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Ukhti Jamil Rustiasari
Ekspresi Cdx2 pada esofagus barret dengan metaplasia kolumnar dan intestinal = The expression of Cdx2 in barrett s esophagus with columnar and intestinal metaplasia
"[ABSTRAK
Latar Belakang : Esofagus Barrett (EB) merupakan lesi premaligna
adenokarsinoma esofagus yang meningkatkan risiko menjadi adenokarsinoma
sebesar 30-125 kali. EB didefinisikan sebagai perubahan epitel esofagus normal
digantikan oleh epitel kolumnar metaplastik, meskipun secara universal belum ada
kesepakatan definisi. Kehadiran sel goblet (metaplasia intestinal) sebagai penanda
EB hingga saat ini masih kontroversi. CDX2 adalah gen regulator transkripsi dalam
diferensiasi intestinal dan diketahui terekspresi pada EB. Studi mengenai ekspresi
protein Cdx2 menggunakan pulasan imunohistokimia pada EB dengan metaplasia
kolumnar (MK) maupun metaplasia intestinal (MI) masih terbatas. Penelitian ini
bertujuan untuk mengetahui ekspresi Cdx2 pada EB dengan MK dan MI serta
hubungannya dengan derajat keparahan endoskopi.
Bahan dan cara : Dilakukan pulasan imunohistokimia Cdx2 pada 38 kasus dari 19
pasien EB dengan MK dan 19 dengan MI. Penilaian dilakukan dengan menghitung
skor pulasan yang menilai intensitas pulasan dan persentase area positif.
Imunoekspresi Cdx2 dinilai positif apabila skor pulasan ≥ 0,1.
Hasil : Ekspresi Cdx2 ditemukan pada 12 (63,16%) kasus MK dan pada 16
(84,21%) kasus MI. Didapatkan nilai median kelompok MK sebesar 0,15 dan MI
sebesar 0,58. Terdapat perbedaan bermakna antara skor Cdx2 pada kelompok MK
dan MI (p=0,05). Diperoleh korelasi bermakna antara kehadiran MI dan skor Cdx2
dengan nilai korelasi positif lemah (0,322). Tidak terdapat hubungan bermakna
antara derajat keparahan endoskopi dengan jenis metaplasia (p=0,794), derajat
inflamasi berdasarkan histopatologik (p=0,300) maupun dengan positivitas Cdx2
(p=0,278).
Kesimpulan : Hasil penelitian menunjukkan ekspresi Cdx2 dapat digunakan sebagai penanda kehadiran MI pada kasus EB dengan MK tanpa gambaran sel goblet.ABSTRACT Background : Barrett?s Esophagus (BE) is premalignan lesion of the esophageal
adenocarcinoma that increases risk of adenocarcinoma as much as 30-125 times.
BE is defined as normal esophageal epithelium that is changed by columnar
epithelial metaplasia. Nevertheless, there is no general agreement about its
definition yet. Currently, the presence of goblet cell (intestinal metaplasia) as an
indicator of BE is still controversial. Cdx2 is a regulator transcript gene in intestinal
differentiation and is known expressed in BE. Study about Cdx2 protein expression
using immunohistochemistry staining in BE with columnar metaplasia (CM) or
intestinal metaplasia (IM) is still limited. This research is intended to find Cdx2
expression in BE with CM and IM as well as its relationship with the severity degree
of endoscopy.
Material and Method : Immunohistochemistry staining of Cdx2 was performed
on 38 cases (i.e. each 19 BE patients with CM and IM). The assessment was
evaluated by calculating staining score that assessed staining intensity and
percentage of positive area. Immunoexpression was considered as positive if
staining score ≥ 0.1.
Result : Cdx2 expression was found on 12 CM patients (63,16%) and 16 IM
patients (84,21%). Median scores of 0,15 and 0,58 were obtained from CM and IM
groups, respectively. There was a significant difference between Cdx2 score of CM
group and IM group (p = 0,05). Significant correlation between the presence of IM
and Cdx2 score was weak positive (0,322). There was no relationship between
severity degree of endoscopy with types of metaplasia (p=0,794), histopathologic
inflammation degree (p=0,300) or Cdx2 positivity (p=0,278).
Conclusion : This study shows that Cdx2 expression can be used an indicator of IM presence on EB cases with CM without goblet cell appearance.;Background : Barrett?s Esophagus (BE) is premalignan lesion of the esophageal
adenocarcinoma that increases risk of adenocarcinoma as much as 30-125 times.
BE is defined as normal esophageal epithelium that is changed by columnar
epithelial metaplasia. Nevertheless, there is no general agreement about its
definition yet. Currently, the presence of goblet cell (intestinal metaplasia) as an
indicator of BE is still controversial. Cdx2 is a regulator transcript gene in intestinal
differentiation and is known expressed in BE. Study about Cdx2 protein expression
using immunohistochemistry staining in BE with columnar metaplasia (CM) or
intestinal metaplasia (IM) is still limited. This research is intended to find Cdx2
expression in BE with CM and IM as well as its relationship with the severity degree
of endoscopy.
Material and Method : Immunohistochemistry staining of Cdx2 was performed
on 38 cases (i.e. each 19 BE patients with CM and IM). The assessment was
evaluated by calculating staining score that assessed staining intensity and
percentage of positive area. Immunoexpression was considered as positive if
staining score ≥ 0.1.
Result : Cdx2 expression was found on 12 CM patients (63,16%) and 16 IM
patients (84,21%). Median scores of 0,15 and 0,58 were obtained from CM and IM
groups, respectively. There was a significant difference between Cdx2 score of CM
group and IM group (p = 0,05). Significant correlation between the presence of IM
and Cdx2 score was weak positive (0,322). There was no relationship between
severity degree of endoscopy with types of metaplasia (p=0,794), histopathologic
inflammation degree (p=0,300) or Cdx2 positivity (p=0,278).
Conclusion : This study shows that Cdx2 expression can be used an indicator of IM presence on EB cases with CM without goblet cell appearance., Background : Barrett’s Esophagus (BE) is premalignan lesion of the esophageal
adenocarcinoma that increases risk of adenocarcinoma as much as 30-125 times.
BE is defined as normal esophageal epithelium that is changed by columnar
epithelial metaplasia. Nevertheless, there is no general agreement about its
definition yet. Currently, the presence of goblet cell (intestinal metaplasia) as an
indicator of BE is still controversial. Cdx2 is a regulator transcript gene in intestinal
differentiation and is known expressed in BE. Study about Cdx2 protein expression
using immunohistochemistry staining in BE with columnar metaplasia (CM) or
intestinal metaplasia (IM) is still limited. This research is intended to find Cdx2
expression in BE with CM and IM as well as its relationship with the severity degree
of endoscopy.
Material and Method : Immunohistochemistry staining of Cdx2 was performed
on 38 cases (i.e. each 19 BE patients with CM and IM). The assessment was
evaluated by calculating staining score that assessed staining intensity and
percentage of positive area. Immunoexpression was considered as positive if
staining score ≥ 0.1.
Result : Cdx2 expression was found on 12 CM patients (63,16%) and 16 IM
patients (84,21%). Median scores of 0,15 and 0,58 were obtained from CM and IM
groups, respectively. There was a significant difference between Cdx2 score of CM
group and IM group (p = 0,05). Significant correlation between the presence of IM
and Cdx2 score was weak positive (0,322). There was no relationship between
severity degree of endoscopy with types of metaplasia (p=0,794), histopathologic
inflammation degree (p=0,300) or Cdx2 positivity (p=0,278).
Conclusion : This study shows that Cdx2 expression can be used an indicator of IM presence on EB cases with CM without goblet cell appearance.]"
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Intan Nevita Oktamiya Bernanthos
Telaah ekspresi P53 dan KI67 pada derajat ringan dan derajat berat esofagitis refluks serta barret esofagus = Expression profile of p53 and Ki67 imumunohistochemical stain in mild and severe degrees of esophagitis reflux and barret esophagus
"Latar belakang: Kanker esofagus dilaporkan sebagai penyebab kematian keenam dari seluruh jenis kanker yang ada di seluruh dunia. Salah satu faktor risiko terjadinya
keganasan esofagus, terutama adenokarsinoma esofagus adalah gastroesophageal reflux disease (GERD). Diagnosis dini GERD sangat penting karena esofagitis refluks kronis
merupakan faktor risiko utama terjadinya Barret esofagus, yang merupakan lesi prekursor terjadinya adenokarsinoma esofagus.Tujuan penelitian ini adalah untuk mengetahui ekspresi p53 dan Ki67 pada esofagitis refluks derajat ringan, esofagitis refluks derajat berat dengan kriteria Esohisto dan Barret esofagus. Bahan dan cara: Penelitian ini merupakan penelitian deskriptif dengan desain
penelitian potong lintang, dengan melakukan pulasan imunohistokimia p53 dan Ki67 pada 76 kasus sampel yang terbagi menjadi 30 kasus esofagitis refluks derajat ringan, 14 kasus esofagitis refluks derajat berat, dan 32 kasus Barret esofagus di Departemen Patologi Anatomik Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Cipto mangunkusumo (FKUI/RSCM) tahun 2016-2018.
Hasil: Ekspresi p53 positif pada 54 kasus sampel (71,1%), terbanyak pada Barret esofagus sebanyak 28 kasus (51,9%). Ekspresi Ki67 tinggi pada 46 kasus (60,5%), terbanyak pada esofagitis refluks derajat berat sebanyak 12 kasus (85,7%) Kesimpulan: Ekspresi p53 dan Ki67 pada esofagitis refluks derajat berrat dan Barret esofagus lebih tinggi dibanding dengan esofagitis refluks derajat ringan.
Background: Esophageal cancer is reported as the sixth leading cause of death from all types of cancer worldwide. One of the risk factors for esophageal malignancy, especially esophageal adenocarcinoma is gastroesophageal reflux disease (GERD). Early diagnosis of GERD is very important because chronic reflux esophagitis is a major risk factor for Barrett esophagus, which is a precursor lesion to esophageal adenocarcinoma. The aim of this study was to determine p53 and Ki67 expression in mild reflux esophagitis, severe reflux esophagitis with the criteria of Esohisto and Barrett esophagus. Materials and methods: This study is a descriptive study with a cross-sectional design, by performing immunohistochemical results of p53 and Ki67 in 76 sample cases which were divided into 30 cases of mild reflux esophagitis, 14 cases of severe reflux esophagitis, and 32 cases of Barret esophagus in the Department Anatomical Pathology, Faculty of Medicine, University of Indonesia / Cipto Mangunkusumo Hospital (FKUI / RSCM) 2016-2018. Results: P53 positive expression in 54 sample cases (71.1%), most in Barret esophagus
as many as 28 cases (51.9%). Ki67 expression was high in 46 cases (60.5%), most in severe reflux esophagitis as many as 12 cases (85.7%) Conclusion: The expression of p53 and Ki67 in severe reflux esophagitis and Barrett esophagus was higher than in mild reflux esophagitis."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
T57616
UI - Tesis Membership  Universitas Indonesia Library
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Budiana Tanurahardja
Perbandingan derajat infeksi helicobacter pylori dan perubahan patologik mukosa lambung penderita gastritis kronik dengan ulkus dan tanpa ulkus: dengan perhatian khusus pada densitas h. pylori, keaktifan radang, metaplasia intestinal dan atrofi kelenjar
"Infeksi Helicobacter pylori (H. pylori) masih merupakan masalah kesehatan yang serius, karena infeksi ini dihubungkan dengan serangkaian kelainan gastrointestinal seperti gastritis kronik, ulkus ventrikulus, ulkus duodenum, karsinoma gaster, hiperplasia folikel limfoid dan limfoma malignum (maltoma). Prevalensi H. pylori pada gastritis kronik dengan ulkus bervariasi antara 40% - 90% (1), sedangkan pada gastritis kronik tanpa ulkus antara 30% - 60% (2). Walaupun prevalensi cukup tinggi, tetapi terdapat kelompok yang menderita infeksi H. pylori tanpa menunjukkan gejala klinik yang bermakna (3,4).
Mekanisme terjadinya kerusakan epitel mukosa lambung pada infeksi H. pylori masih diperdebatkan oleh para ahli apakah oleh efek langsung H. pylori terhadap sel epitel mukosa larnbung atau oleh reaksi inflamasi yang ditimbulkan, Chan (5) dan Hui (6) berpendapat bahwa kerusakan mukosa lambung merupakan akibat langsung dari H. pylori, dan tidak berhubungan dengan reaksi inflamasi, Genta (7,8) menemukan bahwa jumlah folikel limfoid dan limfosit pada lamina propria berhubungan dengan kerusakan epitel., sedangkan sebukan sel radang akut dan normalisasi epitel permukaan sejalan dengan densitas H. pylori.
Hubungan antara atrofi kelenjar, metaplasia intestinalis dan kerusakan epitel permukaan lambung belum banyak dibicarakan, tetapi ada pendapat (9) bahwa: atrofi mukosa gaster ialah hilangnya jaringan kelenjar, sehingga menyebabkan tipisnya mukosa dan menyebabkan kerusakan keras mukosa. Hilangnya jaringan kelenjar ini dapat karena proses inflamasi yang lama dan digantikan oleh fibrosis. Pergantian epitel antrum dengan epitel intestinal disebut metaplasia intestinal yang menimbulkan kesan adanya atrofi kelenjar secara mikroskopik, walaupun metaplasia sebenarnya adalah proses yang berdiri sandhi.
Atrofi mukosa oxyntic berhubungan dengan hilangnya sekresi asam lambung dan terjadinya metaplasia intestinal. Atrofi keras mukosa antrum biasanya dihubungkan dengan metaplasia intestinal dan meninggikan resiko terjadinya keganasan. Atrofi dapat juga ditemukan tanpa adanya metaplasia intestinal terutama pada gastritis autoimun. Penilaian derajat infeksi H. pylori dan perubahan patologi mukosa lambung yang meliputi sebukan sel radang mendadak dan menahun, metaplasia intestinal dan atrofi kelenjar pada sediaan biopsi lambung dapat juga untuk memprediksi prognosis gastritis kronik."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2000
LP-Pdf
UI - Laporan Penelitian  Universitas Indonesia Library
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Indah Widya Lestari
Ekspresi Ezh2 secara imunohistokimia sebagai penanda potensi ganas pada columnar cell lesion payudara = Ezh2 imunohistochemistry expression as a marker of malignant potential in breast columnar cell lesion
"ABSTRAK
Latar belakang: Enhancer of Zeste homolog 2 (EZH2) merupakan kelompok protein grup polycomb yang berperan penting dalam regulasi epigenetik dan berkaitan erat dengan tumorigenesis. EZH2 ekspresinya meningkat pada kanker payudara. Peningkatan ekspresi EZH2 dapat memprediksi peningkatan risiko keganasan. Columnar cell lesion (CCL) merupakan lesi proliferatif, sering ditemukan seiring dengan meningkatnya deteksi dini kanker payudara dengan mammografi. Lesi ini terbagi atas columnar cell change (CCC), columnar cell hyperplasia (CCH), flat epithelial atypia (FEA). CCL menjadi penting setelah dikaitkan dengan risiko menjadi karsinoma payudara, serta hubungannya dengan lesi jinak dan lesi ganas payudara lainnya. Penanda prediktif CCL dibutuhkan untuk memilah CCL yang berpotensi menjadi ganas, sehingga dapat digunakan untuk deteksi dini kanker payudara kelak. Bahan dan cara: Penelitian ini menggunakan metode potong lintang, deskriptif dan analitik. Sampel terdiri atas masing-masing 25 kasus CCL tanpa karsinoma dan CCL dengan karsinoma. Dilakukan pulasan EZH2 secara imunohistokimia dan penilaian dilakukan menggunakan H score dengan modifikasi oleh dua pengamat secara independen. Hasil: Hasil penilaian dua pengamat menyimpulkan nilai tidak ada perbedaan bermakna antar pengamat (p 0,655). Median H score EZH2 pada CCL tanpa karsinoma lebih tinggi secara bermakna (p 0,002) dibandingkan EZH2 dengan karsinoma, dinyatakan tinggi bila H score ≥ 100,16 (dengan sensitivitas 40,00). Kecenderungan sebaran median H score EZH2 didapatkan lebih tinggi pada FEA dengan nilai H score 119,03, diikuti CCH sebesar 103,63 dan CCC sebesar 100,07. Median H score EZH2 pada FEA tanpa karsinoma lebih tinggi (218,26) daripada CCL dengan karsinoma (101,53). Kesimpulan: Ekspresi EZH2 pada CCL tanpa karsinoma lebih tinggi dibandingkan CCL dengan karsinoma, terdapat kecenderungan ekspresi EZH2 yang lebih tinggi pada FEA dibandingkan CCH dan CCC pada semua kasus dan masing-masing kedua kelompok. Ekspresi EZH2 pada FEA tanpa karsinoma lebih tinggi dibandingkan FEA dengan karsinoma. EZH2 diduga berperan dalam karsinogenesis CCL yaitu terutama pada tahap transformasi.
ABSTRACT
Background: Enhancer of Zeste homolog 2 (EZH2) is a group of polycomb which has an important role in epigenetic regulation and is related to tumorigenesis. The expression of EZH2 is increasing in breast cancer. Overexpression of EZH2 can predict the risk of malignant. Columnar cell lesion (CCL) is a proliferatif lesion, and it is increasingly found with the increasing breast screening by mammography. This lesion divided consisted of columnar cell change (CCC), columnar cell hyperplasia (CCH), flat epithelial atypia (FEA). CCL become important related to the risk for carcinoma, and the relation with others benign lesion and maligna lesion. The predictive sign of CCL needed to assess CCL transformation become malignancy. Methods: This was cross sectional study. The sampling consisted of 25 CCL cases without carcinoma and 25 CCL cases with carcinoma. EZH2 immunostainning was assesed using H score by two independent observers. Result: The H score between two observers showed high concordance (p 0,655). Median EZH2 H score in CCL without carcinoma is significantly higher (p 0,002) than CCL with carcinoma, is high if H score ≥ 100,16 (with sensitivity 40,00). Inclination distribution of median H score EZH2 resulted higher in FEA with H score 119,03, followed by CCH 103,63 and CCC 100,07. Median EZH2 H score in FEA without carcinoma (218,26) higher than CCL with carcinoma (101,53). Conclusion: The expression of EZH2 in CCL without carcinoma is higher than CCL with carcinoma, and it shows higher tendency of EZH2 expression in FEA compared by CCH and CCC in all cases and in each group. The expression of EZH2 in FEA without carcinoma is higher than FEA with carcinoma. Hence EZH2 is predicted has a role in malignant transformation and the carcinogenesis of CCL."
2016
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
cover
Jessica Levina
Hubungan mikrosporidiosis intestinal dengan calprotectin feses pada anak dengan diare = Association between intestinal microsporidiosis and fecal calprotectin in children with diarrhea
"Latar belakang: Mikrosporidiosis adalah penyakit infeksi protozoa pada saluran gastrointestinal yang disebabkan oleh Microsporidia. Populasi anak merupakan salah satu kelompok populasi berisiko mengalami mikrosporidiosis karena imunitas yang belum matang. Kerusakan mukosa intestinal terkait mikrosporidiosis tersebut dapat menyebabkan diare kronik, malabsorpsi hingga berat badan menurun terutama pada anak. Namun, mikrosporidiosis kurang terdiagnosis karena gejala klinis tidak spesifik dan pemeriksaan spesifik Microsporidia tidak umum dilakukan. Di Indonesia, infeksi Microsporidia pada anak dengan diare belum pernah diinvestigasi. Untuk mengetahui kerusakan mukosa intestinal akibat mikroposiridosis, pemeriksaan calprotectin feses dapat dilakukan. Penelitian ini bertujuan untuk mengetahui prevalensi mikrosporidiosis intestinal pada anak dengan diare dan hubungannya dengan calprotectin feses positif.
Metode: Penelitian ini menggunakan desain potong lintang. Sebanyak 112 sampel feses dikoleksi dari Laboratorium Parasitologi FKUI yang berasal dari pasien anak di RSUPN Cipto Mangunkusumo (RSCM) berusia 0 sampai 18 tahun dengan diagnosis diare. Setiap sampel dipulas dengan pewarnaan trichrome untuk mendeteksi Microsporidia dan dilakukan pemeriksaan calprotectin feses kualitatif. Untuk mendeteksi parasit usus lain, dilakukan pemeriksaan mikroskopik langsung, konsentrasi, kultur Blastocystis, pulasan modifikasi tahan asam, dan pemeriksaan coproantigen Giardia dan Cryptosporidium. Data sekunder terkait diagnosis klinis, status gizi dan demografi, didapatkan dari rekam medis. Analisis statistik dilakukan antara subjek dengan infeksi tunggal Microsporidia dan hasil calprotectin feses.
Hasil: Prevalensi mikrosporidiosis intestinal pada anak dengan diare yaitu 42,9%, dimana 50% merupakan infeksi Microsporidia tunggal. Infeksi tunggal Microsporidia terbanyak pada usia bayi 8/24 (33,3%), jenis diare akut 17/24 (70,8%) dan penyakit dasar atresia bilier 7/24 (29,1%). Infeksi pada anak laki – laki 15/24 (62,5%), status gizi baik & kurang sama yaitu sebanyak 8/24 (33,3%). Proporsi calprotectin feses positif pada anak dengan diare dan positif Microsporidia yaitu 14/24 (58,3%). Secara statistik, ditemukannya Microsporidia intestinal tidak berhubungan dengan calprotectin feses.
Kesimpulan: Prevalensi infeksi Microsporidia pada anak dengan diare di RSCM tinggi, umumnya pada diare akut dan tidak didapatkan hubungan antara mikrosporidiosis intestinal dengan calprotectin feses.
Background: Microsporidiosis is protozoan infection in gastrointestinal tract caused by Microsporidia. Children have been identified as a population group at risk of developing microsporidiosis due to their immature immune system. Damage to the intestinal mucosa related to microsporidiosis causes chronic diarrhea, malabsorption and weight loss, especially in children. However, microsporidiosis was underdiagnosed because of the clinical symptoms were not specific and Microsporidia examination was not commonly performed. In Indonesia, Microsporidia infection in children with diarrhea has not been investigated. To determine the intestinal mucosa damage due to microposiridosis, a fecal calprotectin test can be performed. This study aims to determine the prevalence of intestinal microsporidiosis in children with diarrhea and its association with positive fecal calprotectin.
Methods: The cross-sectional study design was performed in this research. Stool samples as much as 112 were obtained from the FKUI Parasitology Laboratory from pediatric patients at RSUPN Cipto Mangunkusumo (RSCM) aged 0 to 18 years with a clinical data of diarrhea. Each stool sample was stained with trichrome for Microsporidia detection and a qualitative fecal calprotectin test was performed. To detect other intestinal parasites, direct microscopic examination, concentration, Blastocystis culture, acid-fast modified smear, and Giardia - Cryptosporidium coproantigen examination were also performed. Secondary data related to clinical diagnosis, nutritional status and demographics were obtained from medical records. Statistical analysis was performed between subjects with a single Microsporidia infection and fecal calprotectin results.
Results: The prevalence of intestinal microsporidiosis in children with diarrhea was 42.9% and 50% of them were single Microsporidia infections. Population characteristics of intestinal microsporidiosis in children with diarrhea, are mostly found in infants 8/24 (33.3%), acute diarrhea 17/24 (70.8%) and underlying disease of biliary atresia 7/24 (29.1%). Infections in boys were 15/24 (62.5%), good & poor nutritional status in equal number 8/24 (33.3%). The proportion of positive fecal calprotectin in children with diarrhea and Microsporidia positive is 14/24 (58.3%). Statistically, the presence of intestinal Microsporidia is not associated with fecal calprotectin.
Conclusion: The prevalence of Microsporidia infection in children with diarrhea at RSCM is high, generally in acute diarrhea and there is no association between intestinal microsporidiosis and fecal calprotectin."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2024
T-pdf
UI - Tesis Membership  Universitas Indonesia Library
cover
Siska Wiramihardja
Terapi medik gizi klinik pada Intestinal Failure dengan berbagai etiologi = medical therapy of clinical nutrition for Intestinal Failure with several etiologies
"[ABSTRAK
Latar belakang: Intestinal failure (IF) merupakan masalah pascabedah dengan
outcome yang buruk. Saat ini telah terdapat rekomendasi terapi gizi pada IF
berdasarkan etiologinya, namun belum ada laporan serial kasus yang memaparkan
aplikasinya.
Presentasi Kasus: Pasien dalam serial kasus ini terdiri dari 3 perempuan dan 1
laki-laki, berusia 21?42 tahun. Terhadap pasien ditegakkan diagnosis IF dengan
berbagai etiologi, yaitu 3 pasien dengan fistula enterokutan (FEK) dan 1 pasien
dengan short bowel syndrome (SBS) end jejunostomy. Terapi gizi pada pasien IF
berdasarkan etiologinya. Pada pasien FEK high output, kebutuhan energi 1,5?2
kali resting energy requirement (RER) atau 37?45 kkal/kg BB/hari, protein 1,5?2
g/kg BB/hari. Pada FEK low output kebutuhan energi 1?1,5 kali KEB (25?30
kkal/kg BB/hari), protein 1?1,5 g/kg BB/hari. Pada pasien FEK yang mendapat
terapi konservatif, didapat outcome peningkatan kadar albumin serum dan berat
badan, serta produksi fistel yang berkurang. Pasien FEK dengan persiapan
rekonstruksi usus halus terdapat perbaikan keadaan umum dan peningkatan kadar
albumin serum. Pada pasien SBS, terkait kondisi pascabedah maka terapi gizi
sesuai rekomendasi Enhanced Recovery After Surgery (ERAS), dengan
kebutuhan energi 25?30 kkal/kg BB/hari dengan komposisi makronutrien yang
seimbang. Pada pasien ini dilakukan distal feeding dan pengaturan laju tetesan
kimus untuk mencegah sindrom dumping. Pasien SBS didapat outcome
peningkatan kadar albumin dan berat badan selama masa perawatan.
Kesimpulan: Terapi medik gizi klinik yang adekuat memberikan outcome yang baik pada pasien IF.ABSTRACT Background: Intestinal failure (IF) is a postoperative complication with poor
outcome. Nowadays, many of nutritional management recommendations based on
etiologies of IF, but no report about those application.
Case Presentation: Three female and one male patients were included in this case
series, aged 21?42 years old. Nutritional needs in IF patients are determined by
their etiologies. IF in this case series caused by enterocutaneous fistula (ECF)
and short bowel syndrome (SBS). Nutritional needs on ECF patients depend on
their fistula production. In patients with high output ECF, energy requirement is
in 1.5?2 resting energy requirement (RER) or 37?45 kcal/kg BW/day, protein
1,5?2 g/kg BW/day. In low output ECF, energy requirement is 1?1.5 RER or 25?
30 kcal/kg BW/day hari, protein 1?1.5 g/kg BW/day. In ECF patients given
conservative therapy, serum albumin and body weight increased, while the fistula
production decreased. In patients with preoperative of intestine reconstruction
surgery, there were improvement in general condition with the increase of serum
albumin. In SBS patients, related to the postoperative condition, energy was given
according to Enhanced Recovery after Surgery (ERAS) recommendation 25?30
kkal/kg BW/day with balance of macronutrient composition. In SBS end
jejunostomy patient the food was given through distal feeding with adjusted
chymus drip to prevent dumping syndrome. There were increased in serum
albumin and body weight of the patients.
Conclusion: Adequate support medical therapy of clinical nutrition in IF patients give good outcome. , Background: Intestinal failure (IF) is a postoperative complication with poor
outcome. Nowadays, many of nutritional management recommendations based on
etiologies of IF, but no report about those application.
Case Presentation: Three female and one male patients were included in this case
series, aged 21–42 years old. Nutritional needs in IF patients are determined by
their etiologies. IF in this case series caused by enterocutaneous fistula (ECF)
and short bowel syndrome (SBS). Nutritional needs on ECF patients depend on
their fistula production. In patients with high output ECF, energy requirement is
in 1.5–2 resting energy requirement (RER) or 37–45 kcal/kg BW/day, protein
1,5–2 g/kg BW/day. In low output ECF, energy requirement is 1–1.5 RER or 25–
30 kcal/kg BW/day hari, protein 1–1.5 g/kg BW/day. In ECF patients given
conservative therapy, serum albumin and body weight increased, while the fistula
production decreased. In patients with preoperative of intestine reconstruction
surgery, there were improvement in general condition with the increase of serum
albumin. In SBS patients, related to the postoperative condition, energy was given
according to Enhanced Recovery after Surgery (ERAS) recommendation 25–30
kkal/kg BW/day with balance of macronutrient composition. In SBS end
jejunostomy patient the food was given through distal feeding with adjusted
chymus drip to prevent dumping syndrome. There were increased in serum
albumin and body weight of the patients.
Conclusion: Adequate support medical therapy of clinical nutrition in IF patients give good outcome. ]"
Fakultas Kedokteran Universitas Indonesia, 2015
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Rafida Amalia Salma
Ekspresi NF-κB pada usus halus mencit yang diinduksi dextran sodium sulfate akibat pemberian ekstrak etanol kulit buah punica grantum linn = NF-KB expression on mice small intestinal induced by dextran sodium sulfate due to punica grantum linn. peel ethanol extract administration
"Pendahuluan: Penyakit Crohns merupakan subtipe penyakit radang usus kronis (IBD) yang umumnya terdapat di usus halus. Prevalensi penyakit ini adalah 100 kasus per 100.000 orang. Pengobatan lini pertama untuk IBD adalah kortikosteroid dan asam 5-aminosalisilat (5-ASA). Namun, ada efek samping yang mungkin ditimbulkan, pengobatan alternatif dari bahan alami dapat dipertimbangkan sebagai pengobatan. Konsumsi asam elagat yang terdapat pada kulit buah delima dapat menjadi alternatif pengobatan anti inflamasi.
Tujuan: Penelitian ini dilakukan untuk mengetahui efektivitas ekstrak etanol kulit buah delima sebagai anti inflamasi yang difokuskan pada ekspresi NF-κB pada usus halus mencit yang diinduksi DSS.
Metode: Penelitian ini menggunakan desain eksperimental in vivo dengan menggunakan simpanan bahan biologis jaringan usus halus mencit yang telah diberi perlakuan: tanpa intervensi (N); kontrol negatif (K-) menyebabkan DSS 2%; kontrol positif 1 (KA +) menginduksi DSS 2% dan aspirin; kontrol positif 2 (KE +) menginduksi DSS 2% dan asam elagat; kelompok dosis 1 (D1) diinduksi DSS2% dan ekstrak kulit buah delima dalam dosis kecil (240 mg / kgBB), dan kelompok dosis 2 (KD2) diinduksi oleh DSS2% dan ekstrak kulit buah delima dalam dosis tinggi (480mg / kgBW).
Hasil: Hasil uji One Way ANOVA menunjukkan hasil yang signifikan. Hasil uji Post Hoc Games Howell menunjukkan bahwa terdapat perbedaan yang signifikan antara KN dan K- (p = 0,018), KA + (p = 0,024), KE + (p = 0,034); Kelompok uji D1 dan K- (p = 0,004), KA + (p = 0,001), KE + (p = 0,005); Kelompok uji D2 dan K- (p = 0,020), dan KA + (p = 0,030).
Kesimpulan: Pemberian etanol kulit buah delima dapat menurunkan ekspresi NF-κB pada sel epitel usus halus mencit yang diinduksi oleh DSS 2%.
Introduction: Crohns disease is a chronic inflammatory bowel disease (IBD) subtype that commonly located in the small intestine. The prevalence of this disease is 100 cases per 100.000 individuals. The first-line treatment for IBD is corticosteroids and 5-aminosalicylic acid (5-ASA). However, there are side effects that may be caused, alternative medicines from natural ingredients can be considered as the treatment. The consumption of elagic acid, which is found in pomegranate peels, can be an alternative anti-inflammatory treatment.
Objective: This study was conducted to determine the effectiveness of pomegranate peel ethanol extract as an anti-inflammatory focused on the NF-κB expression on mice small intestine induced by DSS.
Method: This study used an in vivo experimental design using stored biological material of mice small intestine tissue which had been treated: without intervention (N); negative control (K-) induced DSS 2%; positive control 1 (KA +) induced DSS 2% and aspirin; positive control 2 (KE +) induced DSS 2% and elagic acid; dose 1 group (D1) induced DSS2% and pomegranate peel extract in a small dose (240 mg/kgBW), and the dose 2 group (KD2) induced by DSS2% and pomegranate peel extract in a high dose (480mg / kgBW).
Results: The One Way ANOVA test results showed significant results. The results of the Post Hoc Games Howell test showed that there were significant differences between KN and K- (p = 0.018), KA + (p = 0.024), KE + (p = 0.034); D1 test group and K- (p = 0.004), KA + (p = 0.001), KE + (p = 0.005); D2 test group and K- (p = 0.020), and KA + (p = 0.030).
Conclusion: The administration of pomegranate peel ethanol can reduce the expression of NF-κB in mice small intestinal epithelial cells induced by DSS 2%."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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Gina Aulia
Hubungan Status Infeksi Soil-transmitted Helminths dengan Status Inflamasi dan Permeabilitas Usus pada Anak Balita = Association between Soil-transmitted Helminth Infection Status and Intestinal Permeability and Intestinal Inflammation in Preschool-age Children
"Infeksi soil-transmitted helminth (STH) merupakan salah satu permasalahan kesehatan utama di dunia, terutama di negara berkembang. Keberadaan dan aktivitas STH di tubuh inang dapat menyebabkan perubahan pada mukosa usus, termasuk menyebabkan kerusakan sel yang dapat mempengaruhi permeabilitas usus dan menstimulasi respon imun seperti inflamasi. Studi ini dilakukan untuk menentukan status inflamasi dan permeabilitas usus pada berbagai status infeksi parasit cacing usus pada anak usia balita di Kecamatan Nangapanda, Kabupaten Ende, Nusa Tenggara Timur. Sampel tinja yang diperoleh dari anak berusia 20-59 bulan diperiksa keberadaan telur cacing dengan metode Kato-Katz dan diukur konsentrasi biomarker permeabilitas dan inflamasi usus dengan metode Enzyme-linked immunosorbent assay. Biomarker permeabilitas usus yang digunakan adalah α-1-antitripsin (AAT) fekal sedangkan biomarker inflamasi usus yang digunakan adalah calprotektin fekal (FC). Prevalensi infeksi STH pada penelitian ini adalah 17,12%, dengan spesies dominan A. lumbricoides diikuti oleh T. trichiura. Sebagian besar anak memiliki AAT terdeteksi (64,71%), sedangkan hasil sebaliknya ditemukan untuk FC (35,06%). Status infeksi STH tidak memiliki hubungan yang signifikan dengan status konsentrasi AAT, termasuk ketika dianalisis dengan spesies STH. Hubungan yang signifikan hanya ditemukan antara infeksi T. trichiura dan status konsentrasi FC. Sebagian besar anak mengalami peningkatan permeabilitas usus, tetapi tidak selalu disertai inflamasi usus. Infeksi STH tidak memiliki hubungan yang signifikan dengan biomarker tinja kecuali antara status infeksi T. trichiura dan biomarker inflamasi usus yang mungkin dapat dijelaskan oleh perilaku spesies ini pada habitatnya dalam tubuh inang.
Soil-transmitted helminth (STH) infection is still a major health problem in low-and middle-income countries (LMIC). The presence and activity of STH can cause changes in the intestinal mucosa, including cell damage that can affect intestinal permeability and stimulate immune responses such as inflammation. This study investigated the inflammatory and permeability status of the intestinal mucosa in various status of STH infection in preschool-age children (PSC) residing in Nangapanda District, Ende Regency, East Nusa Tenggara. Stool samples were obtained from children aged 20-59 months, and were then examined for worm eggs using Kato-Katz method and measured for the concentrations of biomarkers of intestinal permeability and inflammation by Enzyme-linked Immunosorbent assay. Intestinal permeability biomarkers were represented by fecal α-1-antitrypsin (AAT), while intestinal inflammation biomarkers were represented by fecal calprotectin (FC). The prevalence of STH infection in this study was 17.12%, with A. lumbricoides as the predominant species followed by T. trichiura. Most children had detectable AAT (64,71%), while the opposite result was found for FC (35,06%). STH infection status did not have a significant association with AAT concentration status, including when analyzed by STH species. A significant association was only found between T. trichiura infection and FC concentration status. Most children had increased gut permeability, but not necessarily accompanied by gut inflammation. STH infection did not have a significant correlation with fecal biomarkers except between T. trichiura infection status and gut inflammatory biomarker, which might be explained by the feeding habit of this spesies."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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Atikah Isna Fatya
Perbedaan rerata kadar Intestinal Fatty Acid Binding Protein (I-FABP) pada penyandang obesitas dengan dan tanpa diabetes melitus tipe 2 di Indonesia = The mean difference of Intestinal Fatty Acid Binding Protein (I-FABP) in obesity with and without type 2 diabetes melitus in Indonesia
"Latar Belakang: Terdapat dua jenis obesitas berdasarkan risiko kardiometaboliknya, yaitu metabolically healthy obese (MHO) dan metabolically unhealthy obese (MUO). Kelompok MUO lebih berisiko mengalami DM tipe 2 karena terdapat resistensi insulin yang dicetuskan endotoksemia metabolik akibat disbiosis usus, melalui peningkatan permeabilitas usus. Belum ada data mengenai perbedaan permeabilitas usus, yang diwakili oleh kadar intestinal fatty acid binding protein (I-FABP), pada penyandang obesitas dengan dan tanpa DM tipe 2 di Indonesia.
Tujuan: Mengetahui perbedaan rerata kadar I-FABP pada penyandang obesitas dengan dan tanpa DM tipe 2 di Indonesia.
Metode: Studi potong lintang menggunakan data sekunder dari penelitian Divisi Endokrin, Metabolik, Diabetes FKUI-RSUPN Dr. Cipto Mangunkusumo, Jakarta yang berjudul “Profil Mikrobiota Usus, Mikrobiota Rongga Mulut, Inflamasi, dan Resistensi Insulin pada Berbagai Spektrum Disglikemia” periode Juli 2018-Agustus 2019. Sebanyak 63 subjek obesitas berdasarkan kriteria WHO untuk Asia (IMT ≥25 kg/m2) dibagi menjadi 2 kelompok berdasarkan kriteria ADA: dengan dan tanpa DM tipe 2. Kadar I-FABP diperiksa dengan metode Enzyme-linked immunosorbent assay. Analisis data dengan uji T tidak berpasangan untuk perbedaan rerata I-FABP. Uji regresi logistik dilakukan untuk faktor perancu.
Hasil: Mayoritas subjek ialah perempuan (82,53%), usia >45 tahun (63,50%), obesitas grade I (54,00%), obesitas sentral (93,70%). Rerata I-FABP pada kelompok dengan DM tipe 2 lebih tinggi, yaitu 2,82 (1,23) ng/mL vs. 1,78 (0,81) ng/mL (p<0,001; IK95% 0,51-1,55).
Simpulan: Rerata kadar I-FABP lebih tinggi pada kelompok obesitas dengan DM tipe 2 dan independen terhadap faktor usia.
Background: There are two types of obesity based on its cardiometabolic risk, which are metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO). The MUO exerts higher risk to develop type 2 DM because of higher state of insulin resistance due to metabolic endotoxemia through gut dysbiosis and increased intestinal permeability. There is no study regarding the difference of intestinal permeability, using intestinal fatty acid binding protein (I-FABP), in obese people with and without type 2 DM in Indonesia.
Objective: To know the mean difference of I-FABP in obese people with and without T2DM in Indonesia.
Method: A cross-sectional study using secondary data from the study of Division of Endocrine, Metabolism and Diabetes FMUI-RSUPN Dr. Cipto Mangunkusumo, Jakarta entitled "Profile of the Intestinal Microbiota, Oral Cavity Microbiota, Inflammation, and Insulin Resistance in Various Spectrums of Dysglycemia" for the period July 2018-August 2019. A total of 63 obese subjects based on WHO criteria for Asia (BMI ≥25 kg/m2) were divided into 2 groups based on ADA criteria for diabetes: with and without T2DM. The I-FABP levels were checked using enzyme-linked immunosorbent assay method. Data was analyzed using unpaired T test for mean difference of I-FABP while logistic regression test was performed for confounding factors.
Results: The majority of the subjects were women (82.53%), age >45 years (63.50%), obesity grade I (54.00%) and central obesity (93.70%). The I-FABP level of T2DM group was higher compared to without T2DM group, namely 2.82 (1.23) ng/mL vs. 1.78 (0.81) ng/mL (p<0.001; 95% CI 0.51-1.55).
Conclusion: The mean level of I-FABP was higher in the obese group with T2DM which is independent of age."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021
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Sulaeman Daud
Kelainan lesi prakanker serviks melalui papsmear pada pemeriksaan IVA dengan tampilan sambungan skuamo-kolumnar tidak tampak = Cervical pre cancer lesion with diagnosed by papsmear examination and IVA in women with unvisible squamo-columnar junction
"Tujuan : Untuk mengetahui kelainan yang tersembunyi pada keadaan Sambungan Skuamo-Kolumnar (SSK) tidak tampak melalui pemeriksaan Papsmear.
Metode : Penelitian ini merupakan deskriptif potong lintang (Cross Sectional). Penelitian dilakukan pada periode Agustus 2014 sampai Maret 2015 di beberapa Puskesmas di Jakarta. Sebanyak 1682 subjek yang dilakukan pemeriksaan IVA (Inspeksi Visual dengan Asam asetat). Setelah data dikumpukan, akan dilakukan verifikasi data, editing dan coding. Analisis data statistik berupa deskriptif variabel kategorik yaitu persentase letak Sambungan Skuamo-Kolumnar (SSK) berdasarkan distribusi umur, persentase hasil pemeriksaan IVA berdasarkan SSK, dan persentase hasil pemeriksaan Papsmear pada SSK yang tidak tampak dari hasil pemeriksaan IVA negatif disajikan dalam bentuk n%.
Hasil : Perempuan dengan Sambungan Skuamo-Kolumnar (SSK) yang tampak 1484 (88,2%), yang tidak tampak 198 (11,8%). Sambungan Skuamo-Kolumnar (SSK) yang tidak tampak pada perempuan yang sudah menopause 122 (61,6%), sedangkan pada perempuan yang belum menopause 76 (38,4%). Hampir setengahnya proporsi SSK yang tampak didapatkan pada kelompok perempuan yang sudah menopause 45,78% (103/225). Hasil pemeriksaan IVA positif didapatkan 4(7,1%) pada kelompok perempuan menopause dan 52(92,9%) pada kelompok perempuan yang belum menopause. Pada pemeriksaan Papsmear dengan SSK yang tidak tampak, persentase kelainan lesi prakanker yaitu sebesar 0(0,0%) ASCUS, 0(0,0%) LSIL, 0(0,0%) HSIL, dan 197(100%) normal.
Kesimpulan : Hampir setengahnya Sambungan Skuamo-Kolumnar (SSK) yang tampak ditemukan pada kelompok perempuan menopause. Sebagian besar IVA positif ditemukan pada kelompok perempuan yang belum menopause. Seluruh perempuan dengan SSK yang tidak tampak memiliki hasil pemeriksaan Papsmear normal.
Objective: To know is there any concealed precancer lesion in women with unvisible Squamo-Columnar Junction (SCJ) by Papsmear examination.
Methods : This study was a descriptive cross-sectional design starting from August 2014 to March 2015 at several Public Health Care in Jakarta. A total of 1682 subjects were screening by Acetoacetate Visual Inspection (AVI) examination. After the data was collected, and continued by verification, editing and coding. The analysis from the data by variable categoric descriptive like percentage of SCJ in age distribution, percentage the result of AVI examination based on SCJ and percentage the result of Papsmear examination in unvisible SCJ from negative AVI result. All the result would be present in n%.
Results : Women with the visible SCJ were 1484(88,2%) and women with unvisible SCJ were 198(11,8). The percentage of unvisible SCJ in the menopausal women group were 122(61,6%), However, in the non-menopausal women group were 76(38,4%). Almost a half of the percentage of visible SCJ found in menopausal women group 45,78%(103/225). The positive AVI result was 4(7,1%) in the menopausal women group and 52(92,9%) in non-menopausal women grup. The result of papsmear examination with unvisible SCJ were 0(0,0%) ASCUS, 0(0,0%) LSIL, 0(0,0%) HSIL, and 197(100%) normal.
Conclusion : Almost a half of visible SCJ found in menopausal women group. Most of positive AVI result was found in the non-menopausal women group. All woman with the unvisible SCJ have a normal papsmear result."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
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