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"Osteoblas merupakan sel tulang yang berperan dalam formasi tulang, yang mempunyai kemampuan dalam sintesa dan mengatur deposisi dan mineralisasi dari matrik selular tulang. Kerusakan tulang diatasi dengan penempatan material pengganti yang merangsang pembentukan tulang baru dimana osteoblas berperan dalam pembentukan formasi tulang. Transplantasi jaringan telah dikembangkan untuk merekonstruksi kerusakan tulang dengan penempatan bahan tandur tulang. Dosis akhir sterilisasi 25 kGy biasa dipakai untuk bahan tandur tulang tergantung dari bank jaringan. Dosis radiasi tergantung pada tingkat bioburden jumlah organisma yang tertinggal. Laporan terdahulu mengemukakan bahwa dosis radiasi 15 kGy efektif dalam mensterilkan bahan tandur tulang. Tujuan : Mengevaluasi perilaku osteoblas manusia galur MG63 dalam proses regenerasi tulang setelah ditransplantasi dengan Demineralized freeeze-dried bone, DFDB (Batan, Jakarta, Indonesia) dengan dosis sterilisasi 15 kGy dibandingkan dengan DFDB yang disterilisasi dengan dosis 25 kGy. Metoda : Sel osteoblas manusia dibiakkan dan dibagi dalam 3 kelompok, pertama ditransplantasi dengan DFDB yang disterilisasi dengan dosis 15 kGy, kedua ditransplantasi dengan DFDB dosis sterilisasi 25 kGy, dan grup ketiga tanpa transplantasi sebagai kontrol. Proliferasi of osteoblasdianalisa 24 jam setelah transplantasi dengan test MTT assay. Ekspresi fosfatase alkali dan deposisi ion Ca++ dianalisis setelah 7, 14 dan 21 harai setelah transplantasi. Hasil : Proliferasi sel osteoblas manusia setelah ditransplantasi dengan DFDB yang disterilisasi 15 kGy tidak berbeda bermakna dibandingkan dengan yang ditransplantasi dengan DFDB dosis sterilisasi 25 kGy setelah 24 jam transplantasi. Dan proses remineralisasi antara kedua kelompok relatif sama antara kelompok DFDB 15 kGy dan dengan kelompok DFDB 25 kGy.

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Osteoblasts are the skeletal cells responsible for bone formation, meaning that they synthesize and regulate the deposition and mineralization of the extracellular matrix of bone. Bone defect treated with placement a preparation material to promote new bone formation and osteoblasts play a major role in bone formation. Tissue transplantation were developed to reconstruc bone defect with the placement of bone graft material. A 25 kGy dose is the most commonly used radiation dose for sterilization of bone graft material, but tissue bankers can decide the dosage used to sterillized their tissues. The dose can be selected depending on the bioburden or microbial count on the tissue prior to sterillization and had ben reported a low dose radiation 15 kGy is effective to sterillization a bone graft materials.

Objective : The objective of this study was to evaluate behavior of human osteoblast cell line (MG63) in bone regeneration process, after transplantation of Demineralized freeeze-dried bone, DFDB (Batan, Jakarta, Indonesia) with radiation dose sterilization 15 kGy compare with DFDB with radiation sterilization 25 kGy.

Method : Human osteoblast cell line culture was divided into 3 groups, first group transplanted with dose radiation DFDB 15 kGy, second group transplanted with dose radiation 25 kGy DFDB and and the third group without bone graft as control. After 24 hours, proliperation of osteoblast cell area are analysed with MTT assay test. Expression of alkali phosphatase and deposition of Ca++ are analysed after 7, 14 and 21 days after transplantation.

Results : Proliferation of osteoblast cell in DFDB 15 kGy showed not signifivcantly difference with DFDB 25 kGy after 24 hours and remineralization process between DFDB 15 kGy group transplantation equal with DFDB 25 kGy group."

"Kasus resistensi antimikroba telah menjadi permasalahan klinis utama khususnya pada bakteri gram negatif. Salah satu penyebabnya adalah pompa efflux yang berperan dalam mengekstrusi antimikroba ke luar sel bakteri. Seiring dengan peningkatan kasus resistensi, penghambatan pompa efflux bakteri menjadi menarik untuk membantu menyelesaikan masalah resistensi antimikroba. Berbagai upaya penemuan senyawa efflux pump inhibitor (EPI) baik dari sintetik maupun bahan alam pun sudah dilakukan. Namun, beberapa senyawa EPI sintetik yang sudah diketahui tidak dianjurkan penggunaannya secara klinis karena masalah toksisitas. Oleh karena itu, dilakukan pencarian EPI dari bahan alam yang dapat dikonsumsi oleh manusia sehingga diharapkan toksisitasnya lebih rendah dibandingkan dengan senyawa sintetik. Pada literature review ini, penulis mengulas mengenai perkembangan penemuan EPI yang berasal dari bahan alam sehingga diharapkan dapat memberikan gambaran peneliti yang ingin mengembangkan EPI sebagai terapi dalam mengatasi resistensi antimikroba. Berdasarkan penelitian, banyak bahan alam yang dapat digunakan sebagai EPI. Salah satu contoh yang berpotensi adalah tanaman dari famili Lamiaceae, Apocynaceae, Convolvulaceae dan Malvaceae. Theobroma cacao merupakan tanaman yang tumbuh di Indonesia dan berpotensi lebih baik sebagai EPI pada bakteri gram negatif karena terbukti memiliki aktivitas penghambatan pada empat bakteri gram negatif berbeda yaitu Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosa, dan Salmonella typhimurium.

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Antimicrobial resistance has become a major clinical problem, especially in gram-negative bacteria. One of the causes is the efflux pump which plays a role in extruding the antimicrobials out of the bacterial cell. As resistance cases increase, inhibition of bacterial efflux pumps becomes attractive to help solve the problem of antimicrobial resistance. Many methods to find efflux pump inhibitor (EPI) compounds both from the synthetic and natural sources have also been carried out. However, some known synthetic EPI compounds are not recommended for clinical use because of their toxicity. Therefore, a search for EPI from a natural source that can be consumed by humans is expected to have lower toxicity compared to synthetic compounds. In this literature review, the author reviews the development of EPI findings derived from natural sources so that it is expected to provide an overview of the researchers who want to develop EPI as a therapy in overcoming antimicrobial resistance. Based on research, many natural sources can be used as EPI. Examples of potential plants from the Lamiaceae, Apocynaceae, Convolvulaceae, and Malvaceae families. Theobroma cacao is a plant that grows in Indonesia and has better potential as EPI in gram-negative bacteria because it has been shown to have inhibitory activity on four different gram-negative bacteria, namely Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosa, and Salmonella typhimurium.

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"Diarrhea poses significant health risks in developing countries like Indonesia, especially among children, contributing to high morbidity and mortality rates according to the 2018 World Health Organization report. The escalating antimicrobial resistance among enteric pathogens in these nations is also a critical concern. The aim of this research is to profile Gram-negative bacteria in pediatric patients with diarrheal conditions and analyze the antibacterial gene resistance of Gram-negative bacteria in these patients. Stool samples were cultured and sent to the FKUI Microbiology Laboratory for DNA isolation. Pathogenic Gram-negative bacteria were identified and sequenced at the Bioinformatics Core Facilities at IMERI-FKUI using Next-Generation Sequencing (NGS). Antibiotic resistance to antibiotics such as cefixime, co-trimoxazole, ciprofloxacin, and carbapenem was determined. Eighteen bacterial samples revealed a diverse landscape of Klebsiella pneumoniae and E. coli strains. Klebsiella pneumoniae predominated (56%), with various Sequence Types (STs) and phylotypes identified. Notably, ST-231 and ST-101 were associated with the K1 phylotype, indicating potential virulence. E. coli (44% of samples) showed a spectrum of pathogenicity, including ExPEC as the most prevalent. Virulence gene analysis highlighted complex pathogenic mechanisms and significant antibiotic resistance, especially in E. coli. K. pneumoniae and E. coli isolates showed high resistance to multiple antibiotics, including fluoroquinolones, fosfomycin, aminoglycosides, and beta-lactams. This research enhances the understanding of gastrointestinal health in children and underscores the urgent need for effective antimicrobial stewardship to combat antimicrobial resistance."

"Resistensi antimikroba menjadi masalah kesehatan global. Infeksi bakteri resisten dapatmeningkatkan biaya perawatan kesehatan, lama perawatan di rumah sakit, morbiditasdan mortalitas baik di negara maju maupun negara berkembang. Penelitian yangmenghubungkan antara infeksi oleh bakteri gram negatif resisten antibiotik denganbiaya dan lama perawatan rumah sakit belum banyak dilakukan terutama di Indonesia.Penelitian ini adalah penelitian potong lintang yang melihat perbandingan biayaperawatan dan lama rawat rumah sakit pada pasien dengan infeksi bakteri gram negatifresisten antibiotik dan peka antibiotik. Pengambilan data dilakukan secara konsekutifdengan kriteria inklusi adalah pasien yang berusis ≥18 tahun dan dirawat inap denganhasil biakan positif terdapat isolat bakteri Gram negatif. Kriteria eksklusi adalah datapsien dari laboratorium mikrobiologi yang tidak sesuai dan pasien yang tidak mendapatantibiotik. Dari 359 isolat hasil penelitian didapatkan sebanyak 221 isolat (61.6%)merupakan isolat bakteri gram negatif yang resisten antibiotik. Adapun bakteri tersebutterdiri K. pneumoniae penghasil ESBL sebanyak 97 isolat (27%), E. coli penghasilESBL sebanyak 85 isolat (23.7%), P. aeruginosa yang resisten meropenem sebanyak 11isolat (3.1%) dan A. baumannii resisten meropenem sebanyak 28 isolat (7.8%). Hasilperhitungan biaya perawatan pasien yang terinfeksi bakteri resisten memiliki reratasebesar Rp 26.010.218,- sedangkan pasien yang terinfeksi bakteri peka memiliki reratabiaya perawatan sebesar Rp 18.201.234,- (p<0.05). Pasien yang terinfeksi A. baumanniiresisten meropenem memiliki biaya rawat inap yang paling besar, diikuti E. colipenghasil ESBL, K. pneumoniae penghasil ESBL, dan P. aeruginosa resistenmeropenem. Jumlah hari rawat pasien yang terkena infeksi bakteri adalah 14 hari, danpasien yang terkena infeksi bakteri nonresisten adalah 9 hari (p<0.05). Hasil penelitianini memperlihatkan bahwa infeksi bakteri Gram nehatif resisten mengakibatkan biayaperawatan dan lama rawat rumah sakit meningkat secara bermakna dibandingkan pasiendengan infeksi bakteri peka antibiotik. Pemeriksaan mikrobiologi sangat pentingdilakukan, agar pasien mendapatkan antibiotik yang tepat.

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Antimicrobial resistance is a global health problems. Resistant bacterial infectionincreases hospital costs, length of hospital stay, morbidity and mortality in bothdeveloped and developing countries. A few research has been found linking infectionwith antibiotic resistant Gram-negative bacteria with the hospital costs in Indonesia.This study is a cross-sectional study, analyze the comparison of hospital costs inpatients with antibiotic-resistant Gram-negative bacterial infections and antibioticsensitive infections. The sample method is consecutive non-random sampling, withinclusion criteria were patients who were aged ≥18 years and hospitalized with Gramnegative bacterial positive culture. Exclusion criteria were inappropriate patient dataand patients not receiving antibiotics. From 359 isolates, 221 isolates (61.6%) wereantibiotic resistant Gram negative bacteria. The bacteria consisted of 97 isolates (27%)of ESBL-producing K. pneumoniae, 85 isolates (23.7%) were ESBL-producing E. coli,28 isolates (7.8%) were meropenem-resistant A. baumannii, and 11 isolates (3.1%) weremeropenem-resistant P. aeruginosa. The average hospital cost of patients with antibioticresistant Gram-negative bacteria was Rp. 26,010,218, whereas patients with antibioticsensitive infection was Rp. 18,201,234, - (p<0.05). Patients with meropenem resistantA. baumannii have the highest hospital costs, followed by ESBL-producing E. coli,ESBL-producing K. pneumoniae, and meropenem-resistant P. aeruginosa. The averagelength of hospital stay in patients with antibiotic-resistant Gram-negative bacterialinfections was 14 days, whereas patients with antibiotic sensitive infection was 9 days(p<0.05). The results showed that resistant Gram-negative bacterial infection issignificantly higher hospital costs and hospital stay compared to patients with antibioticsensitivebacterial infections. Microbiological culture is important to do, so the patientswill get the right antibiotics."

"Pendahuluan: Peningkatan resistensi antibiotik global menjadikan kolistin sebagai pilihan terapi untuk infeksi bakteri pandrug resistant (PDR). Namun, karena efek nefrotoksiknya, pemilihan kolistin harus dilakukan secara hati-hati setelah diperoleh hasil uji kepekaannya. Sifat molekul kolistin yang kompleks menyebabkan uji kepekaan tidak dapat dilakukan dengan metode difusi cakram atau mesin otomatis yang tersedia, sehingga diperlukan metode lain yang praktis dan dengan hasil yang baik.Metode: Sebanyak 120 isolat bakteri Gram negatif, terdiri dari Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, masing-masing berjumlah 30 isolat diuji kepekaannya terhadap kolistin. Metode uji menggunakan media CHROMagar Col-APSE dan sebagai baku emas digunakan metode broth microdilution (BMD). Hasil uji kepekaan dianalisis untuk mendapatkan sensitivitas, spesifisitas, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio serta akurasi.Hasil: Ditemukan sebanyak 20 isolat yang resisten terhadap kolistin dari 120 isolat yang diuji pada media CHROMagar Col-APSE. Diantara 20 isolat yang resisten kolistin tersebut, hanya 10 isolat yang resisten kolistin pada uji kepekaan dengan metode BMD. Didapatkan nilai sensitivitas 100% (95% CI, 72,25 – 100), spesifisitas 90,91% (95% CI, 84,07 – 94,9), Positive Predictive Value (PPV) 50% (95% CI, 29,93 – 70,07), Negative Predictive Value 100% (95% CI, 96,3 – 100), positive likelihood ratio 11 (95% CI, 9,04 – 13,38), negative likelihood ratio 0 (95% CI 0), dan nilai akurasi diagnostik 91.67% (95%CI, 85.34 – 95.41).Kesimpulan: Uji kepekaan bakteri Gram negatif terhadap kolistin dapat dilakukan menggunakan CHROMagar Col-APSE, dengan interpretasi dengan hati-hati. Bila hasil uji kepekaan bakteri Gram negatif terhadap kolistin ditemukan resisten berdasarkan CHROMagar Col-APSE, maka hasil tersebut perlu dikonfirmasi lebih lanjut menggunakan metode BMD.

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Introduction: The global increase in antibiotic resistance has made colistin a therapeutic option for infections caused by pandrug-resistant (PDR) bacteria. However, due to its nephrotoxic effects, the use of colistin must be administered carefully after susceptibility test results are obtained. The complex molecular structure of colistin renders susceptibility testing unsuitable using the disc diffusion method or automated systems. Therefore, alternative methods that are both practical and capable of delivering accurate and reliable results are required.

Methods: A total of 120 Gram-negative bacterial isolates, consisting of Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa with a total of 30 isolates were tested for susceptibility to colistin. The susceptibility testing was conducted using CHROMagar Col-APSE, with the broth microdilution (BMD) method serving as the gold standard. The results were analyzed to determine sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and accuracy.

Results: A total of 20 colistin resistant isolates were identified out of 120 isolates tested on CHROMagar Col-APSE. Among these, only 10 isolates were confirmed as colistin-resistant by the broth microdilution (BMD) method. The analysis yielded a sensitivity of 100% (95% CI, 72.25–100), specificity of 90.91% (95% CI, 84.07–94.9), positive predictive value (PPV) of 50% (95% CI, 29.93–70.07), negative predictive value (NPV) of 100% (95% CI, 96.3–100), positive likelihood ratio of 11 (95% CI, 9.04–13.38), negative likelihood ratio of 0 (95% CI, 0), and diagnostic accuracy of 91.67% (95% CI, 85.34–95.41).

Conclusion: Colistin susceptibility testing for Gram-negative bacteria can be performed using CHROMagar Col-APSE, with careful interpretation. When colistin resistance is detected in Gram-negative bacteria based on CHROMagar Col-APSE results, these findings should be further confirmed using the broth microdilution (BMD) method."