Diagnosa dini demam berdarah dengue oleh: Abu Ikhsan M. Kes Dengue Hemorrhagic Fever ( DHF) is a serious disease.

if not diagnosed soon enough, it can cause death. Until now, early diagnosis can be done by using laboratory test, but this test is expensive and not all health community center have this tool. The other test is tourniquet test, but this test is not effective for early symptom and make discomfort to patient, especially for children. Afif test can be a solution to detect pethechie as early symptom of DHF. This test is easy, quick, cheap and more comfortable than tourniquet. Pendahuluan. Demam berdarah dengue adalah penyakit infeksi yang berbahaya, yang jika terlambat penanganannya dapat menyebabkan kematian. Permasalahan dalam penanganan DBD adalah salah diagnose dimana pasien dianggap mengidap penyakit lain seperti tipus, common cold, dan lainnya. Biasanya pasien yang datang ke sarana kesehatan mengeluh adanya panas, pusing, sakit kepala, mual dan kadang disertai nyeri otot abdomen. Data ini sulit bagi petugas untuk mendiagnosa secara pasti sehingga berdasarkan pengamatan , banyak petugas kesehatan dalam memberikan terapi bersifat simptomatik dan kuratif sekaligus preventif. Kondisi ini cenderung akan menyebabkan dampak merugikan bagi pasien karena pasien diharuskan mengkonsumsi antibiotic dua macam sekaligus. Bagi petugas lapangan pemberian antibiotic 2 macam sekaligus dianggap lebih baik, mengingat : 1. Tidak adanya fasilitas laboratorium untuk diagnose penunjang 2. Lebih ekonomis disbanding pasien harus dating lagi 3. Sebagai sarana untuk mendiagnosa penyakit lain, misalnya jika dengan obat tersebut tidak sembuh maka arah penyakit adalah penyakit yang tidak responsive ke antibiotic contoh : jika tipus dianggap responsive ke antibiotic, maka tidak responsive ke antibiotik menunjukan pasien mengidap penyakit non tipus. 4. Di daerah daerah tertentu ( kota ), rata-rata hasil test Widal menunjukan titer tinggi, sehingga dianggap setiap pasien dengan panas harus diberikan antibiotic doble. Alasan lainnya adalah kekhawatiran akan adanya hilangnya market, bahwa jika berobat ke tempat tersebut tidak manjur padahal mereka hanya melakukan diagnose berdasarkan namnesa dan pemeriksaan fisik. Berdasarkan fakta dilapangan membedakan Tipus dengan common cold kadang tidak sulit, tapi membedakan keduanya dari DBD agak susah, kecuali setelah diterapi seperti diatas. Tanda dan gejala Tiphus Common cold Dbd

Abdominalis Pnas tinggi >38 C ++ yang menetap Respon terhadap + antiperetik*) Nyeri abdomen ++ Mual +++ Tes tourniquet *) -

+++ +++ ++ ++ -

+++ + ++ +++ -

Respon terhadap antipiretik

1. Respon terhadap antipiretik dilakukan melalui anannese apakah klien sebelumnya mengkonsumsi antipiretik ( paraaminofenol, salisilat, mefenamat ) yang biasanya di jual diwarung. 2. Tes tourniquet dilakukan pada saat klien dating dengan keluhan pada hari 1-2.

Tes Tourniquet. Test ini bersifat non invansiv untuk mendiagnosa dini DBD, penggunaannya dengan cara mengobstruksi aliran vena, sehingga pada bagian distal lenan akan diperoleh gambaran petechie. Meskipun cara ini mudah dan sarana yang ada dapat mudah diperoleh, namun cara ini mengalami kelemahan diantaranya : dapat di lihat untuk panas setelah 3 hari dimana trombosit telah berkurang, prosedur yang dijalani sangat tidak nyaman bagi pasien terlebih pada anak-anak. Tes Afif Melihat berbagai kendala dalam diagnose DBD, maka penulis mencoba sebuah alternative diagnose dini dari DBD yang bersifat non invansif dan dapat digunakan secara mudah, sehingga terapi dapat dilakukan secara tepat dan efisien. Mudah karena tidak memerlukan biaya yang mahal, prosedur gampang, dan efisien untuk mendiagnosa karena dapat dilakukan pada satu hari setelah pasien menderita panas. Adapun tehnik tes Afif adalah sebgai berikut : Alat : 1. Gelas suction yang kecil 2. Alat penyedot

3. Minyak zaitun 4. Area yang dipilih : bagian dalam dari otot tricep Alat tersebut biasanya digunakan untuk membekam orang Prosedur : 1. 2. 3. 4. Pasien dibaringkan posisi supine Siapkan area yang akan di kop dengan meberi tanda pada pusat gelas Olesi minyak zaitun. Kop dengan ukuran yang sesuai dengan tekanan sedang 0,5-1 psi atau hingga batas yang ditoleransi pasien. 5. Tunggu untuk waktu 1,5-2 menit. 6. Amati adanya pethechie 1cm dari garis tepi

No 1 2 3

Jumlah pethechie/cm 0 1-2 >3

Keterangan Suspect non DBD Suspect DBD Suspect DBD dengan trombosit < 100.000

BAB IVPENUTUP 4 . 1 . K e s i m p u l a n Setelah penyusun menyelesaikan laporan Praktek Kerja Lapan g a n ( P K L ) ini,maka penyusun dapat menyimpulkan bahwa PT. INDAH KIAT PULP & PAPER Tbk CIREBON MILL merupakan salah satu perusahaanyang memproduksi kertasterbesar didunia yang beroprasikan secara komersial dengan status Penanaman ModalAsing ( PMA ), dan sudah Go Publik ( Terbuka untuk Umum ). Bagi siapa saja yangmau menanamkan modalnya dalam bentuk saham.D i p e r u s a h a a n j u g a t e r d a p a t d i v i s i y a n g m e r u p a k a n s a t u k e s a t u an dari padak e b u t u h a n y a n g d i i n g i n k a n d a l a m m e n j a l a n k a n s e b u a h p e k e r j a y a n g d i s e b u t Accounting.P e n u l i s i n g i n m e n y i m p u l k a n b a h w a P T . I N D A H K I A T P U L P & P A P E R T b k CIREBON MILL adalah suatu perusahaan yang : Memproduksi kertas terbesar di bagian Asia, Perduli terhadap pendidikan,terutama di Indonesia dan khususnya di wilayahCirebon - Banten. Memiliki Karyawan atau tenaga kerja yang disiplin,handal, tangguh, berwawasanluas,dan bertanggung jawab.4.2. Saran a)Membuat produk-produk yang lebih berkualitas dan ramah lingkungan, b)Memberikan pelatihan-pelatihan kepada karyawan untuk meningkatkan mutudan kualitas SDM, PT.IKPP,c)Lebih meningkatkan ketertiban yang sudah berlaku,d ) C o m p u t e r - C o m p u t e r y a n g r u s a k d i p e r b a i k i l a g i a g a r t i d a k m e n g g a n g g u aktifitas kerja,e ) H a r g a i l a h K a r y a w a n k a r y a w a n l a m a . 4.3. Penutup Dengan mengucapkan syukur Alhamdulillah , Penulis panjatkan syukur kehadiratA l l a h S W T , y a n g m a n a a t a s r a h m a t d a n h i d a y a h - N y a akhirnya penulis dapatmenyelesaikan laporan Praktek Kerja L a p a n g a n ( P K L ) d i P T , I N D A H K I A T Tbk,CIREBON MILL.dan tidak lupa pula Penulis mengucapkan banyak terima kasihkepada semua pihak yang telah mendukung Penulis, baik moriil maupun materiil danPenulis juga berterima kasih atas bimbingannya selama melaksanakan PKL dan jugaatas diberikannya kesempatan untuk Praktek Kerja Lapangan ( PKL ) dan mengenalidunia usaha di PT,INDAH KIAT PULP & PAPER Tbk,CIREBON MILL .Penulis juga tak lupa mengucapkan terima kasih kepada pembimbing yang telahmembimbing sampai Penulis menyelesaikan Laporan ini dan juga beserta karyawan-karyawan yang membantu Penulis selama PKL.P e n u l i s m o h o n m a a f a t a s s e g a l a k e s a l a h a n y a n g t e l a h d i p e r b u a t , b a i k d i s e n g a j a maupun tidak disengaja.Penulis juga menyadari bahwa Penulis disini juga masih tahap

belajar, jadi harap di makhlumi,dan Penulis juga masih banyak membutuhkan bimbingankepada semua pihak.Cirebon, April 2009Penyusun

(TOO-mer MAR-kirz) These substances are normally present in small amounts in the blood or other tissues. Cancer cells can sometimes make these substances. When the amount of these substances rises above normal, cancer might be present in the body. Examples of biomarkers include CA 125 (ovarian cancer), CA 15-3 and 27-29 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer).

1.

What are tumor markers?

Tumor markers are substances produced by tumor cells or by other cells of the body in response to cancer or certain benign (noncancerous) conditions. These substances can be found in the blood, in the urine, in the tumor tissue, or in other tissues. Different tumor markers are found in different types of cancer, and levels of the same tumor marker can be altered in more than one type of cancer. In addition, tumor marker levels are not altered in all people with cancer, especially if the cancer is early stage. Some tumor marker levels can also be altered in patients with noncancerous conditions.

To date, researchers have identified more than a dozen substances that seem to be expressed abnormally when some types of cancer are present. Some of these substances are also found in other conditions and diseases. Scientists have not found markers for every type of cancer.

2.

What are risk markers?

Some people have a greater chance of developing certain types of cancer because of a change, known as a mutation or alteration, in specific genes. The presence of such a change is sometimes called a risk marker. Tests for risk markers can help the doctor to estimate a persons chance of developing a certain cancer. Risk markers can indicate that cancer is more likely to occur, whereas tumor markers can indicate the presence of cancer (1).

3.

How are tumor markers used in cancer care?

Tumor markers are used in the detection, diagnosis, and management of some types of cancer. Although an abnormal tumor marker level may suggest cancer, this alone is usually not enough to diagnose cancer. Therefore, measurements of tumor markers are usually combined with other tests, such as a biopsy, to diagnose cancer.

Tumor marker levels may be measured before treatment to help doctors plan appropriate therapy. In some types of cancer, tumor marker levels reflect the stage (extent) of the disease. (More information aboutstaging is available in the National Cancer Institute (NCI) fact sheet Staging: Questions and Answers, which can be found at http://www.cancer.gov/cancertopics/factsheet/Detection/staging on the Internet.)

Tumor marker levels also may be used to check how a patient is responding to treatment. A decrease or return to a normal level may indicate that the cancer is responding to therapy, whereas an increase may indicate that the cancer is not responding. After treatment has ended, tumor marker levels may be used to check for recurrence (cancer that has returned).

4.

How and when are tumor markers measured?

The doctor takes a blood, urine, or tissue sample and sends it to the laboratory, where various methods are used to measure the level of the tumor marker.

If the tumor marker is being used to determine whether a treatment is working or if there is recurrence, the tumor marker levels are often measured over a period of time to see if the levels are increasing or decreasing. Usually these serial measurements are more meaningful than a single measurement. Tumor marker levels may be checked at the time of diagnosis; before, during, and after therapy; and then periodically to monitor for recurrence.

5.

Does the NCI have guidelines for the use of tumor markers?

No, the NCI does not have such guidelines. However, some organizations do have these guidelines for some types of cancer.

The American Society of Clinical Oncology (ASCO), a nonprofit organization that represents more than 25,000 cancer professionals worldwide, has published clinical practice guidelines on a variety of topics, including tumor markers for breast and colorectal cancer. These guidelines, called Patient Guides, are available on the ASCO Web site at http://www.cancer.net/patient/ASCO+Resources/Patient+Guides on the Internet.

The National Comprehensive Cancer Network (NCCN), which is also a nonprofit organization, is an alliance of cancer centers. The NCCN provides Treatment Summaries for People with Cancer, which include tumor marker information for several types of cancer. Most of the guidelines are available in English and Spanish versions. The summaries are on the NCCNs Web site athttp://www.nccn.com/Treatment-Summaries/CancerTypes.aspx?id=48 on the Internet.

The National Academy of Clinical Biochemistry (NACB) is a professional organization dedicated to advancing the science and practice of clinical laboratory medicine through research, education, and professional development. The Academy publishes Practice Guidelines and Recommendations for Use of Tumor Markers in the Clinic, which focuses on the appropriate use of tumor markers for specific cancers. More information can be found athttp://www.aacc.org/resourcecenters/resource_topics/tumor_markers/Pages/default.aspx on the Internet.

6.

Can tumor markers be used as a screening test for cancer?

Screening tests are a way of detecting cancer early, before there are any symptoms. For a screening test to be helpful, it should have high sensitivity and specificity. Sensitivity refers to the tests ability to identify people who have the disease. Specificity refers to the tests ability to identify people who do not have the disease. Most tumor markers are not sensitive or specific enough to be used for cancer screening.

Even commonly used tests may not be completely sensitive or specific. For example, prostate-specific antigen (PSA) levels are often used to screen men for prostate cancer, but this is controversial. It is not yet known if early detection using PSA screening actually saves lives. Elevated PSA levels can be caused by prostate cancer or benign conditions, and most men with elevated PSA levels turn out not to have prostate cancer. Moreover, it is not clear if the benefits of PSA screening outweigh the risks of follow-up diagnostic tests and cancer treatments. (More information about PSA screening is available in the NCI fact sheet Prostate-Specific Antigen (PSA) Test, which can be found athttp://www.cancer.gov/cancertopics/factsheet/Detection/PSA on the Internet.)

Another tumor marker, CA 125, is sometimes used to screen women who have an increased risk forovarian cancer. Scientists are studying whether measurement of CA 125, along with other tests and exams, is useful to find ovarian cancer before symptoms develop. So far, CA 125 measurement is not sensitive or specific enough to be used to screen all women for ovarian cancer. Mostly, CA 125 is used to monitor response to treatment and check for recurrence in women with ovarian cancer.