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"AbstrakA 43-year old male presented with persistent discomfort and pain upper abdomen (epigastrium) more on left side associated with fever on and off, along with fatigue and loss of appetite for the last four months. Physical examination revealed mass on left hypochondrium extending to epigastrium with mild distension of the abdomen. Imaging studies of the patient showed dextrocardia on chest x-ray postero-anterior (PA) view, thoracic and abdominal CT scan showed situs inversus totalis with multiple SOL (space occupying lesion) in right lobe of liver with largest measuring 8x6 cm2 in the 4th segment. USG-guided FNAC of the mass showed features of hepatocellular carcinoma. Thereupon, hepatocellular carcinoma in situs inversus totalis was diagosed to this patient and was clinically staged as T3aN0M0. He was given sorafenib 400 mg orally twice daily with an advice to come for regular assessment every 4 week."

"Pneumonia kemunitas adalah infeksi akut pada paru-paru yang tidak memilki riwayat rawat inap dalam waktu dekat atau tidak terpapar dengan perawatan medis secara teratur. Terdapat dua sistem skoring untuk menentukan prognosis pneumonia komnitas yaitu pneumonia severity index (PSI) and CURB-65. Pnemonia Serverity Index (PSI) lebih rumit dalam penghitungannya dibandingkan CURB-65 dimana PSI menilai 19 variabel sementara CURB-65 hanya 5 variabel. Tujuan menentukan apakah pneumonia serverity index (PSI) score lebih superior dibandingkan skor CURB-65.Metode pencarian literatur dilakukan menggunakan pubmed dan OVID Medline. Literatur dipilih bila tidak lebih lama dari 10 tahun, dan bukan review articel. Enam Literatur memenuhi kriteria dan dimasukan dalam analisis. Hasil lima literatur menyatakan bahwa PSI lebih akurat dalam menentukan dalam prognosis mortalitas 30 hari dan kebutuhan ICU pada pasien risiko tinggi (PSI kelas IV/V and skor CURB-65>3). satu literatur ( Luque et al ) menemukan bahwa CURB-65 sama akuratnya dalam menentukan prognosis mortalitas 30 hari pasien pnemonia komunitas secara keseluruhan. Kesimpulan skor PSI lebih dipilih dibandingkan skor CURB-65 dalam menentukan prognosis mortalitas 30 hari pasien secara keseluruhan pada pasien pneumonia kemunitas."

"ABSTRAKDuring 11 years period from January 2005 to December 2015 there were 18 adolescent and adult patients who underwent transcatheter closure of PDA using PDA Amplatzer Duct Occluder (ADO). There were 9 cases with age of 14 to 18 years and 9 cases with age of more than 18 years where the oldest case was 46 years old. Two cases were male and 16 cases were female. Prior to procedures, clinical assessment, ECG, chest x-ray and transthoracic echocardiography (TTE) were performed to confirm the diagnosis of PDA. The procedures of device implantation was performed under conscious sedation in adults and using general anesthesia in adolescents.The size of PDA ranged from 1.6 mm to 11.1 mm. Based on Kritchenko classification, the type of PDA were 15 type A1 and 3type A2. Flow ratio between pulmonary to systemic circulation was between 1.1 and 5.9. The procedure time ranged from 60-189 minutes and the fluoroscopic time 7.1-77.3 minutes. The PA pressure ranged from 22 to 63 mmHg. Immediate results after procedures as seen in angiography showed complete closure in 14 cases and smoky residual shunt or minimal residual shunts in 4 cases, which probably due to the temporary leaking through the devices. In 24 hours, complete closure was achieved in all cases (100%) and continued until 1months. At 6 month follow up, there was no residual shunts detected and also there was no significant complications, such as device embolization or recanalization. This case series suggest that transcatheter closure of PDA in adolescents and adults using Amplatzer duct occluder (ADO) is effective and has excellent resultswithout significant complication. However, long-term follow up is required to assess long term efficacy and safety."

"Aim: to know the effectiveness probiotic in reducing hepatic inflammation among non-alcoholic fatty liver disease (NAFLD) patients. Methods: we performed literature searching regarding the potential role of probiotic in reducing hepatic inflammation among NAFLD patients. Results: six articles were finally critically appraised. All six studies had good validity and importance. These studies unanimously reported that probiotic is useful in reducing hepatic inflammation, and liver fat content. However, further evidence is needed to show whether or not probiotic is beneficial reducing cirrhosis progression and liver-related mortality. Conclusion: probiotic owns robust potential to treat NAFLD. Probiotic reduce hepatic inflammation, as shown by the reduction of liver aminotransferase, and inflammatory markers. Based on this evidence based report, probiotic is a promising adjunct therapy for NAFLD.

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Tujuan: mengetahui efektifitas peran probiotik dalam menurunkan peradangan pada pasien perlemakan hati non-alkoholik (PHNA).

Metode: dilakukan pencarian literatur terstruktur untuk membuktikan apakah pemberian probiotik dapat mengurangi inflamasi hati pada PHNA. Hasil: enam artikel ditemukan dan ditelaah secara kritis. Semua artikel ini menyimpulkan bahwa probiotik dapat menurunkan peradangan hati, yang terlihat dalam penurunan enzim transaminase. Selain itu, probiotik juga menurunkan kandungan lemak dalam parenkim hati. Namun, apakah probiotik bermanfaat dalam menurunkan progresivitas PHNA menjadi sirosis dan menurunkan mortalitas masih perlu dipelajari oleh penelitian lanjutan. Kesimpulan: probiotik memiliki manfaat dalam penanganan PHNA. Probiotik dapat digunakan sebagai salah satu terapi pendamping pada kasus perlemakan hati non-alkoholik."

"In the past 10 years, recent development of targeted therapy in metastatic renal cell carcinoma (mRCC) has provided a new hope and significantly enhanced the prognosis of the disease. Three class of targeted therapy were developed, including multi-targeted tyrosine kinase inhibitors (TKI), the mammalian target of rapamycin (mTOR) complex-1 kinase inhibitors, and the humanized antivascular endothelial growth factor (VEGF) monoclonal antibody. Hence, the objective of this article was to critically examine the current evidence of targeted therapy treatment for patients with mRCC. In the majority of trials evaluating targeted therapy, patients were stratified according to Memorial Sloan Kattering Cancer Center (MSKCC) risk model and the recommendation of targeted treatment based on risk features. In first-line setting (no previous treatment), sunitinib, pazopanib, or bevacizumab plus IFN-α were recommended as treatment options for patient with favorable- or intermediate- risk features and clear cell histology. Patients who progressed after previous cytokine therapy would have sorafenib or axitinib as treatment options. Clear-cell mRCC with favorable- or intermediate- risk features and failure with first-line TKI therapy might be treated with sorafenib, everolimus, temsirolimus or axitinib. However, the current evidence did not show the best treatment sequencing after first-line TKI failure. In patients with poor-risk clear-cell and non-clear cell mRCC, temsirolimus was the treatment option supported by phase III clinical trial. In addition, several new drugs, nowadays, are still being investigated and waiting for the result of phase II or III clinical trial, and this might change the standard therapy for mRCC in the future.

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ada sepuluh tahun terakhir, perkembangan terapi target pada karsinoma sel renal bermetastasis menjadi harapan baru dan mampu meningkatkan prognosis penyakit tersebut. Terdapat tiga terapi target yang telah dikembangkan termasuk multi-targeted tyrosine kinase inhibitors (TKI), penghambat mammalian target of rapamycin (mTOR) complex-1 kinase, dan antibodi monoklonal humanized antivascular endothelial growth factor (VEGF). Tujuan artikel ini secara kritis menelaah studi terkini terapi target untuk tatalaksana pasien tersebut. Pada sebagian besar uji klinis yang mengevaluasi terapi target, pasien distratifikasi berdasakan model yang dikembangkan oleh Memorial Sloan Kattering Cancer Center (MSKCC) dan rekomendasi terapi berdasarkan tingkat resiko pasien. Terapi target lini pertama (belum pernah mendapatkan terapi sistemik sebelumnya), sunitinib, pazopanib, atau bevacizumab ditambah IFN-α merupakan pilihan terapi dengan tingkat resiko menguntugkan dan sedang serta gambaran histologi sel jernih. Pasien yang mengalami progresifitas pasca terapi sitokin, sorafenib atau axitinib adalah pilihan yang direkomendasikan. Karsinoma sel ginjal bermetastasis tipe sel jernih dengan tingkat resiko menguntungkan dan sedang yang gagal pada terapi target lini pertama dapat ditatalaksana dengan sorafenib, everolimus, temsirolimus atau axitinib. Akan tetapi, studi saat ini menunjukkan tidak ada pilihan terapi sekuensial terbaik pasca kegagalan terapi lini pertama. Pasien dengan tingkat risiko buruk dan gambaran histologi bukan sel jernih, temsirolimus merupakan terapi target yang didukung oleh uji klinis fase III. Saat ini, beberapa obat baru masih dalam tahap uji klinis fase II dan III dan hasil uji klinis tersebut mungkin dapat mengubah terapi standar pasien karsinoma sel ginjal bermetastasis di masa yang akan datang."

"Snakebite is an important medical problem in India. Among their various manifestations, cerebral complications are uncommonly found in literature. Moreover, Ischemic stroke following snake bite is quite rare. Here we report a case series of two such cases that developed neurological manifestations following Russell’s viper bite. On computerized tomography (CT) scan of brain; cerebral infarcts were revealed. Their likely mechanisms are discussed in present study which include disseminated intravascular coagulation, toxin induced vasculitis and endothelial damage.

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Gigitan ular adalah masalah medis yang utama di India. Di antara berbagai manifestasinya, komplikasi serebral jarang ditemukan pada literatur. Terlebih lagi, stroke iskemik akibat gigitan ular cukup langka. Kami melaporkan serangkaian kasus dari dua kasus serupa yang mengembangkan manifestasi neurologis setelah gigitan ular viper Russell. Pada pemeriksaan CT scan menunjukkan infark serebral. Kemungkinan mekanisme penyebab kejadian yang mencakup koagulasi intravaskular diseminata, toksin yang diinduksi vaskulitis, dan kerusakan endotel akan dibahas pada artikel ini."

"Usaha-usaha yang dilakukan oleh aparat penegak hukum belum berhasil memberantas peredaran jamu berbahan Kimia Obat (BKO). Salah satu penyebabnya adalah penindakan yang bersifat reaktif sporadis, membuka kesempatan pelanggar hukum untuk beradaptasi dan terus berinovasi dalam melaksanakan modus operandinya demi menghindari tekanan dari penegak hukum. Untuk mengatasi hal ini diperlukan kewaspadaan nasional terhadap ancaman peredaran jamu BKO sebagai dasar penyusunan dan pelaksanaan suatu sistem peringatan dini. Yaitu serangkaian teknologi, kebijakan dan prosedur yang disusun khusus untuk pemprediksi dan memitigasi dampak peredaran jamu BKO. Penelitian ini menggunakan pendekatan kualitatif dengan metode collection and analysis dalam pengolahan data. Teknik triangulasi digunakan untuk memastikan validitas data baik primer maupun sekunder. Hasil penelitian menunjukkan bahwa pelibatan komponen intelijen negara dan partisipasi aktif masyarakat menjadi hal yang mutlak dibutuhkan demi keberhasilan sistem peringatan dini atau early warning terkait peredaran jamu BKO. Badan intelijen negara selaku coordinator dari seluruh intelijen yang ada di instansi negara wajib menjalankan fungsi sebagai komite intelijen pusat (kominpus). Dalam satu system yang dibangun seharusnya Indonesia National Single Window (INSW) seharusnya didapat kerjasama kontrol antar lembaga yaitu BPOM, BIN, Bea dan Cukai, Kepolisian dan masyarakat. Early warning system menghadirkan 4 komponen utama sistem peringatan dini yaitu pengetahuan resiko, layanan pemantauan dan peringatan, diseminasi dan komunikasi serta kemampuan respons. Saran untuk melakukan pemberantasan dan pencegahan peredaran jamu BKO adalah melakukan studi untuk menilai potensi kerugian negara akibat peredaran BKO. Hasil studi tersebut dijadikan dasar untuk membangun kewaspadaan nasional dan ditindak lanjuti dengan penyusunan sistem peringatan dini yang melibatkan berbagai instansi terkait dan dukungan masyarakat.

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Efforts by law enforcement officers have not succeeded in eradicating the circulation of medicinal chemicals-contained herbal medicine or also known as Jamu Berbahan Kimia Obat (BKO). One of the causes is sporadic reactive action, which gives opportunities for law offenders to adapt and continue to innovate in carrying out their operational mode to avoid pressure from law enforcement. In order to overcome this issue, national awareness as an early warning system regarding the threat of BKO herbal medicine distribution is required. Such early warning system comprises a series of technologies, policies and procedures devised specifically for predicting and mitigating the impact of BKO herbal medicine circulation. This research uses the qualitative approach with collection and analysis method in data processing. Triangulation techniques are used to ensure the validity of both primary and secondary data. The results showed that the involvement of state intelligence components and the active participation of the community becomes absolutely necessary for the success of early warning system or early warning related to the circulation of BKO herbal medicine. National Intelligence Agencies (BIN) as the coordinator of all intelligences in state institutions must perform the function as central intelligence committee (Kominpus). The one-stop integrated system namely Indonesia National Single Window (INSW) should maintain cooperation between institutions such as BPOM, BIN, Customs and Excise, Police and society. Early warning system presents 4 main components, such as risk knowledge, monitoring and warning service, dissemination and communication, as well as response capability. As a suggestion, in eradicating and preventing the circulation of BKO herbal medicine, a study to assess the potential loss of the state due to the circulation of BKO herbal medicine should be conducted. The results of these studies serve as a basis for building national awareness and are followed up by the preparation of an early warning system involving various relevant agencies and community support."

"Penelitian ini membahas mengenai perilaku demedikalisasi dari pasien pengguna obat herbal. Penelitian ini menggunakan konsep demedikalisasi oleh Peter Conrad dan penggunaan obat herbal oleh Calixto. Menggunakan pendekatan kuantitatif dengan teknik survei terhadap 100 responden dan menggunakan teknik accidental sampling. Hasil penelitian ini menunjukkan bahwa tingkat perilaku demedikalisasi diantara pasien pengguna obat herbal adalah rendah, namun tingkat penggunaan obat herbal tinggi. Selain itu, terdapat hubungan antara persepsi penggunaan obat herbal dengan perilaku demedikalisasi. Hal ini disebabkan oleh adanya ketakutan yang dirasakan oleh pasien Klinik Sehat terhadap efek samping yang akan ditimbulkan oleh obat-obatan medis. Selain itu, faktor yang berpengaruh adalah obat herbal dirasa menjadi suatu solusi kesehatan yang aman dan bebas dari efek samping. Saran berupa perlu adanya penguatan peran pemerintah dalam mengatur kegiatan medis. Hal ini dilakukan agar kegiatan medis lebih teratur dan lebih aman bagi masyarakat.

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This study discuss the demedicalization behavior among herbal medicine patients. This study uses the concept of demedicalization by Peter Conrad and the use of herbal medicine by Calixto. Using quantitative approach with survey technique to 100 respondents and using accidental sampling technique. The results shows that the level of demedicalization behavior among herbal medicine patients are low, however the level of the use of herbal medicine are high. However, there's a relationship between the use of herbal medicine perception and demedicalization behavior. This is caused by the fear felt by the patient Clinic of side effects that would be caused by medical drugs. In addition, factors that influence is felt to be a herbal medicine health solutions that are safe and free from side effects. Suggestions such as the need for strengthening the role of government in regulating medical activity. This is done so that medical activities more organized and safer for the public."

"Translasi radiofarmaka dari hewan percobaan ke dosis manusia merupakan tugas yang menantang karena variasi biologis antar spesies dan kurangnya standarisasi dalam dosimetri kedokteran nuklir. Studi ini berfokus pada pengaruh seleksi model terhadap perhitungan dosis yang diserap radiasi pada kasus translasi biokinetik dari hewan ke manusia. Penelitian ini menggunakan data biokinetik rata-rata dan individu dari studi radiofarmaka 177Lu-OPS201 pada hewan dan manusia dengan menggunakan model Sum of Exponential (SoE). Analisis Goodness of Fit (GoF) dan corrected Akaike Information Criterion (AICc) digunakan untuk seleksi model. Model f_2 (t)=A_1 e^(-(λ_1+λ_phys )t) terpilih sebagai model terbaik untuk mencit, babi, dan manusia. Penggunaan data biokinetik rata-rata menghasilkan %wAICc sebesar 50,01%, TIAC referensi sebesar 5,41±0,29 jam (manusia), 1,35±0,07 jam (mencit), dan 2,23±0,17 jam (babi). Sementara penggunaan data biokinetik individu menghasilkan %wAICc sebesar 84,00%, TIAC referensi sebesar 5,41±0,24 jam (manusia), 1,35±0,07 jam (mencit), dan 1,68±0,12 jam - 2,85±0,28 jam (babi). Metode regresi linear dan allometric scalling digunakan dalam proses translasi biokinetik radiofarmaka 177Lu-OPS201 dari hewan ke manusia. Hasilnya, model terbaik dengan data biokinetik rata-rata dapat memprediksi TIAC sebesar 5,45±0,03 jam dan akurasi 99,20% mendekati referensi (regresi linear) dan TIAC prediksi sebesar 3,97±1,01 jam dan akurasi 73,50% mendekati referensi (allometric scalling).

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The translation of radiopharmaceuticals from experimental animals to human doses is a challenging task due to biological variations between species and lack of standardization in nuclear medicine dosimetry. This study focuses on the influence of model selection on the calculation of radiation absorbed dose in the case of biokinetic translation from animals to humans. This study used average and individual biokinetic data from the 177Lu-OPS201 radiopharmaceutical study in animals and humans using the Sum of Exponential (SoE) model. Goodness of Fit (GoF) analysis and corrected Akaike Information Criterion (AICc) were used for model selection. The model f_2 (t)=A_1 e^(-(λ_1+λ_phys )t) was selected as the best model for mice, pigs and humans. The use of average biokinetic data resulted in %wAICc of 50.01%, reference TIAC of 5.41±0.29 hours (human), 1.35±0.07 hours (mice), and 2.23±0.17 hours (pigs). Meanwhile, the use of individual biokinetic data resulted in a %wAICc of 84.00%, a reference TIAC of 5.41±0.24 hours (human), 1.35±0.07 hours (mice), and 1.68±0.12 hours - 2.85±0.28 hours (pigs). Linear regression and allometric scaling methods were used in the process of translating the biokinetics of radiopharmaceutical 177Lu-OPS201 from animals to humans. As a result, the best model with average biokinetic data can predict TIAC of 5.45±0.03 hours and 99.20% accuracy close to the reference (linear regression) and predicted TIAC of 3.97±1.01 hours and 73.50% accuracy close to the reference (allometric scalling)."