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"There are many determinant factors that may paly roles in pathophysiology of functional dyspepsia. One of them is psychological stress that cab increase plasma cortisol levels, alter inflammation process and affect helicobacter pylori activity. No study has been conducted to find out the dominant factor among them. This study aimed to find the dominant factor among plasma cortisol levels, IL-6 and IL-8 expressions and H.pylori activity, as the determinant factors in the pathophysiology of functional dyspepsia. Methos: a cross-sectional study was conducted in 80 patients with dyspepsia syndrome at M.Djamil General Hospital, Padang, West Sumatera, Indonesia. The patients were categorized into two groups, i.e. the stress and non-stress group, which were identified using DASS 42 questionairre criteris. The inflammatory expressions (IL-6 and IL-8 expressions) as well as H. pylori ativity were determined using immunohistochemistry of gastric biopsy specimens; while plasma cortisol levels was measured from peripheral blood samples. Data were analyzed using binary multivariate logistic regression. Resultss: there were 80 patients with functional dyspepsia with mean age of 38.9 years old. The morning cortisol level was found significantly higher in the stress group. Higher IL-6 and IL-8 expressions were found in patients of non stress group compared to those in the other group (IL-6; 73.28 (SD 16.60) vs. 72.95 (SD 19.49 and IL-8 18.45 (SD 17.32) vs. 14.80 (SD 12.71) ) although stastically not significant. There was greater helicobacter pylori activity in the group with psychological stress compared to those in the non-stress group since there was antigen-antibody reaction invading the submucosa. The dominant determinant factor was the afternoon plasma cortisol levels. Conclusion: many factors can become the determinant factors for gastric mucosal damage; however, our study has demonstrated that the dominant factor is afternoon plasma cortisol levels. "

"Background: pathophysiology of functional dyspepsia remains poorly understood. Many factors such as gastric motility disorder, visceral hypersensitivity, Helicobacter pylori (Hp) infection, psychological stress and excessive gastric acid secretion play roles in this symptom. Psychological stress may promote peptic ulcer and has an effect on ulcers-associated Hp. This study aimed to determine Helicobacter pylori activity and expression of mucosal IL 6 and their association with psychological stress. Methods: a cross-sectional study was done among 40 outpatients with dyspeptic syndromes in M. Djamil General Hospital and two community health centers in Padang. The subjects were divided into two groups, with and without psychological stress, which were identified using DASS 42. Gastric biopsy specimens and peripheral blood samples were taken while performing esophagogastroduodenoscopy. Immunohistochemistry methods was used to determine the expression of IL 6 and Hp in gastric mucosa. The correlation of each variable in the group experiencing psychological stress and non stress was analyzed using Chi square test. Results: there were 40 patients with functional dyspepsia with average age of 37.58(SD 11.82) years old. The cortisol levels were significantly different between both groups (non stress vs. stress groups); moreover, morning cortisol level in psychological stress group was higher beyond normal limit. Interleukin 6 expression, as the evidence of inflammatory activity, seemed higher in non stress group than the group with psychological stress (8.25% vs. 7.25%). Helicobacter pylori activity was seemed to be increased in the stress group as characterized by higher numbers of invasion to the sub mucosa epithelium compared to the non stress group (11 vs. 7 subjects). Conclusion: psychological stress seems to have no correlation with IL-6 in gastric mucous of patients with functional dyspepsia; however, there is an evidence of increasing activity of Helicobacter pylori."

"Dyspepsia is one of numerous general complaints, which is commonly encountered by doctors of various disciplines. In daily practice, the complaint is not only limited for gastroenterologists. Knowledge on pathophysiology of dyspepsia have been developing continuously since a scientific investigation has been started in 1980s, which considers Helicobacter pylori as one of key factor in managing dyspepsia, either it is associated with ulcer or non-ulcer. The management of dyspepsia cannot be separated from the management of H. pylori and there is an additional new knowledge associated with definition, pathophysiology, diagnosis and treatment of both dyspepsia and H. pylori infection.

This consensus document on the management of dyspepsia and H. pylori infection in Indonesia has been developed using the evidence-based medicine principles; therefore, it can be used as a reference for doctors in dealing with dyspepsia and H. pylori infection cases in their daily practice. It is expected that with the new consensus, doctors can provide greater service to their patients who have dyspepsia and H. pylori infection."

"Dyspepsia is a common complain in clinical practice. Correlation between helicobacter pylori (H. pylori) and functional dyspepsia had been reported in many studies, but studies that analyzed the severity of dyspepsia and H. pylori were limited and the result were controversial. This study is about to know the correlation between the severity of dyspepsia and H. pylori infection. A retrospective descriptive analysis to patients with dyspepsia at Permata Bunda Hospital, Medan was done in 2010-2014. Simple random sampling was done to get 44 patient with dyspepsia, 22 are H. pylori positive and 22 patients are H. pylori negative. The severity of dyspepsia assessed with porto alegre dyspeptic symptoms questionnaire (PADYQ) scoring instrument. Univariate and bivariate analysis (Chi-square and spearman correlation) were done using SPSS version 22. Epigastric pain is teh most common symptom in dyspepsia patients. There is a correlation between ulcer type dyspepsia and H. pylori infection (p=0.030), while dysmotility type and mixed type were not correlated. The severity of epigastric pain has significant positive correlation with H. pylori (r=0.386;p=0.01), while the severity of other symptoms such as nausea, vomit, and abdominal bloating have negative correlation with H.pylori. Dyspepsia total scoring is significantly lower in H. pylori positive than in H.pylori negative (p=0.033). There is a positive correlation between the severity of nausea, vamit, and abdominal bloating and H.pylori infection, and correlation between lower dyspepsia total scoring and H.pylori pain."

"Latar belakang: Dispepsia merupakan gangguan kesehatan yang sering ditemuierologi dan urin (RAPIRUN) dibandingkan dengan UBT sebagai baku emas dalam mengetahui infeksi H. pylori. Penelitian dilakukan pada pasien rawat jalan Puskesmas Kecamatan Koja Kotamadya Jakarta Utara. Yang dinilai adalah sensitivitas, spesivisitas, positive predictive value (PPV), negative predictive value (NPV) tes tersebut. Tujuan: Mengetahui akurasi diagnostik pemeriksaan non-invasif (serologi dan urin) dibandingkan dengan UBT (urea breath test) sebagai baku emas untuk mendeteksi infeksi H. pylori pada pasien dengan sindroma dispepsia. Metode: Penelitian yang digunakan adalah studi potong lintang untuk mengetahui akurasi pemeriksaan non-invasif yaitu s H. pylori menunjukkan hasil positif pada 36,5% subyek, sedangkan pada pemeriksaan serologi (Mataram, Biomedika) didapatkan hasil positif sebanyak 32,4%. Pemeriksaan RAPIRUN (Rapid Urine Test, Otsuka) menunjukkan hasil positif pada 24,3% subyek. Pada serologi didapatkan sensitivitas 74%, spesifitas 91%, PPV 83%, NPV 86%. Sedangkan pada RAPIRUN didapatkan sensitivitas 63%, spesifitas 98%, PPV 94%, NPV 82%. Hasil: Selama kurun waktu April 2015 sampai Juni 2015, 74 subyek, dengan mayoritas perempuan (82,4%), dengan rerata umur 45,05 tahun menjalani pemeriksaan non-invasif. Pemeriksaan UBT sebagai baku emas diagnosis infeksi di pelayanan kesehatan. Infeksi Helicobacter pylori adalah salah satu penyebab dispepsia. Diagnosis infeksi H.pylori dapat dilakukan melalui pemeriksaan invasif dan non invasif. Pemeriksaan non invasif lebih mampu laksana, murah dan memiliki risiko yang lebih sedikit. Simpulan: RAPIRUN lebih unggul dalam hal spesifisitas dibanding serologi.

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Background: Dyspepsia is the common problem in the population. The main etiology of dyspepsia is Helicobacter pylori infection. The diagnosis of H. pylori infection is based on invasive examination and non-invasive examination. The non-invasive examination could be easier to do and have less risk than invasive examination.

Objective: To evaluate the diagnostic accuracy of the non-invasive test (serology and RAPIRUN) compared to UBT as gold standard examination to detect H. pylori infection in patients with dyspepsia syndrome.

Methods: A cross-sectional study for diagnostic H. pylori by using serology and Rapid Urine test (RAPIRUN) is conducted to evaluate the diagnostic accuracy of non-invasive test compared to UBT as gold standard examination in patients with dyspepsia syndrome. This study was conducted at outpatient Community Health Center in Koja District North Jakarta from middle April 2015 until Middle June 2015. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were used to evaluate the diagnostic accuracy.

Results: From mid-April 2015 to Mid-June 2015, 74 subjects, with the majority of patients was female (82.4%), and the mean of age was 45.05 years old, had undergone non-invasive test The UBT test as the gold standard examination for H. pylori infection showed positive result in 36.5% patients while the serology test resulting positive in 32.4%. The RAPIRUN test resulting positive in 32.4% patients. The sensitivity of serology test was 74%, specificity 91%, PPV 83%, NPV 86%, meanwhile the RAPIRUN test was resulting as sensitivity 63%, specificity 98%, PPV 94%, NPV 82%.

Conclusion: RAPIRUN has a high diagnostic value for H. pylori in specificity than serology."

"Latar belakang : Penyakit paru obstruktif kronik (PPOK) merupakan salah satu penyakit kronik yang menjadi masalah kesehatan utama di dunia dan menyebabkan angka kesakitan dan kematian yang tinggi. Uji kondensasi udara napas merupakan metode non invasif, yang dapat digunakan untuk menilai kadar sitokin-sitokin proinflamasi pada pasien PPOK berdasarkan GOLD 2017.Metode penelitian : studi potong lintang dengan melibatkan 77 subjek pasienPPOK stabil yang tidak eksaserbasi dalam 4 minggu terakhir dan berobat di poli asma-PPOK serta menyetujui informed consent. Pasien ini dilakukan wawancara dengan skoring CAT dan mMRC dan dilakukan pemeriksaan fisis serta mengambil data foto toraks atau CT Scan toraks pasien kemudian data spirometri terakhir diambil untuk mendiagnosis pasien tersebut PPOK. Pasien lalu digolongkan derajat PPOK stabilnya berdasarkan kriteria GOLD 2017, dan diambil sampel uji kondensasi udara napas untuk diperiksakan kadar sitokin interleukin (IL) -6, 8, 13 dan tumor necrosis factor (TNF)-α di laboratorium IMERI dengan pemeriksaan ELISA untuk masing-masing sitokin.Hasil: Interleukin 8 dapat terdeteksi pada 8 (10,4 %) pasien dari jumlah 77 pasiendengan nilai rata-rata 2,4 pg/mL, sedangkan kadar IL-13 dan TNF-α hanya terdeteksi pada 1 (1,3 %) pasien dengan nilai IL-13 6,912 pg/mL dan TNF-α 8,766 pg/mL. Kadar IL-6 terdeteksi pada 71 (92,2 %) pasien PPOK stabil dengan nilai rata-rata 0,7 pg/mL. Tidak ada hubungan antara kadar IL-8, IL-6, IL-13 dan TNF- α dengan derajat PPOK (p > 0,05), meskipun kadar IL-8 dan IL-6 ditemukan mengalami peningkatan pada masing-masing kelompok PPOK. Hanya satu pasien ditemukan semua kadar sitokinnya terdeteksi yang setelah ditelusuri, pasientersebut memiliki jumlah eosinofil darah 1120 /ÅμL dan nilai CRP darah 5,8 mg/L.Kadar TNF-α dan IL-13 pada penelitian ini memiliki hubungan bermakna denganstatus merokok pasien (p = 0,00).Kesimpulan: Uji kondensasi udara napas merupakan metode non invasif yang dapat digunakan pada pasien PPOK stabil untuk menilai kadar sitokin proinflamasi pada pasien PPOK stabil.

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Background: Chronic obstructive pulmonary disease (COPD) is a chronic systemic inflammatory disease which is associated with high morbidity and mortality rates. The exhaled breath condensation (EBC) test is a non-invasive test method to assess pro-inflammatory cytokines levels in COPD patients based on GOLD 2017.

Methods: We performed a cross-sectional study involving 77 subjects with stable COPD who had not exacerbated in the past 4 weeks and treated at asthma-COPD outward clinic in Persahabatan National Respiratory Referral Hospital. Subjects were interviewed with CAT and mMRC scoring system and were examined for their radiographic imaging by chest x-ray or CT. Patients were classified as stable COPD levels based on the GOLD 2017, and EBC were examined for levels of interleukin (IL) -6, 8, 13, and tumor necrosis factor (TNF)-α using ELISA methods.

Results: Interleukin 8 was detected in 8 (10.4%) patients out of 77 patients with an average value of 2.4 pg/mL, whereas IL-13 and TNF-α levels were only detected in 1 (1.3%) patient at 6.912 pg/mL and TNF-α 8.766 pg/mL, respectively. IL-6 levels were detected in 71 (92.2%) with average value of 0.7 pg/mL. There were no relationship between IL-8, IL-6, IL-13 and TNF-α levels with COPD degrees (p> 0.05), although IL-8 and IL-6 levels were found to be increased in each COPD group. Only one patient presented with all cytokine detected whose had a blood

eosinophil count of 1120 /ÅμL and a blood CRP level of 5.8 mg/L. TNF-α and IL-

13 levels in this study were correlated with the subject's smoking status (p = 0.00).

Conclusion: The EBC test is a non-invasive method that can be used in stable COPD patients to assess pro-inflammatory cytokines levels in stable COPD patients."

"Latar Belakang: Peningkatan serotonin plasma dan kortisol saliva yang terjadi pada sindrom koroner akut juga terjadi pada gejala ansietas. Dan kedua penanda biologis tersebut digunakan untuk mengetahui adanya gejala ansietas. Tujuan: Mengetahui perbedaan rerata serotonin plasma dan kortisol saliva pada sindrom koroner akut dengan gejala ansietas di RSUPN dr. Cipto Mangunkusumo. Metode: Dilakukan penelitian klinis poong lintang. Hasil: Kadar serotonin plasma dengan gejala ansietas dan tanpa gejala ansietas dibandingkan nilai normal yaitu 194,83 (142,00-892,04) ng/mL dan 167,16 (150,40-225,96) ng/ml. Kadar kortisol saliva pada subjek dengan gejala ansietas dan tanpa gejala ansietas adalah 2,75 (1,28-4,91) µg/dL dan 2,69 (0,91-7,09) µg/dL. Simpulan: Ada peningkatan kadar serotonin plasma dan kortisol saliva pada gejala ansietas walaupun tidak terdapat hubungan antara serotonin plasma dan kortisol saliva dengan gejala ansietas pada pasien SKA.

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Background: Increases in plasma serotonin and salivary cortisol that occur in acute coronary syndrome also occur in symptoms of anxiety. And the two biological markers are used to determine the presence of anxiety symptoms.

Objective: To determine the difference in mean plasma serotonin and salivary cortisol in acute coronary syndrome with anxiety symptoms at RSUPN dr. Cipto Mangunkusumo.

Methods: Poong Lintang clinical research was conducted.

Results: Compared to normal values, plasma serotonin levels with anxiety symptoms and without anxiety symptoms ​​were 194.83 (142.00-892.04) ng/mL and 167.16 (150.40-225.96) ng/ml. Salivary cortisol levels in subjects with anxiety symptoms and without anxiety symptoms were 2.75 (1.28-4.91) µg/dL and 2.69 (0.91-7.09) µg/dL.

Conclusion: There is an increase in plasma serotonin and salivary cortisol levels in anxiety symptoms although there is no relationship between plasma serotonin and salivary cortisol with anxiety symptoms in ACS patients."

"Latar Belakang: Prevalensi infeksi Helicobacter pylori yang masih tinggi di beberapa negara. Penelitian di Guang Zhou terjadi penurunan seroprevalensi infeksi Helicobacter pylori antara tahun 1993 2003 dari 62 5 menjadi 47. Studi prevalensi di salah satu RS swasta Jakarta menunjukkan penurunan prevalensi infeksi Helicobacter pylori dari 12 5 di tahun 1998 menjadi 2 9 di tahun 2005 Perlunya diketahui seroprevalensi dikomunitas saat ini apakah sesuai dengan penurunan yang terjadi pada penelitian berbasis rumah sakit dan faktor faktor yang mempengaruhi infeksi Helicobacter pylori di masyarakat. Tujuan: Mengetahui seroprevalensi dan faktor faktor sosiodemografis yang berhubungan dengan infeksi Helicobacter pylori. Metode: Studi potong lintang terhadap 111 pasien dispepsia yang berobat di Puskesmas Kelurahan Kalibaru Jakarta Utara Januari-Februari 2015. Dilakukan analisa bivariat untuk mengetahui hubungan faktor faktor dengan infeksi Helicobacter pylori menggunakan uji chi square dan uji T tidak berpasangan serta alternatifnya. Analisa multivariat menggunakan uji regresi logistik. Hasil dan Pembahasan: Pada 111 pasien dewasa dengan keluhan dispepsia yang berobat ke Puskesmas Kelurahan Kalibaru didapatkan seroprevalensi Helicobacter pylori sebesar 22 5 95 IK 14 8 30 2. Usia tidak berhubungan dengan infeksi Helicobacter pylori p 0 270. Semakin tinggi tingkat sosial ekonomi semakin rendah rasio odds infeksi Helicobacter pylori OR 0 2 95 IK 0 02-1 71. Semakin tinggi indeks kepadatan penduduk semakin tinggi rasio odds infeksi Helicobacter pylori OR 1 2 95 IK 0 37-4 49. Semakin rendah clean water index semakin tinggi rasio odds infeksi Helicobacter pylori OR 1 5 95 IK 0 57-4 04. Semakin rendah status sanitasi semakin tinggi rasio odds infeksi Helicobacter pylori OR 2 5 95 IK 1 01-6 19. Kesimpulan: Seroprevalensi Helicobacter pylori pada pasien dispepsia kelurahan Kalibaru sebesr 22 5 95 IK 14 8 30 2. Didapatkan hubungan antara sanitasi lingkungan dengan Helicobacter pylori.

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Background: The prevalence of Helicobacter pylori infection in some countries remains high. Study in Guang Zhou showed a decrease in seroprevalence of Helicobacter pylori from 62 5 in 1993 to 47 in 2003. Prevalence studies in one of the private hospitals in Jakarta showed a decrease in the prevalence of Helicobacter pylori infection from 12 5 in 1998 to 2 9 in 2005. It is important to know the seroprevalence in community nowadays and its related factors in society.

Objective: To identify seroprevalence of Helicobacter pylori infection and its socio demogrphic related factors.

Method: A cross sectional study in 111 patients with dyspepsia who got treatment in Kalibaru Primary Health Care in North Jakarta from January to February 2015. A bivariate analysis was done to know relationship between Helicobacter pylori infection and its related factors using chi square unpaired t test and their alternatives. Multivariate analysis was done using logistic regression test.

Result: Seroprevalence of Helicobacter pylori of 111 dyspepsia patients who get treatment in Kalibaru Primary Helath Care in this study was 22 5 95 CI 14 8 30 2. There is no relationship between age and Helicobacter pylori infection p 0 270 Higher socio economic class was related to lower risk Helicobacter pylori infection OR 0 2 95 IK 0 02-1 71. Higher crowding index was related to higher risk Helicobacter pylori infection OR 1 2 95 IK 0 37-4 49. Lower clean water index was related to higher risk Helicobacter pylori infection OR 1 5 95 IK 0 57-4 04. Lower sanitation status was related to higher risk Helicobacter pylori infection OR 2 5 95 IK 1 01-6 19.

Conclusion: Seroprevalence of Helicobacter pylori infection in patient with dyspepsia in Kalibaru village was 22 5 95 CI 14 8 30 2. There is a relation between sanitation and Helicobacter pylori infection. "

"Latar Belakang: Sebagian besar pasien pasca pembedahan abdominal yang masuk ICU menggunakan alat bantu berupa ventilasi mekanik. Kecemasan akibat penggunaan ventilasi mekanik dapat meningkatkan respon stres pasca pembedahan yang bila dibiarkan dapat menghasilkan hal-hal yang tidak diinginkan. Sedasi dibutuhkan untuk meniminalkan respon stres yang terjadi akibat penggunaan ventilasi mekanik. Deksmedetomidin dan midazolam merupakan agen sedasi yang banyak digunakan di ICU. Metode: Penelitian uji klinis acak tersamar ganda ini mengelompokkan 22 pasien dewasa pascabedah abdominal yang mendapat layanan sedasi di ruang ICU RSCM menjadi 2 kelompok. Grup deksmedetomidin menerima 0,5 μg/kgbb intravena. Grup midazolam menerima 0,05 mg/kgbb intravena. Pemberian ke dua obat tanpa loading dose dan mulai diberikan setelah pasien tiba di ICU pada skala RASS nol (0). Kriteria inklusi adalah pasien dengan rentang usia 18-65 tahun, ASA I sampai III yang membutuhkan ventilasi mekanik pascabedah abdominal. Hasil: Deksmedetomidin dan midazolam tidak mampu menurunkan respon stres karena hanya satu dari tiga parameter yang signifikan secara statistik. Penurunan gula darah terjadi pada grup midzolam setelah 6 jam pasca pembedahan abdominal (p<0,05), sedangkan untuk kadar IL-6 dan kortisol tidak ada perbedaan yang signifikan (p>0,05). Skala RAAS pada grup deksmedetomidin menunjukkan perbedaan yang signifikan dibandingkan grup midazolam (p<0,05) sedangkan FAS tidak ada perbedaan yang signifikan (p>0.05). Simpulan: Sebagai agen sedasi, deksmedetomidin dan midazolam tidak mampu menurunkan respon stres pada pasien yang menggunakan ventilasi mekanik pasca bedah abdominal. Tingkat sedasi pada grup deksmedetomidin lebih baik daripada grup midazolam, tetapi deksmedetomidin dan midazolam sama-sama mampu meminimalkan kecemasan.

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Background: Post-operative mechanical ventilation were often needed in patients after abdominal surgeries. Sedation was often given to minimize anxiety and stress response to mechanical ventilation. Both dexmedetomidine and midazolam are commonly used as sedatives in ICU. This study was aimed to compare the ability of dexmedetomidine and midazolam in reducing anxiety and stress response.

Methods: Twenty two patients aged 18-65 years, ASA physical status I to III, underwent abdominal surgery and requiring postoperative ventilation were included. Subjects were randomly divided into equal groups. Subjects in group D received dexmedetomidine 0.5 µg/kg iv, while in group M received midazolam 0,05 mg/kg iv. Vital signs, Face Anxiety Scale, RASS score, cortisol, blood glucose and IL-6 level were taken at baseline when subjects were admitted to the ICU and followed up until 6 hours.

Results: Both of dexmedetomidine and midazolam can not decreased stress response, in group M only decreased blood glucose level after 6 hours post-operative achieved statistical significance (p<0.05). Only RASS scale was significantly differed between group D and group M(p<0.05), while there was no statistically significant difference in other measured parameters.

Conclusions: Both dexmedetomidine and midazolam as sedative can not decreased stress response on abdominal surgery patients who required mechanical ventilation. Sedation level of dexmedetomidine was better than midazolam, but both of them can minimize anxiety."