Open Access. Powered by Scholars. Published by Universities.®

Medical Specialties Commons

Open Access. Powered by Scholars. Published by Universities.®

Jurnal Penyakit Dalam Indonesia

Articles 271 - 300 of 431

Full-Text Articles in Medical Specialties

Relationship Between Symptoms Of Depression And Anxiety With Major Adverse Cardiac Event In 7 Days In Patients With Acute Coronary Syndrome In Cipto Mangunkusumo Hospital, Diah Pravita Sari, E Mudjaddid, Eka Ginanjar, Muhadi Muhadi Dec 2018

Relationship Between Symptoms Of Depression And Anxiety With Major Adverse Cardiac Event In 7 Days In Patients With Acute Coronary Syndrome In Cipto Mangunkusumo Hospital, Diah Pravita Sari, E Mudjaddid, Eka Ginanjar, Muhadi Muhadi

Jurnal Penyakit Dalam Indonesia

Introduction. One of the causes of death in acute coronary syndrome is the occurrence of complication known as major adverse cardiac events (MACE). There are several predictors of the occurance of MACE in patients with ACS, including depression and anxiety. Thi study aimed to determine the association between depression and anxiety with major adverse cardiac events within 7 days in patients with acute coronary syndrome. Methods. Study with prospective cohort design to examine the association between depression and anxiety with MACE within 7 days of ACS patients, using HADS questionnaires on ACS patients undergoing treatment at ICCU, Hospitalization RSCM in …


The Effects Of Curcumin On Nf-Κb Level And Degree Of Liver Fibrosis In Rat Liver Fibrosis, Supriono Supriono, Bogi Pratomo, Dedy Indra Praja Dec 2018

The Effects Of Curcumin On Nf-Κb Level And Degree Of Liver Fibrosis In Rat Liver Fibrosis, Supriono Supriono, Bogi Pratomo, Dedy Indra Praja

Jurnal Penyakit Dalam Indonesia

No abstract provided.


Infection Of Plasmodium Knowlesi Malaria In Human, I Gede Yasa Asmara Dec 2018

Infection Of Plasmodium Knowlesi Malaria In Human, I Gede Yasa Asmara

Jurnal Penyakit Dalam Indonesia

Plasmodium knowlesi (P. knowlesi) has been recognised as the fifth of malaria infections in human after P. vivax, P. falciparum, P. malariae and P. ovale. Epidemiology and clinical features of the disease have much been discussed only in several literatures since the incidence increased in Kapit Division, Sarawak, Malaysia in 2004. A large-scale research investigating real incidence of the infection in South East Asia is important. Because of rapid life cycle, the number of parasite in the blood can increase significantly, result in potential severe malaria. Pathophysiology aspect of the disease has not been clear yet, particularly on how severe …


Correlation Between History Of Fall And Timed Up And Go Test In Geriatric, Mifta Nurmalasari, Novira Widajanti, Rwahita Satyawati Dharmanta Dec 2018

Correlation Between History Of Fall And Timed Up And Go Test In Geriatric, Mifta Nurmalasari, Novira Widajanti, Rwahita Satyawati Dharmanta

Jurnal Penyakit Dalam Indonesia

Introduction. Fall is the global major problem in geriatrics as it causes physical and physicological impairment, even leads to mortality. Timed up and go test (TUG) is the screening method which commonly used in medical practice as standard examination to assess mobility, balance, and fall risk.This study aimed to determine the correlation between TUG and history of falls in geriatric patients at General Hospital Dr. Soetomo Surabaya, Indonesia. Methods. A cross-sectional study was conducted among geriatric patients in Dr. Soetomo hospital with criteria ≥ 60 years old, mini mental state examination (MMSE) score ≥ 17, did not suffer from hemiplegic …


Comparison Of Absolute Neutrophil Count Between Hospital And Community Acquired Methicillin-Resistant Staphylococcus Aureus Infection, Kurniyanto Kurniyanto, Widayat Djoko Santoso, Leonard Nainggolan, Juferdy Kurniawan Dec 2018

Comparison Of Absolute Neutrophil Count Between Hospital And Community Acquired Methicillin-Resistant Staphylococcus Aureus Infection, Kurniyanto Kurniyanto, Widayat Djoko Santoso, Leonard Nainggolan, Juferdy Kurniawan

Jurnal Penyakit Dalam Indonesia

Introduction. The virulence factors from community acquired-methicillin resistant Staphylococcus aureus (CA-MRSA) mainly due to toxins like Panton Valentin Leukocidin (PVL) and Phenol Soluble Modulin (PSM). Both of toxins cause decrease of value through neutrophil lysis. This study aimed to identify different value of absolute neutrophil count between hospital and community acquired MRSA. Methods. A cross sectional was conducted which included subjects who were infected by MRSA and hospitalized during 2012-2017. Classification of MRSA were divided due to its sensitivity and resistance to non-beta lactam antibiotics. Isolate that resistance to ≤ 2 antibiotics were classified as CA-MRSA. The others with resistance …


Relationship Between Neutrophil Lymphocyte Ratio And Lower Extremity Peripheral Artery Disease In Patients With Type 2 Diabetes Mellitus, Krishna Adi Wibisana, Imam Subekti, Dono Antono, Pringgodigdo Nugroho Dec 2018

Relationship Between Neutrophil Lymphocyte Ratio And Lower Extremity Peripheral Artery Disease In Patients With Type 2 Diabetes Mellitus, Krishna Adi Wibisana, Imam Subekti, Dono Antono, Pringgodigdo Nugroho

Jurnal Penyakit Dalam Indonesia

Introduction. Lower extremity peripheral artery disease (PAD) is one of diabetic macrovascular complication which has high rate of morbidity and mortality. Chronic inflammation has been known to have a role in the pathogenesis of PAD in diabetic patient. Recently, neutrophil lymphocyte ratio (NLR) has been used as a marker of chronic inflammation. This study aimed to determine the relationship between neutrophil lymphocyte ratio and lower extremity peripheral artery disease in type 2 diabetic patient in Cipto Mangunkusumo hospital. Methods. A cross sectional study was conducted on 249 patients with type 2 diabetes mellitus who underwent ankle brachial index (ABI) examination …


Cause Of The Low Positivity Of Blood Culture In Septic Patients, Krishna Yana, Bachti Alisjahbana, Yovita Hartantri Dec 2018

Cause Of The Low Positivity Of Blood Culture In Septic Patients, Krishna Yana, Bachti Alisjahbana, Yovita Hartantri

Jurnal Penyakit Dalam Indonesia

Introduction. Sepsis due to bacterial infection is one of the main causes of high disease morbidity and mortality. Management of sepsis, the detection of bacteriemia by examination of blood cultures has an important role, but until now the positivity of blood culture results at Hasan Sadikin Hospital (RSHS) is still low (13.45%). The purpose of this study was to determine profile the causes of low positivity of blood culture results in sepsis patients in RSHS. Methods. A cross sectional study was conducted on sepsis patient treated in Emergency Un it (ER) and inpatient of Hasan Sadikin hospital Internal Medicine from …


Herpes Zooster Induced Diabetic Ketoacidosis, Christopher Surya Suwita, Michael Johan, Dicky L. Tahapary, Budiman Darmowidjojo Dec 2018

Herpes Zooster Induced Diabetic Ketoacidosis, Christopher Surya Suwita, Michael Johan, Dicky L. Tahapary, Budiman Darmowidjojo

Jurnal Penyakit Dalam Indonesia

Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes which is common in daily practice. DKA is the result of severe insulin deficiency and often presents as the first symptom of an undiagnosed diabetes even though it may also appear in individuals with diabetes. Some conditions that can trigger DKA include infections, myocardial infarction, stroke, pancreatitis, trauma, or poor treatment compliance. Skin tissue infections such as herpes zoster are rare inciting factor in DKA. This article will discuss a case of DKA that is triggered by herpes zoster.


The Association Between D-Dimer Concentration And Laboratory Parameters For Plasma Leakage In Dengue Infection, Suhendro Suwarto, Riyanti Astrid Diahtantri, Elian Hudiya Sep 2018

The Association Between D-Dimer Concentration And Laboratory Parameters For Plasma Leakage In Dengue Infection, Suhendro Suwarto, Riyanti Astrid Diahtantri, Elian Hudiya

Jurnal Penyakit Dalam Indonesia

Introduction. Plasma leakage and activation of the coagulation system are the pathological hallmark of dengue hemorrhagic fever (DHF) that causes an increase in D-dimer concentration due to the degradation of fibrin clots. This study was conducted to determine the association between of D-dimer and laboratory parameters of plasma leakage, namely: thrombocytopenia, hypoalbuminemia, hemoconcentration and concentration serum glutamic oxaloacetic transaminase (SGOT) in dengue infected patients. Methods. A retrospective study was conducted at private hospitals in Jakarta, from December 2016 to March 2018. Patients >14 years with dengue infection and positive NS-1 were included in this study, and were classified into dengue …


Comparison Of Renal Safety Of Tenofovir And Telbivudine In Chronic Hepatitis B Patients: A Real World Study In Indonesia, Rino Alvani Gani Sep 2018

Comparison Of Renal Safety Of Tenofovir And Telbivudine In Chronic Hepatitis B Patients: A Real World Study In Indonesia, Rino Alvani Gani

Jurnal Penyakit Dalam Indonesia

Introduction. Tenofovir disoproxil fumarate (tenofovir) and telbivudine are two available nucleos(t)ide analogue (NA) for the treatment of chronic hepatitis B (CHB) patients. Tenofovir has been known as a nephrotoxic agent in HIV patients, but still controversy in CHB patients. On the other hand, telbivudine had a renal protective effect and increased estimated glomerular filtration rate (eGFR). This studi aimed to address the renal safety of tenofovir and telbivudine in Indonesian patients. Method. A retrospective cohort study design was conducted in CHB patients who prescribed with tenofovir or telbivudine from January 2013 to December 2016. Patients who hade baseline eGFR


The Differences Of Marital Satisfaction Of Odha Couples With And Without Depression Symptoms, Muhammad Ismail Salahudin, Alifiati Fitrikasari, Muchlis Achsan Udji Sofro, Hari Peni Julianti Sep 2018

The Differences Of Marital Satisfaction Of Odha Couples With And Without Depression Symptoms, Muhammad Ismail Salahudin, Alifiati Fitrikasari, Muchlis Achsan Udji Sofro, Hari Peni Julianti

Jurnal Penyakit Dalam Indonesia

Introduction. HIV/AIDS disease has caused physical, social, and emotional problems to infected individuals and their spouses. ODHA couples have a prevalence of depression symptoms with physical complaints, which amounted to 12.7%. There is a relationship between love, communication, and physical intimacy to satisfaction in marriage. Depression in ODHA couples is correlated with marital satisfaction. This study aimed to analyze the differences of marital satisfaction of ODHA HIV negative couples who experience depression symptoms with ODHA who do not experience depression symptoms Methods. The research design was cross-sectional. The samples were 52 official couples of ODHA aged 18-60 years who had …


Cedera Hati Hipoksik Pada Infark Miokard Akut, Chyntia Olivia Maurine Jasirwan Sep 2018

Cedera Hati Hipoksik Pada Infark Miokard Akut, Chyntia Olivia Maurine Jasirwan

Jurnal Penyakit Dalam Indonesia

No abstract provided.


Composite Lymphoma: Hodgkin And Non-Hodgkin Lymphoma A Case Report, Noorwati Soetandyo, Ruth Vonky Rebecca, Maria Yunti, Arry Harryanto Reksodiputro Sep 2018

Composite Lymphoma: Hodgkin And Non-Hodgkin Lymphoma A Case Report, Noorwati Soetandyo, Ruth Vonky Rebecca, Maria Yunti, Arry Harryanto Reksodiputro

Jurnal Penyakit Dalam Indonesia

Composite lymphoma (CL) is a rare disease. Composite lymphoma is two or more different type of lymphoma that sequentially or simultaneously occur in one anatomical site. Making a diagnosis of CL is a challenge and there is still no guidelines about the treatment. This case report is about a 36 y.o female with CL, sequentially consisted of Hodgkin and non-Hodgkin lymphoma.


Efficacy And Safety Of Oral Antidiabetic Drugs In Type 2 Diabetes Mellitus With Chronic Kidney Disease, Retta C. Sihotang, Rizka Ramadhani, Dicky L. Tahapary Sep 2018

Efficacy And Safety Of Oral Antidiabetic Drugs In Type 2 Diabetes Mellitus With Chronic Kidney Disease, Retta C. Sihotang, Rizka Ramadhani, Dicky L. Tahapary

Jurnal Penyakit Dalam Indonesia

No abstract provided.


Antibiotic Treatment Based On Guidelines For Reducing Length Of Stay (Los) In Patients With Community Acquired Pneumonia (Cap), Fetri Charya Munarsih, Ronald Irwanto Natadidjadja, Syamsudin Syamsudin Sep 2018

Antibiotic Treatment Based On Guidelines For Reducing Length Of Stay (Los) In Patients With Community Acquired Pneumonia (Cap), Fetri Charya Munarsih, Ronald Irwanto Natadidjadja, Syamsudin Syamsudin

Jurnal Penyakit Dalam Indonesia

Introduction. Community acquired pneumonia (CAP) now is known as the most common infection presented. Empiric antibiotic administered followed by observing parameters. This study aimed to know how far the American Thoracic Society/ Infectious Disease Society of America (ATS/IDSA) antibiotic guidelines 2007 based treatment influenced the length of stay (LOS) of CAP subject in a private hospital ward between January 2014-August 2015 Methods. A retrospective cohort was conducted with bivariate analysis and multivariate analysis for reducing the confounding factor. Sample taken with proportional sampling formula at ward in a hospital in Jakarta. Results. The result showed that subjects with unproper empiric …


Hypoxic Liver Injury As Predictor Of Major Adverse Cardiac Events In Acute Myocardial Infarction Patients Admitted To Intensive Coroner Care Unit Of Cipto Mangunkusumo National General Hospital, Muhadi Muhadi, Nurhayati Adnan Prihartono Sep 2018

Hypoxic Liver Injury As Predictor Of Major Adverse Cardiac Events In Acute Myocardial Infarction Patients Admitted To Intensive Coroner Care Unit Of Cipto Mangunkusumo National General Hospital, Muhadi Muhadi, Nurhayati Adnan Prihartono

Jurnal Penyakit Dalam Indonesia

Introduction. Major adverse cardiac events (MACE) is a complicating myocard infarct which consist of acute heart failure, cardiogenic shock, and fatal arrhytmia. An accurate, easy and cost-effective biomarker is needed to predict MACE and mortality in patients with myocard infarct. Hypoxic liver injury (HLI) is a potential biomarker using serum glutamic-oxaloacetic transaminase (SGOT) level as the parameter. This study is aimed to discover HLI’s role in predicting MACE in non ST elevation myocard infarct (NSTEMI). Methods. This study was designed as cross sectional to predict MACE and prospective cohort for survival analysis. Study population was all NSTEMI patients admitted to …


Validation Of A2ds2 Score As Predictor Of Pneumonia Among Patients Hospitalized For Acute Ischemic Stroke, Toman Nababan, Ceva Wicaksono Pitoyo, Salim Harris, Cleopas Martin Rumende Sep 2018

Validation Of A2ds2 Score As Predictor Of Pneumonia Among Patients Hospitalized For Acute Ischemic Stroke, Toman Nababan, Ceva Wicaksono Pitoyo, Salim Harris, Cleopas Martin Rumende

Jurnal Penyakit Dalam Indonesia

Introduction. Pneumonia is the leading cause of morbidity and mortality in acute ischemic stroke patients admitted to hospital. Thus required a valid scoring system which is easy to apply, to predict and stratify the risk of pneumonia in patients with acute ischemic stroke. This study aimed to assess the performance of calibration and discrimination of A2 DS2 score in predicting the incidence of pneumonia in patients with acute ischemic stroke. Methods. A retrospective cohort study was conducted among adult acute ischemic stroke patients who are hospitalized in Cipto Mangunkusumo Hospital, Jakarta. Age, atrial fibrillation, dysphagia, sex (male), and stroke severity …


Pemeriksaan Prokalsitonin Pada Penyakit Infeksi, Erni Juwita Nelwan Jun 2018

Pemeriksaan Prokalsitonin Pada Penyakit Infeksi, Erni Juwita Nelwan

Jurnal Penyakit Dalam Indonesia

Penegakkan diagnosis infeksi pada seorang pasien tidak selamanya mudah untuk dilakukan. Upaya ini harus selalu dimulai dari melakukan anamnesis yang terarah, pemeriksaan fisik yang menyeluruh ditambah dengan pemeriksaan laboratorium yang sesuai dengan kecurigaan tempat terjadinya infeksi.


The Distinction In Level Of Stress, Anxiety, And Depression Between Efavirenz With Nevirapine Therapies (Study On Hiv/Aids-Infected Patients At Vct-Cst Clinic Dr.Kariadi Hospital Semarang), Muflihatunnaimah Muflihatunnaimah, Alifiati Fitrikasari, Muchlis Achsan Udji Sofro Jun 2018

The Distinction In Level Of Stress, Anxiety, And Depression Between Efavirenz With Nevirapine Therapies (Study On Hiv/Aids-Infected Patients At Vct-Cst Clinic Dr.Kariadi Hospital Semarang), Muflihatunnaimah Muflihatunnaimah, Alifiati Fitrikasari, Muchlis Achsan Udji Sofro

Jurnal Penyakit Dalam Indonesia

No abstract provided.


Correlation Between Rheumatoid Factor And Vascular Cell Adhesion Molecule-1 Levels In Rheumatoid Arthritis Patients Without Metabolic Syndrome, Reza Yogaswara, Rudy Hidayat, Muhadi Muhadi, Ikhwan Rinaldi Jun 2018

Correlation Between Rheumatoid Factor And Vascular Cell Adhesion Molecule-1 Levels In Rheumatoid Arthritis Patients Without Metabolic Syndrome, Reza Yogaswara, Rudy Hidayat, Muhadi Muhadi, Ikhwan Rinaldi

Jurnal Penyakit Dalam Indonesia

No abstract provided.


Bone Marrow Tuberculosis In Severe Systemic Lupus Erythematosus: A Case Study, Vinandia Irvianita Poespitasari, Anastasia Asylia Dinakrisma, Raden Mas Suryo Anggoro Jun 2018

Bone Marrow Tuberculosis In Severe Systemic Lupus Erythematosus: A Case Study, Vinandia Irvianita Poespitasari, Anastasia Asylia Dinakrisma, Raden Mas Suryo Anggoro

Jurnal Penyakit Dalam Indonesia

No abstract provided.


Relationship Between Serum Interferon Gamma Level With Sputum Positivity Of Acid-Fast Bacillus In New Case Pulmonary Tuberculosis, Andi Khomeini Takdir, Erwin Arief, Nur Ahmad Tabri, Arifin Seweng Jun 2018

Relationship Between Serum Interferon Gamma Level With Sputum Positivity Of Acid-Fast Bacillus In New Case Pulmonary Tuberculosis, Andi Khomeini Takdir, Erwin Arief, Nur Ahmad Tabri, Arifin Seweng

Jurnal Penyakit Dalam Indonesia

No abstract provided.


Endoscopic Management Of Esophageal Strictures, Ahmad Hazim, Murdani Abdullah Jun 2018

Endoscopic Management Of Esophageal Strictures, Ahmad Hazim, Murdani Abdullah

Jurnal Penyakit Dalam Indonesia

No abstract provided.


Performance Of Combination Of Symptoms, Chest X-Rays And Mgit 960 Culture For Diagnosis Of Pulmonary Tuberculosis In Hiv Patients, Desi Salwani, Ujainah Zaini Nasir, Evy Yunihastuti, Kuntjro Harimurti, Andriansjah Andriansjah Jun 2018

Performance Of Combination Of Symptoms, Chest X-Rays And Mgit 960 Culture For Diagnosis Of Pulmonary Tuberculosis In Hiv Patients, Desi Salwani, Ujainah Zaini Nasir, Evy Yunihastuti, Kuntjro Harimurti, Andriansjah Andriansjah

Jurnal Penyakit Dalam Indonesia

No abstract provided.


The Role Of Clinical Sign And The Added Value Of Procalcitonin In Determining The Existance Of Infection In The Treated Diabetic Foot Ulcer, Andra Aswar, Em Yunir, Anis Karuniawati, Kuntjoro Harimurti Jun 2018

The Role Of Clinical Sign And The Added Value Of Procalcitonin In Determining The Existance Of Infection In The Treated Diabetic Foot Ulcer, Andra Aswar, Em Yunir, Anis Karuniawati, Kuntjoro Harimurti

Jurnal Penyakit Dalam Indonesia

No abstract provided.


Determinant Factors And Added Value Of Osteoprotegerin (Opg) To Detect Carotid Intima-Media Thickness (Cimt) In Type 2 Diabetes Mellitus Patient, Shirly Elisa Tedjasaputra, Em Yunir, Ika Prasetya Wijaya, Siti Setiati Jun 2018

Determinant Factors And Added Value Of Osteoprotegerin (Opg) To Detect Carotid Intima-Media Thickness (Cimt) In Type 2 Diabetes Mellitus Patient, Shirly Elisa Tedjasaputra, Em Yunir, Ika Prasetya Wijaya, Siti Setiati

Jurnal Penyakit Dalam Indonesia

No abstract provided.


Association Between Thyroid Status And Glucose Intolerance Inhyperthyroid Patients, Wismandari Wisnu, Pradana Soewondo, Imam Subekti Mar 2018

Association Between Thyroid Status And Glucose Intolerance Inhyperthyroid Patients, Wismandari Wisnu, Pradana Soewondo, Imam Subekti

Jurnal Penyakit Dalam Indonesia

Introduction. The most common endocrinopathy in adults are diabetes mellitus (DM) and thyroid disease. Hyperthyroidism decreases blood glucose control and increased the need of insulin. However, the mechanism of abnormal glucose metabolism in hyperthyroidism is not fully understood. This study aims to determine the relationship of thyroid status with incidence of glucose intolerance in hyperthyroid patients compared to hyperthyroid patients who have achieved clinical status of eutyroid and normal population. Methods. This study was cross sectional design in outpatients with hyperthyroidism in hyperthyroid and euthyroid/subclinical hyperthyroid status, and healthy volunteers who had matching age and sex. An oral glucose test …


Pemeriksaan Bilasan Lambung: Alternatif Diagnostik Tuberkulosis Pada Pasien Hiv Dewasa?, Evy Yunihastuti Mar 2018

Pemeriksaan Bilasan Lambung: Alternatif Diagnostik Tuberkulosis Pada Pasien Hiv Dewasa?, Evy Yunihastuti

Jurnal Penyakit Dalam Indonesia

No abstract provided.


Association Of Clinical Features And Hematological Laboratoriesbetween Ph (+)/Bcr-Abl (+) Chronic Myeloid Leukemia And Other Type Of Ph/Bcr-Abl Chronic Myeloid Leukemia, Wulyo Rajabto, A. Harryanto, Hilman Tadjoedin, Kuntjoro Harimurti Mar 2018

Association Of Clinical Features And Hematological Laboratoriesbetween Ph (+)/Bcr-Abl (+) Chronic Myeloid Leukemia And Other Type Of Ph/Bcr-Abl Chronic Myeloid Leukemia, Wulyo Rajabto, A. Harryanto, Hilman Tadjoedin, Kuntjoro Harimurti

Jurnal Penyakit Dalam Indonesia

Introduction. Patients with chronic phase Chronic Myeloid Leukemia (CML) at Hematology-Medical Oncology Clinic Department of Internal Medicine dr. Cipto Mangunkusumo National Hospital who haveperformed cytogenetic and RTPCR BCR-ABL examination showed: Ph (+)/BCR-ABL (+) CML and other type of Ph/BCR-ABL CML. This study aims to identify the clinical features and hematological laboratories of chronic phase CML, the proportion of Ph (+)/BCR-ABL (+) CML, and association of clinical features and hematological laboratories between Ph (+)/BCR-ABL (+) CML and other type of Ph/ BCR-ABL CML. Methods. This is a cross-sectional study. The samples were taken by consecutive method. We used Chi-square test and …


Validation Of C-Reactive Protein And Curb-65 In The Firsthospital Admission Community Acquired Pneumonia Patient Asa Predictor 30 Days Mortality, Borries Foresto Buharman, Ceva Wicaksono Pitoyo, Gurmeet Singh, Sukamto Koesnoe Mar 2018

Validation Of C-Reactive Protein And Curb-65 In The Firsthospital Admission Community Acquired Pneumonia Patient Asa Predictor 30 Days Mortality, Borries Foresto Buharman, Ceva Wicaksono Pitoyo, Gurmeet Singh, Sukamto Koesnoe

Jurnal Penyakit Dalam Indonesia

Child Turcotte Pugh Score, diastolic dysfunction, liver cirrhosis, liver dysfunction