LAMPIRAN. Lampiran 1. Ethical clearance

LAMPIRAN Lampiran 1. Ethical clearance 69

Lampiran 2. Ijin penelitian 70

71 Lampiran 3. Informed consent JUDUL PENELITIAN : HUBUNGAN ABNORMALITAS HASIL CT-SCAN DENGAN DEVELOPMENTAL DELAYED PADA PASIEN SUSPEK INFEKSI CYTOMEGALOVIRUS KONGENITAL INSTANSI PELAKSANA : FAKULTAS KEDOKTERAN UNIVERSITAS DIPONEGORO Persetujuan Setelah Penjelasan (INFORMED CONSENT) Bapak/Ibu Yth : Saya Wilujeng Puja Sari, mahasiswa Fakultas Kedokteran Universitas Diponegoro Semarang, Program Studi Kedokteran Umum. Saya bermaksud melakukan penelitian mengenai Hubungan Abnormalitas Hasil CT-Scan terhadap pada Pasien Suspek Infeksi Cytomegalovirus Kongenital. Penelitian ini dilakukan sebagai tahap akhir dalam penyelesaian studi di Fakultas Kedokteran Universitas Diponogoro, Program Studi Kedokteran Umum. Pada penelitian ini akan dilakukan pengumpulan data pada catatan medis untuk mengetahui apakah kalsifikasi intrakranial, ventrikulomegali, atrofi cerebri, serta kelianan minor lainnya secara sendiri-sendiri atau bersama-sama merupakan faktor resiko terjadinya developmental delayed pada pasien suspek infeksi CMV kongenital. Peneliti akan menjaga kerahasiaan identitas dan informasi yang diberikan dan hanya digunakan untuk kepentingan penelitian. Terima kasih atas kerjasama Bapak/Ibu/Sdr. Setelah mendengar dan memahami penjelasan Penelitian, dengan ini saya menyatakan SETUJU / TIDAK SETUJU Untuk ikut sebagai responden / sampel penelitian. Semarang, Saksi : Nama Terang : Nama Terang : Alamat : Alamat :

Lampiran 4. Hasil Analisis Frequencies N Valid 28 Missing 0 Jenis Kelamin Frequency Percent Valid Percent Cumulative Percent Valid Laki-laki 20 71.4 71.4 71.4 Perempuan 8 28.6 28.6 100.0 Total 28 100.0 100.0 Descriptives Descriptive Statistics N Minimum Maximum Mean Std. Deviation Usia (bulan) 28 1 59 15.36 15.404 Valid N (listwise) 28 FREQUENCIES VARIABLES=AbnormalitasCTScan /PIECHART FREQ /ORDER=ANALYSIS. 72

73 Frequencies Statistics Abnormalitas CT Scan N Valid 28 Missing 0 Abnormalitas CT Scan Frequency Percent Valid Percent Cumulative Percent Valid Ya 22 78.6 78.6 78.6 Tidak 6 21.4 21.4 100.0 Total 28 100.0 100.0 FREQUENCIES VARIABLES=Kalsifikasi Ventrikulomegali AtrofiCerebri KelMinorLain /PIECHART FREQ /ORDER=ANALYSIS. Frequencies Statistics Kalsifikasi Intracranial Ventrikulomegali Atrofi Cerebri Kelainan Minor Lainnya N Valid 28 28 28 28 Missing 0 0 0 0

74 Frequency Table Kalsifikasi Intracranial Frequency Percent Valid Percent Cumulative Percent Valid Ya 7 25.0 25.0 25.0 Tidak 21 75.0 75.0 100.0 Total 28 100.0 100.0 Ventrikulomegali Frequency Percent Valid Percent Cumulative Percent Valid Ya 5 17.9 17.9 17.9 Tidak 23 82.1 82.1 100.0 Total 28 100.0 100.0 Atrofi Cerebri Frequency Percent Valid Percent Cumulative Percent Valid Ya 10 35.7 35.7 35.7 Tidak 18 64.3 64.3 100.0 Total 28 100.0 100.0 Kelainan Minor Lainnya Frequency Percent Valid Percent Cumulative Percent Valid Ya 16 57.1 57.1 57.1 Tidak 12 42.9 42.9 100.0 Total 28 100.0 100.0

75 Pie Chart FREQUENCIES VARIABLES=Developmentaldelayed /PIECHART FREQ /ORDER=ANALYSIS. Frequencies Statistics N Valid 28 Missing 0

76 Frequency Percent Valid Percent Cumulative Percent Valid Ya 21 75.0 75.0 75.0 Tidak 7 25.0 25.0 100.0 Total 28 100.0 100.0 CROSSTABS /TABLES=AbnormalitasCTScan BY Developmentaldelayed /FORMAT=AVALUE TABLES /STATISTICS=CHISQ RISK /CELLS=COUNT ROW /COUNT ROUND CELL. Crosstabs Case Processing Summary Cases Valid Missing Total N Percent N Percent N Percent Abnormalitas CT Scan * 28 100.0% 0.0% 28 100.0%

77 Abnormalitas CT Scan * Crosstabulation Ya Tidak Total Abnormalitas CT Scan Ya Count 20 2 22 % within Abnormalitas CT Scan 90.9% 9.1% 100.0% Tidak Count 1 5 6 % within Abnormalitas CT Scan 16.7% 83.3% 100.0% Total Count 21 7 28 % within Abnormalitas CT Scan 75.0% 25.0% 100.0% Chi-Square Tests Asymp. Sig. (2- Exact Sig. (2- Exact Sig. (1- Value df Pearson Chi-Square 13.859 a 1.000 Continuity Correction b 10.182 1.001 Likelihood Ratio 12.680 1.000 Fisher's Exact Test.001.001 Linear-by-Linear 13.364 1.000 Association N of Valid Cases 28 a. 2 cells (50,0%) have expected count less than 5. The minimum expected count is 1,50. b. Computed only for a 2x2 table Risk Estimate 95% Confidence Interval Value Lower Upper Odds Ratio for Abnormalitas CT 50.000 3.741 668.350 Scan (Ya / Tidak) For cohort Developmental 5.455.907 32.803 Delayed = Ya For cohort Developmental.109.028.429 Delayed = Tidak N of Valid Cases 28

78 CROSSTABS /TABLES=Kalsifikasi BY Developmentaldelayed /FORMAT=AVALUE TABLES /STATISTICS=CHISQ RISK /CELLS=COUNT ROW /COUNT ROUND CELL. Crosstabs Case Processing Summary Cases Valid Missing Total N Percent N Percent N Percent Kalsifikasi Intracranial * 28 100.0% 0.0% 28 100.0% Kalsifikasi Intracranial * Crosstabulation Ya Tidak Total Kalsifikasi Intracranial Ya Count 7 0 7 % within Kalsifikasi Intracranial 100.0%.0% 100.0% Tidak Count 14 7 21 % within Kalsifikasi Intracranial 66.7% 33.3% 100.0% Total Count 21 7 28 % within Kalsifikasi Intracranial 75.0% 25.0% 100.0% Chi-Square Tests Asymp. Sig. (2- Exact Sig. (2- Exact Sig. (1- Value df Pearson Chi-Square 3.111 a 1.078 Continuity Correction b 1.587 1.208 Likelihood Ratio 4.757 1.029 Fisher's Exact Test.141.098 Linear-by-Linear 3.000 1.083 Association N of Valid Cases 28

79 Risk Estimate 95% Confidence Interval Value Lower Upper For cohort Developmental 1.500 1.109 2.030 Delayed = Ya N of Valid Cases 28 a. 1 cells (25,0%) have expected count less than 5. The minimum expected count is 1,75. b. Computed only for a 2x2 table CROSSTABS /TABLES=Ventrikulomegali BY Developmentaldelayed /FORMAT=AVALUE TABLES /STATISTICS=CHISQ RISK /CELLS=COUNT ROW /COUNT ROUND CELL Crosstabs Case Processing Summary Cases Valid Missing Total N Percent N Percent N Percent Ventrikulomegali * 28 100.0% 0.0% 28 100.0% Ventrikulomegali * Crosstabulation Ya Tidak Total Ventrikulomegali Ya Count 5 0 5 % within Ventrikulomegali 100.0%.0% 100.0% Tidak Count 16 7 23 % within Ventrikulomegali 69.6% 30.4% 100.0% Total Count 21 7 28 % within Ventrikulomegali 75.0% 25.0% 100.0%

80 Chi-Square Tests Asymp. Sig. (2- Exact Sig. (2- Exact Sig. (1- Value df Pearson Chi-Square 2.029 a 1.154 Continuity Correction b.730 1.393 Likelihood Ratio 3.224 1.073 Fisher's Exact Test.290.207 Linear-by-Linear 1.957 1.162 Association N of Valid Cases 28 a. 2 cells (50,0%) have expected count less than 5. The minimum expected count is 1,25. b. Computed only for a 2x2 table Risk Estimate 95% Confidence Interval Value Lower Upper For cohort Developmental Delayed = Ya N of Valid Cases 28 CROSSTABS /TABLES=AtrofiCerebri BY Developmentaldelayed /FORMAT=AVALUE TABLES /STATISTICS=CHISQ RISK /CELLS=COUNT ROW /COUNT ROUND CELL. 1.438 1.097 1.884 Crosstabs Case Processing Summary Cases Valid Missing Total N Percent N Percent N Percent Atrofi Cerebri * 28 100.0% 0.0% 28 100.0%

81 Atrofi Cerebri * Crosstabulation Ya Tidak Total Atrofi Cerebri Ya Count 10 0 10 % within Atrofi Cerebri 100.0%.0% 100.0% Tidak Count 11 7 18 % within Atrofi Cerebri 61.1% 38.9% 100.0% Total Count 21 7 28 % within Atrofi Cerebri 75.0% 25.0% 100.0% Chi-Square Tests Asymp. Sig. (2- Exact Sig. (2- Exact Sig. (1- Value df Pearson Chi-Square 5.185 a 1.023 Continuity Correction b 3.319 1.069 Likelihood Ratio 7.434 1.006 Fisher's Exact Test.030.027 Linear-by-Linear 5.000 1.025 Association N of Valid Cases 28 a. 2 cells (50,0%) have expected count less than 5. The minimum expected count is 2,50. b. Computed only for a 2x2 table Risk Estimate 95% Confidence Interval Value Lower Upper For cohort Developmental 1.636 1.132 2.366 Delayed = Ya N of Valid Cases 28 CROSSTABS /TABLES=KelMinorLain BY Developmentaldelayed /FORMAT=AVALUE TABLES /STATISTICS=CHISQ RISK /CELLS=COUNT ROW /COUNT ROUND CELL.

82 Crosstabs Case Processing Summary Cases Valid Missing Total N Percent N Percent N Percent Kelainan Minor Lainnya * 28 100.0% 0.0% 28 100.0% Kelainan Minor Lainnya * Crosstabulation Ya Tidak Total Kelainan Minor Lainnya Ya Count 14 2 16 % within Kelainan Minor Lainnya 87.5% 12.5% 100.0% Tidak Count 7 5 12 % within Kelainan Minor Lainnya 58.3% 41.7% 100.0% Total Count 21 7 28 % within Kelainan Minor Lainnya 75.0% 25.0% 100.0% Chi-Square Tests Asymp. Sig. (2- Exact Sig. (2- Exact Sig. (1- Value df Pearson Chi-Square 3.111 a 1.078 Continuity Correction b 1.750 1.186 Likelihood Ratio 3.133 1.077 Fisher's Exact Test.103.093 Linear-by-Linear Association 3.000 1.083 N of Valid Cases 28 a. 2 cells (50,0%) have expected count less than 5. The minimum expected count is 3,00. b. Computed only for a 2x2 table

83 Risk Estimate 95% Confidence Interval Value Lower Upper Odds Ratio for Kelainan Minor 5.000.767 32.574 Lainnya (Ya / Tidak) For cohort Developmental 1.500.898 2.505 Delayed = Ya For cohort Developmental.300.070 1.291 Delayed = Tidak N of Valid Cases 28 Logistic Regression LOGISTIC REGRESSION VARIABLES Developmentaldelayed /METHOD=ENTER Kalsifikasi AtrofiCerebri KelMinorLain /PRINT=CI(95) /CRITERIA=PIN(0.05) POUT(0.10) ITERATE(20) CUT(0.5). Block 1: Method = Backward Stepwise (Wald) Omnibus Tests of Model Coefficients Chi-square df Sig. Step 1 Step 11.898 3.008 Block 11.898 3.008 Model 11.898 3.008 Step 2 a Step -5.259 1.022 Block 6.639 2.036 Model 6.639 2.036 Step 3 a Step -4.875 1.027 Block 1.763 1.184 Model 1.763 1.184 Step 4 a Step -1.763 1.184 Step 5 Step 6.182 1.013 Block 6.182 1.013 Model 6.182 1.013 a. A negative Chi-squares value indicates that the Chi-squares value has decreased from the previous step.

84 Model Summary Cox & Snell R Nagelkerke R Step -2 Log likelihood Square Square 1 17.199 a.346.536 2 22.458 a.211.327 3 27.333 b.061.094 4 29.096 c.000.000 5 22.915 a.198.307 a. Estimation terminated at iteration number 20 because maximum iterations has been reached. Final solution cannot be found. b. Estimation terminated at iteration number 5 because parameter estimates changed by less than.001. c. Estimation terminated at iteration number 4 because parameter estimates changed by less than.001. Classification Table a Predicted Observed Ya Tidak Percentage Correct Step 1 Ya 19 3 86.4 Tidak 2 4 66.7 Overall Percentage 82.1 Step 2 Ya 22 0 100.0 Tidak 6 0.0 Overall Percentage 78.6 Step 3 Ya 22 0 100.0 Tidak 6 0.0 Overall Percentage 78.6 Step 4 Ya 22 0 100.0 Tidak 6 0.0 Overall Percentage 78.6 Step 5 Ya 22 0 100.0 Tidak 6 0.0 Overall Percentage 78.6 a. The cut value is.500

85 Variables in the Equation c 95% C.I.for EXP(B) B S.E. Wald df Sig. Exp(B) Lower Upper Step Kalsifikasi 20.666 13741.842.000 1.999 944191775.979.000. 1 a AtrofiCerebri 20.492 11832.343.000 1.999 793357780.263.000. KelMinorLain.981 1.155.722 1.396 2.667.277 25.636 Constant - 83.989 36268.028.000 1.998.000 Step AtrofiCerebri 20.274 12629.568.000 1.999 638024225.546.000. 2 a KelMinorLain.693 1.041.443 1.505 2.000.260 15.381 Constant - 42.340 25259.137.000 1.999.000 Step KelMinorLain 1.253.973 1.658 1.198 3.500.520 23.559 3 a Constant -3.199 1.631 3.845 1.050.041 Step Constant 4 a -1.299.461 7.958 1.005.273 Step AtrofiCerebri 20.510 12710.151.000 1.999 807737459.492.000. 5 b Constant - 25420.301.000 1.999.000 41.713 a. Variable(s) entered on step 1: Kalsifikasi, AtrofiCerebri, KelMinorLain. b. Variable(s) entered on step 5: AtrofiCerebri. c. Stepwise procedure stopped because removing the least significant variable results in a previously fitted model.

86 Variables not in the Equation Score df Sig. Step 2 a Variables Kalsifikasi 3.680 1.055 Overall Statistics 3.680 1.055 Step 3 b Variables Kalsifikasi 2.717 1.099 AtrofiCerebri 3.438 1.064 Overall Statistics 7.117 2.028 Step 4 c Variables Kalsifikasi 2.545 1.111 AtrofiCerebri 4.242 1.039 KelMinorLain 1.768 1.184 Overall Statistics 7.774 3.051 Step 5 c Variables Kalsifikasi 3.462 1.063 KelMinorLain.450 1.502 Overall Statistics 4.062 2.131 a. Variable(s) removed on step 2: Kalsifikasi. b. Variable(s) removed on step 3: AtrofiCerebri. c. Variable(s) removed on step 4: KelMinorLain. Score df Sig. Step 0 Variables Kalsifikasi 3.111 1.078 KelMinorLain.778 1.378 AtrofiCerebri 1.867 1.172 Overall Statistics 5.576 3.134

87 Lampiran 5. Biodata Identitas Nama : Wilujeng Puja Sari NIM : 22010110110042 Tempat / tanggal lahir : Samarinda / 30 Agustus 1992 Jenis Kelamin : Perempuan Alamat : Jalan Panglima Batur Gg. 2 No. 31 Samarinda Nomor HP : 085742470742 e-mail : wilujeng.pujasari@gmail.com Riwayat Pendidikan Formal 1. SD : SD Negeri 004 Samarinda Lulus tahun : 2004 2. SMP : SMP Negeri 1 Samarinda Lulus tahun : 2007 3. SMA : SMA Negeri 1 Samarinda Lulus tahun : 2010 4. Pendidikan Dokter Fak. Kedokteran UNDIP Masuk tahun : 2010

88 Keanggotaan Organisasi 1. RISET - BEM KU FK UNDIP Tahun 2010 s/d 2011 2. RISET - HIMA KU UNDIP Tahun 2011 s/d 2012 3. PROJECT AFFAIR - HIMA KU UNDIP Tahun 2012 s/d 2013 4. MER-C SEMARANG Tahun 2013 s/d sekarang