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"Latar belakang dan tujuan: Fibrosis hepar merupakan hal yang perlu diketahui untuk memulai terapi antiviral pada pasien hepatitis C kronik. Pemeriksaan USG Doppler yang bersifat non invasif, tersedia luas dan relatif murah dipertimbangkan sebagai metode alternatif untuk menentukan derajat fibrosis di daerah yang tidak memiliki fibroscan. Parameter splenic artery pulsatility index (SAPI) dipikirkan dapat digunakan sebagai indikator derajat fibrosis. Namun saat ini belum ditemukan nilai titik potong SAPI untuk populasi di Indonesia. Metode: Studi observasional potong lintang dilakukan pada 34 pasien dengan hepatitis C kronik di Divisi Hepatologi Departemen Ilmu Penyakit Dalam Rumah Sakit Cipto Mangunkusumo dalam kurun waktu Desember 2015 hingga Februari 2016. Indeks dan parameter Doppler lainnya merupakan data primer. Subjek dibagi menjadi dua kelompok, yaitu kelompok fibrosis non signifikan dan kelompok fibrosis signifikan. Uji komparatif dilakukan untuk membandingkan rerata indeks dan parameter Doppler lainnya diantara kedua kelompok tersebut. Analisis kurva receiver operating characteristic (ROC) dilakukan pada SAPI untuk mendapatkan nilai sensitifitas dan spesifisitasnya. Hasil: Median SAPI pada kelompok fibrosis signifikan adalah 1.02 dengan range 0.7-1.8 sedangkan median SAPI pada kelompok fibrosis non signifikan adalah 0.89 dengan range 0.7-1.3 dengan nilai p=0.021. Dengan analisis ROC didapatkan titik potong indeks 0.96 yang memberikan sensitifitas 73.9% dan spesifisitas 81.8% untuk membedakan kelompok fibrosis signifikan dan fibrosis non signifikan. Kesimpulan: Terdapat hubungan yang bermakna antara indeks SAPI secara USG dengan derajat fibrosis yang didapat dari fibroscan dan indeks tersebut dapat digunakan sebagai indikator fibrosis signifikan dengan akurasi yang cukup tinggi.

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Background and Objective: Liver fibrosis needs to be evaluated in order to begin anti viral therapy in chronic hepatitis C patients. Doppler ultrasound which is non invasive, widely available and relatively cheap is being considered as an alternative method to determine the degree of fibrosis in areas which do not have a fibroscan available. Splenic artery pulsatility index (SAPI) can be used as an indicator of significant fibrosis, however the cut off value for Indonesian population has yet to be determined.

Method: A cross-sectional observational study is conducted in 34 patients with chronic hepatitis C in the Hepatology Division Department of Internal Medicine Cipto Mangunkusumo Hospital during December 2015 to February 2016. The index and other Doppler parameters are primary data. Subjects are divided into two groups: significant fibrosis group and non significant fibrosis group. Comparative test is conducted to compare the mean index and other Doppler parameters among the two group. Analysis of receiver operating characteristic (ROC) curve was performed on parameters that are statistically significant in order to obtain the sensitivity and specificity value.

Results: Median SAPI in significant fibrosis group is 1.02 with a range of 0.7-1.8 while the median SAPI in non significant group is 0.89 with a range of 0.7-1.3, p=0.021. From ROC curve analysis, we obtained the optimal cutting point index 0.96 which gives 73.9% sensitivity and 81.8% specificity to differentiate significant fibrosis group and non significant fibrosis group.

Conclusion: There is a significant association between SAPI which is obtained by Doppler and the degree of fibrosis obtained from fibroscan which can be used as an indicator for significant liver fibrosis with quite high accuracy."

"Latar Belakang: Fibrosis hati telah menjadi masalah kesehatan global dengan angka mortalitas 800 ribu kematian tahun 2004. Hepatitis kronis yang disebabkan oleh hepatitis C memerlukan perhatian khusus karena secara patogenesis sebelum berkembang menjadi hepatocellular carcinoma (HCC) akan melalui fase fibrosis hati. Baku emas diagnosis fibrosis hati adalah melalui biopsi hati, tetapi terdapat banyak keterbatasan antara lain kesediaan fasilitas dan efek samping. Pemeriksaan non-invasif saat ini menjadi pilihan untuk deteksi fibrosis. Tujuan: untuk mengetahui akurasi pemeriksaan non-invasif (FibroScan, skor APRI, dan FIB-4) dalam mendeteksi fibrosis hati. Metode: Penelitian ini merupakan uji diagnostik dengan menggunakan data sekunder dari rekam medis pasien yang dilakukan biopsi hati di RSPUN dr. Cipto Mangunkusumo dari Januari 2008 hingga Desember 2014. Hasil: Dari 120 orang yang menjalani biopsi hati, 56 pasien yang memenuhi kriteria seleksi. Akurasi APRI, FIB-4, dan FibroScan adalah sebagai berikut, AUC 0,692 (IK95%, 0,381-1,000), AUC 0,567 (IK95%, 0,253-0,882), dan AUC 0,712 (IK 95%, 0,398-1,000). Berdasarkan hasil analisis berjenjang, akurasi diagnostik kombinasi pemeriksaan APRI dan FibroScan, FibroScan dan FIB-4, APRI dan FIB-4, dan kombinasi ketiganya adalah sebagai berikut AUC 0,702 (IK95%, 0,375-1,000), AUC 0,798 (IK95%, 0,533-1,000), AUC 0,774 (IK95%, 0,513- 1,000), dan 0,798 (IK 95%, 0,533-1,000). Kesimpulan: FibroScan memiliki akurasi terbaik dibandingkan APRI dan FIB4 dalam mendeteksi fibrosis hati. Akurasi dengan kombinasi APRI, FIB-4, dan FibroScan meningkat jika dibandingkan dengan pemeriksaan tunggal untuk mendeteksi fibrosis hati pada pasien hepatitis C.

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Background: Liver fibrosis has become a global health problems with the 800 thousand mortality death in 2004. Chronic hepatitis caused by hepatitis c need special attention because before it develops into Hepatocellular Carcinoma (HCC) going through the liver fibrosis. Gold standard of liver fibrosis is liver biopsy, but there are many limitations, such as facilities and side effects. Non-invasive diagnostic tools are the option for the detection fibrosis.

Aim: To know the accuracy of the noninvasive diagnostic tools (FibroScan, the APRI score, FIB-4 score) in detecting liver fibrosis . Methods: This is diagnostic research which used secondary data from medical patient doing liver biopsy conducted in RSUPN dr. Cipto Mangunkusumo in January 2008 to December 2014.

Results: There are 120 patients who underwent liver biopsy and 56 patients who fulfill selection criteria. The accuracy of APRI score, FIB-4, and FibroScan are AUC 0,692 (IK95%, 0,381-1,000), AUC 0,567 (IK95%, 0,253-0,882), and AUC 0,712 (IK95%, 0,398-1,000). Based on the multivariate analysis , accuracy of diagnostic combination FibroScan and APRI , FIB-4 and FibroScan , and FIB-4 and APRI, and combination of the three are as follows AUC 0,702 (IK95% , 0,375-1,000 ), AUC 0,798 (IK95%, 0,533-1,000), AUC 0,774 (IK95%, 0,513- 1,000), and 0,798 ( IK95% , 0,533-1,000 ).

Conclusion: FibroScan has the highest diagnostic accuracy compared with APRI and FIB4 in detecting liver fibrosis. Accuracy of combination APRI, FIB-4, and FibroScan increase compared with the single diagnostic tools for liver fibrosis detection in hepatitis C patient."

"[LatarBelakang: Sekitar 3% populasi di dunia terinfeksi virus hepatitis C. Protein virus hepatitis C memodulasi apoptosis dan steatosis, cedera sel hati, mengaktifkan sel stelata hati dan fibrosis hati. Infeksi virus hepatitis C akan menimbulkan cedera pada hepatosit. Cedera pada hepatosit ini akan mengaktivasi sel stelata hati. Sel stelata berperan besar pada proses perkembangan fibrosis hati..Tujuan: Untuk mengetahui perbedaan jumlah sel stelata hati aktif CD38+ pada berbagai derajat fibrosis serta hubungnnya dengan AST, ALT, jumlah HCV RNA kuantitatif pada hepatitis C kronik.Metoda: Penelitian ini merupakan studi potong lintang yang dilakukan pada 32 pasien hepatitis C kronik yang sudah dilakukan USG hati dan tidak menderita hepatoma serta telah dilakukan biopsi hati. Paraffin block jaringan hati pasien selanjutnya diwarnai menggunakan teknik Hematoksilin Eosin untuk menilai derajat Metavir yang dikategorikan menjadi derajat ringan-sedang atau berat. Pewarnaan khusus dilakukan untuk menilai sel stelata hati yang dihitung rata-rata pada lima lapangan pandang.Hasil: Pada penelitian ini didapatkan perbedaan jumlah sel stelata hati CD38+ yang bermakna antara fibrosis derajat berat dan derajat ringan-sedang (p <0.001), tidak didapatkan hubungan antara sel stelata hati CD38+ dengan AST (p=0,2) maupun ALT (p =0,7), dan tidak didapatkan hubungan antara sel stelata hati CD38+ dengan HCV RNA kuantitatif (r = -0,372).Kesimpulan: Jumlah sel stelata hati CD38+ pada fibrosis berat lebih tinggi daripada jumlah sel stelata hati CD38+ pada fibrosis ringan-sedang. Tidak terdapat hubungan antara nilai AST, ALT dan HCV RNA kuantitatif dengan jumlah sel stelata hati CD38+.;Background: Approximately 3% of the population in the world are infected with hepatitis C. Hepatitis C virus proteins modulate apoptosis and steatosis, liver cell injury, activate liver stellate cells and liver fibrosis. Hepatitis C virus infection will injure to hepatocytes. Hepatocytes injury will activate the liver stellate cells. Stellate cells play a major role in the development of liver fibrosis.Aim: Knowing the CD38+ active hepatic stellate cells count difference at various fibrosis stage and correlation with AST, ALT, quantitative HCV RNA in chronic hepatitis C patientsMethod: Cross-sectional method. 32 paraffin block sample from liver tissue patient with chronic hepatitis C without hepatocellular carcinoma who have performed an abdomen ultrasound and liver biopsy, assess the Metavir score were categorized into mild or severe degree. Samples were stained for liver stellate cells by specific staining and the average of stellate cells were calculated in 10 flat field of view.Result: In this study, the liver stellate cells count CD38+ were significantly correlate with the degree of fibrosis (p <0.001), there were no relationship between liver stellate cells CD38+ with AST levels (p = 0,2) and ALT levels (p = 0,7), and there was no relationship between liver stellate cells CD38+ with quantitative HCV RNA levels (r = -0.372).Conclution: Stellate cells count CD38+ are increasing along with the fibrosis degree. There were no relationship between level of AST, ALT and quantitative HCV RNA with the stellate cells count CD38+., Background: Approximately 3% of the population in the world are infected with hepatitis C. Hepatitis C virus proteins modulate apoptosis and steatosis, liver cell injury, activate liver stellate cells and liver fibrosis. Hepatitis C virus infection will injure to hepatocytes. Hepatocytes injury will activate the liver stellate cells. Stellate cells play a major role in the development of liver fibrosis.Aim: Knowing the CD38+ active hepatic stellate cells count difference at various fibrosis stage and correlation with AST, ALT, quantitative HCV RNA in chronic hepatitis C patientsMethod: Cross-sectional method. 32 paraffin block sample from liver tissue patient with chronic hepatitis C without hepatocellular carcinoma who have performed an abdomen ultrasound and liver biopsy, assess the Metavir score were categorized into mild or severe degree. Samples were stained for liver stellate cells by specific staining and the average of stellate cells were calculated in 10 flat field of view.Result: In this study, the liver stellate cells count CD38+ were significantly correlate with the degree of fibrosis (p <0.001), there were no relationship between liver stellate cells CD38+ with AST levels (p = 0,2) and ALT levels (p = 0,7), and there was no relationship between liver stellate cells CD38+ with quantitative HCV RNA levels (r = -0.372).Conclution: Stellate cells count CD38+ are increasing along with the fibrosis degree. There were no relationship between level of AST, ALT and quantitative HCV RNA with the stellate cells count CD38+.]"

"mengalami kerusakan dan sirosis hati. Walaupun tidak ada data terbaru mengenai insiden kerusakan hati di Indonesia, Riskesdas 2013 menyampaikan adanya prevalensi yang tinggi dari persentase HBsAg, anti-HBs, dan anti-HBc. Selain itu, dalam kurun waktu 30 tahun (1980—2010), terdapat peningkatan tingkat kematian sirosis hati sebanyak 25,1%. Model hewan yang sesuai sangatlah penting dalam meneliti kerusakan hati. Karbon tetraklorida (CCl4) sudah lama digunakan untuk menginduksi fibrosis hati pada model tikus. Walaupun dapat menginduksi pengendapan jaringan ikat, regenerasi hepatoseluler, proliferase sel stelata, dan infiltrasi sel-sel inflamasi, kerusakan pada model tikus yang diinduksi CCl4 hanya merepresentasikan kerusakan hati sampai batas tertentu, mirip dengan kerusakan hati akibat obat. Dengan tujuan meniru kerusakan hati yang lebih parah, penelitian ini mengkombinasikan penggunaan CCl4 dengan asetilaminofluorena-2 (2AAF) karena 2AAF terbukti dapat menekan proliferasi hepatosit sehingga terjadi proliferasi sel oval yang berakibat pada proliferasi duktular. Metode: Desain penelitian ini adalah penelitian observasional terhadap penelitian analitik eksperimental dengan bahan biologis tersimpan yang diambil dari Departemen Patologi Anatomi Fakultas Kedokteran Universitas Indonesia. Penelitian ini menggunakan data primer eksperimental dengan 15 sampel yang dikategorikan dalam 3 kelompok: kontrol sehat, diinduksi CCl4, dan diinduksi 2AAF/CCl4, dan dianalis di bawah mikroskop dalam hal tingkat fibrosis, daerah cakupan fibrosis, dan jumlah proliferasi duktus. Analisis statistik yang digunakan meliputi uji Fisher, Shapiro-Wilk, Kruskal Wallis, dan Mann Whitney menggunakan program SPSS. Hasil: Kelompok 2AAF/CCl4 dan CCl4 memiliki perbedaan derajat fibrosis yang signifikan dengan kontrol sehat (p=0,024 dan p=0,048 secara berurutan), tanpa perbedaan signifikan di antara kedua kelompok tersebut (p=0,286). Perbedaan cakupan area fibrosis antara kedua kelompok juga tidak signifikan (p=0,055), walau kelompok 2AAF/CCl4 dan CCl4 berbeda signifikan dengan kontrol sehat (p=0,007 dan p=0,008 secara berurutan). Dalam hal proliferasi duktular, kelompok CCl4 tidak menunjukkan perbedaan signifikan dengan kontrol sehat (p=0,101), namun berbeda signifikan dengan kelompok 2AAF/CCl4 (p=0,000). Kesimpulan: Tidak terdapat perbedaan derajat dan cakupan area fibrosis yang signifikan antara kelompok 2AAF/CCl4 dan CCl4. Namun demikian, terjadi proliferasi duktular yang secara signifikan lebih tinggi pada kelompok 2AAF/CCl4 dibandingkan kelompok CCl4 saja.

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Background: In 2017, approximately 1.8% of adult in United States suffer from chronic liver disease and cirrhosis. Although there is not any recent data, Riskesdas 2013 showed a high percentage of HBsAg, anti-HBs, and anti-HBc prevalence in Indonesia. On top of that, in Indonesia, in the course of 30 years (1980—2010), liver cirrhosis mortality rate increased by 25,1%. In order to study liver disease, having an appropriate animal model is crucial. Carbon tetrachloride (CCl4) has been used to induce liver fibrosis in mouse model. Although able to induce connective tissue deposition, hepatocellular regeneration, stellate cells proliferation, and inflammatory infiltration, CCl4-induced rat models only represent liver injury to some extent, similar to drug-induced liver injury. In order to mimic a more severe liver injury, this study combined the use of CCl4 with 2- acetylaminofluorene (2AAF), as 2AAF has proven to be able to suppress hepatocyte proliferation and allow oval cells proliferation that leads to ductular proliferation. Method: This research design is an observational research on an analytic experimental study with stored biological material taken from the Department of Anatomy Faculty of Medicine University of Indonesia. This research uses experimental primary data, with 15 samples categorized into three groups: healthy control, CCl4-induced, and 2AAF/CCl4- induced, and analysed for the degree of fibrosis, fibrosis-affected area, and number of proliferating ductules under the microscope. A statistical analysis is then conducted using Shapiro-Wilk, Kruskal Wallis, and Mann Whitney by using SPSS programme. Result: There is a significant difference in the degree of fibrosis between both 2AAF/CCl4 and CCl4 groups with the healthy control (p=0,024 dan p=0,048 respectively), without any significant difference in between the two groups (p=0,286). The affected fibrosis area difference between the two groups is also insignificant (p=0,055), though the 2AAF/ CCl4 and CCl4 groups are significantly different to the healthy control (p=0,007 and p=0,008 respectively). For ductular proliferation, CCl4 group did not show any significant difference compared to the healthy group (p=0,101), but was significantly different to the 2AAF/CCl4 group (p=0,000). Conclusion: There is not any significant difference regarding the degree of fibrosis and its affected area between the 2AAF/CCl4 and CCl4 groups. However, there is a significant difference between the two groups in terms of ductular proliferation, in which the 2AAF/CCl4 group’s ductular proliferation was higher."

"Background: the risk of Non Alcoholic Fatty Liver Disease (NAFLD) is increasing in patients with type 2 diabetes. Prevalence and factors related to the increased risk of NAFLD in diabetic patients in Indonesia has never been studied before. Data regarding the profile of fibrosis in the population has also been unknown. This study aimed to identify the difference on the profile of diabetic patients with and without NAFLD as well as the degree of fibrosis.Methods: the study was conducted using a cross sectional method in type 2 diabetic patients who were treated at the outpatient clinic of endocrinology and metabolic division in Cipto Mangunkusumo Hospital. Sampling was done consecutively. Collected data comprised of age, duration of diabetes, body mass index (BMI), waist circumference, HDL, triglyceride, and HbA1C levels. Abdominal ultrasonography was conducted for all patients to determine the presence of NAFLD. Patients with NAFLD were subsequently underwent transient elastography in order to assess their degree of liver fibrosis. Chi-square or Fishers Exact tests were used for bivariate analysis and logistic regression was used for multivariate analysis.Results: as many as 186 patients were analyzed in the study and 84 patients (45.2%) were demonstrated to have NAFLD. Transient elastography examinations were carried out in 68 patients and 17 patients (25.0%) were found with severe fibrosis. Univariate analysis showed significant differences on BMI (PR=1.878; 95%CI= 1.296 2.721; p<0.001) and waist circumference (PR=2.368; 95%CI= 1.117 5.017; p=0.018) between patients with and without NAFLD. However, the multivariate test showed that BMI was the only factor that had a significance difference between both groups (OR=2.989; 95%CI=1.625-5.499; p<0.001).Conclusion: prevalence of NAFLD among type 2 diabetic patients in Cipto Mangunkusumo Hospital has reached 45.2% and 25.0% among them had severe fibrosis. BMI is the only factor found to be associated with the occurrence of NAFLD."

"Diagnosis of non cirrhotic portal fibrosis was considered when the following criteria were fulfilled evidence of portal hypertension (oesophageal varices, hypersplenism, ascites, or increased hepatic venous pressure gradient), Doppler ultrasound showing patent portal and hepatic veins, and liver biopsy showing sign of cirrhosis. Non cirrhotic portal fibrosis clinically characterized by splenomegaly, anemia, portal hypertension, and histopathological examination portal tract showing fibrosis and sclerosis. Portal hypertension are most caused by a cirrhotic liver (85%), there are only a few reports on non cirrhotic portal hypertension, mostly in Japan and India. We reported a case of non cirrhotic portal fibrosis in young male. The clinical complications of portal hypertension are variceal bleeding and pancytopenia due to hypersplenism. Variceal band ligation and splenectomy were performed. The patient showed good clinical response"

"Latar Belakang: Risiko Non-Alcoholic Fatty Liver Disease NAFLD meningkat pada pasien dengan diabetes melitus DM tipe 2. Prevalensi dan faktor-faktor yang berhubungan dengan peningkatan risiko NAFLD pada populasi DM di Indonesia belum pernah diteliti. Profil derajat fibrosis pada populasi ini juga masih belum diketahui. Tujuan: Mengetahui perbedaan profil pasien DM dengan atau tanpa NAFLD serta derajat fibrosisnya. Metode: Penelitian dikerjakan secara potong lintang terhadap pasien DM tipe 2 dewasa yang berobat di poliklinik endokrin metabolik RSCM. Pengambilan sampel dilakukan secara konsekutif. Data yang dikumpulkan mencakup usia, lama diabetes, indeks masa tubuh IMT , lingkar pinggang, kadar HDL, trigliserida, dan HbA1C. Ultrasonografi abdomen dikerjakan pada semua pasien untuk menentukan adanya NAFLD. Pasien dengan NAFLD lalu menjalani pemeriksaan elastografi transien untuk menilai derajat fibrosis. Uji Chi Square atau Fischer's-Exact digunakan untuk analisis bivariat dan regresi logistik digunakan untuk analisis multivariat. Hasil Penelitian: Sebanyak 186 pasien dianalisis dalam studi ini, dengan 84 pasien 45,2 terbukti mengalami NAFLD. Elastografi transien berhasil dikerjakan pada 68 pasien NAFLD, dengan 17 pasien 25,0 terbukti mengalami fibrosis berat. Analisis univariat menunjukan perbedaan signifikan IMT PR=1,878; 95 CI= 1,296-2,721.

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Background: Risk of Non Alcoholic Fatty Liver Disease NAFLD is increased in patients with type 2 diabetes. Prevalence and factors related to the increased risk of NAFLD in diabetic patients in Indonesia are currently unknown. Data regarding fibrosis profile in this population is also unknown.

Aim: To understand the prevalence and fibrosis profile of Non Alcoholic Fatty Liver Disease in diabetes mellitus and factors associated with it.

Methods: This study was a cross sectional study on diabetic patients treated in the endocrinology and metabolic clinic of Cipto Mangunkusumo Hospital. Sampling was done consecutively. Data collected comprised of age, duration of diabetes, body mass index BMI, waist circumference, HDL, triglyceride, and HbA1C. Abdominal ultrasonography was conducted to every patient to determine the presence of NAFLD. Patients with NAFLD underwent transient elastography to assess their degree of liver fibrosis. Collected data were analyzed in univariate and multivariate manner.

Study Results: We analyzed 186 patients with diabetic. NAFLD were diagnosed in 84 patients 45,2. Transient elastography were carried out in 68 patients, with advanced fibrosis were found in 17 patients 25,0. Univariate analysis showed significant differences between BMI PR 1,878 95 CI 1,296 2,721 p"

"Latar belakang: Atresia bilier merupakan penyebab paling umum fibrosis hati pada anak, dan menjadi indikasi terbanyak transplantasi hati. Fibrosis hati dapat dinilai dengan pemeriksaan histopatologis dan kuantifikasi skor Laennec. Pemeriksaan biomarker dari darah dan metode pencitraan radiologis merupakan upaya lain untuk menilai derajat fibrosis hati. Penelitian ini dimaksudkan untuk meneliti perbandingan biomarker penanda fibrosis transforming growth factor (TFG-β), matrix metalloproteinase (MMP)-7, dan ultrasonografi (USG) Acoustic Radiation Force Impulse (ARFI) dengan derajat fibrosis berdasarkan pemeriksaan histopatologi. Metode penelitian: Penelitian ini merupakan penelitian desain cross sectional pada pasien anak dengan kolestasis yang dicurigai akibat atresia bilier di ruang rawat anak RSUPN Cipto Mangunkusumo. Data penelitian ini adalah data primer dari anamnesis, pemeriksaan fisik, serta data sekunder dari rekam medis untuk melihat riwayat penyakit pasien. Dilakukan pemeriksan serum biomarker TGF-β dan MMP-7, dan USG ARFI oleh operator yang telah ditentukan. Dibandingkan hasil pemeriksaan TGF-β, MMP-7, USG ARFI dengan hasil skoring fibrosis biopsi hati.Hasil penelitian: Dari total 15 pasien dengan AB, terdapat 6 pasien F2-F3, dan 9 pasien F4 berdasarkan derajat fibrosis biopsi hati. Terdapat peningkatan kadar TGF-β dengan adanya peningkatan derajat fibrosis biopsi hati, namun tidak terdapat hubungan bermakna antara derajat fibrosis hati dengan kadar TGF-β (uji Mann-Whitney, p=0.768). Pada penelitian ini, rerata kadar MMP-7 pada kelompok F2-3 dan F4 menunjukan peningkatan, namun tidak terdapat hubungan yang bermakna (Uji Mann-Whitney, p=0.409). Terdapat hubungan bermakna antara derajat fibrosis hati F2-F3 dengan derajat F4 yang diperoleh berdasarkan hasil USG ARFI dan hasil biopsi hati (p<0,01). Kesimpulan: TGF-β dan MMP-7 merupakan biomarker yang cukup efektif namun memiliki keterbatasan tidak spesifik untuk AB. USG ARFI merupakan pemeriksaan minimal invasive yang efektif untuk menentukan derajat fibrosis.

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Background: Biliary atresia is the most common cause of liver fibrosis and the highest indication for liver transplantation in pediatrics. Liver fibrosis is quantified through Laennec score based on histopathology of liver biopsy. Blood serum biomarkers and radiological examinations are alternative methods that could determine liver fibrosis. This study aimed to compare the significance of serum biomarkers transforming growth factor (TFG-β), matrix metalloproteinase (MMP)-7, and Acoustic Radiation Force Impulse (ARFI) ultrasonography (USG) in determining the degree of liver fibrosis compared to histopathology score from liver biopsy. Method: This was a cross-sectional study, on patients in the pediatric ward at dr. Cipto Mangunkusumo National Hospital, that were admitted with cholestasis with biliary atresia as the suspected etiology. Primary data was obtained through anamnesis, and physical examination, and secondary data was obtained through patients’ medical records. Serum biomarkers TGF-β and MMP-7, and USG ARFI were examined by related experts and results were obtained through medical records. Results of TGF-β, MMP-7, and USG ARFI were compared with fibrosis scores based on liver biopsy.

Result: From a total of 15 patients with AB, there were 6 F2-F3 patients, and 9 F4 patients according to the biopsy results. TGF-β levels showed and increasing trend alongside increase in liver biopsy fibrosis score, however it was not statistically significant (Mann- Whitney test, p=0.768). In this study, there was an increase in MMP-7 levels in F2-3 group compared to f4 group, however there was no statically significant difference (Mann-Whitney test, p=0.409). The ARFI USG results showed significant difference between F2-F3 group and F4 group based on ARFI USG compared to liver biopsy (p<0.01). Conclusion: TGF-β and MMP-7 are effective serum biomarkers, however, lacked specificity to determine fibrosis levels in biliary atresia. A minimally invasive test that is effective in determining the degree of fibrosis can be done through ARFI USG. "

"Latar belakang : Gangguan kognitif sebagai komplikasi dari penyakit serebrovaskular terkait hipertensi merupakan masalah kesehatan global seiring dengan meningkatnya angka harapan hidup. Baku emas diagnostik Vascular Cognitive Impairment (VCI) adalah pemeriksaan neuro imaging. Penelitian ini menggunakan modalitas neurosonologi dimana nilai pulsatility index (PI) arteri serebri media (MCA) berdasarkan pemeriksaan Trans Cranial Doppler (TCD) diharapkan menjadi alternatif prediktor gangguan kognitif pada penderita hipertensi. Tujuan : Mengetahui perbedaan nilai PI MCA bilateral antara penderita hipertensi kognitif normal dengan kognitif terganggu. Secara spesifik, penelitian ini bertujuan untuk menilai apakah PI MCA dapat menjadi prediktor gangguan kognitif. Metode : Penelitian ini bersifat potong lintang dengan subyek hipertensi tanpa komplikasi makrovaskular di poliklinik Saraf RSCM. Terdapat 66 subyek yang dipilih berdasarkan kriteria inklusi. Seluruh subyek menjalani pemeriksaan Montreal Cognitive Assesment versi Indonesia (MoCA-Ina) untuk menilai status kognitifnya. Berdasarkan hasil MoCA-Ina seluruh subyek akan dibagi menjadi 2 kelompok yaitu kelompok kognitif normal dan terganggu. Kedua kelompok lalu menjalani pemeriksaan TCD untuk menilai PI MCA bilateral. Hasil : Kelompok dengan gangguan kognitif memiliki nilai PI MCA lebih tinggi dibanding dengan kelompok kognitif normal (p<0,001). Peningkatan nilai PI MCA kiri lebih besar kecenderungannya untuk mengalami gangguan kognitif dibanding peningkatan nilai PI MCA kanan. Faktor-faktor lain yang mempengaruhi gangguan kognitif selain nilai PI MCA adalah lama menderita hipertensi, usia dan Diabetes Mellitus tipe 2 (DMT2). Kesimpulan : Terdapat perbedaan bermakna nilai PI MCA bilateral antara kedua kelompok kognitif. Pulsatility Index MCA dapat menjadi prediktor timbulnya gangguan kognitif pada penderita hipertensi.

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Background : Cognitive impairment as neurologic complications of hypertension related cerebrovascular disease has become global health issue due to increasing life expectancy. Gold standard diagnostic of vascular cognitive impairment (VCI) is through radiologic Magnetic Resonance Imaging (MRI) cerebral. This study utilize another modality by using Transcranial Doppler (TCD) pulsatility index (PI) value of middle cerebral artery (MCA) to evaluate peripheral resistance. The purpose of this study was to determine if pulsatility index of MCA can be a predictor for cognitive impairment in hypertensive patients.

Methods : This is a cross sectional study conducted in Ciptomangunkusumo Hospital, Jakarta. Sixty six hypertensive subjects which lacked of macrovascular complications were selected and screened using Montreal Cognitive Assesment-Indonesia version (MoCA-Ina) to determine their cognitive status. Scores ≥ 26 were grouped under cognitively normal subjects while scores ≤ 26 grouped under cognitive impairment subjects. Both groups then underwent TCD examination to determine values of PI MCA bilateral.

Results : Pulsatility index MCA were significantly higher in cognitive impairment group than normal group (p<0,001). Subjects with elevated left side MCA PI has more tendency to suffer cognitive impairment rather than right side. Other confounding factors related to cognitive impairment would be ages and diabetes mellitus type 2 (DMT2).

Conclusion : Cognitive impairment hypertensive subjects has significantly higher PI MCA compared to cognitively normal hypertensive subjects. Pulsatility index of MCA can be a predictor for cognitive impairment in hypertensive subjects."

"Latar belakang - Mikroangiopati serebral merupakan salah satu komplikasi vaskular pada Diabetes Mellitus (DM). Salah satu parameter pada Transcranial Doppler (TCD) yang menilai adanya resistensi distal dari arteri yang diperiksa yang dapat merefleksikan adanya mikroangiopati di otak adalah Pulsatility Index (PI). Penelitian ini menghubungkan antara rerata PI arteri serebri media (Middle Cerebral Artery/MCA) dengan kejadian retinopati diabetik yang merupakan komplikasi yang paling spesifik dan tersering pada DM tipe 2. Tujuan - Untuk mengetahui perbedaan rerata nilai PI MCA pada penyandang DM tipe 2 di otak pada penyandang DM tipe 2 beserta titik potongnya pada kurva ROC dan faktor-faktor yang mempengaruhinya. Metode - Penelitian ini adalah penelitian potong lintang dengan 60 subyek DM tipe 2 tanpa komplikasi makrovaskular, terdiri dari 29 pasien retinopati dan 31 pasien tanpa retinopati dari poliklinik rawat jalan endokrin RS Cipto Mangunkusumo periode November 2013 ? April 2014. Dilakukan pemeriksaan TCD untuk menilai PI MCA. Usia, riwayat hipertensi, dislipidemia, lama menyandang DM tipe 2 dan HbA1c dianalisis sebagai faktor perancu. Hasil - Pada penyandang DM tipe 2 dengan retinopati memiliki nilai rerata PI arteri serebri media yang lebih tinggi secara bermakna (1,17±0,25) dibandingkan dengan penyandang DM tipe 2 tanpa retinopati (1,05±0,26) dengan p=0,001. Usia, riwayat hipertensi, dislipidemia, lama menyandang DM tipe 2 dan HbA1c tidak berhubungan terhadap perubahan rerata PI MCA (p=0,187; p=0,608; p= 0,734; p=0,159; p=0,548). Titik potong nilai PI MCA pada penyandang DM tipe 2 dengan retinopati adalah pada nilai PI ≥ 1,025 dengan sensitifitas 70% dan spesifisitas 54%. Simpulan - Pada penelitian ini, didapatkan perbedaan rerata nilai PI MCA secara bermakana antara kelompok dengan dan tanpa retinopati dengan nilai titik potong nilai PI MCA pada penyandang DM tipe 2 dengan retinopati adalah pada nilai PI ≥ 1,025 dengan sensitifitas 70% dan spesifisitas 54%.

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Background - Cerebral microangiopathy is one of the most important complications in diabetes mellitus. Elevation in pulsatility index (PI) as measured by Transcranial Doppler (TCD) have been postulated to reflect increased vascular resistance distal of artery being examined. This study correlate PI mean of middle cerebral artery (MCA) with retinal mikroangiopathy which is the most common and specific in diabetic patients.

Objective - To determine differences in PI MCA group with and without retinopathy in type 2 diabetic patients and to find the cuttpoint value at ROC curve.

Methods - The study was carried out in sixty diabetic patients (with no other vascular abnormality), divided into 2 group, 29 type 2 diabetic patients with retinopathy and 31 diabetic patients without retinopathy. TCD was performed to record pulsatility index of MCA then analyzed to find the cuttpoint value. Ages, duration of diabetes, HbA1c levels, history of hypertension and dyslipidemia was analyzes as a confonding factor.

Results - The PI of MCA are significantly higher in diabetic patients with retinopathy than without retinopathy (P=0.001) with cutt of point at PI> 1,025 with 70% sensitivity and 54% spesificity. Age, HbA1c level, diabetes duration, history of hypertension and dislipidemia does not have a meaningful relationship with change cerebral status (p = 1.000, p = 0.657, p = 0.354, p = 0.538).

Conclusions - There are significant differences beetwen mean of pulsatility index in diabetic patients with and without retinopaty. The Cuttpoint are at PI > 1,025 with 70% sensitivity and 54% spesifisity."