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"Pasien dengan kelainan bawaan pada rantai b-globin mungkin mengalami gejala penyakit yang lebih ringan jika mereka menghasilkan hemoglobin fetal (HbF) dengan kadar yang tinggi. Penggunaan hydroxyurea (HU) telah memperlihatkan peningkatan kadar HbF pada pasien penyakit ?sickle cell?, dan mungkin berguna pada b-talassemia. Kami memberi terapi HU kepada 13 pasien b-talassemia intermedia atau mayor, termasuk 6 pasien splenektomi. Pasien-pasien diberi dosis eskalasi (10 sampai 25 mg/kg/h) HU selama sekitar 2 tahun (median: 21 bulan, ?range?: 8 ? 55 bulan). Sebelas pasien menunjukkan respons kenaikan HbF pada pra-transfusi, masing-masing dari median awal 8,0% (2,5 - 61,3%) menjadi 28,0% (6,6 - 49,2%) dan 40,7% (4,8 - 72,3%) pada 3 bulan dan 18 bulan pasca terapi HU. Kenaikan yang sama pada nilai median Hb terlihat pada 1, 3 dan 18 bulan terapi HU. Enam dari 7 pasien yang tergantung transfusi yang menunjukkan kenaikan HbF (seorang dengan b-thalassemia mayor), juga memperlihatkan penurunan kebutuhan transfusi setelah dua tahun terapi HU. Respons terhadap HU juga terlihat dengan adanya pengecilan limpa. Selain ulkus di mulut yang menghilang dengan penurunan dosis HU, tidak terlihat toksisitas lain yang bermakna. Dapat disimpulkan bahwa pemberian HU pada pasien b-thalassemia menyebabkan peningkatan produksi HbF disertai perbaikan pada eritropoiesis, tanpa toksisitas yang bermakna. (Med J Indones 2007; 16:78-83).

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Patients with severe inherited b-globin chain disorders may have milder illness if they produce high levels of fetal hemoglobin (HbF). Hydroxyurea (HU) has been shown to enhance HbF levels in patients with sickle cell disease and may be useful in b-thalassemias. We administered HU to 13 patients with b-thalassemia intermedia or major, including 6 splenectomized patients. The patients received escalating doses (10 to 25 mg/kg/d) of HU for around 2 years (median: 21 months, range: 8 - 55 months). Eleven patients responded with an increase in the pre-transfusion HbF levels, from a base line median of 8.0% (2.5 - 61.3%) to 28.0% (6.6 - 49.2%) and 40.7% (4.8 - 72.3%) at 3 months and 18 months post-HU, respectively. A concomitant increment in median hemoglobin levels was noted at 1, 3 and 18 months of HU therapy. Six of 7 transfusion-dependent patients who had an increment of HbF (one with b-thalassemia major) also had reduced transfusion requirement over the 2-year period of HU therapy. Response to HU was also shown by a reduction in spleen size. Apart from oral ulcers that resolved upon dose reduction of HU, no significant toxicity was noted. We conclude that increased HbF production in b-thalassemia patients, with an improvement in erythropoiesis, can be achieved using HU with minimal toxicity. (Med J Indones 2007; 16:78-83)."

"ABSTRACTinflammation, oxidative stress, and fibrosis play important roles after an acute myocardial infarction (AMI) event. The most studied inflammatory biomarker in cardiovascular disease is C-reactive protein (CRP). It has been demonstrated that myeloperoxidase (MPO) and Galectin-3 (Gal-3) have some essential roles on immune system when an AMI event occurs. We aimed to determine the effect of oral N-acetylcysteine (NAC) supplementation at the dose of 600 mg 3 times daily for 3 consecutive days on the immune system of AMI patients.Methods: our randomized single-blinded experimental study using pre- and post-treatment evaluations was performed at Dr. Moewardi Hospital, Indonesia, from May to August 2018. Thirty-two patients with AMI and ST segment elevation (STEMI) who received fibrinolytic therapy were included. There were 17 patients received standard therapy plus 600 mg oral NAC supplementation every 8 h for 3 days and 15 patients received standard therapy, which served as the control group. High-sensitivity C-reactive protein (HsCRP), MPO, and Gal-3 levels of both groups were evaluated at admission and after 72 h receiving treatment. Results: HsCRP, MPO, and Gal-3 levels between NAC and control groups at admission were not significantly different; while intergroup differences after 72 h of NAC supplementation were significant (p values of HsCRP, MPO, and Gal-3 levels were 0.0001, 0.001, and 0.017, respectively). Furthermore, in the NAC group, HsCRP, MPO, and Gal-3 levels at 72 h after treatment were significantly different from the corresponding levels at admission (p values: 0.0001, 0.0001, and 0.0001, respectively); the control group did not show these differences. There were also significant intergroup differences between the NAC and control groups regarding HsCRP, MPO, and Gal-3 levels (p values: 0.011, 0.022, and 0.014, respectively).Conclusion: oral supplementation of 600 mg NAC every 8 h for 72 h can reduce HsCRP, MPO, and Gal-3 levels in AMI patients receiving fibrinolytic therapy. Results of our study will provide more options for supplementation therapy to improve management of IMA patients."

"Penelitian ini dilakukan untuk mengetahui pengaruh pemberian nutrisi enteral tinggi protein pada status protein penderita stroke akut. Subjek penelitian dibagi 2 kelompok secara randomisasi blok, yaitu kelompok perlakuan mendapat nutrisi enteral tinggi protein (NETP) dan kelompok kontrol mendapat nutrisi enteral standar rumah sakit (NERS). Tiga puluh enam subjek dari 60 penderita stroke akut berhasil menjalani 7 hari penelitian ini. Hasil penelitian menunjukkan bahwa pemberian NETP dapat meningkatkan kadar prealbumin serum, menurunkan ekskresi kreatinin urin, dan memperkecil penurunan kadar albumin serum dibandingkan kelompok kontrol. (Med J Indones 2004; 14: 37-43)

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The objective of this study was to determine the effect of high protein enteral nutrition on protein status in acute stroke patients. The subjects were divided into two groups using block randomisation, i.e. the intervention group that received high protein enteral nutrition (HPEN), and the control group that received enteral hospital diet. Thirty six out of 60 acute stroke patients had completed 7 days of follow-up. The results showed that HPEN have increased prealbumin level, decreased urinary creatinine excretion, and decreased the decline of albumin serum compared to the control group. (Med J Indones 2004; 14: 37-43)"

"Latar Belakang: Stroke iskemik yang disertai dengan diabetes melitus merupakan kondisi yang sering terjadi. Serangan stroke iskemik akut seringkali terjadi bersamaan dengan kadar glukosa darah yang meningkat. Pemberian dukungan nutrisi diperlukan untuk membantu mengontrol glukosa darah dan membantu memperbaiki kapasitas fungsional pada pasien stroke iskemik dengan DM. Salah satu nutrisi yang dapat membantu mengontrol kadar glukosa darah adalah asam lemak tak jenuh tunggal (MUFA) yang berasal dari minyak zaitun. Metode: Serial kasus ini melaporkan empat pasien stroke iskemik yang disertai dengan diabetes melitus dengan rentang usia 52-66 tahun dan status gizi yang bervariasi. Terapi medik gizi diberikan sesuai dengan pedoman nutrisi untuk penderita stroke dan diabetes melitus, serta diberikan tambahan minyak zaitun untuk mencapai pemenuhan target MUFA dan suplementasi mikronutrien vitamin B kompleks, vitamin C, asam folat dan tablet seng. Hasil: Kadar glukosa darah keempat pasien selama perawatan berada dalam rentang 140-180 mg per dL, sesuai dengan rekomendasi. Kapasitas fungsional dua pasien mengalami peningkatan sedangkan dua pasien lainnya tidak mengalami perubahan. Kesimpulan: Dukungan nutrisi dengan penambahan bahan makanan sumber tinggi MUFA pada pasien stroke iskemik dengan diabetes melitus ikut membantu dalam proses penyembuhan pasien.

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Background: Ischemic stroke accompanied by diabetes mellitus is a common condition. Acute ischemic stroke often occurs together with the increase of blood glucose levels. Nutritional support is needed to control blood glucose and improve functional capacity. One of nutrient that can control blood glucose levels is monounsaturated fatty acids (MUFA), which derived from olive oil.

Methods: This case series reported four ischemic stroke patients accompanied by DM which age range of 52-66 years and varied nutritional status. Nutritional medical therapy was given in accordance with nutritional guidelines for stroke and DM. All of patients were given an additional olive oil to achieve the fulfillment of MUFA targets and supplementation of micronutrient such as vitamin B complex, vitamin C, folic acid and zinc tablets.

Results: The blood glucose levels of all patients during the treatment were in the range of 140-180 mg per dL, according to the recommendations. The functional capacity of the two patients has increased while the other two patients have not.

Conclusion: Nutritional support with the addition of high-source of MUFA food in ischemic stroke patients with diabetes mellitus may support the improvement of healing process."

"Latar belakang: Corona Virus Disease 19 (COVID-19) merupakan sebuah kumpulan gejala permasalahan saluran napas atas yang disebabkan olehh virus SARS-CoV-2. Penyakit ini telah menjadi permasalahan global, dan diketahui bahwa populasi lanjut usia memiliki risiko jangkitan dan mortalitas yang tinggi. Prevalensi mortalitas pasien COVID-19 lanjut usia adalah 49,9%. Angka ini sangatlah tinggi karena pasien lanjut usia memiliki faktor risiko yang lebih banyak dibandingkan populasi dewasa, faktor risiko tersebut adalah usia, komorbiditas, dan adanya perubahan fungsi tubuh. Salah satu faktor risiko yang penting untuk dipertimbangkan dalam menilai prognosis adalah status nutrisi pasien. Disebutkan bahwa pasien lanjut usia memiliki prevalensi risiko malnutrisi yang tinggi yaitu berkisar antara 18-78%. Oleh karena itulah penelitian memiliki tujuan untuk melihat hubungan status nutrisi dengan mortalitas pasien COVID-19 berusia lanjut.Metode: Penelitian ini menggunakan desain studi kohort retrospektif dengan menggunakan data sekunder berupa rekam medis pasien Rumah Sakit Cipto Mangungkusumo.Hasil: Total subjek penelitian berjumlah 459 orang dengan pasien berusia 60-69 tahun sebanyak 302 orang (65,7%) dan pasien berusia ≥70 tahun sebanyak 157 orang (34,2%). Rata-rata usia subjek penelitian adalah 67,78 ± 6,9 tahun dengan median 66 tahun. Jenis kelamin subjek yang paling mendominasi adalah laki-laki dengan jumlah 279 orang (60,8%). Sebanyak 177 orang (38,6%) dinyatakan berisiko malnutrisi menggunakan asesmen malnutrition screening tool (MST). Angka mortalitas dalam perawatan pasien COVID-19 berusia lanjut adalah 28,3%. Pada analisis bivariat, didapatkan bahwa malnutrisi memiliki hubungan yang signifikan pada mortalitas pasien COVID-19 berusia lanjut dengan relative risk 2,63 (95% CI: 2,603-6,273; p = 0,000).Kesimpulan: Malnutrisi meningkatkan risiko mortalitas pasien COVID-19 berusia lanjut.

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Introduction: Corona Virus Disease 19 (COVID-19) is a disease that is caused by SARS-CoV-2 and can be identified by several respiratory symptoms. This disease has been a global threat in every country, and it is known that elderly population have the greatest risk of infection and mortality. The mortality prevalence of eldery patients infected by COVID-19 in Indonesia is 49,9%. The prevalence is so high because elderly patient carries a lot of risk factors, such as age itself, comorbidities, and functional body change. One of the risk factors that we need to consider to be prognostic factors is nutrition status. Malnutrition prevalence in elderly patients is estimated to be 18-78%. With that in mind, this research is intended to look at the effect of nutrition status on mortality in COVID-19 elderly patients.     

Method: This research is using retrospective cohort as its study design. We used secondary data from the Rumah Sakit Cipto Mangunkusumo patient’s medical records.

Result: There are 459 research subjects with 302 people (65,7%) in the 60-69 years old age population and 157 remaining people (34,2%) in ≥ 70 years old age population. The mean age in this study was 67,78 ± 6,9 years old with the median of 66 years old. This study population was dominated by males group of 279 people (60,8%). A total of 177 people was diagnosed with risk of malnutrition by malnutrition screening tool (MST) assessment. In-hospital mortality occurred for 28,3% from total sample population.  Bivariat analysis showed that malnutrition has a significant relationship with mortality in COVID-19 elderly patients with a relative risk of 2,63 (95% CI: 2,603-6,273; p = 0,000).

Conclusion: Malnutrition increased the mortality risk for COVID-19 elderly patients."

"Thalassemia b mayor adalah penyakit yang disebabkan oleh kelainan sintesis rantai polipeptida b yang diturunkan secara otosom resesif. Penanganan kasus dengan thalassemia b mayor berupa pemberian transfusi berulang yang akan mengakibatkan hemokromatosis. Hemokromatosis dapat terjadi pada beberapa organ tubuh termasuk pankreas. Tujuan penelitian ini untuk mendapatkan kadar gula darah dan angka kejadian hemokromatosis pada penderita thalassemia b mayor. Telah diperiksa kadar gula darah puasa dan kadar ferritin serum pada 115 penderita thalassemia b mayor yang berumur 10-23 tahun dari Pusat Thalassemia Bagian Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia-Rumah Sakit Cipto Mangunkusumo Jakarta. Kadar gula darah diperiksa dengan metode enzimatik sesuai dengan kriteria American Diabetes Association (ADA), kadar ferritin serum diperiksa dengan metode microparticle enzyme immuno assay (MEIA). Pada penelitian didapatkan semua kasus yang diperiksa menunjukkan hemokromatosis, 14,8% dari pada kasus disertai dengan kadar gula darah puasa terganggu dan 2,6% menujukkan adanya diabetes melitus. Penderita thalassemia b mayor yang mendapat transfusi berulang menyebabkan terjadinya hemokromatosis yang dapat mengganggu fungsi pankreas. (Med J Indones 2003; 12: 87-93)

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b-thalassemia major is a disease caused by b polypeptide chain synthesis disorder which is inherited as an autosomal recessive from both parents which is marked by little or no b globin chain synthesis. Medication for b thalassemia major patients is by repeated blood transfusions, which causes hemochromatosis. Hemochromatosis can occur in various organs including the pancreas. The aim of the study was to assess the alteration of plasma glucose concentration and the hemochromatosis prevalence. Fasting plasma glucose concentration and serum ferritin examination were measured in 115 b thalassemia major patients with ages between 10-23 years who were out-patients in the Thalassemia Centre, Department of Child Health, Medical School, University of Indonesia / Dr. Cipto Mangunkusumo General Hospital, Jakarta. The plasma glucose concentration examination was conducted by the GDH enzymatic method, with American Diabetes Association (ADA) criteria in the evaluation, while the serum ferritin examination was conducted with the microparticle enzyme immuno assay (MEIA) method. All patients had hemochromatosis, 14.8% of the patients had impaired fasting glucose level and 2.6% of the patients showed indications of diabetes mellitus. b thalassemia major patients who receive frequent transfusions will develop hemochromatosis that will in turn impair the pancreatic function. (Med J Indones 2003; 12: 87-93)"