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"Latar Belakang. Penggunaan obat antiepilepsi (OAE) generasi lama (karbamazepin, fenitoin, fenobarbital dan asam valproat) mendominasi tatalaksana epilepsi di Indonesia. OAE tersebut berpotensi menimbulkan efek samping obesitas, peningkatan fraksi lipid aterogenik, peningkatan homosistein, resistensi insulin dan stres oksidatif yang merupakan faktor risiko ateroksklerosis dan penyakit kardiovaskular. Oleh karena itu diperlukan penilaian risiko global kejadian kardiovaskular dan aterosklerosis pada orang dengan epilepsi (ODE) yang menggunakan OAE generasi lama, yaitu dengan mengukur kadar hs-CRP plasma. Molekul hs-CRP merupakan penanda biologis inflamasi tingkat rendah dan penyebab langsung aterosklerosis. Metode. Desain penelitian adalah potong lintang yang membandingkan kelompok studi (ODE yang menggunakan OAE generasi lama) dan kelompok orang normal yang usia dan jenis kelaminnya disesuaikan. Subjek kelompok studi didapatkan dari populasi ODE yang kontrol di Poliklinik Saraf RS Cipto Mangunkusumo dan Yayasan Epilepsi Indonesia. Dilakukan wawancara, pemeriksaan fisik, dan pemeriksaan laboratorium pada semua subjek. Hasil. Didapatkan masing-masing 44 subjek kelompok studi dan kontrol. Kadar hs-CRP pada kelompok studi (1,19 (0,27-9,13) mg/L) lebih tinggi secara signifikan dibandingkan kelompok kontrol (0,745 (0,13-4,9) mg/L). Tidak terdapat hubungan signifikan antara usia, jenis kelamin, tipe bangkitan terakhir, jenis dan jumlah OAE dengan kadar hs-CRP. Kadar hs-CRP cenderung lebih tinggi pada ODE yang menggunakan OAE generasi lama penginduksi ekstensif enzim CYP (fenitoin, karbamazepin dan fenobarbital) dibandingkan asam valproat (1,785 (0,27-9,13) vs 0,77 + 0,36 mg/L). Kadar hs-CRP kelompok OAE penginduksi enzim CYP lebih tinggi secara bermakna dibandingkan kontrol, sedangkan rerata kadar hs-CRP kelompok asam valproat tidak berbeda dengan kontrol. Kadar hs-CRP juga cenderung lebih tinggi pada kelompok politerapi (2,255 (0,43-8,67) mg/L) dibandingkan monoterapi (1,105 (0,27-9,13) mg/L). Nilai median kadar hs-CRP kelompok politerapi penginduksi-penginduksi enzim CYP lebih tinggi (3,11 (1,80-8,67) mg/L) dibandingkan kelompok politerapi penginduksi-bukan penginduksi enzim (0,96 (0,43-4,59) mg/L). Pada analisis multivariat, interaksi antara jumlah dan jenis OAE berhubungan dengan kadar hs-CRP secara bermakna. Simpulan. Kadar hs-CRP pada ODE yang menggunakan OAE generasi lama lebih tinggi dibandingkan kelompok kontrol. Kadar hs-CRP cenderung lebih tinggi pada ODE yang menggunakan OAE generasi lama penginduksi ekstensif enzim CYP dan menggunakan OAE politerapi. Terdapat peningkatan risiko mengalami kejadian kardiovaskular dan aterokslerosis yang lebih tinggi pada ODE yang menggunakan OAE generasi lama penginduksi ekstensif enzim CYP baik monoterapi maupun politerapi.

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Background. Old generation antiepileptic drugs (AED), including carbamazepine, phenytoin, phenobarbital and valproic acid are still utilized extensively in treating epilepsy patients (EP) in Indonesia. Those drugs are potencial causing obesity, higher atherogenic lipid fraction, higher homocysteine, insulin resistance and oxidative stress which are atherosclerosis risk factor and cardiovascular events. Therefore, atherosclerosis and cardiovascular global risk assesment is required in epilepsy patients treated with those AED by measuring high sensitivity C-reactive Protein (hs-CRP). Hs-CRP is well-known biomarker of chronic low level inflammatory and direct etiology of atherosclerosis.

Method. This is a cross sectional study comparing study group (EP treated with old generation AED) and control group (healthy subjects), age and sex are matched. Subjects of study group are selected from EP who are visiting neurology outpatient clinic in Cipto Mangunkusumo Hospital and Indonesia Epilepsy Foundation. All subjects underwent interview, physical examination and laboratory investigations.

Result. Forty four patients are selected for each group. Hs-CRP level of study group (1.19 (0.27-9.13) mg/L) is significantly higher compared to control group (0.745 (0.13-4.9) mg/L). No significant correlation between age, sex, last epileptic seizure type, AED type and duration with hs-CRP level. Hs-CRP level in EP treated with extensive CYP-inducer AED tend to be higher than valproic acid-treated patients (1.785 (0.27-9.13) vs 0.77 + 0.36 mg/L). Hs-CRP level in EP treated with extensive CYP-inducer AED is significantly higher compared to their control group, whereas no difference in valproic acid group compared to their control. Polytherapy group (2.255 (0.43-8.67) mg/L) tends to have higher hs-CRP level compared to monotherapy group (1.105 (0.27-9.13) mg/L). Median of hs-CRP in extensive CYP-inducer polytherapy (3.11 (1.80-8.67) mg/L) is higher than polytherapy with combination AED (0.96 (0.43-4.59) mg/L). In multivariat analysis, interaction between number and type of AED is significantly related to hs-CRP level.

Conclusion. Level of hs-CRP in EP treated with old generation AED is significantly higher than control. Hs-CRP level tends to be higher in EP treated with CYP inducer AED and polytherapy although not reaching significant point. Therefore, there is increased cardiovascular events and atherosclerosis risk in EP treated with extensive CYP-inducer AED in monotherapy and polytherapy manner."

"Latar Belakang: Kadar hsCRP berhubungan dengan mayor adverse cardiac events. Pada PJK stabil, hubungan antara kadar hsCRP dengan skor SYNTAX sebagai gambaran derajat aterosklerosis koroner belum jelas. Tujuan: Mengetahui hubungan antara kadar hsCRP dengan skor SYNTAX pada penderita PJK stabil, dan mengetahui titik-potong kadar hsCRP yang dapat membedakan antara kelompok skor SYNTAX rendah dengan yang tinggi. Metode: Observasional potong-lintang pada consecutive 93 subjek penderita PJK stabil dewasa yang menjalani angiografi koroner di RSUPNCM pada bulan Mei sampai September 2018, untuk memperoleh skor SYNTAX. Diambil darah dari arteri perifer sebelum tindakan angiografi untuk pemeriksaan hsCRP dan laboratorium dasar. Dieksklusi penderita infeksi berat, trauma, PGK, sirosis hati, keganasan, pengobatan steroid. Selanjutnya data dikumpulkan dan dianalisis. Skor SYNTAX dikelompokkan tinggi bila > 27, dan rendah bila nilai < 27. Untuk menilai titikpotong kadar hsCRP dipakai uji Sperman karena distribusi data tidak normal. Hasil: Ditemukan rerata umur 60,23 tahun (SB 8,984), IMT 26,30 Kg/m2 (SB 3,903), kol-LDL 117,74 mg/dL (SB 36,31). Kadar hsCRP dan skor SYNTAX tidak dipengaruhi oleh IMT atau kol-LDL (hsCRP-IMT: r:0,032; p:0,772; skor SYNTAX-IMT: r:-0,021; p:0,849; hsCRP-kol LDL: r:-0,149; p:0,266; skor SYNTAX-kol LDL: r:0,159; p:0,234). Ditemukan korelasi positif lemah hsCRP dengan skorSYNTAX (r:0,270; p:0,009) dan Titik-potong pada kadar hsCRP 2,35 mg/L (sensitifitas 0,69; spesifisitas 0,53). Nilai AUC 0,554, IK 95%, p: 0,472, merupakan diskriminasi yang kurang baik. Simpulan: Pada penderita PJK stabil, kadar hsCRP berkorelasi positif lemah dengan skor SYNTAX sebagai gambaran derajat aterosklerosis. Kadar hsCRP dengan titik-potong > 2,35 mg/L dapat membedakan kelompok yang mempunyai skor SYNTAX rendah dengan kelompok skor SYNTAX tinggi, namun nilai prediksinya relatif rendah.

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Background: High sensitivity C-reactive protein levels are associated with mayor adverse cardiac events. In stable CAD, the association of baseline hcCRP level with coronary atherosclerosis severity assessed by SYNTAX score were not clear.

Objective: To investigate the association between hsCRP level and SYNTAX score in patients with stable CAD, and to know cut-off point of hsCRP level which can differentiated between the group of low SYNTAX score and of high SYNTAX score.

Methods: Cross-sectional observation to the consecutive 93 subject adult patients of stable CAD, undergoing coronary angiography in Cipto Mangunkusumo General Hospital on May to September 2018 to obtain SYNTAX score. The blood tests were taking from pheripheral artery prior to carrying out of coronary angiography to obtain level of hsCRP and laboratory data base. The exclusion were severe infection, trauma, CKD, cirrhosis hepatis, malignancy, and steroid therapy. The SYNTAX score will be differentiated between the group of high if the value > 27, and the group of low if the value < 27. Sperman analysis will be used to evaluate hsCRP cut-off point.

Results: Average age was 60,23 year (SD 8,984), BMI 26,30 Kg/m2 (SD 3,903), and LDL-chol 117,74 (SD 36,31). The Level of hsCRP and SYNTAX score were not influenced by BMI or LDL-chol (hsCRP - BMI: r:0,032; p:0,772; SYNTAX score - BMI: r:-0,021; p:0,849; hsCRP- LDL-chol: r:-0,149; p:0,266; SYNTAX score - LDL-chol: r:0,159; p:0,234). We found positif corelation (weak) between hsCRP and SYNTAX Score (r:0,270; p:0,009). Cut-off point was found in the hsCRP level 2,35 mg/L (sensitivity 0,69; spesivisity 0,53). AUC 0,554, CI 95%, p: 0,472, were the poor discrimination.

Conclusions: There were positif (weak) correlation between hsCRP level and SYNTAX score in stable CAD patients. Cut-off point in the hsCRP level > 2,35 mg/L can differentiated between the group of low SYNTAX score and of high SYNTAX score, but the prediction value is low-grade."

"Penyakit jantung koroner (PIK) merupakan suatu proses inflamasi, beberapa petanda inflamasi dievaluasi sebagai prediktor risiko kejadian koroner. Salah satu petanda inflamasi sistemik yang diproduksi di hati yakni high sensitivity C-reactive protein (hsCRP).Beberapa tahun terakhir ini banyak dilakukan penelitian tentang pengaruh radikal bebas dan peran antioksidan pada aterosklerosis dengan hasil yang bermakna walaupun masih diperdebatkan. Salah satu antioksidan yang memberikan harapan untuk mencegah aterosklerosis adalah teh hijau.Tujuan PenelitianUntuk membuktikan penurunan proses inflamasi sistemik pada pemberian teh hijau pada kelinci yang diberi diet aterogenik.MetologiPenelitian dilakukan pada 20 ekor kelinci New Zealand White jantan usia 4-5 bulan. Adaptasi dilakukan selama 4 minggu dan mendapat pakan standar (normal) yang mengandung 20.31% protein, 5,8% lemak, 40.03% karbohidrat dan 13.63%, selanjutnya dibagi menjadi 4 kelompok secara acak berdasarkan rasio kadar kolesterol total/HDL, yang masing-masing berjumlah 5 ekor yaitu: kelompok A diberi diet normal, kelompok B diberi diet normal ditambah teh hijau, kelompok C diberi diet aterogenik dan kelompok D diberi diet aterogenik ditambah teh hijau. Kadar hsCRP sebagai petanda inflamasi sistemik diperiksa pada minggu ke-12 dengan metode immunoturbidimetri. Analisa statistik dengan anova dan pengujian menggunakan uji pembandingan berpasangan (uji t).HasilKadar rerata hsCRP kelompok A 0.174+0.0948 mg/liter, rerata kelompok B 0.136+0.416 mg/liter, rerata kelompok C 0.350+0.1044 mg/liter dan rerata kelompok D 0.202+0.046 mg/liter. Pemberian teh hijau pada kelompok B tidak menurunkan kadar hsCRP secara bermakna dibanding kelompok A (0.038+0.084 mg/liter, p=0.185). Diet aterogenik pada kelompok C meningkatkan kadar hsCRP kelinci sebesar 0.176+0.1534 mg/liter, yang secara statistik berbeda bermakna dibanding kelompok A (p=4.0311). Penambahan teh hijau pada diet aterogenik pada kelompok D menurunkan kadar hsCRP sebesar 0.148+0.0608 mg/liter dan berbeda bermakna secara statistik dibanding kelompok C (p=0.03).KesimpulanTeh hijau menurunkan kadar hsCRP sebagai petanda inflamasi-sistemik pada kelinci yang diberi diet aterogenik.

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Background

Coronary artery disease is an inflammation disease and some inflammation markers have been evaluated as risk predictors for coronary events. One of the inflammation markers which are produced in liver is high sensitivity C-reactive protein (hsCRP). Recently, there are studies about free radicals and anti-oxidant effect in preventing atherosclerosis.

Methods

Twenty New Zealand White Rabbits, male, were given normal feeding for 4 weeks as an adaptation period. They were divided randomly into 4 groups, group A were given normal diet, group B were given normal diet and 6% green tea, group C were given atherogenic diet and group D were given atherogenic diet and 6% green tea. The hsCRP level and lipid profile were evaluated at the 12 week

Result

The mean of hsCRP level in group A is 0.174+0.0948 mg/liter, in group B is 0.136+0.416 mg/liter, in group C is 0.350± 0.1044 mg/liter and the mean of hsCRP level in group D is 0.202 + 0.046 mg/liter. Green tea in group B did not decrease the hsCRP level significantly compare to group A (0.038+0.084 mg/liter, p=4.185). Atherogenie diet in group C increased the hsCRP level 0.176±0.1534 mg/liter, which is significant compare to group A (p=0.0311). Six percent of green tea decreased the hsCRP level in group D 0.1480.0608 mg/liter and is significant compare to group C (1=0.03).

Conclusion

Green tea decreased the hsCRP level as inflammation marker in rabbits that were given atherogenic diet."

"C-Reactive Protein merupakan protein penanda biologis yang jumlahnya akan meningkat ketika terjadi proses inflamasi di dalam tubuh. Pada kehamilan, proses inflamasi merupakan proses fisiologis namun tentunya dalam batas normal. Status gizi maternal dipercaya memiliki hubungan dengan proses inflamasi yang terjadi. Penelitian ini bertujuan untuk melihat hubungan antara kadar high-sensitivity C-Reactive Protein (hs-CRP) pada ibu hamil trimester satu dengan indeks massa tubuh. Penelitian ini dilakukan dengan metode studi potong lintang dengan jumlah subjek penelitian 62 responden yang dipilih berdasarkan sistem simple random sampling. Dari penelitian ini didapatkan hasil median kadar hs-CRP adalah 2,95 mg/L (0,30-35,30 mg/L). Penelitian ini menggunakan cut-off kadar hs-CRP 5 mg/L dan didapatkan hasil 32,3% subjek memiliki kadar yang tinggi. Indeks massa tubuh ibu hamil trimester pertama ini memiliki nilai rerata 23,68±3,73 kg/m2. Data kemudian dicari korelasinya dengan uji Pearson. Terdapat korelasi sedang positif antara kadar hs-CRP dengan indeks massa tubuh ibu hamil trimester satu (r = 0,435, p = < 0,001). Dapat disimpulkan bahwa semakin tinggi nilai indeks massa tubuh, maka semakin tinggi kadar hs-CRP pada ibu hamil trimester satu.

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C-Reactive Protein (CRP) is a biomarker protein which increases during inflammation. During pregnancy, there is a physiologic amount of inflammation which increases CRP. Maternal nutrition status is known to be associated with the inflammatory process and pregnancy outcome. The objective of this study was to find the normal value of high-sensitivity C-Reactive Protein (hs-CRP) in first trimester pregnancy and its association with body mass index. This study used cross-sectional design with 62 first trimester pregnant women as subjects. The subjects were chosen using simple random sampling method.

It was found that the median serum level of hs-CRP in the subjects was 2.95 mg/L (0.30-35.30 mg/L). The cut-off point of hs-CRP level in this study was 5 mg/L. There were 32.3 % subjects who had higher hs-CRP value. The mean body mass index was 23.68±3.73 kg/m2. Pearson analysis demonstrated medium correlation between the level of hs-CRP and body mass index in first trimester pregnant women (r = 0.435, p = < 0.001). In conclusion, higher body mass index was associated with the higher hs-CRP level in first trimester pregnant women."

"Obesitas merupakan masalah epidemik di dunia. Obesitas menyebabkan inflamasi kronik derajat rendah dan meningkatkan risiko beberapa penyakit kronis dengan komplikasi seperti aterosklerosis, dan masalah kardiovaskuler. Penanda inflamasi yang dianggap terbaik saat ini adalah high sensitivity C-Reactive Protein hsCRP . HsCRP juga merupakan prediktor terbaik untuk mengetahui risiko penyakit kardiovaskuler. Diperlukan penanganan secara interdisiplin untuk mengatasi masalah obesitas ini. Akupunktur merupakan terapi pelengkap yang paling cepat berkembang dan diakui oleh National Institutes of Health dan WHO. Penelitian ini bertujuan mengetahui efektivitas terapi kombinasi elektroakupunktur dan intervensi diet terhadap kadar HsCRP dan body fat pada pasien obesitas. Uji klinis acak tersamar tunggal terhadap 36 pasien obesitas yang dialokasikan secara acak menjadi 2 kelompok yaitu kelompok kombinasi elektroakupunktur dan intervensi diet kelompok perlakuan dan kelompok kombinasi elektroakupunktur sham dan intervensi diet kelompok kontrol. Hasil penelitian menunjukkan penurunan kadar hsCRP sebelum dan sesudah perlakuan tetapi belum terdapat perbedaan yang bermakna secara statistik p= 0.476. Terdapat perbedaan yang bermakna terhadap perbandingan kadar body fat sebelum dan sesudah perlakuan pada kelompok perlakuan p=0.002. Kesimpulan penelitian ini terapi kombinasi elektroakupunktur dan intervensi diet memiliki pengaruh terhadap kadar hsCRP dan body fat pada pasien obesitas.

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Obesity is an epidemic problem in the world. Obesity causes low grade chronic inflammation and increases the risk of some chronic diseases with complications such as atherosclerosis, and cardiovascular problems. The best current inflammatory marker is the high sensitivity of C Reactive Protein hsCRP . HsCRP is also the best predictor of risk of cardiovascular disease. Interdisciplinary treatment is needed to overcome this obesity problem. Acupuncture is the most rapidly growing complementary therapy and is recognized by the National Institutes of Health and WHO.

This study aims to determine the effectiveness of electroacupuncture combination therapy and dietary intervention on HsCRP and body fat levels in obese patients. Single blinded randomized clinical trials of 36 obese patients were randomly assigned to 2 groups, electroacupuncture combined with dietary intervention group treatment group and sham electroacupuncture combined with dietary intervention group control group.

The results showed decrease of hsCRP levels before and after treatment but there was no statistically significant difference p 0.476 . There was a significant difference to the body fat content before and after treatment in the treatment group p 0.002.

The conclusions of this study combined electroacupuncture and dietary intervention therapy have an influence on levels of hsCRP and body fat in obese patients."

"[ABSTRAKLatar Belakang. Obat Anti Epilepsi (OAE) generasi lama banyak digunakan di Rumah Sakit sebagai terapi epilepsi. Beberapa studi terdahulu telah mengonfirmasi bahwa terapi OAE generasi lama terasosiasi dengan penurunan rerata kadar serum asam folat. Penurunan kadar serum asam folat ini berhubungan dengan anemia, defisit kognitif, penyakit vaskular, kanker, gangguan psikiatri, aborsi spontan dan malformasi kongenital. Oleh karena itu, maka dilakukan penelitian mengenai kadar serum folat pada ODE yang menggunakan OAE generasi lama di Indonesia. Metode. Desain penelitian adalah potong lintang untuk mengetahui gambaran kadar serum asam folat ODE pengguna OAE generasi lama (fenitoin, fenobarbital, karbamazepin dan asam valproat) jika dibandingkan dengan populasi normal serta kaitan dengan asupan. Subyek penelitian sejumlah 75 orang didapatkan di poli rawat jalan RSUPN Cipto Mangunkusumo dan Yayasan Epilepsi Indonesia yang dibandingkan dengan 76 orang populasi normal. Dilakukan wawancara pola makan melalui metode food recall, pemeriksaan laboratorium kadar folat. Hasil. Didapatkan kadar rerata serum asam folat sebesar 9.95 + 3.61 ng/mL pada ODE pengguna OAE generasi lama. Populasi normal didapatkan kadar rerata 4.59 + 2.4 ng/mL (p=<0.001). Rerata asupan diet setara folat kelompok studi 119.7 (28.4-340) microgram, kelompok kontrol 104.65 (38-510) microgram (p=0.095). Simpulan. Rerata kadar serum asam folat ODE yang menggunakan OAE generasi lama lebih tinggi dari rerata kadar serum asam folat populasi normal secara bermakna. Hanya terdapat 2,7% ODE dengan kadar asam folat rendah secara bermakna. Tidak ada perbedaan bermakna antara jumlah asupan diet folat dengan klasifikasi kadar serum asam folat pada ODE.

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ABSTRACTBackground. Antiepileptic drugs (AEDs) are frequently used in the treatment of epilepsy, psychiatric diseases, and pain syndromes. Studies have established that chronic anticonvulsant therapy can lead to folate deficiency. Anti-convulsant-induced folate deficiency has been associated with megaloblastic anemia, cognitive decline, vascular diseases, cancer, psychiatric comorbidity, spontaneous abortion and teratogenesis. Thus, patients with epilepsy are a suitable population to investigate the association of AED treatment with folate serum levels in comparison with normal population. Method. This is comparative cross-sectional study focusing on the level and intake of folate in relation with AED (phenytoin, phenobarbital, carbamazepine, valproic acid) in epileptic patients in outpatient clinic of Neurology Cipto Mangunkusumo General Hospital and Indonesia Epilepsy Foundation, with comparison to normal population. Seventy five epileptic patients and seventy six healthy people were recruited with food recall interview and their serum folate were measured. Results. The mean folate serum of study group were 9.95 + 3.61 ng/mL and the mean folate serum of control group were 4.59 + 2.4 ng/mL (p=<0.001). The mean dietary folate of study group were 119.7 (28.4-340) microgram and the mean dietary folate of control group 104.65 (38-510) microgram (p=0.095). Conclusion. The mean folate serum in study group were significant much more higher compare with the control group. As many as 2.7% of study group with significantly low folate serum level. There were no any significant association of dietary folate with folate serum classification of study group. ;Background.. Antiepileptic drugs (AEDs) are frequently used in the treatment of epilepsy, psychiatric diseases, and pain syndromes. Studies have established that chronic anticonvulsant therapy can lead to folate deficiency. Anti-convulsant-induced folate deficiency has been associated with megaloblastic anemia, cognitive decline, vascular diseases, cancer, psychiatric comorbidity, spontaneous abortion and teratogenesis. Thus, patients with epilepsy are a suitable population to investigate the association of AED treatment with folate serum levels in comparison with normal population. Method. This is comparative cross-sectional study focusing on the level and intake of folate in relation with AED (phenytoin, phenobarbital, carbamazepine, valproic acid) in epileptic patients in outpatient clinic of Neurology Cipto Mangunkusumo General Hospital and Indonesia Epilepsy Foundation, with comparison to normal population. Seventy five epileptic patients and seventy six healthy people were recruited with food recall interview and their serum folate were measured. Results. The mean folate serum of study group were 9.95 + 3.61 ng/mL and the mean folate serum of control group were 4.59 + 2.4 ng/mL (p=<0.001). The mean dietary folate of study group were 119.7 (28.4 ? 340) microgram and the mean dietary folate of control group 104.65 (38-510) microgram (p=0.095). Conclusion. The mean folate serum in study group were significant much more higher compare with the control group. As many as 2.7% of study group with significantly low folate serum level. There were no any significant association of dietary folate with folate serum classification of study group. , Background.. Antiepileptic drugs (AEDs) are frequently used in the treatment of epilepsy, psychiatric diseases, and pain syndromes. Studies have established that chronic anticonvulsant therapy can lead to folate deficiency. Anti-convulsant-induced folate deficiency has been associated with megaloblastic anemia, cognitive decline, vascular diseases, cancer, psychiatric comorbidity, spontaneous abortion and teratogenesis. Thus, patients with epilepsy are a suitable population to investigate the association of AED treatment with folate serum levels in comparison with normal population. Method. This is comparative cross-sectional study focusing on the level and intake of folate in relation with AED (phenytoin, phenobarbital, carbamazepine, valproic acid) in epileptic patients in outpatient clinic of Neurology Cipto Mangunkusumo General Hospital and Indonesia Epilepsy Foundation, with comparison to normal population. Seventy five epileptic patients and seventy six healthy people were recruited with food recall interview and their serum folate were measured. Results. The mean folate serum of study group were 9.95 + 3.61 ng/mL and the mean folate serum of control group were 4.59 + 2.4 ng/mL (p=<0.001). The mean dietary folate of study group were 119.7 (28.4 – 340) microgram and the mean dietary folate of control group 104.65 (38-510) microgram (p=0.095). Conclusion. The mean folate serum in study group were significant much more higher compare with the control group. As many as 2.7% of study group with significantly low folate serum level. There were no any significant association of dietary folate with folate serum classification of study group. ]"

"Latar Belakang. Pasien epilepsi memerlukan obat antiepilepsi (OAE) dalam waktu lama, minimal 1-2 tahun.OAE yang terbanyak digunakan di Indonesi adalah OAE generasi lama yaitu karbamazepin, fenitoin, fenobarbital, dan valproat.Karbamazepin, fenitoin, dan fenobarbital dapat menyebabkan stres oksidatif dan peningkatan kolesterol sedangkan menyebabkan resistensi insulin.Keempat OAE dapat menyebabkan peningkatan homosistein. Hal tersebut dapat menyebabkan disfungsi endotel yang merupakan awal dari aterosklerosis.Ketebalan kompleks intima-media (KIM) karotis komunis dapat digunakan sebagai indikator dari aterosklerosis.Oleh karena itu diperlukan pengukuran ketebalan KIM karotis komunis pada pasien epilepsi yang menggunakan OAE generasi lama untuk deteksi awal aterosklerosis. Metode penelitian. Penelitian ini menggunakan desain potong lintang untuk melihat perbandingan ketebalan KIM karotis komunis kelompok studi (pasien epilepsi) dengan kelompok kontrol (populasi normal) dengan usia dan jenis kelamin yang disesuaikan. Variabel independen adalah usia, jenis kelamin, jumlah OAE, jenis OAE, dan durasi OAE. Hasil. Didapatkan sampel masing-masing 46 subjek kelompok studi dan kontrol. Median ketebalan KIM karotis komunis kelompok studi (0,49 (0,36-1,40) mm) lebih dari kontrol (0,43 (0,35-0,77) mm) secara bermakna. Pada penelitian ini tidak didapatkan hubungan antara usia, jenis kelamin, jumlah OAE, jenis OAE, durasi OAE dengan ketebalan KIM karotis komunis pada pasien epilepsi. Kesimpulan. Ketebalan KIM karotis komunis pasien epilepsi yang menggunakan OAE generasi lama lebih tebal dari kelompok kontrol.

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Background. Epilepsy patients requires long-term antiepileptic drugs (AEDs) at least for 1-2 years. The most common AEDs used in Indonesia are first generation AEDs which are carbamazepine (CBZ), phenytoin (PHT), phenobarbital (PB), and valproate (VPA). The first three AEDs may cause oxidative stress and increased cholesterol level while VPA causes insulin resistance. All AEDs cause increased homocysteine level. All those factors could cause endothelial dysfunction which is known as initial process in atherosclerosis. Common carotid intima-media thickness (CC IMT) is a well-known indicator of atherosclerosis. Therefore CC IMT measurement on epilepsy patients with old generation AEDs is required for early detection of atherosclerosis.

Methods. This was a cross-sectional study that comparing CC IMT of epilepsy patients and control group (normal subjects) with age and sex matched. The independent variables were age, sex, number of AEDs, type of AEDs, and duration of AEDs.

Results. There were 46 subjects for each group. The CC IMT median of epilepsy patients (0,49 (0,36-1,40) mm) were significantly thicker than control group (0,43 (0,35-0,77) mm). There were no association of age, sex, number of AEDS, type of AEDs, duration of AEDs with CC IMT.

Conclusions. CC IMT of epilepsy patients with first generation AEDs was higher than control group."

"Hs-CRP adalah sebuah protein fase akut yang dihasilkan oleh hati yang berperan sebagai prediktor independen yang kuat dalam mengindikasikan risiko aterosklerosis. Sitokin adalah protein kecil yang diproduksi oleh sel T helper (Th) dan makrofag untuk memengaruhi respon imun. Sitokin yang diteliti dibedakan menjadi 2, yaitu sitokin pro-inflamasi (IL-6 dan IL-8) dan sitokin anti-inflamasi(IL-10). Penelitian ini bertujuan untuk mengetahui perubahan hs-CRP dan sitokin inflamasi pada pasien lansia usia di atas 60 tahun yang melakukan operasi bedah pintas arteri koroner di RS. Pusat Jantung Nasional Harapan Kita serta kaitannya dengan lama rawat di ICU, sehingga dapat menjadi indikator pengurangan risiko komplikasi pasca-operasi. Konsentrasi hs-CRP dan sitokin inflamasi dianalisis dari plasma darah dengan metode ELISA dan Luminex. Hasil penelitian menunjukkan bahwa terdapat perbedaan bermakna kadar hs-CRP, IL-6, dan IL-8 antar kelompok pra-operasi dan pasca-operasi. Terdapat korelasi positif antar kadar plasma darah sitokin pro-inflamasi (IL-8) terhadap lama rawat di ICU, dengan koefisien korelasi= 0,459 dan nilai relative risk sebesar 2,7 artinya berindikasi 2,7 kali beresiko terhadap perpanjangan lama rawat di ICU.

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Hs-CRP is an acute-phase protein produced by the liver and serving as a strong independent predictor of atherosclerosis risk. Cytokines are small proteins produced by helper T cells (Th) and macrophages to influence the immune response. The cytokines studied are divided into two categories: pro-inflammatory cytokines (IL-6 and IL-8) and anti-inflammatory cytokines (IL-10). This study aims to determine changes in hs-CRP and inflammatory cytokines in elderly patients over 60 years old undergoing coronary artery bypass surgery at the Pusat Jantung Nasional Harapan Kita Hospital and their relationship with ICU length of stay, thereby serving as indicators for reducing the risk of postoperative complications. The concentrations of hs-CRP and inflammatory cytokines were analyzed from blood plasma using ELISA and Luminex methods. The results showed significant differences in levels of hs-CRP, IL-6, and IL-8 between pre-operative and post-operative groups. There was a positive correlation between plasma levels of the pro-inflammatory cytokine IL-8 and the length of ICU stay, with a correlation coefficient of 0.459 and a relative risk value of 2.7, indicating a 2.7 times higher risk of prolonged ICU stay."

"Menentukan rerata kadar Protein C-Reaktif sensitivitas tinggi (hs-CRP) pada penyakit jantung koroner, hubungan antara kadar hs-CRP dengan luas lesi koroner dan fungsi sistolik jantung. Telah dilakukan penelitian observasional dengan disain potong lintang terhadap 106 pasien penyakit jantung koroner yang meliputi 90 angina pektoris stabil, 11 angina pektoris tidak stabil dan 5 infark miokard akut. Dilakukan pemeriksaan kadar kuantitatif hs-CRP, angiografi koroner untuk menentukan luas lesi koroner dan ejection fraction. Rerata kadar hs-CRP pada luas lesi koroner SVD 5,5 ± 7,6 mg/L, DVD 6,6 ± 21,7 mg/L dan TVD 5,5 ± 8,0 mg/L dengan p=0,056. Tidak didapatkan hubungan bermakna antara kadar hs-CRP dengan luas lesi koroner. Fungsi sistolik jantung mempunyai korelasi negatif dengan kadar hs-CRP (p=0,015, r = -0,235). Penelitian ini menunjukkan bahwa kadar hs-CRP tidak dapat menggambarkan luas lesi koroner, kadar hs-CRP mempunyai korelasi negatif dengan fungsi sistolik jantung. (Med J Indones 2003; 12: 201-6)

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To determine the mean value of high sensitivity C-Reactive Protein (hs-CRP), association between plasma level of hs-CRP with extent of disease and systolic function. A cross sectional study had been conducted to 106 coronary artery disease patients (90 stable angina pectoris, 11 unstable angina pectoris and 5 acute myocardial infarction). Plasma quantitative level of hs-CRP with cor angiography to determine extent of disease and ejection fraction were measured. The mean of hs-CRP levels in patients with SVD were 5,5 ± 7,6 mg/L, DVD were 6,6 ± 21,7 mg/L and TVD were 5,5 ± 8,0 mg/L and p=0,056, respectively. There were no significant association between hs- CRP levels with extent of disease. Systolic function had negative correlation with levels of hs-CRP (p=0,015, r=-0,235). This study showed that plasma level of hs-CRP cannot reflect the extent of disease, and it had negative correlation with systolic function. (Med J Indones 2003; 12: 201-6)"

"Penelitian ini bertujuan untuk menilai penanda biokimia adiponektin, status antioksidan total (SAT), dan high sensitvity C-reactive protein (hsCRP) pada individu dengan dan tanpa sindrom metabolik (SM). Metode Penelitian pontong lintang pada 36 subyek SM dan 36 subyek tanpa SM yang dilakukan di Jakarta. Indikatorindikator yang diukur adalah adiponektin, SAT dan hsCRP, di samping berat badan, tinggi badan, lingkar pinggang (LP), tekanan darah sistolik, tekanan darah diastolik, dan glukosa darah puasa. Risiko terjadinya SM dihitung dengan odds ratio (OR) adiponektin, hsCRP, dan rasio adiponektin/hsCRP dengan mengambil nilai median sebagai titik dikotomi antara nilai tinggi dan nilai rendah masing-masing parameter tersebut. Hubungan antara adiponektin, SAT, dan hsCRP dengan LP dianalisis dengan uji korelasi Spearman, sedangkan peranan keseluruhan parameter dengan SM dianalisis dengan regresi logistik. Hasil Adiponektin dan hsCRP berbeda secara signifi kan antara subjek dengan dan tanpa SM (3,1 + 1,0 vs 4,2 + 1,4 ug/mL) dan (3,35 + 3,43 vs 0,97 + 0,92 mg/L) (p < 0,01), sedangkan SAT tidak berbeda secara signifi kan (1,28 + 0,2 vs 1,24 + 0,1 mmol/L). Adiponektin berkorelasi negatif dengan LP (rs = - 0,436, p < 0,01), sedangkan SAT dan hsCRP berkorelasi positif dengan LP (masing-masing rs= 0.286, p = 0.02 dan rs = 0,597, p < 0. 01). Odds ratio (OR) adiponektin dan hsCRP untuk terjadinya SM masing-masing 4 (p = 0,01) dan ~6,8 (p < 0,01), sedangkan risiko pada subyek dengan rasio adiponektinhsCRP ≤ 2.31 adalah 25 kali lipat (p < 0,01) dibanding subyek dengan rasio adiponektin-hsCRP > 2.31. Kesimpulan Penggunaan rasio adiponektin-hsCRP meningkatkan prediksi SM 4 - 6 kali lipat dibanding bila menggunakan biomarker tunggal.

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AbstractAim To examine biochemical markers of adiponectin, total anti-oxidant status (TAOS) and high sensitvity C-reactive protein (hsCRP) in individuals with and without metabolic syndrome (MetS). Methods A cross-sectional study on 36 non-MetS and 36 MetS subjects was undertaken in Jakarta. Measured indicators were adiponectin, TAOS and hsCRP, apart from weight, height, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood glucose (FBG). Odds ratio (OR) of adiponectin, TAOS and hsCRP were calculated to assess risk for the development of MetS. Median values were determined as cutoffs to defi ne high and low values of each parameter. Relationships between adiponectin, TAOS and hsCRP with WC were analyzed by using Spearman correlation analysis, and the contributions of all indicators to the development of MetS were analyzed by using logistic regression. Results Adiponectin dan hsCRP differed signifi cantly between non MetS and MetS subjects (4.2 + 1.4 vs 3.1 + 1.0 ug/ mL) dan (0.97 + 0.92 vs 3.35 + 3.43 mg/L) (p < 0.01), but no signifi cant difference was found in TAOS (1.24 + 0.1 vs 1.28 + 0.2 mmol/L). Adiponectin associated negatively with WC (rs= -0.436; p < 0.01), while TAOS and hsCRP associated positively with WC (rs= 0.286, p = 0.02 and rs= 0.597, p < 0.01). The odds ratios (ORs) of adiponectin and hsCRP for the development of MetS were 4 (p = 0.01) and ~6,8 (p < 0.01), respectively; while the risk of subjects with adiponectinhsCRP ratio of ≤ 2.31 to develop MetS was 25 times (p < 0.01) those with adiponectin-hsCRP ratio > 2.31. Conclusion The use of adiponectin-hsCRP ratio increases the predictive power for the occurrence of MetS by 4-6 times the predictive power of adiponectin or hsCRP alone. "