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"Latar belakang Kardiotoksisitas subklinis merupakan kondisi yang sering terjadi pada anak dengan keganasan yang mendapat kemoterapi, tetapi belum dapat terdeteksi menggunakan pemeriksaan ekokardiografi konvensional. Pemeriksaan global longitudinal strain menggunakan ekokardiografi speckle tracking dilaporkan dapat mendeteksi disfungsi ventrikel kiri lebih awal dibandingkan ekokardiografi konvensional. Namun, belum banyak penelitian terkait pemeriksaan kuantitatif fungsi jantung dengan ekokardiografi speckle tracking pada anak dengan keganasan. Studi ini diharapkan dapat membantu deteksi dini gangguan fungsi jantung. Metode Penelitian ini merupakan studi potong lintang di RSUPN dr. Cipto Mangunkusumo Jakarta terhadap 49 subyek anak berusia 6 bulan sampai 17 tahun 10 bulan pada September-November 2022. Subyek penelitian adalah anak yang baru terdiagnosis keganasan, tidak memiliki masalah jantung sebelumnya, dan mendapatkan kemoterapi kemudian dievaluasi pemeriksaan kuantitatif fungsi jantung dengan pemeriksaan kuantitatif ekokardiografi (konvensional, Doppler jaringan, speckle tracking) sebelum dan sesudah mendapat kemoterapi 3 bulan. Pasien yang mengalami reduksi relatif GLS >15% dilakukan pemeriksaan lanjutan berupa biomarker jantung troponin I. Hasil ekokardiografi speckle tracking dapat dipertimbangkan untuk deteksi disfungsi sistolik ventrikel kiri lebih dini dengan sensitivitas 100% (IK 95% 82,35-100) dan spesifisitas 60% (IK 95% 40,60-77,34). Subyek yang mengalami kardiotoksisitas subklinis didapatkan sebanyak 63,3% ditandai dengan reduksi relatif GLS>15% setelah kemoterapi 3 bulan. Didapatkan penurunan bermakna nilai LPSS ventrikel kiri segmen mid dan segmen apikal serta GLS dari median -18,4 (RIK -17,3 sd. -19,6) % sebelum kemoterapi menjadi -15,3 (RIK -13,65 sd. -17,85) % (p<0,0001) sesudah kemoterapi 3 bulan dengan median dosis kumulatif antrasiklin 150 (RIK 120-300) mg/m2. Reduksi relatif GLS>15% ini ditemukan di saat yang bersamaan belum ditemukan penurunan EF/FS sampai di bawah batas normal. Tidak terbukti usia, jenis kelamin, status nutrisi, dan regimen kemoterapi memengaruhi kardiotoksisitas subklinis pada pasien anak dengan keganasan yang mendapat kemoterapi selama 3 bulan pada penelitian ini. Kesimpulan Pemeriksaan ekokardiografi speckle tracking dapat dipertimbangkan untuk dilakukan dalam mendeteksi kardiotoksisitas subklinis. Pemeriksaan ini memiliki sensitivitas 100% (IK 95% 82,35-100) dan spesifisitas 60% (IK 95% 40,60-77,34).......Background Subclinical cardiotoxicity is a condition that often occurs in children with malignancy who receive chemotherapy, but it has not been frequently detected using conventional echocardiography. Global longitudinal strain examination using speckle tracking echocardiography is reported to be able to identify left ventricular dysfunction earlier than conventional echocardiography. However, there are not many studies related to quantitative examination of cardiac function by speckle tracking echocardiography in children with malignancy. This study is expected to help early detection of impaired heart function. Methods This research is a cross sectional study at RSUPN dr. Cipto Mangunkusumo Jakarta on 49 child subjects aged 6 months to 17 years 10 months in September-November 2022. The research subjects were children who had just been diagnosed with malignancy, had no previous heart problems, and received chemotherapy. Then they were evaluated by quantitative echocardiography (conventional, tissue Doppler, speckle tracking) before and after 3 months of chemotherapy. Patients who experienced a relative reduction of GLS > 15% underwent further examination of troponin I.Results Speckle tracking echocardiography can be considered for early detection of left ventricular systolic dysfunction with 100% sensitivity (95% CI 82.35-100) and 60% specificity (95% CI 40.60-77.34). Children with subclinical cardiotoxicity were found to be 63.3% characterized by a relative reduction in GLS>15% after 3 months of chemotherapy, with a significant decrease in mid and apical segment left ventricular LPSS values and GLS from a median -18.4 (IQR -17.3 sd. -19.6) % before chemotherapy to -15.3 (IQR -13.65 sd. -17.85) % (p<0.0001) after 3 months of chemotherapy with a median cumulative dose of anthracycline 150 (IQR 120-300) mg/m2. This relative reduction of GLS> 15% was found at the same time that there was no decrease in EF/FS below normal limits. There was no evidence that age, gender, nutritional status, and chemotherapy regimen had an effect on subclinical cardiotoxicity in pediatric patients with malignancy who received chemotherapy for 3 months in this study. Conclusion Speckle tracking echocardiography can be considered for detecting subclinical cardiotoxicity. This examination has a sensitivity of 100% (95% CI 82.35-100) and a specificity of 60% (95% CI 40.60-77.34)."

"Latar belakang: Hampir sebagian besar pasien kanker akan memiliki keluhan kulit, rambut, dan kuku (KRK) terkait efek samping kemoterapi yang diberikan. Antrasiklin merupakan kemoterapi yang banyak digunakan pada pasien kanker. Meskipun jarang mengancam nyawa, kelainan KRK dapat menyebabkan penurunan kualitas hidup. Berbagai faktor risiko berpengaruh terhadap kelainan tersebut. Waktu timbulnya manifestasi kelainan KRK pada pasien kanker yang menjalani kemoterapi berbasis antrasiklin juga beragam munculnya. Penelitian ini bertujuan untuk menganalisis hubungan antara usia, penyakit penyerta sistemik, status gizi, ECOG, dan anemia dengan manifestasi klinis KRK pada pasien kanker yang menjalani dua siklus kemoterapi berbasis antrasiklin.Metode: Penelitian ini merupakan penelitian deskriptif analitik dengan kohort prospektif yang diikuti dalam dua siklus pertama kemoterapi berbasis antrasiklin. Sebesar 65 pasien kanker berusia di atas 18 tahun yang mendapatkan kemoterapi siklus pertama berbasis antrasiklin di RSUPN dr. Cipto Mangunkusumo. Semua SP dilakukan anamnesis, pemeriksaan dermatovenereologikus, dan dokumentasi klinis sampai sebelum kemoterapi siklus ke-3. Pencatatan faktor risiko, jenis, dan waktu timbulnya kelainan dilakukan apabila ditemukan manifestasi KRK.Hasil: Kelainan kulit terbanyak berupa xerosis dan hiperpigmentasi. Anagen effluvium ditemukan pada 89,2% pasien kemoterapi. Melanonikia dan xanthonikia ditemukan pada 87,7% pasien. Xerosis ditemukan dengan median (minimum-maximum) 7 (2-56) hari, anagen effluvium timbul dalam median (minimum-maximum) 13(1-27 hari), dan melanonikia dengan median (minimum-maximum) 23(1-65) hari. Tidak terdapat hubungan antara usia, penyakit penyerta sistemik, status gizi, status performa ECOG, dan anemia dengan manifestasi KRK pada pasien kanker yang menjalani dua siklus kemoterapi berbasis antrasiklin.Kesimpulan: Semua pasien memiliki kelainan KRK. Kelainan yang paling cepat timbul adalah xerosis, diikuti anagen effluvium, dan melanonikia. Tidak ditemukan hubungan antara usia, penyakit penyerta sistemik, status gizi, status performa ECOG, dan anemia dengan manifestasi KRK pada pasien kanker yang menjalani dua siklus kemoterapi berbasis antrasiklin.......Background: Nearly most cancer patients experience skin, hair, and nail complaints due to chemotherapy side effects. Anthracycline-based chemotherapy is widely utilized in cancer care. While rarely life-threatening, cutaneous, hair, and nail alterations can significantly impact quality of life. Several risk factors influence these disorders. The onset timing of skin, hair, and nail manifestations varies among cancer patients undergoing anthracycline-based chemotherapy. This study analyses the association between age, systemic comorbidities, nutritional status, ECOG performance status, and anaemia with clinical manifestations of skin, hair, and nails in cancer patients undergoing two cycles of anthracycline-based chemotherapy.Methods: This is an analytical descriptive study involving a prospective cohort followed during the first two cycles of anthracycline-based chemotherapy. A total of 65 cancer patients aged above 18, receiving the first cycle of anthracycline-based chemotherapy at RSUPN dr. Ciptomangunkusumo, were enrolled. All subjects underwent anamnesis, dermatovenereological examination, and clinical documentation before the third chemotherapy cycle. Risk factors, type, and onset time of abnormalities were recorded upon detection of skin, hair, and nail manifestations.Results: All patients presented with skin, hair, or nail abnormalities. The most rapidly occurring abnormalities were xerosis, followed by anagen effluvium and melanonychia. No correlation was found between age, systemic comorbidities, nutritional status, ECOG performance status, and anaemia with skin, hair, and nail manifestations in cancer patients undergoing two cycles of anthracycline-based chemotherapy. Conclusions: The most frequent skin abnormalities observed were xerosis and hyperpigmentation. Anagen effluvium was detected in 89.2% of chemotherapy patients. Melanonychia and xanthonychia were found in 87.7% of patients. Xerosis had a median (min-max) onset of 7 (2-56) days, anagen effluvium manifested within a median (min- max) of 13 (1-27) days, and melanonychia with a median (min-max) onset of 23 (1-65) days. There was no association found between age, systemic comorbidities, nutritional status, ECOG performance status, and anaemia with skin, hair, and nail manifestations in cancer patients undergoing two cycles of anthracycline-based chemotherapy."