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"Nephrotoxic effects of Doxorubicin (DXR) is still a problem in clinical practice. On the other hand Pentoxyfilline (PTX) as an electron-donor material can be nephroprotective. Therefore, combination of DXR and PTX would be expected to reduce nephrotoxic effects of DXR. In this study we examined the effects of PTX on TGF-B1 expression and interstitial fibrosis in an experimental model of DXR nephropathy in mice. Mice were divided into three groups of eight each i.e. untreated Swiss mice (controls), DXR treatment alone to induce nephropathy, and DXR treatment followed by PTX. Following 4 week treatment, each group was sacrificed. Examination of TGF-B1 expression was carried out by immunohistochemistry employing monoclonal antibody. Interstitial fibrosis examination was performed by a histopathologist using Verheoff van Giesen staining and the one way Anova was used for statistical analysis. It was observed that DXR treatment followed by PTX treatment prevented the increase of TGF-B1 expression and interstitial fibrosis in mice with DXRnephropathy (p<0.05). These findings suggested the beneficial nephroprotective effect of PTX."

"Fibrosis hati merupakan penyakit dengan tingkat morbiditas dan mortalitas yang tinggi. Terapi yang efektif dalam mengatasi fibrosis hanyalah transplantasi hati, tetapi mahal dan sulit didapatkan sehingga diperlukan alternatif lain. Umbilical cord mesenchymal stem cell (UC-MSC) mampu mendegradasi matriks ekstraselular sehingga potensial mengatasi fibrosis. Tujuan penelitian adalah mengetahui pengaruh UC-MSC terhadap fibrosis pada hati kelinci (Oryctolagus cuniculus). Jumlah sampel yang digunakan sebanyak 16 hati yang terdiri dari 2 kelompok normal, 7 kelompok fibrosis model ligasi duktus bilier (LDB), dan 7 kelompok fibrosis yang diinjeksi UC-MSC secara intrahepatika (LDB + UC-MSC). Penelitian dilakukan dengan analisis histologi dan ekspresi gen Matrix Metalloproteinase-2 (­MMP-2). Sediaan histologi diwarnai dengan pewarnaan Hematoksilin-Eosin untuk analisis sistem penilaian Laennec dan Masson Trichrome untuk analisis area fraksi kolagen. Analisis ekspresi gen MMP-2 dilakukan dengan metode qRT-PCR. Hasil analisis histologi berdasarkan sistem penilaian Laennec antara kelompok LDB dan LDB + UC-MSC tidak terdapat perbedaan, sedangkan persentase area kolagen menunjukkan perbedaan yang signifikan (p < 0,0001). Hasil analisis ekspresi gen MMP-2 pada kedua kelompok menunjukkan perbedaan yang tidak signifikan (p = 0,2593). Dapat disimpulkan bahwa UC-MSC dapat mengurangi area fraksi kolagen dengan kecenderungan peningkatan ekspresi gen MMP-2 walaupun belum terdapat perubahan secara morfologi.

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Liver fibrosis is a disease with high morbidity and mortality. The effective therapy is liver transplantation, but it is expensive and difficult, so needs alternative. Umbilical cord mesenchymal stem cell (UC-MSC) can degrade extracellular matrix which is potential to decrease fibrosis. The study aims to know the effect of UC-MSC on liver fibrosis in rabbits (Oryctolagus cuniculus). The sample is 16 livers consisting of 2 normal groups, 7 groups of biliary duct ligation fibrosis models (LDB), and 7 groups of fibrosis injected intrahepatic UC-MSC (LDB + UC-MSC). The study uses histological and matrix metalloproteinase-2 (MMP-2) gene expression analysis. Histological slides were stained by Hematoxylin-Eosin for Laennec scoring system and Masson Trichrome for analyze collagen fractions area. Analysis of MMP-2 gene expression was assessed using qRT-PCR. The results of histological analysis based on the Laennec scoring system showed no difference between the LDB and LDB + UC-MSC groups, while the percentage of collagen area showed a significant difference (p <0.0001). The results of the MMP-2 gene expression in the two groups showed no significant difference (p = 0.2593). The conclusion is UC-MSC can reduce the collagen fraction area with a tendency to increase MMP-2 gene expression although no change in morphology."

"Latar belakang: Pemberian albumin hiperonkotik intravena lazim dilakukan pada pasien hipoalbuminemia berat (kadar albumin plasma ≤2,5 g/dl). Walaupun demikian, hingga ini, berbagai referensi menunjukkan hasil yang inkonklusif terkait manfaat "koreksi" kadar albumin pada pasien, terutama dalam menurunkan mortalitas dan morbiditas.Metode: Penelitian ini menilai karakteristik pasien hipoalbuminemia berat dan pola penggunaan albumin intravena hiperonkotik di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo. Analisis kesintasan dilakukan dengan variabel bebas berupa pemberian albumin intravena, penyakit dasar, kadar albumin saat admisi dan sebelum pemberian, serta durasi hingga temuan hipoalbuminemia berat. Data deskriptif ditampilkan terkait pemberian albumin, yaitu mencakup jumlah yang diberikan dan respons terhadap pemberian albumin.Hasil dan Diskusi: Mayoritas pasien (79,19%) dengan kadar albumin ≤2,5 g/dl diberikan albumin hiperonkotik intravena. Insidens mortalitas 30 hari pada pasien hipoalbuminemia berat adalah 47,20%. Pemberian albumin intravena didapatkan tidak memiliki hubungan bermakna dengan kesintasan 30 hari (HR 0,902; IK 95% 0,598-1,361; p=0,624). Faktor yang berhubungan bermakna dengan kesintasan 30 pada pasien hipoalbuminemia berat adalah sepsis, syok hipovolemik, keganasan padat, serta temuan kadar albumin sebelum pemberian ≤2,0 g/dl.Kesimpulan: Pemberian albumin hiperonkotik intravena pada pasien rawat inap tidak berhubungan dengan kesintasan 30 hari.

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Introduction: Intravenous hyperoncotic albumin administration is a common practice to be done to patients with severe hypoalbuminemia (plasma albumin level ≤2.5 g/dl). However, until now, many references has shown inconclusive results associated with "correction" of albumin level in patients, especially in reducing mortality and morbidity.

Method: This study assessed severe hypoalbuminemia patients' characteristics and pattern of use from hyperoncotic albumin intravenously in Cipto Mangunkusumo National Hospital. Survival analysis was done with independent variables including: intravenous albumin administration, underlying diseases, albumin level during admission and before albumin administration, as well as time duration from admission to severa hypoalbuminemia detection. Descriptive data was also shown associated with albumin administration consisted of amount of albumin given and response after albumin administration.

Result and Discussion: Majority of subjects (79.19%) with albumin level ≤2.5 g/dl was given hyperoncotic albumin intravenously. Incidences of 30-day mortality in severe hypoalbuminemia patients is 47.20%. There as no association between intravenous albumin administration and 30-day survival (HR 0.902; 95 CI% 0,598-1.361; p=0.624). Factors which were found associated with 30-day mortality are sepsis, hypovolemic shock, solid malignancy, and findings of albumin level ≤2.0 g/dl before albumin administration.

Conclusion: Hyperoncotic intravenous albumin administration didn't associate with 30-days survival."

"Studi eksperimental hewan memperlihatkan bahwa kadar vasopresin serum yang tinggi berhubungan dengan hiperfiltrasi, albuminuria dan hipertrofi glomerulus, dan dikhawatirkan berlanjut menjadi penurunan laju filtrasi glomerulus (LFG) dalam jangka panjang. Namun, belum terdapat laporan yang membuktikan hubungan sebab-akibat antara peningkatan vasopresin serum dengan gangguan ginjal. Studi ini bertujuan untuk mengetahui hubungan peningkatan vasopresin serum dengan gangguan ginjal, beserta lokasi gangguan ginjal tersebut. Studi ini juga ditujukan untuk melihat kemampuan berat jenis (BJ) urin untuk mendeteksi gangguan ginjal.Penelitian ini adalah studi potong lintang dengan consecutive sampling di sebuah pabrik sepatu pada bulan Januari–Maret 2020. Subjek adalah pekerja terpajan panas yang dinyatakan sehat berdasarkan medical checkup tahun 2019. Sampel darah dan urin diambil lima jam setelah subjek bekerja. Subjek diperiksakan kreatinin plasma, estimasi LFG berdasarkan CKD-EPI, BJ urin, albuminuria carik-celup, albumincreatinine ratio (ACR) urin, vasopresin serum, kidney injury molecule-1 (KIM-1) urin, dan nefrin urin. Data masa kerja, dan jenis kelamin diperoleh melalui wawancara.Pada studi ini, diperoleh 119 subjek wanita dengan median usia 38 (31–51) tahun dan median masa kerja 10 (3–14) tahun. Hiperfiltrasi didapatkan pada 18 subjek, LFG tidak menurun pada 104 subjek (87,4%), dan peningkatan nefrin urin pada 104 pekerja (87,4%). Tidak terdapat hubungan antara vasopresin meningkat dengan hiperfiltrasi, penurunan LFG, albuminuria, nefrin urin, dan KIM-1 urin. Terdapat hubungan bermakna antara peningkatan nefrin urin dengan masa kerja ≥ 10 tahun (p = 0,03). Terdapat hubungan peningkatan KIM-1 urin dengan albuminuria (p = 0,008). Terdapat area under the curve (AUC) antara BJ urin dan nefrin urin sebesar 81,7% (95% CI 68,8–94,6%), dengan titik potong BJ urin ≥ 1,018 yang memiliki sensitivitas 71,2% dan spesifisitas 80% untuk kenaikan nefrin.Sebagai simpulan, peningkatan vasopresin serum tidak berhubungan dengan hiperfiltrasi, penurunan LFG, albuminuria, dan peningkatan KIM-urin. Masa kerja > 10 tahun dihubungkan dengan peningkatan nefrin urin. BJ urin ≥ 1,018 dapat dijadikan acuan untuk mendeteksi kenaikan nefrin urin pada pekerja terpajan panas.

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Animal experimental studies have shown that high serum vasopressin levels are associated with hyperfiltration, albuminuria, and glomerular hypertrophy, which may lead to decreased glomerular filtration rate (GFR) in long-term. However, there was no earlier report that has established the causal relationship between elevated serum vasopressin and renal impairment. This study aims to determine the association between increased serum vasopressin and kidney impairments, along with the location of these impairments. This study is also aimed to look at the ability of urine specific gravity to detect elevated serum vasopressin and kidney impairments.This study was a cross-sectional study with consecutive sampling in a shoe factory from January–March 2020. Subjects were heat-exposed workers who were declared healthy based on the medical checkup in 2019. Blood and urine samples were taken five hours after the subject worked. Subjects were examined for plasma creatinine, estimated GFR (eGFR) based on CKD-EPI, urine specific gravity, dipstick albuminuria, urine albumin-creatinine ratio (ACR), serum vasopressin, urine kidney injury molecule-1 (KIM-1), and urinary nephrin. Data on age, length of service, and gender were obtained through interviews.There were 119 female subjects with a median age of 38 (31–51) years and a median length of service 10 (3–14) years. eGFR was not decreased in 104 subjects (87.4%) and urinary nephrin increased in 104 workers (87.4%). There were no increase in urinary albumin excretion and urinary KIM-1. There were significant association between increased urinary nephrin with length of service ≥ 10 years (p = 0.03), normal-increased eGFR with age 30–39 years (p = 0.001), and increased urinary KIM-1 with albuminuria (p = 0.008). There was an area under the curve (AUC) of 81.7% (95% CI 68.8–94.6%) between urine specific gravity and urinary nephrin, with a cut-off point of urine specific gravity > 1.018 having a sensitivity of 71.2% and a specificity of 80% for the increase in urinary nephrin.In conclusion, increased serum vasopressin does not cause a decrease in GFR, albuminuria, and increase in urinary KIM, but does cause an increase in urinary nephrin. urine specific gravity ≥ 1.018 can be used as a cut-off for detecting increased urinary nephrin in heat-exposed workers."

"Latar belakang: Ginjal merupakan target organ hipertensi yang cukup sering terjadi. Deteksi kerusakan ginjal menjadi salah satu hal yang direkomendasikan dalam penatalaksanaan hipertensi terbaru. Indeks resistif renalis IRR yang diperkenalkan pada beberapa dekade terakhir dipercaya dapat mendeteksi lebih awal kerusakan ginjal serta dapat mengevaluasi hasil pengobatan hipertensi yang diberikan. Penelitian terdahulu telah membuktikan terdapat hubungan antara nilai IRR dengan tekanan darah serta kejadian mikroalbuminuria pada populasi pasien hipertensi tidak terkontrol dan hipertensi resisten, tetapi hingga saat ini belum ada penelitian yang menilai hubungan tersebut pada hipertensi terkontrol. Tujuan: Mengetahui hubungan nilai IRR dengan kadar albuminuria pada pasien hipertensi terkontrol. Metode: Pasien hipertensi terkontrol akan menjalani pemeriksaan duplex renalis untuk mendapatkan nilai IRR. Luaran kerusakan ginjal sebagai target organ hipertensi dinilai dengan pemeriksaan albuminuria melalui rasio albumin kreatinin urin (UACR). Hasil: Terdapat 47 pasien yang menjadi subjek penelitian. Rerata nilai IRR pada subyek penelitian ini adalah 0,68 ± 0,07 dan rerata kadar UACR adalah 6,0 (1-122) mg/g. Tidak didapatkan hubungan yang bermakna antara nilai IRR dengan kadar albuminuria pada pasien hipertensi terkontrol (P=0,18 dengan nilai koefisien korelasi r=0,20). Faktor-faktor lain seperti usia, jenis golongan serta jumlah antihipertensi serta lama pengobatan hipertensi tidak berhubungan dengan kadar albuminuria. Kesimpulan: Nilai IRR tidak berhubungan dengan kadar albuminuria pada hipertensi terkontrol.

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Background: Kidney is a target organ hypertension is quite common. Detection of kidney damage is one of the things that is recommended in the management of recent hypertension. The renalis resistive index IRR introduced in the last few decades is believed to detect early kidney damage and can evaluate the results of treatment of hypertension given. Previous research has shown there is a correlation between RRI value with blood pressure and incidence of microalbuminuria in patient with uncontrolled and resistent hypertension, but until now there has been no study that assesses the relationship in patient with controlled hypertension. Objectives: To investigate the relationship between RRI value with albuminuria levels in patient with controlled hypertension.Methods: Patients with controlled hypertension will undergo duplex renalis examination to obtain an RRI score. The outcome of renal impairment as a target organ of hypertension was assessed by albuminuia examination through urine albumin creatinine ratio (UACR) Results: There were 47 patients who became the subject of the study. The average RRI value in this study subjects was 0.68 ± 0.07 and UACR value was 6,0 (1-122) mg/g. There was no significant relationship between IRR and albuminuria levels in hypertensive patients with controlled blood pressure (P = 0.18 with correlation coefficient r = 0.20). Other factors such as age, class type and number of antihypertensives and length of treatment of hypertension are not associated with albuminuria levels. Conclusion: RRI values has no relationship with albuminuria levels in patient with controlled hypertension. "

"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."

"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."

"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."

"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. "

"[ABSTRAKLatar Belakang : Continous ambulatory peritoneal dialysis (CAPD) telah menjadialternatif selain hemodialisis untuk pengobatan penyakit ginjal tahap akhir. Fibrosisperitoneum merupakan penyebab utama terjadinya kerusakan membran peritoneum.Mekanisme fibrosis peritoneum belum diketahui secara pasti, namun ditengaraitransforming growth factor ? β (TGF ?β) berhubungan erat terhadap terjadinya fibrosisperitoneum.Tujuan : Tujuan penelitian ini adalah untuk mengetahui pengaruh kombinasi ACEinhibitor (ACEI) dan calcium channel Blocker (CCB) terhadap penurunan ekspresi TGF? β dan fibrosis peritoneum tikus jantan yang telah dilakukan CAPD.Metode Penelitian : Penelitian eksperimental, post test only control group design. Tigapuluh tikus Dawley spraque dibagi menjadi lima kelompok yaitu kelompok kontrol(kelompok 1) dan kelompok perlakuan dengan pemberian masing-masing cairan CAPD4,25% (kelompok2) lisinopril 1,44 mg oral dan CAPD (kelompok 3) diltiazem CD 6,48mg oral dan CAPD (kelompok 4) lisinopril 1,44 mg dan diltiazem CD 6,48 mg oral danCAPD (kelompok 5). Setelah 4 minggu tikus dikorbankan dengan cara dislokasi cervicalkemudian diperiksa ekspresi TGF ? β dan terjadinya fibrosis pada peritoneum tikus,selanjutnya dibuat sediaan histopatologi dan diwarnai dengan hematoksilin eosin sertaimunohistokimia menggunakan antihuman TGF-ß.Hasil : Dua puluh peritoneum tikus berhasil diperiksa. Rerata skor TGF-β kelompokkontrol 1,8, kelompok CAPD 2, kelompok lisinopril dan CAPD 1,8, kelompok diltiazemCD dan CAPD 1,8, kelompok lisinopril dan diltiazem CD dan CAPD 1,7 (p=0,959).Rerata skor fibrosis peritoneum kelompok kontrol 1,1, kelompok CAPD 2,6, kelompoklisinopril dan CAPD 1,2, kelompok diltiazem CD dan CAPD 1,3, kelompok lisinopril dandiltiazem CD dan CAPD1,5 (p=0,268)Simpulan : Kombinasi lisinopril dan diltiazem mempunyai kecenderungan menurunkanekspresi TGF ? β lebih baik dibandingkan lisinopril maupun diltiazem yang diberikansecara terpisah tetapi tidak bermakna secara statistik. Kombinasi lisinopril dan diltiazemmempunyai kecenderungan mengurangi fibrosis peritoneum tetapi tidak bermakna secarastatistik dan tidak lebih baik dibandingkan lisinopril maupun diltiazem bila diberikansecara terpisah.

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ABSTRACTBackground : Continuous ambulatory peritoneal dialysis (CAPD) has been analternative other than hemodialysis for end stage kidney disease treatment.Peritoneal fibrosis is the most serious cause of the damage in membraneperitoneum. Mechanism of fibrosis peritoneum is not exactly known yet,transforming growth factor ? β(TGF ? β) is closely related with the existence offibrosis peritoneum.Purposes : The purpose of this study is to evaluate the effect of combinationbetween ACE inhibitor (ACEI) dan Calcium channel blocker (CCB) in reducingexpression of TGF ? β and fibrosis peritoneum in a male rat treated with CAPD.Research Method : Experimental study, post test only control group design.Thirsty Dawley spraque rats are divided into five groups control group ( Group1), CAPD liquid 4,25% (group 2), lisinopril 1,44 mg oral and CAPD (group 3)diltiazem CD 6,48 mg oral and CAPD (group 4) lisinopril 1,44mg + diltiazem CD6,48 mg oral and CAPD (group 5). After 4 weeks, rats sacrificed. Expression ofTGF ? β and peritoneal fibrosis are conducted by histopatology with hematoxillineosinstaining and immunology with anti human-TGF-β.Result : Twenty peritoneal of rats can be examined. Mean score TGF-β controlgroup is 1,8, CAPD group is 2, lisinopril and CAPD group is 1,8,diltiazem CDand CAPD group is 1,8, lisinopril and diltiazem CD and CAPD group is 1,7(p=0,959) .Mean score peritoneal fibrosis control group is 1,1, CAPD group is2,6, lisinopril and CAPD group is 1,2, diltiazem CD and CAPD group is 1,3,lisinopril and diltiazem CD and CAPD group is 1,5 (p=0,268)Summary : Combination of lisinopril and diltiazem lower the expression of TGF? β and fibrosis peritoneum better than lisinopril or diltiazem but statistically notsignificant. Combination of lisinopril and diltiazem lower the peritoneal fibrosisbut statistically not significant and it doesn?t better than lisinopril or diltiazem.Key words: ACE inhibitor, calcium channel blocker, TGF-β, peritoneal fibrosis.;Background : Continuous ambulatory peritoneal dialysis (CAPD) has been analternative other than hemodialysis for end stage kidney disease treatment.Peritoneal fibrosis is the most serious cause of the damage in membraneperitoneum. Mechanism of fibrosis peritoneum is not exactly known yet,transforming growth factor ? β(TGF ? β) is closely related with the existence offibrosis peritoneum.Purposes : The purpose of this study is to evaluate the effect of combinationbetween ACE inhibitor (ACEI) dan Calcium channel blocker (CCB) in reducingexpression of TGF ? β and fibrosis peritoneum in a male rat treated with CAPD.Research Method : Experimental study, post test only control group design.Thirsty Dawley spraque rats are divided into five groups control group ( Group1), CAPD liquid 4,25% (group 2), lisinopril 1,44 mg oral and CAPD (group 3)diltiazem CD 6,48 mg oral and CAPD (group 4) lisinopril 1,44mg + diltiazem CD6,48 mg oral and CAPD (group 5). After 4 weeks, rats sacrificed. Expression ofTGF ? β and peritoneal fibrosis are conducted by histopatology with hematoxillineosinstaining and immunology with anti human-TGF-β.Result : Twenty peritoneal of rats can be examined. Mean score TGF-β controlgroup is 1,8, CAPD group is 2, lisinopril and CAPD group is 1,8,diltiazem CDand CAPD group is 1,8, lisinopril and diltiazem CD and CAPD group is 1,7(p=0,959) .Mean score peritoneal fibrosis control group is 1,1, CAPD group is2,6, lisinopril and CAPD group is 1,2, diltiazem CD and CAPD group is 1,3,lisinopril and diltiazem CD and CAPD group is 1,5 (p=0,268)Summary : Combination of lisinopril and diltiazem lower the expression of TGF? β and fibrosis peritoneum better than lisinopril or diltiazem but statistically notsignificant. Combination of lisinopril and diltiazem lower the peritoneal fibrosisbut statistically not significant and it doesn?t better than lisinopril or diltiazem.Key words: ACE inhibitor, calcium channel blocker, TGF-β, peritoneal fibrosis.;Background : Continuous ambulatory peritoneal dialysis (CAPD) has been analternative other than hemodialysis for end stage kidney disease treatment.Peritoneal fibrosis is the most serious cause of the damage in membraneperitoneum. Mechanism of fibrosis peritoneum is not exactly known yet,transforming growth factor ? β(TGF ? β) is closely related with the existence offibrosis peritoneum.Purposes : The purpose of this study is to evaluate the effect of combinationbetween ACE inhibitor (ACEI) dan Calcium channel blocker (CCB) in reducingexpression of TGF ? β and fibrosis peritoneum in a male rat treated with CAPD.Research Method : Experimental study, post test only control group design.Thirsty Dawley spraque rats are divided into five groups control group ( Group1), CAPD liquid 4,25% (group 2), lisinopril 1,44 mg oral and CAPD (group 3)diltiazem CD 6,48 mg oral and CAPD (group 4) lisinopril 1,44mg + diltiazem CD6,48 mg oral and CAPD (group 5). After 4 weeks, rats sacrificed. Expression ofTGF ? β and peritoneal fibrosis are conducted by histopatology with hematoxillineosinstaining and immunology with anti human-TGF-β.Result : Twenty peritoneal of rats can be examined. Mean score TGF-β controlgroup is 1,8, CAPD group is 2, lisinopril and CAPD group is 1,8,diltiazem CDand CAPD group is 1,8, lisinopril and diltiazem CD and CAPD group is 1,7(p=0,959) .Mean score peritoneal fibrosis control group is 1,1, CAPD group is2,6, lisinopril and CAPD group is 1,2, diltiazem CD and CAPD group is 1,3,lisinopril and diltiazem CD and CAPD group is 1,5 (p=0,268)Summary : Combination of lisinopril and diltiazem lower the expression of TGF? β and fibrosis peritoneum better than lisinopril or diltiazem but statistically notsignificant. Combination of lisinopril and diltiazem lower the peritoneal fibrosisbut statistically not significant and it doesn?t better than lisinopril or diltiazem.Key words: ACE inhibitor, calcium channel blocker, TGF-β, peritoneal fibrosis.;Background : Continuous ambulatory peritoneal dialysis (CAPD) has been analternative other than hemodialysis for end stage kidney disease treatment.Peritoneal fibrosis is the most serious cause of the damage in membraneperitoneum. Mechanism of fibrosis peritoneum is not exactly known yet,transforming growth factor ? β(TGF ? β) is closely related with the existence offibrosis peritoneum.Purposes : The purpose of this study is to evaluate the effect of combinationbetween ACE inhibitor (ACEI) dan Calcium channel blocker (CCB) in reducingexpression of TGF ? β and fibrosis peritoneum in a male rat treated with CAPD.Research Method : Experimental study, post test only control group design.Thirsty Dawley spraque rats are divided into five groups control group ( Group1), CAPD liquid 4,25% (group 2), lisinopril 1,44 mg oral and CAPD (group 3)diltiazem CD 6,48 mg oral and CAPD (group 4) lisinopril 1,44mg + diltiazem CD6,48 mg oral and CAPD (group 5). After 4 weeks, rats sacrificed. Expression ofTGF ? β and peritoneal fibrosis are conducted by histopatology with hematoxillineosinstaining and immunology with anti human-TGF-β.Result : Twenty peritoneal of rats can be examined. Mean score TGF-β controlgroup is 1,8, CAPD group is 2, lisinopril and CAPD group is 1,8,diltiazem CDand CAPD group is 1,8, lisinopril and diltiazem CD and CAPD group is 1,7(p=0,959) .Mean score peritoneal fibrosis control group is 1,1, CAPD group is2,6, lisinopril and CAPD group is 1,2, diltiazem CD and CAPD group is 1,3,lisinopril and diltiazem CD and CAPD group is 1,5 (p=0,268)Summary : Combination of lisinopril and diltiazem lower the expression of TGF? β and fibrosis peritoneum better than lisinopril or diltiazem but statistically notsignificant. Combination of lisinopril and diltiazem lower the peritoneal fibrosisbut statistically not significant and it doesn?t better than lisinopril or diltiazem.Key words: ACE inhibitor, calcium channel blocker, TGF-β, peritoneal fibrosis.;Background : Continuous ambulatory peritoneal dialysis (CAPD) has been analternative other than hemodialysis for end stage kidney disease treatment.Peritoneal fibrosis is the most serious cause of the damage in membraneperitoneum. Mechanism of fibrosis peritoneum is not exactly known yet,transforming growth factor ? β(TGF ? β) is closely related with the existence offibrosis peritoneum.Purposes : The purpose of this study is to evaluate the effect of combinationbetween ACE inhibitor (ACEI) dan Calcium channel blocker (CCB) in reducingexpression of TGF ? β and fibrosis peritoneum in a male rat treated with CAPD.Research Method : Experimental study, post test only control group design.Thirsty Dawley spraque rats are divided into five groups control group ( Group1), CAPD liquid 4,25% (group 2), lisinopril 1,44 mg oral and CAPD (group 3)diltiazem CD 6,48 mg oral and CAPD (group 4) lisinopril 1,44mg + diltiazem CD6,48 mg oral and CAPD (group 5). After 4 weeks, rats sacrificed. Expression ofTGF ? β and peritoneal fibrosis are conducted by histopatology with hematoxillineosinstaining and immunology with anti human-TGF-β.Result : Twenty peritoneal of rats can be examined. Mean score TGF-β controlgroup is 1,8, CAPD group is 2, lisinopril and CAPD group is 1,8,diltiazem CDand CAPD group is 1,8, lisinopril and diltiazem CD and CAPD group is 1,7(p=0,959) .Mean score peritoneal fibrosis control group is 1,1, CAPD group is2,6, lisinopril and CAPD group is 1,2, diltiazem CD and CAPD group is 1,3,lisinopril and diltiazem CD and CAPD group is 1,5 (p=0,268)Summary : Combination of lisinopril and diltiazem lower the expression of TGF? β and fibrosis peritoneum better than lisinopril or diltiazem but statistically notsignificant. Combination of lisinopril and diltiazem lower the peritoneal fibrosisbut statistically not significant and it doesn?t better than lisinopril or diltiazem.Key words: ACE inhibitor, calcium channel blocker, TGF-β, peritoneal fibrosis., Background : Continuous ambulatory peritoneal dialysis (CAPD) has been analternative other than hemodialysis for end stage kidney disease treatment.Peritoneal fibrosis is the most serious cause of the damage in membraneperitoneum. Mechanism of fibrosis peritoneum is not exactly known yet,transforming growth factor – β(TGF – β) is closely related with the existence offibrosis peritoneum.Purposes : The purpose of this study is to evaluate the effect of combinationbetween ACE inhibitor (ACEI) dan Calcium channel blocker (CCB) in reducingexpression of TGF – β and fibrosis peritoneum in a male rat treated with CAPD.Research Method : Experimental study, post test only control group design.Thirsty Dawley spraque rats are divided into five groups control group ( Group1), CAPD liquid 4,25% (group 2), lisinopril 1,44 mg oral and CAPD (group 3)diltiazem CD 6,48 mg oral and CAPD (group 4) lisinopril 1,44mg + diltiazem CD6,48 mg oral and CAPD (group 5). After 4 weeks, rats sacrificed. Expression ofTGF – β and peritoneal fibrosis are conducted by histopatology with hematoxillineosinstaining and immunology with anti human-TGF-β.Result : Twenty peritoneal of rats can be examined. Mean score TGF-β controlgroup is 1,8, CAPD group is 2, lisinopril and CAPD group is 1,8,diltiazem CDand CAPD group is 1,8, lisinopril and diltiazem CD and CAPD group is 1,7(p=0,959) .Mean score peritoneal fibrosis control group is 1,1, CAPD group is2,6, lisinopril and CAPD group is 1,2, diltiazem CD and CAPD group is 1,3,lisinopril and diltiazem CD and CAPD group is 1,5 (p=0,268)Summary : Combination of lisinopril and diltiazem lower the expression of TGF– β and fibrosis peritoneum better than lisinopril or diltiazem but statistically notsignificant. Combination of lisinopril and diltiazem lower the peritoneal fibrosisbut statistically not significant and it doesn’t better than lisinopril or diltiazem.Key words: ACE inhibitor, calcium channel blocker, TGF-β, peritoneal fibrosis.]"