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A. Definisi
Renal oncocytoma atau Onkositoma Ginjal adalah sebuah tumor yang tergolong jinak pada ginjal. Onkositoma ginjal merupakan tumor ginjal jinak yang paling umum setelah angiomyolipoma.5 Onkositoma ginjal terdiri atas onkosit dengan sitoplasma eosinofilik granular.3 Tumor tersebut berasal dari onkosit yang merupakan sel epitel besar dengan sitoplasma yang memiliki banyak mitokondria yang mengalami distorsi.1 Onkositoma ginjal dapat tumbuh hingga sangat besar dan seringkali salah diartikan sebagai karsinoma sel renal.1
Tumor jinak ini dijelaskan pertama kali pada tahun 1942 oleh Zippel dan merupakan wujud patologis yang berbeda dari yang lain. Pada tahun 1967, Klein dan Valensi menerbitkan beberapa kasus pasien yang menderita onkositoma dan menyoroti ciri-ciri patologis yaitu penderita onkositoma biasanya juga menderita renal carcinoma cell (RCC).4 Onkositoma ginjal ditemukan secara tidak sengaja, dan keluhan gejala paling umum dari penderita onkositoma ginjal adalah pasien mengalami hematuria atau kencing darah.1

B. Etiologi
Penyebab pasti dari Onkositoma Ginjal masih belum diketahui hingga saat ini. Akan tetapi, para peneliti beranggapan bahwa perubahan pada DNA mitokondria setelah lahir dapat menjadi faktor berkembangnya tumor ini.1 Onkositoma yang dipengaruhi oleh sindrom genetik disebabkan karena perubahan atau mutasi pada gen tertentu.1
Onkositoma ginjal terkadang terjadi pada orang yang memiliki sindrom genetik tertentu seperti sindrom Birt-Hogg-dube atau Tuberous sclerosis.1 Pada penderita sindrom tersebut onkositoma ginjal biasanya menyerang kedua ginjal yang disebut juga onkositoma multiple atau bilateral.1
Kebanyakan onkositoma ginjal tidak diwariskan. Umumnya terjadi secara sporadis pada orang-orang yang keluarganya tidak memiliki riwayat penyakit tumor. 1

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C. Patofisiologi
Onkositoma ginjal dapat berkembang menjadi tumor yang sangat besar dikarenakan perkembangan dari sel ductus pengumpul.3 Sel ductus pengumpul atau yang biasa disebut sel dari tubulus pengumpul (tubulus kolektivus) tersebut membelah di satu area yang menimbulkan tumor jinak pada ginjal.3
Onkositoma ginjal pada dasarnya adalah kumpulan onkosit yang asal-usul selnya dianggap juga dapat berasal dari sel interkari dari bagian kortikal yang merupakan bagian dari tubulus pengumupul.3

D. Epidemiologi
Onkositoma ginjal cenderung lebih sering di diagnosis pada pria dibangdingkan wanita.3 Rentangan usia yang banyak di diagnosis terkena onkositoma ginjal adalah kelompok usia 50 tahun ke atas. Penelitian menyatakan bahwa 4%-7% dari epitel ginjal dewasa terkena onkositoma ginjal.3 Seseorang yang terkena onkositoma ginjal biasanya hidup berdampingan dengan karsinoma sel ginjal atau biasa disebut Renal Cell Carcinoma (RCC).3 Tumor jinak ini memang bisa berkembang menjadi sangat besar dan menyerang kedua ginjal (Tumor Bilateral) tetapi penderita Onkositoma ginjal jarang terkait dengan gagal ginjal.3
Dari keseluruhan penderita tumor ginjal, terdapat 3-5% yang memiliki kasus onkositoma.2

E. Tanda Gejala
Kebanyakan penderita onkositoma ginjal tidak merasakan adanya gejala atau tanda sebelum menyadari keberadaan penyakit tersebut. Namun, gejala yang umumnya timbul adalah nyeri perut, nyeri panggul, adanya darah dalam urin atau biasa disebut hematuria, dan penambahan massa perut.1
Bahkan, mayoritas penderita onkositoma ginjal menyadari keberadaan tumor tersebut secara kebetulan saat sedang melakukan pencitraan untuk diagnosis penyakit lain seperti saat ultrasound atau computed tomography.1

F. Tata Laksana
Onkositoma ginjal yang merupakan tumor jinak sangat jarang terjadi metastasis. Walau kebanyakan tumor jinak tidak memerlukan pengobatan kecuali tumor yang dirasakan tersebut mengganggu dan menyebabkan gejala yang tidak menyenangkan, akan menjadi sulit dalam mendeteksi onkositoma ginjal dan membedakannya dengan karsinoma sel ginjal (RCC) hanya dengan tes pencitraan diagnostik saja.1
Oleh karena itu, diperlukan pembedahan untuk mengkonfirmasi diagnosis akan keberadaan penyakit. Sebagian ahli menyebutkan bahwa onkositoma adalah prakanker dan memberi rekomendasi untuk langsung mengeluarkannya secara operasi. Jika onkositoma ginjal pada penderita sangat dicurigai dan memungkinkan timbul penyakit yang lebih lanjut sebelum operasi, prosedur seperti nefrektomi parsial bisa dilakukan atau eksisi yang bersifat kuratif.1
Diagonisis awal dari onkositoma ginjal biasanya dicurigai berdasarkan hasil pada studi pencitraan seperti computed tomography (CT Scan), ultrasound ginjal, angiogram, dan / atau magnetic resonance imaging (MRI Scan).4 Ketelitian sangat diperlukan dalam membaca hasil pencitraan karena sangat sulit dalam membedakan antara onkositoma ginjal dengan karsinoma sel ginjal (RCC).1 Belum ada temuan klinis, radiologi, dan/atau laboratorium spesifik yang dapat membedakannya, diagnosis pasti hanya bergantung pada pemeriksaan histologis. Dalam mengonfirmasi hasil diagnosis agar lebih tepat, biopsi, aspirasi jarum halus, dan/atau pembedahan biasanya diperlukan.
Tes genetik tidak tersedia bagi penderita onkositoma ginjal yang tidak memiliki riwayat penyakit tersebut dalam keluarganya terdahulu. Namun, tes genetic bisa menjadi sebuah opsi jika penderita berkerabat atau memiliki sejarah riwayat penyakit keluarga dengan seseorang yang menderita sindrom genetic Birt-Hogg-dube atau Tuberous sclerosis.1
Progonosis bagi penderita onkositoma ginjal secara sporadic (tidak memiliki riwayat penyakit keluarga yang sejenis) secara umum terbilang bagus. Setelah operasi pengangkatan onkositoma ginjal, tumor jinak tersebut pada umumnya tidak kembali. Onkositoma ginjal juga tidak mempengaruhi panjang pendeknya umur seseorang.1

G. Diagnosis
Onkostioma ginjal umumnya terkait dengan tiga kelainan genetic yang khas, tetapi dalam beberapa kasus tidak ada kelainan kromosom yang terdeteksi. Tiga kelainan genetic tersebut antara lain adalah hilangnya kromosom Y, translokasi di daerah 11q13, dan/atau kelainan genetic seperti trisomi, monosomi, dan/atau hilangnya heterozigositas.4
Secara mikroskopis, onkositoma ginjal berbentuk seperti pulau yang tersusun atas sel onkosit dengan sitoplasma yang bersifat eosinofilik kasar. Onkositoma tersebut memiliki bentuk seperti nucleus bulat, vesikuler, dan ditandai dengan polimorfisme yang meliputi tubular, asinar, padat, kistik, dan pola bersarang.6

a

a) Issue Analysis
Article 1: “Standards of Medical Care in Diabetes—2017 Abridged for Primary Care Providers”
Issue by American Diabetes Association
Key Messages:
1. Promoting health and reducing disparities in populations are the responsibility of each individual especially medical practitioner.
2. General medical evaluation and the role of medical practitioners in caring diabetes patient
3. Recommendations are given for overall assessment and treatment plan with all forms of diabetes.
Summary:
The article gives the useful clinical practice guidelines which are important in improving population health. Thus, such efforts require a combination of all clinical level and high patient-focused level of care, “the care refers to respectful of and responsive to individual patient preferences, needs, and values that all medical practitioners should acknowledge for the near future real practices”.
On the other hand, the studies mentioned the general medical evaluation which comprises the initial and ongoing assessment, the complications, rather, the participation of the patient throughout the treatment process. Medical Practitioners do notice that diabetes patient should receive the healthcare from many interdependent sides that may include physicians, exercise specialists, nurses care, caregiver, families….Especially each of patient or potential patient with diabetes must acknowledge how important they care themselves. The engagement of care also includes the awareness of not only the care team, but also the family side to refer assessment and treatment plan. In which, the lifestyle management, as well as psychosocial care, are highly recommended in the article. Accordingly, “Patients should be referred for diabetes self-management education (DSME), diabetes self-management support (DSMS), medical nutrition therapy (MNT), and psychosocial/emotional health concerns if indicated”.
One of the most important thing was mentioned in the article is that the medical practitioners should take notice for the preventive care services; even it is the less crucial things but may have a big result for the patient e.g., immunizations and cancer screening; ophthalmological, dental, and smoking cessation counseling,…
Article 2: “The associations of self-care, illness perceptions and psychological distress with metabolic control in Singaporean adolescents with Type 1 Diabetes Mellitus”
Issue by Taylor & Francis Group
Key Messages:
1. Adolescents in Singapore with Type 1 Diabetes Mellitus with poorer metabolic control tend to have poorer self-care behaviors.
2. The importance of treatment control cognitions (i.e. patients perceived treatment impact
over illness) and illness perception in Singaporean youth with Type 1 Diabetes Mellitus.
3. General psychological distress was not predictive of poor metabolic control and Type 1 Diabetes Mellitus
Summary:
The study did the examination for the role of self-care, illness perceptions and psychological distress in T1DM management conducted through the research of sample of 41 Singaporean adolescents (age 14 – 20) The findings of this research highlighted the importance of the perceptions of treatment control and dietary self-care in diabetes outcomes for adolescents with T1DM. Besides, it also noted the relationship between self-care, illness perceptions and psychological distress with metabolic control in Singaporean adolescents with T1DM. Indeed, it is hypothesised that the poorer metabolic control will be associated with lower adherence/self-care behaviours, the more negative illness perceptions (i.e. lower perceptions of control; more perceived consequences and symptoms, stronger identity) and higher distress.
Individuals need to coordinate a number of self-care behaviors on daily basis including blood glucose checks, calculating and administering insulin doses, and keeping to dietary and exercise recommendations for Singaporean adolescents with T1DM should try to work on strengthening perceptions of treatment control as well as improving self-care behaviours, or intrinsic motivation which is reflected as better self-care behaviours.
The study used the Kessler psychological distress scale (K10) which is a generic questionnaire, consisting of 10 items designed to measure level of psychological distress over the past four weeks (Kessler et al.,2005) in the survey. And results showed low distress scores and hence insufficient variation to allow relationships (if any) to emerge in the investigation. This all research and findings are enriched information and statistic practitioners and for the DSS.

Article 3: “A qualitative study of patient experiences of Type 2 Diabetes care delivered comparatively by General Practice Nurses and Medical Practitioners”
Issued by Journal of Clinical Nursing (JCU)
Key Messages:
1. The efficient and effective care makes treatment on Type 2 Diabetes patients.
2. The collaborative approach in Type 2 Diabetes patient’s care delivery
3. The care to inform would more supportive if it has taken by the medical practitioners
Summary:
The articles try to examine the patient experiences of type 2 diabetes mellitus and the care delivered by nurse, caregivers and in collaboration with the general and medical practitioners. The studies based on the Australian general practice nurses contexts as they have substantial role in caring the patient in type 2 diabetes and other type of diabetes.

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Accordingly, the research has applied the qualitative method under purposeful sampling of the 10 patients. All of them were invited to join into the research and after that, results were gathered from semi-structured face-to-face interviews. Eventually, all the agreed patients have been gone through the General Practice Nurse consulting process. At the meantime, the patients were asked to tell what have they faced with the ongoing challenge of living with T2DM and moreover, the study aimed to identified how need and important of additional awareness and advice properly.
What they have feel and face with the challenging living with type 2 diabetes were obviously come out and the results highlighted the need of general practice nurse go along with the care delivery. Being acknowledge the essential of effective delivered care in Diabetes treatment, nonetheless, the collaborative approach withdrawn from the study require the cooperation of assessments, necessary education, and self-supportive care and other duty of inform conducted by General Practitioners.

MEDIA RELEASE
FOR IMMEDIATE RELEASE

CARE FOR DIABETES – A GROWING HEALTH CONCERN
Date: 04 June 2018

The growing concern is given on the diabetes, both globally and in Singapore. One third the Singapore population is in risk of life with this growing diabetes disease.

Mr Yong Chiang Boon, the President of the Diabetic Society of Singapore (DSS), mentioned “If we do not take action today, it is estimated that one million Singapore residents will have diabetes by 2050. In April this year, MOH declared War on Diabetes, and set up the national Diabetes Prevention and Care Taskforce”.

For medical practitioners, the forehead is effort to address diabetes in three key aspects: lifestyle management, disease management and caring management. Moreover, the responsibilities of each of Singapore citizens is rising the own and public awareness. Mr. Yong also addressed: “The War on Diabetes is a whole-of-nation effort which requires the commitment of every Singaporean”. Everyone should recognize that health is absolutely important and that is crucial to take the awareness about it. An appealing for everyone is needed to take action from this moment.

– ENDS –
For more information,
The Diabetes Society of Singapore site is an initiative support. http://www.diabetes.org.sg
Q and Jurong Diabetes Education ; Care Centre
Blk 528 Jurong West St 52
#01-353 Singapore 640528
Tel : (65) 6564 9818, (65) 6564 9819

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