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"Studi kasus serial ini bertujuan untuk memberikan tatalaksana nutrisi pada pasien kanker kepala dan leher yang menjalani terapi kemoradiasi. Status nutrisi seorang pasien kanker merupakan salah satu prediktor dalam menentukan QOL dan survival, tetapi status nutrisi pada kasus serial ini dipengaruhi oleh banyak faktor antara lain metabolisme sel kanker, perubahan metabolisme dalam tubuh, efek samping radiasi, efek samping kemoterapi, serta faktor-faktor lain seperti psikis dan ekonomi. Serial kasus ini merupakan empat pasien kanker kepala dan leher berusia 30-57 tahun yang sedang menjalani kemoradioterapi dan telah mengalami penurunan berat badan bahkan sebelum dilakukan kemoradioterapi. Dalam perjalanan penyakitnya pasien mengalami efek samping terapi yang mempengaruhi status nutrisi pasien. Kebutuhan nutrisi pasien pada kasus serial ini dihitung menggunakan rumus Harris Benedict dengan faktor stres 1,5 dan diberikan protein sebanyak 1,5-2,0 g/kgBB/hari serta lemak 25-30%. Pemberian mikronutrien disesuaikan dengan RDA. Hasil dari kasus serial ini menunjukkan bahwa pasien yang status nutrisinya dapat dipertahankan menghasilkan outcome yang lebih baik daripada pasien yang status nutrisinya menurun. Untuk itu pada kasus keganasan kepala dan leher yang menjalani kemoradiasi sebaiknya diberikan konseling dan terapi nutrisi sejak awal sebelum timbul efek samping kemoradioterapi.

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This case studies aims to provide nutritional management of head and neck cancer patients undergoing chemoradiation therapy. Nutritional status of a patient's cancer is one of the predictors in determining QOL and survival. Nnutritional status is influenced by many factors, such as cancer cell metabolism, metabolic changes, the side effects of radiation and chemotherapy, as well as other factors such as psychological and economic. This is a case series of four head and neck cancer patients aged 30-57 years who were undergoing chemoradiotherapy and has lost weight even before chemoradiotherapy. In the course of illness of patients experience side effects of therapy affects the nutritional status of patients. Nutritional needs of patients in the case series were calculated using the Harris Benedict formula and stress factor 1.5. Protein was given 1.5 to 2.0 g protein/kgBW/day and 25-30% of fat. Micronutrient was provide as RDA. Results of this case series suggests that the nutritional status of patients who can be maintained produced better outcomes than patients whose nutritional status declined. For it is in the case of head and neck malignancies who underwent chemoradiation should be given counseling and nutrition therapy early before any side effects of chemoradiotherapy."

"Tatalaksana nutrisi pada pasien cedera kepala sedang dan berat mencakup pemberian makronutrien mikronutrien nutrien spesifik pengelolaan cairan dan elektrolit serta pemantauan dan evaluasi Dukungan nutrisi yang adekuat perlu diberikan pada pasien cedera kepala agar meningkatkan perbaikan kondisi optimal pasien Sebagian besar pasien cedera kepala memiliki status gizi yang baik sebelum terjadinya trauma Pemenuhan nutrisi yang optimal dapat turut menunjang perbaikan inflamasi metabolisme dan menjaga tidak terjadi penurunan status gizi Pasien pada serial kasus ini seluruh pasien laki laki mempunyai rentang usia 19 sampai 49 tahun Adanya penyakit penyerta mempengaruhi luaran akhir pasien cedera kepala Terapi nutrisi diberikan sesuai dengan kebutuhan setiap pasien Kebutuhan energi total dihitung berdasarkan perkiraan kebutuhan energi basal menggunakan persamaan Harris Benedict dikalikan faktor stres 1 4 1 6 dan pemberiannya disesuaikan dengan kondisi klinis pasien Kebutuhan protein 1 5 2 g kg BB hari dan lemak 20 30 Pemantauan mencakup tanda klinis toleransi asupan makanan kapasitas fungsional keseimbangan cairan parameter laboratorium dan antropometri Pemberian nutrisi pada pasien cedera kepala berat dengan sakit kritis bersifat individual dan mencakup semua aspek Tatalaksana nutrisi yang baik dan dilanjutkan dengan edukasi pada pasien dan keluarga diharapkan dapat meningkatkan kualitas hidup pasien cedera kepala dengan meminimalkan komplikasi yang dapat terjadi

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Nutrition therapy in patients with moderate and severe traumatic brain injury includes the provision of macronutrient micronutrient specific nutrition fluid and electrolyte management with monitoring and evaluation Adequate nutrition support should be given in traumatic brain injury to optmalyze outcome patient Three from four this case series have a normoweight before trauma Nutritional support can improve metabolism decrease inflammation and manage nutritional status Patients in this case series all male have an age range from 19 to 49 kg years Their comorbid condition influence outcome of traumatic brain injury patient Nutritional support is given according to each patient rsquo s requirement which is calculated with basal energy requirement using Harris Benedict equation with stress factor 1 4 1 6 and the administration starts with individual condition which gradually increased to reach the total energy expenditure Protein requirement 1 5 2 g kg day and lipid requirement is calculated 20 30 total energy requirement Patient rsquo s monitoring include clinical signs food intake tolerance functional capacity fluid balance laboratory and anthropometric parameter were taken With the management of good nutrition expected quality of life of patients with moderate and severe traumatic brain injury various comorbidities would be better "

"Dukungan nutrisi bertujuan memperbaiki status gizi dan prognosis pasien bedah dengan status gizi malnutrisi Pasien yang menjalani pembedahan traktus gastrointestinal GI merupakan kelompok pasien berisiko tinggi mengalami malnutrisi Dilaporkan bahwa terdapat hubungan positif antara malnutrisi dengan morbiditas dan mortalitas pasca bedah lama perawatan RS re admisi RS kebutuhan pembedahan sekunder dan diagnosis atau terapi Serial kasus ini terdiri dari empat kasus dukungan nutrisi perioperatif pada pasien malnutrisi dengan berbagai indikasi pembedahan GI dan komorbid yang berbeda Pasien pada serial kasus ini berusia antara 45 hingga 70 tahun Seluruh pasien menjalani pembedahan mayor abdominal atas indikasi kanker GI Status gizi pasien adalah malnutrisi ringan hingga sedang Terapi nutrisi diberikan berdasarkan kebutuhan dan kondisi klinis pasien Kebutuhan energi basal dihitung menggunakan persamaan Harris Benedict Pemberian energi dimulai dari kebutuhan energi basal dan ditingkatkan bertahap hingga mencapai kebutuhan energi total Lama perawatan RS pada pasien ini antara 19 hingga 43 hari Monitoring yang dilakukan meliputi toleransi asupan kapasitas fungsional imbang cairan data antropometri dan laboratorium serta dilakukan edukasi dan konseling nutrisi setiap hari Secara umum pasien mengalami peningkatan kondisi umum status gizi toleransi asupan Periode perioperatif mempengaruhi toleransi pasien terhadap asupan makanan dan status GI Terapi nutrisi pada pasien bedah harus dilakukan secara individual sebagai bagian integral tata laksana pembedahan Dukungan nutrisi harus dilakukan pada periode pra intra dan pasca bedah untuk menyediakan nutrien yang adekuat agar dapat mengatasi perubahan metabolik pada pasien Dukungan nutrisi yang baik pada pasien bedah terutama dengan malnutrisi dapat memperbaiki prognosis pasca bedah dan akan meningkatkan kualitas hidup pasien.

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The aim of nutritional support is to improve nutritional status and clinical outcome in severely malnourished patients Patients who undergone gastrointestinal surgery constitute as important risk group for malnutrition It has been reported that there is a positive correlation between malnutrition and postoperative morbidity and mortality prolonged hospital stays re admissions secondary operation requirement and diagnosis treatment This case series consisted of four cases of periopertive nutrition support in malnutrition patients with different surgical indication and comorbidities The patients in this case series aged between 45 to 70 years old All patients undergoing major abdominal surgery for gastrointestinal cancer Patients have nutritional status ranged from mild nutrition to moderate malnutrition Nutritional therapy was given according to patients needs and clinical condition The basal energy requirement was calculated using the Harris Benedict equation The intake was given begin with basal energy expenditure and gradually increased to the total energy expenditure Monitoring includes food intake tolerance functional capacity fluid balance anthropometric and laboratory data The nutrition education and counseling was conducted everyday In general all the patients show improvement during monitoring The perioperative periode influenced patients tolerance to food intake and gastrointestinal status Nutrition therapy in surgical patient should be done individually as part of integrated therapy in surgical treatment The nutritional support was done in pre intra and post surgery to provide adekuat nutrient to blunt metabolic changes in this patients Each period of perioperative nutrition support have different function and procedure Good nutritional support in surgical patients specially with malnutrition will improved outcome of the surgery and eventually improved quality of life."

"[ABSTRAKLatar belakang: Prevalensi Diabetes Melitus Tipe (DM) tipe 2 semakin meningkat setiap tahun. Kontrol glisemik yang buruk, hipertensi, dislipidemia, dan kebiasaan merokok serta menopause dapat meningkatkan risiko komplikasi penyakit kardiovaskular. Komplikasi kardiovaskular merupakan komplikasi paling sering ditemukan dengan angka mortalitas yang tinggi. Oleh karena itu, untuk menekan progresivitas komplikasi kardiovaskular diperlukan suatu terapi nutrisi medik yang adekuat sesuai dengan kondisi klinis dan edukasi dalam memodifikasi gaya hidup.Metode: Pasien pada serial kasus berusia 55-65 tahun. Tiga pasien didiagnosis DM tipe 2 dengan gagal jantung, satu pasien dengan penyakit jantung hipertensi. Semua pasien memiliki skor skrining malnutrition screening tools (MST) ≥ 2. Dua pasien mempunyai status gizi obesitas, satu pasien berat badan dan pasien lainnya dengan berat badan normal. Kebutuhan energi basal (KEB) berdasarkan rumus Harris-Benedict dengan faktor stress 1,3-1,4 tergantung kondisi klinis dan penyakit penyerta. Komposisi makronutrien sesuai dengan rekomendasi American Diabetes Association dan Dietary Approach to Stop Hypertension. Pemberian mikronutrien dan nutrient spesifik diberikan pada satu dua kasus. Pasien dipantau selama 5-17 hari, meliputi keluhan subyektif, hemodinamik, toleransi dan analisis asupan, antropometri, pemeriksaan laboratorium, imbang cairan, dan kapasitas fungsional.Hasil: Selama pemantauan di RS, keempat pasien menunjukkan perbaikan klinis yaitu tekanan darah turun dan kapasitas fungsional membaik. Satu pasien kadar glukosa darah dipertahankan < 200 mg/dL.Kesimpulan: Terapi nutrisi medik yang adekuat dapat memperbaiki kondisi klinis pasien DM tipe 2 dengan komplikasi sistem kardiovaskular.

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ABSTRACTBackground: The prevalence of type 2 diabetes mellitus (DM) is increasing every year. Poor glycemic control, hypertension, dyslipidemia, smooking and menopause increase the risk for cardiovascular complications. Cardiovascular complications is the most common complications in type 2 DM with a significant high mortality rate. Therefore, a medical nutrition therapy is required to decreased the progresitivity of the cardiovascular complication in DM, based on improvement of clinical conditions and lifestyle modifications.Method: Patients in this case series were between 55-65 years old. There of those patients were diagnosed heart failure and one with hypertension heart disease. All patients had a screening score ≥ 2 with malnutrition screening tools (MST). Two of patients had nutritional status of obesity, one patients was overweight, and another patients was normoweight. Basal calorie requirement were calculating using Harris-Benedict formula with stress factor 1,3-1,4 adjusment according to clinical conditions and comorbidities. Macronutriens were given recommendations by The American Diabetes Association and Dietary Approach to Stop Hypertension. Two patients received micronutrien and specific nutrients. Monitoring was done for 5-17 days included subjective complaints, hemodynamic, tolerance and intake analysis, anthropometric measurement, laboratory test, fluid balance and functional capacity.Results : All the patients showed the improvement of clinical conditions, blood control and functional capacity. Blood glucose levels of one patients was maintained to below 200 mg/dLConclusion: Medical nutrition therapy can improved clinical conditions of patients type 2 DM with cardiovascular complications., Background:The prevalence of type 2 diabetes mellitus (DM) is increasing every year. Poor glycemic control, hypertension, dyslipidemia, smooking and menopause increase the risk for cardiovascular complications. Cardiovascular complications is the most common complications in type 2 DM with a significant high mortality rate. Therefore, a medical nutrition therapy is required to decreased the progresitivity of the cardiovascular complication in DM, based on improvement of clinical conditions and lifestyle modifications.Method:Patients in this case series were between 55-65 years old. There of those patients were diagnosed heart failure and one with hypertension heart disease. All patients had a screening score ≥ 2 with malnutrition screening tools (MST). Two of patients had nutritional status of obesity, one patients was overweight, and another patients was normoweight. Basal calorie requirement were calculating using Harris-Benedict formula with stress factor 1,3-1,4 adjusment according to clinical conditions and comorbidities. Macronutriens were given recommendations by The American Diabetes Association and Dietary Approach to Stop Hypertension. Two patients received micronutrien and specific nutrients. Monitoring was done for 5-17 days included subjective complaints, hemodynamic, tolerance and intake analysis, anthropometric measurement, laboratory test, fluid balance and functional capacity.Results :All the patients showed the improvement of clinical conditions, blood control and functional capacity. Blood glucose levels of one patients was maintained to below 200 mg/dLConclusion:Medical nutrition therapy can improved clinical conditions of patients type 2 DM with cardiovascular complications.]"

"ABSTRAKLatar belakang: Sistektomi radikal dengan ileal conduit yang merupakan tata laksana utama karsinoma buli adalah prosedur pembedahan kompleks yang seringkali membutuhkan rawat inap yang lama dan menyebabkan berbagai komplikasi. Malnutrisi praoperatif merupakan kontributor penting terhadap tingginya morbiditas dan mortalitas pada sistektomi radikal. Dukungan nutrisi perioperatif yang adekuat bertujuan untuk menurunkan stres akibat pembedahan sehingga dapat mencegah komplikasi, menunjang outcome yang baik, dan memperpendek masa rawat inap pascaoperasi.Metode: Laporan serial kasus ini menyajikan empat kasus karsinoma buli, dengandua kasus termasuk kaheksia kanker dan dua kasus termasuk pra-kaheksia. Keempat pasien dilakukan sistektomi radikal dengan ileal conduit dan diberikan dukungan nutrisi perioperatif yang mencakup carbohydrate loading dan nutrisi enteral dini pascaoperasi serta pemberian nutrisi secara bertahap. Dilakukan pemantauan yang meliputi keluhan klinis, pemeriksaan fisik, antropometri, hasil laboratorium, dan analisis asupan.Hasil: Tiga pasien mengalami hiperglikemia yang berlangsung singkat tanpa membutuhkan terapi insulin. Dua pasien mengalami ileus paralitik pascaoperasi, namun dapat teratasi secara konservatif dalam waktu cepat. Dua pasien mencapai 70-80 target kalori dalam 5 hari pascaoperasi, sedangkan pasien yang mengalami ileus paralitik mencapai target kalori 60-70 dalam waktu 9 hari pascaoperasi. Masa rawat inap pascaoperasi bervariasi mulai dari 7 hingga 10 hari.Kesimpulan: Dukungan nutrisi perioperatif pada keempat pasien menunjang dalam mengontrol stres pembedahan yang terlihat dari hiperglikemia yang hanya berlangsung singkat, mencegah komplikasi, serta memperpendek masa rawat inap.

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ABSTRACT

Background Radical cystectomy and ileal conduit, a mainstay treatment of bladder carcinoma, is a complex surgery which not rarely requires a long hospital stay and has many complications. Preoperative malnutrition is on of important contributor to high morbidity and mortality in radical cystectomy. Adequate perioperative nutritional support aims to alleviate surgical stress, thus prevent complications, support good outcome, and shorten length of hospital stay after surgery.

Method This case series presenting 4 cases of bladder carcinoma, consists of 2 cases of cancer cachexia and 2 cases of pre cachexia. All of the patients had undergone radical cystectomy and ileal conduit, and was supported by perioperative nutrition including carbohydrate loading and postoperative early enteral nutrition. The monitoring included clinical complaints, physical examination, anthropometry, laboratory results, and intake analysis.

Result Three patients had hyperglycemia lasted only in short period and no insulin treatment needed. Two patients experienced postoperative paralytic ileus and was resolved only with conservative treatment. Two patients achieved 70 ndash 80 calorie target on 5 days after surgery, while the others who experienced paralytic ileus achieved 60 ndash 70 calorie target in 9 days postoperative. Length of stay in the hospital after surgery was varied between 7 to 10 days.

Conclusion Perioperative nutritional support on the above patients had contribution in controlling surgical stress, seen on the short period hyperglycemia, preventing complications, and shortening the hospital stays."

"ABSTRAK Umumnya fistula enterokutan terjadi pasca tindakan pembedahan open abdomen, yang disertai dengan status nutrisi buruk saat preoperatif. Malnutrisi merupakan salah satu komplikasi fistula enterokutan, selain gangguan keseimbangan cairan dan elektrolit hingga sepsis. Hal ini menunjukkan adanya fistula enterokutan akan memperburuk status nutrisi hingga menyebabkan kematian. Terapi nutrisi berperan penting dalam tatalaksana umum fistula enterokutan, karena pada kasus ini terjadi kondisi emergensi nutrisi. Semakin lama penundaan terapi nutrisi akan menambah risiko perburukan. Terapi nutrisi bertujuan untuk memenuhi kebutuhan energi, mendukung penutupan spontan dari fistula, mempersiapkan komposisi dan fisiologis tubuh dalam menghadapi tindakan pembedahan selanjutnya serta meningkatkan imunitas mukosa saluran pencernaan. Pemberian terapi nutrisi berupa perhitungan kebutuhan energi, makronutrien dan mikronutrien. Pasien pada serial kasus ini berjumlah empat orang dengan rentang usia 22-39 tahun. Berdasarkan skrining dengan malnutrition screening tools MST keempat pasien mendapatkan skor ge;3. Kebutuhan energi total dihitung menggunakan persamaan Harris-Benedict yang dikalikan dengan faktor stres sebesar 1,5-2. Target kebutuhan protein 1,5-2 g/kgBB untuk mencegah katabolisme. Kebutuhan cairan harus terpenuhi dengan mempertimbangkan output fistula, demikian juga dengan kadar elektrolit. Nutrisi diberikan melalui oral atau enteral dengan kombinasi parenteral. Dari keempat pasien dalam serial kasus ini, satu pasien meninggal dunia akibat sepsis sedangkan 3 pasien lainnya pulang ke rumah dengan sebelumnya dilakukan repair fistula. Terapi nutrisi pada pasien fistula enterokutan bila dilakukan secara cepat dan tepat akan mengembalikan fungsi gastrointestinal, memperbaiki status nutrisi dan membantu penyembuhan luka.

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ABSTRACT Enterocutaneous fistula occurs in general after open abdominal surgery, commonly associated with poor nutritional status prior to operation. Malnutrition is one of the complications of enterocutaneous fistula, besides fluid or electrolyte losses and sepsis. The existence of enterocutaneous fistula will exacerbate the nutritional status leading to death. Nutritional therapy plays an important role in the general management of enterocutaneous fistula, because this case will cause a nutritional emergency condition. The longer delays in nutritional therapy will increase the risk of worsening. Nutritional therapy aims to meet energy needs, supports spontaneous closure of the fistula, to prepare the composition and physiological body in the face of further surgical procedures and to improve the gastrointestinal mucosal immunity. Provision of nutritional therapy is in the form of the calculation of energy needs, macronutrients and micronutrients. Patients in this case series amounted to four people with the age range 22 39 years. Based on the screening with malnutrition screening tools MST the four patients scored ge 3. Total energy requirements were calculated using the Harris Benedict equation multiplied by a stress factor of 1.5 2. Protein requirement target is 1.5 2g kgBW to prevent catabolism. The fluid requirement must be met by considering the fistula output, as well as the electrolyte losses. Nutrition is given by oral or enteral with a parenteral combination. Of the four patients in this case series, one patient died of sepsis while the other 3 returned home undergoing fistula repair previously. Nutritional therapy patients with fistula enterocutaneous if it is done quickly and accurately will reestablishment of gastrointestinal continuity, improve nutritional status and wound healing process."