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"ABSTRAKPreeklamsia merupakan masalah kesehatan maternal yang berdampak luas pada kesehatan manusia. Defek plasentasi merupakan faktor predisposisi utama preeklamsia yang mengakibatkan spektrum kematian sel apoptosis, aponekrosis dan autofagi. Autofagi juga berperan sebagai mekanisme ketahanan selular melalui nutrisi sebagai regulator utama. Penelitian ini bertujuan untuk mengetahui peran nutrisi dan autofagi sebagai ketahanan selular pada patomekanisme preeklamsia . Penelitian ini merupakan penelitian dengan desain potong lintang yang dilakukan terhadap 4 kelompok yakni; hamil normal, preeklamsia awitan lanjut, preeklamsia awitan dini dan PJT dengan jumlah sampel 10 pasien tiap kelompok. Dilakukan analisis nutrisi secara kualitatif dan kuantitatif untuk zat nutrisi vitamin D, kalsium dan seng serta zat nutrisi sebagai marka inflamasi yaitu vitamin A dan mineral besi. Dilakukan pemeriksaan marka kematian sel LDH dan pemeriksaan marka autofagi LC3, Beclin-1, kegagalan autofagi rasio LC3/Beclin-1 serta marka nutrisi plasenta VDR. Selama periode Agustus hingga Oktober 2015 terdapat 40 pasien yang mengikuti penelitian di RSUPN Cipto Mangunkusumo dan RS Budi Kemuliaan Jakarta. Terdapat perbedaan bermakna ekspresi LC3 dan Beclin-1 serta rasio LC3/Beclin-1 di antara kelompok penelitian. Kelompok preeklamsia awitan dini dan PJT memiliki ekspresi LC3 dan Beclin-1 tertinggi, sedangkan kelompok hamil normal dan preeklamsia awitan lanjut memiliki rasio LC3/Beclin-1 tertinggi. Terdapat korelasi antara kegagalan autofagi dengan LDH. Terdapat defisiensi vitamin D, kalsium dan seng serta terdapat peningkatan retinol dan ferrum sebagai marka inflamasi pada kelompok kehamilan patologis. Terdapat mekanisme up regulation ekspresi nutrisi plasenta reseptor vitamin D VDR pada kelompok preeklamsia awitan lanjut dan awitan dini , sementara ditemukan ekspresi VDR yang rendah pada kelompok PJT. Terdapat korelasi negatif antara rasio LC3/Beclin-1 dengan marka nutrisi maternal terutama kelompok preeklamsia awitan lanjut dan awitan dini. Terdapat korelasi bermakna antara rasio LC3/Beclin-1 dengan ekspresi VDR sebagai marka nutrisi plasenta pada kelompok preeklamsia awitan dini. Autofagi berperan dalam proses kematian sel dan ketahanan selular trofoblas. Terdapat peran nutrisi yang berkorelasi dengan proses autofagi pada patomekanisme preeklamsia. Kata kunci : Autofagi, kematian sel, ketahanan selular, nutrisi, preeklamsia.

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ABSTRACTPreeclampsia is a maternal health problem which largely affects human well being. Placentation defects is the main predisposition factor of preeclampsia which cause cell death spectrum of apoptotic, aponecrosis, and autophagy. Autophagy also has a role as cellular survival mechanism as well through nutrition as main regulator. This research aims to understand the roles of nutrition and autophagy as cellular survival in pathomechanism of preeclampsia. The research has cross sectional study design which was conducted to four groups of pregnancy normal pregnancy, late onset preeclampsia, early onset preeclampsia, and intrauterine growth restriction IUGR with 10 samples for each group. Qualitative and quantitative nutrition analysis was done for vitamin D, calcium and zinc. The same methods was done to nutrients as inflammatory markers which is vitamin A and iron. Assessment was done for cell death marker LDH, autophagy markers LC3, Beclin 1, autophagy failure ratio of LC3 Beclin 1, and placenta nutrition marker VDR. During the period of August to October 2015 there were 40 patients participated in research which was conducted in RSUPN Cipto Mangunkusumo and RS Budi Kemuliaan Jakarta. Analysis shows statistically significant difference between groups of the expression of LC3 and Beclin 1 and ratio of LC3 Beclin 1 as well. Early onset preeclampsia and IUGR group showed the highest LC3 and Beclin 1 expression, while normal pregnancy and late onset preeclampsia group showed the highest ratio of LC3 Beclin 1. There was a correlation between autophagy failure and LDH. There were deficiencies of vitamin D, calcium and zinc and the increase of retinol and iron as inflammatory markers in pathological pregnancy. There was up regulation of vitamin D receptor VDR expression in early and late onset preeclampsia, while low expression of VDR in placenta of IUGR group. There was negative correlation between ratio of LC3 Beclin 1 and maternal nutrition markers particularly in preeclampsia group. There was significant correlation between the ratio of LC3 Beclin 1 and expression of placenta VDR as nutrition marker in early onset preeclampsia group. Autophagy plays a role in the spectrum of cell death and cellular survival in trophoblast. There is role of nutrition in correlation with autophagy process in pathomechanism of preeclampsia Keywords Autophagy, cell death, cellular survival, nutrition, preeclampsia"

"Preeklamsia merupakan kondisi spesifik pada kehamilan yang menjadi penyebab utama morbiditas dan mortalitas maternal-perinatal. Plasentasi abnormal menyebabkan hipoksia plasenta dan gangguan regulasi responss imun sehingga mengakibatkan perubahan mikroskopik struktur plasenta berupa penurunan syncytial bridge. Penelitian ini bertujuan mengetahui toleransi imun dan nekrosis pada preeklamsia berdasarkan gambaran syncytial bridge, jumlah sel Treg, konsentrasi LDH serta profil vitamin 1,25(OH)2D3, dan seng. Penelitian potong lintang ini dilakukan pada bulan Februari–Agustus 2019 di RS Budi Kemuliaan dan RSUD Koja, Jakarta. Subjek penelitian adalah ibu hamil normotensi dan preeklamsia yang memenuhi kriteria penerimaan dan tidak memenuhi kriteria penolakan. Subjek dibagi tiga kelompok yaitu: normotensi/NT (n = 20), preeklamsia tanpa komplikasi/PE (n = 21), dan preeklamsia dengan komplikasi/PEK (n = 20). Semua subjek dilakukan pengukuran. jumlah syncytial bridge plasenta (HE), jumlah sel Treg (flowcytometric dan IHK), konsentrasi LDH (enzymatic colorimetric dan ELISA), vitamin 1,25(OH)2D3 (LC-MS/MS) dan seng (ICP-MS) darah maternal dan plasenta. Data diolah menggunakan SPSS versi 2 dan dianalisis dengan uji test-tidak berpasangan dan Mann-Whitney. Jumlah syncytial bridge pada kelompok PE (10,52/LPB) dan PEK (6,33/LPB) lebih rendah bermakna dibanding NT (14,71/LPB). Syncytial bridge PEK lebih rendah bermakna dibanding PE. Jumlah Treg plasenta kelompok PE (2,89/LPB) dan PEK (2,94/LPB) lebih rendah bermakna dibanding NT (4,11/LPB). Konsentrasi LDH maternal pada PEK (418U/L) lebih tinggi dibanding NT (167,5 U/L), dan PEK lebih tinggi dibanding PE (204 U/L) secara bermakna. Kkonsentrasi 1,25(OH)2D3 maternal kelompok PE (55 pg/mL) dan PEK (41,3 pg/mL) lebih rendah dibanding NT (63,5 pg/mL). Konsentrasi 1,25(OH)2D3 maternal PEK lebih rendah bermakna dibanding PE. Tidak ada perbedaan bermakna konsentrasi seng maternal dan plasenta pada ketiga kelompok. Sel Treg plasenta kelompok syncytial bridge sangat rendah (SSR) 2,86/LPB dan syncytial bridge rendah (SR) 3,09/LPB lebih rendah secara bermakna dibanding syncytial bridge normal (SN) 3,87/LPB. Konsentrasi LDH maternal SSR (318 U/L) lebih tinggi bermakna dibanding SR (213 U/L) dan SN (168 U/L). Konsentrasi vitamin 1,25(OH)2D3 maternal pada SSR (39 pg/mL) lebih rendah dibandingkan SR (53,85 pg/mL) dan SN (58,10 pg/mL). Peningkatan konsentrasi LDH maternal, penurunan konsentrasi 1,25(OH)2D3 maternal dan sel Treg plasenta merupakan faktor risiko berkurangnya jumlah syncytial bridge. Disimpulkan berkurangnya jumlah syncytial bridge menggambarkan beratnya proses nekrosis yang berhubungan dengan penurunan toleransi imun dan konsentrasi 1,25(OH)2D3 maternal.

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Preeclampsia is a specific condition in pregnancy as the main cause of maternal-perinatal morbidity and mortality. Abnormal placentation causes placental hypoxia and disturbances in the regulation of the immune response, thereby resulting in the microscopic structure of the placenta in the form of syncytial bridges. The present study aimed to determine the immune tolerance and necrosis in preeclampsia, on the basis of the syncytial bridge characteristic, Treg cell count, LDH concentration and vitamin 1,25(OH)2D3, and zinc profiles.

This cross-sectional study was carried out from February to August 2019 at RS Budi Kemuliaan and RSUD Koja, Jakarta. The subjects were pregnant women who met the inclusion criteria and did not meet the exclusion criteria. The subjects were divided into three groups, namely the normotensive (NT) group (n = 20), the uncomplicated preeclampsia (PE) group (n = 21), and the complicated preeclampsia (PEC) group (n = 20). All subjects underwent the following examinations: placental syncytial bridge count (HE), Treg cell count (flowcytometric and IHC), LDH (enzymatic colorimetric and ELISA), 1,25(OH)2D3 (LC-MS/MS) and zinc (ICP-MS) concentration in maternal blood and placenta. The data were processed using SPSS version 20 and analyzed by means of the unpaired t and Mann-Whitney tests.

The syncytial bridge count in groups PE (10.52/HPF) and PEC (6.33/HPF) was significantly lower compared with NT (14.71/HPF). PEC syncytial bridge count was significantly lower than PE. Placental Treg count in groups PE (2.89/HPF) and PEC (2.94/HPF) were significantly lower than that of the NT (4.11/HPF). Maternal LDH concentration in PEC (418U/L) was significantly higher than in NT (167.5 U/L), and PE (204 U/L). Maternal 1,25(OH)2D3 concentration in groups PE (55 pg/mL) and PEC (41.3 pg/mL) was lower compared with NT (63.5 pg/mL). Maternal 1,25(OH)2D3 concentration in group PEC was significantly lower than in PE. There were no significant differences in maternal blood and placental zinc concentration in the three groups. Placental Treg cell counts in the very low syncytial bridge count (VLSB) group (2.86/HPF) and the low syncytial bridge count (LSB) (3.09/HPF) were significantly lower than in the normal syncytial bridge count (NSB) (3.87/HPF). Maternal blood LDH in group VLSB (318 U/L) was higher than those in LSB (213 U/L) and NSB (168 U/L). Maternal 1,25(OH)2D3 concentration in group VLSB (39 pg/mL) was lower compared with LSB (53.85 pg/mL) and NSB (58.10 pg/mL). Increased maternal LDH concentration, decreased maternal 1,25(OH)2D3 concentration and placental Treg cell count were risk factors for decreased syncytial bridge count. It was concluded that the decrease in syncytial bridge count depicts the severity of the necrotic process that is associated with decreased immune tolerance and maternal 1,25(OH)2D3 concentration."

"Endometriosis merupakan jaringan yang ditemukan di luar uterus dan dapat menjadi faktor penyebab terjadinya infertilitas. Endometriosis dapat terjadi pada wanita umur reproduktif dengan probabilitas sebesar 10—15%. Selain itu, endometriosis dapat terjadi pada wanita yang memiliki nyeri kronis pada pelvis dengan besar probabilitas sebesar 70%. Pertumbuhan dan perkembangan jaringan endometriosis dipengaruhi oleh autofagi. Mekanisme autofagi yang terjadi pada tubuh manusia dapat dipicu dengan keberadaan HMGB1. Selain dengan HMGB1, autofagi dapat dipicu dengan adanya ekspresi gen LC3 dan BECN1. Adanya HMGB1 berpengaruh terhadap jumlah gen LC3 dan BECN1. Penelitian dilakukan dengan menganalisis sampel jaringan endometriosis pada fase proliferasi dan sekretori menggunakan metode RT-qPCR absolut dengan kurva standard. Kurva standard dibuat dengan fragmen gen HMGB1 didapatkan nilai efisiensi sebesar 88,38% dan nilai R2 sebesar 0,99618. Kedua nilai yang telah disebutkan masuk ke dalam kisaran yang dapat diterima yaitu dalam rentang 80—110% dan diatas 0,99. Sementara itu, Uji T menunjukkan perbedaan dengan hasil yang tidak signifikan (p<0,05) namun menunjukkan kecenderungan pada rata-rata kelompok. Penelitian ini juga melakukan uji Spearman’s Rank pada HMGB1 dan BECN1 dan menunjukkan korelasi positif baik itu pada kelompok sekretori maupun proliferasi dengan hasil masing-masing 0,721 dan 0,729. Sehingga dapat disimpulkan dari penelitian yang dilakukan bahwa jumlah salinan gen HMGB1 berperan dalam mekanisme autofagi dan memengaruhi tingkat autofagi pada jaringan endometriosis.

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Endometriosis is human tissue found outside the uterus and can be a contributing factor to infertility. Endometriosis can occur in women of reproductive age with a percent probability of 10—15%. In addition, it can occur in women who have chronic pelvic pain with a 70%. The growth of endometriotic tissue can be influenced by autophagy. The mechanism of autophagy that occurs in the human body can be triggered by the presence of the HMGB1 protein. In addition to the HMGB1 protein, autophagy also regulated by the presence of LC3 and BECN1 genes. The presence of HMGB1 protein affects LC3 and BECN1. The study was conducted by analyzing tissue samples of endometriosis in the proliferative and secretory phase using the RT-qPCR absolute method with standard curve. The standard curve was made by HMGB1 gene fragment and obtained an efficiency value of 88.38% and R2 value of 0.99618. The two values ​​mentioned above fall into the acceptable range, namely in the range of 80-110% and above 0.99. Meanwhile, the results the T test showed there is no significant difference (p<0,05) but showed a tendency if it compared by the group means. Spearman's Rank test showed a positive correlation between HMGB1 and BECN1 expression in both the secretory and proliferative phase with results of 0.721 and 0.729, respectively. So, it can be concluded from the research that was conducted, it was found that the expression of HMGB1 gene mRNA in the secretory phase was higher in endometrial tissue while in the proliferative phase it was higher in endometrial tissue. In addition, it can be concluded that there is a tendency for the HMGB1 gene take parts to autophagy mechanism in endometriotic tissue.

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"Preeklamsia dibagi menjadi preeklamsia awitan dini (PEAD) jika terjadi pada usia kehamilan < 34 minggu dan preeklamsia awitan lanjut (PEAL) pada kehamilan > 34 minggu. Intoleransi imun diduga menyebabkan penolakan imun terhadap fetus di plasenta. Dendritic cell 10 (DC-10) dan sel T regulator CD4+CD25+FoxP3 (Treg) di desidua berperan penting dalam menciptakan lingkungan yang tolerogenik selama kehamilan. Namun, peran spesifik dalam patomekanisme PEAD dan PEAL serta faktor-faktor nutrisi yang berperan dalam regulasi DC-10 dan Treg, yaitu seng, vitamin A, dan vitamin D belum diteliti secara jelas. Penelitian ini bertujuan untuk memahami patomekanisme penolakan imun pada preeklamsia melalui jumlah DC-10 dan sel Treg desidua serta hubungannya dengan vitamin A, vitamin D, dan seng.Desain penelitian ini adalah studi potong lintang komparatif antara kehamilan dengan PEAD, PEAL, dan NT antara Oktober 2019 dan Desember 2021. Subjek penelitian direkrut dari RSUP Fatmawati (Jakarta), RSUPN Cipto Mangunkusumo (Jakarta), dan RSUD Karawang (Jawa Barat). Kriteria penerimaan adalah semua ibu hamil 20–40 minggu yang menjalani persalinan dengan seksio sesaria dan setuju untuk dilibatkan dalam penelitian. Kriteria penolakan meliputi pasien dengan penyulit obstetrik, plasenta previa, memiliki riwayat penyakit kronik, hipertensi sebelum kehamilan 20 minggu, terdiagnosis COVID-19, demam dan leukosit >15.000 /mL pada saat pemeriksaan dan kematian janin dalam rahim. Spesimen desidua diperoleh dengan kuretase tajam setelah seksio sesaria. Jumlah DC-10 dan sel Treg dihitung dengan flow cytometry. Konsentrasi faktor nutrisi diperiksa dengan metode ICP-MS dan LC-MS. Perbandingan median dianalisis dengan uji Kruskal-Wallis, sedangkan koefisien korelasi diperoleh dengan uji korelasi Spearman. Subjek penelitian adalah 14 ibu hamil untuk setiap kelompok (total 42 kasus). Jumlah DC-10 lebih rendah secara bermakna pada PEAD dibandingkan NT (p < 0,001) dan lebih rendah secara bermakna pada PEAL dibandingkan NT (p = 0,015). Sebaliknya, sel Treg FoxP3+CD25+ lebih tinggi secara bermakna pada PEAD dibandingkan NT (p = 0,015). Tidak terdapat korelasi antara faktor nutrisi dan jumlah faktor tolerogenik pada kelompok preeklamsia (PE). Namun, terdapat korelasi sedang antara konsentrasi seng desidua dan DC-10 di kelompok NT (r = 0,656; p = 0,011) dan korelasi kuat antara konsentrasi retinol desidua dan DC-10 juga di kelompok NT (r = 0,746; p = 0,002). Korelasi sedang didapatkan antara konsentrasi vitamin D dan jumlah sel Treg FoxP3+CD25+ di kelompok NT (r = 0,590; p = 0,026). Disimpulkan bahwa jumlah DC-10 pada PEAD lebih rendah dibandingkan dengan kehamilan NT, sedangkan jumlah sel Treg pada PEAD secara bermakna lebih tinggi dibandingkan dengan kehamilan NT. Konsentrasi faktor nutrisi desidua tidak berkorelasi dengan jumlah DC-10 atau Treg desidua pada preeklamsia (PEAD dan PEAL). Namun, pada kelompok NT terdapat korelasi positif antara seng dan DC-10, retinol dan DC-10, serta vitamin D dan jumlah sel Treg desidua.

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Preeclampsia is categorized as early-onset preeclampsia (EOPE) at < 34 week of gestation and late-onset preeclampsia (LOPE) at > 34 week of gestation. Immune intolerance is thought to be the underlying cause of immune rejection to the fetus in the placenta. Decidual dendritic cell-10 (DC-10) and T regulator cell CD4+CD25+FoxP3 (Treg) play important role to create a tolerogenic environment during pregnancy. However, the specific role in the pathomechanism of EOPE or LOPE and nutritional factors that play role in the regulation of DC-10 and Treg, i.e. zinc, vitamin A, and vitamin D have not been widely studied. This study was aimed to know the pathomechanism of immune rejection in preeclampsia through the number of decidual DC-10 and Treg cell and their correlations with vitamin A, vitamin D, and zinc.

The study design was cross-sectional comparative among EOPE, LOPE, and NT pregnancies between October 2019 and December 2021. Study subjects were recruited from Fatmawati General Hospital (Jakarta), Cipto Mangukusumo National General Hospital (Jakarta), and Karawang Regional Public Hospital (West Java). Inclusion criteria were all pregnant women between 20–40 weeks of gestation who underwent cesarean delivery and gave their written consent to be included in the study. Exclusion critera were patients with obstetric complications, placenta previa, history of chronic disease, hypertension before 20 weeks of gestation, was diagnosed with COVID-19, fever and leukocyte count of >15.000 /mL at the time of examination and presence of intrauterine fetal death. Decidual specimens were obtained by curettage after the cesarian section. The number of DC-10 and Treg cells were counted using flow cytometry. Concentrations of nutritional factors were assayed using ICP-MS and LC-MS method. Median comparison among groups was analyzed using Kruskal-Wallis test, while correlation coefficient was obtained by using the Spearman correlation test. Study subjects were 14 pregnant women for each group (42 cases in total). The DC-10 was significantly lower in EOPE compared to NT (p < 0.001) and significantly lower in LOPE compared to NT (p = 0.015). On the other hand, Treg FoxP3+CD25+ cells were significantly higher in EOPE compare to NT (p = 0.015). No correlation between nutritional factors and the number of tolerogenic factors in the preeclampsia group. However, there was a moderate correlation between decidual zinc concentration and DC-10 in the NT group (r = 0.656; p = 0.011) and a strong correlation between decidual retinol concentration and DC-10 also in NT group (r = 0.746; p= 0.002). A moderate correlation was found between vitamin D concentration and Treg FoxP3+CD25+ cells in the NT group (r = 0.590; p = 0.026). To conclude, the number of DC-10 in EOPE is lower than NT pregnancy, whereas the number of Treg cells in EOPE is higher than NT pregnancy. Concentrations of dedicual nutritional factors do not correlate with the number of decidual DC-10 or Treg cells in preeclampsia (EOPE and LOPE). However, in NT group, there is positive correlation between decidual zinc and DC-10, retinol and DC-10, and vitamin D and Treg cells."

"Latar belakang : Preeklamsia merupakan penyebab utama morbiditas dan mortalitas ibu dan bayi yang masih tergolong cukup tinggi di dunia. Preeklamsia menduduki kedua tertinggi sebesar 14% penyebab kematian ibu. Penyebab kematian bayi pada masa neonatus sebesar 78,5% disebabkan oleh asfiksia, bayi berat lahir rendah dan infeksi. Salah satu akibat hal tersebut dikarenakan faktor maternal seperti preeklamsia. Luaran neonatal dengan kasus preeklamsia yaitu pertumbuhan janin terhambat, gangguan darah (Trombositopenia), gangguan sistem saraf pusat (hypoxic ischemic ensephalopathy, cerebral palsy), gangguan organ pernafasan (bronchopulmonary dysplasia, respiratory distress syndrome) serta gangguan saluran pencernaan (NEC).Tujuan : Mengetahui adakah perbedaan luaran neonatal pada kelahiran preterm dengan preeklamsia dibandingkan dengan kelahiran preterm tanpa preeklamsia.Metode : penelitian ini merupakan penelitian analitik observasional dengan menggunakan metode case-control. Pengambilan sampel dengan cara consecutive sampling. Subjek penelitian ini merupakan neonatal dari kelahiran preterm di usia kehamilan kurang dari 37 minggu yang dilakukan di RSCM. Data yang didapatkan dianalisis secara bivariat menggunakan uji chi-square untuk mengetahui ada atau tidaknya preeklamsia pada kelahiran preterm dengan bayi yang mengalami hypoxic ischemic ensephalopathy (HIE), broncopulmonary syndrome (BPD), respiratory distress syndrome (RDS) dan necrotizing entercolitis (NEC) selama masa perinatal.Hasil : Dari 2.750 subjek yang diteliti dari tahun 2015 hingga 2018 didapatkan luaran neonatal preterm dari ibu yang mengalami Preklamsia sebanyak 455 subjek (16,5%) dibandingkan ibu yang tidak mengalami Preeklamsia sebanyak 2295 subjek (83,5%). Terdapat perbedaan bermakna untuk seluruh gangguan luaran neonatus preterm yaitu hypoxic ischemic ensephalopathy dengan nilai p = 0,002, OR 3,84, CI95% 1,61-9,17, broncopulmonary syndrome dengan nilai p = 0,04, OR 1,87, CI95% 1,03-3,42, respiratory distress syndrome dengan nilai p < 0,0001, OR 5,51 CI95% 4,35-6,98 dan necrotizing entercolitis dengan nilai p< 0,001, OR 2,22 CI95% 1,5-3,17.Kesimpulan : Terdapat perbedaan bermakna untuk seluruh gangguan luaran neonatus preterm berupa hypoxic ischemic ensephalopathy (HIE), broncopulmonary syndrome (BPD), respiratory distress syndrome (RDS) dan necrotizing entercolitis (NEC) pada ibu dengan preeclampsia.

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Background: Preeclampsia is one of major causes of maternal and infant morbidity and mortality in the world. Preeclampsia is the second highest causes maternal death. Factors of death in infants are due to asphyxia, low birth weight and infections. One of the reasons causing infant death are maternal factors such as preeclampsia. Neonatal outcomes with maternal preeclampsia are fetal growth restriction, trombositopenia, nervous system disorder (hypoxic ischemic ensephalopathy, cerebral palsy), respiratory disorder (broncopulmonary dysplasia, respiratory distress syndrome), and digestive tract disorder (necrotizing enterocolitis).

Objective : To investigate whether there are differences of preterm neonatal outcomes in cases with and without preeclampsia.

Method : This study is an observational analytic study using case-control method and consequtive sampling. The subject of this study was preterm neonatal outcomes at gestational age less than 37 weeks in Cipto Mangunkusumo Hospital. The data then bivariately analyzed in order to determine preterm neonatal outcomes in cases with and without preeclampsia with hypoxic ischemic ensephalopathy (HIE), bronchopulmonary dysplasia (BPD), respiratory distress syndrome (RDS) and necrotizinf enterocolitus (NEC) on perinatal period.

Result : Two-thousand and seventy hundred fifty subjects from 2015 until 2018 was studied, preterm infants with preeclampsic mother were 455 subjects (16,5%) and without preeclampsia is 2295 subjects (82,4%). There were significant relationship between preeclampsia with hypoxic ischemic ensephalopathy ( p = 0,002, OR 3,84, CI95% 1,61-9,17) broncopulmonary syndrome (p = 0,04, OR 1,87, CI95% 1,03-3,42), respiratory distress syndrome (p < 0,0001, OR 5,51 CI95% 4,35-6,98) and necrotizing entercolitis (p< 0,001, OR 2,22 CI95% 1,5-3,17).

Conclusion : There were significant relationship between preeclampsia with neonatal outcame hypoxic ischemic ensephalopathy (HIE), bronchopulmonary dysplasia (BPD), respiratory distress syndrome (RDS) and necrotizif enterocolitus (NEC)."

"Preeklamsia merupakan salah satu penyebab kematian utama ibu dan perinatal di dunia. Inflamasi disertai tingginya indeks apoptosis di syncytiotrophoblast dan ekspresi Cyclophilin A diduga berperan pada preeklamsia. Faktor tersebut diasumsikan menyebabkan jejas jantung/pembuluh darah yang meningkatkan risiko morbiditas dan mortalitas ibu dan perinatal. Tujuan penelitan ini adalah menganalisis peran inflamasi, indeks apoptosis dan Cyclophilin A terhadap jejas jantung/pembuluh darah pada preeklamsia awitan dini, lanjut dan kehamilan normal. Sebanyak 47 wanita hamil yang terpilih dilakukan pemeriksaan hematologi, ekokardiografi dan ultrasonografi Doppler. Plasenta diperiksa secara histopatologis untuk mengukur ekspresi NF-KB dan PARP-1, indeks apoptosis berdasarkan pemeriksan TUNEL, ekspresi Cyclophilin A dan pemeriksaan ultrastruktur mikroskopik pada syncytiotrophoblast. Analisis Anova digunakan untuk mengidentifikasi perbedaan antara ketiga kelompok, sedangkan regresi linier digunakan untuk mengetahui korelasi faktor yang diduga terhadap jejas jantung/pembuluh darah menggunakan SPSS 20. Usia ibu, indeks massa tubuh (IMT), hitung trombosit, NF- KB dan indeks apoptosis lebih tinggi disertai Cyclophilin A lebih rendah pada preeklamsia awitan dini dibandingkan preeklamsia awitan lanjut dan kehamilan normal. Hitung leukosit lebih tinggi pada preeklamsia awitan lanjut dibandingkan awitan dini dan normal. Total peripheral resistance (TPR) paling tinggi pada kelompok awitan dini dibandingkan awitan lanjut dan kehamilan normal, sedangkan cardiac index (CI) tidak berbeda bermakna pada ketiga kelompok. Resistensi indeks (RI) lebih tinggi pada preeklamsia awitan dini dibandingkan awitan lanjut dan kehamilan normal. Berdasarkan analisis regresi linier multivariat, membuktikan indeks apoptosis dan Cyclophilin A memiliki hubungan dengan jejas jantung/pembuluh darah. Hal tersebut menunjukkan inflamasi, indeks apoptosis, Cyclophilin A disertai pemeriksan ekokardiografi dan ultrasonografi Doppler merupakan metode yang cepat, tepat dan noninvasif faktor risiko terhadap jejas jantung/pembuluh darah pada preeklamsia. Penelitian yang dianjurkan di masa datang adalah menilai geometri jantung dengan ekokardiografi dan volumetri plasenta dengan ultrasonografi.

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Preeclampsia is one of the leading cause of maternal and perinatal death in the world. Inflammation accompanied by a high apototic index of syncytiotrophoblast and Cyclophilin A were speculated to play a role in preeclampsia. Those response were assumed to cause cardiovascular injury which lead to the risk of maternal and perinatal morbidity and mortality in preeclampsia. The objective of the study was to investigate the role of inflammation, apoptotic index and Cyclophilin A in cardiovascular injury in early and late onset preeclampsia compared to normal pregnancy.

A total of 47 pregnant women were selected, consisting almost the same size of each group (30%) and assessed for maternal hematology, echocardiography and Doppler ultrasound. Placentae were assessed histopathologically by measuring nuclear factor kappa-light-chain-enhancer of activated B cells (NF- KB) and Poly (ADP-ribose) polymerase 1 (PARP-1) expression for inflammation marker, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay for apoptotic index and Cyclophilin A. Confirmation by transmission electron microscopy (TEM) was done. Anova analysis was used to identify the differences between the three groups while linier regression was employed to assess the correlation between factors on cardiovascular injury using SPSS 20.

Maternal age, body mass index (BMI), platelet count, NF- KB and apoptotic index, resistance index (RI) were higher supported by low Cyclophilin A in early onset preeclampsia (EOP) than in late onset preeclampsia (LOP) and normal pregnancy. Leukocyte count was higher in late onset preeeclampsia than in early and normal pregnancy. Total peripheral resistance (TPR) was highest in the EOP compared to LOP and normal pregnancy, while the cardiac index (CI) was not significantly different in all groups.

Based on multivariate linear regression analysis, the apoptotic index and Cyclophilin A correlated to cardiovascular injury. Assesing inflammation, apoptotic index, Cyclophilin A, echocardiography examination and Doppler ultrasound examination might indicated timely and non-invasive detection as an alarm entry point for cardiovascular injury in both early and late onset preeclampsia. Cardiac geometry by echocardiography and placental volumetry by Doppler ultrasound should be performed in future research."

"Latar Belakang: Gagal napas merupakan suatu sindrom pada sistem pernapasan yang gagal dalam fungsi pertukaran gas, sehingga menyebabkan hipoksemia dan/atau hiperkapnia. Pasien dengan gagal napas sangat memerlukan penggunaan ventilator mekanik. Terdapat hubungan antara malnutrisi dengan gagal napas. Terapi medik gizi pasien sakit kritis berupa nutrisi enteral dini dapat menjadi strategi terapi yang dapat mengurangi ketergantungan pada ventilator, mengurangi komplikasi, menurunkan lama rawat di ICU dan meningkatkan keluaran klinis pasien.Metode: Serial kasus ini melaporkan empat pasien sakit kritis dengan gagal napas yang dirawat di ICU RSUPNCM. Terapi medik gizi diberikan sesuai pedoman pada sakit kritis. Nutrisi enteral dini diberikan dalam 48 jam perawatan di ICU. Tiga pasien dapat mencapai target energi 25-30 kkal/kg BB, dan minimal protein 1,2 g/kg BB, sedangkan 1 pasien dengan obes I hanya dapat mencapai energi <70% dari kebutuhan energi total dan protein 0,6 g/kg BB. Mikronutrien diberikan dalam makanan cair. Volume makanan cair yang diberikan disesuaikan dengan imbang cairan pasien setiap hari.Hasil: Pasien pada serial kasus ini berusia 44-67 tahun, semua adalah laki-laki. Satu pasien dengan status gizi malnutrisi ringan, 2 pasien berat badan normal dan 1 pasien dengan obes 1. Dua dari empat pasien termasuk gagal napas tipe I akibat gagal jantung kongestif dengan edema paru. Dua pasien lainnya termasuk gagal napas tipe II akibat fasitis nekrotikan. Seluruh pasien mendapatkan nutrisi enteral dalam 48 jam pertama perawatan. Satu pasien dengan malnutrisi ringan, dan hipoalbuminemia berat mengalami perawatan >21 hari karena sulit weaningventilator dan masuk sebagai chronically crtically ill sedangkan tiga lainnya dengan BB normal dan obes mengalami <21 hari perawatan.Kesimpulan: Status gizi memengaruhi lama pemakaian ventilator mekanik. Terapi medik gizi dapat diterapkan pada semua pasien sesuai dengan komorbid dan dapat mendukung perbaikan keluaran klinis pasien.

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Background: Respiratory failure is a respiratory system syndrome of inadequate gas exchange, resulting hypoxemia and/or hypercapnia. Respiratory failure patient needs mechanical ventilation as the main therapy. Malnutrition and respiratory failure are related. Early enteral nutrition is a therapeutic strategy that can reduce dependence on mechanical ventilation, complications, length of stay in ICU and improve clinical outcomes in critically ill respiratory failure patients.

Methode: This case series report four critically ill patients with respiratory failure from the ICU of Cipto Mangunkusumo Hospital. Medical nutrition therapy is implemented according to the ESPEN clinical nutrition guideline in critically ill. Early enteral nutrition is given in 48 hours of ICU care. Three patients can reach the energy target of 25-30 kcal/kg ABW, and a minimum of 1.2 g/kg ABW protein, whereas 1 obese patient can only achieved <70% of estimated TEE and protein needs of 0.6 g/kg IBW. Micronutrients given within enteral formula. The volume of enteral nutrition is adjusted to patient's fluid balance every day.

Result: Patients were 44-67 years old, all males. One patient was with mild malnutrition, 2 patients were in normal weight and 1 patient was obese I. Two of them were diagnosed as respiratory failure type I due to congestive heart failure with pulmonary edema. The two others were respiratory failure type II due to necrotizing fasciitis. All patients received early enteral nutrition within 48 hours. One patient with malnutrition and severe hypoalbuminemia stayed for >21 days in ICU for mechanical ventilation need, and become a chronically crtically ill while others are <21 days.

Conclusion: Nutritional status affects mechanical ventilation dependence. Medical nutrition therapy can be applied to all patients according to their comorbidities and can improve clinical outcomes. "

"Latar Belakang: Penuaan merupakan proses fisiologis yang terjadi pada semua organ tubuh. Usia lanjut dan sejumlah komorbid yang terjadi seperti hipertensi, penyakit jantung koroner, diabetes melitus, penyakit paru obstruktif kronik dan penyakit ginjal kronik, merupakan faktor risiko mayor gagal jantung kongestif. Pasien usia lanjut dengan gagal jantung kongestif berisiko tinggi readmisi rumah sakit, malnutrisi, defisiensi mikronutrien, dehidrasi atau kelebihan cairan, dan mengalami penurunan ambang rasa. Pada tata laksana gagal jantung kongestif, penting untuk membatasi asupan natrium dan cairan yang dapat menyebabkan penurunan asupan nutrisi, sehingga terapi nutrisi diperlukan sejak awal perawatan. Metode: Laporan serial kasus ini memaparkan empat kasus pasien usia lanjut dengan gagal jantung kongestif, berusia 65-78 tahun dengan minimal satu penyakit komorbid yaitu hipertensi, penyakit jantung koroner, penyakit ginjal kronik, penyakit paru obstruktif kronik, dan diabetes melitus. Semua pasien memerlukan dukungan nutrisi. Dua pasien mengalami malnutrisi, satu pasien berat badan lebih dan satu pasien obes I. Masalah nutrisi yang didapatkan antara lain asupan makronutrien dan mikronutrien tidak adekuat dan komposisi nutrisi tidak seimbang selama sakit dan 24 jam terakhir, gangguan elektrolit, hiperurisemia, hiperglikemia, peningkatan kadar kolesterol LDL dan gangguan keseimbangan cairan. Terapi nutrisi gagal jantung kongestif diberikan pada semua pasien disesuaikan dengan penyakit komorbid masing-masing. Suplementasi mikronutrien dan nutrien spesifik diberikan pada keempat pasien. Pemantauan meliputi keluhan subyektif, hemodinamik, tanda dan gejala klinis, analisis dan toleransi asupan, pemeriksaan laboratorium, antropometri, keseimbangan cairan, dan kapasitas fungsional. Hasil: Keempat pasien menunjukkan peningkatan asupan nutrisi, perbaikan klinis berupa penurunan tekanan darah dan frekuensi nadi, serta peningkatan kapasitas fungsional. Kesimpulan: Terapi nutriso yang adekuat dapat memperbaiki kondisi klinis pasien usia lanjut dengan gagal jantung kongestif dan berbagai penyakit komorbid.

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Background: Aging is a physiological process, which is occurs in all organs. Elderly people and various comorbidities, such as hypertension, coronary artery disease, diabetes mellitus, chronic obtructive pulmonary disease and chronic kidney disease, are major risk factors of congestive heart failure. Elderly patients with congestive heart failure are at high risk of hospital readmission, malnutrition, micronutrients deficiency, dehydration or fluid overload and decreased sense of taste. In the congestive heart failure therapy, fluid and sodium intake restriction is important, however it may result in decreased nutrition intake so that is necessary to provide early adequate nutrition therapy.

Method: This serial case report describes four cases of congestive heart failure with various comorbidities in the elderly patients, aged 65-78 years old, with at least one comorbid, such as hypertension, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, and diabetes mellitus. All patients required nutrition support. Two patients classified as malnutrition, one overweight and one obese I. Nutrition problems in this serial case report are macromicronutrients intake, and nutrition composition imbalance during ill and 24 hours before hospitalized, electrolyte imbalance, hyperuricemia, hyperglycemia, elevated LDL cholesterol levels, and fluid imbalance. Nutrition therapy for congestive heart failure was given to all patients, and adjusted to the comorbidities in each patient. Micronutrients and specific nutrients supplementation were given to all patients. Monitoring include subjective complaints, hemodynamic, clinical signs and symptoms, analysis and tolerance of food intake, laboratory results, anthropometric, fluid balance, and functional capacity.

Result: During monitoring in the hospital, all patients showed improved food intake, clinical outcomes, such as decreased of blood pressure, heart rate and increased of fungcional capacity.

Conclusion: Adequate nutrition therapy an important role in improving clinical conditions in the elderly patients with congestive heart failure and various comorbidities."

"ABSTRAK Latar Belakang : Preeklamsia pada kehamilan didapatkan sekitar 3-7 dan merupakan salah satu penyebab utama dari kematian ibu, yaitu sekitar 18 .Pemeriksaan petanda preeklamsia masih mahal dan belum rutin dilakukan. Adanya pemeriksaan yang lebih murah dan mudah untuk menilai tingkat keparahan preeklamsia sangat diperlukan dalam penatalaksanaan preeklamsia, terutama di tempat dengan fasilitas yang terbatas. Banyak penelitian telah dilakukan untuk mengetahui petanda preeklamsia dan keparahannya. Walaupun demikian belum didapatkan petanda yang khusus, disamping biaya yang mahal dan belum rutin digunakan. Rasio netrofil limfosit NLR dan Red Distribution Width RDW diketahui telah banyak diteliti untuk menilai inflamasi yang berhubungan dengan tingkat keparahan preeklamsia. Pemeriksaan ini termasuk dalam pemeriksaan darah lengkap yang relatif murah, mudah dan rutin digunakan. Tujuan Penelitian : Penelitian ini bertujuan untuk mencari perbedaan rasio netrofil limfosit NLR dan Red Distribution Width RDW pada pasien dengan preeklamsia dibandingkan dengan kehamilan normal serta perbedaan rasio netrofil limfosit dan RDW pada preeklamsia early onset dan late onset. Metode Penelitian : Penelitian ini merupakan penelitian potong lintang dengan menggunakan data rekam medis pasien hamil normal dan preeklamsia yang ke IGD dan Poliklinik Obstetri RSU Persahabatan pada bulan Juli 2014-Juni 2016. Data penelitian didokumentasikan pada dan ditabulasi serta dianalisis menggunakan SPSS 20.0. Hasil Penelitian : Didapatkan 254 sampel data yang memenuhi kriteria inklusi penelitian, yang terdiri atas 136 preeklamsia dan 118 kehamilan normal, 24 preeklamsia early onset dan 112 preeklamsia late onset. Dilakukan analisis Mann Whitney dan T Test Didapatkan rasio netrofil limfosit preeklamsia 4,41 1,41-32,54 dan pada kehamilan normal 2,61 1,39-5,48 dengan p: 0.000. Red Distribution Width pada preeklamsia adalah 14,2 11,48-23,90 dan pada kehamilan normal 13,8 10,81 ndash; 18,70 dengan p:0.001. Rasio netrofil limfosit pada preeklamsia early onset 4,35 1,41-17,56 dan preeklamsia late onset 4,41 1,69-32,54 dengan p:0,993. Red Distribution Width pada preeklamsia early onset 13,50 1,47 dan preeklamsia late onset 14,91 2,16 dengan p:0.003. Uji power rasio netrofil limfosit pada preeklamsia early onset dan late onset adalah 16,4 . Uji power Red Distribution Width pada preeklamsia early onset dan late onset adalah 97,29 .Kesimpulan : Terdapat perbedaan bermakna rasio netrofil limfosit dan RDW pada preeklamsia dibandingkan dengan kehamilan normal, terdapat perbedaan bermakna RDW preeklamsia early onset dan late onset. Belum dapat disimpulkan tidak ada perbedaan bermakna rasio netrofil limfosit pasien preeklamsia early onset dan late onset.

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ABSTRACTBackground Preeclampsia in pregnancy found about 3 7 and is one of the main causes of maternal mortality, which is about 18 . Examination markers of preeclampsia is still expensive and not routinely performed. Inspections are cheaper and easier to assess the severity of preeclampsia is indispensable in the management of pre eclampsia, especially in places with limited facilities. Many studies have been conducted to determine markers of preeclampsia and severity. Nevertheless, specific markers have not been obtained, while costs are expensive and not routinely used. Neutrophil lymphocyte ratio NLR and Red Distribution Width RDW are known to have been studied to assess the inflammation associated with the severity of preeclampsia. These examinations included in the CBC relatively inexpensive, easily and routinely used.Objective This study aims to find differences in neutrophil lymphocyte ratio NLR and Red Distribution Width RDW in patients with preeclampsia compared with normal pregnancy as well as the differences in neutrophil lymphocyte ratio and RDW in preeclampsia early onset and late onset.Methods This study is a cross sectional study using medical records of patients of normal pregnancy and preeclampsia were comes to ER and Obstetrics Clinic Persahabatan Hospital in July 2014 to June 2016. Data were documented in and tabulated and analyzed using SPSS 20.0.Results 254 samples obtained data that met the inclusion criteria research, consisting of 136 preeclampsia and 118 normal pregnancies, 24 preeclampsia early onset and 112 late onset preeclampsia, using Mann Whitney and T Test analysis. Neutrophil lymphocyte ratio obtained in preeclampsia 4.41 1.41 to 32.54 and normal pregnancy 2.61 1.39 to 5.48 with p 0.000. Red Distribution Width in preeclampsia 14.2 11.48 to 23.90 and in normal pregnancies 13.8 10.81 to 18.70 with p 0001. Neutrophil lymphocyte ratio in early onset preeclampsia 4.35 1.41 to 17.56 and late onset preeclampsia 4.41 1.69 to 32.54 with p 0.993. Red Distribution Width in preeclampsia early onset preeclampsia 13.50 1.47 and 14.91 2.16 late onset with p 0003. Test power of neutrophil lymphocyte ratio in preeclampsia early onset and late onset was 16.4 . Test power of Red Distribution Width in preeclampsia early onset and late onset was 97.29 .Conclusions There are significant differences neutrophil lymphocyte ratio and RDW in preeclampsia compared with normal pregnancy, there are significant differences RDW preeclampsia early onset and late onset. Can not be concluded no significant difference in the ratio of neutrophils lymphocytes of patients with preeclampsia early onset and late onset."

"Latar Belakang: Tuberkulosis Paru (TB Paru) merupakan penyakit infeksi yang bersifat kronis dengan tingkat morbiditas dan mortalitas yang tinggi. Perubahan metabolisme akibat infeksi Mycobacterium Tuberkulosa(M.TB) dan aktivasi sistem neurohormal turut berperan terhadap terjadinya malnutrisi, yang dapat memberikan efek negatif terhadap prognosis pasien dengan TB Paru. Penderita TB Paru mengalami penurunan kapasitas fungsional dan kualitas hidup. Terapi Medik Gizi sejak awal diagnosis ditegakkan, akan mendukung proses pemulihan pasien TB.Kasus :Dalam serial kasus ini, dipaparkan empat kasus pasien TB Paru dengan berbagai faktor risiko, diantaranya adalah penyakit TB Paru, TB Miliar, PPOK et causa TB Paru, Meningitis TB. Pada awal pemeriksaan didapatkan adanya defisiensi asupan makronutrien dan mikronutrien, hipoalbuminemia, CRP yang meningkat, hemoglobin (Hb) yang turun, penurunan kapasitas fungsional dan kualitas hidup. Terapi medik gizi diberikan secara individual, sesuai dengan kondisi klinis, hasil pemeriksaan laboratorium, dan analisis asupan makan terakhir. Hasil:Tiga dari empat pasien mengalami peningkatan asupan, perbaikan kondisi klinis, dan kapasitas fungsional serta kualitas hidup pasien. Status nutrisi pasien tidak mengalami perburukan selama perawatan,Kesimpulan:Terapi Medik gizi yang adekuat pada pasien TB dapat mempertahankan status nutrisi pasien dan mendukung perbaikan kondisi klinis, kapasitas fungsional, serta kualitas hidup pasien.

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Background:

Pulmonary tuberculosis (pulmonary TB) is a chronic infectious disease with high morbidity and mortality. Changes in metabolism due to infection with Mycobacterium Tuberculosis and activation of the neurohormal system contribute to the occurrence of malnutrition, which can have a negative effect on the prognosis of patients with pulmonary TB. Patients with pulmonary TB have decreased functional capacity and quality of life.Early medical nutrition therapywill support the recovery process of pulmonary TB patients.

Case :

In this case series, four cases of pulmonary TB patients were presented with various risk factors, including pulmonary TB disease, miliar TB, COPD et causa lung TB, and TB meningitis. Deficiency of macro and micronutrient intake, hypoalbuminemia, increased CRP, decreased hemoglobin (Hb), decreased functional capacity and quality of life were found at the beginning of examination. Nutrition medical therapy is given individually, according to clinical conditions, results of laboratory examinations, and analysis of recent food intake.

Result :

Three out of four patients experience increased intake, improvement of clinical conditions, functional capacity and quality of life. The nutritional status of patients did not experience worsening during treatment.

Conclusion:

Adequate nutritional medical therapy in TB patients can maintain patient nutritional status and support improvement of clinical conditions, functional capacity, and quality of life."