 130)}}
{\shp{\*\shpinst
16, 122);( 7, 80);( 19, 32);( 59, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
112, 17);( 76, 29);( 34, 46);( 0, 61);( 7, 71);( 57, 53);( 128, 23
);( 180, 14);( 172, 10);( 180, 0);( 176, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
52, 53);( 52, 46);( 63, 50);( 67, 46);( 63, 43)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}

{\shp{\*\shpinst
0, 61);( 3, 57);( 10, 68);( 14, 64)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
95, 0);( 67, 21);( 33, 25);( 0, 32);( 3, 32);( 0, 43);( 3, 43
)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
162, 14);( 165, 3);( 140, 0);( 116, 0);( 73, 7);( 56, 14);( 34, 21
);( 16, 32);( 2, 46);( 13, 50);( 0, 54);( 2, 64);( 9, 57)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
69, 0);( 94, 23);( 110, 89);( 67, 111);( 63, 118)}}
{\shp{\*\shpinst
67, 115);( 80, 115);( 70, 59);( 73, 34);( 20, 0);( 16, 10);( 16, 0
);( 0, 3);( 13, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
96, 36);( 92, 29);( 85, 22);( 48, 0);( 51, 0);( 0, 7);( 0, 18
);( 58, 0);( 97, 37);( 103, 94);( 106, 87);( 110, 97);( 117, 97);( 113,
90)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
45, 14);( 52, 14);( 60, 10);( 56, 0);( 49, 0);( 20, 14);( 13, 21
);( 6, 25);( 3, 32);( 13, 36);( 0, 36);( 0, 50);( 9, 43)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}

{\shp{\*\shpinst
186, 0);( 67, 21);( 0, 95);( 121, 112);( 170, 108);( 272, 59);( 274, 52
)}}
{\shp{\*\shpinst
300, 55);( 300, 41);( 296, 37);( 286, 30);( 265, 22);( 223, 13);( 201, 15
);( 170, 11);( 109, 30);( 81, 44);( 27, 65);( 48, 62);( 10, 91);( 14,
102);( 10, 91);( 0, 102);( 14, 102)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 64);( 32, 63);( 134, 35);( 154, 7)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
294, 16);( 352, 41);( 334, 19);( 392, 55);( 414, 78);( 429, 83)}}
{\shp{\*\shpinst
17, 0);( 21, 10);( 14, 0);( 0, 10);( 17, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
297, 10);( 236, 0);( 201, 3);( 141, 17);( 88, 29);( 41, 50);( 0, 85
);( 7, 96);( 88, 31);( 194, 4);( 297, 21);( 325, 28);( 353, 39);( 368,
42);( 378, 53);( 392, 60);( 416, 78);( 430, 91);( 448, 114);( 452, 103);(
452, 118);( 466, 118);( 459, 107)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst

268, 107);( 262, 93);( 255, 79);( 244, 68);( 230, 61);( 181, 36);( 110, 13
);( 57, 0);( 0, 39);( 21, 100);( 43, 115);( 64, 122);( 77, 125);( 92,
129);( 103, 133);( 162, 132);( 232, 126)}}
{\shp{\*\shpinst
52, 125);( 52, 64);( 45, 50);( 39, 35);( 32, 21);( 21, 10);( 7, 0
);( 3, 0);( 7, 0);( 3, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
172, 71);( 176, 61);( 154, 50);( 134, 43);( 109, 32);( 87, 25);( 67, 17
);( 45, 10);( 23, 7);( 3, 0);( 0, 0);( 3, 0);( 0, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
3, 43);( 3, 50);( 3, 43);( 0, 46);( 3, 50)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
16, 64);( 20, 68);( 16, 64);( 20, 68)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
7, 0);( 0, 10);( 30, 29);( 66, 42);( 103, 43);( 99, 43);( 103, 43
)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
109, 14);( 91, 7);( 70, 3);( 49, 0);( 23, 0);( 0, 3);( 3, 14
);( 55, 12);( 116, 11);( 151, 57);( 162, 54);( 151, 57);( 162, 64);( 162,
54)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst

65, 17);( 78, 21);( 100, 43);( 130, 79);( 188, 184);( 189, 223);( 181, 223
);( 171, 212);( 153, 205);( 132, 197);( 96, 176);( 78, 169);( 65, 158);( 21,
109);( 0, 67)}}
65535}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
2, 14);( 101, 10);( 147, 142);( 172, 215)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
25, 18);( 25, 14);( 21, 7);( 21, 0);( 7, 3);( 10, 10);( 10, 18
);( 14, 14);( 18, 14);( 14, 10);( 10, 7);( 7, 3);( 3, 3);( 7,
3);( 3, 3)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
6, 79);( 9, 97);( 16, 111);( 27, 129);( 34, 143);( 49, 154);( 60, 169
);( 73, 180);( 98, 196);( 140, 218);( 169, 226);( 172, 215);( 151, 208);( 134,
197);( 112, 190);( 98, 180);( 80, 172);( 70, 158);( 56, 147);( 45, 133);(
18, 101);( 5, 48);( 9, 7);( 6, 14);( 3, 0);( 0, 0);( 0, 7
)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
10, 0);( 0, 7);( 20, 47);( 60, 85);( 101, 104);( 112, 97);( 101, 104
);( 120, 115);( 112, 97)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
10, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
156, 93);( 170, 107);( 183, 133);( 197, 154);( 205, 182);( 223, 210);( 226, 237
);( 223, 237);( 216, 233);( 212, 230);( 205, 226);( 201, 219);( 170, 194);( 112,
151);( 51, 108);( 19, 74)}}
65535}}{\sp{\sn fLine}{\sv 0}}}}}}

{\shp{\*\shpinst
0, 10);( 59, 27);( 73, 33);( 123, 68);( 137, 82);( 148, 100);( 163, 115
);( 177, 136);( 190, 162);( 205, 190);( 216, 219);( 216, 223);( 216, 219);( 216,
223)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
32, 32);( 39, 25);( 39, 10);( 32, 0);( 21, 7);( 28, 21);( 28, 17
);( 25, 17);( 17, 10);( 14, 3);( 10, 3);( 14, 3);( 10, 3)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
205, 230);( 212, 223);( 130, 142);( 44, 130);( 14, 7);( 7, 14);( 10, 3
);( 0, 0);( 0, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
286, 338);( 172, 266);( 67, 338);( 102, 208);( 0, 129);( 134, 122)}}

65535}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
50, 133);( 54, 136);( 50, 133);( 50, 136);( 54, 136)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
127, 17);( 123, 7);( 130, 14);( 145, 7);( 127, 7)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
3, 82);( 3, 90);( 3, 82);( 0, 86);( 3, 90)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst

35, 129);( 46, 122);( 39, 133);( 53, 140);( 46, 125)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
7, 3);( 0, 3);( 7, 3);( 3, 0);( 0, 3)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
7, 71);( 17, 79);( 3, 75);( 0, 90);( 14, 82)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
49, 7);( 45, 0);( 49, 7);( 49, 0);( 45, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}

{\shp{\*\shpinst
18, 0);( 14, 10);( 14, 0);( 0, 0);( 10, 7)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
134, 14);( 137, 10);( 134, 14);( 137, 14);( 137, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
52, 21);( 41, 21);( 52, 14);( 49, 0);( 41, 14)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
177, 121);( 188, 129);( 214, 212);( 206, 222);( 201, 222);( 190, 212);( 168, 186
);( 182, 198);( 143, 180);( 127, 169);( 94, 147);( 80, 136);( 69, 122);( 37,
87);( 19, 41)}}
65535}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 0);( 0, 10);( 38, 17);( 78, 28);( 109, 54);( 123, 68);( 136, 82
);( 151, 100);( 161, 122);( 176, 144);( 190, 172);( 201, 201);( 201, 205);( 201,
201);( 201, 205)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
27, 36);( 34, 28);( 38, 21);( 38, 10);( 31, 0);( 21, 7);( 27, 14
);( 27, 21);( 21, 21);( 10, 10);( 10, 7);( 10, 10);( 10, 7)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
98, 161);( 124, 184);( 166, 193);( 190, 219);( 201, 208);( 177, 187);( 123, 170
);( 109, 151);( 64, 116);( 39, 58);( 16, 7);( 10, 14);( 10, 3);( 0,
0);( 3, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
54, 54);( 39, 35);( 25, 25);( 18, 10);( 10, 0);( 0, 7);( 23, 47
);( 76, 96);( 117, 115);( 127, 107);( 117, 115);( 127, 118);( 124, 107)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
14, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
125, 130);( 134, 183);( 136, 216);( 136, 244);( 140, 255);( 140, 266);( 136, 270
);( 133, 270);( 127, 266);( 123, 262);( 120, 252);( 102, 241);( 84, 226);( 69,
212);( 56, 198);( 42, 183);( 34, 169);( 0, 108);( 0, 66)}}
65535}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 14);( 96, 36);( 110, 176);( 116, 255);( 116, 252);( 116, 255)}}
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{\shp{\*\shpinst
17, 32);( 23, 32);( 31, 25);( 34, 17);( 34, 7);( 31, 0);( 20, 3
);( 20, 17);( 17, 14);( 14, 7);( 10, 3);( 14, 7);( 10, 3)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
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0, 61);( 0, 97);( 7, 133);( 27, 191);( 68, 230);( 117, 266);( 124, 255
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77, 125
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129);(
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151);(
42, 107
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104);(
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0, 68);( 3, 61);( 10, 71);( 14, 71);( 14, 68)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
7, 21);( 7, 32);( 7, 21);( 0, 25);( 7, 32)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst

56, 165);( 34, 143);( 27, 133);( 20, 125);( 17, 118);( 14, 107);( 7, 100
);( 38, 100);( 31, 90);( 23, 75);( 17, 64);( 14, 53);( 7, 39);( 3,
25);( 0, 14);( 0, 0);( 62, 59);( 135, 91);( 215, 118)}}
{\shp{\*\shpinst
87, 93);( 126, 111);( 165, 123);( 208, 126);( 208, 111);( 133, 106);( 152, 102
);( 94, 82);( 70, 63);( 28, 29);( 16, 3);( 10, 14);( 10, 3);( 0,
0);( 7, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
38, 17);( 42, 7);( 38, 17);( 56, 21);( 42, 7)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
21, 36);( 44, 73);( 22, 45);( 56, 75);( 63, 68);( 43, 50);( 26, 28
);( 18, 3);( 10, 14);( 10, 0);( 0, 0);( 7, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
31, 14);( 38, 3);( 31, 14);( 45, 14);( 38, 3)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
14, 68);( 21, 82);( 25, 93);( 31, 107);( 42, 118);( 52, 111);( 28, 91
);( 16, 44);( 14, 14);( 3, 17);( 10, 10);( 0, 0);( 0, 17)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
138, 82);( 83, 58);( 54, 35);( 7, 0);( 0, 7);( 46, 56);( 149, 112
);( 216, 125);( 212, 122);( 223, 122);( 223, 115);( 219, 115)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst

0, 151);( 7, 143);( 7, 158);( 10, 158);( 10, 151)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
286, 180);( 248, 192);( 211, 199);( 172, 187);( 197, 158);( 129, 164);( 57, 121
);( 0, 90);( 30, 73);( 63, 63);( 98, 64);( 92, 35);( 98, 39);( 105,
39);( 116, 43);( 130, 50);( 141, 54);( 148, 61);( 156, 64);( 148, 32);(
183, 29);( 215, 45);( 243, 64);( 212, 0);( 257, 27);( 306, 56);( 361, 54
);( 361, 165)}}
{\shp{\*\shpinst
141, 10);( 134, 0);( 105, 17);( 44, 41);( 10, 28);( 14, 39);( 3, 32
);( 0, 43);( 7, 43)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
32, 18);( 25, 7);( 32, 18);( 42, 0);( 25, 7)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
123, 10);( 120, 0);( 105, 7);( 94, 10);( 80, 10);( 67, 14);( 38, 14
);( 27, 10);( 13, 7);( 16, 17);( 6, 10);( 0, 17);( 9, 21)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
32, 10);( 28, 0);( 32, 10);( 43, 0);( 28, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
212, 82);( 212, 72);( 133, 63);( 83, 46);( 17, 0);( 14, 10);( 10, 0
);( 0, 3);( 7, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst

0, 27);( 3, 38);( 46, 24);( 50, 14);( 102, 17);( 109, 6);( 102, 17
);( 112, 17);( 109, 6)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
14, 7);( 7, 14);( 10, 0);( 0, 0);( 3, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
45, 14);( 38, 10);( 27, 7);( 20, 7);( 9, 3);( 3, 0);( 0, 14
);( 9, 14);( 31, 25);( 41, 28);( 56, 36);( 63, 43);( 74, 36);( 63,
43);( 74, 54);( 74, 36)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
14, 7);( 7, 14);( 7, 0);( 0, 0);( 0, 7)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}

{\shp{\*\shpinst
0, 0);( 0, 14);( 23, 14);( 56, 25);( 70, 28);( 81, 36);( 87, 43
);( 98, 36);( 87, 43);( 109, 57);( 98, 36)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
21, 17);( 10, 25);( 18, 14);( 0, 0);( 7, 25)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
64, 34);( 31, 23);( 7, 0);( 0, 10);( 41, 49);( 98, 60);( 152, 68
);( 145, 61);( 158, 61);( 158, 57);( 152, 53)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 111);( 3, 118);( 0, 111);( 0, 115);( 3, 118)}}

0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
31, 28);( 31, 17);( 38, 28);( 45, 25);( 38, 17)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
112, 9);( 163, 9);( 176, 16);( 190, 20);( 201, 27);( 216, 34);( 194, 13
);( 291, 0);( 345, 70);( 374, 153);( 350, 132);( 317, 127);( 286, 121);( 290,
157);( 273, 140);( 249, 132);( 226, 128);( 236, 153);( 201, 163);( 155, 175);(
120, 164);( 138, 139);( 106, 139);( 73, 135);( 49, 114);( 81, 103);( 67, 96
);( 52, 92);( 42, 85);( 32, 77);( 25, 67);( 14, 60);( 7, 52)}}
{\shp{\*\shpinst
0, 28);( 7, 39);( 45, 20);( 93, 16);( 130, 39);( 134, 28);( 130, 39
);( 145, 46);( 134, 28)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}

{\shp{\*\shpinst
14, 3);( 10, 10);( 7, 0);( 0, 0);( 3, 7)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
67, 7);( 54, 3);( 39, 0);( 14, 0);( 0, 3);( 3, 14);( 44, 7
);( 66, 17);( 103, 35);( 110, 28);( 103, 35);( 152, 68);( 110, 28)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
18, 3);( 14, 14);( 14, 0);( 0, 3);( 10, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 13);( 0, 27);( 94, 13);( 143, 79);( 173, 161);( 183, 153);( 173, 164
);( 190, 179);( 183, 157)}}

0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
42, 21);( 74, 32);( 81, 35);( 88, 43);( 98, 32);( 88, 25);( 78, 21
);( 67, 14);( 56, 10);( 42, 7);( 31, 7);( 21, 3);( 7, 3);( 0,
10);( 7, 3);( 0, 0);( 0, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
3, 36);( 14, 32);( 7, 39);( 21, 50);( 18, 36)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
67, 39);( 74, 32);( 67, 25);( 60, 21);( 52, 14);( 45, 10);( 34, 7
);( 27, 3);( 10, 3);( 3, 10);( 10, 3);( 0, 0);( 3, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
10, 28);( 13, 18);( 16, 32);( 23, 28);( 20, 25)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
70, 28);( 85, 25);( 103, 21);( 117, 17);( 134, 14);( 130, 0);( 113, 7
);( 99, 10);( 85, 10);( 70, 14);( 25, 14);( 14, 10);( 18, 21);( 7,
14);( 0, 21);( 10, 25)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
32, 10);( 25, 0);( 32, 10);( 39, 0);( 25, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
63, 32);( 74, 36);( 99, 36);( 99, 21);( 71, 24);( 38, 18);( 18, 0
);( 14, 10);( 10, 0);( 0, 3);( 7, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
32, 10);( 32, 0);( 32, 10);( 46, 7);( 32, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
25, 39);( 43, 53);( 64, 65);( 85, 75);( 88, 61);( 63, 55);(
);( 14, 3);( 10, 10);( 3, 0);( 0, 3);( 3, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
152, 122);( 98, 94);( 46, 49);( 10, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
25);(
28);(
26, 26
133);(

35, 28);( 28, 21);( 21, 10);( 10, 0);( 0, 7);( 10, 17);(
);( 32, 46);( 35, 53);( 39, 57);( 39, 64)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
17, 14);( 14, 3);( 10, 0);( 0, 3);( 9, 19);( 15, 43);(
)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
2, 17);( 0, 32);( 36, 34);( 29, 29);( 60, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
63, 21);( 53, 17);( 39, 14);( 3, 0);( 0, 14);( 31, 24);(
);( 99, 25)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
39);(
25, 39
28);(
17, 61
17);(
21);(
68, 44

{\shp{\*\shpinst
45, 21);( 36, 18);( 25, 14);( 18, 7);( 7, 0);( 0, 10);( 21, 25
);( 43, 32);( 52, 32);( 63, 36);( 74, 32);( 81, 32)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 3);( 30, 81);( 59, 122);( 110, 187)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 3);( 10, 19);( 0, 37);( 0, 54)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 3);( 0, 10);( 3, 18);( 3, 43);( 0, 50);( 0, 57)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 7);( 15, 31);( 41, 45);( 63, 61)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 7);( 12, 32);( 53, 40);( 77, 50)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 15);( 107, 14);( 215, 50);( 322, 26)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
7,
0);(
7,
0);(
0,
5);(

41, 39);( 41, 28);( 49, 39);( 56, 32);( 49, 28)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 43)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
56, 10);( 56, 0);( 56, 10);( 67, 7);( 56, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
7, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
34, 14);( 34, 3);( 34, 14);( 41, 7);( 34, 3)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
3, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 10);( 102, 34);( 205, 51);( 310, 54)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 43);( 10, 43);( 32, 35);( 39, 32);( 45, 28);( 56, 21);(
);( 70, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
28);(
35);(
0);(
28);(
63, 17
{\shp{\*\shpinst
25, 10);( 3, 0);( 0, 10);( 3, 14);( 10, 17);( 14, 21);(
);( 25, 32);( 28, 35);( 36, 39);( 39, 43)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
23, 14);( 21, 17);( 7, 25);( 0, 25);( 3, 39);( 18, 32);(
);( 45, 17);( 56, 7)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
56, 36);( 35, 12);( 30, 14);( 3, 0)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
17);(
21, 25
10);(
23, 28
43);(
16, 17);( 10, 21);( 0, 21);( 0, 35);( 7, 32);( 14, 32);( 20, 28
);( 27, 28);( 34, 21);( 42, 17);( 45, 14);( 52, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 14);( 14, 21);( 32, 25);( 46, 32);( 63, 39);( 81, 46);( 96, 53
);( 114, 61);( 130, 64)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 10);( 19, 22);( 30, 40);( 39, 61)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 14);( 56, 14);( 63, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}

{\shp{\*\shpinst
7, 100);( 96, 56);( 172, 33);( 268, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
74, 10);( 67, 0);( 56, 3);( 41, 17);( 31, 21);( 25, 28);(
);( 7, 53);( 10, 61);( 7, 53);( 0, 61);( 10, 61)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 14);( 10, 17);( 70, 17);( 81, 14);( 94, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
28, 35);( 31, 28);( 49, 10);( 41, 0);( 26, 18);( 5, 40);(
)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
90);(
14);(
21, 39
7);(
43);(
0, 64
{\shp{\*\shpinst
0, 10);( 33, 30);( 56, 28);( 94, 28)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
135, 121);( 143, 121);( 141, 93);( 146, 57);( 119, 28);( 101, 0);( 91, 10
);( 103, 35);( 127, 56);( 127, 86);( 128, 98);( 127, 117);( 112, 118);( 112,
122);( 105, 122);( 101, 126);( 94, 126);( 87, 122);( 83, 122);( 70, 115);(
56, 104);( 31, 83);( 17, 53);( 14, 21)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 14);( 70, 38);( 77, 28);( 145, 14)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst

39, 128);( 70, 126);( 32, 126);( 19, 116);( 15, 101);( 14, 86);( 17, 79
);( 17, 72);( 21, 61);( 25, 54);( 28, 43);( 43, 21);( 50, 7);( 39,
0);( 28, 10);( 25, 25);( 10, 46);( 3, 68);( 0, 75);( 0, 97);(
3, 104);( 3, 111);( 10, 126);( 17, 129);( 21, 136);( 25, 136);( 32, 140
);( 57, 140);( 63, 136);( 70, 133);( 81, 126);( 104, 118);( 135, 46);( 145,
25)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
123, 14);( 106, 7);( 70, 0);( 56, 0);( 43, 3);( 28, 7);( 14, 14
);( 0, 25);( 0, 28);( 0, 25);( 0, 28)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
60, 25);( 39, 21);( 21, 17);( 14, 14);( 10, 10);( 10, 3);( 0, 0
);( 0, 17);( 35, 35);( 46, 31);( 81, 43);( 99, 46);( 106, 50);( 110,
53);( 113, 57);( 113, 61);( 113, 57);( 127, 64);( 127, 61)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
74, 46);( 85, 43);( 92, 43);( 99, 39);( 110, 35);( 117, 28);( 124, 25
);( 128, 14);( 134, 7);( 121, 0);( 104, 55);( 39, 26);( 3, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
17, 140);( 26, 89);( 58, 45);( 95, 10)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 10);( 32, 49);( 50, 97);( 56, 147)}}
0}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
85, 28);( 85, 32);( 88, 32);( 92, 36);( 92, 39);( 96, 39);( 96, 43
);( 99, 46);( 99, 64);( 96, 68);( 96, 75);( 92, 75);( 92, 79);( 81,
90);( 77, 90);( 74, 93);( 67, 93);( 60, 93);( 53, 93);( 53, 90);(
46, 90);( 46, 86);( 43, 86);( 0, 57);( 7, 46);( 46, 75);( 50, 75
);( 53, 79);( 57, 79);( 61, 82);( 74, 82);( 74, 79);( 77, 79);( 77,
75);( 81, 75);( 81, 72);( 85, 72);( 85, 64);( 88, 64);( 88, 50);(
85, 50);( 85, 43);( 81, 43);( 77, 39);( 74, 39);( 74, 36)}}
{\shp{\*\shpinst
42, 10);( 49, 0);( 109, 64);( 98, 75);( 16, 54);( 67, 108)}}
{\shp{\*\shpinst
{\shp{\*\shpinst
60, 79);( 63, 79);( 63, 82);( 67, 86);( 67, 58);( 67, 31);(
);( 74, 0);( 77, 93)}}
{\shp{\*\shpinst
14, 17);( 17, 46);( 67, 35);( 67, 46);( 21, 57);( 25, 86);(
61);(
75)}}
75);(
63, 3
10);(
77, 75
);( 81, 86)}}

{\shp{\*\shpinst
63, 3);( 63, 7);( 67, 7);( 67, 10);( 70, 14);( 70, 36);( 67, 39
);( 67, 43);( 63, 43);( 60, 46);( 52, 46);( 49, 50);( 45, 50);( 49,
50);( 52, 54);( 56, 54);( 56, 57);( 63, 64);( 78, 90);( 63, 90);(
52, 72);( 52, 68);( 49, 68);( 49, 64);( 45, 61);( 45, 57);( 42, 57
);( 42, 54);( 38, 54);( 34, 50);( 14, 50);( 14, 90)}}
{\shp{\*\shpinst
38, 25);( 41, 25);( 41, 21);( 45, 21);( 45, 7);( 41, 7);( 41, 3
);( 38, 3);( 38, 0);( 0, 0)}}
{\shp{\*\shpinst
13, 61);( 13, 72);( 16, 72);( 20, 75);( 23, 75);( 23, 79);( 34, 7
9);( 34, 82);( 45, 82);( 45, 79);( 52, 79);( 52, 75);( 56, 75);( 56
, 61);( 52, 61);( 52, 57);( 49, 57);( 49, 53);( 42, 53);( 42, 50);(
34, 50);( 34, 46);( 31, 46);( 27, 43);( 23, 43);( 23, 39);( 20, 3
9);( 20, 35);( 16, 35);( 16, 32);( 13, 32);( 13, 14);( 16, 10);( 16
, 7);( 20, 7);( 20, 3);( 27, 3);( 27, 0);( 49, 0);( 52, 3);(
60, 3);( 60, 7);( 67, 7);( 67, 10);( 70, 10);( 70, 14);( 73, 1
7);( 73, 35);( 63, 32);( 63, 21);( 60, 17);( 56, 14);( 52, 14);( 49
, 10);( 31, 10);( 27, 14);( 23, 17);( 23, 25);( 27, 28);( 27, 32);(
34, 32);( 34, 35);( 38, 35);( 42, 39);( 45, 39);( 49, 43);( 52, 4
3);( 52, 46);( 56, 46);( 60, 50);( 63, 50);( 63, 53);( 67, 57);( 67
, 79);( 63, 79);( 63, 82);( 60, 86);( 56, 86);( 56, 90);( 49, 90);(
45, 93);( 34, 93);( 31, 90);( 20, 90);( 20, 86);( 13, 86);( 13, 8
2);( 9, 82);( 9, 79);( 6, 79);( 6, 75);( 3, 75);( 3, 68);( 0
, 68);( 0, 62);( 0, 56)}}
{\shp{\*\shpinst
{\shp{\*\shpinst
81, 36);( 74, 46);( 49, 28);( 10, 97)}}
{\shp{\*\shpinst
50, 90);( 60, 61);( 36, 35);( 10, 50)}}

{\shp{\*\shpinst
34, 7);( 38, 3);( 38, 0);( 34, 3);( 31, 3);( 27, 7);( 23, 7
)}}
{\shp{\*\shpinst
10, 39);( 10, 54);( 14, 57);( 14, 61);( 17, 64);( 17, 68);( 21, 6
8);( 21, 72);( 25, 72);( 25, 75);( 31, 75);( 37, 75);( 43, 75);( 43
, 72);( 46, 72);( 46, 66);( 46, 60);( 46, 54);( 43, 54);( 43, 46);(
39, 43);( 39, 32);( 36, 32);( 36, 26);( 36, 20);( 36, 14);( 39, 1
4);( 39, 7);( 43, 7);( 46, 3);( 52, 3);( 52, 0);( 60, 0);( 63
, 3);( 70, 3);( 70, 7);( 74, 7);( 74, 10);( 77, 10);( 77, 14);(
81, 14);( 81, 17);( 85, 21);( 85, 25);( 88, 28);( 88, 32);( 88, 3
8);( 88, 44);( 88, 50);( 85, 50);( 85, 54);( 81, 57);( 77, 57);( 77
, 61);( 70, 50);( 74, 50);( 74, 46);( 77, 46);( 77, 40);( 77, 34);(
77, 28);( 74, 28);( 74, 25);( 70, 21);( 70, 17);( 67, 17);( 67, 1
4);( 63, 14);( 60, 10);( 56, 10);( 52, 14);( 49, 14);( 49, 17);( 46
, 17);( 46, 25);( 49, 28);( 49, 36);( 52, 39);( 52, 50);( 56, 50);(
56, 58);( 56, 67);( 56, 75);( 52, 75);( 52, 79);( 49, 82);( 46, 8
2);( 46, 86);( 25, 86);( 21, 82);( 17, 82);( 17, 79);( 14, 79);( 10
, 75);( 10, 72);( 7, 72);( 7, 68);( 3, 64);( 3, 57);( 0, 57);(
0, 50);( 0, 43);( 0, 36);( 3, 36);( 3, 28);( 7, 28);( 7, 2
5);( 10, 25)}}
{\shp{\*\shpinst
18, 17);( 14, 17);( 14, 21);( 10, 25);( 10, 46);( 14, 50);( 14, 53
);( 18, 57);( 21, 57);( 21, 61);( 32, 61);( 32, 57);( 36, 57);( 36,
53);( 39, 50);( 39, 32);( 43, 28);( 43, 14);( 46, 14);( 46, 10);(
50, 7);( 50, 3);( 54, 3);( 57, 0);( 70, 0);( 74, 3);( 78, 3
);( 78, 7);( 81, 7);( 81, 10);( 85, 10);( 85, 17);( 88, 21);( 88,
46);( 85, 50);( 85, 53);( 80, 59);( 74, 63);( 67, 64);( 64, 53);(
67, 53);( 70, 50);( 74, 50);( 74, 46);( 78, 46);( 78, 21);( 74, 17
);( 74, 14);( 70, 14);( 70, 10);( 61, 10);( 61, 14);( 57, 14);( 57,
17);( 54, 17);( 55, 53);( 48, 30);( 50, 57);( 46, 57);( 46, 61);(
43, 64);( 43, 68);( 39, 68);( 36, 71);( 18, 71);( 18, 68);( 14, 68
);( 10, 64);( 7, 61);( 7, 57);( 3, 57);( 3, 50);( 0, 50);( 0,
44);( 0, 38);( 0, 32);( 0, 21);( 3, 17);( 3, 14);( 7, 14);(
7, 10);( 10, 7);( 14, 7);( 14, 3);( 21, 3);( 21, 0)}}
{\shp{\*\shpinst
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{\phpg\posx2115\pvpg\posy5129\absw7677\absh3151 \b \f10 \fs32 \cf0 \fi1146 \b \f
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cf0 \fi1740 DAN PENANGANANNYA
cf0 \fi2498 {\b0 \fs25 Pidato}{\b0 \fs25 Pengukuhan }
cf0 \fi2053 {\b0 \fs25 Jabatan}{\b0 \fs25 Guru}{\b0 \fs25 Besar}{\b0 \fs25 Te
tap }
cf0 \fi622 {\b0 \fs21 dalam}{\b0 \fs21 Bidang}{\b0 \fs21 Ilmu}{\b0 \fs21 Pato
logi}{\b0 \fs21 pada}{\b0 \fs21 Fakultas}{\b0 \fs21 Kedokteran, }
cf0 {\b0 \fs21 Diucapkan}{\b0 \fs21 di}{\b0 \fs21 hadapan}{\b0 \fs21 Rapat}{\
b0 \fs21 Terbuka}{\b0 \fs21 Universitas}{\b0 \fs21 Sumatera}{\b0 \fs21 Utara
}\par
}
{\phpg\posx2564\pvpg\posy9662\absw6778\absh264 \f10 \fs21 \cf0 \f10 \fs21 \cf0 G
elanggang Mahasiswa, Kampus USU, 16 Nopember 2005 \par
}
{\phpg\posx4312\pvpg\posy11344\absw3263\absh707 \f10 \fs21 \cf0 \fi1329 \f10 \fs
21 \cf0 Oleh:
\par}{\phpg\posx4312\pvpg\posy11344\absw3263\absh707 \sl-483 \f10 \fs21 \cf0 {\b
\fs25 RATNA}{\b \fs25 AKBARI}{\b \fs25 GANIE }\par
}
{\phpg\posx1701\pvpg\posy13957\absw6993\absh1695 \b \f10 \fs21 \cf0 \fi2491 \b \
f10 \fs21 \cf0 UNIVERSITAS SUMATERA UTARA
\par}{\phpg\posx1701\pvpg\posy13957\absw6993\absh1695 \sl-220 \par\b \f10 \fs21
\cf0 \fi3820 MEDAN
\cf0 \fi3984 {\i 2005 }
\cf0 {\b0 \f20 \fs16 Ratna}{\b0 \f20 \fs16 Akbari}{\b0 \f20 \fs16 Ganie}{\b0 \
f20 \fs16 :}{\b0 \f20 \fs16 Pidato}{\b0 \f20 \fs16 Pengukuhan}{\b0 \f20 \fs16
"Thalasemia}{\b0 \f20 \fs16 Permasalahan}{\b0 \f20 \fs16 dan}{\b0 \f20 \fs16
Penanganannya",}{\b0 \f20 \fs16 2005 }
\par}{\phpg\posx1701\pvpg\posy13957\absw6993\absh1695 \sl-227 \b \f10 \fs21 \cf0
{\b0\i \f20 \fs18 USU}{\b0\i \f20 \fs18 Repository}{\b0\i \f20 \fs18 }{\b0\i \
f20 \fs18 2006 }\par
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d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
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\fs19 \cf0 Thalassemia: Permasalahan dan Penanganannya \par
}
{\phpg\posx7231\pvpg\posy1707\absw2985\absh241 \b\i \f10 \fs21 \cf0 \b\i \f10 \f
s21 \cf0 Bismillahirrahmanirrahim, \par
}
{\phpg\posx2215\pvpg\posy2534\absw8262\absh4339 \i \f10 \fs21 \cf0 \fi2014 \i \f
10 \fs21 \cf0 Bapak Menteri Pendidikan Nasional Republik Indonesia,
\par}{\phpg\posx2215\pvpg\posy2534\absw8262\absh4339 \sl-413 \i \f10 \fs21 \cf0
\fi1802 Bapak Ketua dan Bapak/Ibu Anggota Majelis Wali Amanat
\fi4977 Universitas Sumatera Utara,
\fi2229 Bapak Ketua dan Bapak/Ibu Anggota Senat Akademik
\fi4977 Universitas Sumatera Utara,
Bapak Ketua dan Anggota Dewan Guru Besar Universitas Sumatera Utara,
\fi3456 Bapak Rektor Universitas Sumatera Utara,
\fi1896 Bapak/Ibu Pembantu Rektor Universitas Sumatera Utara,
\fi963 Para Dekan, Ketua Lembaga dan unit kerja, Dosen dan Karyawan
\fi3495 di lingkungan Universitas Sumatera Utara,
\fi226 Bapak dan Ibu para undangan, keluarga, teman sejawat, mahasiswa dan
\fi4978 hadirin yang Saya muliakan. \par
}
{\phpg\posx1701\pvpg\posy8330\absw9146\absh5641 \b \f10 \fs21 \cf0 \b \f10 \fs21
\cf0 Assalamu'alaikum Warohmatullahi' Wabarakatuh
cf0 \fi720 {\b0 Pada}{\b0 kesempatan}{\b0 yang}{\b0 berbahagia}{\b0 ini}{\b0
perkenankan}{\b0 Saya}{\b0 mengucapkan }
{\b0 puji}{\b0 syukur}{\b0 kepada}{\b0 Allah}{\b0 SWT}{\b0 yang}{\b0
telah}{\b0 melimpahkan}{\b0 rahmat}{\b0 dan}{\b0 karunia- }
{\b0 Nya}{\b0 kepada}{\b0 kita}{\b0 sekalian,}{\b0 sehingga}{\b0 kita}
{\b0 dapat}{\b0 berkumpul}{\b0 bersama}{\b0 dalam }
{\b0 keadaan}{\b0 sehat}{\b0 wal'afiat}{\b0 pada}{\b0 hari}{\b0 ini,}{\b0
yang}{\b0 merupakan}{\b0 hari}{\b0 yang}{\b0 bahagia}{\b0 bagi }
{\b0 Saya}{\b0 dan}{\b0 keluarga}{\b0 karena}{\b0 mendapat}{\b0 syukur}{\b0
nikmat}{\b0 dari}{\b0 Allah}{\b0 SWT. }

\fi720 {\b0 Bersama}{\b0
ini}{\b0
Saya}{\b0
mengucapkan}{\b0
terima}
{\b0
kasih}{\b0
kepada}{\b0
Pemerintah }
{\b0 Republik}{\b0 Indonesia}{\b0 yang}{\b0 telah}{\b0 memberikan}{\b0
kepercayaan}{\b0 kepada}{\b0 Saya}{\b0 untuk }
{\b0 mendapatkan}{\b0 jabatan}{\b0 Guru}{\b0 Besar}{\b0 Tetap}{\b0 Bid
ang}{\b0 Ilmu}{\b0 Patologi}{\b0 Klinik}{\b0 pada }
{\b0 Universitas}{\b0 Sumatera}{\b0 Utara. }
\fi720 {\b0 Oleh}{\b0 karenanya}{\b0 izinkanlah}{\b0 Saya}{\b0 menyampai
kan}{\b0 pidato}{\b0 pengukuhan }
{\b0 sebagai}{\b0 Guru}{\b0 Besar}{\b0 Tetap}{\b0 dalam}{\b0 bidang}{\
b0 Ilmu}{\b0 Patologi}{\b0 Klinik}{\b0 di}{\b0 Fakultas }
{\b0 Kedokteran}{\b0 Sumatera}{\b0 Utara}{\b0 ini}{\b0 dengan}{\b0 judul: }
cf0 \fi721 {\b0 \f12 \fs25 THALASSEMIA:}{\b0 \f12 \fs25 PERMASALAHAN}{\b0 \f12
\fs25 DAN}{\b0 \f12 \fs25 PENANGANANNYA }\par
}
{\phpg\posx10096\pvpg\posy15184\absw146\absh218 \f20 \fs19 \cf0 \f20 \fs19 \cf0
1 \par
}
Ratna Akbari Ganie : Pidato Pengukuhan "Thalasemia Permasalahan dan Penangananny
a", 2005
\par}{\phpg\posx1701\pvpg\posy15432\absw6993\absh388 \sl-228 \f20 \fs16 \cf0 {\i
\fs18 USU}{\i \fs18 Repository}{\i \fs18 }{\i \fs18 2006 }\par
}
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\fs19 \cf0 Pidato Pengukuhan Jabatan Guru Besar Tetap
\par}{\phpg\posx1701\pvpg\posy720\absw4986\absh486 \sl-271 \i \f10 \fs19 \cf0 Un
iversitas Sumatera Utara \par
}
\cf0 Pendahuluan \par
}
{\phpg\posx1701\pvpg\posy2602\absw3126\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 H
adirin yang Saya muliakan, \par
}
21 \cf0 Judul ini Saya pilih dengan pertimbangan bahwa thalassemia merupakan
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-414 \f10 \fs21 \cf0 pe
nyakit darah herediter (keturunan) yang paling sering dan akan merupakan
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-413 \f10 \fs21 \cf0 ke
lainan genetik utama yang timbul setelah penyakit infeksi dan gangguan gizi
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-414 \f10 \fs21 \cf0 te
ratasi di Indonesia. Menyambut Paradigma Indonesia Sehat 2010 yang baru
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-413 \f10 \fs21 \cf0 di
canangkan, kualitas sumber daya manusia tentu saja merupakan faktor yang
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-414 \f10 \fs21 \cf0 ut
ama dan keberadaan thalassemia tentu saja akan menurunkan kualitas
sehatan masyarakat.
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-413 \f10 \fs21 \cf0 \f
i720 Thalassemia berasal dari kata Yunani, yaitu{\i talassa} yang berar
ti laut.
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-413 \f10 \fs21 \cf0 Ya

ng dimaksud dengan laut tersebut ialah Laut Tengah, oleh karena penyakit
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-413 \f10 \fs21 \cf0 in
i pertama kali dikenal di daerah sekitar Laut Tengah. Penyakit ini pe
rtama
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-414 \f10 \fs21 \cf0 se
kali ditemukan oleh seorang dokter di Detroit USA yang bernama Thomas B.
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-413 \f10 \fs21 \cf0 Co
oley pada tahun 1925. Beliau menjumpai anak-anak yang menderita anemia
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-413 \f10 \fs21 \cf0 de
ngan pembesaran limpa setelah berusia satu tahun. Selanjutnya, anemia ini
namakan anemia{\i splenic} atau{\i eritroblastosis} atau anemia mediteranean a
tau
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-414 \f10 \fs21 \cf0 an
emia Cooley sesuai dengan nama penemunya (Weatherall, 1965).
i720 Sebagai sindrom klinik penderita thalassemia mayor (homozigot) yang
lah agak besar menunjukkan gejala-gejala fisik yang unik berupa hambatan
rtumbuhan, anak menjadi kurus bahkan kurang gizi (Lubis,{\i et.al.,} 1
991),
rut membuncit akibat hepato-splenomegali dengan wajah wajah yang khas
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-413 \f10 \fs21 \cf0 mo
ngoloid,{\i frontal}{\i bossing,} mulut tongos ({\i rodent}{\i like}{\i mout
h}), bibir agak tertarik,
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-414 \f10 \fs21 \cf0 ma
loklusi gigi (Lihat Gambar 1).
i720 Thalassemia adalah penyakit genetik yang diturunkan secara autosomal
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-413 \f10 \fs21 \cf0 re
sesif menurut hukum Mendel dari orang tua kepada anak-anaknya. Penyakit
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-414 \f10 \fs21 \cf0 th
alassemia meliputi suatu keadaan penyakit dari gelaja klinis yang palin
g
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-413 \f10 \fs21 \cf0 ri
ngan (bentuk heterozigot) yang disebut thalassemia minor atau thalassemi
a
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-414 \f10 \fs21 \cf0 tr
ait (carrier = pengemban sifat) hingga yang paling berat (bentuk homozigot)
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-414 \f10 \fs21 \cf0 ya
ng disebut thalassemia mayor. Bentuk heterozigot diturunkan oleh salah satu
\par}{\phpg\posx1701\pvpg\posy3430\absw8738\absh10300 \sl-413 \f10 \fs21 \cf0 or
ang tuanya yang mengidap penyakit thalassemia, sedangkan bentuk \p
ar
}
2
\par}{\phpg\posx1701\pvpg\posy15436\absw6993\absh612 \sl-213 \f20 \fs19 \cf0 {\f
s16 Ratna}{\fs16 Akbari}{\fs16 Ganie}{\fs16 :}{\fs16 Pidato}{\fs16 Pengukuh
an}{\fs16 "Thalasemia}{\fs16 Permasalahan}{\fs16 dan}{\fs16 Penanganannya",}
{\fs16 2005 }
}

0}}}}
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homozigot diturunkan oleh kedua orang tuanya yang mengidap penyaki
t
alassemia.
i720 Thalassemia ternyata tidak saja terdapat di sekitar Laut Tengah, tetapi
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-414 \f10 \fs21 \cf0 ju
ga di Asia Tenggara yang sering disebut sebagai sabuk thalassemia (WHO,
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-413 \f10 \fs21 \cf0 19

83) sebelum pertama sekali ditemui pada tahun 1925 (Lihat Gambar 2). Di
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-414 \f10 \fs21 \cf0 In
donesia banyak dijumpai kasus thalassemia, hal ini disebabkan oleh karena
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-414 \f10 \fs21 \cf0 mi
grasi penduduk
dan percampuran penduduk. Menurut hipotesis, migrasi
nduduk tersebut diperkirakan berasal dari Cina Selatan yang dikelompokkan
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-413 \f10 \fs21 \cf0 da
lam dua periode. Kelompok migrasi pertama diduga memasuki Indonesia
kitar 3.500 tahun yang lalu dan disebut Protomelayu (Melayu awal) dan
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-414 \f10 \fs21 \cf0 mi
grasi kedua diduga 2.000 tahun yang lalu disebut Deutromelayu (Melayu
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-413 \f10 \fs21 \cf0 ak
hir) dengan fenotip Monggoloid yang kuat. Keseluruhan populasi ini menjadi
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-414 \f10 \fs21 \cf0 me
njadi Hunian kepulauan Indonesia tersebar di Kalimantan, Sulawesi, pulau
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-414 \f10 \fs21 \cf0 Ja
wa, Sumatera, Nias, Sumba dan Flores (Weatherall and Clegg, 2001).
i720 Pada tahun 1955, Lie-Injo Luan Eng dan Yo Kian Tjai, telah melaporkan
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-413 \f10 \fs21 \cf0 ad
anya 3 orang anak menderita thalassemia mayor dan 4 tahun kemudian
temukan 23 orang anak dengan penyakit yang serupa di Indonesia. Dalam
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-414 \f10 \fs21 \cf0 ku
run waktu 17 tahun, yaitu dari tahun 1961 hingga tahun 1978
telah
nemukan tidak kurang dari 300 penderita dengan sindrom thalassemia ini.
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-413 \f10 \fs21 \cf0 Ka
sus-kasus yang serupa telah banyak pula dilaporkan oleh berbagai rumah
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-413 \f10 \fs21 \cf0 sa
kit di Indonesia, di antaranya Manurung (1978) dari bagian Ilmu Kesehatan
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-413 \f10 \fs21 \cf0 An
ak F.K. Universitas Sumatera Utara Medan telah melaporkan 13 kasus,
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-414 \f10 \fs21 \cf0 Su
mantri (1978) dari bagian Kesehatan Anak F.K. Universitas Diponegoro
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-413 \f10 \fs21 \cf0 Se
marang, Untario (1978) dari bagian Ilmu Kesehatan Anak F.K. Airlangga,
narto (1978) dari bagian Ilmu Kesehatan Anak F.K. Universitas Gadjah Mada
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-414 \f10 \fs21 \cf0 Yo
gyakarta. Demikian pula telah dilaporkan kasus-kasus yang serupa dari F.K.
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-413 \f10 \fs21 \cf0 Un
iversitas Hasanuddin Ujung Pandang (Wahidayat, 1979). Vella (1958), Li-Injo
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-414 \f10 \fs21 \cf0 &
Chin (1964) dan Wong (1966). Demikian juga di Malaysia dengan kasus yang
rupa dilaporkan oleh George{\i et.al}. (1992).
i720 Di negara-negara yang mempunyai frekuensi gen thalassemia yang
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-414 \f10 \fs21 \cf0 ti
nggi penyakit tersebut menimbulkan masalah kesehatan masyarakat{\i (Publ
ic }
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-414 \f10 \fs21 \cf0 {\
i Health).} Pada umumnya anak dengan penyakit thalassemia mayor tidak akan
\par}{\phpg\posx1701\pvpg\posy1706\absw8695\absh12741 \sl-312 \par\f10 \fs21 \cf
0 \fi8395 {\f20 \fs19 3 }

f20 \fs16 Ratna}{\f20 \fs16 Akbari}{\f20 \fs16 Ganie}{\f20 \fs16 :}{\f20 \fs1
6 Pidato}{\f20 \fs16 Pengukuhan}{\f20 \fs16 "Thalasemia}{\f20 \fs16 Permasal
ahan}{\f20 \fs16 dan}{\f20 \fs16 Penanganannya",}{\f20 \fs16 2005 }
i \f20 \fs18 USU}{\i \f20 \fs18 Repository}{\i \f20 \fs18 }{\i \f20 \fs18 2006
}\par
}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
mencapai usia reproduktif bahkan mati di dalam kandungan atau mati setelah
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-430 \f10 \fs21 \cf0 lah
ir seperti pada thalassemia-{\f40 {\field{\*\fldinst SYMBOL 97 \\f Symbol }}}
Hb bart's hydrop fetalis (lihat Gambar 3).
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-423 \f10 \fs21 \cf0 Kea
daan ini sangat memprihatinkan andaikata anak-anak yang lahir tidak akan
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-413 \f10 \fs21 \cf0 men
capai usia dewasa, maka generasi berikutnya akan semakin berkurang
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-414 \f10 \fs21 \cf0 bah
kan akan lenyap setelah beribu-ribu tahun.
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-413 \f10 \fs21 \cf0 \fi
720 Ditinjau dari segi keluarga penderita, adanya seorang atau beberapa
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-414 \f10 \fs21 \cf0 ana
k yang menderita penyakit thalassemia mayor merupakan beban yang
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-413 \f10 \fs21 \cf0 san
gat berat karena mereka menderita anemia berat dengan kadar Hb di
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-414 \f10 \fs21 \cf0 baw
ah 6-7 gr%. Mereka harus mendapatkan transfusi darah seumur hidup
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-414 \f10 \fs21 \cf0 unt
uk mengatasi anemia mempertahankan kadar haemoglobin 9-10 gr%. Dapat
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-413 \f10 \fs21 \cf0 dib
ayangkan bagaimana beratnya beban keluarga apabila beberapa anak yang
derita penyakit tersebut. Pemberian transfusi darah yang berulang-ulang
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-414 \f10 \fs21 \cf0 dap
at menimbulkan komplikasi hemosiderosis dan hemokromatosis, yaitu
imbulkan penimbunan zat besi dalam jaringan tubuh sehingga dapat
yebabkan kerusakan organ-organ tubuh seperti hati, limpa, ginjal, jantung,
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-414 \f10 \fs21 \cf0 tul
ang, dan pankreas. Tanpa transfusi yang memadai penderita thalassemia
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-414 \f10 \fs21 \cf0 may
or akan meninggal pada dekade kedua (Weatherall & Clegg, 2001).
720 Efek lain yang ditimbukan akibat transfusi, yaitu tertularnya penyak
it
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-413 \f10 \fs21 \cf0 lew
at transfusi seperti penyakit hepatitis B, C, dan HIV. Hingga sekarang belum
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-414 \f10 \fs21 \cf0 dik
enal obat yang dapat menyembuhkan penyakit tersebut bahkan cangkok
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-412 \f10 \fs21 \cf0 sum
sum tulang pun belum dapat memuaskan. Para ahli berusaha untuk
gurangi atau mencegah kelahiran anak yang menderita thalassemia mayor
\par}{\phpg\posx1701\pvpg\posy1706\absw8734\absh8478 \sl-432 \f10 \fs21 \cf0 ata
u thalassemia-{\f40 {\field{\*\fldinst SYMBOL 97 \\f Symbol }}} homozigot. \par
}
\cf0 Thalassemia Penyakit Hemoglobin (Hemoglobinopati) \par
}
21 \cf0 Hemoglobin manusia terdiri dari persenyawaan hem dan globin. Hem
rdiri dari zat besi (atom Fe) sedangkan globin suatu protein yang terdiri dari
\par}{\phpg\posx1701\pvpg\posy12591\absw8672\absh1774 \sl-414 \f10 \fs21 \cf0 ra
ntai polipeptida. Hemoglobin manusia normal pada orang dewasa terdiri dari
rantai alfa ({\f40 {\field{\*\fldinst SYMBOL 97 \\f Symbol }}}) dan 2 rantai bet
a ({\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol }}}) yaitu HbA ({\f40 {\field{\
*\fldinst SYMBOL 97 \\f Symbol }}}2{\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol
}}}2 = 97%), sebagian lagi
0 HbA2 ({\f40 {\field{\*\fldinst SYMBOL 97 \\f Symbol }}}2{\f40 {\field{\*\fldin
st SYMBOL 100 \\f Symbol }}}2 = 2,5%) dan sisanya HbF ({\f40 {\field{\*\fldinst
SYMBOL 97 \\f Symbol }}}2{\f40 {\field{\*\fldinst SYMBOL 103 \\f Symbol }}}2) ki
ra-kira 0,5%. \par
}
4
{\fs16 2005 }
}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
21 \cf0 Sintesa globin ini telah dimulai pada awal kehidupan masa embri
o di
lam kandungan sampai dengan 8 minggu kehamilan dan hingga akhir
hamilan. Organ yang bertanggung jawab pada periode ini adalah hati, limpa,
n sumsum tulang (Gale{\i et.al.,} 1979) (lihat Gambar 4).
i720 Karena rantai globin merupakan suatu protein maka sintesisnya
kendalikan oleh gen tertentu. Ada 2 kelompok gen yang bertanggung jawab
lam proses pengaturannya, yaitu kluster gen globin-{\f40 {\field{\*\fldins
t SYMBOL 97 \\f Symbol }}} yang terletak pada
0 lengan pendek autosom 16 (16 p 13.3) dan kluster gen globin-{\f40 {\field{\*\f
ldinst SYMBOL 98 \\f Symbol }}} yang terletak
0 pada lengan pendek autosom 11 (11 p 15.4). Kluster gen globin-{\f40
{\field{\*\fldinst SYMBOL 97 \\f Symbol }}} secara
0 berurutan mulai dari 5' sampai 3' yaitu gen 5'-{\f40 {\field{\*\fldins
t SYMBOL 122 \\f Symbol }}}2-{\f40 {\field{\*\fldinst SYMBOL 121 \\f Symbol }}{\
field{\*\fldinst SYMBOL 122 \\f Symbol }}}1-{\f40 {\field{\*\fldinst SYMBOL 97 \
\f Symbol }}{\field{\*\fldinst SYMBOL 121 \\f Symbol }}}2-{\f40 {\field{\*\fldin
st SYMBOL 97 \\f Symbol }}{\field{\*\fldinst SYMBOL 121 \\f Symbol }}}1-{\f40 {\
field{\*\fldinst SYMBOL 97 \\f Symbol }}}2-{\f40 {\field{\*\fldinst SYMBOL 97 \\
f Symbol }}}1-{\f40 {\field{\*\fldinst SYMBOL 113 \\f Symbol }}}1-3'
0 (Evans{\i et}{\i al}., 1990). Sebaliknya kluster gen globin-{\f40 {\field{\*
\fldinst SYMBOL 98 \\f Symbol }}} terdiri dari gen 5'-{\f40 {\field{\*\fldinst S
YMBOL 101 \\f Symbol }}}-G{\f40 {\field{\*\fldinst SYMBOL 103 \\f Symbol }}}-A{\
f40 {\field{\*\fldinst SYMBOL 103 \\f Symbol }}}\par}{\phpg\posx1701\pvpg\posy1706\absw9310\absh11379 \sl-220 \par\f10 \fs21 \cf
0 {\f40 {\field{\*\fldinst SYMBOL 121 \\f Symbol }}{\field{\*\fldinst SYMBOL 98
\\f Symbol }}}-{\f40 {\field{\*\fldinst SYMBOL 100 \\f Symbol }}}-{\f40 {\field{
\*\fldinst SYMBOL 98 \\f Symbol }}}-3' (Collins{\i et}{\i al.}, 1984) (lihat G
ambar 5).
i720 Thalassemia diartikan sebagai sekumpulan gangguan genetik yang
ngakibatkan berkurang atau tidak ada sama sekali sintesis satu atau lebih
ntai globin (Weatherall and Clegg, 1981). Abnormalitas dapat terjadi pa
da
tiap gen yang menyandi sintesis rantai polipeptid globin, tetapi
yang
mpunyai arti klinis hanya gen-{\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol
}}} dan gen-{\f40 {\field{\*\fldinst SYMBOL 97 \\f Symbol }}}. Karena ada 2
pasang gen-{\f40 {\field{\*\fldinst SYMBOL 97 \\f Symbol }}},
ka dalam pewarisannya akan terjadi kombinasi gen yang sangat bervariasi.
\par}{\phpg\posx1701\pvpg\posy1706\absw9310\absh11379 \sl-432 \f10 \fs21 \cf0 Bi
la terdapat kelainan pada keempat gen-{\f40 {\field{\*\fldinst SYMBOL 97 \\f Sym
bol }}} maka akan timbul manifestasi klinis
0 dan masalah. Adanya kelainan gen-{\f40 {\field{\*\fldinst SYMBOL 97 \\f Sy
mbol }}} lebih kompleks dibandingan dengan
0 kelainan gen-{\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol }}} yang hanya
terdapat satu pasang. Gangguan pada sintesis
0 rantai-{\f40 {\field{\*\fldinst SYMBOL 97 \\f Symbol }}} dikenal dengan pen
yakit thalassemia-{\f40 {\field{\*\fldinst SYMBOL 97 \\f Symbol }}}, sedangkan
gangguan pada
0 sintesis rantai-{\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol }}} disebut thal
assemia-{\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol }}}.
i720 Kelainan klinis pada sintesis rantai globin-alfa dan beta dapat te
rjadi,
bagai berikut:
\par}{\phpg\posx1701\pvpg\posy1706\absw9310\absh11379 \sl-412 \f10 \fs21 \cf0 1.
{\i Silent}{\i carrier} yang hanya mengalami kerusakan 1 gen, sehingga pada k
asus
i357 ini tidak terjadi kelainan hematologis. Identifikasi hanya dapat di
lakukan
i357 dengan analisis molekular menggunakan RFLP atau sekuensing.
Bila terjadi kerusakan pada 2 gen-{\f40 {\field{\*\fldinst SYMBOL 97 \\f Symbo
l }}} atau thalassemia-{\f40 {\field{\*\fldinst SYMBOL 97 \\f Symbol }}} minor a
tau carrier
0 \fi357 thalassemia-{\f40 {\field{\*\fldinst SYMBOL 97 \\f Symbol }}} menyebabk
an kelainan hematologis. \par
}
5 \par
}
a", 2005
}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9

}
3. Bila terjadi kerusakan 3 gen-{\f40 {\field{\*\fldinst SYMBOL 97 \\f Sym
bol }}} yaitu pada penyakit HbH secara klinis
i357 termasuk thalassemia intermedia.
Pada Hb-Bart's hydrop fetalis disebabkan oleh kerusakan keempat gen
i357 globin-alfa dan bayi terlahir sebagai Hb-Bart's hydrop fetali
s akan
i357 mengalami oedema dan asites karena penumpukan cairan dalam jaringan
i357 fetus akibat anemia berat.
0 \fi5570 {\fs14 0 }
Pada thalassemia-{\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol }}} mayor bentu
k homozigot ({\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol }}} ) dan thalassemia
-{\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol }}} minor
0 \fi571 {\fs14 + }
i360 ({\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol }}} ) bentuk heterozigot yan
g tidak menunjukkan gejala klinis yang berat.
0 \fi720 Gangguan yang terjadi pada sintesis rantai globin-{\f40 {\field{\
*\fldinst SYMBOL 97 \\f Symbol }}} ataupun-{\f40 {\field{\*\fldinst SYMBOL 98 \
\f Symbol }}} jika
rjadi pada satu atau dua gen saja tidak menimbulkan masalah yang seri
us
\par}{\phpg\posx1701\pvpg\posy1700\absw8779\absh10427 \sl-414 \f10 \fs21 \cf0 ha
nya sebatas pengemban sifat ({\i trait} atau{\i carrier}). Thalassemia{\
i trait} disebut
ga thalassemia minor tidak menunjukkan gejala klinis yang berarti sama
lnya seperti orang normal kalaupun ada hanya berupa anemia ringan. Kadar
\par}{\phpg\posx1701\pvpg\posy1700\absw8779\absh10427 \sl-413 \f10 \fs21 \cf0 Hb
normal pada laki-laki: 13,5 - 17,5 g/dl dan pada wanita: 12 - 14 g/dl. Namun
mikian nilai indeks hematologis, yaitu nilai MCV dan MCH berada di bawah
\par}{\phpg\posx1701\pvpg\posy1700\absw8779\absh10427 \sl-413 \f10 \fs21 \cf0 ni
lai rentang normal. Rentang normal MCV: 80 - 100 g/dl, MCH: 27 - 34 g/dl.
\par}{\phpg\posx1701\pvpg\posy1700\absw8779\absh10427 \sl-413 \f10 \fs21 \cf0 Pe
meriksaan sedimen darah tepi ({\i Blood}{\i Film}) dijumpai bentuk erit
rosit tidak
ma besar (anisositosis) dan bervariasi (poikilositosis) (lihat Gambar 6)
.
\par}{\phpg\posx1701\pvpg\posy1700\absw8779\absh10427 \sl-414 \f10 \fs21 \cf0 Be
ntuk sel darah merah pada penderita thalassemia berbeda dengan bentuk
\par}{\phpg\posx1701\pvpg\posy1700\absw8779\absh10427 \sl-413 \f10 \fs21 \cf0 er
itrosit pada orang normal.
i720 Permasalahan thalassemia akan muncul jika thalassemia{\i trait} kaw

in
samanya sehingga 25% dari keturunannya menurunkan thalassemia mayor,
% kemungkinan anak mereka menderita thalassemia{\i trait} dan hanya 25
%
\par}{\phpg\posx1701\pvpg\posy1700\absw8779\absh10427 \sl-414 \f10 \fs21 \cf0 an
ak mempunyai darah normal (lihat Gambar 7).
i720 Dari uraian di atas semakin jelas bahwa thalassemia merupak
an
salah kesehatan apakah thalassemia-{\f40 {\field{\*\fldinst SYMBOL 97 \\f Symbol
}}} ataupun thalassemia-{\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol }}}. Diha
rapkan
\par}{\phpg\posx1701\pvpg\posy1700\absw8779\absh10427 \sl-423 \f10 \fs21 \cf0 na
ntinya ada persamaan persepsi dan pemahaman tentang masalah
alassemia dan penanganannya. \par
}
6
{\fs16 2005 }
}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
\cf0 Permasalahan \par
}
{\phpg\posx1701\pvpg\posy2602\absw8707\absh6251 \f10 \fs21 \cf0 \fi720 \f10 \fs2
1 \cf0 Thalassemia telah menimbulkan berbagai masalah kesehatan dunia
\par}{\phpg\posx1701\pvpg\posy2602\absw8707\absh6251 \sl-414 \f10 \fs21 \cf0 ter
utama pada negara-negara berkembang, sehingga WHO (1983) telah
cantumkan program penanganannya. Keberadaan penyakit tersebut di
\par}{\phpg\posx1701\pvpg\posy2602\absw8707\absh6251 \sl-414 \f10 \fs21 \cf0 Ind
onesia, harus dianggap sebagai masalah kesehatan masyarakat yang
\par}{\phpg\posx1701\pvpg\posy2602\absw8707\absh6251 \sl-414 \f10 \fs21 \cf0 ser
ius, karena skrining pengemban sifat kelainan darah tersebut pada berbagai
\par}{\phpg\posx1701\pvpg\posy2602\absw8707\absh6251 \sl-413 \f10 \fs21 \cf0 pop
ulasi menujukkan angka yang cukup memprihatinkan. Pada beberapa
ulasi, frekuensi pengemban sifat thalassemia sangat tinggi mencapai 10%
\par}{\phpg\posx1701\pvpg\posy2602\absw8707\absh6251 \sl-414 \f10 \fs21 \cf0 dan
36% untuk Hb-E (Lanni, 2002).
720 Sumatera Utara khususnya Medan, pengemban sifat thalassemia
capai 7,69% dengan taksiran 6,35% sampai 9,03% yang terdiri dari
\par}{\phpg\posx1701\pvpg\posy2602\absw8707\absh6251 \sl-431 \f10 \fs21 \cf0 tha
lassemia-{\f40 {\field{\*\fldinst SYMBOL 97 \\f Symbol }}} yaitu 3,35% dengan
taksiran 2,45% sampai 4,2%, pengemban
\par}{\phpg\posx1701\pvpg\posy2602\absw8707\absh6251 \sl-220 \par\f10 \fs21 \cf0
sifat thalassemia-{\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol }}} yaitu 4,
07% dengan taksiran antara 3,08% sampai 5,06%

0,26% HbE dengan taksiran 0,004% sampai 0,576% yang terdistribusi
\par}{\phpg\posx1701\pvpg\posy2602\absw8707\absh6251 \sl-413 \f10 \fs21 \cf0 pad
a berbagai suku di Medan, yaitu suku Batak, Jawa, Cina, Mela
yu,
\par}{\phpg\posx1701\pvpg\posy2602\absw8707\absh6251 \sl-413 \f10 \fs21 \cf0 Min
angkabau, dan Aceh (Ganie, 2003). Jika tidak ada tindakan preventif atau
\par}{\phpg\posx1701\pvpg\posy2602\absw8707\absh6251 \sl-414 \f10 \fs21 \cf0 pen
gendalian dalam bentuk apapun, maka angka tersebut akan terus
\par}{\phpg\posx1701\pvpg\posy2602\absw8707\absh6251 \sl-413 \f10 \fs21 \cf0 ber
tambah. \par
}
\cf0 Tindakan
\par}{\phpg\posx1701\pvpg\posy9694\absw1783\absh613 \sl-413 \f10 \fs21 \cf0 peng
endalian \par
}
\cf0 preventif
\par}{\phpg\posx3443\pvpg\posy9694\absw1280\absh613 \sl-413 \f10 \fs21 \cf0 thal
assemia \par
}
{\phpg\posx4861\pvpg\posy9694\absw627\absh613 \f10 \fs21 \cf0 \f10 \fs21 \cf0 ya
ng
\par}{\phpg\posx4861\pvpg\posy9694\absw627\absh613 \sl-413 \f10 \fs21 \cf0 \fi16
4 dan \par
}
{\phpg\posx5648\pvpg\posy9694\absw1125\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 d
ianjurkan \par
}
{\phpg\posx7021\pvpg\posy9694\absw504\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 ol
eh \par
}
{\phpg\posx8594\pvpg\posy9694\absw787\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 (1
994) \par
}
{\phpg\posx9554\pvpg\posy9694\absw713\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 da
lam \par
}
hemoglobinopati \par
}
{\phpg\posx7741\pvpg\posy9694\absw685\absh613 \f10 \fs21 \cf0 \f10 \fs21 \cf0 WH
O
pada \par
}
negara-negara \par
}
berkembang adalah tindakan preventif berupa skrining penyakit thalassemi
a
\par}{\phpg\posx1701\pvpg\posy10521\absw8667\absh4808 \sl-414 \f10 \fs21 \cf0 pa
da pupulasi tertentu, konseling genetik pranikah dan prenatal diagnosis.
\par}{\phpg\posx1701\pvpg\posy10521\absw8667\absh4808 \sl-413 \f10 \fs21 \cf0 Ko
nseling genetik pranikah ditujukan untuk pasangan pranikah terutama pada
\par}{\phpg\posx1701\pvpg\posy10521\absw8667\absh4808 \sl-414 \f10 \fs21 \cf0 po
pulasi yang berprevalensi tinggi (berprevalensi > 5%) untuk memeriksakan

ri apakah mereka mengemban sifat genetik tersebut atau tidak. Konseling
\par}{\phpg\posx1701\pvpg\posy10521\absw8667\absh4808 \sl-413 \f10 \fs21 \cf0 ge
netik juga ditujukan kepada mereka yang mempunyai kerabat dekat
nderita thalassemia. Berdasarkan penelitian skrining pada donor darah dari
\par}{\phpg\posx1701\pvpg\posy10521\absw8667\absh4808 \sl-432 \f10 \fs21 \cf0 po
pulasi
di
kota
Medan,
prevalensi
thalassemia
(thalassemia-{\f4
0 {\field{\*\fldinst SYMBOL 97 \\f Symbol }}}
dan
0 thalassemia-{\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol }}}) > 5 % yaitu 7,6
9% dengan taksiran 6,35 - 9,03%. Karena itu,
\par}{\phpg\posx1701\pvpg\posy10521\absw8667\absh4808 \sl-422 \f10 \fs21 \cf0 ko
nseling genetik harus segera disosialisasikan untuk mengurangi insidensi
alassemia pada masa yang akan datang.
0 \fi8395 {\f20 \fs19 7 }
}\par
}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
\cf0 Dengan menggunakan persamaan Hardy-Weiberg (Galanello,{\i et}{\i a
l. }
), maka kelahiran bayi thalassemia heterozigot dan homozigot dapat
\par}{\phpg\posx1701\pvpg\posy1706\absw8647\absh985 \sl-414 \f10 \fs21 \cf0 dira
malkan sebagai berikut: \par
}
{\phpg\posx5028\pvpg\posy3324\absw256\absh274 \b \f10 \fs14 \cf0 \fi146 \b \f10
\fs14 \cf0 2
\par}{\phpg\posx5028\pvpg\posy3324\absw256\absh274 \sl-217 \b \f10 \fs14 \cf0 {\
fs21 p }\par
}
0 \fs14 \cf0 2
\par}{\phpg\posx5330\pvpg\posy3324\absw1593\absh274 \sl-217 \b \f10 \fs14 \cf0 {
\fs21 +}{\fs21 2pq}{\fs21 +}{\fs21 q}{\fs21 =}{\fs21 1 }\par
}
{\phpg\posx1701\pvpg\posy4189\absw316\absh1731 \f10 \fs21 \cf0 \f10 \fs21 \cf0 p
\par}{\phpg\posx1701\pvpg\posy4189\absw316\absh1731 \sl-414 \f10 \fs21 \cf0 q
\fi133 {\fs14 2 }
\par}{\phpg\posx1701\pvpg\posy4189\absw316\absh1731 \sl-217 \f10 \fs21 \cf0 p
\par}{\phpg\posx1701\pvpg\posy4189\absw316\absh1731 \sl-414 \f10 \fs21 \cf0 pq
\fi133 {\fs14 2 }
\par}{\phpg\posx1701\pvpg\posy4189\absw316\absh1731 \sl-217 \f10 \fs21 \cf0 q \p
ar
}
= Prekuensi gen thalassemia (1/2 frekuensi{\i carrier})
\par}{\phpg\posx2421\pvpg\posy4189\absw5594\absh1731 \sl-414 \f10 \fs21 \cf0 = P
rekuensi gen HbA = 1-p
rekuensi kelahiran homozigot

rekuensi heterozigot
rekuensi homozigot normal \par
}
{\phpg\posx1701\pvpg\posy6673\absw8682\absh613 \f10 \fs21 \cf0 \f10 \fs21 \cf0 C
ontoh: Jika frekuensi pengemban sifat (carrier) thalassemia di satu neg
ara
\par}{\phpg\posx1701\pvpg\posy6673\absw8682\absh613 \sl-413 \f10 \fs21 \cf0 sebe
sar 3% maka frekuensi gen diperkirakan 1,5% atau 0.015 \par
}
{\phpg\posx1701\pvpg\posy7915\absw243\absh986 \f10 \fs21 \cf0 \f10 \fs21 \cf0 p
\par}{\phpg\posx1701\pvpg\posy7915\absw243\absh986 \sl-413 \f10 \fs21 \cf0 q
\par}{\phpg\posx1701\pvpg\posy7915\absw243\absh986 \sl-151 \par\f10 \fs21 \cf0 \
fi133 {\fs14 2 }
\par}{\phpg\posx1701\pvpg\posy7915\absw243\absh986 \sl-217 \f10 \fs21 \cf0 p \pa
r
}
{\phpg\posx1701\pvpg\posy9571\absw462\absh613 \f10 \fs21 \cf0 \f10 \fs21 \cf0 2p
q
\par}{\phpg\posx1701\pvpg\posy9571\absw462\absh613 \sl-151 \par\f10 \fs21 \cf0 \
fi133 {\fs14 2 }
\par}{\phpg\posx1701\pvpg\posy9571\absw462\absh613 \sl-217 \f10 \fs21 \cf0 q \pa
r
}
= Prekuensi gen thalassemia (1/2 frekuensi{\i carrier}) = 0.015
\par}{\phpg\posx2420\pvpg\posy7915\absw7908\absh2104 \sl-413 \f10 \fs21 \cf0 =
Prekuensi gen HbA = 1-p = 1-0,015 = 0,985
Prekuensi kelahiran homozigot = 0,000225 = 0,0225% atau
360 0,225/1000
Prekuensi heterozigot = 0,02955 ~ 3%
Prekuensi homozigot normal = 97% \par
}
\fs14 \cf0 2
\par}{\phpg\posx3182\pvpg\posy10776\absw256\absh274 \sl-217 \b \f10 \fs14 \cf0 {
\fs21 p }\par
}
{\phpg\posx3484\pvpg\posy10776\absw5371\absh274 \b \f10 \fs14 \cf0 \fi1053 \b \f
10 \fs14 \cf0 2
{\fs21 +}{\fs21 2pq}{\fs21 +}{\fs21 q}{\fs21 =}{\fs21 0,000225}{\fs21 +}{
\fs21 0,02955}{\fs21 +}{\fs21 0,970225}{\fs21 =}{\fs21 1 }\par
}
1 \cf0 Jika diumpamakan kelahiran bayi 500.000 setiap tahunnya, ma
ka
\par}{\phpg\posx1701\pvpg\posy11641\absw8624\absh986 \sl-414 \f10 \fs21 \cf0 kel
ahiran bayi homozigot thalassemia mayor adalah sebesar 112,5/tahun.
\par}{\phpg\posx1701\pvpg\posy11641\absw8624\absh986 \sl-414 \f10 \fs21 \cf0 Sec
ara kasar dapat juga dilakukan perhitungan, sebagai berikut. \par
}
\cf0 Pengemban sifat thalassemia = 3% dari populasi atau 1/33
\par}{\phpg\posx2835\pvpg\posy13297\absw6446\absh986 \sl-413 \f10 \fs21 \cf0 Jik

a terjadi perkawinan antara pengemban sifat thalassemia
\par}{\phpg\posx2835\pvpg\posy13297\absw6446\absh986 \sl-414 \f10 \fs21 \cf0 = 1
/33 x 1/33 = 1/1089. \par
}
8
{\fs16 2005 }
}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
21 \cf0 Kemungkinan terjadi kelahiran bayi homozigot thalassemia mayor =
\par}{\phpg\posx1701\pvpg\posy1706\absw8659\absh10672 \sl-412 \f10 \fs21 \cf0 1/
1089 x 1/4 = 1/4356. Dengan memperkirakan kelahiran bayi 500.000 setiap
\par}{\phpg\posx1701\pvpg\posy1706\absw8659\absh10672 \sl-414 \f10 \fs21 \cf0 ta
hunnya maka kelahiran bayi homozigot thalassemia mayor per tahun adalah
0.000 x 1/4356 = 114,8.
i720 Dari angka tersebut dapat ditentukan berapa biaya yang haru
s
keluarkan untuk menangani penderita thalassemia di Indonesia. Sebagai
tokan untuk biaya penatalaksanaan penyakit thalassemia secara optimal di
ggris dibutuhkan biaya kira-kira US $ 7500 per orang per tahun.
i720 Biaya tersebut jauh di atas pendapatan per kapita penduduk Indonesia
n dapat dipastikan hanya penderita thalassemia dari keluarga mampu saja
ng mendapat penanganan yang memadai yang sebenarnya hanya bersifat
\par}{\phpg\posx1701\pvpg\posy1706\absw8659\absh10672 \sl-414 \f10 \fs21 \cf0 su
pportif karena sampai sekarang thalassemia mayor belum ditemukan
\par}{\phpg\posx1701\pvpg\posy1706\absw8659\absh10672 \sl-413 \f10 \fs21 \cf0 ob
atnya.
Tidak
mengherankan
dampak
psiko-sosial
yang
ditimbulkan
alassemia sangat luas dan banyak negara memilih tindakan preventif seperti
ng dianjurkan oleh WHO tahun 1983.
i720 Permasalahan yang paling pokok adalah bahwa manajemen klinis
nyakit thalassemia dapat dikatakan belum merata di Indonesia, ji
ka
bandingkan dengan negara maju bahkan di negara ASEAN sekalipun. Hingga
at ini, hanya kota Jakarta yang mempunyai pusat pelayanan khusus untuk
\par}{\phpg\posx1701\pvpg\posy1706\absw8659\absh10672 \sl-413 \f10 \fs21 \cf0
alassemia, yang mungkin hanya dapat dimanfaatkan oleh sebagian kecil
nderita. Padahal tanpa penanganan klinis yang serius penderita thalassemia
yor (homozigot) jarang dapat mencapai usia dewasa (Weatherall and Clegg,
01).
th
pe
ma
20
\f
i720 Oleh karena itu sudah saatnya sekarang penyakit thalassemia

di
donesia mendapat perhatian khusus dan diletakkan pada proporsi yang
mestinya dalam sistem pelayanan kesehatan nasional. Tindakan preventif
n pengendalian penyakit tersebut harus segera disosialisasi kepada
syarakat dengan tetap berpatokan pada nilai-nilai etika, moral, dan budaya
\par}{\phpg\posx1701\pvpg\posy1706\absw8659\absh10672 \sl-414 \f10 \fs21 \cf0 ba
ngsa kita. \par
}
9 \par
}
a", 2005
}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
\cf0 Tindakan Preventif dan Kontrol \par
}
1 \cf0 Program tindakan preventif dan kontrol thalassemia pada tin
gkat
ulasi haruslah direncanakan dan dikelola dengan baik dengan melibatkan
\par}{\phpg\posx1701\pvpg\posy2602\absw8800\absh6946 \sl-413 \f10 \fs21 \cf0 ban
yak pihak. Selain para dokter, peneliti, perawat, juga perlu melibatkan para
\par}{\phpg\posx1701\pvpg\posy2602\absw8800\absh6946 \sl-414 \f10 \fs21 \cf0 psi
kolog, pekerja sosial, dan organisasi orang tua penderita yang berkompeten
\par}{\phpg\posx1701\pvpg\posy2602\absw8800\absh6946 \sl-414 \f10 \fs21 \cf0 dal
am program ini (Weatherall and Clegg, 2001). Media masa baik cetak
\par}{\phpg\posx1701\pvpg\posy2602\absw8800\absh6946 \sl-413 \f10 \fs21 \cf0 mau
pun elektronik sangat besar perannya dalam sosialisasi penyakit tersebut
\par}{\phpg\posx1701\pvpg\posy2602\absw8800\absh6946 \sl-413 \f10 \fs21 \cf0 kep
ada masyarakat luas. Peran media massa juga diperlukan untuk
\par}{\phpg\posx1701\pvpg\posy2602\absw8800\absh6946 \sl-414 \f10 \fs21 \cf0 "me
nggugah hati" masyarakat dan instansi terkait untuk lebih memperhatikan
mengevaluasi tentang masalah yang sedang dan akan kita hadapi
kaitan dengan penyakit genetik thalassemia ini.
720 Berdasarkan pengalaman beberapa negara yang berprevalensi tinggi
dianggap
cukup
berhasil
dalam
pengendalian
thalassemia
ber
\fi
dan
dan
\par}{\phpg\posx1701\pvpg\posy2602\absw8800\absh6946 \sl-414 \f10 \fs21 \cf0 hem

oglobinopati, seperti Thailand, Cyprus, Italia, dan Sisilia (Cao and Rosatelli,
8; Fucharoen and Winichagoon, 1992) kiranya sudah saatnya kita mengikuti

\par}{\phpg\posx1701\pvpg\posy2602\absw8800\absh6946 \sl-413 \f10 \fs21 \cf0 lan
gkah-langkah sukses mereka. Tentu saja program yang akan dilakukan
\par}{\phpg\posx1701\pvpg\posy2602\absw8800\absh6946 \sl-412 \f10 \fs21 \cf0 har
us disesuaikan terlebih dahulu dengan kondisi sosial-budaya bangsa kita,
\par}{\phpg\posx1701\pvpg\posy2602\absw8800\absh6946 \sl-414 \f10 \fs21 \cf0 dim
ana tingkat sosial-ekonomi dan pendidikan sangat berpengaruh pada
\par}{\phpg\posx1701\pvpg\posy2602\absw8800\absh6946 \sl-413 \f10 \fs21 \cf0 keb
erhasilan program ini. Langkah-langkah yang mungkin dapat diambil untuk
gendalikan thalassemia di negara kita dapat dirangkum sebagai berikut. \par
}
1 \cf0 1. Pembentukan Kelompok Kerja Thalassemia di Tingkat Nasional dan
\fi339 Regional
\fi719 {\b0 Kelompok}{\b0 kerja}{\b0 thalassemia}{\b0 perlu}{\b0 dibentuk}{
\b0 dengan}{\b0 melibatkan}{\b0 para}{\b0 ahli }
{\b0 yang}{\b0 berminat}{\b0 dan}{\b0 berkecimpung}{\b0 dalam}{\b0 penyaki
t}{\b0 tersebut.}{\b0 Kelompok}{\b0 ini}{\b0 harus }
{\b0 terdiri}{\b0 dari}{\b0 ahli}{\b0 penyakit}{\b0 anak}{\b0 dan}{\b0 pe
nyakit}{\b0 dalam,}{\b0 patologi}{\b0 klinik,}{\b0 genetik,}{\b0 ahli }
{\b0 penyakit}{\b0 kandungan,}{\b0 bidan,}{\b0 perawat,}{\b0 bahkan}{\b
0 kalau}{\b0 perlu}{\b0 melibatkan}{\b0 para }
{\b0 psikolog,}{\b0 pekerja}{\b0 sosial,}{\b0 dan}{\b0 wakil}{\b0 orang}{\
b0 tua}{\b0 penderita. }
\fi720 {\b0 Diharapkan}{\b0
mereka}{\b0
dapat}{\b0
menyelenggarakan}{\
b0
pertemuan-pertemuan }
{\b0 ilmiah}{\b0 secara}{\b0 rutin}{\b0 baik}{\b0 tingkat}{\b0 lokal}{\b0
maupun}{\b0 regional}{\b0 dan}{\b0 mengevaluasi}{\b0 serta }
{\b0 memantau}{\b0 permasalahan}{\b0 yang}{\b0 ada,}{\b0 kebijaksanaan,}{\b
0 dan}{\b0 langkah-langkah}{\b0 yang }\par
}
10
{\fs16 2005 }
}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
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0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
{\phpg\posx1701\pvpg\posy1706\absw8570\absh985 \f10 \fs21 \cf0 \f10 \fs21 \cf0 h
arus diambil untuk mengatasi masalah thalassemia. Mereka juga diharapkan
\par}{\phpg\posx1701\pvpg\posy1706\absw8570\absh985 \sl-412 \f10 \fs21 \cf0 memb
uat laporan dan meneruskannya ke instansi terkait atau Departemen
\par}{\phpg\posx1701\pvpg\posy1706\absw8570\absh985 \sl-414 \f10 \fs21 \cf0 Kese
hatan (Fucharoen and Winichagoon, 1992). \par
}
1 \cf0 2. Meningkatkan Penelitian tentang Epidemiologi, Patofisiologi Molekular
,
\fi339 dan Manajemen Klinis Penyakit Thalassemia
\fi720 {\b0 Studi}{\b0 epidemiologi}{\b0 dapat}{\b0 dimulai}{\b0 dari}{
\b0 skrining}{\b0 populasi}{\b0 dimaksudkan }

{\b0 untuk}{\b0 mendapatkan}{\b0 angka}{\b0 atau}{\b0 frekuensi}{\b0
pengemban}{\b0 sifat}{\b0 thalassemia}{\b0 dan }
{\b0 hemoglobinopati}{\b0 terkait}{\b0 dalam}{\b0 populasi.}{\b0 Pendataan}
{\b0 penderita}{\b0 thalassemia}{\b0 pada }
{\b0 rumah-rumah}{\b0 sakit}{\b0 dan}{\b0 pusat-pusat}{\b0 pelayanan}{\b0
kesehatan}{\b0 juga}{\b0 perlu}{\b0 dilakukan }
{\b0 untuk}{\b0
menjaring}{\b0
para}{\b0
penderita}{\b0
thalass
emia}{\b0
mayor}{\b0
(Fucharoen}{\b0
and }
{\b0 Winichagoon,}{\b0 1988). }
\fi720 {\b0 Langkah}{\b0 ini}{\b0 perlu}{\b0 dilakukan}{\b0 untuk}{\b0
mengetahui}{\b0 seberapa}{\b0 besar}{\b0 "risiko" }
{\b0 penyakit}{\b0 thalassemia}{\b0 dalam}{\b0 populasi}{\b0 tersebut,}{\b0
sehingga}{\b0 dapat}{\b0 dipertimbangkan }
{\b0 perlu}{\b0 tidaknya}{\b0 diterapkan}{\b0 langkah}{\b0 kontrol}{\b0 be
rikutnya}{\b0 seperti}{\b0 konseling}{\b0 genetik. }
{\b0 Analisis}{\b0 molekular}{\b0 juga}{\b0 perlu}{\b0 dilakukan}{\b0
baik}{\b0 pada}{\b0 DNA}{\b0 pengemban}{\b0 sifat }
{\b0 maupun}{\b0
penderita}{\b0
untuk}{\b0
mengetahui}{\b0
jenis}{\
b0
mutan}{\b0
umum}{\b0
dalam}{\b0
populasi }
{\b0 tersebut}{\b0 sebagai}{\b0 data}{\b0 rujukan}{\b0 program}{\b0 d
iagnosis}{\b0 prenatal}{\b0 (Old}{\b0\i et}{\b0\i al}{\b0 .,}{\b0 1990
). }
{\b0 Skrining}{\b0 populasi}{\b0 dan}{\b0 identifikasi}{\b0 jenis}{\b0 mut
an}{\b0 umum}{\b0 merupakan}{\b0 langkah}{\b0 awal }
{\b0 dari}{\b0 tindakan}{\b0 preventif}{\b0 dan}{\b0 kontrol}{\b0 tha
lassemia}{\b0 yang}{\b0 disarankan}{\b0 oleh}{\b0\i WHO }
{\b0\i working}{\b0\i group}{\b0 (1994)}{\b0 untuk}{\b0 semua}{\b0 ne
gara}{\b0 berkembang}{\b0 yang}{\b0 berprevalensi }
{\b0 tinggi,}{\b0 termasuk}{\b0 Indonesia. }
\fi720 {\b0 Pengetahuan}{\b0
para}{\b0
ahli}{\b0
tentang}{\b0
p
atofisiologi}{\b0
molekular}{\b0
penyakit }
{\b0 thalassemia}{\b0 juga}{\b0 perlu}{\b0 ditingkatkan,}{\b0 karena}{\
b0 tidak}{\b0 semua}{\b0 mutan}{\b0 menimbulkan }
{\b0 manifestasi}{\b0 klinis}{\b0 berat.}{\b0 Beberapa}{\b0 mutan}{\b0
seperti}{\b0 Hb-E}{\b0 (Cd-26)}{\b0 dan}{\b0 Hb-Malay }
{\b0 (Cd-19)}{\b0 misalnya,}{\b0 haruslah}{\b0 dipandang}{\b0 sebagai}{
\b0 "thalassemia}{\b0 ringan"}{\b0 karena }
{\b0 tidak}{\b0 memerlukan}{\b0 penanganan}{\b0 klinis}{\b0 apapun.}{\b0 T
etapi}{\b0 jika}{\b0 mereka}{\b0 berkombinasi }

{\b0 dengan}{\b0 mutan}{\b0 lain,}{\b0 maka}{\b0 dapat}{\b0 menimbulkan}{\
b0 individu}{\b0 heterozigot}{\b0 ganda}{\b0 yang }
{\b0 secara}{\b0 klinis}{\b0 sama}{\b0 dengan}{\b0 thalassemia}{\b0 mayor.
}
\fi720 {\b0 Pengetahuan}{\b0 tentang}{\b0 dasar}{\b0 molekular}{\b0 penyaki
t}{\b0 thalassemia}{\b0 juga}{\b0 sangat }
{\b0 penting,}{\b0 karena}{\b0 ekspresi}{\b0 gen}{\b0 globin}{\b0 ini}{\b0
sangat}{\b0 kompleks}{\b0 dan}{\b0 melibatkan}{\b0 banyak }
{\b0 komponen}{\b0 yang}{\b0 terletak}{\b0 di}{\b0 luar}{\b0 gen}{\b0 itu
}{\b0 sendiri.}{\b0 Dalam}{\b0 diagnosis}{\b0 prenatal}{\b0 selain }
\cf0 \fi8284 {\b0 \f20 \fs19 11 }
{\b0 \f20 \fs16 Ratna}{\b0 \f20 \fs16 Akbari}{\b0 \f20 \fs16 Ganie}{\b0 \f20
\fs16 :}{\b0 \f20 \fs16 Pidato}{\b0 \f20 \fs16 Pengukuhan}{\b0 \f20 \fs16 "T
halasemia}{\b0 \f20 \fs16 Permasalahan}{\b0 \f20 \fs16 dan}{\b0 \f20 \fs16 Pe
nanganannya",}{\b0 \f20 \fs16 2005 }
f20 \fs18 2006 }\par
}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
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0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
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2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
identifikasi mutan pada janin juga harus dilakukan identifikasi keberada
an
\par}{\phpg\posx1701\pvpg\posy1706\absw8631\absh1400 \sl-412 \f10 \fs21 \cf0 beb
erapa situs polimorfik pada kluster gen yang bersangkutan. Keberadaan
situs Xmnl/y pada kluster gen globin-{\f40 {\field{\*\fldinst SYMBOL
98 \\f Symbol }}} misalnya, pada berbagai kasus
thalassemia-{\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol }}} homozigot tel
ah dilaporkan sangat menguntungkan, karena \par
}
{\phpg\posx1701\pvpg\posy3416\absw1290\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 m
engurangi \par
}
{\phpg\posx4757\pvpg\posy3416\absw590\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 kl
inis \par
}
{\phpg\posx5578\pvpg\posy3416\absw605\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 ya
ng \par
}
{\phpg\posx6390\pvpg\posy3416\absw1215\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 d
itimbulkan \par
}
{\phpg\posx7890\pvpg\posy3416\absw1095\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 w
alaupun \par
}
{\phpg\posx9205\pvpg\posy3416\absw1071\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 t
ergolong \par
}
thalassemia-{\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol }}} (Cao and Moi{\i
et}{\i al.,} 2000). Dalam kaitannya dengan diagnosis
prenatal, maka walaupun janin terdeteksi sebagai thalassemia-{\f40 {\field{\*\f
ldinst SYMBOL 98 \\f Symbol }}} homozigot, jika
dapat situs Xmnl/y) dapat dipastikan terminasi kehamilan tidak p
erlu
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-414 \f10 \fs21 \cf0 dil
akukan.
720 Di negara-negara yang maju, di mana penyakit thalassemia telah dapat
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-414 \f10 \fs21 \cf0 dit
angani dengan baik, seorang penderita dapat hidup dan tumbuh kembang
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-413 \f10 \fs21 \cf0 sep
erti orang normal (Cao{\i et}{\i al}., 1993). Dengan dukungan banyak tenaga ah
li
pusat pelayanan, mereka dapat menjalani transfusi darah rutin dan
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-413 \f10 \fs21 \cf0 pem
berian agen pengkelat besi yang memadai untuk mencegah penimbunan
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-413 \f10 \fs21 \cf0 zat
besi pada organ tubuh. Usaha cangkok sumsum tulang, pengaktifan
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-413 \f10 \fs21 \cf0 pro
duksi Hb-F,terapi gen un telah banyak dilakukan untuk memperbaiki kualitas
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-413 \f10 \fs21 \cf0 kes
ehatan mereka (Weatherall and Clegg, 2001). Para psikolog juga banyak
libat untuk mendukung mereka supaya dapat tumbuh berkembang seperti
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-413 \f10 \fs21 \cf0 ana
k-anak normal lainnya tanpa merasa minder atau dan merasa tidak berdaya
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-414 \f10 \fs21 \cf0 (Ka
nokpongsakdi{\i
et.l}., 1990). Dengan managemen klinis yang memad
ai,
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-414 \f10 \fs21 \cf0 mer
eka dapat mencapai usia dewasa, kuliah, dan menikah. Begitu pedulinya
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-413 \f10 \fs21 \cf0 pem
erintah dan masyarakat di negara-negara maju, sehingga thalassemia
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-414 \f10 \fs21 \cf0 sud
ah merupakan salah satu penyakit yang masuk dalam klaim asuransi
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-414 \f10 \fs21 \cf0 kes
ehatan.
720 Dengan adanya pusat-pusat pelayanan kesehatan atau klinik khusus
uk penderita thalassemia, baik ditingkat pusat maupun daerah, diharapkan
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-413 \f10 \fs21 \cf0 dap
at memberi pelayanan dari pemeriksaan penunjang diagnosis, manajemen
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-413 \f10 \fs21 \cf0 kli
nis, konseling genetik, sampai prenatal diagnosis. Selain itu juga diharapkan
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-414 \f10 \fs21 \cf0 seb
agai pusat informasi tentang thalassemia dengan melibatkan berbagai
\par}{\phpg\posx1701\pvpg\posy3823\absw8665\absh9237 \sl-414 \f10 \fs21 \cf0 dis
iplin ilmu. \par
}
\cf0 manifestasi
{\fs14 o }\par
}
12
{\fs16 2005 }

}
0}}}}
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5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
1 \cf0 3. Meningkatkan Kualitas SDM dan Fasilitas Laboratorium
\fi720 {\b0 Pelatihan}{\b0 bagi}{\b0 tenaga}{\b0 ahli}{\b0 dari}{\b0 berba
gai}{\b0 disiplin}{\b0 ilmu}{\b0 yang}{\b0 terkait}{\b0 perlu }

{\b0 segera}{\b0 dilakukan}{\b0 untuk}{\b0 meningkatkan}{\b0 kualitas}{
\b0 dan}{\b0 keahlian}{\b0 di}{\b0 bidangnya }
{\b0 masing-masing.}{\b0 Pada}{\b0 tahap}{\b0 pertama,}{\b0 tentu}{\b0 saj
a}{\b0 perlu}{\b0 mengirim}{\b0 beberapa}{\b0 ahli }
{\b0 yang}{\b0 berkompeten}{\b0 di}{\b0 bidangnya}{\b0 untuk}{\b0 men
gikuti}{\b0 pelatihan}{\b0 di}{\b0 pusat-pusat }
{\b0 thalassemia}{\b0 terkenal}{\b0 di}{\b0 dunia}{\b0 seperti}{\b0 di}{\b
0 Italia,}{\b0 Inggris,}{\b0 dan}{\b0 Thailand}{\b0 (Old}{\b0\i et.al., }
{\b0 2001a). }
\fi720 {\b0 Keahlian}{\b0 dalam}{\b0 menegakkan}{\b0 diagnosis}{\b0 yan
g}{\b0 benar,}{\b0 manajemen}{\b0 klinis, }
{\b0 sampling}{\b0 jaringan}{\b0 fetus,}{\b0 kultur}{\b0 sel,}{\b0 sa
mpai}{\b0 berbagai}{\b0 teknik}{\b0 biologi}{\b0 molekular }
{\b0 terkini}{\b0 untuk}{\b0 diagnosis}{\b0 prenatal}{\b0 dan}{\b0 ko
nseling}{\b0 genetik}{\b0 mutlak}{\b0 harus}{\b0 dikuasai }
{\b0 dengan}{\b0 baik.}{\b0 Kemudian}{\b0 mereka}{\b0 perlu}{\b0 dihi
mpun}{\b0 dalam}{\b0 sesuatu}{\b0 pusat}{\b0 rujukan }
{\b0 atau}{\b0 pelatihan}{\b0 untuk}{\b0 menularkan}{\b0 ilmu}{\b0 yang}{\
b0 diperoleh}{\b0 di}{\b0 luar}{\b0 negeri}{\b0 kepada}{\b0 ahli- }
{\b0 ahli}{\b0 yang}{\b0 lain}{\b0 terutama}{\b0 dari}{\b0 daerah-daerah,}
{\b0 sehingga}{\b0 negara}{\b0 kita}{\b0 mempunyai }
{\b0 banyak}{\b0 tenaga}{\b0 ahli}{\b0 dan}{\b0 konsultan}{\b0 yang}{\b0
handal}{\b0 tentang}{\b0 thalassemia. }
\fi720 {\b0 Beberapa}{\b0 teknik}{\b0 sederhana}{\b0 dalam}{\b0 diagnosis,}
{\b0 seperti}{\b0 indeks}{\b0 hematologis }
{\b0 (MCV,}{\b0 MCH),}{\b0 presipitasi}{\b0 DCIP,}{\b0 tes}{\b0 fragilitas
}{\b0 osmotik}{\b0 juga}{\b0 perlu}{\b0 dikembangkan }
{\b0 di}{\b0 Puskesmas}{\b0 dan}{\b0 Rumah}{\b0 Sakit}{\b0 daerah}{\b
0 yang}{\b0 belum}{\b0 mempunyai}{\b0 fasilitas }
\cf0 {\b0 pemeriksaan}{\b0 khusus}{\b0 untuk}{\b0 thalassemia}{\b0 seper
ti}{\b0 pemeriksaan}{\b0 kadar}{\b0 HbA}{\b0\dn006 \fs14 2}{\b0 dan }
{\b0 analisis}{\b0 hemoglobin}{\b0 dengan}{\b0 metode}{\b0 Hb-elektrofo
resis.}{\b0 Rumah}{\b0 Sakit}{\b0 rujukan }
{\b0 dan}{\b0 rumah}{\b0 sakit}{\b0 pendidikan}{\b0 perlu}{\b0 dileng
kapi}{\b0 dengan}{\b0\i electronic}{\b0\i cell}{\b0\i counter }
{\b0 untuk}{\b0 mendapatkan}{\b0 nilai}{\b0 indeks}{\b0 hematologis}{\b0 d
an}{\b0 alat}{\b0 untuk}{\b0 pemeriksaan}{\b0 kadar }
\cf0 {\b0 HbA }{\b0\dn006 \fs14 2}{\b0 serta}{\b0 Hb-elektroforesis}{\b0
untuk}{\b0 menegakkan}{\b0 diagnosa}{\b0 yang}{\b0 benar}{\b0 dan }

{\b0 akurat}{\b0 (Fucharoen}{\b0\i et}{\b0\i al.}{\b0 ,}{\b0 1999). }
\fi720 {\b0 Selain}{\b0 dilengkapi}{\b0 oleh}{\b0 fasilitas}{\b0 pemeri
ksaan}{\b0 khusus}{\b0 untuk}{\b0 diagnosis }
{\b0 thalassemia}{\b0 juga}{\b0 harus}{\b0 dilengkapi}{\b0 dengan}{\b0 ala
t}{\b0 HPLC}{\b0 (High}{\b0 Performance}{\b0 Liquid }
{\b0 Chromatography)}{\b0 untuk}{\b0 identifikasi}{\b0 berbagai}{\b0 fraksi
}{\b0 hemoglobin}{\b0 (Galanello}{\b0\i et}{\b0\i al}{\b0 ., }
{\b0 1995).}{\b0
Fasilitas}{\b0
yang}{\b0
memadai}{\b0
untuk}{\b0
pemeriksaan}{\b0
molekular}{\b0
terutama }
{\b0 diagnosis}{\b0 prenatal}{\b0 juga}{\b0 perlu}{\b0 ditingkatkan.}{\b0
Diagnosis}{\b0 prenatal}{\b0 harus}{\b0 dilakukan }
{\b0 dengan}{\b0\i
quality}{\b0\i
control}{\b0
yang}{\b0
ketat}{\b0
karena}{\b0
menyangkut}{\b0
nasib}{\b0
janin}{\b0
yang }
{\b0 diperiksa}{\b0
(Old}{\b0\i
et}{\b0\i
al}{\b0 .,}{\b0
2001b).}{
\b0
Setidaknya}{\b0
laboratorium}{\b0
harus}{\b0
mempunyai }
{\b0 ruangan}{\b0 dan}{\b0 peralatan}{\b0 yang}{\b0 steril}{\b0 serta}{\b0
tersandardisasi}{\b0 dengan}{\b0 baik. }\par
}
{\phpg\posx9986\pvpg\posy15184\absw281\absh218 \f20 \fs19 \cf0 \f20 \fs19 \cf0 1
3 \par
}
a", 2005
}
0}}}}
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02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
\cf0 4. Konseling Genetik dan Diagnosis Prenatal
\par}{\phpg\posx1701\pvpg\posy1707\absw5181\absh984 \sl-412 \b \f10 \fs21 \cf0 \
fi284 a. Konseling Genetik
fi719 {\b0 Istilah}{\b0
Konseling}{\b0
Genetik}{\b0
(}{\b0\i Gene
tic }\par
}
{\phpg\posx7070\pvpg\posy2533\absw1321\absh241 \i \f10 \fs21 \cf0 \i \f10 \fs21
\cf0 Counseling{\i0 ) }\par
}
{\phpg\posx8659\pvpg\posy2533\absw958\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 pe
rtama \par
}
{\phpg\posx9847\pvpg\posy2533\absw403\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 ka
li \par
}
diperkenalkan oleh Dr. Sheldon Redd (1947) dari{\i Dight}{\i Institute}{\i f
or}{\i Human }
i Genetics,} University of Minnesota. Konseling genetik diartikan
sebagai
\par}{\phpg\posx1985\pvpg\posy2947\absw8627\absh10301 \sl-414 \f10 \fs21 \cf0 "{
\i memberi}{\i informasi}{\i atau}{\i pengertian}{\i kepada}{\i masyar
akat}{\i tentang}{\i masalah }
i genetik}{\i yang}{\i ada}{\i dalam}{\i keluarganya". }

i435 Penerapan konseling genetik pada masyarakat kita mungkin harus
dikit berbeda dari apa yang direkomendasikan oleh para ahli di luar negeri,
\par}{\phpg\posx1985\pvpg\posy2947\absw8627\absh10301 \sl-413 \f10 \fs21 \cf0 ka
rena struktur sosial ekonomi, budaya, dan tingkat pendidikan yan
g
\par}{\phpg\posx1985\pvpg\posy2947\absw8627\absh10301 \sl-414 \f10 \fs21 \cf0 be
rbeda. Istilah konseling genetik sendiri masih asing dan mungkin masih
kar diterima oleh sebagian masyarakat kita, yang sebagian besar
rpendidikan di bawah SMU.
i720 Pada prinsipnya sebelum konseling genetik diterapkan, kita harus
mpunyai para konselor genetik yang handal. Konselor tidak harus
orang dokter, tetapi bisa seorang perawat, bidan, psikolog, bahkan pekerja
\par}{\phpg\posx1985\pvpg\posy2947\absw8627\absh10301 \sl-413 \f10 \fs21 \cf0 so
sial (Simons and pardes, 1977). Yang terpenting adalah seorang konselor
dah terlatih dan menguasai segala sesuatu yang berkaitan dengan
alassemia. Seorang konselor juga dituntut untuk dapat bersikap simpatik,
\par}{\phpg\posx1985\pvpg\posy2947\absw8627\absh10301 \sl-413 \f10 \fs21 \cf0 ti
dak terkesan menggurui apalagi mamaksa, agar dapat terjalin suat
u
\par}{\phpg\posx1985\pvpg\posy2947\absw8627\absh10301 \sl-413 \f10 \fs21 \cf0 ko
munikasi dan hubungan batin yang baik antara konselor dengan yang
konseling. Seorang konselor harus dapat menyampaikan informasi
banyak dan selengkap mungkin sehubungan dengan penyakit thalassemia
ng diderita atau yang mungkin ada pada keluarga yang dikonseling (klien).
formasi itu menyangkut 3 hal pokok, yaitu:
i141 1. Tentang
penyakit
thalassemia
itu
sendiri,
bagaimana
cara
i424 penurunannya, dan masalah-masalah yang akan dihadapi oleh seorang
i424 penderita thalassemia mayor. Konselor juga terlebih dahulu ha
rus
i424 mengumpulkan data medis dari kliennya terutama riwayat keluarga sang
i424 klien sebelum memulai konseling, agar informasi yang disampaikan tepat
i424 dan bersifat khusus untuk pasangan tersebut. \par
}
14
{\fs16 2005 }

}
0}}}}
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40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
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2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
2. Memberi jalan keluar cara mengatasi masalah yang sedang dihadapi
283 oleh sang klien dan membiarkan mereka yang membuat keputusan

283 sendiri sehubungan dengan tindakan yang akan dilakukan. Seorang
283 konselor tidak selayaknya memberikan jalan keluar yang kira-kira tidak
283 mungkin terjangkau atau dapat dilakukan orang sang klien.
Membantu
mereka
agar
keputusan
yang
telah
diambil
dapat
283 dilaksanakan dengan baik dan lancar. \par
}
1 \cf0 Secara umum sasaran konseling genetik adalah pasangan pranikah,
284 terutama yang berasal dari populasi atau etnik yang berpotensial ti
nggi
284 menderita thalassemia, atau kepada mereka yang mempunyai anggota
284 keluarga yang berpenyakit thalassemia. Kepada pasangan tersebut perlu
284 dianjurkan untuk melakukan pemeriksaan indeks hematologis ({\i full}{\
i blood }
284 {\i count}) terlebih dahulu sebelum menikah untuk memastikan apakah mereka
284 mengemban cacat genetik thalassemia.
1004 Apabila hanya salah satu dari mereka yang mengemban (pembawa
284 sifat) thalassemia tidak jadi masalah, tetapi jika keduanya pengemban sifat
284 thalassemia
maka
perlu
diinformasikan
bahwa
jika
mereka
tetap
284 memutuskan untuk menikah maka 25% dari keturunannya berpeluang
284 menderita thalassemia mayor. Keputusan tergantung pada pasangan
284 tersebut apakah mereka memutuskan tidak kawin, tetap kawin t
anpa
284 mempunyai anak, atau kawin dan ingin mempunyai anak.
719 Konseling genetik secara khusus juga ditujukan untuk pasangan berisiko
284 tinggi, baik yang terjaring pada pemeriksaan premarital maupun pasan
gan
284 yang telah mempunyai anak thalassemia sebelumnya. Kepada mereka perlu
284 disampaikan bahwa telah ada teknologi yang dapat membantu un
tuk
284 mengetahui apakah janin yang dikandung menderita thalassemia atau tidak
284 pada awal kehamilan atau yang dikenal dengan diagnosis prenatal.
1004 Perlu diinformasikan pula selengkap-lengkapnya tentang prosedur

284 diagnosis tersebut, di mana mereka dapat melakukannya, siapa yang harus
284 dihubungi, tingkat kesalahan diagnosis, biaya serta kemungkinan keguguran
284 akibat proses sampling. Dengan demikian mereka dapat mempertimbangkan
\fi8284 {\f20 \fs19 15 }
20 \fs16 Ratna}{\f20 \fs16 Akbari}{\f20 \fs16 Ganie}{\f20 \fs16 :}{\f20 \fs16
Pidato}{\f20 \fs16 Pengukuhan}{\f20 \fs16 "Thalasemia}{\f20 \fs16 Permasala
han}{\f20 \fs16 dan}{\f20 \fs16 Penanganannya",}{\f20 \fs16 2005 }
\f20 \fs18 USU}{\i \f20 \fs18 Repository}{\i \f20 \fs18 }{\i \f20 \fs18 2006
}\par
}
0}}}}
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0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
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5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
benar-benar untung ruginya sebelum mengambil keputusan agar tidak timbul
\par}{\phpg\posx1986\pvpg\posy1706\absw8604\absh7691 \sl-412 \f10 \fs21 \cf0 kek
ecewaan atau penyesalan di kemudian hari (Blumberg{\i et}{\i al}., 1975).
435 Kesuksesan program konseling genetik sangat dipengaruhi oleh tingkat
didikan dan sosial budaya pasangan tersebut. Menurut pengalaman pada
\par}{\phpg\posx1986\pvpg\posy1706\absw8604\absh7691 \sl-413 \f10 \fs21 \cf0 neg
ara yang berprevalensi tinggi thalassemia, seperti Sisilia, Cyprus, dan
\par}{\phpg\posx1986\pvpg\posy1706\absw8604\absh7691 \sl-414 \f10 \fs21 \cf0 Ita
lia, program konseling genetik dan diagnosis prenatal dapat menurunkan
\par}{\phpg\posx1986\pvpg\posy1706\absw8604\absh7691 \sl-414 \f10 \fs21 \cf0 ins
idensi thalassemia sampai 80% dalam 10 tahun terakhir ini (Cao dan
\par}{\phpg\posx1986\pvpg\posy1706\absw8604\absh7691 \sl-413 \f10 \fs21 \cf0 Ros
atelli, 1988).
435 Kebanyakan dari pasangan berisiko tersebut memutuskan tetap menikah
\par}{\phpg\posx1986\pvpg\posy1706\absw8604\absh7691 \sl-414 \f10 \fs21 \cf0 tet
api memutuskan untuk tidak mempunyai anak. Kiranya hal ini agak sukar
\par}{\phpg\posx1986\pvpg\posy1706\absw8604\absh7691 \sl-413 \f10 \fs21 \cf0 dit
erapkan pada masyarakat kita jika sebagian besar masih beranggapan
\par}{\phpg\posx1986\pvpg\posy1706\absw8604\absh7691 \sl-414 \f10 \fs21 \cf0 bah
wa keberadaan seorang anak merupakan target utama dari sebuah
\par}{\phpg\posx1986\pvpg\posy1706\absw8604\absh7691 \sl-413 \f10 \fs21 \cf0 per
kawinan. Apabila pandangan seperti itu dapat sedikit dirubah menjadi
\par}{\phpg\posx1986\pvpg\posy1706\absw8604\absh7691 \sl-413 \f10 \fs21 \cf0 'an
ak yang sehat merupakan target dari perkawinan', mungkin konseling
\par}{\phpg\posx1986\pvpg\posy1706\absw8604\absh7691 \sl-413 \f10 \fs21 \cf0 gen
etik akan jauh lebih mudah dilakukan.
720 Karena berbagai alasan, baik menyangkut agama maupun aspek
\par}{\phpg\posx1986\pvpg\posy1706\absw8604\absh7691 \sl-413 \f10 \fs21 \cf0 psi
kologis lainnya yang tidak merestui pengakhiran kehamilan, maka
dampingan perlu melibatkan tokoh-tokoh agama dan para psikolog.
\par}{\phpg\posx1986\pvpg\posy1706\absw8604\absh7691 \sl-413 \f10 \fs21 \cf0 Lan
gkah ini perlu dilakukan agar semua tindakan yang diambil dengan hati
\par}{\phpg\posx1986\pvpg\posy1706\absw8604\absh7691 \sl-413 \f10 \fs21 \cf0 yan
g mantap sehingga tidak timbul penyesalan atau rasa bersalah di
\par}{\phpg\posx1986\pvpg\posy1706\absw8604\absh7691 \sl-413 \f10 \fs21 \cf0 kem
udian hari. \par
}
1 \cf0 b. Diagnosis Prenatal
\fi435 {\b0 Diagnosis}{\b0
prenatal}{\b0
(PND)}{\b0
pada}{\b0
thala
ssemia}{\b0
pertama}{\b0
kali}{\b0
berhasil }
{\b0 dilakukan}{\b0 oleh}{\b0 Nathan}{\b0 and}{\b0 Kan}{\b0 (1974)}{\
b0 dengan}{\b0 menggunakan}{\b0 darah}{\b0 fetal }
{\b0 (Kan}{\b0\i et.al}{\b0 .,}{\b0 1979).}{\b0 Tujuan}{\b0 dari}{\b0 diag
nosis}{\b0 prenatal}{\b0 adalah}{\b0 untuk}{\b0 mengetahui }
{\b0 sedini}{\b0 mungkin,}{\b0 apakah}{\b0 janin}{\b0 yang}{\b0 dikandung}
{\b0 menderita}{\b0 thalassemia}{\b0 mayor. }
{\b0 PND}{\b0
terutama}{\b0
ditujukan}{\b0
pada}{\b0
janin}{\b0
pasangan}{\b0
baru}{\b0
yang}{\b0
sama-sama }
{\b0 pengemban}{\b0 sifat}{\b0 thalassemia}{\b0 dan}{\b0 janin}{\b0 pasang
an}{\b0 yang}{\b0 telah}{\b0 mendapat}{\b0 bayi }
{\b0 thalassemia}{\b0 sebelumnya. }
\fi435 {\b0 Pada}{\b0 kasus}{\b0 thalassemia,}{\b0 sekarang}{\b0 PND}{\
b0 dapat}{\b0 dilakukan}{\b0 pada}{\b0 usia }
{\b0 kehamilan}{\b0 6-8}{\b0 minggu}{\b0 dengan}{\b0 menggunakan}{\b0 samp
el}{\b0 villi}{\b0 chorialis}{\b0 (Old}{\b0\i et.al}{\b0 ., }\par
}
16
{\fs16 2005 }
}
0}}}}
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1990). Untuk mempercepat proses PND, dapat dimulai dengan pemeriksaan
\par}{\phpg\posx1985\pvpg\posy1706\absw8396\absh4338 \sl-412 \f10 \fs21 \cf0 DNA
kedua orang tuanya terlebih dahulu. Tindakan ini dapat dilakukan lebih
\par}{\phpg\posx1985\pvpg\posy1706\absw8396\absh4338 \sl-414 \f10 \fs21 \cf0 awa
l
bahkan
sebelum
kehamilan
terjadi,
pada
saat
mereka
tel
ah
\par}{\phpg\posx1985\pvpg\posy1706\absw8396\absh4338 \sl-413 \f10 \fs21 \cf0 mem
utuskan untuk mempunyai anak. Kemudian setelah usia kehamilan
capai 6-8 minggu, baru dilakukan pengambilan sampel jaringan villi
\par}{\phpg\posx1985\pvpg\posy1706\absw8396\absh4338 \sl-413 \f10 \fs21 \cf0 cho
rialis janin serta dilakukan pemeriksaan molekular sesuai dengan mutan
\par}{\phpg\posx1985\pvpg\posy1706\absw8396\absh4338 \sl-414 \f10 \fs21 \cf0 yan
g diemban oleh kedua orang tuanya (Old{\i et.al}., 1990). Sedikitnya harus
\par}{\phpg\posx1985\pvpg\posy1706\absw8396\absh4338 \sl-414 \f10 \fs21 \cf0 ada
dua teknik berbeda yang dilakukan pada PND, agar hasil idenfikasi lebih
\par}{\phpg\posx1985\pvpg\posy1706\absw8396\absh4338 \sl-413 \f10 \fs21 \cf0 aku
rat dan dapat dipertanggungjawabkan. PND juga harus dilakukan
\par}{\phpg\posx1985\pvpg\posy1706\absw8396\absh4338 \sl-414 \f10 \fs21 \cf0 sec
epat mungkin (dalam waktu kurang dari seminggu) agar tidak menjadi
\par}{\phpg\posx1985\pvpg\posy1706\absw8396\absh4338 \sl-413 \f10 \fs21 \cf0 beb
an psikologis kedua orang tua selama menunggu hasil untuk mengambil
\par}{\phpg\posx1985\pvpg\posy1706\absw8396\absh4338 \sl-414 \f10 \fs21 \cf0 kep
utusan. \par
}
1 \cf0 Selain itu usia kehamilan juga masih memungkinkan untuk tindakan
minasi kehamilan kalau memang hal tersebut diperlukan. Biasanya
\par}{\phpg\posx1986\pvpg\posy7087\absw8375\absh5830 \sl-414 \f10 \fs21 \cf0 pas
angan masih membutuhkan waktu beberapa hari hingga minggu, untuk
\par}{\phpg\posx1986\pvpg\posy7087\absw8375\absh5830 \sl-413 \f10 \fs21 \cf0 mem

utuskan nasib janin mereka jika ternyata sang janin menderita
\par}{\phpg\posx1986\pvpg\posy7087\absw8375\absh5830 \sl-413 \f10 \fs21 \cf0 tha
lassemia, dan selama itu mereka mungkin perlu pendampingan.
720 Beberapa tahun belakangan ini telah dikembangkan teknik inseminasi
\par}{\phpg\posx1986\pvpg\posy7087\absw8375\absh5830 \sl-413 \f10 \fs21 \cf0 sel
ektif, pada pasangan berisiko tinggi. Dengan teknik ini maka kemungkinan
\par}{\phpg\posx1986\pvpg\posy7087\absw8375\absh5830 \sl-414 \f10 \fs21 \cf0 lah
irnya bayi thalassemia dapat diperkecil. Apabila pada kehamilan normal
\par}{\phpg\posx1986\pvpg\posy7087\absw8375\absh5830 \sl-413 \f10 \fs21 \cf0 pro
babilitas terjadinya bayi thalassemia mayor adalah 25%, maka pada
\par}{\phpg\posx1986\pvpg\posy7087\absw8375\absh5830 \sl-414 \f10 \fs21 \cf0 ins
eminasi selektif, jika ada enam embrio yang dibuahi secara in-vitro, dan
\par}{\phpg\posx1986\pvpg\posy7087\absw8375\absh5830 \sl-414 \f10 \fs21 \cf0 han
ya dua embrio yang diambil secara acak yang ditanamkan ke rahim
\par}{\phpg\posx1986\pvpg\posy7087\absw8375\absh5830 \sl-413 \f10 \fs21 \cf0 mak
a berarti probabilitas terjadinya bayi thalassemia dari pasangan tersebut
jadi 1/3 x 1/4 = 1/12 atau 3 kali lebih rendah dari risiko kehamila
n
\par}{\phpg\posx1986\pvpg\posy7087\absw8375\absh5830 \sl-414 \f10 \fs21 \cf0 nor
mal. Teknik inseminasi selektif dianggap lebih menyenangkan terutama
\par}{\phpg\posx1986\pvpg\posy7087\absw8375\absh5830 \sl-414 \f10 \fs21 \cf0 bag
i sebagian pasangan yang karena alasan pribadi atau lainnya keberatan
uk melakukan PND dan terminasi kehamilan. \par
}
7 \par
}
a", 2005
}
0}}}}
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}
1 \cf0 5. Pembentukan Organisasi atau Perhimpunan Orang Tua Penderita
\fi787 {\b0 Dibandingkan}{\b0
dengan}{\b0
berbagai}{\b0
penyakit}{\b0
degeneratif}{\b0
dan}{\b0
penyakit }
{\b0 infeksi}{\b0 lainnya}{\b0 seperti}{\b0 kanker,}{\b0 kardiovaskular
,}{\b0 hepatitis,}{\b0 dan}{\b0 HIV,}{\b0 tampaknya }
{\b0 thalassemia}{\b0 "kurang}{\b0 popular"}{\b0 atau}{\b0 "kurang}{\b0 me
nggugah}{\b0 perasaan"}{\b0 masyarakat. }
{\b0 Sedikit}{\b0 sekali}{\b0 organisasi}{\b0 maupun}{\b0 LSM}{\b0 ya
ng}{\b0 berkecimpungan}{\b0 atau}{\b0 peduli }
{\b0 dengan}{\b0 masalah}{\b0 thalassemia,}{\b0 sehingga}{\b0 dana}{\b0 pu
n}{\b0 sulit}{\b0 untuk}{\b0 dihimpun.}{\b0 Padahal }
{\b0 para}{\b0 penderita}{\b0 thalassemia}{\b0 membutuhkan}{\b0 dana}{\b0
yang}{\b0 cukup}{\b0 besar}{\b0 untuk}{\b0 tetap }
{\b0 dapat}{\b0 bertahan}{\b0 hidup}{\b0 melalui}{\b0 transfusi}{\b0 darah
}{\b0 rutin}{\b0 yang}{\b0 harus}{\b0 dibarengi}{\b0 dengan }
{\b0 pemberian}{\b0 agen}{\b0 pengkhelat}{\b0 besi}{\b0 yang}{\b0 mem
adai.}{\b0 Dapat}{\b0 dikatakan}{\b0 hanya }
{\b0 penderita}{\b0 yang}{\b0 berasal}{\b0 dari}{\b0 keluarga}{\b0 ma

mpu}{\b0 saja}{\b0 yang}{\b0 dapat}{\b0 menikmati }
{\b0 pelayanan}{\b0 kesehatan}{\b0 tersebut. }
\fi720 {\b0 Perhimpunan}{\b0
Thalassemia}{\b0
Indonesia}{\b0
telah}{\b
0
ada}{\b0
di}{\b0
Jakarta,}{\b0
tetapi }
{\b0 organisasi}{\b0 serupa}{\b0 juga}{\b0 perlu}{\b0 dibentuk}{\b0 di}{\b
0 daerah.}{\b0 Partisipasi}{\b0 orang}{\b0 tua}{\b0 penderita }
{\b0 dan}{\b0 masyarakat}{\b0 sangat}{\b0 diharapkan}{\b0 untuk}{\b0
menghimpun}{\b0 dana}{\b0 bagi}{\b0 penderita }
{\b0 yang}{\b0 kurang}{\b0 mampu.}{\b0 Selain}{\b0 itu}{\b0 melalui}{
\b0 wadah}{\b0 ini,}{\b0 para}{\b0 orang}{\b0 tua}{\b0 penderita }
{\b0 diharapkan}{\b0 dapat}{\b0 sering}{\b0 bertemu}{\b0 untuk}{\b0
bertukar}{\b0
informasi,}{\b0
pikiran,}{\b0
serta }
{\b0 pengalaman}{\b0 dalam}{\b0 mengatasi}{\b0 masalah}{\b0 kesehatan}{
\b0 dan}{\b0 psikologis}{\b0 putra-putri }
{\b0 mereka. }
\fi720 {\b0 Perkumpulan}{\b0 seperti}{\b0 ini}{\b0 jika}{\b0 dikelola}{
\b0 dengan}{\b0 baik}{\b0 dapat}{\b0 memberikan }
{\b0 dukungan}{\b0 moral}{\b0 kepada}{\b0 orang}{\b0 tua,}{\b0 agar}{
\b0 mereka}{\b0 tidak}{\b0 merasa}{\b0 frustasi}{\b0 dan }
{\b0 sendiri}{\b0 dalam}{\b0 menghadapi}{\b0 masalah}{\b0 berat}{\b0 berka
itan}{\b0 dengan}{\b0 penyakit}{\b0 anaknya. }
\fi720 {\b0 Setidaknya}{\b0 ada}{\b0 tiga}{\b0 hal}{\b0 yang}{\b0 harus}{\
b0 diketahui}{\b0 oleh}{\b0 masyarakat}{\b0 umum:}{\b0 1. }
{\b0 bahwa}{\b0
pengemban}{\b0
sifat/thalassemia}{\b0\i
trait}{\b0
(}{\b0\i carrier}{\b0 )}{\b0
tidak}{\b0
menjadi}{\b0
masalah }
{\b0 kesehatan}{\b0 bagi}{\b0 dirinya}{\b0 sendiri,}{\b0 tetapi}{\b0 beris
iko}{\b0 mendapatkan}{\b0 anak}{\b0 thalassemia }
{\b0 jika}{\b0 pasangannya}{\b0 juga}{\b0 seorang}{\b0 pengemban,}{\b0
2.}{\b0 bahwa}{\b0 bentuk}{\b0 homozigot }
{\b0 thalassemia}{\b0 (pasangan}{\b0 thalassemia}{\b0\i trait}{\b0 )}{\b0 m
enimbulkan}{\b0 dampak}{\b0 medico-sosial }
{\b0 dan}{\b0 psikologis}{\b0 yang}{\b0 besar,}{\b0 penanganannya}{\b0 san
gat}{\b0 mahal}{\b0 dan}{\b0 sering}{\b0 berakhir }
{\b0 dengan}{\b0
kematian}{\b0
pada}{\b0
masa}{\b0
kanak-kanak,}{\b
0
3.}{\b0
bahwa}{\b0
kelahiran}{\b0
bentuk }
{\b0 homozigot}{\b0 dapat}{\b0 dihindari}{\b0 dengan}{\b0 tidak}{\b0 menik
ah}{\b0 dengan}{\b0 sesama}{\b0 pengemban }
{\b0 sifat,}{\b0 tidak}{\b0 mempunyai}{\b0 anak}{\b0 baik}{\b0 pasangan}{\
b0 yang}{\b0 berisiko}{\b0 tinggi}{\b0 atau}{\b0 terminasi }

{\b0 kehamilan}{\b0 bagi}{\b0 janin}{\b0 yang}{\b0 homozigot}{\b0 (Wahidiy
at,}{\b0 1992). }\par
}
18
{\fs16 2005 }
}
0}}}}
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\cf0 Kesimpulan \par
}
1. Bahwa penyakit thalassemia prevalensinya cukup tinggi di Indon
esia
360 khususnya di Medan dan belum mendapat perhatian yang serius.
Bahwa tindakan preventif dan kontrol thalassemia perlu disosialisasikan
360 kepada masyarakat umum untuk mengurangi insidensi. Apapun bentuk
360 tindakan preventif dan kontrol yang dilakukan hendaknya harus disesuaikan
360 dengan nilai-nilai sosial-budaya dan agama setempat.
Tindakan preventif dan penanganan thalassemia dapat dilakukan dengan
360 melibatkan berbagai disiplin ilmu dan harus ditunjang dengan fasilit
as
360 laboratorium yang lengkap untuk diagnosa thalassemia. \par
}
{\phpg\posx1824\pvpg\posy6746\absw912\absh280 \b \f10 \fs25 \cf0 \b \f10 \fs25 \
cf0 Saran \par
}
1. Program ini harus didukung oleh semua pihak harus ada usaha untuk
360 mengangkat masalah thalassemia di Indonesia ke permukaan untuk
360 meyakinkan pemerintah bahwa sudah saatnya pemerintah, khususnya
360 Departemen Kesehatan, menempatkan thalassemia sebagai suatu penyakit
360 yang harus mendapat prioritas penanganan kesehatan. Media masa baik
360 media cetak dan elektronik sangat diharapkan peranannya dalam sosialisasi
360 masalah thalassemia kepada masyarakat luas. Sosialisasi masalah penyakit
360 ini juga perlu dilakukan pada remaja pranikah setingkat SMU
atau
360 universitas terutama yang berkecimpung dalam bidang kesehatan.
Pengadaan website khusus untuk penyakit thalassemia di Indonesia sangat
360 membantu, sehingga informasi lengkap dan terkini mudah diakses secar
a
360 langsung oleh berbagai pihak yang berkepentingan. \par
}
9 \par
}
a", 2005
}
0}}}}
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5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
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}
{\phpg\posx1701\pvpg\posy1707\absw8745\absh11882 \b\i \f10 \fs21 \cf0 \b\i \f10
\fs21 \cf0 Bapak Rektor yang Saya muliakan serta para hadirin sekalian,
\par}{\phpg\posx1701\pvpg\posy1707\absw8745\absh11882 \sl-258 \par\b\i \f10 \fs2
1 \cf0 \fi720 {\b0\i0 Demikianlah}{\b0\i0
uraian}{\b0\i0
Saya}{\b0\i0
t
entang}{\b0\i0
Thalassemia:}{\b0\i0
Permasalahan}{\b0\i0
dan }
\par}{\phpg\posx1701\pvpg\posy1707\absw8745\absh11882 \sl-414 \b\i \f10 \fs21 \c
f0 {\b0\i0 Penanganannya,}{\b0\i0 yang}{\b0\i0 mungkin}{\b0\i0 masih}{\b0\i0
banyak}{\b0\i0 kekurangan.}{\b0\i0 Semoga}{\b0\i0 generasi }
f0 {\b0\i0 berikutnya}{\b0\i0
dapat}{\b0\i0
melengkapinya}{\b0\i0
da
n}{\b0\i0
memanfaatkan}{\b0\i0
peluang}{\b0\i0
untuk }
f0 {\b0\i0 mempelajari}{\b0\i0 ilmu}{\b0\i0 Allah}{\b0\i0 yang}{\b0\i0 s
angat}{\b0\i0 luas.}{\b0\i0 Kontribusi}{\b0\i0 Saya}{\b0\i0 sangat}{\b0\
i0 kecil}{\b0\i0 jika }
f0 {\b0\i0 dibandingkan}{\b0\i0 dengan}{\b0\i0 luasnya}{\b0\i0 bidang}{\b0
\i0 yang}{\b0\i0 seharusnya}{\b0\i0 Saya}{\b0\i0 tekuni.}{\b0\i0 Oleh
}
f0 {\b0\i0 karena}{\b0\i0
itu,}{\b0\i0
sebelum}{\b0\i0
Saya}{\b0\i0
mengakhiri}{\b0\i0
pidato}{\b0\i0
pengkuhan}{\b0\i0
ini,}{\b0\i0
sek
ali}{\b0\i0
lagi }
f0 {\b0\i0 perkenankanlah}{\b0\i0 Saya}{\b0\i0 untuk}{\b0\i0 kesekian}{\b0
\i0 kalinya}{\b0\i0 mengucapkan}{\b0\i0 syukur}{\b0\i0 kepada }
f0 {\b0\i0 Allah}{\b0\i0 SWT,}{\b0\i0 yang}{\b0\i0 telah}{\b0\i0 memberi
kan}{\b0\i0 kesempatan}{\b0\i0 kekuatan,}{\b0\i0 bimbingan,}{\b0\i0 dan
}
f0 {\b0\i0 petunjuk}{\b0\i0 kepada}{\b0\i0 Saya}{\b0\i0 selama}{\b0\i0 ini}{
\b0\i0 dalam}{\b0\i0 menjalani}{\b0\i0 tugas}{\b0\i0 Saya}{\b0\i0 sebagai}{
\b0\i0 pendidik }
f0 {\b0\i0 dan}{\b0\i0 ilmuan.}{\b0\i0 Syukur}{\b0\i0 tidak}{\b0\i0 terh
ingga}{\b0\i0 atas}{\b0\i0 ridho-Nya}{\b0\i0 sehingga}{\b0\i0 Saya}{\b0\
i0 mendapat }
f0 {\b0\i0 kesempatan}{\b0\i0
untuk}{\b0\i0
diangkat}{\b0\i0
sebagai}{\
b0\i0
Guru}{\b0\i0
Besar}{\b0\i0
Madya}{\b0\i0
di}{\b0\i0
Univers
itas }
f0 {\b0\i0 Sumatera}{\b0\i0 Utara}{\b0\i0 (USU). }
f0 \fi720 {\b0\i0 Pada}{\b0\i0 kesempatan}{\b0\i0 ini}{\b0\i0 Saya}{\b0\i0
mengucapkan}{\b0\i0 terima}{\b0\i0 kasih}{\b0\i0 pula}{\b0\i0 kepada
}
f0 {\b0\i0 Pemerintah}{\b0\i0 Republik}{\b0\i0 Indonesia}{\b0\i0 c.q.}{\b0\i0
Departemen}{\b0\i0 Pendidikan}{\b0\i0 dan}{\b0\i0 Kebudayaan, }
f0 {\b0\i0 yang}{\b0\i0 telah}{\b0\i0 memberikan}{\b0\i0 kepercayaan}{\b0\i0
dan}{\b0\i0 mengangkat}{\b0\i0 Saya}{\b0\i0 untuk}{\b0\i0 menduduki }
f0 {\b0\i0 jabatan}{\b0\i0 Guru}{\b0\i0 Besar}{\b0\i0 Madya.}{\b0\i0 Ucapan}
{\b0\i0 terima}{\b0\i0 kasih}{\b0\i0 yang}{\b0\i0 setulus-tulusnya}{\b0\i0
Saya }
f0 {\b0\i0 sampaikan}{\b0\i0 kepada}{\b0\i0 Bapak}{\b0\i0 Prof.}{\b0\i0 dr.}
{\b0\i0 Chairuddin}{\b0\i0 P.}{\b0\i0 Lubis,}{\b0\i0 D.T.M.&H.,}{\b0\i0 Sp.
A.(K.) }
f0 {\b0\i0 selaku}{\b0\i0 Rektor}{\b0\i0 dan}{\b0\i0 Ketua}{\b0\i0 Senat}{\b
0\i0 USU}{\b0\i0 yang}{\b0\i0 telah}{\b0\i0 mendorong}{\b0\i0 Saya}{\b0\i0
membantu }
f0 {\b0\i0 dan}{\b0\i0 memproses}{\b0\i0 pengusulan}{\b0\i0 Saya}{\b0\i0
untuk}{\b0\i0 menjadi}{\b0\i0 Guru}{\b0\i0 Besar}{\b0\i0 sampai}{\b0\i0
acara }
f0 {\b0\i0 pengukuhan}{\b0\i0 yang}{\b0\i0 diselenggarakan}{\b0\i0 pada}{\
b0\i0 hari}{\b0\i0 ini.}{\b0\i0 Semoga}{\b0\i0 Allah}{\b0\i0 SWT}{\b0\
i0 tetap }
f0 {\b0\i0 memberikan}{\b0\i0 kesehatan,}{\b0\i0 hidayah,}{\b0\i0 dan}{\b0
\i0 kemudahan}{\b0\i0 kepada}{\b0\i0 beliau}{\b0\i0 untuk}{\b0\i0 teru
s }
f0 {\b0\i0 memimpin}{\b0\i0 Universitas}{\b0\i0 Sumatera}{\b0\i0 Utara}{\b0\i
0 yang}{\b0\i0 kita}{\b0\i0 cintai}{\b0\i0 ini. }
f0 \fi720 {\b0\i0 Ucapan}{\b0\i0 terima}{\b0\i0 kasih}{\b0\i0 yang}{\b0\i0 t
ulus}{\b0\i0 juga}{\b0\i0 Saya}{\b0\i0 sampaikan}{\b0\i0 kepada}{\b0\i0 Pro
f.}{\b0\i0 dr.}{\b0\i0 T. }
f0 {\b0\i0 Bahri}{\b0\i0
Anwar,}{\b0\i0
Sp.J.P.(K.),}{\b0\i0
Dekan}{\b0
\i0
Fakultas}{\b0\i0
Kedokteran}{\b0\i0
USU}{\b0\i0
yang}{\b0\i0
telah }
f0 {\b0\i0 mendukung}{\b0\i0 dan}{\b0\i0 bersedia}{\b0\i0 mengusulkan}{\b0
\i0 kenaikan}{\b0\i0 jabatan}{\b0\i0 akademik}{\b0\i0 Saya}{\b0\i0 ke
}
f0 {\b0\i0 jenjang}{\b0\i0 Guru}{\b0\i0 Besar.}{\b0\i0 Demikian}{\b0\i0
pula}{\b0\i0 kepada}{\b0\i0 para}{\b0\i0 pembantu}{\b0\i0 dekan}{\b0\i0
Saya }

f0 {\b0\i0 ucapkan}{\b0\i0 terima}{\b0\i0 kasih. }
f0 \fi720 {\b0\i0 Kepada}{\b0\i0
mantan}{\b0\i0
Dekan}{\b0\i0
Fakultas}
{\b0\i0
Kedokteran}{\b0\i0
USU}{\b0\i0
Prof.}{\b0\i0
Sutomo }
f0 {\b0\i0 Kasiman,}{\b0\i0 Sp.J.P.(K.)}{\b0\i0 dan}{\b0\i0 Kepala}{\b0\i0
Departemen}{\b0\i0 Gizi}{\b0\i0 dr.}{\b0\i0 Halomoan}{\b0\i0 Hutagalu
ng }
f0 {\b0\i0 yang}{\b0\i0
telah}{\b0\i0
memberikan}{\b0\i0
izin}{\b0\i0
kepada}{\b0\i0
Saya}{\b0\i0
untuk}{\b0\i0
mengikuti}{\b0\i0
pendid
ikan }
f0 {\b0\i0 Pascasarjana}{\b0\i0 S3}{\b0\i0 tak}{\b0\i0 lupa}{\b0\i0 Saya}{\b
0\i0 ucapkan}{\b0\i0 terima}{\b0\i0 kasih. }\par
}
20
{\fs16 2005 }
}
0}}}}
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21 \cf0 Ucapan terima kasih yang sebesar-besarnya Saya tujukan kepada dr
.
\par}{\phpg\posx1701\pvpg\posy1706\absw8803\absh12741 \sl-412 \f10 \fs21 \cf0 Ad
i Koesoema Aman, Sp.P.K.(K.) selaku Kepala Departemen Bagian Patologi
\par}{\phpg\posx1701\pvpg\posy1706\absw8803\absh12741 \sl-414 \f10 \fs21 \cf0 Kl
inik yang telah mengusulkan Saya untuk menjadi Guru Besar pada
\par}{\phpg\posx1701\pvpg\posy1706\absw8803\absh12741 \sl-413 \f10 \fs21 \cf0 De
partemen Patologi Klinik.
i720 Ucapan terima kasih juga Saya sampaikan kepada Prof. Dr. Ir. Sumono,
\par}{\phpg\posx1701\pvpg\posy1706\absw8803\absh12741 \sl-414 \f10 \fs21 \cf0 M.
S., mantan Direktur Program Pascasarjana USU, Prof. Harun Rasyid Lubis,
\par}{\phpg\posx1701\pvpg\posy1706\absw8803\absh12741 \sl-413 \f10 \fs21 \cf0 Sp
.P.D.K.G.H., Prof. drg. Ismet Danial Nasution, Ph.D. selaku Ketua dan
kretaris Program Studi S3 Kedokteran USU dan Prof. dr. Marwali Harahap,
.K.K.(K.) mantan Ketua Program Studi S3 Kedokteran USU yang telah
nerima Saya membimbing dan memberikan motivasi ketika Saya mengikuti
ndidikan sebagai mahasiswa Program Studi S3 Kedokteran USU.
i720 Ucapan terima kasih juga Saya sampaikan kepada Promotor dan Co\par}{\phpg\posx1701\pvpg\posy1706\absw8803\absh12741 \sl-413 \f10 \fs21 \cf0 Pr
omotor, Prof. dr. Djafar Siddik, Sp.O.G.(K.), Prof. Dr. Elizabeth George, Prof.
\par}{\phpg\posx1701\pvpg\posy1706\absw8803\absh12741 \sl-413 \f10 \fs21 \cf0 dr
. Herman Hariman, Sp.P.K.(K.H.), Ph.D. dan Prof. dr. Darwin Dalimunthe,
.D. yang telah membimbing Saya ketika Saya mengikuti pendidikan Program
udi S3 Kedokteran USU hingga sampai saat ini.
i720 Kepada Pimpinan Palang Merah Indonesia (PMI) Cabang Medan, dr.
iah Yatim beserta staf Saya ucapkan terima kasih atas partisipasinya dalam
Ph
St
\f
As
ra
ngka pelaksanaan penelitian sewaktu Saya mengikuti pendidikan Program

\par}{\phpg\posx1701\pvpg\posy1706\absw8803\absh12741 \sl-414 \f10 \fs21 \cf0 St
udi S3 Kedokteran Pascasarjana USU.
i720 Ucapan terima kasih juga Saya sampaikan kepada Dr. Zubaidah
\par}{\phpg\posx1701\pvpg\posy1706\absw8803\absh12741 \sl-413 \f10 \fs21 \cf0 Za
karia, M.B.B.S. (Mal.) D.C.P. (UK),{\i
Head}{\i
of}{\i
Haematol
ogy}{\i
Division }
i Pathologist,}{\i Institute}{\i for}{\i Medical}{\i Research} Kuala L
umpur, Malaysia yang
ngan kebijaksanaannya telah memberi izin kepada Saya untuk dapat
nggunakan fasilitas di Laboratorium Bahagian Kajidarah pada waktu Saya
ngikuti Program Studi S3 dalam meneliti analisis DNA Thalassemia alfa
ngan metode PCR.
i720 Kepada Prof. dr. Sangkot Marzuki, M.Sc. Ph.D. D.Sc., Direktur Lembaga
\par}{\phpg\posx1701\pvpg\posy1706\absw8803\absh12741 \sl-414 \f10 \fs21 \cf0 Bi
ologi Molekul Eijkman, Dr. Iswari Setianingsih, Ph.D., Dr. Herawati Sudoyo,
\par}{\phpg\posx1701\pvpg\posy1706\absw8803\absh12741 \sl-413 \f10 \fs21 \cf0 Ph
.D. dan Dr. Alida R. Harahap, Ph.D., yang telah memberikan kesempatan
pada Saya untuk menambah ilmu pengetahuan di bidang diagnosis
lekular Thalassemia, Saya ucapkan terima kasih.
0 \fi8284 {\f20 \fs19 21 }
}\par
}
0}}}}
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3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
21 \cf0 Terima kasih Saya ucapkan kepada alm. Prof. dr. Bachtiar Gintin
g
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-412 \f10 \fs21 \cf0 M.
P.H. yang telah menerima Saya sebagai staf di bagian Gizi F.K. USU dan
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-414 \f10 \fs21 \cf0 al
marhumah Prof. Helena Siregar, Sp.A..(K) yang telah mengizinkan Saya
lanjutkan pendidikan ke spesialis Patologi Klinik.
i720 Ucapan terima kasih juga Saya sampaikan kepada mantan Kepala
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-414 \f10 \fs21 \cf0 Ba
gian Gizi Fakultas Kedokteran USU Prof. Dr. dr. Arsiniati M. Brata dan Prof.
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-413 \f10 \fs21 \cf0 T.
Renardi Harun MPH, Sp.P.D.(K.Kar.), yang telah menerima Saya sebagai
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-414 \f10 \fs21 \cf0 as
isten di bagian Gizi F.K. USU pada tahun 1976.
i720 Ucapan terimakasih yang tulus Saya sampaikan kepada para sejawat di
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-414 \f10 \fs21 \cf0 De
partemen Gizi Fakultas Kedokteran USU, dr. Mardiana Jayusman, Sp.A., dr.
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-413 \f10 \fs21 \cf0 Ra
sita Sembiring, dr. Harun Alrasyid Damanik, Sp.P.D., dr. Hasanul Arifin
,
.An., dr. Murniati Manik, M.Sc.Sp.K.K., dr. Aryani Atiyatul Amra, Sp.M., d
r.
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-413 \f10 \fs21 \cf0 Za
imah Tala, M.Sc. dan Nenny Dwi Aprianti Lubis, S.P.
i720 Khususnya kepada Prof dr. E.N. Kosasih, Sp.P.D., Sp.P.K., mantan
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-413 \f10 \fs21 \cf0 Ke
tua Program Pendidikan Spesialis Patologi Klinik yang telah menerima Saya
n telah banyak memberikan dorongan serta motivasi pada waktu Saya
ngikuti pendidikan Spesialis Patologi Klinik, Saya ucapkan terima kasih yang
besar-besarnya. Demikian juga kepada para senior dan sejawat Saya di
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-413 \f10 \fs21 \cf0 Ba
gian Patologi Klinik Fakultas Kedokteran USU, Prof. dr. Burhanud
din
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-413 \f10 \fs21 \cf0 Na
sution, Sp.P.K.(K.N.), Prof. dr. Iman Sukiman, Sp.P.K.(K.), dr. Arif Siregar,
.P.K.(K.), dr. Nurmansyah Tahir, Sp.P.K., dr. Arjuna Burhan, D.M
.M.,
.P.K.(K.), dr. Muzahar, D.M.M., Sp.P.K.(K.), dr. Tapisari Tambunan, Sp.P.K.,
. Farida Siregar, Sp.P.K., dr. Ulfa M., Sp.P.K., dr. Zulfikar Lubis, Sp.P.K., dr
.
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-414 \f10 \fs21 \cf0 Ri
eke L., Sp.P.K., dr. Ozar, Sp.P.K., dr. Nelli Samosir, Sp.P.K. dan dr. T. Azhar
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-413 \f10 \fs21 \cf0 Jo
han Sp.P.K.
i720 Kepada almarhum dr. Paulus Sembiring, Sp.P.K.(K.H.), dr. Irfa
n
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-414 \f10 \fs21 \cf0 Ab
dullah, Sp.P.K.(K.H.), dr. Hendra Lumanauw, Sp.P.K.(K.), terima kasih atas
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-413 \f10 \fs21 \cf0 ja
sa-jasanya.
i720 Ucapan terima kasih yang tiada terhingga saya sampaikan kepada
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-413 \f10 \fs21 \cf0 Dr
. Fransiska Lanni, dr. Ria Masniari Lubis MSc., dr. Nurhaida Jamil, S
pM,
. Rosdini Yusuf, SpA, dr. Cut Idawani, MSc, dr. Rohani Rani, SpA, dr. Daratia
\par}{\phpg\posx1701\pvpg\posy1706\absw8852\absh11790 \sl-414 \f10 \fs21 \cf0 J.
Bahroeny, SpKK, Rosmeri Sabri, Dewi Hermansyah, dan kakanda Habibah \par
}
22
{\fs16 2005 }
}
0}}}}
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5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
Lida, yang selalu mengkoreksi saya dalam pendidikan maupun dala
m
rgaulan.
i720 Kepada Direktur RSUP HAM dan Direktur RSUD Pirngadi bersama
\par}{\phpg\posx1701\pvpg\posy1706\absw8727\absh12741 \sl-414 \f10 \fs21 \cf0 ja

jaran
stafnya,
Saya
mengucapkan
terima
kasih
atas
bantuan
dan
rjasamanya dalam hal pendidikan mengadakan penelitian dan pelayanan
syarakat di Departemen Patologi Klinik.
i720 Tak lupa ucapan terimakasih juga Saya sampaikan kepada keluarga
sar Yayasan Rumah Sakit Islam Malahayati, di antaranya Prof. dr. Buchari
sim, Sp.B.P.(K.) dan keluarga, Prof. T. Samsul Bahri, S.H. dan keluarga, dr.
\par}{\phpg\posx1701\pvpg\posy1706\absw8727\absh12741 \sl-414 \f10 \fs21 \cf0 Ha
sdiana Hasan, Sp.O.G. dan keluarga, Prof. Dr. Hasballah Thaib M.A. dan
luarga, Bapak Riza Mutyara dan keluarga, yang telah banyak membantu
mberikan dorongan dan bimbingan dalam bekerja sebagai pimpinan SPK
n RSI Malahayati. Demikian juga kepada Prof. T. Bahri Anwar dan keluarga
ng telah memberikan perhatian yang tak putus-putusnya kepada Saya dan
luarga Saya.
i720 Ucapan terima kasih juga saya sampaikan kepada keluarga besar
\par}{\phpg\posx1701\pvpg\posy1706\absw8727\absh12741 \sl-413 \f10 \fs21 \cf0 Ta
miang Serumpun, Bapak Sulaiman AB dan keluarga, dan Bapak Hamdan
\par}{\phpg\posx1701\pvpg\posy1706\absw8727\absh12741 \sl-414 \f10 \fs21 \cf0 Sa
ti dan keluarga, yang selalu menyemangati saya untuk terus berkarya.
i720 Kepada USU Press tak lupa Saya mengucapkan terima kasih,
\par}{\phpg\posx1701\pvpg\posy1706\absw8727\absh12741 \sl-413 \f10 \fs21 \cf0 kh
ususnya Bapak Drs. Ridwan Siregar, S.H., M.Lib., yang telah banyak
mbantu dalam penulisan buku, dan lain-lain.
i720 Kepada
Pimpinan
dan
Staff
Rumah
Sakit
Gleneagles,
Saya
ngucapkan terima kasih atas kepercayaan yang diberikan dan kerjasamanya
lama ini.
i720 Ucapan terima kasih Saya sampaikan kepada keluarga besar Persatuan
\par}{\phpg\posx1701\pvpg\posy1706\absw8727\absh12741 \sl-414 \f10 \fs21 \cf0 Ik
atan Isteri Sarjana Ekonomi Indonesia (PIISEI) Cabang Medan terutama
pada sesepuh PIISEI, Ibu Aisyah Hadibroto, Ibu Intan Pulungan dan Ibu
\par}{\phpg\posx1701\pvpg\posy1706\absw8727\absh12741 \sl-414 \f10 \fs21 \cf0 Na
ya Miraza serta anggota pengurus, Ibu Komaria Pandia, Ibu Diana Samat,
\par}{\phpg\posx1701\pvpg\posy1706\absw8727\absh12741 \sl-413 \f10 \fs21 \cf0 Ib
u Wina Ubit, Ibu Yani Iskandar yang telah banyak memberikan motivasi dan
ntuan kepada Saya.
i720 Kepada para dosen dan teman sejawat FK USU beserta staf edukatif
n administrasi yang telah menghantarkan Saya mencapai derajat keilmuan

0 \fi8284 {\f20 \fs19 23 }
}\par
}
0}}}}
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2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
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5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
saat ini, Saya ucapkan terima kasih yang sebesar-besarnya. Semoga Alla
h
\par}{\phpg\posx1701\pvpg\posy1706\absw8777\absh11790 \sl-412 \f10 \fs21 \cf0 SW
T dapat membalas segala kebaikannya.
i720 Ucapan terima kasih juga Saya sampaikan kepada Sdr. Syawaluddin
n Sdr. Mundo Saragih yang telah banyak membantu Saya sejak pelaksanaan
nelitian sampai dengan penyusunan disertasi Program S3 Kedokteran.
i720 Kepada seluruh Panitia Pengukuhan Guru Besar yang telah membantu
n bekerja keras hingga acara ini dapat terlaksana dengan baik Saya tak lupa
ngucapkan terima kasih.
i720 Kepada guru-guru saya di Sekolah Rakyat Kuala Simpang (Aceh Timur),
marhumah Ibu Asmah Affan, Ibu Fatimah Sinambela, dan guru saya SMP,
m. Bapak Tono Siswoyo serta guru saya di SMA Negeri V Medan, alm. Bapak
\par}{\phpg\posx1701\pvpg\posy1706\absw8777\absh11790 \sl-414 \f10 \fs21 \cf0 A.
Depari Nasution. Demikian juga kepada guru ngaji saya yang pertama kali
ngajar saya membaca Al-qur'an, alm. Ustadz Syuib Lubis dan mualimah Hj.
\par}{\phpg\posx1701\pvpg\posy1706\absw8777\absh11790 \sl-413 \f10 \fs21 \cf0 Nu
raini Nasution, alm. Hj. Siti Mariam dan masih banyak lagi yang tidak dapat
ya sebutkan satu persatu, saya ucapkan terima kasih yang setinggi-tingginya.
moga amal Bapak dan Ibu guru tersebut mendapat balasan yang setimpal
ri Allah SWT.
i720 Selanjutnya tentu saja saya tak dapat melupakan jerih payah kedua
\par}{\phpg\posx1701\pvpg\posy1706\absw8777\absh11790 \sl-413 \f10 \fs21 \cf0 or
angtua saya ayahanda H.M. Ganie dan almarhumah ibunda Hj. Siti Aminah
ng telah bersusah payah mendidik kami anak-anaknya kiranya terima kasih
n sembah sujud saya belum cukup untuk mengganti pengorbanan beliau.
moga dengan jabatan Guru Besar Madya yang saya sandang saat ini dapat
mbahagiakan ayahanda dalam kesendiriannya yang sekarang sakit tidak
pat berjalan untuk hadir dalam pengukuhan saya sebagai Guru Besar pada
ri ini. Kepada ibunda yang telah tiada, saya selalu mendo'akan agar beliau
nantiasa diterima disisiNya sesuai dengan amal dan ibadahnya, demikian

ga kepada almarhumah ibunda Hj. Fatimah. Terima kasih juga say
a
mpaikan kepada ibu Hj. Farah Saba yang selalu mendoakan saya. Kepada
kcik Kamarudin Harun dan keluarga yang selalu mengiringi saya dengan
\par}{\phpg\posx1701\pvpg\posy1706\absw8777\absh11790 \sl-414 \f10 \fs21 \cf0 do
a-doanya saya ucapkan terima kasih.
Kepada saudara-saudaraku yang
\par}{\phpg\posx1701\pvpg\posy1706\absw8777\absh11790 \sl-413 \f10 \fs21 \cf0 ku
sayangi. Basri, Bustami, Basyaruddin, Farida, Rohani, Bustamam, Sandiyah,
\par}{\phpg\posx1701\pvpg\posy1706\absw8777\absh11790 \sl-414 \f10 \fs21 \cf0 Ta
ufik, Nurhayani, Kadaman, Doni, Syahrul, Rusmin beserta keluarga,
\par
}
24
{\fs16 2005 }
}
0}}}}
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3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
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31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
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05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
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5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
kehangatan dan kerukunan hubungan kekeluargaan diantara kita kiranya ik
ut
ndorong keberhasilan saya saat ini.
i720 Demikian juga kepada saudara-saudara ipar saya T. Derikansyah
,
ryakanta, Muhibah AB, Asmana AB, Ruslan, Zuraida, Zulia, Rusman, Ruslim
n Redwin beserta seluruh keluarga. Khususnya kepada kakanda H.
\par}{\phpg\posx1701\pvpg\posy1706\absw8666\absh11417 \sl-414 \f10 \fs21 \cf0 Sa
lahuddin N. Kaoy dan kakanda Hj. Syarifah Salahuddin N. Kaoy yang telah
nyak memberikan perhatian, nasehat dan bantuan kepada kami sekeluarga
ya tak lupa mengucapkan terima kasih. Semoga Allah SWT selalu
mbimbing dalam bakti kita terhadap orangtua dan mendidik serta
nghantarkan anak-anak kita sebagaimana telah diteladankan orangtua kita.
i720 Pada saat seperti ini Saya terkenang kepada kedua mertua Saya
marhum Bapak H. Rahimun dan almarhumah Ibu Hj. Zubaidah Hasibuan,
ga kepada almarhumah Ibu Hj. Mariani, almarhum Bapak H. Abubakar serta
marhumah Ibu Hj. Mariamahni dan Bapak H. Arifin A.B., Saya sangat
rterimakasih atas perhatian dan doa restu yang selalu mengiringi kehidupan
mi sekeluarga. Semoga kebaikannya menjadi amal ibadah dan diterima Allah
\par}{\phpg\posx1701\pvpg\posy1706\absw8666\absh11417 \sl-413 \f10 \fs21 \cf0 SW
T.
i719 Akhirnya kepada suami tercinta H. Razali Rahimun yang telah
ndampingi Saya dalam suka dan duka selama 33 tahun tanpa dukunganmu
sanya aku tidak mungkin berhasil dalam meniti karir sampai kepada jenjang
\par}{\phpg\posx1701\pvpg\posy1706\absw8666\absh11417 \sl-414 \f10 \fs21 \cf0 gu
ru besar seperti yang disaksikan saat ini. Untuk itu aku mengucapkan terima
sih atas pengertian, kesabaran dan kasih sayang yang telah diberikan serta
hon maaf yang sebesar-besarnya jika di dalam perjalanan karir ini kadang
la aku terpaksa meninggalkan tugas-tugasku sebagai seorang ibu.
i720 Kepada belahan jiwaku Ridha Dharmajaya, Riyadh Ikhsan, Bismi Aziza
\par}{\phpg\posx1701\pvpg\posy1706\absw8666\absh11417 \sl-414 \f10 \fs21 \cf0 Ma
harani yang selalu menunjukkan baktimu kepada orang tua untuk itu mama
\par}{\phpg\posx1701\pvpg\posy1706\absw8666\absh11417 \sl-414 \f10 \fs21 \cf0 uc
apkan terima kasih. Kami sangat menggantungkan harapan kepada kalian
\par}{\phpg\posx1701\pvpg\posy1706\absw8666\absh11417 \sl-414 \f10 \fs21 \cf0 ag
ar belajar lebih giat lagi dalam menuntut ilmu dan berprestasi yang lebih baik
\par}{\phpg\posx1701\pvpg\posy1706\absw8666\absh11417 \sl-413 \f10 \fs21 \cf0 un
tuk mengharungi kehidupan dengan persaingan yang tidak ringan pada masa
ng akan datang seperti syair lagu yang sering kunyanyikan sewa
ktu
nidurkanmu untuk menyemangatimu ketika kalian masih kecil: \par
}
5 \par
}
a", 2005
}
0}}}}
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d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
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10 \fs21 \cf0 Do kudaidang
Rangkang diblang tameh bangka
\fi194 Berejang rayk banta sedang
\fi194 Jt jak lamprang bela bangsa \par
}
1 \cf0 Do'a kami tak henti-hentinya semoga kalian termasuk kedalam golongan
\par}{\phpg\posx1701\pvpg\posy3775\absw8824\absh2849 \sl-414 \f10 \fs21 \cf0 ora
ng-orang yang beriman, berilmu, dan beramal shaleh. Demikian pula kepada
antuku Dina Keumalasari serta kedua cahaya mataku Aina dan Aisya yang
\par}{\phpg\posx1701\pvpg\posy3775\absw8824\absh2849 \sl-414 \f10 \fs21 \cf0 sel
alu memberikan inspirasi dan semangat untuk geni.
720 Marilah kita syukuri bersama atas kebesaran dan karunia Allah SWT ini.
La}{\i in}{\i syakartum}{\i laaziidannakum}{\i walain}{\i kafartum}{\i in
na}{\i adzabi}{\i lasyadiid}. Semoga
\par}{\phpg\posx1701\pvpg\posy3775\absw8824\absh2849 \sl-413 \f10 \fs21 \cf0 All
ah SWT selalu melimpahkan taufik dan hidayah-Nya kepada kita semua.
\par}{\phpg\posx1701\pvpg\posy3775\absw8824\absh2849 \sl-414 \f10 \fs21 \cf0 Ami
n. \par
}
{\phpg\posx1701\pvpg\posy7502\absw8795\absh4431 \b\i \f10 \fs21 \cf0 \b\i \f10 \
fs21 \cf0 Bapak rektor serta hadirin yang Saya muliakan,
\par}{\phpg\posx1701\pvpg\posy7502\absw8795\absh4431 \sl-258 \par\b\i \f10 \fs21
\cf0 \fi720 {\b0\i0 Demikianlah}{\b0\i0 akhir}{\b0\i0 pidato}{\b0\i0 penguku

han}{\b0\i0 Saya}{\b0\i0 yang}{\b0\i0 telah}{\b0\i0 banyak}{\b0\i0 menyita
}
\par}{\phpg\posx1701\pvpg\posy7502\absw8795\absh4431 \sl-413 \b\i \f10 \fs21 \cf
0 {\b0\i0 waktu}{\b0\i0 dan}{\b0\i0 perhatian}{\b0\i0 hadirin.}{\b0\i0 Atas}
{\b0\i0 kesabaran}{\b0\i0 dan}{\b0\i0 perhatiannya}{\b0\i0 mengikuti}{\b0\i0
pidato }
0 {\b0\i0 ini,}{\b0\i0 Saya}{\b0\i0 ucapkan}{\b0\i0 terima}{\b0\i0 kasih}{\b
0\i0 dan}{\b0\i0 mohon}{\b0\i0 maaf}{\b0\i0 apabila}{\b0\i0 ada}{\b0\i0 tu
tur}{\b0\i0 kata}{\b0\i0 maupun }
0 {\b0\i0 sikap}{\b0\i0 yang}{\b0\i0 kurang}{\b0\i0 berkenan}{\b0\i0 di}{\b0
\i0 hati}{\b0\i0 hadirin.}{\b0\i0 Kepada}{\b0\i0 para}{\b0\i0 undangan}{\b0
\i0 dan}{\b0\i0 rekan }
0 {\b0\i0 dari}{\b0\i0 luar}{\b0\i0 kota}{\b0\i0 yang}{\b0\i0 telah}{\b0\i0
meluangkan}{\b0\i0 waktunya,}{\b0\i0 Saya}{\b0\i0 haturkan}{\b0\i0 ribuan}
{\b0\i0 terima }
0 {\b0\i0 kasih}{\b0\i0 dan}{\b0\i0 mohon}{\b0\i0 ma'af}{\b0\i0 yang}{\b0\i0
sebesar-besarnya.}{\b0\i0 Hanya}{\b0\i0 Allah}{\b0\i0 SWT}{\b0\i0 yang}{\b
0\i0 dapat }
0 {\b0\i0 membalas}{\b0\i0
segala}{\b0\i0
pengorbanan}{\b0\i0
yang}{\b0
\i0
bapak/ibu/saudara}{\b0\i0
ikhlaskan}{\b0\i0
untuk }
0 {\b0\i0 menghadiri}{\b0\i0 acara}{\b0\i0 ini. }
0 \fi720 {\b0\i0 Semoga}{\b0\i0 Allah}{\b0\i0 SWT}{\b0\i0 melimpahkan}{\b0
\i0 taufik}{\b0\i0 dan}{\b0\i0 hidayah-Nya}{\b0\i0 kepada}{\b0\i0 kita
}
0 {\b0\i0 semua.}{\b0\i0 Amin.}{\b0\i0 Wabillahi}{\b0\i0 taufik}{\b0\i0
walhidayah,}{\b0\i0 Wassalamu'alaikum}{\b0\i0 waramatullahi }
0 {\b0\i0 wabarokatuh. }\par
}
Medan, November 2005 \par
}
Ratna Akbari Ganie \par
}
26
{\fs16 2005 }
}
0}}}}
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5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
\cf0 DAFTAR PUSTAKA \par
}
Blumberg B.D., Golbus M.S. and Hanson K.H. (1975). The Psychological

i719 Sequelae of Abortion Performed for Genetic Indication.{\i Am}{\i J.}{\i
Ob.}{\i Gyn. }
i720 122: 799-808.
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ehm
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7 \par
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a", 2005
}
0}}}}
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3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
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}
28
{\fs16 2005 }
}
0}}}}
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3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
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2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
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5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
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d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
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therall D.J. (1965). Historical Introduction. In: Weatherall DJ (ed). T
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therall D.J. and Clegg J.B. (2001).{\i The}{\i Thalassemia}{\i Syndromes} (4
edn).
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Working Group. (1983). Community Control of Hereditary Anemias
720 Memorandum from a WHO Meeting.{\i Bull}{\i WHO} 61: 6380
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(1994).{\i Guidelines}{\i for}{\i the}{\i control}{\i of}{\i haemoglobin}
{\i disorders.}{\i Report}{\i of}{\i the }\par
}
\cf0 VI \par
}
\cf0 th \par
}
\cf0 Annual \par
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Working \par
}
{\phpg\posx8911\pvpg\posy10839\absw746\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 G
roup \par
}
n \par
}
21 \cf0 Haemoglobinopathies. Cagliari. Sardinia, 8-9 April, 1989. Wordld Health
i720 Organization, Geneva.
\par}{\phpg\posx1701\pvpg\posy11253\absw8765\absh1731 \sl-414 \f10 \fs21 \cf0 Wo
od W.G., Bunch C., Kelly S., Gunn Y. and Breckon G. (1985). Control
of
i719 Haemoglobin Switching by a Developmental Clock?{\i Nature.} 313: 3
20\par}{\phpg\posx1701\pvpg\posy11253\absw8765\absh1731 \sl-414 \f10 \fs21 \cf0 \f
i719 327. \par
}
9 \par
}
a", 2005
}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
\cf0 RIWAYAT HIDUP \par
}
\cf0 1. DATA PRIBADI
\fi360 {\b0 a.}{\b0 Nama }
\fi360 {\b0 b.}{\b0 NIP }
\fi360 {\b0 c.}{\b0 Pangkat/Golongan }
\fi360 {\b0 d.}{\b0 Jabatan }
\fi360 {\b0 e.}{\b0 Tempat/Tanggal}{\b0 Lahir }
\fi360 {\b0 f.}{\b0 Agama }
\fi359 {\b0 g.}{\b0 Nama}{\b0 Ayah }
\fi360 {\b0 h.}{\b0 Nama}{\b0 Ibu }
\fi360 {\b0 i.}{\b0 Suami }
\fi360 {\b0 j.}{\b0 Anak }\par
}
{\phpg\posx2061\pvpg\posy8536\absw1192\absh612 \f10 \fs21 \cf0 \f10 \fs21 \cf0 k
. Menantu
\par}{\phpg\posx2061\pvpg\posy8536\absw1192\absh612 \sl-412 \f10 \fs21 \cf0 l. C
ucu \par
}
: Dr. dr. Ratna Akbari Ganie, Sp.P.K.
\par}{\phpg\posx5300\pvpg\posy3568\absw4380\absh5456 \sl-414 \f10 \fs21 \cf0 : 1
30 802 436
\par}{\phpg\posx5300\pvpg\posy3568\absw4380\absh5456 \sl-414 \f10 \fs21 \cf0 : P
embina Tk. I / IV/b
\par}{\phpg\posx5300\pvpg\posy3568\absw4380\absh5456 \sl-413 \f10 \fs21 \cf0 : G
uru Besar Patologi Klinik / 1 Juli 2005
\par}{\phpg\posx5300\pvpg\posy3568\absw4380\absh5456 \sl-414 \f10 \fs21 \cf0 : B
anda Aceh, 11 Juli 1948
\par}{\phpg\posx5300\pvpg\posy3568\absw4380\absh5456 \sl-413 \f10 \fs21 \cf0 : I
slam
\par}{\phpg\posx5300\pvpg\posy3568\absw4380\absh5456 \sl-414 \f10 \fs21 \cf0 : H
. M. Ganie
\par}{\phpg\posx5300\pvpg\posy3568\absw4380\absh5456 \sl-414 \f10 \fs21 \cf0 : H
j. Siti Aminah
\par}{\phpg\posx5300\pvpg\posy3568\absw4380\absh5456 \sl-413 \f10 \fs21 \cf0 : D
rs. H. Razali Rohimun
\par}{\phpg\posx5300\pvpg\posy3568\absw4380\absh5456 \sl-414 \f10 \fs21 \cf0 : d
r. Ridha Dharmajaya
135 dr. Riyadh Ikhsan
135 Bismi Aziza Maharani, S.E.
\par}{\phpg\posx5300\pvpg\posy3568\absw4380\absh5456 \sl-413 \f10 \fs21 \cf0 : d
r. Dina Keumala Sari
\par}{\phpg\posx5300\pvpg\posy3568\absw4380\absh5456 \sl-412 \f10 \fs21 \cf0 : N
adya Keumala Fitri
121 Raisya Keumala Putri \par
}
\cf0 2. RIWAYAT PENDIDIKAN
\fi360 {\b0 Formal: }\par
}
a. 1960
\par}{\phpg\posx2061\pvpg\posy11019\absw1538\absh2104 \sl-414 \f10 \fs21 \cf0 b.
1963
\par}{\phpg\posx2061\pvpg\posy11019\absw1538\absh2104 \sl-413 \f10 \fs21 \cf0 c.
1966/1967
\par}{\phpg\posx2061\pvpg\posy11019\absw1538\absh2104 \sl-414 \f10 \fs21 \cf0 d.
1976
\par}{\phpg\posx2061\pvpg\posy11019\absw1538\absh2104 \sl-413 \f10 \fs21 \cf0 e.
1996
\par}{\phpg\posx2061\pvpg\posy11019\absw1538\absh2104 \sl-414 \f10 \fs21 \cf0 f.
2004 \par
}
: Lulus SR Negeri 1 Kuala Simpang, Aceh Timur
\par}{\phpg\posx3860\pvpg\posy11019\absw6393\absh2104 \sl-414 \f10 \fs21 \cf0 :
Lulus SMP Negeri 1 Kuala Simpang, Aceh Timur
Lulus SMA Negeri 5 Medan, Sumatera Utara
Lulus Dokter Umum F.K. USU, Medan
Lulus Dokter Spesialis Patologi Klinik F.K. USU, Medan
Lulus Program S3 Kedokteran Pascasarjana USU, Medan \par
}
Tambahan:
\par}{\phpg\posx2061\pvpg\posy13917\absw1295\absh613 \sl-414 \f10 \fs21 \cf0 a.
1980 \par
}
: Mengikuti Penataran Sistem Kredit Semester F.K. USU,
266 Medan. \par
}
30
{\fs16 2005 }
}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
{\phpg\posx2061\pvpg\posy1706\absw1519\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 b
. 1984/1985 \par
}
: Mengikuti Program Akta Mengajar Lima Format Jarak
266 Jauh.
Work Shop Teknik Imunofloresen, Surabaya.
Kursus Immnunologi F.K. UISU, Medan.
Work Shop Thalassemia, Jakarta.
Course Techniques PCR Method F.K. USU, Medan.
Mengikuti Work Shop on Computing Application for
266 Reproductive.
Course Techniques PCR Method, Kuala Lumpur.
Kursus Biologi Molekular Dan Immunologi, Yogyakarta. \par
}
{\phpg\posx2061\pvpg\posy2533\absw993\absh1731 \f10 \fs21 \cf0 \f10 \fs21 \cf0 c
. 1994
1994
1997
\par}{\phpg\posx2061\pvpg\posy2533\absw993\absh1731 \sl-414 \f10 \fs21 \cf0 f.
1997
\par}{\phpg\posx2061\pvpg\posy2533\absw993\absh1731 \sl-413 \f10 \fs21 \cf0 g.
1997 \par
}
{\phpg\posx2061\pvpg\posy5017\absw957\absh613 \f10 \fs21 \cf0 \f10 \fs21 \cf0 h.
1999
\par}{\phpg\posx2061\pvpg\posy5017\absw957\absh613 \sl-414 \f10 \fs21 \cf0 i.
2003 \par
}
\cf0 3. RIWAYAT JABATAN/GOLONGAN \par
}
a. 30 Juni 1979
16 Maret 1982
11 Juli 1984
7 Juli 1986
23 Mei 1988 \par
}
: Asisten Ahli Madya/Penata Muda/Gol III/a
\par}{\phpg\posx4581\pvpg\posy7087\absw4655\absh1731 \sl-413 \f10 \fs21 \cf0 : A
sisten Ahli/Penata Muda Tk I/Gol III/b
\par}{\phpg\posx4581\pvpg\posy7087\absw4655\absh1731 \sl-413 \f10 \fs21 \cf0 : L
ektor Muda/Penata/Gol III/c
ektor Madya/Penata Tk I/Gol III/d
ektor /Pembina/Gol IV/a \par
}
{\phpg\posx2017\pvpg\posy9157\absw7489\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 f
. 9 September 1997 : Lektor Kepala Madya/Pembina Tk I/Gol IV/b \par
}
{\phpg\posx2017\pvpg\posy9571\absw1535\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 g
. 1 Juli 2005 \par
}
{\phpg\posx4599\pvpg\posy9571\absw5133\absh613 \f10 \fs21 \cf0 \f10 \fs21 \cf0 :
Guru Besar Madya, pada bidang Ilmu Patologi
61 Klinik F.K. USU \par
}
\cf0 4. RIWAYAT PEKERJAAN \par
}
a. 1978 - sekarang
1980 - sekarang
1986 - 1990 \par
}
\par}{\phpg\posx4446\pvpg\posy11227\absw93\absh986 \sl-414 \f10 \fs21 \cf0 : \pa
r
}
d. 1994 - 1996 \par
}
\par
}
e. 1996 - sekarang \par
}
\par
}
Staf Pengajar Bagian Ilmu Gizi F.K. USU
af Pengajar Bagian Ilmu Gizi F.K. UISU
kretaris Jurusan Ilmu Kedokteran Masyarakat

\par}{\phpg\posx4795\pvpg\posy11227\absw5507\absh2849 \sl-414 \f10 \fs21 \cf0 F.
K. USU
af Pengajar (Data Sering) Bagian Ilmu Patologi
\par}{\phpg\posx4795\pvpg\posy11227\absw5507\absh2849 \sl-414 \f10 \fs21 \cf0 Kl
inik F.K. UNSYIAH
af Pengajar Bagian Ilmu Patologi Klinik F.K.
\par}{\phpg\posx4795\pvpg\posy11227\absw5507\absh2849 \sl-414 \f10 \fs21 \cf0 US
U \par
}
1 \par
}
a", 2005
}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
{\phpg\posx2061\pvpg\posy1706\absw1520\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 f
. 1996 - 2002 \par
}
{\phpg\posx4446\pvpg\posy1706\absw91\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 : \
par
}
{\phpg\posx4795\pvpg\posy1706\absw942\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 Re
daksi \par
}
{\phpg\posx6115\pvpg\posy1706\absw1199\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 P
elaksana \par
}
{\phpg\posx7688\pvpg\posy1706\absw893\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 Ma
jalah \par
}
{\phpg\posx8979\pvpg\posy1706\absw1245\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 K
edokteran \par
}
{\phpg\posx4795\pvpg\posy2119\absw3871\absh613 \f10 \fs21 \cf0 \f10 \fs21 \cf0 N
usantara (MKN) F.K. USU
\par}{\phpg\posx4795\pvpg\posy2119\absw3871\absh613 \sl-413 \f10 \fs21 \cf0 Angg
ota
Unit
Pengembangan \par
}
{\phpg\posx2061\pvpg\posy2533\absw1581\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 g
. 2001 - 2003 \par
}
par
}
{\phpg\posx9073\pvpg\posy2533\absw1140\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 I
lmiah/Unit \par
}
{\phpg\posx2061\pvpg\posy3361\absw2045\absh241 \f10 \fs21 \cf0 \f10 \fs21 \cf0 h
. 2003 - sekarang \par
}
par
}
{\phpg\posx4795\pvpg\posy2947\absw5455\absh986 \f10 \fs21 \cf0 \f10 \fs21 \cf0 P
engabdian Masyarakat F.K. USU
\par}{\phpg\posx4795\pvpg\posy2947\absw5455\absh986 \sl-413 \f10 \fs21 \cf0 Kepa
la Subdivisi Imunologi Departemen Patologi
\par}{\phpg\posx4795\pvpg\posy2947\absw5455\absh986 \sl-414 \f10 \fs21 \cf0 Klin
ik RSUP. H. Adam Malik Medan \par

}
\cf0 5. RIWAYAT ORGANISASI \par
}
Nasional:
360 a. Anggota IDI (Ikatan Dokter Indonesia)
360 b. Sekretaris Umum Persatuan Dokter Spesialis Patologi Klinik Cabang
720 Medan
360 c. Anggota PHTDI (Perhimpunan Hemostasis dan Transfusi Darah
720 Indonesia)
360 d. Anggota HKKI (Himpunan Kimia Klinik Indonesia)
360 e. Anggota PERALMUNI (Persatuan Alergi Imunologi)
360 f. Anggota PERHUKI (Persatuan Hukum Kedokteran Indonesia) \par
}
nternasional:
\par}{\phpg\posx2061\pvpg\posy9571\absw8105\absh613 \sl-413 \f10 \fs21 \cf0 Fell
ow of International Society of Hematology Asian Pacific Division (FISH) \par
}
1 \cf0 6. PENELITIAN
\fi360 {\b0 a.}{\b0
Ahmad}{\b0 Yusuf,} Ratna Akbari Ganie{\b0 ,}{\b0
Mardiana}{\b0 D.J.K.}{\b0 Pola}{\b0 Pemberian }
\fi749 {\b0 ASI}{\b0 Dan}{\b0 Makanan}{\b0 Tambahan}{\b0 Pada}{\b0 Anak}{\
b0 di}{\b0 Desa}{\b0 Pantai}{\b0 Kabupaten}{\b0 Deli }
\fi750 {\b0 Serdang}{\b0 Sumatera}{\b0 Utara}{\b0 (1982). }
\fi360 {\b0 b.} Ratna Akbari Ganie{\b0 ,}{\b0 I.}{\b0 Abdullah}{\b0 ,
}{\b0 Azmi}{\b0 S.}{\b0 Kar.}{\b0 The}{\b0 Incidence}{\b0 of }
\fi750 {\b0 Deficiency}{\b0 Anemia}{\b0 From}{\b0 The}{\b0 Sub}{\b0 Divisi
on}{\b0 of}{\b0 Haematology,}{\b0 Department }
\fi750 {\b0 of}{\b0 Medicine,}{\b0 DR.}{\b0 Pirngadi}{\b0 Hospital}{\b0 in
}{\b0 Medan}{\b0 (1993). }
\fi360 {\b0 c.} Ratna Akbari Ganie{\b0 .}{\b0 Profil}{\b0 Lemak}{\b0
Karyawan}{\b0 PT}{\b0 Perkebunan}{\b0 Rumah }
\fi750 {\b0 Sakit}{\b0 Tembakau}{\b0 Deli}{\b0 Medan}{\b0 (1994). }
\fi360 {\b0 d.} Ratna Akbari Ganie{\b0 .}{\b0 Profil}{\b0 Lemak}{\b0 Pada}
{\b0 Geriatri}{\b0 (Lansia)}{\b0 (1994). }\par
}
32

{\fs16 2005 }
}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}

e.{\b
Ratna}{\b Akbari}{\b Ganie}. Serum Feritin Pada Wanita Hamil (1996).
\fi5594 {\fs14 0 }
\par}{\phpg\posx2061\pvpg\posy1706\absw8246\absh1755 \sl-217 \f10 \fs21 \cf0 f.{
\b
Ratna}{\b Akbari}{\b Ganie}. Studi DNA Thalassemia-{\f40 {\field{\*\fld
inst SYMBOL 97 \\f Symbol }}} Southeast Asian Type
390 Di Medan (2003).
\par}{\phpg\posx2061\pvpg\posy1706\absw8246\absh1755 \sl-414 \f10 \fs21 \cf0 g.{
\b
Ratna}{\b
Akbari}{\b
Ganie}. Relationships Between Lipid Pro
file And
390 Traditional Risk Factors of Coronary Heart Disease (2004). \par
}
\cf0 7. SEMINAR NASIONAL SEBAGAI PEMBICARA \par
}
Author:
360 a.{\b Ratna}{\b Akbari}{\b Ganie}. Penanggulangan Anemi Pada Wanita Hami
l Dari
720 Sudut Ilmu Gizi Kongress IBI, 1985, Medan.
360 b.{\b Ratna}{\b Akbari}{\b Ganie}. KONAS I PDS PATKLIN. Hubungan
Status Gizi
720 Dengan Pemerksaan Laboratorium, 1991, Jakarta.
360 c.{\b
Ratna}{\b Akbari}{\b Ganie,} Irfan Abdullah, Azmi S. Kar. KONAS V
II PHTDI &
720 ISMHSEAC. The Incidence of Deficiency Anemia Reported From The
720 Sub Division of Haematology, Department of Medicine, DR. Pirngadi
720 Hospital in Medan, 1-3/12/1993, Medan.
360 d.{\b Ratna}{\b Akbari}{\b Ganie}, Adi Koesoema Aman, Burhanuddin Nst.,
T. Bachri
720 A. KONAS II PDS PATKLIN. Gambaran Frofil Lemak Karyawan PT
720 Perkebunan yang Mengikuti Uji Kesehatan Di RS Tembakau Deli Medan,
720 29-31/01/1994, Surabaya.
360 e.{\b Ratna}{\b Akbari}{\b Ganie}, Farida Siregar, Zulfian, Muzahar DMM.
KONAS II
720 PDS PATKLIN. Gambaran Beberapa Parameter Laboratorium, Glucose,
720 Creatinin, Albumin, Lipid Profil Pada Geriatri (Lansia), 29-31/01/199
4,
720 Surabaya .
360 f.{\b
Ratna}{\b Akbari}{\b Gani}, KONAS IV PDS PTKLIN. Evaluasi
Kadar Serum
720 Feritin Pada Kehamilan Trimester II dan Trimester III, 22-24/10/2001
,
720 Bandung.
360 Co-Author{\b : }
360 a. Hasanul Arifin,{\b Ratna}{\b Akbari}{\b Ganie}. Parentral Nutrition D
ipandang dari
720 Sudut Ilmu Gizi. Pekan Ilmiah dalam rangka HUT F.K. USU ke XXX,
720 Medan, 21 Agustus 1982.
\fi8284 {\f20 \fs19 33 }
}\par
}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
b. Ahmad Yusuf,{\b Ratna}{\b Akbari}{\b Ganie}. Mardiana D.J.K. Pola
Pemberian
360 Asi Dan Makanan Tambahan Pada Anak di Daerah Pantai Kabupaten
360 Deli Serdang Dan Langkat Sumatera Utara pada Travelling Seminar On
360 Recent Development in Breast Feeding, Medan, 30-31 Agustus 1982.
H. Alrasyid,{\b Ratna}{\b Akbari}{\b Ganie}, H. Arifin. Peranan Mak
anan Bergizi
359 Dalam Membentuk Fisik Sehat Dalam Keluarga, Panel Diskusi PHBI F.K.
359 USU, Medan, 1986.
H. Alrasyid,{\b Ratna}{\b Akbari}{\b Ganie}, Darwin Dalimunthe. Aspek Gizi d
alam
359 Usaha Meningkatkan Kesehatan Kerja, Seminar Keselamatan Kerja dan
360 Kesehatan Kerja, Medan, 1987.
Murniati Manik,{\b Ratna}{\b Akbari}{\b Ganie}, Rasita Sembiring, Mardiana K
arim.
359 Penanggulangan Anemi Pada Anak Balita Yang Berkunjung ke RSCM
359 KPPIK F.K. USU, Medan, 1984. \par
}
\cf0 8. SEMINAR INTERNASIONAL SEBAGAI PEMBICARA \par
}
Author:
360 a.{\b Ganie}{\b R.A}. Detection{\f40 {\field{\*\fldinst SYMBOL 97 \\f Sy
mbol }}} Thal Using The PCR Method at Blood Donors in

720 Medan. Presented at The 29th World Congress of the International
720 Society of Hematology, August 24-28, 2002, Seoul, Korea.
360 b.{\b Ganie}{\b R.A}. Alfa Thalasemia Gene (South-East Asian Type)
in Medan.
720 Presented at The 4th Malaysian National Haematology Scientific
720 Meeting, March15-17, 2002, Penang, Malaysia.
360 c.{\b
Ganie}{\b R.A}. Hemoglobin Concentration Transferin Saturatio
n Ferritin in
720 Pregnancy. Presented at The 4th Malaysian National Haematology
720 Scientific Meeting, March 15-17, 2002, Penang, Malaysia.
360 d.{\b Ganie}{\b R.A}. Alfa Thalasemia in Medan. Presented at Xth
Congress of
720 The International Society of Hematologi, Asian-Pacific Division Nagoya,
720 September 10-14, 2003 Nagoya, Japan. \par
}
34
{\fs16 2005 }
}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
14 \cf0 0
s21 e.}{\b \fs21 Ganie}{\b \fs21 R.A}{\fs21 .}{\fs21 Ethnic}{\fs21 Diver
sity}{\fs21 in}{\fs21 the}{\fs21 Distribution}{\fs21 of}{\fs21 Alpha}{
\fs21 Thal}{\fs21 1}{\fs21 (}{\f40 \fs21 {\field{\*\fldinst SYMBOL 97 \\f
Symbol }}}{\fs21 )}{\fs21 in }
\fi1394 rd
359 {\fs21 Medan,}{\fs21 3}{\fs21
International}{\fs21 Eijkman}{\fs21 Sym
posium,}{\fs21 30}{\fs21 September-3}{\fs21 Oktober }
359 {\fs21 2004,}{\fs21 Yogyakarta-Indonesia. }\par
}
{\phpg\posx1701\pvpg\posy3388\absw8616\absh613 \f10 \fs21 \cf0 \f10 \fs21 \cf0 C
o-author:
60 a. Dalimunthe D.,{\b Ganie}{\b R.A.}, Topical Aplication of Insulin in the
Treatment \par
}
f Diabetic Gangrene. 13
\par}{\phpg\posx2421\pvpg\posy4216\absw3018\absh613 \sl-414 \f10 \fs21 \cf0 Nove
mber 1988. \par
}
{\phpg\posx5371\pvpg\posy4179\absw158\absh160 \f10 \fs14 \cf0 \f10 \fs14 \cf0 th
\par
}
DF Congress, Sidney, Australia, 20-25 \par

}
b. Hiratna,{\b Ganie}{\b R.A.}, Relationships Between Lipid Profile and Trad
itional
\fi6588 {\fs14 th }
359 Risk Factors of Coronary Heart Disease. Presented at 8 Internation
al
360 Congress of the Asian Society of Clinical Pathology and Laboratory
360 Medicine, November 29- December 2, 2004, Medan. \par
}
\cf0 9. PUBLIKASI \par
}
1 \cf0 Nasional:
360 a. Ahmad Yusuf,{\b Ratna}{\b Akbari}{\b Ganie}. Mardiana D.J.K. Laporan
Penelitian
720 Pola Pemberian ASI dan Makanan Tambahan pada Anak di Desa Pantai
720 Kabupaten Deli Serdang Sumatera Utara (Perpustakaan Pusat USU No.
720 867/PT05/T.1982, tgl. 16 April 1982 dan Perpustakaan F.K. USU No.
720 10/Has.Penp./83 tgl. 23 Juli 1983).
360 b.{\b Ratna}{\b Akbari}{\b Ganie}, Harun Alrasyid. Peranan Pemeriksaan S
tatus Gizi
720 pada Wanita Hamil (MKN, 1983).
360 c. Harun Alrasyid,{\b Ratna}{\b Akbari}{\b Ganie}, Darwin Dalimunthe. P
ola Makanan
720 Ibu Hamil dan Menyusui di Daerah Rural & Urban. (MKN Vol. XVI, 2
0
720 Agustus 1986).
360 d. Arsiniati M.B. Arbai, Harun Alrasyid, Hasanul Arifin dan{\b Rat
na}{\b Akbari }
720 {\b Ganie}. Status Thiamine (Vitamin B1) dan Pola Konsumsi Makanan
720 Karyawan Perkebunan di Sumatera Utara (MKN Vo. 16 No. 3,
720 September 1986).
360 e.{\b Ratna}{\b Akbari}{\b Ganie}. Aspek Gizi Pada Usia Lanjut (
Majalah Dokter
720 Keluarga vol. 7 No. 4, Maret 1988).
\fi8284 {\f20 \fs19 35 }

}\par
}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9

}
f.{\b
Ratna}{\b
Akbari}{\b
Ganie}. Pola Menu Diet Serat (Maja
lah USU No.
360 173/PT05/Mj.IV.K/89 tgl. 6/9, 1989).
\par}{\phpg\posx2061\pvpg\posy1706\absw8289\absh6946 \sl-413 \f10 \fs21 \cf0 g.{
\b Ratna}{\b Akbari}{\b Ganie}. Pandangan Aspek Gizi tentang Makanan
Baru
360 yang
Beredar
di
Pasaran
(Reg.
Perpustakaan
F.K.-USU
No.
360 15/BUK/PERP/89 tgl. 7/9, 1989).
\par}{\phpg\posx2061\pvpg\posy1706\absw8289\absh6946 \sl-414 \f10 \fs21 \cf0 h.{
\b Ratna}{\b
Akbari}{\b
Ganie.} Penggunaan Bahan Makanan Pokok
dalam
360 Rangka Diversifikasi Pangan (Majalah USU No. 174/PT05/Mj.IV.K/89 tgl.
360 7/9,1989).
\par}{\phpg\posx2061\pvpg\posy1706\absw8289\absh6946 \sl-413 \f10 \fs21 \cf0 i.
Darwin Dalimunthe, Harun Alrasyid, Halomoan Hutagalung, Hasanul
360 Arifin,{\b Ratna}{\b Akbari}{\b Ganie}. Manfaat Diit pada Penanggulangan
Diabetis
359 Mellitus (MKN Vol. XX No. 5, Agustus 1990).
\par}{\phpg\posx2061\pvpg\posy1706\absw8289\absh6946 \sl-414 \f10 \fs21 \cf0 j.{
\b
Ratna}{\b Akbari}{\b Ganie}. Formulasi Menu Sederhana Menggunakan Bahan
360 Pangan Bergizi (MKN Vol. XXI, Februari 1991).
\par}{\phpg\posx2061\pvpg\posy1706\absw8289\absh6946 \sl-414 \f10 \fs21 \cf0 k.{
\b
Ratna}{\b Akbari}{\b Ganie}, Adi Koesoema Aman, Burhanuddin Nasution, da
n
360 T. Bachri Anwar Djohan. Gambaran Profil Lemak Karyawan Perkebunan
360 Dikaitkan dengan Faktor Resiko (MKN Vol. XXVII, Maret 1997).
\par}{\phpg\posx2061\pvpg\posy1706\absw8289\absh6946 \sl-413 \f10 \fs21 \cf0 l.{
\b
Ratna}{\b Akbari}{\b Ganie}. Evaluasi Kadar Serum Feritin pada Wanita H
amil
360 yang Mendapat Suplementasi Sulfas Ferosus (MKN Vol. XXXII No. 4,
360 Desember 1999). \par
}
Internasional:
\par}{\phpg\posx2061\pvpg\posy9985\absw8264\absh2897 \sl-413 \f10 \fs21 \cf0 a.{
\b Ganie}{\b R.A}., Yatim A., Kamaluddin N., Zakaria Z., Dalimunthe
D.,
360 Hariman H., George E., Detection{\f40 {\field{\*\fldinst SYMBOL 97 \\f
Symbol }}} Thal using The PCR Method at
360 Blood Donors in Medan. International Journal of Hematology, Vol. 76

360 Supl. 1, August 2002.
\par}{\phpg\posx2061\pvpg\posy9985\absw8264\absh2897 \sl-413 \f10 \fs21 \cf0 b.{
\b Ganie}{\b R.A}., Kamaluddin N., Zakaria Z., Dalimunthe D., Hariman
H.,
360 George E.,{\f40
{\field{\*\fldinst SYMBOL 97 \\f Symbol }}}-thalassaemia
gene (South-East Asian type) in Medan,
360 International Journal of Hematology, Vol. 76 Supl. 1 August 2002. \par
}
36
{\fs16 2005 }
}
0}}}}
0}}}}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
\cf0 10. SEBAGAI EDITOR BUKU
fi427 {\b0 Majalah}{\b0 Kedokteran}{\b0 Nusantara,}{\b0 Edisi}{\b0 Khusus}{\
b0 Vol.}{\b0 XXI/Februari}{\b0 1991. }\par
}
\cf0 11. SEBAGAI PENULIS BUKU
fi427 {\b0 {\ul R}{\ul a}{\ul t}{\ul n}{\ul a}}{\b0 {\ul }{\ul A}{\ul k}{\ul b}
{\ul a}{\ul r}{\ul i}}{\b0 {\ul }{\ul G}{\ul a}{\ul n}{\ul i}{\ul e}:}{\b0 Kaj
ian}{\b0 DNA}{\b0 Thalassemia}{\b0 Alpha}{\b0 di}{\b0 Medan. }\par
}
1 \cf0 12. MENGHADIRI PERTEMUAN ILMIAH
\fi420 {\b0 a.}{\b0 Simposium}{\b0 Terapi}{\b0 Oksigen,}{\b0 Medan,}{\b0
12}{\b0 Agustus}{\b0 1997. }
\cf0 \fi913 {\b0 \fs14 nd }
\fi420 {\b0 b.}{\b0 2}{\b0
Workshop}{\b0 on}{\b0 Thalassemia,}{\b0 Jak
arta,}{\b0 2-6}{\b0 September}{\b0 1997. }
\fi420 {\b0 c.}{\b0
Temu}{\b0 Ilmiah}{\b0 Populer:}{\b0 Demam}{\b0 Berda
rah}{\b0 Dengue,}{\b0 Medan,}{\b0 9}{\b0 Mei}{\b0 1998. }
\fi420 {\b0 d.}{\b0 Seminar}{\b0 Surgical}{\b0 Bypass}{\b0 &}{\b0 Stentin
g}{\b0 Techniques}{\b0 for}{\b0 Caronary}{\b0 Artery }
\fi780 {\b0 Disease,}{\b0 Medan,}{\b0 5}{\b0 Desember}{\b0 1998. }
\fi420 {\b0 e.}{\b0 Seminar}{\b0 Pemakaian}{\b0 Obat}{\b0 Tradisional}{\b0
di}{\b0 Sumatera}{\b0 Utara,}{\b0 Medan,}{\b0 9}{\b0 Juni }
\fi780 {\b0 1999. }
\fi420 {\b0 f.}{\b0
Seminar}{\b0 Bayi}{\b0 Milenium,}{\b0 Medan,}{\b0 24
}{\b0 Juli}{\b0 1999. }
\fi420 {\b0 g.}{\b0 Seminar}{\b0 Healthy}{\b0 Life}{\b0 Style}{\b0 for}{\

b0 Renal}{\b0 Failure}{\b0 Patient,}{\b0 Medan,}{\b0 7}{\b0 Agustus }
\fi780 {\b0 1999. }
\fi420 {\b0 h.}{\b0
IX}{\b0 Congress}{\b0 of}{\b0 the}{\b0 International
}{\b0 Society}{\b0 of}{\b0 Hematology}{\b0 Asian-Pacific }
\fi780 {\b0 Division,}{\b0 Bangkok,}{\b0 24-28}{\b0 Oktober}{\b0 1999. }
\fi420 {\b0 i.}{\b0
Molecular}{\b0 Approaches}{\b0 to}{\b0 Host}{\b0 Pa
rasite}{\b0 Relationship}{\b0 in}{\b0 Malaria,}{\b0 Jakarta, }
\fi780 {\b0 6-7}{\b0 Maret}{\b0 2000. }
\fi420 {\b0 j.}{\b0
Konas}{\b0 II}{\b0 PDGMI}{\b0 Peluang}{\b0 &}{\b0
Tantangan}{\b0 Gizi}{\b0 di}{\b0 Era}{\b0 Millenium}{\b0 III, }
\fi780 {\b0 Surabaya,}{\b0 13-14}{\b0 Oktober}{\b0 2000. }
\fi420 {\b0 k.}{\b0
Konas}{\b0 VIII}{\b0 Clinical}{\b0 Chemistry}{\b0 an
d}{\b0 Laboratory}{\b0 Medicine}{\b0 towards}{\b0 the}{\b0 New }
\fi780 {\b0 Milenium,}{\b0 Jakarta,}{\b0 26-28}{\b0 Oktober}{\b0 2000. }
\fi420 {\b0 l.}{\b0
KONAS}{\b0 ke}{\b0 X}{\b0 PGI,}{\b0 PEGI,}{\b0 Med
an,}{\b0 9-13}{\b0 September}{\b0 2001. }
\fi420 {\b0 m.}{\b0 KONAS}{\b0 IV}{\b0 PDS}{\b0 PATKLIN,}{\b0 Bandung,}{\b
0 22-24}{\b0 Oktober}{\b0 2001. }
\cf0 \fi913 {\b0 \fs14 th }
\fi420 {\b0 n.}{\b0 4}{\b0
Malaysian}{\b0 National}{\b0 Haematology}{\b0
Scientific,}{\b0 Penang,}{\b0 15-17}{\b0 Maret }
\fi780 {\b0 2002. }
\fi420 {\b0 o.}{\b0 Simposium}{\b0 New}{\b0 Horizon}{\b0 in}{\b0 Thalassa
emia}{\b0 Control,}{\b0 Jakarta,}{\b0 2002. }
\cf0 \fi1526 {\b0 \fs14 th }
\fi420 {\b0 p.}{\b0 The}{\b0 29}{\b0
World}{\b0 Congress}{\b0 of}{\b0
the}{\b0 International,}{\b0 Seoul,}{\b0 24-28}{\b0 Agustus }
\fi779 {\b0 2002. }
\cf0 \fi8284 {\b0 \f20 \fs19 37 }
{\b0 \f20 \fs16 Ratna}{\b0 \f20 \fs16 Akbari}{\b0 \f20 \fs16 Ganie}{\b0 \f20
\fs16 :}{\b0 \f20 \fs16 Pidato}{\b0 \f20 \fs16 Pengukuhan}{\b0 \f20 \fs16 "T
halasemia}{\b0 \f20 \fs16 Permasalahan}{\b0 \f20 \fs16 dan}{\b0 \f20 \fs16 Pe
nanganannya",}{\b0 \f20 \fs16 2005 }
f20 \fs18 2006 }\par
}
ffd8ffe000104a46494600010100000100010000ffdb004300080606070605080707070909080a0c
393d38323c2e333432ffdb0043010909090c0b0c180d0d1832211c21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232ffc0
0011080136013803012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
40051451400514514005145140051451400514514005145140051451400514514005145140095ca7
3a028a28a60145145001451450014514500145145001451450014514500274149d07348ccaa8599b
d1e9d45311d2440ca4146190474229f5fa09ca14514500145145001451450014514500727f12a792
4972c4f7a8d185187241682d14515a9a851451400514514005145140051451400514514005145140
2118760002d8f527935b14515dc7a414514500145145001451450014514500145145001451450014
5145001451450014514500145145001451450014514500145145001451450015956be1cd12cb527b
8a28a0028a28a0028a28a0028a28a00fffd9
}
q. Pertemuan Ilmiah Tahunan 2002, Medan, 1-2 Oklober 2002.
\par}{\phpg\posx2121\pvpg\posy1706\absw8191\absh2102 \sl-412 \f10 \fs21 \cf0 r.
The International Society of Hematology Asian Pacific Division, Nagoya,
359 1-4 September 2004.
\par}{\phpg\posx2121\pvpg\posy1706\absw8191\absh2102 \sl-413 \f10 \fs21 \cf0 s.
Pendidikan Berkesinambungan Patologi Klinik Departemen Patologi
360 Klinik F.K.-UI, Jakarta, 2004.
\par}{\phpg\posx2121\pvpg\posy1706\absw8191\absh2102 \sl-414 \f10 \fs21 \cf0 t.

Konas Hemofilia I, Jakarta, 10-11 September 2005. \par
}
\cf0 13. KEGIATAN PADA MASYARAKAT
\fi420 {\b0 a.}{\b0 Memberikan}{\b0
Kesehatan}{\b0
pada}{\b0
Bakti}{\
b0
Sosial}{\b0
Masyarakat}{\b0
dan}{\b0
Khitan }
\fi780 {\b0 Massal}{\b0 di}{\b0 Madrasah}{\b0 Nurul}{\b0 Hikmah}{\b0 Paluh}
{\b0 Getah,}{\b0 29}{\b0 Juni}{\b0 1997. }
\fi420 {\b0 b.}{\b0 Memberikan}{\b0
Kursus}{\b0
Kesejahteraan}{\b0
Ke
luarga}{\b0
pada}{\b0
Yayasan}{\b0
Nurul }
\fi780 {\b0 Muslimah}{\b0 Medan,}{\b0 29-30}{\b0 Nopember}{\b0 1997. }
\fi420 {\b0 c.}{\b0
Identifikasi}{\b0
dan}{\b0
Aplikasi}{\b0
Penghem
atan}{\b0
Energi}{\b0
Listrik}{\b0
pada}{\b0
Warga }
\fi780 {\b0 Kelurahan}{\b0 Babura}{\b0 Kecamatan}{\b0 Medan}{\b0 Baru,}{\b0
14-16}{\b0 Desember}{\b0 1999. }
\fi420 {\b0 d.}{\b0 Tim}{\b0 Penanganan}{\b0 Pasien}{\b0 Bayi}{\b0 Kem
bar}{\b0 Siam}{\b0 Mariana-Mariani}{\b0 pada }
\fi780 {\b0 RSUP}{\b0 H.}{\b0 Adam}{\b0 Malik}{\b0 Medan}{\b0 (SK}{\b0 Dir
ektur}{\b0 RSUP}{\b0 H.}{\b0 Adam}{\b0 Malik}{\b0 Medan, }
\fi780 {\b0 No.}{\b0 YM.01.01.4.2513,}{\b0 Tgl.}{\b0 8}{\b0 Mei}{\b0 2005)
}\par
}
38
{\fs16 2005 }
}
0}}}}
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}
\cf0 LAMPIRAN \par
}
21 \cf0 Gambar 1.
332 Karakteristik Wajah Anak Thalassemia-{\f40 {\field{\*\fldinst SYMBOL 98 \\f
Symbol }}} Mayor/Homozigot
Thalassemia-{\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol }}}. (Sumber: Hoffbra
nd AV and Pettit JE, 2001) \par
}
1 \cf0 Gambar 2.
\par}{\phpg\posx3045\pvpg\posy8782\absw5886\absh986 \sl-413 \f10 \fs21 \cf0 Daer
ah Penyebaran Thalassemia/Sabuk Thalassemia.

68 (Sumber: Weatherall D.J. and Clegg J.B., 2001) \par
}
9 \par
}
a", 2005
}
0}}}}
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0}}}}
{\sp{\sn LineWidth}{\sv 15}}
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}
21 \cf0 Gambar 3.
\par}{\phpg\posx2960\pvpg\posy1706\absw6103\absh1010 \sl-430 \f10 \fs21 \cf0 Bay
i Hb-Bart's hydrop fetalis/Homozigot Thalassemia-{\f40 {\field{\*\fldinst SYMBOL
97 \\f Symbol }} }
660 (Sumber: Hoffbrand AV and Pettit JE, 2001) \par
}
\par
}
1 \cf0 Gambar 4.
\par}{\phpg\posx1785\pvpg\posy5909\absw8457\absh986 \sl-414 \f10 \fs21 \cf0 Sint
esis Rantai Globin pada Berbagai PeriodeKehidupan Manusia serta Organ
40 yang Berperan (Sumber: Weatherall DJ and Clegg JB, 2001) \par
}
21 \cf0 Gambar 5.
\par}{\phpg\posx1930\pvpg\posy9889\absw8074\absh1010 \sl-432 \f10 \fs21 \cf0 Ske
ma Struktur Organisasi Cluster Gen Globin-{\f40 {\field{\*\fldinst SYMBOL 97 \\f
Symbol }}} dan Kluster Gen Globin-{\f40 {\field{\*\fldinst SYMBOL 98 \\f Symbol
}}}.
1483 (Sumber: Weatherall D.J. and Clegg J.B., 2001) \par
}
40

{\fs16 2005 }
}
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be65ea47d926d3ee5eeada077c0320c9c7d6b3bc4f1896c610c4fdfcf07af14515ba5efc7d4741fb
e7ffd9
}}\par}{\shpgrp\shpbxpage\shpbypage
{\shp{\*\shpinst
7, 0);( 10, 0);( 14, 3);( 14, 7);( 14, 267);( 14, 271);( 10, 274
);( 7, 274);( 3, 274);( 0, 271)}}
65793}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
26, 120);( 0, 93);( 0, 60);( 0, 26);( 26, 0);( 60, 0);( 93, 0
);( 120, 26)}}
65793}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
{\sp{\sn pVerticies}{\sv 8; 2;( 0, 120);( 60, 0)}}
65793}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
292, 4);( 295, 7);( 295, 11);( 291, 14);( 13, 212);( 9, 214);( 4, 213
);( 2, 210);( 0, 206);( 1, 201)}}
65793}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst

0, 75);( 6, 38);( 32, 19);( 60, 0);( 97, 5);( 116, 33);( 135, 60
);( 129, 97)}}
65793}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
65793}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
146, 286);( 142, 287);( 137, 286);( 136, 283);( 1, 11);( 0, 8);( 1, 3
);( 4, 2);( 8, 0);( 13, 2)}}
65793}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
70, 0);( 106, 11);( 122, 41);( 136, 71);( 124, 107);( 94, 122);( 64, 137
);( 28, 125)}}
65793}}{\sp{\sn fLine}{\sv 0}}}}}}

{\shp{\*\shpinst
65793}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
286, 4);( 287, 8);( 286, 13);( 283, 15);( 11, 150);( 8, 152);( 3, 151
);( 2, 147);( 0, 143);( 2, 139)}}
65793}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
0, 64);( 11, 28);( 41, 14);( 71, 0);( 107, 12);( 122, 40);( 137, 70
);( 125, 106)}}
65793}}{\sp{\sn fLine}{\sv 0}}}}}}
{\shp{\*\shpinst
65793}}{\sp{\sn fLine}{\sv 0}}}}}}

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}
21 \cf0 Gambar 6.
\par}{\phpg\posx2032\pvpg\posy1706\absw7922\absh1621 \sl-412 \f10 \fs21 \cf0 Sed
imen Darah Tepi dari Penderita Thalassemia Trait dan Orang Normal.
2260 (Sumber Koleksi Pribadi, 2003)
\fi3486 {\b \f20 d }\par
}
cf0 b \par
}
cf0 c \par
}
cf0 a \par
}
{\phpg\posx2114\pvpg\posy7090\absw8399\absh984 \i \f20 \fs21 \cf0 \fi603 \i \f20
\fs21 \cf0 Variasi bentuk eritrosit (sel darah merah) pada sedimen darah tepi
\par}{\phpg\posx2114\pvpg\posy7090\absw8399\absh984 \sl-413 \i \f20 \fs21 \cf0 \
fi529 dilihat dengan mikroskop dari penderita thalassemia: a = hipokrom,
\par}{\phpg\posx2114\pvpg\posy7090\absw8399\absh984 \sl-206 \par\i \f20 \fs21 \c
f0 b = teardrop, c = target cell, d = basophilic stipling dengan pewarnaan giems
a \par
}
\cf0 Bentuk eritrosit (sel darah merah) pada orang normal
\fi1317 dengan pewarnaan giemsa \par
}
1 \par
}
a", 2005
}
0}}}}
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}
1 \cf0 Gambar 7.
\par}{\phpg\posx2640\pvpg\posy1706\absw6641\absh612 \sl-412 \f10 \fs21 \cf0 Skem
a Penurunan Gen Thalassemia Menurut Hukum Mendel. \par
}
\fs19 \cf0 50%
\par}{\phpg\posx6502\pvpg\posy3862\absw696\absh467 \sl-267 \i \f10 \fs19 \cf0 {\
b sehat }\par
}
\cf0 Salah satu orang tua menderita
fi316 thalassemia trait/carrier \par
}
0 \fs19 \cf0 50%
\par}{\phpg\posx6963\pvpg\posy7132\absw2496\absh475 \sl-273 \i \f10 \fs19 \cf0 t
halassemia trait/carrier \par
}
\fs19 \cf0 25%
\par}{\phpg\posx5770\pvpg\posy9640\absw2046\absh704 \sl-255 \i \f10 \fs19 \cf0 t
halassemia mayor
fi413 homozigot \par
}
{\phpg\posx8067\pvpg\posy9852\absw646\absh475 \i \f10 \fs19 \cf0 \fi87 \i \f10 \
fs19 \cf0 25%
\par}{\phpg\posx8067\pvpg\posy9852\absw646\absh475 \sl-273 \i \f10 \fs19 \cf0 se
hat \par
}
\cf0 Kedua orang tua menderita
\par}{\phpg\posx2752\pvpg\posy13025\absw2991\absh645 \sl-219 \par\i \f10 \fs21 \
cf0 thalassemia trait/carrier \par
}
10 \fs19 \cf0 50%
thalassemia trait/carrier \par
}
42
{\fs16 2005 }
}
}

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