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"Malnutrisi energi dan protein merupakan suatu masalah umum yang ditemukan pada pasien rawat inap di rumah sakit. Berbagai studi menunjukkan sebanyak 40% pasien bedah sudah mengalami malnutrisi pada saat masuk ke rumah sakit. Studi tersebut menunjukkan terdapat hubungan langsung antara penurunan berat badan pra bedah dengan laju mortalitas pasca bedah. Terapi nutrisi perioperatif yang adekuat telah dilaporkan dapat menurunkan laju morbiditas dan menurunkan masa rawat inap secara bermakna. Serial kasus ini terdiri atas empat kasus terapi nutrisi perioperatif pada pasien malnutrisi dengan kanker periampular yang menjalani pembedahan pankreatikoduodenektomi. Pasien adalah laki-laki, berusia antara 40-60 tahun, dengan kanker periampular (pankreas dan ampula Vateri). Keempat pasien kasus ini mengalami sindrom kaheksia-kanker, yaitu ditemukan penurunan BB sebesar 10-15% dalam ena bulan terakhir, anemia, fatigue, dan hipoalbuminemia. Kebutuhan energi total dihitung dengan menggunakan persamaan Harris-Bennedict dengan menambahkan faktor stres sebesar 1,5. Pemberian kalori dan nutrisi dilakukan secara bertahap dan ditingkatkan sesuai dengan perbaikan keadaan klinis, gastrointestinal, dan toleransi asupan pasien. Pemantauan dan evaluasi pasien dilakukan sesuai dengan perubahan subyektif dan obyektif. Selain itu, konseling dan edukasi mengenai terapi nutrisi diberikan setiap hari pada pasien. Selama perawatan, keempat pasien serial kasus ini menunjukkan perbaikan, baik secara subyektif maupun obyektif. Kebutuhan energi total tercapai selama periode pra bedah dan tujuh hingga sembilan hari pasca bedah. Masa rawat pasien ini adalah 12-20 hari. Perbaikan status nutrisi tidak tercapai pada pasien ini, namun terjadi perbaikan kapasitas fungsional dan proses penyembuhan luka yang adekuat. Terapi nutrisi perioperatif yang diberikan diharapkan mampu meningkatkan atau mempertahankan status nutrisi pasien, prognosis pasca bedah, serta meningkatkan kapasitas fungsional dan kualitas hidup pasien secara keseluruhan.

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Energy and protein malnutrition are common issues in hospitalized patient worldwide. Various studies had reported that 40% of surgical patient were already malnutrition when admitted to the hospital. The study reported that there were direct relationships between lost of body weight with mortality rate post surgery. Adequate perioperative nutritional therapy had been reported could decrease the morbidity rate and length of stay significantly. This case series consist of four perioperative nutritional management cases in malnourished patients with periampullary cancer that undergone pancreaticoduodenectomy surgery. Patients were male, age between 40-60 years, with periampullary cancer (pancreas & ampulla of Vatery). This four patients were having cancer-cahexia syndrome, which was characterized by lost of body weight 10-15% in the last six months, anemia, fatigue, and hypoalbuminemia. Total energy requirement were calculated with Harris-Bennedict equation with stress factor equal to 1,5. Energy and nutrition were given gradually and increased according to the improvement of clinical & gastrointestinal condition, and food intake tolerance of the patients. Monitoring and evaluation of the patients were applied according to the changes of subjective and objective parameter. Besides that, counseling and education were also given everyday to all of the patients. During the hospitalization, this four case series patients showed improvement, in both subjective and objective parameter. Total energy requirement was achieved in preoperative periode and seven until nine days postoperative in all of this patients. Length of stay of this patients were 12-20 days. Improvement of nutritional status were not found in this patients, but there were significant improvement of functional capacity and wound healing happened in them. Perioperative nutritional management applied to the patients were expected could increase or maintain the patiens’ nutritional status, improve prognosis post surgery functional capacity, and eventually leads to improvement of overall quality of life of the patients."

"Penyakit kardiovaskular, salah satunya sindrom koroner akut merupakan penyebab utama kematian di dunia akibat penyakit tidak menular, di mana penyakit ini memiliki faktor risiko yang dapat dimodifikasi dengan pengaturan nutrisi. Faktor risiko utama sindrom koroner akut pada pasien serial kasus ini adalah sindrom metabolik yang meningkatkan risiko terjadinya penyakit kardiovaskular dan diabetes melitus tipe 2. Semua pasien memiliki masalah dengan obesitas abdominal, di mana adipositokin yang disekresikan oleh jaringan adiposa abdominal merupakan mediator inflamasi, menyebabkan stres oksidatif, resistensi insulin, dan mengganggu metabolisme lipoprotein. Dua pasien pada serial kasus ini mengalami miokard infark dengan ST elevasi dan dua lainnya dengan non ST elevasi. Faktor risiko penyerta adalah hipertensi, diabetes melitus tipe 2, dislipidemia, gangguan fungsi hati, dan hiperurisemia. Kebutuhan energi sesuai dengan Harris Benedict dengan faktor stres antara 1,3–1,4 sesuai dengan beratnya kasus. Pada saat kondisi akut setelah hemodinamik stabil, nutrisi mulai diberikan sesuai dengan 80% kebutuhan basal. Kebutuhan makronutrien sesuai dengan National Cholesterol Education Program-Adult Treatment Panel III. Kebutuhan cairan dan elektrolit diberikan sesuai dengan kondisi jantung pasien. Pemberian mikronutrien seperti vitamin B dan nutrien spesifik yaitu koenzim Q10 dan omega-3 dapat dilakukan pada beberapa kasus. Monitoring dan evaluasi yang dilakukan meliputi keadaan klinis, antropometri yaitu berat badan, tinggi badan, dan lingkar pinggang, serta toleransi asupan, keseimbangan cairan, dan kapasitas fungsional. Selama pemantauan didapatkan perbaikan klinis dan peningkatan asupan nutrisi pasien. Selanjutnya diperlukan pengendalian faktor risiko pasien dengan modifikasi gaya hidup yaitu pengaturan nutrisi dan peningkatan aktivitas fisik untuk pencegahan sekunder penyakit kardiovaskuler dan mengendalikan komplikasi yang sudah terjadi agar tidak semakin memburuk.

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Cardiovascular disease, which one of them is acute coronary syndrome is the most caused of death from non comunicable diseases in the world. It have modified risk factors can be affected by nutrition.In this case series, the risk factor was metabolic syndrome that could elevated risk of cardiovascular diseases and type 2 diabetes mellitus. All of the patients had abdominal obesity, where it secreted adipocytokine, the inflamation mediators that can cause oxidative stress, insulin resistance and interfered lipoprotein metabolism. Two patients in this case series have ST elevation miokard infark dan others were non ST elevation miokard infark. Comorbid risk factors were hypertension, type 2 diabetes mellitus, dyslipidemia, disturbance liver function, and hyperuricaemia. Energy needs were calculated by Harris Benedict with risk factor between 1,3–1,4 depends on severe of the diseases. In acute condition after stable hemodinamic, nutrition was given from 80% basalt. Macronutrients need were appropiate with National Cholesterol Education Program-Adult Treatment Panel III. Fluids need and electrolyte were given appropiate of heart condition. Micronutrients, like vitamin B and specific nutrients like coenzyme Q10 and omega-3 could be given in several cases. Evaluation and monitoring included clinical condition, antropometric : body weight, height, waist circumference, tolerance intake, fluid balance, and functional capacity. During follow up, the clinical improvement and enhancement nutrient intake were developed. After that we concidered to control patients risk factors with lifestyle modification include nutrition arrangement and elevated physical activity for secondary prevention of cardiovascular diseases and to control complications."

"Dukungan nutrisi bertujuan memperbaiki status gizi dan prognosis pasien bedah dengan status gizi malnutrisi Pasien yang menjalani pembedahan traktus gastrointestinal GI merupakan kelompok pasien berisiko tinggi mengalami malnutrisi Dilaporkan bahwa terdapat hubungan positif antara malnutrisi dengan morbiditas dan mortalitas pasca bedah lama perawatan RS re admisi RS kebutuhan pembedahan sekunder dan diagnosis atau terapi Serial kasus ini terdiri dari empat kasus dukungan nutrisi perioperatif pada pasien malnutrisi dengan berbagai indikasi pembedahan GI dan komorbid yang berbeda Pasien pada serial kasus ini berusia antara 45 hingga 70 tahun Seluruh pasien menjalani pembedahan mayor abdominal atas indikasi kanker GI Status gizi pasien adalah malnutrisi ringan hingga sedang Terapi nutrisi diberikan berdasarkan kebutuhan dan kondisi klinis pasien Kebutuhan energi basal dihitung menggunakan persamaan Harris Benedict Pemberian energi dimulai dari kebutuhan energi basal dan ditingkatkan bertahap hingga mencapai kebutuhan energi total Lama perawatan RS pada pasien ini antara 19 hingga 43 hari Monitoring yang dilakukan meliputi toleransi asupan kapasitas fungsional imbang cairan data antropometri dan laboratorium serta dilakukan edukasi dan konseling nutrisi setiap hari Secara umum pasien mengalami peningkatan kondisi umum status gizi toleransi asupan Periode perioperatif mempengaruhi toleransi pasien terhadap asupan makanan dan status GI Terapi nutrisi pada pasien bedah harus dilakukan secara individual sebagai bagian integral tata laksana pembedahan Dukungan nutrisi harus dilakukan pada periode pra intra dan pasca bedah untuk menyediakan nutrien yang adekuat agar dapat mengatasi perubahan metabolik pada pasien Dukungan nutrisi yang baik pada pasien bedah terutama dengan malnutrisi dapat memperbaiki prognosis pasca bedah dan akan meningkatkan kualitas hidup pasien.

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The aim of nutritional support is to improve nutritional status and clinical outcome in severely malnourished patients Patients who undergone gastrointestinal surgery constitute as important risk group for malnutrition It has been reported that there is a positive correlation between malnutrition and postoperative morbidity and mortality prolonged hospital stays re admissions secondary operation requirement and diagnosis treatment This case series consisted of four cases of periopertive nutrition support in malnutrition patients with different surgical indication and comorbidities The patients in this case series aged between 45 to 70 years old All patients undergoing major abdominal surgery for gastrointestinal cancer Patients have nutritional status ranged from mild nutrition to moderate malnutrition Nutritional therapy was given according to patients needs and clinical condition The basal energy requirement was calculated using the Harris Benedict equation The intake was given begin with basal energy expenditure and gradually increased to the total energy expenditure Monitoring includes food intake tolerance functional capacity fluid balance anthropometric and laboratory data The nutrition education and counseling was conducted everyday In general all the patients show improvement during monitoring The perioperative periode influenced patients tolerance to food intake and gastrointestinal status Nutrition therapy in surgical patient should be done individually as part of integrated therapy in surgical treatment The nutritional support was done in pre intra and post surgery to provide adekuat nutrient to blunt metabolic changes in this patients Each period of perioperative nutrition support have different function and procedure Good nutritional support in surgical patients specially with malnutrition will improved outcome of the surgery and eventually improved quality of life."

"Latar Belakang: Penyakit keganasan urogenital merupakan spektrum penyakit yang luas, dengan penatalaksanaan mulai dari observasi dan pemantauan ketat hingga pembedahan ekstirpatif mayor. Risiko malnutrisi praoperatif akibat kanker dan pascaoperatif akibat stres pembedahan akan meningkatkan risiko morbiditas dan mortalitas. Terapi nutrisi perioperatif yang adekuat bertujuan untuk menunjang perbaikan klinis dan status nutrisi, mendukung proses pemulihan, menurunkan risiko komplikasi pascaoperasi, serta menurunkan lama rawat di rumah sakit. Metode: Laporan serial kasus ini menyajikan empat kasus kanker urogenital, terdiri dari dua kasus kanker buli, satu kasus kanker ginjal, dan satu kasus kanker penis. Tiga kasus termasuk kaheksia kanker, dan satu kasus termasuk pra-kaheksia. Seluruh pasien menjalani pembedahan urologi mayor dengan anestesi umum dan epidural. Terapi nutrisi perioperatif yang diberikan antara lain carbohydrate loading, nutrisi enteral dini pascaoperasi, serta pemberian nutrisi secara bertahap berdasarkan kondisi klinis. Dilakukan pemantauan yang meliputi keluhan klinis, antropometri, pemeriksaan fisik, hasil laboratorium, dan analisis asupan. Hasil: Dua pasien mengalami ileus paralitik pascaoperasi dengan satu pasien di antaranya membutuhkan nutrisi parenteral total, dan dapat teratasi dalam 7 hari pascaoperasi. Satu pasien mengalami hiperglikemia reaktif dan diberikan terapi insulin, dapat teratasi dalam 7 hari pascaoperasi. Satu pasien mengalami perlambatan penyembuhan luka dan memiliki masa rawat pascaoperasi paling lama. Pasien yang mengalami ileus paralitik membutuhkan waktu lebih lama untuk mencapai target kalori 80 , namun seluruh pasien telah dapat mencapai target tersebut dalam 7 hari pascaoperasi. Lama perawatan pascaoperasi bervariasi, sekitar 10-27 hari. Kesimpulan: Terapi nutrisi perioperatif yang diberikan pada keempat pasien menunjang perbaikan klinis dan status nutrisi, mendukung proses pemulihan, menurunkan risiko komplikasi pascaoperasi, serta menurunkan lama rawat di rumah sakit.

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Background: Genitourinary malignancy represents a broad spectrum of disease, with treatments ranging from watchful waiting to major extirpative surgery. The risk of preoperative malnutrition due to cancer and postoperatively due to surgical stress will increase the risk of morbidity and mortality. An adequate perioperative nutrition therapy aims to support clinical and nutritional status improvement, hasten the recovery process, reduce the risk of postoperative complications, and decrease the length of hospital stay.

Method This case series report presents four cases of genitourinary cancers, consist of two cases of bladder cancer, one case of kidney cancer, and one case of penile cancer. Three cases are classified into cancer cachexia, and one case of pre cachexia. All patients had undergone major urological surgery under general and epidural anesthesia. Perioperative nutrition therapy provides carbohydrate loading, postoperative early enteral nutrition, as well as gradual nutrition based on clinical conditions. The monitoring given included clinical complaints, anthropometric measurement, physical examination, laboratory test results, and intake analysis.

Result Two patients had postoperative paralytic ileus with one patient requires total parenteral nutrition, and resolved within 7 days after surgery. One patient had reactive hyperglycemia and treated with insulin therapy, resolved in 7 days postoperative. One patient experienced impaired wound healing and had the longest postoperative care period. Patients with paralytic ileus may take more days to achieve 80 calorie target, yet all patients have been able to achieve the target in 7 days postoperative. The length of hospital stay after surgery was varied between 10 to 27 days.

Conclusion Perioperative nutrition therapy given to four patients in this case series leads to the clinical and nutritional status improvement, supports the recovery process, decreases the risk of postoperative complications, and shortens the hospital stays."

"Malnutrisi pada kanker nasofaring (KNF) disebabkan oleh peradangan, sel tumor dan efek kemoradioterapi. Malnutrisi dikaitkan dengan penurunan kualitas hidup, fungsi fisik, dan kelangsungan hidup. Pemberian nutrisi pasien KNF yang menjalani radioterapi (RT) memperbaiki status gizi, kapasitas fungsional, dan prognosis keseluruhan. Pasien KNF dengan kaheksia, usia 29 - 67 tahun, tiga pria dan satu wanita yang menjalani kemoradioterapi. Diberikan nutrisi sesuai kebutuhan energi, makronutrien, mikronutrien, dan nutrien spesifik. Pemantauan pasien di awal, hingga RT selesai, pada keluhan terkait terapi, analisis asupan, antropometri, komposisi tubuh, kapasitas fungsional, dan pemeriksaan CRP. Didapatkan penurunan asupan pada empat pasien saat RT, tetapi meningkat lagi pada tiga pasien setelah pemasangan NGT. Satu pasien dengan peningkatan berat badan (BB), sedangkan 3 pasien lainnya BB menurun 2,2-13% pasca RT. Tiga pasien dengan CRP meningkat pada awal RT, tetapi hanya 1 pasien dengan CRP kembali normal. Massa otot meningkat pada 3 pasien setelah RT. Tiga pasien mengalami perbaikan skor ECOG pasca RT, dan satu pasien dengan skor ECOG tetap stabil. Pemasangan NGT dapat mempertahankan asupan pasien. Terapi nutrisi memperbaiki penurunan BB, tetapi tidak terlihat kaitan dengan CRP, massa otot dan kapasitas fungsional karena faktor lain.

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Malnutrition in nasopharyngeal carcinoma (NPC) is induced by inflammation, tumor cells and the effects of chemoradiotherapy. Malnutrition is associated with decrease in quality of life, physical function and survival. Nutritional therapy to NPC who underwent radiotherapy (RT) improves nutritional status, functional capacity, and prognosis. NPC cachexic patients, ages 29 - 67 years, three male and one female, all underwent chemoradiotherapy. Nutrition therapy start with planning of energy, macronutrient, micronutrient and specific nutrients needs. Patients monitoring start from the the beginning, until completed RT, related to therapy, intake analysis, anthropometry, body composition, functional capacity, and C-Reactive Protein (CRP) examination. Decrease intake in four patients during RT, but it increased in three patients after NGT insertion. One patient increase body weight (BW), while other 3 patients dropped BW 2.2-13% post-RT. Three patients increase in CRP at the start of RT, but only 1 CRP patient returned to normal. Muscle mass increased in 3 patients after RT. Three patients had improved ECOG scores after RT, and one patient with ECOG scores remained stable. Insertion of NGT can maintain patient intake. Nutritional therapy maintains BW, but does not appear to be related to CRP, muscle mass and functional capacity due to other factors."

"Studi serial kasus ini bertujuan untuk mengetahui pengaruh tata laksana nutrisi perioperatif pada pasien kanker saluran cerna yang menjalani pembedahan elektif dalam menurunkan angka morbiditas dan lama rawat di rumah sakit. Tindakan pembedahan yang dilakukan pada pasien kanker saluran cerna yang sudah mengalami malnutrisi berkaitan dengan serangkaian reaksi inflamasi yang berpotensi memperberat kondisi malnutrisi yang pada akhirnya memperberat gangguan sistem imun. Studi kasus dilakukan terhadap empat pasien dewasa dengan malnutrisi yang direncanakan menjalani pembedahan elektif akibat kanker saluran cerna di divisi Bedah Digestif Departemen Bedah RSUPN dr. Cipto mangunkusumo. Dukungan nutrisi diberikan semenjak periode pra pembedahan sampai dengan periode pasca pembedahan. Penentuan kebutuhan dihitung dengan menggunakan rumus Harris Benedict. Protein diberikan sebesar 1,8?2 g/kgBB kecuali pada satu orang pasien diberikan sebesar 0,8 g/kgBB/hari karena adanya gagal ginjal kronis. Lemak diberikan sebesar 25% dan sisanya berupa karbohidrat. Mikronutrien yang diberikan berupa kapsul multivitamin-multimineral. Hasil studi ini mendapatkan bahwa bahwa pemberian dukungan nutrisi perioperatif yang optimal dapat mempertahankan fungsi fisiologis, berat badan dan kapasitas fungsional serta memberikan kontrol glikemik yang baik pada periode pra pembedahan dan memperbaiki berbagai parameter status nutrisi termasuk fungsi imun pasca pembedahan walaupun tidak didapatkan peningkatan berat badan.

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This case series study aimed to investigate the effect of perioperative nutritional support in gastrointestinal cancer patients who underwent elective surgery in reducing morbidity and and length of hospitalization. Surgery which was performed in patients with gastric cancer who had experienced malnutrition associated with a series of inflammatory reactions that could potentially aggravate the condition of malnourished which in turn aggravate the immune system disorders. The case study was carried out on four adult patients suffer from malnutrition due to elective surgery for gastric cancer at the Surgical Division of The Department of Digestive Surgery RSUPN dr. Cipto Mangunkusumo. The nutritional support was gave since the preoperative to postoperative period. Determination of energy needs was calculated using the Harris benedict equation. Protein was given by 1.8 to 2 g/kg body weight/day except in one patient given at 0.8 g/kg body weight/day due to chronic renal failure. Fats were given by 25% and the rest were given as carbohydrate. Micronutrient was given in the form of multivitamin-multimineral capsule. The results of this study found that the provision of perioperative nutritional support could maintain optimal preoperative physiological function, body weight and functional capacity as well as provide good glycemic control and improve the nutritional status parameters including immune function after surgery althought there were not increased in body weight."

"Sepsis adalah keadaan infeksi yang disertai dengan respon infeksi secara sistemik yang merupakan salah satu penyebab morbiditas dan mortalitas pasien dengan penyakit kiritis Penyakit kritis dapat menyebabkan seorang pasien jatuh ke dalam kondisi malnutrisi Prevalensi malnutrisi pada pasien sakit kritis yang dirawat di unit perawatan intensif adalah 50 Tujuan penatalaksanaan nutrisi pasien sepsis adalah untuk menurunkan stres metabolik mencegah kerusakan sel akibat stres oksidatif dan memodulasi fungsi imun Penatalaksanaan nutrisi meliputi kegiatan skrining assessment terapi nutrisi pemantauan dan evaluasi Pasien pada serial kasus ini adalah pasien dewasa dengan diagnosis sepsis yang disebabkan oleh pneumonia 3 pasien dan infeksi intraabdomen 1 pasien Komplikasi sepsis terbanyak dalam serial kasus ini adalah acute kidney injury AKI Kebutuhan energi dihitung berdasarkan rule of thumb yaitu 20 25 kkal kg BB hari pada fase akut dan 25 30 kkal kg BB hari pada fase anabolik Pada pasien yang mendapat continuous renal replacement therapy CRRT diberikan energi 35 kkal kg BB hari Pemberian protein dengan jumlah minimal 1 5 gram kg BB hari diberikan kepada pasien tanpa AKI sementara pada pasien dengan CRRT diberikan protein 1 7 gram kg BB hari Pemantauan terapi nutrisi meliputi tanda klinis toleransi asupan makanan kapasitas fungsional balans cairan parameter laboratorium dan antropometri Selama pemantauan didapatkan semua pasien dapat mencapai kebutuhan energi total dalam waktu kurang dari tujuh hari namun karena terjadi beberapa efek samping seperti peningkatan volume residu lambung dan tekanan karbon dioksida maka dilakukan penurunan asupan pada 2 pasien Pemberian nutrisi pada pasien sakit kritis bersifat individual dan terintegrasi Tatalaksana nutrisi yang baik diharapkan dapat menurunkan laju morbiditas dan mortalitas pasien dengan sepsis

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Sepsis is a state of infection accompanied by systemic inflammatory response syndrome It often associated with increase morbidity and mortality rate in critically ill patient Fifty percent of critically patient admitted in intensive care unit were malnourished Aims of nutritional management of septic patients are to reduce metabolic stress prevent cell damage from oxidative stress and modulate immune function Nutrition intervention in septic patients are including nutrition screening and assessment nutrition therapy monitoring and evaluation Subjects were four adult septic patients caused by pneumonia infection 3 patients and intra abdominal infection 1 patient Most frequent septic complications in this serial case report were acute kidney injury AKI Energy requirementis calculated based on the rule of thumb which is 20 25 kcal kg BW day in the acute phase and 25 30 kcal kg BW day in the anabolic phase Patients whose receiving continuous renal replacement therapy CRRT were given an energy of 35 kcal kg BW day Minimal protein requirement for patient without AKI was 1 5g kg BW day and in patients with CRRT protein intake were 1 7 grams kg BW day Monitoring includes clinical symptoms tolerance of food intake functional capacity fluid balance laboratory and anthropometric findings All patients were able to obtain total energy requirement in less than seven days However reduction of total energy was appied in 2 patients after several days of treatment due to increased gastric residual volume and carbon dioxide pressure Nutrition therapy in critically ill patients is individualized and integrated Proper nutrition therapy may decrease of morbidity and mortality rate in septic patients "

"ABSTRAKPasien kanker umumnya mengalami penurunan berat badan terkait kaheksia. Patofisiologi kaheksia kanker multifaktorial, termasuk efek sitokin pro inflamasi dan inflamasi sistemik. Profil asam amino plasma pada pasien kanker mengalami perubahan. Deplesi protein dapat terjadi akibat asupan yang menurun atau efek langsung dari tumor. Penelitian ini bertujuan untuk mengetahui profil dan hubungan antara asam amino serum, status nutrisi dan sitokin-sitokin pro-anti inflamasi, serta sel T helper 17 pada pasien kaheksia kanker paru. Penelitian potong lintang dengan consecutive sampling pada pasien kanker paru dengan kaheksia ini mengambil subjek berusia lebih dari 18 tahun dan belum diterapi atau sudah selesai terapi lebih dari 2 bulan di Rumah Sakit Kanker Dharmais. Analisis asupan dilakukan dengan food frequency questionnaire semikuantitatif dan 24-hours food recall. Pemeriksaan asam amino serum dengan metode spektofotometri, Sel T helper-17 dengan metode flowcytometry, dan C-reactive protein dengan metode latex agglutination, serta kadar IL 17, IL 6 dan TNFα dengan metode ELISA. Data yg didapat kemudian di analisis dengan uji T atau Mann Whitney untuk melihat hubungan dan untuk menganalisis hubungan dalam tabel digunakan uji Chi-Square atau Fischer Exact, sedangkan untuk korelasi digunakan uji Pearson atau Spearman. Asam amino triptofan, asparagin, glutamin, valin, lisin dan sistein berkorelasi positif dengan sitokin anti-inflamasi dan status nutrisi, sebaliknya negatif dengan sitokin pro inflamasi. Asam amino fenilalanin, treonin, dan glutamat berkorelasi positif dengan sitokin pro-inflamasi dan berkorelasi negatif dengan status nutrisi dan sitokin anti inflamasi. Khusus aspartat, selain berkorelasi positif dengan sitokin pro inflamasi, juga berkorelasi positif dengan indeks massa tubuh, tetapi menunjukkan korelasi negatif dengan penurunan berat badan. Beberapa asam amino serum terbukti berhubungan dengan status sitokin dan status nutrisi pada subjek kanker paru dengan kaheksia, sehingga perlu menjadi perhatian dalam terapi nutrisi pasien kankerKata kunci: asam amino serum, status nutrisi, sitokin, kaheksia kanker

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ABSTRACTCancer patients generally experience weight loss associated with cancer cachexia. The pathophysiology of cancer cachexia is multifactorial, including the effects of pro inflammatory cytokines and systemic inflammation.. The plasma amino acid profile was found to significantly undergo changes in cancer patients. Protein depletion can occur due to decreased intake or direct effects of tumors on protein metabolism. This study aimed to determine the profile and relationship between serum amino acids, nutritional status and pro-anti-inflammatory cytokines, and T helper 17 cells in lung cancer cachexia patients. This cross-sectional study with consecutive sampling in lung cancer patients with cachexia took subjects over the age of 18 years and who had not been treated or who had finished therapy for more than 2 months at the Dharmais Cancer Hospital. Dietary intake analyses were carried out with semiquantitative food frequency questionnaire and 24-hour food recalls. Blood tests were carried out in the form of serum amino acids, cytokines, C-reactive protein and T helper 17 cells. Data obtained were then analyzed by the T or Mann Whitney test to see the relationship and to analyze relationships in the table used chi-square or Fischer Exact, while for correlation used Pearson or Spearman test. The amino acids tryptophan, asparagine, glutamine, valine, lysine and cysteine were positively correlated with anti-inflammatory cytokines and nutritional status, and negatively correlated with pro-inflammatory cytokines. Phenylalanine, threonine and glutamate amino acids were positively correlated with pro-inflammatory cytokines and negatively correlated with nutritional status and anti-inflammatory cytokines. Aspartate showed a positive correlation pro inflammatory cytokines and body mass index, but a negative correlation with weight loss. Some serum amino acids have been shown to be related to cytokines and nutritional status in lung cancer cachexia patients, so it should be a concern in nutritional therapy for cancer patients"

"[ABSTRAKLatar belakang: Kanker kepala dan leher merupakan salah satu keganasan yang dapat menyebabkan malnutrisi. Radioterapi dan kemoterapi merupakan bagian dari terapi pasien yang dapat menimbulkan berbagai efek samping sehingga dapat memperburuk status gizi pasien. Tujuan tatalaksana nutrisi adalahmeningkatkan asupan pasien, mempertahankan berat badan dan meminimalkan penurunan berat badan selama radiasi dan kemoterapi, meningkatkan kualitas hidup, menurunkan angka mortalitas pasien KKL pasca radioterapi dan kemoterapi. Tatalaksana nutrisi yang diberikan meliputi pemberian makronutrien, mikronutrien, nutrien spesifik serta konseling dan edukasi.Metode: Pasien pada serial kasus ini berjumlah empat orang dan berusia antara 41 hingga 57 tahun. Ketiga pasien menjalani kemoradiasi dan hanya satu pasien yang menjalani radioterapi. Hasil skrining pada semua pasien dengan menggunakan malnutrition screening tool (MST) mendapatkan nilai ≥2. Kebutuhan energi pasien dihitung dengan menggunakan rumus Harris Benedict selanjutnya dihitung kebutuhan energi total dengan faktor stres 1,5. Pemantauan yang dilakukan pada pasien meliputi keluhan subyektif, kondisi klinis, tanda vital, antropometri, kapasitas fungsional, dan analisis asupan. Monitoring dan evaluasi dilakukan secara teratur untuk memantau pencapaian target nutrisi.Hasil: Dukungan nutrisi yang diberikan pada keempat pasien dapat meningkatkan asupan dan menaikkan berat badan pasien ketiga, mempertahahankan berat badan pasien pertama dan keempat, serta meminimalkan penurunan berat badan pasien kedua. Kapasitas fungsional pasien tidak mengalami penurunan.Kesimpulan: Dukungan nutrisi yang diberikan pada pasien kanker kepala dan leher dalam terapi radiasi dapat meminimalkan, mempertahankan, dan meningkatkan berat badan, serta mempertahankan kapasitas fungsional pasien.

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ABSTRACTIntroduction: Head and Neck Cancer is malignant disease associated with malnutrition. Radiotherapy and Chemotherapy will give side effect which can worsen nutritional status. The goal of nutritional management are to maintain or increase nutritional status, improve quality of life, and prolong survival of patients. Nutrition management include provide macronutrient, micronutrient, specific nutrients, counseling, and education. Methode: Patient in this case series were between 41 to 57 years old. Three of patients undergoing chemoradiation and one of patients on radiation therapy. All patients had a screening score ≥2 using a Malnutrition Screening Tool (MST). Nutritional status of patients were obese, normoweight with risk of malnutrition, and normoweight. Basal energy requirement were calculated using Harris Benedict Formula then calculated with stress factor 1.5 for total energy requirement. Monitoring included subjective complaints, clinical condition, vital signs, anthropometric, functional capacity and nutrition analysis. Monitoring and evaluation were done for accomplishment of nutritional targets.Results : Nutritional support could increase intake and weight gain in third patients, weight maintaining in first and fourth patients, and for second patients were minimizing weight loss. There was no decrease in functional capacity.Conclusion: Nutritional support in head and neck cancer with radiotherapy could minimizing, maintaining, and increasing body weight also maintaining functional capacity., Introduction: Head and Neck Cancer is malignant disease associated withmalnutrition. Radiotherapy and Chemotherapy will give side effect which canworsen nutritional status. The goal of nutritional management are to maintain orincrease nutritional status, improve quality of life, and prolong survival ofpatients. Nutrition management include provide macronutrient, micronutrient,specific nutrients, counseling, and education. Methode: Patient in this case series were between 41 to 57 years old. Three ofpatients undergoing chemoradiation and one of patients on radiation therapy. Allpatients had a screening score ≥2 using a Malnutrition Screening Tool (MST). Nutritional status of patients were obese, normoweight with risk of malnutrition,and normoweight. Basal energy requirement were calculated using HarrisBenedict Formula then calculated with stress factor 1.5 for total energyrequirement. Monitoring included subjective complaints, clinical condition, vitalsigns, anthropometric, functional capacity and nutrition analysis. Monitoring andevaluation were done for accomplishment of nutritional targets. Results : Nutritional support could increase intake and weight gain in thirdpatients, weight maintaining in first and fourth patients, and for second patientswere minimizing weight loss. There was no decrease in functional capacity.Conclusion: Nutritional support in head and neck cancer with radiotherapy could minimizing, maintaining, and increasing body weight also maintaining functional capacity.]"

"[ABSTRAK Kanker kolorektal merupakan kanker yang muncul di sekitar kolon dan rektum. Salah satu dampak kanker kolorektal adalah kekurangan nutrisi atau malnutrisi. Padahal asupan nutrisi yang adekuat sangat diperlukan untuk meningkatkan sistem imun melawan sel kanker dan mempersiapkan jaringan dalam proses penyembuhan pasca pembedahan. Kebersihan mulut dan perawatan bibir dengan madu menjadi salah satu implementasi keperawatan yang dapat dilakukan untuk memperbaiki status nutrisi pasien kanker kolorektal. Hasil implementasi selama kurang lebih dua minggu menunjukkan dampak yang positif terhadap status nutrisi pasien yang ditunjukkan dengan peningkatan nafsu makan dan perbaikan manifestasi klinis yang berhubungan dengan status nutrisi. Kebersihan mulut dan perawatan bibir dengan madu dapat direkomendasikan untuk implementasi keperawatan pada pasien kanker kolorektal terutama yang mengalami malnutrisi.;ABSTRACT Cancer colorectal is cancer that located at around colon and rectum, one of effect cancer colorectal is malnourished. Adequat nutrition is very important to enhance immunity systems to against cancer cells and heal the wound after surgery. Oral hygiene and lip care with honey liquid can be done to repaire the nutritional status. The results of these implementations showed the positive impact which indicated by enhancement of appetite and improvement of clinical manifestations related to nutritional status for two weeks. So, oral hygiene and lip care with honey are recommended to repaire the nutritional status for patient cancer colorectal.;Cancer colorectal is cancer that located at around colon and rectum, one of effect cancer colorectal is malnourished. Adequat nutrition is very important to enhance immunity systems to against cancer cells and heal the wound after surgery. Oral hygiene and lip care with honey liquid can be done to repaire the nutritional status. The results of these implementations showed the positive impact which indicated by enhancement of appetite and improvement of clinical manifestations related to nutritional status for two weeks. So, oral hygiene and lip care with honey are recommended to repaire the nutritional status for patient cancer colorectal.;Cancer colorectal is cancer that located at around colon and rectum, one of effect cancer colorectal is malnourished. Adequat nutrition is very important to enhance immunity systems to against cancer cells and heal the wound after surgery. Oral hygiene and lip care with honey liquid can be done to repaire the nutritional status. The results of these implementations showed the positive impact which indicated by enhancement of appetite and improvement of clinical manifestations related to nutritional status for two weeks. So, oral hygiene and lip care with honey are recommended to repaire the nutritional status for patient cancer colorectal.;Cancer colorectal is cancer that located at around colon and rectum, one of effect cancer colorectal is malnourished. Adequat nutrition is very important to enhance immunity systems to against cancer cells and heal the wound after surgery. Oral hygiene and lip care with honey liquid can be done to repaire the nutritional status. The results of these implementations showed the positive impact which indicated by enhancement of appetite and improvement of clinical manifestations related to nutritional status for two weeks. So, oral hygiene and lip care with honey are recommended to repaire the nutritional status for patient cancer colorectal., Cancer colorectal is cancer that located at around colon and rectum, one of effect cancer colorectal is malnourished. Adequat nutrition is very important to enhance immunity systems to against cancer cells and heal the wound after surgery. Oral hygiene and lip care with honey liquid can be done to repaire the nutritional status. The results of these implementations showed the positive impact which indicated by enhancement of appetite and improvement of clinical manifestations related to nutritional status for two weeks. So, oral hygiene and lip care with honey are recommended to repaire the nutritional status for patient cancer colorectal.]"