Given the high prevalence in patients with type 2 diabetes where the incidence of 650.000 new cases each year. In type-2, the pancreas does not make enough insulin to keep blood sugar levels remain normal, often because the body does not respond well to insulin. Most people do not realize had been suffering from type 2 diabetes, although the situation has become very serious. Type 2 diabetes has become a commonly experienced in the world and in Indonesia, and the numbers continue to grow due to unhealthy lifestyles, obesity and lazy to exercise. Purpose: To determine how the image of risk factors in patients with type 2 diabetes in the clinic Endocrine and Metabolic Section / SMF FK-UNSRAT BLU RSU Prof. Dr. R.D. Manado Kandou the period of May-October2011. Methods: This type of research is a descriptive study using secondary data. Population of type 2 DM patients who come for treatment at the Polyclinic Endocrine and Metabolic Section / SMF FK-UNSRAT BLU RSU Prof.Dr. R.D. Kandou Manado the period of May - October 2011. The number of samples of 138 patients comprising 60 men and 78 women. Result: The case of DM Tiipe 2 in Endocrine and Metabolic Clinic ever found in women than in men. Acquired risk factors for type 2 diabetes mellitus is a BMI> 23 ever found in an obese BMI groups 1 (25-29,9) of 37 patients, patients with stage 1 hypertension (130-159/80-99 mmHg) obtained by 80 patients , patients with dyslipidaemia as many as 22 patients, patients with a family history of as many as 45 patients, patients with age> 40 years as many as 130 patients, and patients who have risk factors for most of the patients with 3 risk factors as many as 74 patients. Conclusion: Risk factors affecting the incidence of type 2 diabetes mellitus in Endocrine and Metabolic Clinic is a BMI> 23, hypertension> 140/90 mmHg, family history,age> 40 years, dyslipidemia. Key words : Risk factors, Diabetes mellitus type 2, Endocrine and Metabolic Clinic.     Abstrak: Mengingat tingginya prevalensi untuk pasien dengan DM tipe 2 dimana insidennya sebesar 650.000 kasus baru tiap tahunnya. Pada tipe-2, pankreas tidak cukup membuat insulin untuk menjaga level gula darah tetap normal, seringkali disebabkan tubuh tidak merespon dengan baik terhadap insulin tersebut. Kebanyakan orang tidak menyadari telah menderita dibetes tipe 2, walaupun keadaannya sudah menjadi sangat serius. Diabetes tipe 2 sudah menjadi umum dialami didunia maupun di Indonesia, dan angkanya terus bertambah akibat gaya hidup yang tidak sehat, kegemukan dan malas berolahraga. Tujuan: Untuk mengetahui bagaimana gambaran faktor risiko pada pasien DM tipe 2 di Poliklinik Endokrin dan Metabolik Bagian/SMF FK-UNSRAT BLU RSU Prof. Dr. R.D. Kandou Manado periode Mei - Oktober 2011. Metode: Jenis penelitian merupakan penelitian deskriptif dengan menggunakan data sekunder. Populasi pasien DM tipe 2 yang datang berobat di Poliklinik Endokrin dan Metabolik Bagian/SMF FK-UNSRAT BLU RSU Prof.Dr. R.D. Kandou Manado periode Mei-Oktober 2011. Jumlah sampel 138 pasien yang terdiri dari 60 laki-laki dan 78 perempuan. Hasil: Kasus DM Tiipe 2 di Poliklinik Endokrin dan Metabolik terbanyak didapatkan pada perempuan dibandingkan pada laki-laki. Faktor risiko yang didapatkan untuk terjadinya DM tipe 2 adalah IMT >23 terbanyak didapatkan pada IMT golongan obes 1 (25-29,9) sebanyak 37 pasien, pasien dengan hipertensi stage 1 (130-159/80-99 mmHg) didapatkan sebanyak 80 pasien, pasien dengan dislipidemia sebanyak 22 pasien, pasien dengan riwayat keluarga sebanyak 45 pasien, pasien dengan umur >40 tahun sebanyak 130 pasien, dan pasien yang memiliki faktor risiko paling banyak adalah pasien dengan tiga faktor risiko yaitu sebanyak 74 pasien. Simpulan: Faktor risiko yang berpengaruh terhadap kejadian DM tipe 2 di Poliklinik Endokrin dan Metabolik adalah IMT >23, hipertensi >140/90 mmHg, riwayat keluarga, umur > 40 tahun, dislipidemia. Kata kunci : Faktor risiko, diabetes melitus tipe 2, Poliklinik Endokrin dan Metabolik.

Asbtract: Medical nutrition therapy is a vital component in managing diabetes which aims to prevent the progression of chronic complications of diabetes by modification in nutrient intake and lifestyle. Medical nutrition therapy for people with diabetes should be individualized, with consideration given to the individual’s usual food, eating habits, metabolism, physical activity, and co-morbid conditions. Medical nutrition therapy in special conditions such as acute illness, hypoglycemia, old age, pregnancy, lactation, hypertension, nephropathy, and dyslipidemia should be managed carefully. Key words: Medical nutrition therapy, diabetes, individual, complication     Abstrak: Terapi gizi medis merupakan komponen penting dalam pilar penatalaksanaan diabetes yang bertujuan untuk mencegah dan memperlambat laju perkembangan komplikasi kronis dari diabetes dengan memodifikasi asupan gizi dan gaya hidup. Pada setiap penyandang diabetes, terapi gizi medis bersifat individual sebab harus mempertimbangkan kebiasaan makan setempat, metabolisme, aktivitas fisik, dan adanya komorbid. Terapi gizi medis pada penyandang diabetes dengan keadaan khusus, seperti  penyakit akut, hipoglikemia, perawatan medis, lanjut usia, kehamilan, laktasi, hipertensi, nefropati dan dislipidemia, amat penting dilaksanakan sebab menentukan keberhasilan terapi. Kata kunci: Terapi gizi medis, diabetes, individu, komplikasi

A diabetic foot ulcer is a common and fearful chronic complication of diabetes mellitus often resulting in amputation, and even death. A diabetic foot ulcer can be prevented by early screening and education in high risk individuals, and the management of underlying conditions such as neuropathy, peripheral arterial disease, and deformity. The prevalence of diabetic foot ulcer patients is 4-10% of the general population, with a higher prevalence in elderly people. Around 14-24 % of diabetic foot ulcer patients need amputations with a recurrence rate of 50% after three years. The main pathogenesis of diabetic foot ulcer is neuropathy and peripheral arterial disease (PAD). PAD contributes to diabetic foot ulcers in 50% of cases; however, it rarely stands alone. Other factors such as smoking, hypertension, and hyperlipidemia may contribute, too. In addition, PAD reduces the access of oxygen and antibiotics to the ulcers. Management of diabetic foot ulcers includes treatment of ischemia by promoting tissue perfusion, debridement for removing necrotic tissues, wound treatment for creating moist wound healing, off-loading the affected foot, surgery intervention, management of the co-morbidities and infections, and prevention of wound recurrences. Other adjuvant modalities include hyperbaric oxygen treatment, GCSF, growth factors, and bioengineered tissues. Key words: diabetic ulcer, debridement, off loading.   Abstrak: Ulkus kaki diabetes (UKD) merupakan salah satu komplikasi kronik diabetes melitus yang sering dijumpai dan ditakuti oleh karena pengelolaannya sering mengecewakan dan berakhir dengan amputasi, bahkan kematian. UKD dapat dicegah dengan melakukan skrining dini serta edukasi pada kelompok berisiko tinggi, dan penanganan penyebab dasar seperti neuropati, penyakit artei perifer dan deformitas. Prevalensi pasien UKD berkisar 4-10% dari populasi umumnya, dengan prevalensi yang lebih tinggi pada manula. Sekitar 14-24% pasien UKD memerlukan amputasi dengan rekurensi 50 % setelah tiga tahun. Patogenesis utama UKD yaitu neuropati dan penyakit arteri perifer (PAP). PAP berkontribusi 50% pada pasien UKD, tetapi hal ini jarang dijumpai tunggal. Terdapat faktor-faktor lain yang turut berperan seperti merokok, hipertensi dan hiperlipidemia. Selain itu PAP menurunkan akses oksigen dan antibiotik ke dalam ulkus. Penatalaksanaan UKD meliputi penanganan iskemia dengan meningkatkan perfusi jaringan, debridemen untuk mengeluarkan jaringan nekrotik, perawatan luka untuk menghasilkan moist wound healing, off-loading kaki yang terkena, intervensi bedah, pananganan komorbiditas dan infeksi, serta pencegahan rekurensi luka. Terapi ajuvan meliputi terapi oksigen hiperbarik, pemberian granulocyte colony stimulating factors (GCSF), growth factors dan bioengineerd tissues. Kata kunci: ulkus diabetes, debridemen, off loading.

Chronic kidney disease (CKD) is a pathophysiological process with a diverse etiology that causes progressive decrease of renal function and is generally ended with renal failure. Patients with CKD are given low-protein and low-water diets that can affect their nutritional status and immune system. This study was aimed to determine the relationship between nutritional status and cellular immune system in patients with stage V CKD that had hemodialysis perfomed on them at the Installation of Hemodialysis of Prof. Dr. R. D. Kandou Hospital Manado. This was a descriptive analytical study with a cross sectional design. Variables were age, gender, lymphocyte count, body mass index (BMI), and upper arm circumference. There were 30 samples in this study; males (56.7%) were more dominant. The age range was 36-76 years; lymphocyte count range was 1000-4131; IMT range was 16-28.1; and upper arm circumference range was 17-28.50. The Spearman parametric test of the relationship between nutritional status and cellular immune system based on BMI and lymphocyte count obtained a P-value of 0.111 meanwhile the relationship between nutritional status based on upper arm circumference and lymphocytes obtained a P-value of 0.309. Conclusion: There was no relationship between nutritional status (BMI and arm circumference) and cellular immune system (lymphocyte count) in stage V CKD patients that had hemodialysis perfomed on them. Keywords: CKD V-HD, nutritional status, cellular immune systemAbstrak: Penyakit ginjal kronik (PGK) adalah suatu proses patofisiologis dengan etiologi beragam yang mengakibatkan penurunan fungsi ginjal secara progesif dan umumnya berahir dengan gagal ginjal. Pasien PGK diberikan terapi rendah protein dan air sehingga dapat berdampak pada status gizi dan sistem imun pasien. Penelitian ini bertujuan untuk mengetahui hubungan status gizi dengan sistem imun seluler pada subyek PGK stadium V hemodialisis di Instalasi Tindakan Hemodialisis RSUP Prof. Dr. R. D. Kandou Manado. Jenis penelitian ialah deskriptif analitik dengan desain potong lintang. Variabel penelitian ialah usia, jenis kelamin, hasil hitung limfosit, hitung IMT, dan ukuran lingkar lengan atas (LILA). Hasil penelitian mendapatkan 30 sampel dengan jumlah terbanyak ialah laki-laki 17 orang (56,7%), cengan rentang usia 36-76 tahun. Kisaran nilai untuk limfosit ialah 1000-4131; IMT 16-28,1; dan LILA 17-28,50. Uji parametrik Spearman terhadap hubungan antara status gizi berdasarkan IMT dan limfosit mendapatkan P=0,111 sedangkan antara status gizi berdasarkan LILA dan limfosit mendapatkan P=0,309. Simpulan: Tidak terdapat hubungan antara status gizi (IMT dan LILA) dengan limfosit (sistem imun) pada pasien PGK V yang menjalani hemodialisis.Kata kunci: PGK V-HD, status gizi, sistem imun seluler

Introduction Hyperbaric oxygen therapy (HBOT), a procedure that involves the patient inhaling 100% oxygen gas under pressure, is currently used as an adjunctive treatment option for certain inflammatory conditions. HBOT can improve wound healing by increasing the rate of angiogenesis in injured tissue by increasing levels of vascular endothelial growth factor (VEGF). VEGF causes re-epithelialization, the migration of endothelial cells, and the formation of granulation tissue, which are involved in the wound healing process. Methods This study contains secondary data analyses of information previously collected in two separate studies, each concerning the effects of HBOT on diabetic foot ulcers and crush injury fractures at Prof. Dr. R. D. Kandou Hospital Manado and Siloam Hospital Manado from 2019 to early 2020. Results Based on the classification tree analysis, the predictors of HBOT success were leukocytes level (34%), platelet count (32%), and age (26%). The conditional inference tree analysis also indicated significant leukocyte levels, age, and platelet counts (p < 0.001), with which the interpretation of these results was the same as the classification tree analysis method. The results obtained from the random forest analysis revealed that the mean value of Gini reduction for leukocytes (207.3), platelets (110.2), age (97.9), and hemoglobin (57.9) can be used as indicators of successful HBOT. These three methods support that age, leukocytes, and platelets are determinants of HBOT success, while hemoglobin levels were only significant in one analysis method. Therefore, a new, proposed algorithm containing these factors was assembled from the results of this study. Conclusion HBOT cannot be separated from specific variables that contribute to and can predict its success.