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"ABSTRAKTesis ini bertujuan untuk mengevaluasi waktu respon terapi vorikonazol topikal yang dikombinasikan dengan injeksi vorikonazol intrastromal, dan natamisin topikal pada keratitis Fusarium kelinci. Penelitian ini adalah penelitian uji klinis terandomisasi dengan dua kelompok terapi yaitu injeksi tunggal vorikonazol intrastroma dikombinasi dengan vorikonazol topikal dibandingkan dengan natamisin topikal terapi tunggal. Terapi berlangsung selama 21 hari dengan evaluasi klinis pada minggu pertama, kedua, ketiga serta pemeriksaan mikologi awal dan akhir terapi.Hasil penelitian menggambarkan tidak terdapat perbedaan bermakna antara natamisin dan vorikonazol dalam waktu memperbaiki gambaran klinis ataupun pada hasil pemeriksaan mikologi. Peneliti menyarankan untuk penelitian lanjutan dengan menambahkan jumlah injeksi vorikonazol intrastroma.

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ABSTRACTThis thesis aims to evaluate the response time topical and intrastromal injection of voriconazole versus topical natamycin Fusarium keratitis in rabbit. This study has two treatment groups, single intrastroma voriconazole injection combined with topical voriconazole compared with a single topical natamycin therapy. The therapy lasted for 21 days with clinical evaluation in the first, second, third week along with pre and post therapy mycological examination. There are no significant differences between natamycin and voriconazole in time to improve the clinical picture or on mycological examination. The authors suggest for follow up studies by adding the number of intrastromal voriconazole injection, keratitis Fusarium, voriconazole, natamycinintrastroma voriconazole injections"

"Latar Belakang: Infeksi kornea yang disebabkan oleh jamur dapat menyebabkankerusakan yang lebih berat dibandingkan infeksi bakteri dikarenakan kemampuan jamuruntuk menembus kornea hingga ke bilik mata depan atau sklera. Antijamur tetes yangtersedia secara komersil hanya natamisin yang memiliki penetrasi rendah. Vorikonazolsebagai alternatif anti jamur dapat digunakan secara intrastromal untuk mempertahankankadar pada kornea. Penggunaan injeksi intrastromal vorikonazol secara tunggal maupunserial banyak dilaporkan dalam bentuk laporan kasus dan terdapat variasi dalam hal dosisdan frekuensi serta teknik pemberian.Tujuan: Mengetahui perbandingan efektivitas pemberian kombinasi vorikonazol topikal1% dan intrastromal 0.05% secara tunggal dan serial dibandingkan dengan natamisintopikal 5% sebagai terapi keratitis jamur yang disebabkan oleh jamur Fusarium sp padakelinci.Metodologi: Penelitian ini merupakan uji eksperimental tersamar dengan randomisasiterhadap kelompok hewan coba kelinci New Zealand White (NZW) dengan desain empatkelompok. Masing-masing kelompok terdiri dari 3 kelinci. Kelompok pertama mendapatterapi kombinasi tetes vorikonazol 1% tiap jam dan injeksi intrastromal vorikonazol0.05% yang diberikan 1 kali pada hari 1. Kelompok ke-dua mendapatkan terapikombinasi tetes vorikonazol 1% tiap jam dan injeksi intrastromal vorikonazol 0.05%yang diberikan 2 kali pada hari 1 dan 7. Kelompok ke-tiga mendapatkan terapikombinasi tetes vorikonazol 1% tiap jam dan injeksi intrastromal vorikonazol 0.05%yang diberikan 3 kali pada hari 1, 7 dan 14. Kelompok ke-empat mendapatkanmonoterapi tetes natamisin 5% tiap jam.Hasil: Hasil penelitian ini menunjukan perbaikan secara klinis berdasarkan luas defek,luas infiltrat, kedalaman keratitis dan tinggi hipopion pada semua kelompok yangmendapatkan terapi injeksi vorikonazol maupun natamisin. Pada akhir terapi masihdidapatkan hifa jamur positif secara kualitatif pada 1 kelinci yang mendapatkan injeksiintrastromal 1 kali dan 1 kelinci dengan terapi natamisin.Kesimpulan: Kombinasi vorikonazol topikal dan injeksi vorikonazol intrastromal secaraserial menunjukan perbaikan klinis setara dengan natamisin topikal. Dalam hal dayaeliminasi jamur kombinasi vorikonazol topikal dan injeksi vorikonazol intrastromalsecara serial menunjukan hasil lebih baik dibandingkan terapi natamisin topikal daninjeksi tunggal.

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Background: Fungal corneal infections can cause more damage than bacterial infectionsdue to the fungus's ability to penetrate the cornea to the anterior chamber or sclera.Natamycin is the only commercially available antifungal drops which has lowpenetration. Voriconazole as an antifungal alternative can be used intrastromally tomaintain corneal concentration. The use of single or serial intrastromal voriconazoleinjections is widely reported in the form of case reports and there are variations in termsof dosage and frequency and administration techniques.Objective: Comparing the effectiveness of topical voriconazole 1% combined withintrastromal 0.05% single and serial compared to 5% topical natamycin as fungal keratitistherapy caused by Fusarium sp in rabbits.Methods: This research is an experimental test by randomizing a group of New ZealandWhite (NZW) rabbit animals with a four-group design. Each group consists of 3 rabbits.The first group received combination therapy of voriconazole drops 1% every hour andintrastromal injection of 0.05% voriconazole given once on day 1. The second groupreceived combination therapy of voriconazole drops 1% per hour and intrastromalinjection of voriconazole 0.05% given 2 times on day 1 and 7. The third group receivedcombination therapy of voriconazole drops 1% every hour and intrastromal injection of0.05% voriconazole given 3 times on days 1, 7 and 14. The fourth group receivedmonotherapy with 5% natamycin drops hourly.Results: The results of this study showed clinical improvement based on corneal defectsize, infiltrate size, keratitis depth and height of hypopyon in all groups receivingvoriconazole and natamycin injection therapy. At the end of the therapy, fungal hyphaewere found in 1 rabbit who received 1 times intrastromal injection and 1 rabbit withnatamycin therapy.Conclusion: The combination of topical voriconazole and serial intrastromal injectionshows clinical improvement equivalent to topical natamycin. In terms of the fungalelimination, topical voriconazole and serial intrastromal injection is superior than topicalnatamisin therapy and single injection."

"Latar belakang: Ulkus kornea dapat menyebabkan kebutaan karena sikatriks kornea. Transplantasi kornea sebagai tatalaksana sikatriks kornea berisiko tinggi mengalami kegagalan dengan adanya neovaskular pada kornea resipien. VEGF-A diduga sebagai faktor angiogenik utama dalam terbentuknya neovaskular kornea. Berdasarkan pengamatan klinis, neovaskular kornea pada pasien ulkus kornea bakteri lebih luas dibandingkan ulkus kornea jamur, namun belum pernah dibandingkan secara ilmiah. Tujuan: Studi ini membandingkan VEGF-A air mata dan neovaskularisasi kornea antara ulkus kornea bakteri dan jamur. Korelasi antara VEGF-A dengan luas neovaskular juga dihitung. Metode: Penelitian dilakukan terhadap pasien ulkus kornea bakteri dan jamur dengan sampel foto kornea dan air mata. Pengambilan sampel dilakukan pada hari pertama kedatangan dan diulang pada minggu keempat. Analisis foto kornea menggunakan peranti lunak ImageJ® untuk menilai luas neovaskular kornea dan luas defek kornea. Analisis VEGF-A air mata menggunakan enzyme-linked immunosorbent assay (ELISA). Perbedaan dianggap signifikan jika p<0,05. Hasil: Didapatkan 12 subjek ulkus kornea bakteri dan 10 subjek ulkus kornea jamur dengan rerata usia 37 tahun. Bakteri terbanyak Pseudomonas aeruginosa. dan jamur terbanyak Fusarium sp. Defek kornea setara pada awal (bakteri 25,6% (1,8-81,5) vs jamur 22,7% (3,0-45,0), p = 0,644) dan membaik pada minggu keempat (bakteri 0,04% (0-30,5) vs jamur 2,5% (0-15,1), p=0,368). Luas neovaskular kornea pada hari pertama setara (bakteri 10,3% (2,3-37,5) vs jamur 8,0% (3,7-22,8), p = 0,262) namun pada minggu keempat lebih luas pada kelompok bakteri (bakteri 21,6% (2,3-58,0) vs jamur 11,0% (5,4-22,5), p=0,033). VEGF-A air mata setara pada hari pertama (bakteri 215,6 pg/ml (58,0-1111,6) vs jamur 339,3 pg/ml (22,7-1313,0), p=0,391) dan minggu keempat (bakteri 399,7 pg/ml (181,9-1496,3) vs jamur 743,8 pg/ml (78,7-1416,5), p=0,792). Tidak didapatkan korelasi VEGF-A terhadap luas area neovaskular kornea (hari pertama r -0,28, p=0,212, minggu keempat r -0,04 p=0,855). Kesimpulan: Perbedaan luas neovaskular pada minggu keempat diduga karena faktor proangiogenik pada bakteri yang jarasnya melalui VEGF-A serta faktor antiangiogenik pada jamur yang mengalahkan pengaruh VEGF-A. Diperlukan penelitian mendasar yang mencari faktor antiangiogenik tersebut pada jamur.

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Background: Corneal ulcer can cause blindness due to corneal cicatrix. Corneal transplantation as the treatment of corneal cicatrix had higher risk for rejection or failure if the recipient’s cornea possessed neovascularization. VEGF-A was thought to be the major angiogenic factor in corneal neovascularization. Based on clinical observation, corneal neovascularization in bacterial corneal ulcers had more area than in fungal corneal ulcers, however it was never proved scientifically. Objective: This study aimed to compare tear fluid VEGF-A and corneal neovascularization between bacterial and fungal corneal ulcers. The correlation between VEGF-A and neovascular area was also measured. Methods: Corneal photograph and tear fluid samples of bacterial and fungal in corneal ulcer patients were studied. Sample was taken at the first visit and at the fourth week follow up. Corneal photograph was analyzed using ImageJ® software to measure neovascular area and defect area. Tear fluid VEGF-A was examined using enzyme-linked immunosorbent assay (ELISA). Difference was considered significant if p<0,05. Results: There were 12 bacterial corneal ulcer patients and 10 fungal corneal ulcer patients with mean age 37 years old. Most common bacteria was Pseudomonas aeruginosa and most common fungi was Fusarium sp. Corneal defect area between the groups was similar at the first visit (bacterial 25,6% (1,8-81,5) vs fungal 22,7% (3,0-45,0), p = 0,644) and improved at the fourth week (bacterial 0,04% (0-30,5) vs fungal 2,5% (0-15,1), p=0,368). Neovascular area was similar among the groups at the first visit (bacterial 10,3% (2,3-37,5) vs fungal 8,0% (3,7-22,8), p = 0,262), however bacterial group showed larger area at the fourth week (bacterial 21,6% (2,3-58,0) vs fungal 11,0% (5,4-22,5), p=0,033). Tear fluid VEGF-A was similar at the first visit (bacterial 215,6 pg/ml (58,0-1111,6) vs fungal 339,3 pg/ml (22,7-1313,0), p=0,391) and the fourth week (bacterial 399,7 pg/ml (181,9-1496,3) vs fungal 743,8 pg/ml (78,7-1416,5), p=0,792). No correlation obtained between VEGF-A and corneal neovascular area (first visit r -0,28, p=0,212, fourth week r -0,04 p=0,855). Conclusion: The difference of neovascular area at the fourth week could be due to proangiogenic factor of bacteria through its effect on VEGF-A and antiangiogenic factor in fungi that may overcome VEGF-A effect. Further study is needed to confirm the antiangiogenic factor that fungi possess."

"This book presents the morphological features, dynamics, and sequelae of adenovirus and Thygeson's keratitides captured at high magnification in the living human cornea. It thereby fills the existing void between conventional photographs and slit-lamp observations. Case reports demonstrate the importance of patient history in differential diagnosis, illustrate the need for familiarity with early manifestations of adenovirus infections, and assist in the diagnosis of rare variants of TSPK. Furthermore, the detailed observations on the natural course of the diseases ensure that the book will serve not only as a diagnostic tool but also as a reference when evaluating the effects of potential new treatments."

"Tujuan: Membandingkan efek terapi kombinasi Natamisin 5% dan Natrium diklofenak 0,1% dengan Natamisin 5% tunggal pada pengobatan keratomikosis A. fumigates dalam hal daya bunuh obat terhadap jamur serta respons inflamasi. Subyek dan metode: Penelitian ini bersifat eksperimental, dilakukan secara acak dengan metode tersamar dan menggunakan kelinci sebagai hewan percobaan. Kelompok I adalah kelompok yang diobati dengan tetes mata natamisin 5% dan mulai hari ke-9 diberi tetes mata Natrium diklofenak 0,1% (Nata-NaD). Kelompok II adalah kelompok yang diobati dengan tetes mata natamisin 5% dan mulai hari ke-9 diberi tetes mata BSS (Na-BSS). Parameter yang dinilai adalah daya bunuh obat terhadap jamur yang dinilai secara klinis melalui luas ulkus dan secara mikologi melalui hasil kultur Agar Sabouraud Dekstrosa. Parameter respon inflamasi dinilai secara klinis melalui panjang infiltrat dan hipopion, secara histopatologi melalui sebukan sel radang. Hasil: Penilaian klinis serta histopatologi menunjukkan peran Na-diklofenak 0,1% dalam meningkatkan daya bunuh Natamisin 5% terhadap A. fumigates (p=0,206). Hasil pemeriksaan kultur kornea bagian dalam menunjukkan perbedaan bermakna antar kelompok (p=0,05). Penilaian respon inflamasi menunjukkan suatu kecenderungan hasil lebih baik pada kelompok kombinasi Natamisin 5% dengan Nadiklofenak 0,1% (p=1,000). Kesimpulan: Na-diklofenak 0,1% bermanfaat meningkatkan daya bunuh Natamisin 5% terhadap jamur A. fumigates dan menekan respons inflamasi pada keratomikosis.

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Objectives: To determine the efficacy of topical 0,1% Na-diclofenac as a combination with 5% Natamycin in reducing inflammation and improving killing action against A. fumigatus.

Subject and methods: The study is randomized, single-blinded experimental trial. Twenty rabbits were included and divided into two groups and both assigned to topical 5% Natamycin. On the 9`, day, the 1S` group received 0,1% Na-diclofenac additionally (subject group) and the other received topical Basal Saline Solution ( placebo group). Outcome measure including ulcer size, mycology test using Dextrose Sabouraud Agar (DSA), infiltrate width, hypopion, and histopathology examination.

Results: There is an improvement of Natamycin killing action against A. fumigatus in subject group (p=0,206). Culture test demonstrated statistically significant difference (1=0,05). Inflammation is more reduced in subject group but not statistically significant (p=1,000).

Conclusion: Topical 0,1% Na-diclofenac tend to improve Natamycin killing action against A. fumigatus and reducing inflammation responses, however, not statistically significant."

"ABSTRAKTesis ini bertujuan menilai perbandingan efektivitas terapi adjuvan injeksi kombinasi intrastromal IS dan intrakameral IK vorikonazol VCZ dengan intrastromal IS VCZ pada ulkus kornea jamur derajat sedang akibat Aspergillus fumigatus. Uji eksperimental tersamar acak dilakukan pada 11 kelinci albino New Zealand white yang terbagi menjadi 3 kelompok, yaitu kontrol, injeksi intrastromal, serta intrastromal dan intrakameral. Parameter yang dinilai adalah perubahan klinis, mikologis, dan histopatologik kornea. Sebagian besar subjek pada grup kombinasi memperlihatkan kecendrungan perbaikan klinis dibandingkan kelompok kontrol namun tidak bermakna secara statistik p>0,05 . Pemeriksaan histopatologik memperlihatkan kecenderungan peningkatan jumlah sel radang pada kelinci yang dilakukan inokulasi pada kedua matanya.

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ABSTRACTThe purpose of this study was to compare the efficacy of intrastromal IS and combined with intracameral IK voriconazole VCZ therapy in moderate keratomycosis caused by Aspergillus fumigatus in rabbits. A randomized, masked, controlled experimental study was administered on 11 albino New Zealand white rabbits, which latter allocated into three different treatment groups of control, intrastromal VCZ and combinations. Clinical grading was performed at multiple times, while mycology analysis and histopathological examination were performed after treatment. All subjects in combination groups demonstrated a tendency of better clinical response with decreasing size of epithelial defect and infiltrate but statistically not significant p 0,05 . "

"ABSTRAK Tesis ini bertujuan menilai perbandingan efektivitas injeksi intravitrealvorikonazol 100 µg/0.1 mL dengan amfoterisin B 5 µg/0.1 mL pada endoftalmitisakibat Aspergillus flavus di hewan coba kelinci. Uji eksperimental tersamar acakdilakukan pada 15 kelinci albino New Zealand white yang terbagi menjadi tigakelompok, yaitu kelompok vorikonazol, amfoterisin B, dan kontrol. Parameteryang dinilai adalah perubahan klinis, pemeriksaan mikologi, dan perubahanhistopatologi jaringan. Perubahan skor klinis di akhir evaluasi tidak berbedabermakna antara kelompok vorikonazol dengan amfoterisin B, namun respons klinis cenderung lebih baik pada kelompok vorikonazol. Jumlah koloni jamur terkecil dan berbeda bermakna didapatkan pada kelompok amfoterisin B. Tidakdidapatkan perbedaan bermakna pada rerata nilai histopatologi jaringan keduakelompok, namun derajat inflamasi cenderung lebih ringan pada kelompok vorikonazol.ABSTRACT The purpose of this study was to compare the efficacies of intravitreal 100 µg voriconazole and 5 µg amphotericin B treatment against Aspergillus flavus in anexogenous endophthalmitis model in rabbit eyes. A randomized, controlledexperimentalstudy was conducted on 15 albino New Zealand white rabbits, which latter allocated into three differenttreatment group of voriconazole, amphotericin B, and control. Clinical grading were performed at multiple times, while mycology analysis and histopathological examination were performed at 10 daysafter treatment. No significant change in clinical grading was found between the treatment group, but voriconazole group showed better response tendency. The smallest number of fungal colony forming unit was found significantly in theamphotericin B group. No significant difference was found, however, between the mean histopathological score of the two treatment groups, but the tendency of a lower inflammation score was shown in voriconazole group. ;The purpose of this study was to compare the efficacies of intravitreal 100 µgvoriconazole and 5 µg amphotericin B treatment against Aspergillus flavus in anexogenous endophthalmitis model in rabbit eyes. A randomized, controlledexperimentalstudywasconductedon15albinoNewZealandwhiterabbits,whichlatterallocatedintothreedifferenttreatmentgroupofvoriconazole,amphotericinB,and control. Clinical grading were performed at multiple times, whilemycology analysis and histopathological examination were performed at 10 daysafter treatment. No significant change in clinical grading was found between the treatment group, but voriconazole group showed better response tendency. The smallest number of fungal colony forming unit was found significantly in theamphotericin B group. No significant difference was found, however, between themean histopathological score of the two treatment groups, but the tendency of a lower inflammation score was shown in voriconazole group. ;The purpose of this study was to compare the efficacies of intravitreal 100 µgvoriconazole and 5 µg amphotericin B treatment against Aspergillus flavus in anexogenous endophthalmitis model in rabbit eyes. A randomized, controlledexperimentalstudywasconductedon15albinoNewZealandwhiterabbits,whichlatterallocatedintothreedifferenttreatmentgroupofvoriconazole,amphotericinB,and control. Clinical grading were performed at multiple times, whilemycology analysis and histopathological examination were performed at 10 daysafter treatment. No significant change in clinical grading was found between the treatment group, but voriconazole group showed better response tendency. The smallest number of fungal colony forming unit was found significantly in theamphotericin B group. No significant difference was found, however, between themean histopathological score of the two treatment groups, but the tendency of a lower inflammation score was shown in voriconazole group. ;The purpose of this study was to compare the efficacies of intravitreal 100 µgvoriconazole and 5 µg amphotericin B treatment against Aspergillus flavus in anexogenous endophthalmitis model in rabbit eyes. A randomized, controlledexperimentalstudywasconductedon15albinoNewZealandwhiterabbits,whichlatterallocatedintothreedifferenttreatmentgroupofvoriconazole,amphotericinB,and control. Clinical grading were performed at multiple times, whilemycology analysis and histopathological examination were performed at 10 daysafter treatment. No significant change in clinical grading was found between the treatment group, but voriconazole group showed better response tendency. The smallest number of fungal colony forming unit was found significantly in theamphotericin B group. No significant difference was found, however, between themean histopathological score of the two treatment groups, but the tendency of a lower inflammation score was shown in voriconazole group. "

"Latar Belakang: Ulkus kornea bakteri merupakan penyebab utama buta kornea. Tatalaksana standar ulkus kornea bakteri hingga kini masih terfokus pada eliminasi infeksi melalui antibiotik. Meskipun amplifikasi bateri telah dihentikan, inflamasi sekunder kornea terus berlangsung dan mengakibatkan destruksi kornea lebih lanjut dan sikatriks yang tebal. Tujuan: Untuk mengevaluasi efektivitas dan keamanan terapi kombinasi keratektomi superfisial dengan transplantasi membran amnion dan plasma autolog topikal pada ulkus kornea bakteri sedang dan berat, dalam memfasilitasi penyembuhan dan meminimalisasi inflamasi sekunder kornea. Metode: Uji klinis terandomisasi terbuka. Pembedahan pada kelompok eksperimental dilakukan dalam 72 jam pasca pemberian tiga hari antibiotik inisial. Hasil: Enambelas mata dengan ulkus kornea bakteri diikutkan dalam penelitian ini. Seluruh ulkus sembuh dalam waktu 36 hari pada kelompok eksperimental, dan 54 hari pada kelompok kontrol. Kecepatan epitelisasi kelompok eksperimental lebih cepat dibandingkan dengan kontrol (1,82±1,11 vs 0,97±0,74 mm2/hari, p=0,04, uji t tidak berpasangan). Terdapat kecenderungan pembentukan sikatriks kornea yang lebih tebal pada kelompok kontrol. Pada akhir evaluasi, tajam penglihatan lebih baik didapatkan pada kelompok eksperimental (0,344 ± 0,15 vs 0,196 ± 0,12 pada ulkus sedang, p=0,2, uji t tidak berpasangan; dan 0,14 ± 0,05 vs 0,014 ± 0,02 pada ulkus berat, p<0,01, uji t tidak berpasangan). Tidak ada komplikasi pada kelompok eksperimental, namun terdapat dua komplikasi pada kelompok kontrol. Simpulan: Terapi kombinasi keratektomi superfisial dengan transplantasi membran amnion dan plasma autolog topikal pada ulkus kornea bakteri terbukti lebih efektif dan aman dibandingkan terapi antibiotik konvensional. Terapi ini mempercepat epitelisasi dan penyembuhan ulkus, sehingga membentuk sikatriks kornea yang lebih tipis dengan tajam penglihatan lebih baik.

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Background: Bacterial corneal ulcer is a leading cause of corneal blindness. Up to now, the standard treatment for bacterial corneal ulcer is limited to the elimination of infection with antibiotic. However, the secondary tissue inflammation may still persist, leading to further corneal tissue destruction and dense corneal scar.

Objectives: To evaluate the efficacy and safety of superficial keratectomy, freeze-dried amniotic membrane transplantation and topical autologous plasma as a novel combination therapy in moderate and severe bacterial corneal ulcer, for promoting corneal wound healing and minimizing second injury of the cornea.

Methods: An open randomized controlled trial. The operation in experimental group was performed within 72 hours after three days application of initial antibiotic.

Results: Sixteen eyes of bacterial corneal ulcers were enrolled. All ulcers were healed within 36 days in the experimental group, compared to 54 days in the control group. Epithelialization rate of the experimental group was significantly faster than the control group (1,82±1,11 vs 0,97±0,74 mm2/day, p=0,04, unpaired t-test). Dense corneal scarring was more likely marked in the control group. Higher visual acuity at the last follow-up was achieved in the experimental group (0,344±0,15 vs 0,196±0,12 for moderate cases, p=0,2, unpaired t-test; and 0,14±0,05 vs 0,014±0,02 for severe cases, p<0,01, unpaired t-test). None complication was found in experimental group, while two complications (impending perforation and limbal damage) were noted within the control group.

Conclusions: Combination of superficial keratectomy with amniotic membrane transplantation and topical autologous plasma shows its benefits and safety for bacterial corneal ulcers. It promotes early epithelialization and corneal wound healing, thus achieving less corneal scarring with better visual acuity than conventional antibiotic therapy."

"Imunisasi pada masa anak-anak merupakan tindakan yang menimbulkan trauma karena menyebabkan nyeri. Tujuan penelitian untuk membandingkan pemberian ASI dan topikal anestesi terhadap respon nyeri imunisasi pada bayi di Puskesmas Bahu Manado. Desain penelitian adalah quasi experimental dengan rancangan perbandingan kelompok (static group comparism). Sampel yaitu bayi usia 0-12 bulan yang dilakukan tindakan penyuntikan imunisasi yang terdiri dari 49 responden kelompok intervensi ASI dan 49 responden kelompok intervensi topikal anestesi. Analisis perbedaan respon nyeri saat penyuntikan imunisasi menggunakan Mann-Whitney U test. Hasil penelitian menunjukkan bahwa respon nyeri bayi yang diberi ASI lebih rendah dibandingkan dengan bayi yang diberi topikal anestesi (p= 0,000). Rekomendasi penelitian ini yaitu ASI dapat digunakan untuk menurunkan respon nyeri bagi bayi.

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Immunization in childhood is a traumatic event for children, because it's causes pain. Research purposes to compare of providing milk and topical anesthesia administration to the pain response in infants immunized at the Primary Health Care Bahu Manado. Design research is quasi-experimental with comparison group design (static group comparism). The sample of infants aged 0-12 months who perceived immunization injection consisting of 49 respondents breastfeeding intervention group and 49 intervention group respondents topical anesthesia. Analysis of differences in pain response during immunization injections using the Mann-Whitney U test. The results showed that pain response of breastfed babies is lower compared with infants who were given topical anesthesia (p = 0.000). Recommendations of this study that breast feeding can be used to reduce the pain response for infants."

"Latar Belakang: Tingginya pertumbuhan kasus keganasan ginekologi dan organ panggul menyebabkan penggunaan terapi radiasi meningkat. Akan tetapi, terapi radiasi juga cukup banyak menimbulkan proktitis radiasi sebesar 30%. Tatalaksana menggunakan agen topikal seperti SCFA, sukralfat, steroid, formalin, dan 5-ASA diketahui memiliki hasil yang baik, namun belum banyak studi yang membandingkan terapi mana yang lebih superior. Tujuan: Menilai efektivitas beberapa terapi topikal terhadap perbaikan gejala klinis dan gambaran endoskopi pasien proktitis radiasi. Sumber Data: Pencarian utama dilakukan secara elektronik pada basis data PubMed, Cochrane/CENTRAL, Scopus, dan Science Direct antara September hingga November 2020. Pencarian sekunder dilakukan secara snowballing pada referensi studi yang terkait, dan melalui register uji klinis yang tersertifikasi lainnya seperti Global Index Medicus, Garba Rujukan Digital (GARUDA), ClinicalTrial.gov, dan International Clinical Trials Registry Platform (ICTRP) WHO. Seleksi Studi: Studi uji klinis acak terkontrol dengan intervensi terapi topikal dibandingkan plasebo atau terapi topikal lainnya atau kombinasi terapi medikamentosa, yang menilai luaran berupa respon gejala klinis dan gambaran endoskopi, serta dapat disertai luaran lain, ataupun tidak. Tidak ada batasan terhadap tahun publikasi dan bahasa. Penilaian judul, abstrak, dan studi dilakukan oleh dua orang peninjau independen. Dari total 1786 studi, didapatkan 9 studi memenuhi kriteria eligibilitas.Ekstraksi Data: Ekstraksi data dilakukan oleh dua peninjau independen dan dikonfirmasi pada peninjau ketiga. Konfirmasi data dilakukan dengan menghubungi peneliti dari studi terkait. Tidak didapatkan data tambahan. Hasil: Studi yang melaporkan efektivitas terapi berupa banyaknya jumlah subjek yang mengalami perbaikan atau penurunan skor klinis dan endoskopi dirangkum secara kualitatif. Masing-masing studi saling membahas antar terapi, dan memiliki heterogenitas yang tinggi. Dua studi mengenai formalin dapat dilakukan meta-analisis dengan hasil perbaikan klinis dan endoskopi, namun tidak bermakna terhadap dua studi tersebut (RR 0.97, 95% CI: 0.82-1.15) dan tidak terdapat terapi yang lebih superior dibanding terapi lain dalam meta-analisis tersebut. Empat studi yang membahas formalin 4% memiliki kualitas hasil studi menengah dengan risiko bias rendah. Terdapat 3 dari 9 studi yang membandingkan terapi SCFA dengan plasebo sehingga sulit untuk menyimpulkan terapi mana yang berefek lebih baik, dan memiliki risiko bias tidak jelas, namun dengan jumlah pasien yang sedikitsehingga kualitas studi rendah. Satu studi mengenai efektivitas sukralfat menunjukkan hasil bermakna dengan estimasi risiko rendah (RR 0.57, 95% CI: 0.35-0.92, P = 0.02). Akan tetapi studi mengenai 5-ASA topikal tidak ditemukan dalam inklusi telaah sistematis ini. Secara umum, kualitas hasil studi berdasarkan GRADE dapat dimasukkan ke dalam kategori sedang.Kesimpulan: Penggunaan terapi SCFA enema, formalin topikal, steroid topikal, dan sukralfat enema efektif dalam memperbaiki gejala klinis dan gambaran endoskopi proktitis radiasi. Namun, hingga saat ini belum ada studi klinis berkualitas baik sehingga sulit untuk menilai terapi yang terbaik. Sedangkan dari 2 studi formalin 4% yang dapat dilakukan meta-analisis, menunjukkan bahwa tidak ada terapi yang lebih superior dibandingkan lainnya. Selain itu, tidak ditemukan tidak ditemukan efek samping berat pada penggunaan terapi SCFA enema, formalin topikal, steroid topikal, dan sukralfat enema dalam mengobati proktitis radiasi.

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Background: The high incidence of gynecological and pelvic malignancies has led to the usage of radiation therapy. Nonetheless, radiation therapy also causes a significant complication, about 30% of radiation proctitis. Treatments using topical agents such as SCFA, sucralfate, steroids, formalin, and 5-ASA are known to have good results. However, there are only a few studies comparing the superiority of those therapies.

Objectives: To assess the effectiveness of topical therapies in the clinical and endoscopic improvement of radiation proctitis patients.

Data Sources: Primary searching was conducted on electronic databases such as PubMed, Cochrane/CENTRAL, Scopus, and Science Direct between September and November 2020. Secondary searching was done by snowballing method on the relevant study references and through other certified clinical trial registries (Global Index Medicus, Garba Digital Reference (GARUDA), ClinicalTrial.gov, and WHO's International Clinical Trials Registry Platform (ICTRP).

Study Selection: A randomized controlled trial comparing topical therapies versus placebo or other topical therapies or combination with medical therapies that evaluating the clinical response and endoscopic response. There is no restriction regarding the year of publication and language. Each study were assessed by two independent reviewers. From a total of 1,786 studies identified, 9 studies met the eligibility criteria.

Data Extraction: Data extraction was performed by two independent reviewers and confirmed by a third reviewer. Data confirmation was made by contacting the first researchers from related studies. No additional information was obtained.

Results: Studies reporting the effectiveness of therapy in the form of a large number of subjects experiencing improvement or reduction in clinical symptoms and endoscopy were summarized qualitatively. Each study discussed the therapies and the heterogeneity that could not be calculated due to the different outcomes. Two studies on formalin were subject to meta-analysis with clinical and endoscopy improvement. However, they were not significant in the two studies (RR 0.97, 95% CI: 0.82-1.15), and no better treatment compared with others in those studies. Further, four studies discussing 4% formalin had medium study quality results with a low risk of bias. There are 3 out of 9 studies that compared SCFA therapy with placebo so it is difficult to conclude which therapy has a better effect, and has an unclear risk of bias, but with a small number of patients so that the quality of the study is low. One study using sucralfate showed significant results with a low-risk estimate (RR 0.57, 95% CI: 0.35-0.92, P = 0.02). However, the study of topical 5-ASA was not found in the inclusion of this systematic review. The level of evidence for the majority of outcomes was downgraded using GRADE to a moderate level, due to imprecision and study limitation.

Conclusion: The usage of SCFA enema, topical formalin, topical steroid and sucralfate enema are effective in improving the clinical and endoscopic response in radiation proctitis patient. However, until now, there are no good quality studies, making it difficult to prove the best therapy. A meta-analysis from 2 studies using 4% formalin versus irrigation and antibiotics, shows no therapy is superior to another. Otherwise, no serious side effects were found in the usage of these topical therapies"