bluuebunny/crossref_metadata_2025_split huggingface dataset:
PENGARUH LATIHAN FISIK AKUT TERHADAP KADAR GULA DARAH PADA MAHASISWA FAKULTAS KEDOKTERAN UNIVERSITAS SAM RATULANGI MANADO
Authors: Matindas Willem R. , Supit Siantan , Engka Joice N. A. 
Published: July 2019

Abstract: Physical exercise can influence body metabolism. The Harvard test is a simple method used in determining physical fitness. This test is performed by stepping up and down on a bench for certain periods of times. This study aimed to compare the levels of blood glucose of medical students of Sam Ratulangi University aged 20-22 years before and after performing the Harvard test. This was a field experimental study with One Group Pre-Post Test Design. The respondents were 35 students consisting of 22 males and 13 females who met the inclusion criteria. They were instructed to perform the Harvard test for five minutes and then were examined for blood glucose levels. The data were analyzed by using a t-test. The results showed an increase of the mean blood glucose levels from 75.80 mg/dL (before acute physical exercise) to 77.71 mg/dL (after acute physical exercise), but it was not statistically significant (P > 0.05). Conclusion: The acute physical exercise (the Harvard test) had no effect on before or after-exercise blood sugar levels. Keywords: acute physical exercise, Harvard test, blood sugar level Abstrak: Latihan fisik dapat mempengaruhi metabolisme tubuh. Harvard test merupakan latihan fisik berupa naik turun bangku yang dilakukan dalam kurun waktu tertentu. Penelitian ini bertujuan untuk membandingkan kadar gula darah sebelum dan sesudah diberikan latihan fisik akut (Harvard test) pada mahasiswa Fakultas Kedokteran Unsrat dengan kisaran usia 20-22 tahun. Jenis penelitian ini bersifat eksperimental lapangan dengan rancangan One Group Pre-Post Test Design. Subyek penelitian sebanyak 35 mahasiswa, terdiri dari 22 laki-laki dan 13 perempuan yang memenuhi kriteria inklusi. Semua subyek diberikan latihan fisik akut (Harvard test) selama lima menit dan kemudian dilakukan pemeriksaan kadar gula darah. Data statistik di analisis mengunakan uji-t. Hasil penelitian memperlihatkan terjadinya peningkatan rerata kadar gula darah dari 75,80 mmHg (sebelum latihan fisik akut) menjadi 77,71 mmHg (sesudah latihan fisik akut) yang secara statistik tidak bermakna (P > 0,05). Simpulan: Latihan fisik akut (Harvard test) tidak memengaruhi kadar gula darah sebelum dan sesudah latihan. Kata kunci: latihan fisik akut, Harvard test, kadar gula darah.
PENGARUH SENAM BUGAR LANJUT USIA TERHADAP KADAR KOLESTEROL
Authors: Pontoh Li Ping , Pangemanan Damajanty H. C. , Wungouw Herlina I. S. 
Published: July 2019

Abstract: Risks of coronary heart diseases (CHD), degenerative diseases, and metabolic disorders have increased in the elderly. Exercise and physical activity are beneficial to improve their physical fitness which can prevent or delay the occurences of the diseases. This study aimed to determine the effect of aerobic exercise for the eldery on blood cholesterol levels. This was a field experimental study with one group pre-post test design. Subjects were elderly who lived in BPLU Senja Cerah Manado. Blood cholesterol examinations were carried out before and after excercise. Thirty elderly were treated with elderly aerobic exercise routinely 3 times weekly for 3 consecutive weeks. Data were analyzed by using paired sample t-tests. The results showed that the mean cholesterol levels of the elderly before the designated exercise was 236.23 mg/dL and after the excercise was 195.63 mg/dL. Conclusion: The elderly aerobic exercises reduced blood cholesterol levels of the elderly. Keywords: elderly, exercise, cholesterol, elderly aerobic exercise. Abstrak: Pada lanjut usia (lansia) terdapat peningkatan risiko penyakit jantung koroner (PJK), berbagai penyakit degeneratif, serta gangguan metabolisme. Kebugaran jasmani lansia sangat dibutuhkan untuk mencegah atau menunda perlangsungan penyakit-penyakit tersebut. Olahraga dan aktifitas fisik merupakan salah satu solusi untuk meningkatkan kebugaran jasmani. Penelitian ini bertujuan untuk mengetahui pengaruh senam bugar lansia terhadap kadar kolesterol darah. Penelitian ini bersifat eksperimental lapangan dengan rancangan pre-post one group test. Subyek penelitian ialah lansia yang berdiam di BPLU Senja Cerah Manado. Pengambilan darah dilakukan sebelum dan sesudah diberikan perlakuan. Subyek penelitian sejumlah 30 orang lansia yang diberi perlakuan berupa senam bugar lansia secara rutin 3 kali seminggu selama 3 minggu. Analisis statistik menggunakan paired sample t-test untuk menentukan pengaruh senam bugar lansia terhadap kadar kolesterol sebelum dan sesudah perlakuan dengan α = 0,05. Hasil penelitian menunjukkan bahwa rerata kadar kolesterol sebelum senam bugar lansia 236,23 mg/dL sedangkan sesudah senam bugar lansia selama 3 minggu 195,63 mg/dL. Simpulan: Senam bugar lansia yang dilakukan secara teratur dapat menurunkan kadar kolesterol darah pada lansia. Kata kunci: lansia, olahraga, kolesterol, senam bugar lansia.
PROFIL CONTENT SCALES MINNESOTA MULTIPHASIC PERSONALITY INVENTORY-2 (MMPI-2) ADAPTASI INDONESIA PADA MAHASISWA SEMESTER 5 TA 2012/2013 FAKULTAS KEDOKTERAN UNIVERSITAS SAM RATULANGI MANADO
Authors: Astuti Dwi W. P. , Kairupan Barnabas H. R. , Elim Christofel 
Published: July 2019

Abstract: Stress factors derived from academic and non-academic aspects can cause mental disorders in medical students. Mental disorders can lead to the impairment of student cognitive development and learning, as well as impact on the performance or functionality as a doctor later. This study aimed to determine the mental status profile of the fifth semester students of the Faculty of Medicine University of Sam Ratulangi, Manado, by using the content scales of MMPI-2 mental health tests. This was a descriptive study using a cross-sectional design. A hundred students who were randomly selected had to fill in the MMPI-2 questionnaires. A univariate analysis was conducted to analyze the data by using the SPSS version 20. The results showed that of the total respondents the majority (56%) were 20 years old; females were 53%; from outside of North Sulawesi were those from tribes (66%), and regions (56%). The siblings (2 brothers) represented 38% while the second born 37%. Most parents worked as civil servants: 46% fathers, 49% mothers. All content scales showed a high profile with the greatest percentages on scales SOD (32%) and WRK (30%). Based on the high score of content scales, the most prominent content component scales were SOD₁ (84.4%) and TRT₁ (62.5%). Conclusion: The profile of mental disorders among the fifth semester students of the Faculty of Medicine, University of Sam Ratulangi Manado, was generally low. Keywords: Content Scales, students, MMPI-2. Abstrak: Faktor-faktor stres yang berasal dari aspek akademik maupun non-akademik dapat menimbulkan gangguan mental pada mahasiswa kedokteran, yang berakibat lanjut berupa gangguan perkembangan kognitif dan belajar yang berdampak pada prestasi sekaligus fungsionalitas mereka sebagai dokter nanti. Penelitian ini bertujuan untuk mengetahui profil status mental mahasiswa semester 5 FK Universitas Sam Ratuilangi Manado berdasarkan content scales pada tes kesehatan mental MMPI-2. Penelitian ini bersifat deskriptif dengan cross-sectional design. Kuesioner MMPI-2 dibagikan pada 100 sampel mahasiswa yang dipilih secara acak. Analisis univariat dilakukan menggunakan program SPSS 20. Hasil penelitian menunjukkan sebagian besar responden berusia 20 tahun (56%), jenis kelamin perempuan (53%), berasal dari suku dan daerah di luar Sulawesi Utara (66% dan 56%), 2 bersaudara dan anak ke-2 dalam keluarga (38% dan 37%), dengan pekerjaan orang tua terbanyak PNS (46% dan 49%). Semua content scales menunjukkan profil tinggi dengan presentase yang terbesar pada skala SOD (32%) dan WRK (30%). Berdasarkan skor tinggi content scales, content component scales yang paling menonjol ialah SOD₁ (84,4%) dan TRT₁ (62,5%). Simpulan: Profil gangguan mental pada mahasiswa semester 5 Fakultas Kedokteran Universitas Sam Ratulangi Manado secara umum rendah. Kata kunci: content scales, mahasiswa, MMPI-2.
GAMBARAN ERUPSI GIGI DESIDUI BERDASARKAN STATUS GIZI ANAK USIA 6-24 BULAN DI PUSKESMAS BAHU
Authors: Sangande Chandra , Kawengian Shirley E. S. , S. Anindita P. 
Published: July 2019

Abstract: Nutritional status is the health status generated by a balance between the needs and input of nutrients. Children aged 6-24 months have a period of growth and development of deciduous teeth that is very important. Delayed deciduous tooth eruption in children is one impact of malnutrition. This study aimed to reveal deciduous tooth eruptions based on the nutritional status of children aged 6-24 months in Bahu Health Center. This was a descriptive study. Samples were obtained by using a purposive sampling method. Examinations of teeth eruptions were carried out by looking at deciduous teeth that had erupted. Nutritional status was assessed using the indicator of weight for age (W/A). Data of age were calculated using the z-score. Concerning their nutritional status, the results showed that 0.86% of the samples were overweight; 82.60% were well-nourished; 13.04% were less-nourished; and 3.47% suffered from malnutrition. Furthermore, related to their nutritional status, the percentages of the children who experienced complete deciduous teeth eruption were as follow: 100% in overweight, 21.05% in well-nourished, 40.00% in less-nourished, and 0.00% in malnutrition. Conclusion: Most of the children aged 6-24 months in Bahu Health Center were well-nourished. Complete deciduous teeth eruption were found in a single overweight child, a part of well-nourished and less-nourished children, and none in malnutrition children. Keywords: deciduous teeth, tooth eruption, nutritional status. Abstrak: Status gizi ialah status kesehatan yang dihasilkan oleh keseimbangan antara kebutuhan dan asupan nutrisi. Anak berusia 6-24 bulan memiliki masa pertumbuhan dan perkembangan gigi desidui yang sangat penting untuk diperhatikan. Keterlambatan erupsi gigi desidui pada anak merupakan salah satu akibat kekurangan gizi. Penelitian ini bertujuan untuk mengetahui gambaran erupsi gigi desidui berdasarkan status gizi anak usia 6-24 bulan di Puskesmas Bahu. Penelitian ini bersifat deskriptif. Pemilihan sampel dilakukan dengan cara purposive sampling. Pemeriksaan erupsi gigi dilakukan dengan melihat gigi desidui yang telah erupsi. Status gizi dinilai dengan indikator berat badan menurut usia (BB/U), pengambilan data usia, kemudian dihitung dalam nilai z-skor. Hasil penelitian menunjukkan subyek dengan status gizi lebih 0,86%; status gizi baik 82,60%; status gizi kurang 13,04%; dan status gizi buruk 3,47%. Erupsi gigi desidui lengkap ditemukan pada subyek dengan status gizi lebih 100,00%; status gizi baik 21,05%; status gizi kurang 40%; dan status gizi buruk 0,00%. Simpulan: Sebagian besar anak berusia 6-24 bulan di Puskesmas Bahu memiliki status gizi baik. Erupsi gigi desidui lengkap ditemukan pada anak dengan status gizi lebih serta sebagian anak dengan status gizi baik dan kurang, tetapi tidak ditemukan pada anak dengan status gizi buruk. Kata kunci: gigi desidui, erupsi gigi, status gizi.
REHABILITASI MEDIK PADA HEMOFILIA
Authors: Yoshua Vincentius , Angliadi Engeline 
Published: July 2019

Abstract: Haemophilia is an inherited disorder of blood coagulation with sex-linked recessive and autosomal recessive characteristics. It may manifest itself by prolonged bleeding (internal or external) and clotting formation disturbances that need a multidiciplinary management. This disease is initiated at the neonatal stage. The diagnosis is based on anamnesis, physical examination, and other supporting examinations, such as homeostasis functions. The most common complications are found in the musculoskeletal system and auto-antibody (inhibitor) reaction against clotting factors VIII or IX. A pharmacological approach to haemophilia depends on the clinical signs, but medical rehabilitation’s approach is focused on all life aspects of the patient. This approach has to be done as early as possible to avoid threatening disabilities and handicaps affecting the musculoskeletal system. Team work is needed to achieve a minimalization of musculoskeletal complications and to realize a more promising better prognosis. Keywords: haemophilia, complications, bleeding, musculoskeletal, rehabilitation. Abstrak: Hemofilia adalah kelainan pembekuan darah dengan karakteristik sex-linked resesif dan autosomal resesif, disertai masalah perdarahan dan kelainan pembekuan yang memerlukan penanganan multidisipliner. Gejala yang paling sering terjadi ialah perdarahan, baik di dalam tubuh (internal bleeding) maupun di luar tubuh (external bleeding). Perjalanan penyakitnya sendiri sudah dimulai dari masa neonatal. Diagnosis dapat ditegakkan dari anamnesis, pemeriksaan fisik dan pemeriksaan penunjang berupa pemeriksaan fungsi homeostasis. Komplikasi yang paling sering ditemukan ialah komplikasi muskuloskeletal dan reaksi auto-antibodi (inhibitor) terhadap faktor pembekuan darah sendiri baik terhadap faktor VIII atau faktor IX. Pendekatan farmakologik pada hemofilia tergantung dari gejala klinis yang muncul namun pendekatan rehabilitasi medik pada hemofilia tidak tergantung gejala klinis yang muncul karena pendekatan ini lebih difokuskan ke seluruh aspek kehidupan pasien hemofilia. Pendekatan ini sudah harus dilakukan sejak dini mengingat komplikasi yang mungkin ditimbulkan, yang dapat menyebabkan disabilitas dan handicap, tersering akibat komplikasi muskuloskeletal. Dengan penanganan rehabilitasi medik yang berbasis pendekatan tim, diharapkan komplikasi muskuloskeletal dapat diminimalisasikan dan prognosis pasien hemofilia dapat lebih baik. Kata kunci: hemofilia, komplikasi, perdarahan, muskuloskeletal, rehabilitasi.
THE IMPACT OF METABOLIC SYNDROME ON RADIAL ARTERY DIAMETERS
Authors: Luntungan Marshell , Purabaya Andhi , Budiono Bambang , Pangemanan Janry A. , Lefrandt Reginald L. 
Published: July 2019

Abstrak: Dewasa ini akses arteri radialis telah digunakan secara luas pada intervensi koroner transkateter. Pada pasien sindroma metabolik (MetS) yang berisiko tinggi diabetes melitus tipe 2 (DMT2), proses aterosklerosis sistemik telah memengaruhi struktur arteri radialis. Penelitian ini bertujuan untuk menentukan faktor-faktor yang berpengaruh terhadap diameter arteri radialis pada pasien MetS. Penelitian ini bersifat prospektif dan dilaksanakan di Laboratorium Kateterisasi Rumah Sakit Awal Bros Makassar sejak 1 Januari sampai dengan 15 Ferbuari 2013 (45 hari). Hasil penelitian memperlihatkan bahwa dari 40 pasien yang menjalani prosedur angiografi koroner melalui akses transradial, 22 di antaranya (55%) menyandang MetS. Rerata diameter arteri radialis pada kelompok pasien MetS dan non-MetS ialah 2,13 mm dan 2 mm. Lingkar pinggang, lingkar pergelangan, kolesterol total, HDL-C, dan trigliserida berbeda secara bermakna antara kedua kelompok. Analisis statistik dengan regresi linear menunjukkan korelasi bermakna antara diameter arteri radialis terhadap usia saja (r = 0,185; P < 0,05). Simpulan: Terdapat korelasi bermakna antara diameter arteri radialis dengan usia, dan tidak dengan faktor lainnya. Kata kunci: diameter arteri radialis, sindroma metabolik. Abstract: Nowadays, radial artery access is widely used as a route for transcatheter coronary interventions. Albeit, in metabolic syndrome (MetS) patients who are at high risks of developing type 2 diabetes mellitus, the systemic atheroslerosis process may have influenced the radial artery structures. This study aimed to determine factors that might influence the radial artery diameters in MetS patients. This was a prospective study conducted in the Catheterization Laboratory Awal Bros Hospital Makassar from 1st January until 15th Febuary 2013 (45 days). The results showed that in this study there were 40 consecutive patients who underwent coronary angiography procedures using the transradial apporach, of these 22 patients (55%) were with MetS. The mean radial artery diameters in MetS and non-MetS patients were 2.13 mm and 2 mm, respectively. The waist circumference, wrist circumference, total cholesterol, HDL-C, and triglyceride were significantly different between the two groups. The data were analyzed by using a linear regression resulting in radial artery diameters (RAD) which were significantly and positively correlated only with age among the MetS subjects (r = 0.185, P < 0.05). Conclusion: Among the metabolic syndrome patients radial artery diameters were only significantly correlated to ages, and not other factors. Keywords: radial artery diameter, metabolic syndrome.
KORELASI ANTARA INTERVAL S2-OPENING SNAP DAN MITRAL VALVE AREA YANG DIIDENTIFIKASI DENGAN COLOR SPECTROGRAPH PHONOCARDIOGRAPHY PADA PASIEN MITRAL STENOSIS
Authors: Suhartono Iman Y. , Ransun Terrance , Kawilarang Michael S. , Moeljono Elfan , Tedjo Fonny M. , Panda Agnes L. , Awaloei Jan H. , Lefrandt Reginald L. 
Published: July 2019

Abstract: Color spectrograph phonocardiography (CSP) is a method for recording heart sounds by using a digital stethoscope. The recorded result can be analyzed by using a soft ware. CSP can identify the opening snap (OS) and measure the S2-OS interval. This study aimed to determine the correlation between adjusted S2-OS to the mitral valve area (MVA) in mitral stenosis (MS) patients. The samples were MS patients admitted to the ICCU and the ward of Prof. Dr. R.D. Kandou Hospital, Manado. Patients with atrial fibrillation were excluded. Every patient underwent echocardiography and CSP to obtain the MVA and S2-OS interval. The adjusted S2-OS interval is the S2-OS interval divided by the number of heart beats (milisecond/beat per minute). Variables were analyzed by using the Pearson correlation test. The results showed that there were 14 MS patients involved in this study. There was a strong correlation between adjusted S2-OS interval and MVA. Estimated MVA was obtained by using the formula MVA = -1.358 + 2.07. Conclusion: The adjusted S2-OS interval was strongly correlated to the MVA of MS Patients and could predict the MVA value. Keywords: color spectrograph phonocardiography, S2-OS interval, mitral valve area, mitral stenosis, echocardiography. Abstrak: Color spectrograph phonocardiography (CSP) merupakan metode merekam bunyi jantung dengan menggunakan stetoskop digital. Hasil rekaman ini dapat dianalisis dengan piranti lunak. CSP dapat mengidentifikasi opening snap (OS) dan mengukur interval S2 – OS. Penelitian ini bertujuan untuk mendeteksi korelasi antara interval S2-OS yang sudah disesuaikan dengan mitral valve area (MVA) pada pasien mitral stenosis (MS). Sampel penelitian ialah pasien mitral stenosis yang dirawat di ICCU dan bangsal BLU RSUP Prof. Dr. R.D. Kandou Manado. Pasien dengan atrial fibrilasi dieksklusi. Masing-masing pasien menjalani pemeriksaan echocardiography dan CSP untuk memperoleh MVA dan interval S2-OS. Interval S2-OS yang telah disesuaikan adalah interval S2-OS yang dibagi dengan denyut jantung (milidetik/denyut jantung per menit). Variabel-variabel tersebut dianalisis dengan menggunakan analisis korelasi Pearson. Hasil penelitian memperlihatkan sebanyak 14 pasien mitral stenosis diikutsertakan dalam penelitian. Terdapat korelasi sangat kuat antara interval S2-OS yang telah disesuaikan dengan MVA. Estimasi MVA dapat diperoleh dari persamaan MVA = -1,358 + 2,07.(Interval S2-OS yang telah disesuaikan). Simpulan: Interval S2-OS yang telah disesuaikan memiliki korelasi yang sangat kuat dengan MVA pada pasien-pasien mitral stenosis. Interval S2-OS yang telah disesuaikan dapat memperkirakan nilai MVA. Kata kunci: color spectrograph phonocardiography, interval S2-OS, mitral valve area, mitral stenosis, echocardiography.
METABOLISME LIPOPROTEIN
Authors: Jim Edmond L. 
Published: July 2019

Abstract: Lipid is a hydropobic substance. Thence, it needs a transporter protein called apoprotein. This lipid together with its apoprotein is called lipoprotein which is needed to deliver lipids to and from body tissues to produce energy. Based on their density, there are six types of lipoproteins: chylomicron, VLDL, IDL, LDL, HDL, and Lp(a). The metabolism of lipoproteins consists of three pathways: the exogenic pathway that produces chylomicron; the endogenic pathway that produces VLDL, IDL, and LDL; and the reverse cholesterol transport that produces HDL. Keywords: lipoprotein, lipid, apoprotein, protein. Abstrak: Lipid umumnya bersifat hidrofobik, oleh karena itu diperlukan protein pengangkut yang disebut apoprotein. Senyawa lipid bersama apoprotein disebut lipoprotein. Kompleks lipoprotein diperlukan agar lipid dapat disalurkan ke dan dari jaringan tubuh untuk menghasilkan energi. Lipoprotein dapat dibedakan berdasarkan densitas yaitu kilomikron, VLDL, IDL, LDL, HDL, dan Lp(a). Terdapat tiga jalur metabolisme lipoprotein, yaitu: jalur eksogen yang menghasilkan kilomikron; jalur endogen yang menghasilkan VLDL, IDL, dan LDL; dan reverse cholesterol transport yang menghasilkan HDL. Kata kunci: lipoprotein, lipid, apoprotein, protein.
DIAGNOSIS DAN PENATALAKSANAAN CEDERA SERVIKAL MEDULA SPINALIS
Authors: Maja Junita P. S. 
Published: July 2019

Abstract: Spinal cord injury is a traumatic lesion of the spinal cord which causes neurological disorders. The symptoms vary from pain, paralysis, and the occurence of incontinence, depending on the location of the injured spinal cord. The damage of the spinal cord may be incomplete or complete. We reported a 55-year-old male with his main complaint being weakness throughout all four limbs which occured after a fall with a hyperextended neck position. At the time of admission, the duration of injury was 12 hours. Physical examinations showed motoric and sensoric disorders, without any autonomic abnormalities. Cervical radiographics and a CT scan revealed no abnormalities, whereas the MRI images showed a contusion at C3. The management of this case included stabilization of the neck, a protocol treatment for cervical injuries, an administration of a high-dose of methylprednisolone, prevention of complications, and a regular session of physiotherapy. During treatment, the patient showed a significant progression in both motoric and sensoric functions. Conclusion: Based on all the tests performed and the follow-up, the diagnosis of this case was central cord syndrome (CCS) due to incomplete cervical medulla spinalis injury. Keywords: cervical injury, spinal cord, diagnosis, treatment Abstrak: Trauma medula spinalis adalah trauma pada tulang belakang yang menyebabkan lesi di medula spinalis sehingga menimbulkan gangguan neurologik. Gejala-gejala dapat bervariasi mulai dari nyeri, paralisis sampai terjadinya inkontinensia, dan sangat bergantung pada lokasi medula spinalis yang mengalami cedera. Kerusakan medula spinalis dapat bersifat “inkomplit” dan “komplit”. Kami melaporkan kasus seorang laki-laki 55 tahun dengan kelemahan keempat anggota gerak yang terjadi setelah terjatuh dengan posisi leher yang hiperekstensi. Saat masuk rumah sakit, cedera sudah berlangsung selama 12 jam. Pada pemeriksaan fisik ditemukan gangguan motorik dan sensorik, sedangkan otonom tidak ditemukan kelainan. Gambaran radiologik foto servikal dan CT-Scan servikal tidak terdapat kelainan, sedangkan pada MRI tampak gambaran kontusio di segmen medula spinalis C3. Penanganan pada kasus ini yaitu stabilisasi leher, tatalaksana umum untuk cedera leher, pemberian metilprednisolon dosis tinggi, pencegahan komplikasi yang muncul, dan fisioterapi yang teratur. Selama perawatan pasien menunjukkan kemajuan yang berarti, baik dari fungsi motorik maupun sensorik. Simpulan: Berdasarkan hasil pemeriksaan yang telah dilakukan dan pemantauan lanjut selama perawatan, diagnosis yang ditegakkan ialah central cord syndrome (CCS) akibat cedera medula spinalis servikal inkomplit. Kata kunci: cedera servikal, medula spinalis, diagnosis, tatalaksana