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"Tumor otak merupakan jenis tumor yang sangat sulit ditangani dan menyebabkan mortalitas serta morbiditas yang berat. Saat ini, kombinasi radioterapi, kemoterapi (temozolomid dan agen lainnya), serta kortikosteroid menjadi terapi utama untuk berbagai jenis tumor, termasuk tumor otak. Walaupun demikian, data menunjukkan bahwa kombinasi terapi tersebut tidak memberikan perbaikan pada kondisi klinis pasien. Hal ini menyebabkan perlunya dilakukan pencarian senyawa baru atau repurposing terapi yang sudah ada yang dapat memperbaiki prognosis pasien tumor otak. Metformin, suatu agen antidiabetes yang telah dikenal, belakangan ini banyak diteliti potensinya sebagai antineoplasma. Metformin berperan memberi efek apoptosis, autofagi, dan antiproliferasi melalui jalur p53 dengan aktivasi adenosine 5’-monophosphate (AMP)-activated protein kinase (AMPK). Review article ini bertujuan untuk mengkaji perkembangan studi terkini mengenai efek metformin pada pasien tumor otak melalui tinjauan klinisnya. Penelusuran literatur dilakukan dengan sistematis pada pangkalan data PubMed, ScienceDirect, dan SpringerLink yang diseleksi berdasarkan kriteria inklusi dan eksklusi yang ditetapkan. Manfaat klinis obat dinilai melalui Overall Survival (OS) dan Progression Free Survival (PFS) pasien tumor otak. Studi juga menunjukkan efek sinergis kombinasi metformin dengan temozolomid, tetapi tidak dengan kortikosteroid. Melalui kombinasi dengan temozolomid yang diberikan pasca radioterapi, potensi antineoplasma menghasilkan kelangsungan hidup yang lebih baik. Meskipun demikian, efikasi dan keamanan metformin perlu diuji klinis lebih lanjut pada populasi yang lebih luas.

 

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Brain tumors are a type of tumor that is very difficult to handle and causes severe mortality and morbidity. Currently, the combination of radiotherapy and chemotherapy (temozolomide and other agents), as well as corticosteroids become the primary therapy for various types of tumors, including brain tumors. However, data indicating that the combination of therapy does not provide improvement in the patient's clinical condition. This leads to the need for a new compound search or repurposing existing therapies that can improve the prognosis of brain tumor patients. Metformin, a known antidiabetic agent, has recently been examined by its potential as a antineoplastic. Metformin is responsible for the effects of apoptosis, autophagy, and antiproliferative via the p53 line with adenosine 5’-monophosphate (AMP)-activated protein kinase (AMPK) activation. This article review aims to examine the recent study developments on the effects of metformin in brain tumor patients through its clinical reviews. The literature search is systematically performed on the PubMed, ScienceDirect, and SpringerLink selected based on the defined inclusion and exclusion criteria. The clinical benefits of the drug are assessed through Overall Survival (OS) and Progression Free Survival (PFS) brain tumor patients. Studies have also demonstrated a synergistic effect of metformin combinations with temozolomide, but not with corticosteroids. Through a combination with temozolomide given post radioterapy, the potential of antineoplastic results in better survival. Nonetheless, the efficacy and safety of metformin need further clinical testing in the wider population.

 

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"Kesehatan merupakan salah satu indikator penting dalam Sustainable Development Goals (SDGs). Seluruh isu kesehatan diintegrasikan dengan tujuan ke-3 SDGs, yaitu menjamin kehidupan yang sehat dan mendorong kesejahteraan bagi semua orang di segala usia. Apoteker adalah tenaga kesehatan yang berperan sebagai penanggung jawab dalam hal obat dari hulu ke hilir. Tujuan utamanya adalah agar masyarakat dapat memperoleh obat yang aman, berkhasiat, bermutu, dan terjangkau, serta meningkatkan kesehatan masyarakat. Sebagai calon apoteker, penting untuk mempelajari mengenai peran-peran apoteker di dunia pekerjaan. Sebagai gambaran peran apoteker di dunia kerja dilakukanlah praktik kerja profesi apoteker. Praktik kerja dilakukan di Apotek Atrika sebagai gambaran pelayanan kefarmasian di apotek. Rumah Sakit Universitas Indonesia sebagai rumah sakit pendidikan dipilih sebagai lokasi praktik sebagai gambaran untuk peran apoteker di pelayanan instalasi rumah sakit. Selain di bidang pelayanan, praktik kerja juga dilakukan di PT. Anugerah Pharmindo Lestari sebagai gambaran peran apoteker di distribusi obat dan alat kesehatan. Praktik Kerja dilakukan dari Bulan Juli hingga November 2021. Selain belajar secara langsung dari mengamati, calon apoteker juga diberikan kesempatan untuk menganalisis masalah yang ada di masing-masing tempat kerja. Oleh karena itu, laporan praktik kerja ini akan membahas mengenai masalah beserta solusi yang diajukan di tiap tempat praktik kerja.

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Health is one of the important indicators for Sustainable Development Goals (SDGs). All health issues are integrated with the 3rd goal of the SDGs, which is to ensure a healthy life and promote well-being for all of all ages. The pharmacist is a health worker who acts as the person in charge of medicine from upstream to downstream. The main goal is so that people can obtain safe, efficacious, quality, and affordable medicines, as well as improve public health. As a prospective pharmacist, it is important to learn about the roles of pharmacists in the world of work. As an illustration of the role of the pharmacist in the world of work, a pharmacist's professional work practice (internship) is carried out. The internship is carried out at Atrika Pharmacy as an illustration of pharmaceutical service in pharmacies. Universitas Indonesia’s Hospital as a teaching hospital was chosen as an intern location as an illustration of the role of pharmacists in hospital installation services. In addition to the service sector, internships are also carried out at PT. Anugerah Pharmindo Lestari is an illustration of the role of the pharmacist in the distribution of drugs and medical devices. Internships are carried out from July to November 2021. In addition to learning directly from observing, prospective pharmacists are also allowed to analyze problems that exist in each workplace. Therefore, this intern report will discuss the problems and solutions proposed in each intern workplace."

"Latar Belakang: Radioterapi adalah salah satu terapi kanker yang telah banyak digunakan untuk mengendalikan tumor secara lokal dan regional. Namun, tumor yang resisten terhadap radiasi dapat mengurangi efektivitas terapi. Radiosensitizer adalah agen penting untuk meningkatkan sensitivitas radiasi. Ulva lactuca (U. lactuca) adalah sejenis ganggang dan sudah terbukti memiliki efek antitumor. Diketahuinya jalur kerja U. lactuca mungkin memberikan pemahaman dasar terkait perannya sebagai radiosensitizer.Metode: Telaah sistematis dilakukan melalui pencarian literatur pada beberapa database. Pedoman PRISMA digunakan untuk melaporkan hasil pencarian. Studi in vivo atau in vitro yang menganalisis efek U. lactuca pada kanker dimasukkan dalam penelitian ini. Telaah kritis dinilai menggunakan Systemic Review Centre for Laboratory animal Experimentation Risk of Bias (SYRCLE RoB) tool pada studi in vivo dan Science in Risk Assessment and Policy (SciRAP) pada studi in vitro.Hasil: Tujuh artikel dimasukkan dalam telaah sistematis ini. Semua studi in vivo memiliki bias risiko rendah. Dua penelitian melaporkan bahwa U. lactuca memiliki efek antitumor (CEA, AFP, kadar bcl-2 menurun dan kadar p53 meningkat). Enam studi menunjukkan bahwa U. lactuca juga memiliki efek antioksidan (MDA, TNF alpha, kadar NO menurun, sementara TAC, MPO, SOD, CAT dan GR, GST, kadar GSH meningkat, dengan aktivitas pembersihan radikal). Lima penelitian menunjukkan bahwa U. lactuca memiliki aktivitas antikanker terhadap Caco-2 dan HT-29 CRC, MCF-7, Fem-x, HepG2, dan lini sel Hela.Kesimpulan: Aktivitas radikal bebas, p53, dan caspase-8, 9 adalah jalur utama efek antitumor U. lactuca. Jalur ini mungkin mengungkap potensinya sebagai radiosensitizer, yang memerlukan penelitian lebih lanjut.

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Introduction: Radiotherapy is one of the main treatments for cancer. It had been widely used to control tumor locally and regionally. However, a radioresistant tumor might compromise efficacy of the therapy. Radiosensitizer is an important agent to improve radiation sensitivity. Ulva lactuca (U. lactuca) is a type of algae with known antitumor effects. Analysis of its molecular pathway might provide basic understanding of its role as radiosensitizer.

Method: A systematic review was conducted through literature searching on several databases. PRISMA guideline was used to present the results. In vivo or in vitro study which analyzed U. lactuca effects on cancer were included in this study. In vivo studies were critically appraised using Systemic Review Centre for Laboratory animal Experimentation Risk of Bias (SYRCLE RoB) tool and in vitro studies were critically appraised using Science in Risk Assessment and Policy (SciRAP).

Result: Seven articles were included in this systematic review. All in vivo studies had low risk bias. Two studies reported that U. lactuca had antitumor effect (CEA, AFP, decreased bcl-2 levels and increased p53 level). Six studies showed that U. lactuca also had antioxidant effect (MDA, TNF alpha, decreased NO levels, while TAC, MPO, SOD, CAT and GR, GST, increased GSH levels, with radical scavenging activity). Five studies showed that U. lactuca had anticancer activities against Caco-2 and HT-29 CRC, MCF-7, Fem-x, HepG2, and Hela cell lines.

Conclusion: Free radicals scavenging activity, p53, and caspase-8, 9 were the primary pathways of U. lactuca antitumor effects. These pathways might unravel its potential as radiosensitizer, which needs further analysis in future studies."

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Latar Belakang: WBRT adalah salah satu terapi utama pada tumor otak metastasis. Gangguan kognitif, terutama memori, adalah komplikasi yang umum terjadi pada WBRT. Preservasi memori merupakan hal yang penting diteliti karena memori memiliki banyak keterkaitan dengan domain kognitif lain, serta dengan kualitas hidup. WBRT dengan hippocampal sparing, dimana hipokampus dilindungi dari radiasi, telah menunjukkan efek protektif pada preservasi memori pada bukti-bukti ilmiah sebelumnya.

Metode: Dilakukan sebuah tinjauan sistematis untuk mengkaji apakah WBRT dengan hippocampal sparing bermanfaat dalam preservasi memori, dibandingkan dengan WBRT konvensional. Pencarian sistematis dilakukan untuk uji klinis dan studi observasional, dengan WBRT hippocampal sparing sebagai intervensi dan memori sebagai salah satu luaran pada basis data mayor, register uji klinis, dan basis data lokal serta gray literature. Penilaian risiko bias dilakukan menggunakan Risk of Bias-2 (RoB-2), Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I), dan Newcastle-Ottawa Scale (NOS), sesuai jenis studi. Data dipresentasikan menggunakan Harvest plot dan focused narrative synthesis.

Hasil: Kami menemukan 8 studi. Studi yang dirandomisasi memiliki risiko bias rendah dan studi yang tidak dirandomisasi memiliki risiko bias sedang. Distribusi Harvest plot menunjukkan gradien positif, yaitu efek protektif WBRT dengan hippocampal sparing.

Kesimpulan: WBRT dengan hippocampal sparing menujukkan efek protektif terhadap fungsi memori pasien tumor otak metastasis dan aplikabel untuk dilakukan di setting RSCM. Diperlukan penelitian lebih lanjut mengenai peran WBRT hippocampal sparing pada pasien di RSCM.

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Background: Whole brain radiotherapy (WBRT) is the mainstay therapy for metastatic brain tumor. Cognitive dysfunction, particularly memory, is a common side effect of WBRT. Memory preservation has become increasingly popular, as memory is inter-related with other cognitive domains as well as with quality of life. WBRT with hippocampal sparing, where the hippocampus is avoided from radiation, has shown some protective effects in memory preservation in previous studies.

Methods: We conducted systematic review to determine whether WBRT with hippocampal sparing is beneficial in preserving memory compared to conventional WBRT. We systematically searched for clinical trials and observational studies with hippocampal sparing WBRT as the intervention and memory as one of the outcomes. Major databases, clinical trial registries, as well as local databases and gray literature were searched. Risk of bias assessment was performed using Risk of Bias-2 (RoB-2), Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I), and Newcastle-Ottawa Scale (NOS) tools, according to study type. Data were presented using Harvest plot and focused narrative synthesis.

Results: We identified 8 studies, which consisted of randomized and non-randomized studies. All randomized clinical trials showed overall low risk of bias, whereas nonrandomized trials and cohort studies showed moderate risk of bias. Harvest plot distribution showed a positive gradient. i.e. protective effect of hippocampal sparing WBRT.

Conclusions: WBRT with hippocampal sparing is effective in preserving memory in metastatic brain tumor patients. It is applicable to be performed in Cipto Mangukusumo Hospital. Further research is needed to assess its effectiveness in patients of Cipto Mangunkusumo Hospital.

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"Nyeri kanker timbul pada sekitar 40% pasien kanker dan meningkat hingga 75-80% saat kankernya menyebar. Penatalaksanaan nyeri secara farmakologis dengan opioid dapat menimbulkan efek samping, toleransi dan adiksi, sehingga diperlukan modalitas lain dalam mengatasi nyeri kanker. Akupunktur merupakan suatu modalitas terapi yang banyak digunakan untuk membantu kondisi ini. Penelitian terhadap penggunaan akupunktur aurikular sebagai terapi untuk nyeri kanker masih sedikit, dan belum terdapat suatu tinjauan sistematis untuk menilainya. Tujuan dari makalah ini adalah untuk mengetahui efektivitas akupunktur aurikular pada nyeri kanker. Tinjauan sistematis ini menggunakan daftar periksa PRISMA. Dari 3 studi yang dianalisis, semuanya menunjukkan penurunan intensitas nyeri dan terdapat luaran tambahan berupa pengurangan dosis analgesik harian, jumlah obat, dan posisi dalam WHO analgesic ladder. Kualitas studi yang dinilai dengan Cochrane Risk of Bias Tool terbaru dan GRADE mengungkapkan bahwa meski terdapat risiko bias yang digunakan pada dua studi, namun masih termasuk dalam rekomendasi Moderate, sementara studi oleh Ruela dkk (2018) mendapat rekomendasi High. Dapat disimpulkan, meskipun studi yang dianalisa masih sedikit, namun kualitasnya cukup baik dalam memaparkan efektivitas akupunktur aurikular pada nyeri kanker.

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Cancer pain occurs in about 40% of cancer patients and increases to 75-80% when the cancer spreads. Pharmacological pain management with opioids can cause side effects, tolerance and addiction, so other modalities are needed in dealing with cancer pain. Acupuncture is a widely therapeutic modality to help this condition. There is little research of auricular acupuncture as a therapy for cancer pain, and there is no a systematic review to assess it. The purpose of this paper is to determine the effectiveness of auricular acupuncture on cancer pain. This systematic review uses the PRISMA checklist. Of the 3 studies analyzed, all showed a decrease in pain intensity and additional outcomes that is a reduction in the daily analgesic dose, drug amount, and position in the WHO analgesic ladder. The quality of the study assessed by Cochrane Risk of Bias Tool and GRADE revealed that although there was a risk of bias used in the two studies, it was still included in the Moderate recommendation, while the study by Ruela (2018) received a High recommendation. It can be concluded, although the studies analyzed are still few, they are of good quality in describing the effectiveness of auricular acupuncture in cancer pain."

"ABSTRAKLatar Belakang: Ameloblastoma merupakan tumor odontogenik yang sering dijumpai.Tatalaksana dari Ameloblastoma dapat berupa terapi konservatif seperti enukleasi atau radikal kuretase maupun dengan terapi bedah radikal seperti reseksi mandibula.Defek yang ditimbulkan pasca reseksi akan berpengaruh pada sistem mastikasi dan penampilan pasien. Standar emas rekonstruksi defek dapat menggunakan vascularised bone graft serta rehabilitasi dental implat untuk mengembalikan fungsi mastikasi dan estetik.Tujuan: Untuk mengetahui bagaimana keberhasilan rehabilitasi menggunakan dental implantpada rekonstruksi vascularisedbone graft sebagai tatalaksana ameloblastomaMetode: Penelitian yang digunakan berjenis systematic review, sesuai dengan PRISMA-P, Penelitian ini dilakukan dengan menggunakan desain PICO.Pencarian elektronik dilakukan tanpa batasan tanggal pada Bulan September 2019 melalui basis data online Cochrane, EBSCOhost, Pubmed, Scopus, Wiley Online Library, dan SpringerLink dengan kata kunci utama mandibular resection, ameloblastoma, vascularised bone graft, dental implant, Studi dengan desain penelitian berupa controlled trials, retrospektif,prospektif, case report dan case series. Artikel Studi dieksklusi dengan desain penelitianopinion articles, dan review articles, Studi pada selain pasien Ameloblastoma, Studi mengenai implan selain dental implant, Studi yang dilakukan pada hewan atau laboratoris.Hasil: Sebanyak 5.996 artikel publikasi ilmiah ditemukan. Kemudian 82 artikel ilmiah dieksklusi setelah dilakukan skrining duplikasi. Sisa 5.914 artikel publikasi ilmiah kemudian dilakukan skrining elektronik berdasarkan criteria didapatkan 28 artikel yang tersisa. Kemudian dilakukan pencarian artikel dalam bentuk full text. Setelah semua artikel full text berhasil dikumpulkan, dilakukan eksklusi kembali dengan alasan tidak menampilkan record data pasien ameloblstoma yang jelas. Hasil eksklusi tersebut didapatkan sebanyak 13 artikel. Survival dental implant pada vascularised bonegraft mencapai 238/241 (99%) dengan metode delay placement lebih banyak digunakan. Jenis rekonstruksi pada tatalaksana pasien ameloblastoma dengan reseksi mandibula terbanyak menggunakan vascularised free fibula flap dengan tekhnik double barel fibula, yaitu sebanyak 24 (30,76%) pasien.Kesimpulan: Delay dental implant placement pada vascularised bone graftdoubel barel fibulalebih banyak dilakukan karena dengan teknik rekonstruksi ini dapat memberikan dimensi vertikal yang baik dan dapat memberikan dukungan yang baik untuk rehabilitasi dental implant serta dapat memberikan kesempatan untuk memperoleh evaluasi kondisi yang baik tentang vaskularisasi flap, mengevaluasi kebutuhan prostetik dan motivasi pasien serta mengevaluasi kemungkinan titik penempatan regio dental implant .

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ABSTRACTBackground: Ameloblastoma is an odontogenic tumor that is often found. The management of Ameloblastoma can be in the form of conservative therapy such as enucleation or radical curettage or with radical surgical therapy such as mandible resection. Defects caused after resection will affect the system of mastication and the appearance of the patient. The gold standard for reconstructive defects can use vascularised bone graft and dental implant rehabilitation to restore mastication and aesthetic function.Objective: To find out how the success of rehabilitation using dental implants in vascularised bone graft reconstruction as an ameloblastoma treatmentMethods: The study used is a systematic review type, according to PRISMA-P, this research was conducted using the PICO design. Electronic searches were carried out indefinitely in September 2019 through online databases of Cochrane, EBSCOhost, Pubmed, Scopus, Wiley Online Library, and SpringerLink with the main keywords mandibular resection, ameloblastoma, vascularised bone graft, dental implants, studies with controlled research designs in the form of controlled trials, retrospectives, prospectives, case reports and case series. Study articles were excluded by opinion opinion research designs, and review articles, studies in addition to Ameloblastoma patients, studies of implants other than dental implants, studies conducted in animals or laboratories.Results: A total of 5,996 scientific publication articles were found. Then 82 scientific articles were excluded after duplication screening. The remaining 5,914 scientific publications articles were then screened electronically based on the criteria for the remaining 28 articles. Then search for articles in full text. After all the full text articles have been collected, exclusion is done again with the reason that it does not display a clear ameloblstoma patient data record. The exclusion results obtained as many as 13 articles. Dental implant survival in vascularised bonegraft reached 238/241 (99%) with more delay placement methods used. Types of reconstruction in the management of ameloblastoma patients with the most mandibular resection using vascularised free fibula flap with double barrel fibula technique, which is as many as 24 (30.76%) patients.Conclusion: Delay of dental implant placement in vascularised bone graft doubel barrel fibula is mostly done because with this reconstruction technique can provide good vertical dimensions and can provide good support for dental implant rehabilitation and can provide an opportunity to obtain a good evaluation of the condition of flap vascularization, evaluating prosthetic needs and patient motivation and evaluating possible placement points for the dental implant region."

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ABSTRAK

 

Nama : Fredy Budhi Dharmawan

Program Studi : Ilmu Bedah Mulut dan Maksilofasial

Judul :

 

SYSTEMATIC REVIEW REHABILITASI DENTAL IMPLANT PADA VASCULARISED BONE GRAFT SEBAGAI TATALAKSANA AMELOBLASTOMA

Latar Belakang:Ameloblastoma merupakan tumor odontogenik  yang sering dijumpai.Tatalaksana dari Ameloblastoma dapat berupa terapi konservatif seperti enukleasi atau radikal kuretase maupun dengan terapi bedah radikal seperti reseksi mandibula.Defek yang ditimbulkan pasca reseksi akan berpengaruh pada sistem mastikasi dan penampilan pasien. Standar emas rekonstruksi defek dapat menggunakan vascularised bone graft serta rehabilitasi dental implat untuk mengembalikan fungsi mastikasi dan estetik.

Tujuan: Untuk mengetahui  bagaimana keberhasilan rehabilitasi menggunakan dental implantpada rekonstruksi vascularisedbone graft  sebagai tatalaksana ameloblastoma

Metode: Penelitian yang digunakan berjenis systematic review, sesuai dengan PRISMA –P, Penelitian ini dilakukan dengan menggunakan desain PICO.Pencarian elektronik dilakukan tanpa batasan tanggal pada Bulan September 2019  melalui basis data online Cochrane, EBSCOhost, Pubmed, Scopus, Wiley Online Library, dan SpringerLink dengan kata kunci utama mandibular resection, ameloblastoma, vascularised bone graft, dental implant, Studi dengan desain penelitian berupa controlled trials, retrospektif,prospektif, case report dan case series. Artikel Studi dieksklusi dengan desain penelitianopinion articles, dan review articles, Studi pada selain pasien Ameloblastoma, Studi mengenai implan selain dental implant, Studi yang dilakukan pada hewan atau laboratoris.

Hasil: Sebanyak 5.996 artikelpublikasiilmiahditemukan.Kemudian 82 artikelilmiahdieksklusi setelahdilakukanskriningduplikasi.Sisa 5.914 artikelpublikasiilmiahkemudiandilakukanskrining elektronik berdasarkan criteria didapatkan 28 artikel yang tersisa.Kemudiandilakukanpencarianartikeldalambentukfull text.Setelahsemuaartikelfull text berhasildikumpulkan, dilakukaneksklusikembalidenganalasan tidak menampilkan record data pasien ameloblstoma yang jelas .Hasileksklusitersebutdidapatkansebanyak 13 artikel.Survival dental implant pada vascularised bonegraft mencapai 238/241 (99%) dengan metode delay placement lebih banyak digunakan. Jenis rekonstruksi pada tatalaksana pasien ameloblastoma dengan reseksi mandibula terbanyak menggunakan vascularised free fibula flap dengan tekhnik double barel fibula, yaitu sebanyak 24 (30,76%) pasien.

Kesimpulan:Delay dental implant placement pada vascularised bone graftdoubel barel fibulalebih banyak dilakukan karena dengan teknik rekonstruksi ini dapat memberikan dimensi vertikal yang baik dan dapat memberikan dukungan yang baik untuk rehabilitasi dental implant serta dapat memberikan kesempatan untuk memperoleh evaluasi kondisi yang baik tentang vaskularisasi flap, mengevaluasi kebutuhan prostetik dan motivasi pasien serta mengevaluasi kemungkinan titik penempatan regio dental implant .

 

Kata kunci:ameloblastoma, mandibular resection, dental implant, vascularised bone graft.

 

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ABSTRACT

 

Name                        : Fredy Budhi Dharmawan

Study Programme    : Oral and Maxillofacial Surgery

Title                          :

 

DENTAL IMPLANT REHABILITATION  ON VASCULARISED BONE GRAFT IN AMELOBLASTOMA TREATMENT; A SYSTEMATIC REVIEW

 

Background:Ameloblastoma is an odontogenic tumor that is often found. The management of Ameloblastoma can be in the form of conservative therapy such as enucleation or radical curettage or with radical surgical therapy such as mandible resection. Defects caused after resection will affect the system of mastication and the appearance of the patient. The gold standard for reconstructive defects can use vascularised bone graft and dental implant rehabilitation to restore mastication and aesthetic function.

Objective: To find out how the success of rehabilitation using dental implants in vascularised bone graft reconstruction as an ameloblastoma treatment

Methods: The study used is a systematic review type, according to PRISMA-P, this research was conducted using the PICO design. Electronic searches were carried out indefinitely in September 2019 through online databases of Cochrane, EBSCOhost, Pubmed, Scopus, Wiley Online Library, and SpringerLink with the main keywords mandibular resection, ameloblastoma, vascularised bone graft, dental implants, studies with controlled research designs in the form of controlled trials, retrospectives, prospectives, case reports and case series. Study articles were excluded by opinion opinion research designs, and review articles, studies in addition to Ameloblastoma patients, studies of implants other than dental implants, studies conducted in animals or laboratories.

Results: A total of 5,996 scientific publication articles were found. Then 82 scientific articles were excluded after duplication screening. The remaining 5,914 scientific publications articles were then screened electronically based on the criteria for the remaining 28 articles. Then search for articles in full text. After all the full text articles have been collected, exclusion is done again with the reason that it does not display a clear ameloblstoma patient data record. The exclusion results obtained as many as 13 articles. Dental implant survival in vascularised bonegraft reached 238/241 (99%) with more delay placement methods used. Types of reconstruction in the management of ameloblastoma patients with the most mandibular resection using vascularised free fibula flap with double barrel fibula technique, which is as many as 24 (30.76%) patients.

Conclusion: Delay of dental implant placement in vascularised bone graft doubel barrel fibula is mostly done because with this reconstruction technique can provide good vertical dimensions and can provide good support for dental implant rehabilitation and can provide an opportunity to obtain a good evaluation of the condition of flap vascularization , evaluating prosthetic needs and patient motivation and evaluating possible placement points for the dental implant region.

Keywords: ameloblastoma, mandibular resection, dental implant, vascularised bone graft.

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"Skrining kanker payudara merupakan salah satu strategi pencegahan yang dilakukan perawat sebagai peran dan tanggung jawab professional untuk menurunkan angka mortalitas dan morbiditas kanker payudara, namun saat ini penerapan praktiknya belum berjalan dengan optimal. Tujuan dari telaah sistematik ini adalah untuk mengidendifikasi, menilai, dan mensintesis gambaran penerapan kemampuan perawat dalam praktik deteksi dini kanker payudara. Pencarian data penelitian dilakukan dengan strategi PRISMA melalui lima basis data: Google Schoolar, PubMed Central, Science Direct, ProQuest, dan Oxford Journals pada bulan Mei-Juli 2020 dan dihasilkan 10 artikel untuk dianalisis. Pengetahuan dan sikap memengaruhi praktik perawat dalam deteksi dini kanker payudara. Pemahaman yang belum cukup baik memengaruhi praktik skrining kanker payudara yang rendah, walaupun sikap sudah positif. Penelitian menunjukkan pentingnya meningkatkan kemampuan perawat dalam praktik skrining kanker payudara melalui pendidikan berkelanjutan dan pelatihan yang adekuat serta dukungan dari penyusun kebijakan.

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Breast cancer screening is a preventive strategy carried out by nurses as a professional role and responsibility to reduce mortality and morbidity due to breast cancer, but currently the practice has not been optimal. The purpose of this systematic study was to identify, assess, and synthesize an overview of the application of nurses' abilities in the practice of early detection of breast cancer. Research data search was carried out using the PRISMA strategy through five databases:  Google Schoolar, PubMed Central, Science Direct, ProQuest, and Oxford Journals during May-July 2020 and produced 10 articles to be analyzed.  Knowledge and attitudes influence nurses' practices in early detection of breast cancer. Inadequate understanding caused inadequate breast cancer screening practices, even though their attitudes were already positive. This study showed the importance of promoting nurses' abilities of breast cancer screening practices through continuing education and adequate training as well as supports from policy markers."

"Peran reseptor progesteron pada meningioma masih diperdebatkan. Namun ekspresi reseptor ini cenderung memberikan prognosis yang baik bagi pasien. Berbagai studi telah dilakukan untuk mengidentifikasi faktor prognosis yang mempengaruhi luaran meningioma. Telaah sistematis ini mengevaluasi berbagai studi yang menilai hubungan ekspresi reseptor progesteron terhadap derajat meningioma, serta luaran klinis berupa rekurensi, recurrence free survival (RFS), progression free survival (PFS), local control (LC), dan overall survival (OS) pada pasien meningioma. Berdasarkan hasil telaah sistematis ini, ekspresi reseptor progesteron mempunyai hubungan terbalik dengan peningkatan derajat meningioma. Ekspresi reseptor progesteron positif juga memberikan luaran yang lebih baik pada pasien pasca operasi. Studi mengenai respons radiasi terkait reseptor progesteron masih sangat jarang.

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The role of progesterone receptors in meningiomas is still debatable. However, the expression of these receptors tends to provide a good prognosis. Various studies have been conducted to identify progesterone receptors as a prognostic factors. This systematic review evaluates various studies assessing relation of progesterone receptor expression to the grade of meningioma and clinical outcomes in the form of recurrence, recurrence free survival (RFS), progression free survival (PFS), local control (LC), and overall survival (OS). Based on the results of this systematic review, progesterone receptor expression has an inverse relation with an increased grade. Positive progesterone receptor expression also have a better outcome in postoperative patients. Studies of the radiation response associated with progesterone receptors are rare."

"This book is in many ways a manual for the public health decathlete, althoughthe editors have gone much further by including 15, not 10, items. These items covermany of the contemporary challenges confronting population health. Seven chaptersreview the changing burden of disease and injury, providing many examples ofthe tremendous successes of the public health community. The most celebrated havebeen those in the struggle against communicable disease, with the authors notingachievements in transforming acquired immune deficiency syndrome (AIDS) intoa condition that those infected die with rather than from. However, there are others,less well-recognised, such as the 50 % decline in mortality from cardiovasculardisease in North Western Europe in the past four decades. Yet, as the authors of allof these chapters note, progress is not inevitable. Communicable diseases that onceseemed to be coming under control are reappearing, such as tuberculosis, but nowin a much more alarming drug-resistant form. Indeed, antimicrobial resistance isnow recognised as a global threat, potentially posing an existential threat to humanity,just like climate change. Failure by governments to act against the vectors ofnon-communicable disease, and especially the major corporations that profit fromsales of unhealthy products, for example by placing considerations of health abovethose of trade liberalisation, has permitted the spread of obesogenic and alcogenicenvironments, with profound consequences for our future health."