eJournal Kedokteran Indonesia

Establishing Rare Diagnosis of Myopericytoma of The Foot

Muhammad Rizqi Adhi Primaputra, Fajar Defian Putra — Wed, 11 Sep 2024 00:00:00 +0700

Myopericytoma is a benign tumor that consists of oval to spindle-shaped myoid-like cells with a strong proclivity for concentric perivascular growth. Due to the mild nature of the disease, myopericytoma is often difficult to diagnose and might be overlooked. We reported a 59-year-old female who presented severe and persisting pain in the fourth toe in the last 4 years. The diagnosis is not considered initially due to clinical symptoms of pain without any significant growth of the toes hence the patient was initially diagnosed with ganglion cyst. However, further, a combination of clinical, radiological, histopathological, and immunohistochemical examination concludes the diagnosis of myopericytoma.

Cellulitis and Bullous Erysipelas in a Geriatric Patient

Wed, 11 Sep 2024 00:00:00 +0700

Erysipelas and cellulitis are common infections of the skin. Erysipelas is a superficial infection affecting the upper layers of the skin, while cellulitis affects the deeper tissues. Bullous formation represents a severe clinical condition of erysipelas. We report a case of cellulitis concurrent with bullous erysipelas focusing on diagnostic and treatment challenges in a geriatric patient with comorbid. A 70-year-old male with a history of diabetes mellitus was admitted to the emergency department with a chief complaint of painful erythematous, warm on palpation, swelling and blistering on his right lower leg for one week. The wound culture was sterile. Cellulitis and bullous erysipelas were determined as the diagnosis. The patient was treated concurrently with intravenous ampicillin-sulbactam, as well as incision and debridement. Clinical symptoms were improved after several days of hospitalization. Bullous erysipelas is an aggressive form of erysipelas that responds less well to therapy. Microbiological culture in erysipelas and cellulitis are negative in up to 70% of cases, including in our patient. Thus, the diagnosis was made based on clinical examination. The administration of intravenous broad-spectrum antibiotic ampicillin-sulbactam and additional incision and debridement significantly improved the patient. In conclusion this case of cellulitis and bullous erysipelas in a geriatric patient with diabetes mellitus was successfully treated with intravenous broad-spectrum antibiotic ampicillin-sulbactam and additional incision and debridement.

Mpox Darurat Kesehatan Dunia

Tjandra Yoga Aditama — Wed, 11 Sep 2024 00:00:00 +0700

The Auricular Elevation Stage in Microtia Reconstruction

Wed, 11 Sep 2024 00:00:00 +0700

Microtia is a congenital hypoplastic malformation of the pinna that can cause hearing impairment, cosmetic, and psychosocial problems. The auricular elevation in stage two is one of the most challenging procedures of autologous ear reconstruction. This article aims to determine whether the use of posterosuperior auricular fascia flap (PSFF), temporoparietal fascia flap (TPF), or retroauricular fascia flap (RFF) in stage 2 auricle reconstruction. A literature search was conducted in public databases and registries (PubMed/Medline, EBSCOhost, ProQuest, CENTRAL, ICTRP, Clinicaltrial.gov). Patients with unilateral or bilateral microtia were included in this study. The validity rating was assessed using the guideline from CEBM Oxford University. All these studies were analyzed for the systematic review of outcome studies of each surgical technique. PSFF is superior by reducing surgical time compared to RFF (p<0.01) with less risk of scarring (p=0.03) and less incidence of partial skin graft necrosis (p= 0.01). RFF offered superior aesthetic results compared to TPF. PSFF is a preferable technique for stage two reconstruction surgery in congenital microtia due to its ease of use, shorter operating time, and reduced complications compared to RFF. RFF may still be considered for better aesthetic outcomes, while TPF can be a suitable option in challenging cases.

Infeksi Toxoplasma gondii dan Hubungannya dengan Penyakit Skizofrenia

Ika Puspa Sari, Tanwirotun Ni’mah — Wed, 11 Sep 2024 00:00:00 +0700

Toksoplasmosis merupakan penyakit yang disebabkan oleh infeksi parasit kelompok sporozoa yaitu, Toxoplasma gondii. Toksoplasmosis merupakan zoonosis kosmopolitan, namun banyak ditemukan di negara dengan iklim yang panas, kelembaban tinggi, dan ketinggian yang rendah. Penderita toksoplasmosis sering kali tidak menunjukkan gejala atau asimtomatik namun individu dengan status imunokompromi dan belum pernah terinfeksi T. gondii sebelumnya, gejala seringkali lebih parah. Gejala toksoplasmosis yang timbul dapat berupa rasa lelah, demam, nyeri otot dan sakit kepala. Ibu hamil dengan toksoplasmosis memiliki risiko mempengaruhi janin yang dapat menyebabkan bayi lahir prematur dan mikrosefalus atau hidrosefalus. Infeksi T. gondii berhubungan dengan kejadian skizofrenia, infeksi parasit tersebut meningkatkan peluang untuk terkena skizofrenia. Infeksi T. gondii dapat menyebabkan penyakit neuropsikiatri termasuk skizofrenia melalui dua cara yaitu direct effects dan neuroimmunological mechanisms.

Sindrom Refeeding pada Neonatus

Wed, 11 Sep 2024 00:00:00 +0700

Refeeding syndrome (SR) adalah sekelompok gejala yang terjadi setelah pemberian nutrisi enteral atau parenteral pada pasien kekurangan gizi. Angka kejadian SR bervariasi yaitu hipofosfatemia 20–90%, hipokalemia 8,8–66,7%, dan hipomagnesemia 1–8,3%. Faktor risiko SR meliputi neonatus dengan kecil masa kehamilan (KMK), pertumbuhan janin terhambat (PJT), bayi berat lahir sangat rendah (BBLSR), prematur ekstrim, umbilical artery resistency index (UARI) tinggi, atau berat badan menurut panjang badan berdasarkan z-score <-2 standar deviasi (SD). Pemberian asam amino tinggi pada awal kehidupan secara bermakna dapat meningkatkan risiko SR termasuk hipofosfatemia berat pada BBLASR. SR dapat dicegah dengan melengkapi pemberian elektrolit (khususnya fosfat) pada awal pemberian nutrisi.

Adipose-Derived Mesenchymal Stem Cells Extracellular Vesicles (ADMSCs-EVs) Implantation in Critical Size Bone Defect Model: Callus Formation Histology, BMP2, and Wnt Signaling

Wed, 25 Sep 2024 00:00:00 +0700

Critical bone defects pose a substantial healthcare burden globally. This study aimed to investigate the miRNA content ADMSCs-Evs (exosomes), which affected critical-sized bone histology, BMP2, and Wnt signalling pathways. Total RNA extraction and microarray analysis of miRNA were conducted. In-vivo experiments were performed on 16 critical-sized bone defect SD rats (eight for ADMSCs-EVs/exosomes and eight for NaCl) and four healthy control SD rats. The rats from each group were sacrificed on day 14 and day 28. Bone defect samples were collected for histology, protein, and molecular analysis. Histology analysis revealed increasing soft callus formation in the EVs ADMCs (exosomes) treated group on days 14 and 28 compared to the negative control group. Downregulation of miR-433-3p, miR-542-3p, and miR-328-3p in EVs ADMCSs (exosomes) enhances Wnt3A expression. Upregulation of miR-93-5p in ADMSCs-Evs (exosomes) inhibits BMP2 signalling, confirmed by BMP2 ELISA and higher chordin (BMP-2 antagonist) expression. Spp1 as a downstream gene of BMP-2 and Wnt signalling are indifferent. Specific miRNA inside ADMSCs-EVs (exosomes) regulates BMP-2 and Wnt signalling to enhance soft callus formation in critical size bone defect in EVs treated group than in negative control.

The Comparison of Laboratory Parameters of COVID-19 Patients in Universitas Indonesia Hospital Before and During Delta Variant Periode

Wed, 11 Sep 2024 00:00:00 +0700

There has been a change in the SARS-CoV-2 variant from the initial entry into Indonesia (March 2020) until now, and the Delta variant was discovered in March 2021. This study aims to evaluate the differences in clinical and laboratory characteristics between the initial period for the entry of COVID-19 and the Delta variant period at Universitas Indonesia Hospital, Depok, Indonesia. The study design was a retrospective cross-sectional conducted at Universitas Indonesia Hospital, Depok, using medical record data of COVID-19 patients who were admitted to the hospital from July 2020 to October 2021, which was divided into two periods, namely July 2020-February 2021, which was considered the initial period of the COVID-19 pandemic in Indonesia, and March-October 2021 which are considered as the period of the Delta variant. 100 patients were randomly selected in each period. There was a shift to older age with moderate to critical severity, more co-morbidities, longer length of stay in hospital, and higher mortality in the Delta period than the initial period of COVID-19. Laboratory parameters that gave significant differences were leukocytes, neutrophils, lymphocytes, aPTT, D-dimer, AST, urea, pCO₂, O₂ saturation, sodium, and CRP. During the Delta variant period, there was an increase in the levels of leukocytes, neutrophils, D-dimer, AST, urea, pCO2, and CRP. Conversely, lymphocyte counts decreased and the aPTT duration was shortened. The median oxygen saturation was also higher, although its minimal value was lower and sodium levels were reduced. The results of this study can be used as the basis for further research in the direction of pathogenesis, therapy, and prognosis of COVID-19.

Characteristics of Patients with Carotid-Cavernous Fistula who Underwent Endovascular Intervention

Wed, 11 Sep 2024 00:00:00 +0700

Carotid cavernous fistula (CCF) is an abnormal connection between the arterial and venous systems within the cavernous sinus. Direct CCF is usually created from a tear in the intracavernous carotid artery wall. Indirect CCF often develops spontaneously and causes subtle manifestations. Direct CCF, commonly characterized by high blood flow, usually exhibits oculo-orbital venous congestion and cephalic bruit. The low-flow indirect CCF commonly presents with similar manifestations but is more subtle in nature. Generally, direct CCF requires endovascular treatment. This is done to seal the fistula while preserving the patency of the internal carotid artery (ICA). A retrospective descriptive study was conducted on 44 patients with CCF who underwent endovascular intervention at Cipto Mangunkusumo Hospital, Indonesia, between 2014 and 2021. Data from medical records were analyzed to assess patient characteristics, clinical presentations, radiological findings, and treatment modalities.Most patients presented with ocular bruit (74.4%) and proptosis (68.1%), with high-flow (59.1%) and type A (90.9%) CCF being predominant. Endovascular interventions included balloon insertion (80.9%), coil insertion (9.1%), and combined balloon and coil procedures (9.1%). When performed by an experienced interventionist, the success rates of fistula closure could be as high as 85%-99% and 70%-78% for direct and indirect fistula, respectively. CCF is a non-life-threatening condition but can lead to severe clinical consequences. Recognition of characteristics is significant in helping to guide appropriate and timely treatment for patients. Serious complications are rare.

Characteristics and Management Outcome of Vaginismus

Wed, 25 Sep 2024 00:00:00 +0700

Vaginismus, a common pelvic floor dysfunction characterized by involuntary vaginal muscle spasms, often impedes sexual intercourse and is exacerbated by cultural barriers in Indonesia, where sexual issues are taboo. Healthcare providers' lack of knowledge contributes to patient dissatisfaction with treatments. This study aimed to evaluate risk factors and management outcomes in 36 Indonesian women with vaginismus. Primary data, including demographic details, vaginismus history, severity, and FSFI-6 scores, were collected through interviews and medical records. Results showed that 94.4% of participants were under 40 years old, 66.7% had been married for over two years, and 94.5% were university graduates. Most had normal BMI and no significant illness history. Among them, 77.8% had no history of penetration, with the majority having no medical, social, or psychological risk factor yet reporting good sexual satisfaction. Self-dilation was the primary treatment, with a 29.41% success rate in achieving penetration. Younger age and higher education were notable characteristics among cases, suggesting a need for increased disease awareness. The study highlights that while traditional risk factors were not predominant, self-dilation therapy yielded moderate success, and patient satisfaction with sexual and interpersonal relationships remained high.

Peran HIIT dan MICT terhadap Kadar Angiotensin II, Ekspresi Fibronektin, dan Gambaran Histologis Aorta pada Model Tikus Hipertensi Induksi NOS Inhibitor

Wed, 11 Sep 2024 00:00:00 +0700

Salah satu mekanisme adaptif terhadap hipertensi adalah perubahan struktur pembuluh darah, sehingga perubahan tekanan darah berhubungan dengan perubahan struktur aorta. High-Intensity Interval Training (HIIT) dan Moderate-Intensity Continuous Training (MICT) berperan menurunkan hipertensi dan memperbaiki kerusakan pembuluh darah. Tujuan penelitian ini ialah untuk mengetahui perbandingan HIIT dan MICT terhadap kadar angiotensin dan fibronektin tikus hipertensi yang diinduksi N(gamma)-nitro-L-arginine methyl ester (L-NAME) dengan desain penelitian eksperimental. Penelitian ini dilakukan di empat Laboratorium di lingkungan Fakultas Kedokteran Universitas Indonesia pada bulan Maret 2023–Januari 2024. Penelitian ini menggunakan 24 ekor tikus putih jantan galur Wistar (Rattus Novergicus) usia 10–13 minggu dengan berat 220–300 g di awal penelitian. Tikus dibagi menjadi empat kelompok yaitu: tikus kontrol, tikus yang diberi L-NAME secara oral selama 5 minggu, tikus L-NAME yang diberi perlakuan HIIT dan kelompok tikus L-NAME yang diberi perlakuan MICT. Penelitian awal menunjukkan tikus HIIT mengalami penurunan berat badan yang bermakna dibandingkan kontrol. Pada tikus yang diinduksi L-Name, tekanan darah meningkat dibandingkan kelompok kontrol. Setelah perlakuan 5 minggu,tekanan darah pada kelompok L-NAME, HIIT dan MICT menurun tidak bermakna dibandingkan dengan kontrol. Kadar angiotensin II pada kelompok HIIT menunjukkan penurunan tekanan darah secara bermakna dibandingkan MICT dan HIIT secara bermakna lebih berperan dalam menurunkan kadar fibronektin dibandingkan MICT. Disimpulkan induksi L-NAME dapat menyebabkan hipertensi dan HIIT dapat menurunkan berat badan, kadar angiotensin II, dan kadar fibronektin dibandingkan MICT. HIIT lebih berperan menurunkan risiko hipertensi dibandingkan MICT.

A Ten-Year Retrospective Study of the Clinicopathological Profile of Pancreatic Neoplasms at the dr. Cipto Mangunkusumo Hospital

Wed, 11 Sep 2024 00:00:00 +0700

Pancreatic neoplasms exhibit diverse clinical and pathological features, necessitating collaboration between clinicians, radiologists, and anatomical pathologists to enhance diagnostic accuracy and patient management. This study aimed to provide a clinicopathological overview of pancreatic neoplasms in the Indonesian population from 2012 to 2022. A descriptive-analytical cross-sectional study was conducted using secondary data from the Department of Anatomical Pathology, dr. Cipto Mangunkusumo Hospital and electronic medical records. A total of 62 resected pancreatic epithelial neoplasms were analyzed, with solid neoplasms (85%) and cystic neoplasms (15%) predominant. Clinicopathological profiles were associated with neoplasm types based on stage. Pancreatic ductal adenocarcinoma (PDAC), solid pseudopapillary neoplasms (SPN), pancreatic neuroendocrine tumor (PanNET), and pancreatic neuroendocrine carcinoma (PanNEC) were the most common solid neoplasms. Meanwhile, mucinous cystic neoplasm (MCN) was the most common cystic neoplasm. Both solid and cystic neoplasms were more prevalent among women, with 58% of patients under 50 years old. Patients with PDAC and mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) have a higher proportion of <10-month survival rates and advanced stages. Although many clinicopathological features align with existing literature, further research with larger patient cohorts and comprehensive data is warranted.

Faktor-faktor yang Berhubungan dengan Ketidakpatuhan Minum Obat pada Pasien Lupus Eritematosus Sistemik

Ghefira Nur Imami, Alvina Widhani — Wed, 11 Sep 2024 00:00:00 +0700

Kepatuhan pasien Lupus Eritematosus Sistemik (LES) berperan penting dalam mencapai aktivitas penyakit yang terkontrol. Penelitian ini bertujuan untuk mengetahui prevalensi ketidakpatuhan, faktor-faktor yang berhubungan dengan ketidakpatuhan, dan hambatan minum obat pada pasien LES. Data potong lintang diperoleh dari pasien Poliklinik Alergi-Imunologi RSUPN Dr. Cipto Mangunkusumo secara konsekutif pada Juli–Agustus 2023. Dilakukan evaluasi terhadap ketidakpatuhan pengobatan (self-report medication-taking behaviour measure for thai patients scale; MTB-Thai), komorbiditas, jumlah obat, aktivitas penyakit (skor MEX-SLEDAI), depresi (Hospital Anxiety and Depression Scale; HADS), dan hambatan lain dalam pengobatan (Identification of Medication Adherence Barriers Questionnaire; IMAB-Q 30). Data kategorik dianalisis dengan uji Chi-square atau Fisher, sedangkan data numerik dianalisis dengan uji Mann-Whitney. Dari 100 pasien LES dewasa, mayoritas merupakan perempuan (97%), dewasa muda (61%), menamatkan pendidikan tinggi (48%), dan memiliki aktivitas penyakit remisi˗ringan (90%). Median (min-maks) jumlah obat yang dikonsumsi 6 (2–14). Prevalensi ketidakpatuhan minum obat mencapai 27%. Tingkat pendidikan pasien ditemukan berhubungan dengan ketidakpatuhan (pendidikan menengah vs. pendidikan tinggi, 59,3% vs. 40,7%; p=0,035). Pasien yang tidak patuh memiliki skor hambatan minum obat yang lebih tinggi secara signifikan (p<0,001). Hambatan yang paling banyak dialami pasien yang tidak patuh adalah kekhawatiran terhadap efek samping dan mudah terdistraksi dari mengonsumsi obat-obatan.

Hubungan Locus of Control dengan Academic Burnout pada Mahasiswa Tahap Akhir Studi S1 Kedokteran Universitas Muhammadiyah Semarang

Wed, 11 Sep 2024 00:00:00 +0700

Stres akademik seringi dialami mahasiswa tahap akhir studi. Stres berlebihan dan berkepanjangan karena tuntutan yang menguras emosi dan fisik secara terus menerus menyebabkan mahasiswa mengalami kelelahan emosional, fisik, dan mental yang menimbulkan academic burnout. Academic burnout adalah perasaan putus asa dan tidak berdaya akibat stres berlarut-larut yang berkaitan dengan proses belajar. Faktor yang memengaruhi academic burnout salah satunya adalah locus of control yaitu persepsi individu mengenai sebab utama suatu kejadian dalam hidup. Penelitian ini bertujuan untuk mengetahui hubungan antara locus of control dan academic burnout pada mahasiswa tahap akhir studi program studi S1 Kedokteran Universitas Muhammadiyah Semarang. Penelitian ini menggunakan desain potong lintang. Partisipan adalah mahasiswa tingkat akhir program Sarjana Kedokteran Fakultas Kedokteran Universitas Muhammadiyah Semarang tahun 2023. Teknik pengambilan sampel yang digunakan adalah total sampling. Kuesioner locus of control dan kuesioner Maslach Burnout Inventory - Student Survey digunakan untuk pengumpulan data kemudian dianalisis dengan uji chi-square. Jumlah partisipan adalah 125 responden; mayoritas memiliki locus of control eksternal (68 responden, 54,4%) dan tingkat academic burnout kategori sedang 123 responden (98,4%). Tidak terdapat hubungan antara locus of control dengan academic burnout (p=0,362). Locus of control penting untuk mengontrol dan memotivasi diri untuk menurunkan tingkat academic burnout.

Potential of Single-Bulb Garlic and Single-Bulb Black Garlic Extracts to Eradicate Uropathogenic Escherichia coli

Wed, 11 Sep 2024 00:00:00 +0700

Uropathogenic Escherichia coli (UPEC) is the main causative organism of urinary tract infections (UTIs). The increasing resistance of UPEC to conventional antibiotics necessitates the exploration of alternative treatments, including the use of herbal remedies such as single-bulb garlic. This study aimed to evaluate and compare the antibacterial potential of single-bulb garlic extract and single-bulb black garlic extract against clinical isolates of UPEC. The study was conducted at the Microscopic Laboratory, Faculty of Medicine, Universitas Tanjungpura, in June 2023. Ethanol (96%) was used for the extraction process and the antibacterial activity was assessed using the disc diffusion method. The study included 10 treatment groups, comprising single-bulb garlic and single-bulb black garlic extracts at concentrations of 25%, 50%, 75%, and 100%, with nitrofurantoin (300 µg/disc) as the positive control and 1% DMSO as the negative control. The results indicated that the single-bulb garlic extract exhibited no antibacterial activity against UPEC at any concentration. In contrast, the single-bulb black garlic extract demonstrated antibacterial activity at 75% and 100% concentrations, with inhibition zones of 7.28 mm and 7.24 mm, respectively. These findings suggest that single-bulb black garlic extract is more effective than single-bulb garlic extract in inhibiting the growth of UPEC (p = 0.001).

Perbandingan HPV DNA Test Hybrid Capture dan Pap Smear untuk Diagnosis Dini Karsinoma Serviks

Bagus Wira Wibawa, Resti Hardianti Lestari, Dimas Seto Prasetyo — Wed, 11 Sep 2024 00:00:00 +0700

Kanker serviks adalah kanker paling sering terjadi keempat pada wanita di seluruh dunia. Standar baku yang biasa dipakai untuk diagnosis dini adalah Pap smear. Sensitivitas yang rendah, tingkat negatif palsu yang tinggi, dan variabilitas interobserver menjadi kendala dari Pap smear. Saat ini telah dikembangkan pemeriksaan HPV DNA (hybrid capture) sebagai metode alternatif diagnosis dini karsinoma serviks. Laporan kasus berdasarkan bukti ini bertujuan untuk mengetahui perbandingan akurasi pemeriksaan HPV DNA (hybrid capture) dengan pemeriksaan Pap smear untuk diagnosis dini karsinoma serviks. Telusur kepustakaan dilakukan dengan pencarian di PubMed, Embase, Cochrane, dan Scopus menggunakan kata kunci “Cervical Carcinoma Diagnostic”, “Cancer Early Detection”, “Early Diagnosis of Cancer”, “Carcinoma Cervix”, “Ca Cervix”, “Cervical Neoplasm”, “Cervix Neoplasm”, “HPV DNA Test”, “Human Papilomavirus DNA Test”, “Hybrid Capture”, “Pap Smear”, “Papanicolaou Test”, “Papanicolaou Smear”. Didapatkan dua studi dengan level of evidence 4 yang kemudian ditinjau secara kritis. Studi menunjukkan nilai sensitivitas dan spesifisitas yang menjanjikan, terutama dengan hasil diperoleh dengan cepat. Akan tetapi rendahnya level of evidence, menyebabkan untuk mendiagnosis cervical carcinoma dengan HPV DNA test belum dapat digunakan sebagai modalitas diagnosis rutin. Penelitian selanjutnya dengan penyeragaman jenis pemeriksaan (HPV DNA (hybrid capture) dan Pap smear) perlu dilakukan untuk menentukan uji diagnostik dini yang lebih baik.

Prediksi Depresi Preoperatif Terhadap Terjadinya Nyeri Kronis pada Pasien Lansia Pasca Operasi Total Knee Arthroplasty

Wed, 11 Sep 2024 00:00:00 +0700

Osteoarthritis (OA) lutut merupakan penyebab utama disabilitas fisik pada lansia yang menyebabkan keterbatasan dalam kehidupan sosial dan seringkali mempengaruhi kesehatan mental. Total Knee Arthroplasty (TKA) atau Total Knee Replacement (TKR) merupakan tatalaksana OA lutut stadium akhir yang tidak menunjukkan perbaikan pasca tatalaksana non-operatif. Akan tetapi, ditemukan sekitar 10- 67 % pasien mengalami nyeri kronis atau persisten setelah TKA. Banyak faktor yang dapat memprediksi terjadinya nyeri kronis pasca TKA, salah satunya adalah faktor psikologis seperti depresi. Penelitian ini bertujuan untuk mengetahui prognosis terjadinya nyeri kronis pada pasien lansia pasca operasi TKA yang mengalami depresi sebelum operasi. Pencarian artikel dilakukan di tiga basis data, yaitu PubMed®, Cochrane® dan Embase®. Menggunakan Medical Subject Heading (MeSH) terms, title/abstract, text word, dan Boolean (“OR” dan “AND”). Studi yang ditelaah adalah systematic review, meta-analysis, dan cohort study, yang dinilai menggunakan Centre for Evidence-Based Medicine (Oxford). Pencarian dilakukan pada bulan Maret 2023. Terdapat 3 artikel yang dianalisis. Depresi pre-operasi berpengaruh signifikan terhadap nyeri derajat ringan sedang yang dirasakan pada 2 tahun pasca operasi TKA primer dengan adjusted OR 1,5 ([95% CI 1,2-2,0], p<0,01) dan 5 tahun pasca operasi TKA primer dengan adjusted OR 2,0 ([95% CI 1,4-2,9], p<0,01). Depresi sebelum operasi merupakan faktor prediksi yang sangat signifikan dan berpengaruh kuat terhadap kemungkinan terjadinya nyeri kronis secara objektif dan subjektif pada pasien lansia pasca operasi TKA.