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"[ABSTRAKPendahuluan : Glioma adalah jenis tumor yang paling umum dari neoplasma intraserebralprimer. Tumor ganas primer sistem saraf pusat (SSP) mencapai sekitar 2% dari semua kankerdan high grade glioma adalah jenis yang paling banyak ditemukan. High grade gliomamenyebabkan tingkat morbiditas dan mortalitas yang tinggi. Saat ini belum ada data yangmenggambarkan profil pasien glioma yang menjalani radioterapi di Indonesia.Metode penelitian : Penelitian ini merupakan penelitian retrospektif deskriptif analitikterhadap 121 pasien glioma yang mendapat radiasi di departemen Radioterapi RSUPN Dr.Cipto mangunkusumo dari Januari 2009 sampai Januari 2014. Data diperoleh dari catatanmedisdan hasil penelusuran melalui telepon terhadap pasien atau keluarganya. Respon tumordianalisa terhadap 22 pasien yang mempunyai CT scan atau MRI pre dan post radiasi denganmenggunakan kriteria RECIST.Hasil : Sebagian besar pasien adalah laki-laki (53,7%), dengan usia rata-rata 45 tahun.Histopatologi yang paling banyak ditemukan adalah astrositoma. Prosedur bedah yang palingbanyak ditemukan pada penelitian ini adalah craniotomi removal tumor (70%). Teknik 3DCRT paling banyak digunakan yaitu pada 77,7% pasien. Nimotuzumab sebagai antibodimonoklonal digunakan pada 9% pasien. Respon parsial ditemukan 59,1%. Analisis kesintasanhidup tiga tahun dari seratus sebelas pasien yang memenuhi kriteria didapatkan angkakesintasan yaitu 46,15%. Analisis kaplan meyer menunjukkan overall treatment timemerupakan faktor prognostik untuk kesintasan hidup (p = 0,016).Kesimpulan : Teknik operasi terbanyak pada pasien glioma yang menjalani radiasi didepartemen radioterapi RSUPN DR. Cipto Mangunkusumo adalah kraniotomi removal tumor(70,9%). Teknik 3D CRT adalah teknik radiasi yang paling banyak digunakan. Responparsial ditemukan 59,1%. Kesintasan hidup tiga tahun pasien glioma yaitu 46,2% dan overalltreatment time merupakan faktor prognostik yang bermakna untuk kesintasan hidup

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ABSTRACTIntroduction : Glioma is the most common type of primary intracerebral neoplasms. Highgrade glioma being the most frekuent type found (70,9%) causes a high morbidity andmortality rate. There is currently no data describing the profile management of patientsundergoing radiotherapy glioma in Indonesia.Methods : This study Retrospective analytic descriptive study of 121 glioma patients fromjanuari 2009 until december 2014. The data was obtained from medical records and indivualcontact via telephone. Tumor response was evaluated in 22 patients with pre and postirradiation imaging (CT or MRI) using 3D volumetric data and assessed via RECISTcriteria.Results : Most of our patients were male (53,7%), with median age 45 years old.Astrocytoma was the most histopathological type found. 70.9% of Patients who receivedradiotherapy in Cipto Mangunkusumo hospital were post craniotomi tumor removal. 3DConformal technique was used in 81.0% of patients. Seventy nine point three had a two graydose perfraction. Provision of chemotherapy in patients undergoing radiation still only at7.4% of patients. Nimotuzumab as a monoclonal antibody used on 9% patient. The medianoverall treatment time was 45 days and delay treatment time 38 days. Fifty nine point onepercent of partial respon was found. Local recurrences were found throughout the follow-upof 6.6%. Analysis kaplan meyer showed that overall treatment time was a prognostic factorfor overal survival rate (p=0,016).Conclusions : : Almost seventy one percent of glioma patients who received radiotherapyhad craniotomy removal tumor. 3D Conformal techniques is the most widely used. Fifty ninepoint one percent of partial respon founded. Three years overall survival was 46,2% andoverall treatment time was found as a factor that significantly affects overall survivalprognosis.;Introduction : Glioma is the most common type of primary intracerebral neoplasms. Highgrade glioma being the most frekuent type found (70,9%) causes a high morbidity andmortality rate. There is currently no data describing the profile management of patientsundergoing radiotherapy glioma in Indonesia.Methods : This study Retrospective analytic descriptive study of 121 glioma patients fromjanuari 2009 until december 2014. The data was obtained from medical records and indivualcontact via telephone. Tumor response was evaluated in 22 patients with pre and postirradiation imaging (CT or MRI) using 3D volumetric data and assessed via RECISTcriteria.Results : Most of our patients were male (53,7%), with median age 45 years old.Astrocytoma was the most histopathological type found. 70.9% of Patients who receivedradiotherapy in Cipto Mangunkusumo hospital were post craniotomi tumor removal. 3DConformal technique was used in 81.0% of patients. Seventy nine point three had a two graydose perfraction. Provision of chemotherapy in patients undergoing radiation still only at7.4% of patients. Nimotuzumab as a monoclonal antibody used on 9% patient. The medianoverall treatment time was 45 days and delay treatment time 38 days. Fifty nine point onepercent of partial respon was found. Local recurrences were found throughout the follow-upof 6.6%. Analysis kaplan meyer showed that overall treatment time was a prognostic factorfor overal survival rate (p=0,016).Conclusions : : Almost seventy one percent of glioma patients who received radiotherapyhad craniotomy removal tumor. 3D Conformal techniques is the most widely used. Fifty ninepoint one percent of partial respon founded. Three years overall survival was 46,2% andoverall treatment time was found as a factor that significantly affects overall survivalprognosis.;Introduction : Glioma is the most common type of primary intracerebral neoplasms. Highgrade glioma being the most frekuent type found (70,9%) causes a high morbidity andmortality rate. There is currently no data describing the profile management of patientsundergoing radiotherapy glioma in Indonesia.Methods : This study Retrospective analytic descriptive study of 121 glioma patients fromjanuari 2009 until december 2014. The data was obtained from medical records and indivualcontact via telephone. Tumor response was evaluated in 22 patients with pre and postirradiation imaging (CT or MRI) using 3D volumetric data and assessed via RECISTcriteria.Results : Most of our patients were male (53,7%), with median age 45 years old.Astrocytoma was the most histopathological type found. 70.9% of Patients who receivedradiotherapy in Cipto Mangunkusumo hospital were post craniotomi tumor removal. 3DConformal technique was used in 81.0% of patients. Seventy nine point three had a two graydose perfraction. Provision of chemotherapy in patients undergoing radiation still only at7.4% of patients. Nimotuzumab as a monoclonal antibody used on 9% patient. The medianoverall treatment time was 45 days and delay treatment time 38 days. Fifty nine point onepercent of partial respon was found. Local recurrences were found throughout the follow-upof 6.6%. Analysis kaplan meyer showed that overall treatment time was a prognostic factorfor overal survival rate (p=0,016).Conclusions : : Almost seventy one percent of glioma patients who received radiotherapyhad craniotomy removal tumor. 3D Conformal techniques is the most widely used. Fifty ninepoint one percent of partial respon founded. Three years overall survival was 46,2% andoverall treatment time was found as a factor that significantly affects overall survivalprognosis., Introduction : Glioma is the most common type of primary intracerebral neoplasms. Highgrade glioma being the most frekuent type found (70,9%) causes a high morbidity andmortality rate. There is currently no data describing the profile management of patientsundergoing radiotherapy glioma in Indonesia.Methods : This study Retrospective analytic descriptive study of 121 glioma patients fromjanuari 2009 until december 2014. The data was obtained from medical records and indivualcontact via telephone. Tumor response was evaluated in 22 patients with pre and postirradiation imaging (CT or MRI) using 3D volumetric data and assessed via RECISTcriteria.Results : Most of our patients were male (53,7%), with median age 45 years old.Astrocytoma was the most histopathological type found. 70.9% of Patients who receivedradiotherapy in Cipto Mangunkusumo hospital were post craniotomi tumor removal. 3DConformal technique was used in 81.0% of patients. Seventy nine point three had a two graydose perfraction. Provision of chemotherapy in patients undergoing radiation still only at7.4% of patients. Nimotuzumab as a monoclonal antibody used on 9% patient. The medianoverall treatment time was 45 days and delay treatment time 38 days. Fifty nine point onepercent of partial respon was found. Local recurrences were found throughout the follow-upof 6.6%. Analysis kaplan meyer showed that overall treatment time was a prognostic factorfor overal survival rate (p=0,016).Conclusions : : Almost seventy one percent of glioma patients who received radiotherapyhad craniotomy removal tumor. 3D Conformal techniques is the most widely used. Fifty ninepoint one percent of partial respon founded. Three years overall survival was 46,2% andoverall treatment time was found as a factor that significantly affects overall survivalprognosis.]"

"ABSTRAKLama rawat dihitung dari tanggal keluar pasien dikurangi tanggal pasien masuk ruang perawatan yang tercatat pada data rekan medik.Penelitian ini bertujuan untuk mengidentifikasi karakteristik anak dengan lama rawat anak yang mengalami infeksi sistem saraf pusat di RSUD Cibinong tahun 2013-2016. Penelitian ini menggunakan desain potong lintang dengan studi korelasi. Penelitian ini menggunakan data sekunder yaitu data rekam medik pada tahun 2013-2016. Sampel dalam penelitian ini adalah anak yang berusia 0-18 tahun yang mengalami infeksi sistem saraf pusat yaitu 106 responden dengan menggunakan simple random sampling. Hasil penelitian menunjukkan karakteristik anak yang memiliki hubungan bermakna dengan lama rawat adalah jenis kelamin p value 0,032 , status gizi p value 0,000 , dan penyakit penyerta p value 0,000 . Rekomendasi bagi pelayanan keperawatan agar dapat meningkatkan asuhan keperawatan yang komprehensif dan bagi manajemen rumah sakit agar menetapkan standar lama rawat untuk anak dengan penyakit infeksi sistem saraf pusat.

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ABSTRACTThe length of stay was calculated from the patient 39 s discharge date minus the date of patient enters the treatment room that recorded on the medical records. This study aimed to identify relationship between children rsquo s characteristics with the length of stay of children who had central nervous system infection at RSUD Cibinong in 2013 2016. This study used cross sectional design with correlation studies. This study used secondary data that was medical record in 2013 2016. The sample in this study were children aged 0 18 years who had central nervous system infection, that was 106 respondents by using simple random sampling. The results showed that the characteristics of children with significant association with length of stay were gender p value 0,032 , nutritional status p value 0,000 , and comorbidities p value 0,000 . The recommendation on this study is for nursing services to improve comprehensive nursing care and for hospital management to establish the standard length of stay for children with central nervous system infection. "

"Pandemi COVID-19 membawa dampak besar pada pembelajaran anatomi. Pembelajaran anatomi yang secara konvensional dilakukan berbasis kadaver tidak dapat dilakukan atau hanya dapat dilakukan secara terbatas. Aplikasi anatomi tiga dimensi hadir sebagai media pembelajaran anatomi yang dapat memudahkan mahasiswa memahami struktur dan topografi secara akurat. Penelitian ini dilakukan untuk mengetahui hubungan antara penggunaan aplikasi anatomi 3D dengan peningkatan hasil pembelajaran anatomi (nilai pre-post test) sistem saraf pusat pada mahasiswa FKUI angkatan 2023. Desain penelitian yang digunakan adalah quasi-eksperimental. Tiga puluh satu subjek dibagi menjadi dua kelompok yaitu menggunakan aplikasi anatomi 3D (n = 14) dan tidak menggunakan aplikasi anatomi 3D (n =17). Kedua kelompok diberikan materi tambahan berupa referensi buku anatomi. Dilakukan pre-test dan post test pada kedua kelompok untuk menilai hasil pembelajaran. Analisis data dilakukan uji Spearman rank correlation menggunakan aplikasi SPSS ver. 24. Ditemukan korelasi nilai r = 0,07 dengan nilai p = 0,7 (p > 0,05) antara hasil pembelajaran dan penggunaan aplikasi anatomi 3D. Terdapat peningkatan hasil belajar yang lebih tinggi pada kelompok yang menggunakan aplikasi anatomi 3D (30,00) dibandingkan dengan yang tidak menggunakan aplikasi anatomi 3D (26,47). Terdapat hubungan yang sangat lemah dengan tendensi tidak signifikan antara penggunaan aplikasi anatomi 3D dengan peningkatan hasil pembelajaran anatomi (nilai pre-post test) sistem saraf pusat pada mahasiswa FKUI angkatan 2023. Kedua kelompok mengalami peningkatan hasil pembelajaran. Diperlukan analisis lebih lanjut pengaruh preferensi metode pembelajaran anatomi, kemampuan spasial, gaya belajar, dan kecepatan belajar mahasiswa terhadap hubungan antara penggunaan aplikasi anatomi 3D dan hasil pembelajaran anatomi.

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The COVID-19 pandemic has had a significant impact on anatomy education. Conventional anatomy learning based on cadavers cannot be conducted or can only be done in a limited manner. Three-dimensional anatomy applications are presented as a learning tool that can facilitate students in understanding anatomical structures and topography accurately. This research was conducted to determine the relationship between the use of 3D anatomy applications and the improvement in central nervous system anatomy learning outcomes (pre-post test scores) among 2023 students of the Faculty of Medicine, Universitas Indonesia. The research design used is quasi-experimental. Thirty-one subjects were divided into two groups: one using 3D anatomy applications (n = 14) and one not using 3D anatomy applications (n = 17). Both groups were provided with additional anatomical reference materials. Pre- tests and post-tests were conducted on both groups to assess learning outcomes. Data analysis was performed using the Spearman rank correlation test with SPSS version 24. A correlation with a value of r = 0.07 and a p-value of 0.7 (p > 0.05) was found between learning outcomes and the use of 3D anatomy applications. There was a higher improvement in learning outcomes in the group that used 3D anatomy applications (30.00) compared to the group that did not use 3D anatomy applications (26.47). There is a very weak and non-significant correlation between the use of 3D anatomy applications and the improvement in central nervous system anatomy learning outcomes (pre-post test scores) among 2023 students of the Faculty of Medicine, Universitas Indonesia. Both groups experienced an improvement in learning outcomes. Further analysis is needed to understand the influence of students' preference for anatomy learning methods, student’s spatial abilities, learning styles, and learning speed on the relationship between the use of 3D anatomy applications and anatomy learning outcomes."

"Latar Belakang: Kanker primer tahap lanjut dapat bermetastasis ke sistem saraf pusat (SSP) yaitu otak dan spinal, maupun ke selain SSP. Perbedaan gejala klinis antara metastasis SSP dan tanpa keterlibatan SSP adalah defisit neurologis pada metastasis SSP. Kedua metastasis tersebut dapat berisiko menyebabkan indeks massa otot skeletal yang rendah akibat gejala klinis dan peningkatan metabolisme akibat kanker. Namun, belum diketahui perbedaan di antara keduanya. Tujuan penelitian ini untuk mengetahui perbedaan appendicular skeletal muscle index (ASMI) pada pasien metastasis dengan dan tanpa keterlibatan SSP. Metode: Penelitian ini adalah studi potong lintang pada subjek berusia 18-65 tahun. Karakteristik subjek berupa usia, jenis kelamin, indeks massa tubuh, status gizi berdasarkan ASPEN, lokasi tumor primer, lokasi metastasis, waktu terdiagnosis metastasis, defisit neurologis, asupan energi dan protein, Karnofsky Performance Scale, kemoterapi, terapi glukokortikoid, dan nilai ASMI. Analisis bivariat digunakan untuk menilai perbedaan nilai ASMI antara metastasis SSP dan tanpa keterlibatan SSP. Hasil: Terdapat 59 subjek dengan nilai ASMI rendah. Rerata nilai ASMI pada metastasis SSP lebih rendah (3,81±1,19 kg/m2) dibandingkan dengan metastasis tanpa keterlibatan SSP (3,97±0,93 kg/m2) dengan perbedaan tidak signifikan pada kedua kelompok (p = 0,568). Terdapat perbedaan bermakna antara ASMI rendah dengan jenis kelamin (p=0,000), asupan energi (p=0,012), disfagia (p=0,027), nyeri kepala (p=0,033), dan gangguan kognitif (p=0,032). Kesimpulan: Tidak ditemukan perbedaan bermakna antara subjek yang memiliki ASMI rendah pada metastasis SSP dan tanpa keterlibatan SSP. Perbedaan bermakna ditemukan antara ASMI dengan karakteristik subjek yaitu jenis kelamin, asupan energi, disfagia, nyeri kepala, dan gangguan kognitif.

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Background: Advanced primary cancer can metastasize to the central nervous system (CNS), namely the brain and spinal cord, or to other than the CNS. The difference in clinical symptoms between CNS metastases and those without CNS involvement is the neurological deficit in CNS metastases. Both metastases may be at risk for low skeletal muscle mass index due to clinical symptoms and increased metabolism due to cancer. However, the differences between them are unknown. The aim of this study was to determine the difference of appendicular skeletal muscle index in metastatic patients with and without CNS involvement. Methods: This study was a cross-sectional study on subjects aged 18-65 years. Subject characteristics included age, gender, body mass index, nutritional status based on ASPEN, primary tumor location, metastasis location, time of metastasis diagnosis, neurological deficits, energy and protein intake, Karnofsky Performance Scale, chemotherapy, glucocorticoid therapy, and ASMI value. Bivariate analysis was used to assess the difference in ASMI value between CNS metastasis and without CNS involvement Results: There were 59 subjects with low ASMI values. The mean ASMI value in CNS metastasis was lower (3,81±1,19 kg/m2) compared to metastasis without CNS involvement (3,97±0,93 kg/m2) without significant difference in both groups (p=0,568). There was a significant difference between low ASMI and gender (p=0,000), energy intake (p=0,012), dysphagia (p=0,027), headache (p=0,033), and cognitive impairment (p=0,032). Conclusion: No significant difference was found between subjects who had low ASMI in CNS metastasis and without CNS involvement. Significant differences were found between ASMI and subject characteristics such as gender, energy intake, dysphagia, headache, and cognitive impairment."

"Covering all aspects of clinical radiology, this book takes you directly into the clinic, where you learn alongside fictional medical students as they work up actual cases. Illustrated throughout with high-quality images and diagrams, this unique text is structured to help you retain and recall critical clinical information when it really counts"

"Latar belakang: Infeksi susunan saraf pusat (SSP) dapat berakibat fatal bagi anak. Salah satu komplikasi infeksi SSP adalah gangguan keseimbangan natrium yang dapat menyebabkan keterlambatan diagnosis, memperberat gejala infeksi SSP, dan berkaitan dengan luaran buruk. Meskipun demikian, masih sedikit penelitian yang berupaya memprediksi gangguan keseimbangan natrium pada anak dengan infeksi SSP.Tujuan: Penelitian ini bertujuan untuk mengidentifikasi dan memprediksi gangguan keseimbangan natrium pada anak dengan infeksi SSP.Metode: Penelitian ini merupakan studi prognostik dengan rancangan penelitian kohort retrospektif di RSCM menggunakan data rekam medis dari Januari 2020-Desember 2023. Subyek yang diteliti ialah anak berusia >1 bulan sampai 18 tahun yang mengalami infeksi SSP. Prediktor yang diteliti adalah penurunan kesadaran saat masuk rumah sakit, dugaan patogen penyebab, sepsis, kelainan struktural kranioserebral sebelumnya, dan kejang sebelum masuk RS.Hasil: Terdapat 76 subyek yang mengalami infeksi SSP. Median usia subyek ialah 1,61 tahun (rentang 0,09-17,14 tahun). Proporsi lelaki dan perempuan hampir sama dengan lelaki sebanyak 39 (51,3%). Jenis infeksi SSP terbanyak ialah meningitis bakterialis (22 pasien, 28,9%). Terdapat 54 episode gangguan keseimbangan natrium pada 48 subyek (63,1%). Etiologi gangguan keseimbangan natrium diketahui pada 13 pasien dengan penyebab terbanyak ialah cerebral salt wasting (CSW) pada empat subyek. Pada analisis multivariat regresi logistik hanya penurunan kesadaran saat masuk rumah sakit yang dapat memprediksi gangguan keseimbangan natrium pada subyek dengan infeksi SSP probable dan terkonfirmasi dengan RR 1,5 (IK 95% 1,033-2,176), nilai p=0,033. Gangguan keseimbangan natrium pada infeksi SSP probable dan terkonfirmasi meningkatkan risiko kematian dengan RR 7,8 (IK 95% 1,074-56,65), nilai p=0,015.Simpulan: Penurunan kesadaran saat masuk rumah sakit merupakan prediktor gangguan keseimbangan natrium pada anak dengan infeksi SSP probable dan terkonfirmasi. Gangguan keseimbangan natrium pada populasi ini dapat meningkatkan risiko kematian secara signifikan.

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Background: Central nervous system (CNS) infection can be fatal for children. One of the complications of CNS infection is impaired sodium balance which can cause delayed diagnosis, aggravate symptoms of CNS infection, and is associated with poor outcomes. However, few studies have attempted to predict sodium balance disturbances in children with CNS infections.

Objective: This study aims to identify and predict impaired sodium balance in children with central nervous system infection.

Methods: This is a prognostic study with an retrospective cohort design at RSCM using medical record data from January 2020-December 2023. The subjects studied were children aged >1 month to 18 years who had CNS infections. The predictors studied were decreased consciousness at admission, suspected causative pathogen, sepsis, previous craniocerebral structural abnormalities, and seizures before admission.

Results: There were 76 subjects with central nervous system infection. The median age of the subjects was 1.61 years (range 0.09-17.14 years). The proportion of males and females was almost equal with males 39 (51.3%). The most common type of CNS infection was bacterial meningitis (22 subjects, 28.9%). There were 54 episodes of sodium balance disorder in 48 subjects (63.1%). The etiology of sodium balance disorders was known in 13 patients with the most common cause was cerebral salt wasting (CSW) in four subjects. In multivariate logistic regression analysis, only decreased consciousness at hospital admission predicted sodium balance disturbance in subjects with probable and confirmed CNS infection with RR 1,5 (95% CI 1,033-2,176), p value=0,033. Impaired sodium balance in probable and confirmed CNS infection increased the risk of death with RR 7,8 (95% CI 1,074-56,65), p value=0,015.

Conclusion: Decreased consciousness at hospital admission is a predictor of impaired sodium balance in children with probable and confirmed CNS infection. Impaired sodium balance in this population can significantly increase the risk of death."

"Latar Belakang: Diperkirakan 20-40% pasien kanker mengalami metastasis ke sistem saraf pusat (SSP). Kondisi inflamasi sistemik pada kanker yang dimediasi sitokin berkaitan dengan penurunan massa otot. Pada kondisi inflamasi, sel hepatosit terstimulasi untuk memproduksi protein fase akut c-reative protein (CRP). Kadar CRP di sirkulasi mengalami peningkatan pada lebih dari 50% pasien keganasan. CRP diperkirakan berhubungan dengan penurunan massa otot dan menjadi prediktor dini dalam kehilangan jaringan lean. Penelitian ini dilakukan untuk mengetahui hubungan kadar CRP dengan indeks massa otot skeletal (skeletal muscle mass index, SMI) pada pasien metastasis SSP. Metode: Penelitian ini adalah studi potong lintang pada pasien kanker dengan metastasis SSP di RSCM. Karakteristik subjek berupa usia, jenis kelamin, tipe metastasis, lokasi tumor primer, defisit neurologis, status performa Karnofsky, penyakit komorbid, penyakit infeksi, terapi glukokortikoid, sedang menjalani kemoterapi, radioterapi, dan tindakan bedah, indeks massa tubuh (IMT), status gizi berdasarkan IMT dan kriteria ASPEN, asupan energi, asupan protein, kadar CRP, dan nilai SMI. Dilakukan analisis hubungan kadar CRP dengan SMI.Hasil: Terdapat 57 pasien yang mengalami metastasis SSP. Mayoritas subjek perempuan (56,1%). Median usia 47 tahun. Lokasi metastasis lebih banyak ditemukan di otak (56,1%), tipe metastasis berdasarkan lokasi susunan saraf terbanyak adalah sinkronus (86%), seluruh subjek merupakan oligometastasis, dan lokasi tumor primer mayoritas berasal dari nasofaring (17,5%), payudara (15,8%), dan paru (14%). Defisit neurologis terbanyak yaitu nyeri kanker (68,4%), nyeri kepala (56,1%), dan kelemahan anggota gerak (43,9%). Kelemahan anggota gerak mayoritas hemiparesis (22,8%). Sebagian besar status performa Karnofsky pasien terganggu sedang (45,6%), 63,2% subjek tidak memiliki penyakit komorbid, 68,4% tidak memiliki penyakit infeksi, 52,6% tidak dalam terapi glukokortikoid, 75,4% subjek tidak sedang menjalani kemoterapi, masing-masing 1,8% subjek sedang menjalani radioterapi dan tindakan bedah. Rerata IMT estimasi 21,28 kg/m2 dan mayoritas status gizi berdasarkan IMT estimasi adalah berat badan normal (43,9%). Berdasarkan kriteria ASPEN, mayoritas termasuk malnutrisi sedang (49,1%) dan berat (31,6%). Rerata asupan energi 19 kkal/kgBB dan median asupan protein 0,6 g/kgBB. Median kadar CRP 46,6 mg/L dan 96,5% subjek mengalami peningkatan kadar CRP. Rerata SMI seluruh subjek yaitu 6,17 kg/m2, rerata SMI laki-laki 7,2 kg/m2 sedangkan rerata SMI perempuan 5,4 kg/m2. Terdapat korelasi negatif lemah (r=-0,373) yang bermakna secara statistik (p=0,005) antara kadar CRP dengan SMI pasien metastasis SSP .Kesimpulan: Terdapat korelasi yang bermakna antara kadar CRP dengan SMI pada pasien metastasis SSP.

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Background: It is estimated that 20-40% of cancer patients experience metastases to the central nervous system (CNS). Systemic inflammatory conditions in cancer mediated by cytokines are associated with a decrease in muscle mass. In inflammatory conditions, hepatocyte cells are stimulated to produce the acute-phase protein called c-reactive protein (CRP). Circulating CRP levels increase in over 50% of cancer patients. CRP is believed to be related to a decrease in muscle mass and serves as an early predictor in lean tissue loss. This study was conducted to determine the relationship between CRP levels and the skeletal muscle mass index (SMI) in patients with CNS metastases. Methods: This study is a cross-sectional study on cancer patients with CNS metastases at RSCM. Subject characteristics include age, gender, metastases type, primary tumor location, neurological deficits, Karnofsky performance status, comorbidities, infectious diseases, glucocorticoid therapy, undergoing chemotherapy, radiotherapy, and surgery, body mass index (BMI), nutritional status based on BMI and ASPEN criteria, energy intake, protein intake, CRP levels, and skeletal muscle mass index (SMI). An analysis of the relationship between CRP levels and SMI was conducted.

Results: There were 57 patients with CNS metastases. Most subjects were female (56.1%). The median age was 47 years. Metastases was more commonly found in the brain (56.1%), and the most common type of metastasis based on the nervous system location was synchronous (86%). All subjects had oligometastasis, and most primary tumor locations were in the nasopharynx (17.5%), breast (15.8%), and lungs (14%). The most common neurological deficits were cancer pain (68.4%), headaches (56.1%), and limb weakness (43.9%). Most limb weakness was hemiparesis (22.8%). Most Karnofsky performance status was moderately impaired (45.6%), 63.2% had no comorbidities, 68.4% had no infectious diseases, 52.6% were not on glucocorticoid therapy, 75.4% were not undergoing chemotherapy, and 1.8% each were undergoing radiotherapy and surgery. The estimated mean BMI was 21.28 kg/m2, with the majority having a normal weight (43.9%). According to ASPEN criteria, the majority were moderately malnourished (49.1%) and severely malnourished (31.6%). The mean energy intake was 19 kcal/kgBW, and the median protein intake was 0.6 g/kgBW. The median CRP level was 46.6 mg/L, with 96.5% of subjects experiencing an increased CRP level. The mean SMI for all subjects was 6.17 kg/m2, with male subjects having a mean SMI of 7.2 kg/m2 and female subjects having a mean SMI of 5.4 kg/m2. There was a weak negative correlation (r=- 0.373) that was statistically significant (p=0.005) between CRP levels and SMI in patients with CNS metastases.

Conclusion: CRP levels are correlated with SMI in patients with CNS metastasis. Higher CRP levels are associated with lower SMI in patients with CNS metastases."

"Latar Belakang : Inflamasi kronik berhubungan dengan tumor dan menyebabkan prognosis yang buruk pada pasien kanker. Salah satu penanda inflamasi yang meningkat pada tumor adalah C-Reactive Protein (CRP). Kadar CRP meningkat pada lebih dari 50% pasien keganasan. Peningkatan CRP berhubungan kuat dengan keparahan penyakit pada beberapa kanker. Salah satu zat gizi dalam inflamasi adalah asam lemak omega-3. Asam lemak omega-3 dapat meningkatkan pembentukan specialized pro-resolving mediators (SPM) yang berfungsi meningkatkan mediator antiinflamasi, melindungi blood brain barrier, menurunkan sitokin proinflamasi, menurunkan apoptosis neuron. Penelitian ini bertujuan untuk menilai hubungan asupan asam lemak omega-3 dengan CRP pada pasien tumor sistem saraf pusat.Metode : Studi potong lintang ini dilakukan pada subjek berusia 18-65 tahun di RSUPN Cipto Mangunkusumo pada bulan November hingga Desember 2023. Pengukuran CRP menggunakan metode immunoturbidimetric assay. Pengambilan asupan asam lemak omega-3 menggunakan Food Frequency Questionnaires semikuantitatif. Analisis bivariat digunakan untuk menilai hubungan antara variabel bebas dan terikat.Hasil : Dari total 63 subjek penelitian, sebanyak 35 subjek (55,6%) pada kelompok asupan asam lemak omega-3 < 2 g/hari dan 28 subjek (44,4%) pada kelompok asupan asam lemak omega-3 ≥ 2 g/hari. Nilai median CRP 8,3 (0,6 – 71,5) mg/L. Tidak terdapat hubungan yang bermakna (p = 0,714) antara asupan asam lemak omega-3 dengan CRP pada pasien tumor sistem saraf pusat.Kesimpulan : Tidak terdapat hubungan bermakna antara asupan asam lemak omega-3 dengan CRP pada pasien tumor sistem saraf pusat.

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Background: Chronic inflammation is associated with tumors and causes poor prognosis in tumor patients. One of the inflammatory markers that increase in tumors is C-Reactive Protein (CRP). CRP levels are elevated in more than 50% of patients with malignancies. Elevated CRP is associated with disease severity in some cancers. One of the nutrients in inflammation is omega-3 fatty acids. Omega-3 fatty acids can increase the formation of specialized pro-resolving mediators (SPM) which function to increase anti-inflammatory mediators, protect the blood brain barrier, reduce pro-inflammatory cytokines, reduce neuron apoptosis. This study aims to assess the relationship between omega-3 fatty acid intake and CRP in patients with central nervous system tumors.

Methods: This cross-sectional study was conducted on subjects aged 18-65 years at Cipto Mangunkusumo Hospital from November to December 2023. CRP measurement using immunoturbidimetric assay method. Omega-3 fatty acid intake was collected using semiquantitative Food Frequency Questionnaire. Bivariate analysis was used to assess the relationship between independent and dependent variables.

Results: From the total 63 research subjects, 35 subjects (55,6%) in the omega-3 fatty acid intake group < 2 g/day and 28 subjects (44,4%) in the omega-3 fatty acid intake group ≥ 2 g/day. The median CRP value was 8.3 (0.6 - 71.5) mg/L. There was no significant relationship (p = 0,714) between omega-3 fatty acid intake and CRP in patients with central nervous system tumors.

Conclusion: There is no significant relationship between omega-3 fatty acid intake and CRP in patients with central nervous system tumors."

"Latar Belakang: Tumor sistem saraf pusat (SSP) meningkatkan tekanan intrakranial dan menyebabkan berbagai gangguan neurologis yang dapat memengaruhi status gizi pasien. Status gizi memengaruhi imunitas bawaan dan adaptif. Pada hampir semua jenis keganasan kadar asam amino rantai cabang (AARC) didapatkan rendah. Asam amino rantai cabang meningkatkan imunitas dengan meningkatkan fagositik neutrofil, proliferasi limfosit, sintesis protein, menjaga jalur pensinyalan yang sensitif terhadap nutrisi. Rasio neutrofil limfosit (RNL) menggambarkan keseimbangan sistem imunitas dengan inflamasi. Peningkatan RNL dihubungkan dengan penurunan respon imun tubuh, terapi, harapan hidup dan prognosis. Penelitian ini dilakukan untuk mengetahui hubungan asupan AARC terhadap RNL pada pasien tumor SSP.Metode: Penelitian ini merupakan studi potong lintang pada pasien tumor SSP yang dirawat di RSCM. Karakteristik subjek berupa usia, jenis kelamin, jenis tumor, defisit neurologis, status performa karnofsky, indeks massa tubuh (IMT), status gizi berdasarkan ASPEN, penyakit komorbid, status infeksi, kemoterapi, radiasi, dan atau kemoradiasi, terapi glukokortikoid, asupan energi dan protein, asupan AARC, serta nilai RNL. Dilakukan analisis hubungan antara dua kelompok asupan AARC yang dibagi sesuai median populasi penelitian terhadap RNL.Hasil: Terdapat 66 subjek penelitian dengan median usia 48 tahun, mayoritas subjek perempuan (56,1%), dengan jenis tumor sekunder sebanyak 38 subjek (57,6%). Defisit neurologis tertinggi berupa nyeri kepala (60,6%), proporsi status performa karnofsky terganggu sedang-berat (60,6%). Proporsi IMT estimasi normal sebanyak 34,8%, rerata IMT 23,46 ± 4,95 kg/m2, dengan mayoritas malnutrisi (54,5%) berdasarkan kriteria ASPEN. Mayoritas subjek tidak memiliki komorbid (65,2%), tidak infeksi (80,3%), tidak menjalani kemoterapi, radiasi dan atau kemoradiasi (84,8%), serta tidak mendapat glukokortikoid (71,2%). Rerata asupan energi 1519 kkal, protein 65 g/hari, median AARC 9 g/hari. Terdapat perbedaan bermakna nilai RNL (p=0,047) pada kelompok asupan AARC <9 g/hari (median RNL 4,9); pada kelompok asupan AARC ≥9 g/hari (median RNL 3,1).

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Background: Central nervous system (CNS) tumors increase intracranial pressure and cause various neurological disorders that can affect the nutritional status of patients. Nutritional status influences both innate and adaptive immunity. In almost all malignancies, low levels of branched-chain amino acids (BCAA) are observed. Branched-chain amino acids enhance immunity by increasing neutrophil phagocytosis, lymphocyte proliferation, protein synthesis, and maintaining nutrient-sensitive signaling pathways. The neutrophil lymphocyte ratio (NLR) reflects the balance of the immune system with inflammation. An elevated NLR is associated with decreased body immune response, therapy outcomes, life expectancy, and prognosis. This study aims to determine the relationship between BCAA intake and NLR in CNS tumor patients.

Method: This is a cross-sectional study on CNS tumor patients treated at RSCM. Subject characteristics include age, gender, tumor type, neurological deficits, Karnofsky performance status, body mass index (BMI), nutrition status based on ASPEN, comorbidities, infection status, chemotherapy, radiation, and/or chemoradiation, glucocorticoid therapy, energy, and protein intake, BCAA intake, and NLR values. The analysis examines the relationship between two groups of BCAA intake divided according to the study population's median with NLR.

Results: There were 66 study subjects with a median age of 48 years, mostly female subjects (56,1%), with 38 subjects (57,6%) having secondary tumors. The highest neurological deficit was headache (60,6%), and the majority have a moderately to severely impaired Karnofsky performance status (60,6%). The proportion of estimated normal Body Mass Index (BMI) was 34.8%, with a mean BMI of 23,46 ± 4,95 kg/m2, and the majority were malnourished (54,5%) based on ASPEN criteria. Most subjects had no comorbidities (65,2%), no infections (80,3%), did not undergo chemotherapy, radiation, and/or chemoradiation (84,8%), and did not receive glucocorticoids (71.2%). The mean energy intake was 1519 kcal, protein intake 65 g/day, and the median BCAA was 9 g/day. There was a significant difference in the NLR values (p=0,047) between the group with BCAA intake <9 g/day (median NLR 4,9) and the group with BCAA intake ≥9 g/day (median NLR 3,1).

Conclusion: BCAA intake is related to NLR values in CNS tumor patients. Higher BCAA intake is associated with lower NLR values."

"Tumor sistem saraf pusat (SSP) dapat menurunkan massa otot dan massa bebas lemak akibat defisit neurologis yang terjadi serta efek sistemik karena keganasan. Penurunan massa bebas lemak dan massa otot dengan inflamasi saling memengaruhi serta dikaitkan dengan prognosis yang buruk. Penelitian ini bertujuan untuk mengetahui korelasi indeks massa bebas lemak (FFMI) dengan indeks inflamasi imun sistemik (SII) pada pasien tumor SSP. Studi ini merupakan studi potong lintang pada pasien dewasa dengan diagnosis tumor SSP di RSUPN Dr. Cipto Mangunkusumo. Pengukuran FFMI menggunakan bio impedance analysis (BIA). Nilai SII didapatkan dari hasil pemeriksaan laboratorium darah perifer lengkap. Terdapat 74 pasien tumor SSP dengan mayoritas perempuan (59,5%) dan lokasi tersering adalah tumor di otak (79,7%). Proporsi jenis tumor primer maupun sekunder adalah sama (50%). Median indeks massa tubuh (IMT) yaitu 22,85 kg/m2 (11,99–37,60 kg/m2) dengan kategori IMT terbanyak adalah berat badan normal (33,8%). Rerata FFMI yaitu 16,05±3,12 kg/m2 dengan 51,4% pasien memiliki FFMI yang rendah. Median SII sebesar 1140,9 (103,6–8745,6). Tidak didapatkan korelasi antara FFMI dengan SII pada pasien tumor SSP. Pada analisis tambahan didapatkan korelasi negatif bermakna antara FFMI dengan SII pada wanita (r=- 0,351; p=0,019), sebaliknya pada pria tidak ditemukan adanya korelasi (r=-0,096; p=0,613).

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Central nervous system (CNS) tumors can reduce muscle mass and fat-free mass due to neurological deficits and systemic effects of malignancy. Decreased fat-free mass and muscle mass with inflammation are mutually influential and associated with poor prognosis. This study aimed to determine the correlation between fat-free mass index (FFMI) and systemic immune inflammation index (SII) in patients with CNS tumors. This is a cross-sectional study of CNS tumors adult patients at Dr. Cipto Mangunkusumo National General Hospital. FFMI measurements were obtained using bioimpedance analysis (BIA). SII values obtained from complete peripheral blood laboratory examination results. There were 74 patients with CNS tumors, with the majority being female (59.5%), and the most common location was brain tumors (79.7%). The proportion of primary and secondary tumor types was equal (50%). The median body mass index (BMI) was 22.85 kg/m2 (11.99– 37.60 kg/m2), with the majority falling under the normal weight category (33.8%). The mean FFMI was 16.05±3.12 kg/m2, with 51.4% of patients having a low FFMI. The median SII was 1140.9 (103.6–8745.6). There was no correlation between FFMI and SII in patients with CNS tumors. In additional analysis, a significant negative correlation was found between FFMI and SII in women (r=-0.351; p=0.019), whereas in men, no correlation was found (r=-0.096; p=0.613)."