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Abstrak :
Latar Belakang. Prediksi mortalitas pada kelompok lanjut usia yang semakin meningkat jumlahnya akan memberikan banyak manfaat bagi kesehatan. Cystatin C ditunjukkan memiliki kemampuan sebagai prediktor mortalitas pada beberapa studi. Studi-studi mengenai kemampuan prediksi cystatin c masih sangatlah beragam dan belum ada telaah sistematis untuk menilai kemampuannya dalam memprediksi mortalitas jangka panjang pada kelompok lansia. Tujuan. Penelitian ini bertujuan untuk menilai kemampuan cystatin c sebagai prediktor mortalitas semua sebab dan mortalitas kardiovaskular jangka panjang pada kelompok lanjut usia. Metode. Studi ini merupakan telaah sistematis dan meta-analisis dari studi kohort prospektif observasional. Pencarian studi dilakukan di PubMed, Cochrane, Scopus, EBSCOHost, dan Proquest serta pencarian menual. Kriteria inklusi berupa lansia minimal berusia 65 tahun dengan data cystatin c serum tercantum, kematian semua sebab sebagai luaran. Waktu follow up minimal 5 tahun. Seleksi studi dilakukan berdasarkan alur dari PRISMA. Penilaian kualitas studi dan risiko bias dinilai menggunakan Newcastle Ottawa Scale untuk studi kohort. Hasil studi ditampilkan dalam bentuk deskriptif serta Forest plot. Hasil. Dari 609 studi hasil pencarian, didapatkan 12 studi yang memenuhi kriteria: 5 studi menilai kematian semua sebab, 3 studi menilai kematian kardiovaskular saja, dan 4 studi menilai keduanya. Sebanyak 6 studi dengan kualitas baik dan 6 studi kualitas sedang setelah dilakukan penilaian. Hasil meta-analisis menunjukkan kadar Cystatin C yang tinggi meningkatkan risiko mortalitas jangka panjang akibat semua sebab [HR: 1,74 (95% CI: 1,48 – 2,04); p < 0,00001)] dan mortalitas jangka panjang kardiovaskular [(HR: 2,01 (95% CI: 1,63 – 2,47); p < 0,00001)] pada lansia. Kemampuan prognostik cystatin c tergolong moderat [AUC 0,70 (95% CI: 0,68-0,72); p = 0,02)]. ...... Background. Prediction of mortality in growing aged-population will offer several benefits for health sector. Cystatin C, which has long been known as biomarker to more accurately evaluate glomerular filtration rate in elderly, has also been shown to predict mortality from several studies. Studies regarding its predictive ability were vastly varied and there has not been systematic review to examine its ability in predicting long-term mortality in elderly population. Objectives. This study aimed to evaluate Cystatin C performance as predictor for all-cause and cardiovascular mortality among elderly population. Methods. A systematic review of prospective cohort studies was performed. Literature searching was done in major databases such as PubMed, Cochrane, Scopus, EBSCOhost, and Proquest. Manual searching was also performed. Inclusion criteria were studies involving elderly age 65 or older, cystatin c serum levels available, all-cause mortality as outcome, and 5-years minimum of follow-up. Study selection was performed according to PRISMA algorithm. Newcastle Ottawa Scale for cohort study was used to assess primary studies’ quality and risk of bias. Study results were presented in descriptive tables and Forest plot. Results. Initial searching revealed 609 hits with 12 studies eligible for the review: five studies evaluated all-cause mortality, three studies evaluated cardiovascular mortality, and four studies evaluated both. Meta-analysis showed that high cystatin c levels increasing risk of long-term all-cause mortality [(HR: 1.74 (95% CI: 1.48 – 2.04); p < 0.0001)] and cardiovascular mortality [HR: 2.01 (95% CI: 1,63 – 2,47); p < 0,0001)]. The prognostic ability of cystatin c was considerably moderate [AUC 0.70 (95% CI: 0.68-0,72); p = 0.02]. Conclusion. Cystatin C was able to predict long-term mortality in elderly population.

Abstrak :
Latar belakang: Angka morbiditas dan mortalitas meningkat pada pasien fibrilasi atrium (FA) yang mengalami gagal jantung akut. Pada pasien irama sinus, left atrial volume index (LAVI) dan heart rate variability (HRV) merupakan prediktor kuat terjadinya komplikasi kardiovaskular. Penelitian LAVI dan HRV pada pasien FA hingga saat ini belum konklusif. Tujuan: Mengetahui hubungan LAVI dan HRV dengan kejadian gagal jantung akut pada pasien FA Metode: Studi kohort retrospektif dengan populasi terjangkau pasien dewasa FA di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) 1 Januari 2020 hingga 31 Desember 2021 yang berasal dari registri Optimal INR measures for Indonesians (OPTIMA). Data sekunder LAVI diukur dengan ekokardiografi dan parameter HRV terdiri dari standar deviation of NN intervals (SDNN), root mean square of successive differences (RMSSD), rasio low frequency dan high frequency (LF/HF) diukur menggunakan alat HRV portabel. Pasien diikuti hingga 30 Januari 2023, luaran dinilai dengan melihat catatan medik atau melalui telepon. Hasil: Dilakukan analisis pada 144 sampel. Proporsi kejadian gagal jantung akut sebesar 15,3%. Tidak terdapat hubungan antara SDNN dengan kejadian gagal jantung akut (RR 1,75; IK95% 0,260 – 11,779, p=0,565). Tidak terdapat hubungan antara LF/HF dengan kejadian gagal jantung akut (RR 2,865; IK 95% 0,765 – 10,732, p=0,118). Terdapat hubungan antara LAVI dengan kejadian gagal jantung akut (adjusted RR 2,501; IK 95% 1,003 – 6,236, p=0,049). Diabetes melitus dan hipertensi merupakan faktor perancu pada penelitian ini. Kesimpulan: Peningkatan LAVI berhubungan dengan kejadian gagal jantung akut pada pasien FA. HRV tidak berhubungan dengan kejadian gagal jantung akut pada pasien FA. ......Background Morbidity and mortality rates increase in patients with atrial fibrillation (AF) who experience acute heart failure. In patients with sinus rhythm, left atrial volume index (LAVI) and heart rate variability (HRV) are strong predictors of cardiovascular complications. Research on LAVI and HRV in AF patients has so far not been conclusive. Objectives: To determine the relationship between LAVI and HRV and the incidence of acute heart failure in AF patients. Methods: A retrospective cohort study was conducted with an accessible population of adult AF patients at RSCM from January 1, 2020, to December 31, 2021, originating from the Optimal measures INR for Indonesians (OPTIMA) registry. LAVI was measured by echocardiography, and HRV parameters consist of the standard deviation of NN intervals (SDNN), the root mean square of successive differences (RMSSD), and the ratio of low frequency and high frequency (LF/HF) measured using a portable ECG device. Patients were followed until January 30, 2023, and outcomes were assessed by looking at medical records or by telephone. Result: A total of 144 subjects were analysed. The proportion of acute heart failure is 15.3%. There was no relationship between SDNN and the incidence of acute heart failure (RR 1.75; 95% CI 0.260–11.779, p=0.565). There was no relationship between LF/HF and the incidence of acute heart failure (RR 2.865; 95% CI 0.765–10.732, p=0.118). There is a relationship between LAVI and the incidence of acute heart failure (adjusted RR 2.501; 95% CI 1.003–6.236, p = 0.049). DM and hypertension were confounding factors in this study. Conclusion: The elevation of LAVI is associated with the incidence of acute heart failure in AF patients. HRV is not associated with the incidence of acute heart failure in AF patients.

Abstrak :
Latar Belakang. Hanya sepertiga pasien DM tipe 2 yang mencapai target HbA1c yang diharapkan. Beberapa studi menunjukkan bahwa health coaching terbukti mampu menurunkan kadar HbA1c secara bermakna, namun belum banyak diketahui pengaruh health coaching dalam jangka panjang setelah coaching dihentikan. Tujuan. Tujuan penelitian ini adalah untuk mengetahui pengaruh edukasi dan health coaching dalam perbaikan kendali glikemik jangka panjang pada pasien DM tipe 2 rawat jalan di pusat kesehatan nasional tersier. Metode. Penelitian ini merupakan penelitian observasional lanjutan dari 6 bulan RCT yang dilaksanakan di dua pusat kesehatan nasional tersier untuk membandingkan kombinasi edukasi dan health coaching dengan edukasi saja pada pasien DM tipe 2 dengan diabetes yang tidak terkontrol. Subjek penelitian diikuti pada bulan ke-6 dan ke-18 dari RCT awal. Keluaran primer adalah beda rerata HbA1c antar kedua kelompok, dan keluaran sekunder adalah beda proporsi subjek yang mengalami penurunan HbA1c ≥1% dari baseline dan beda proporsi subjek yang mencapai target HbA1c <7%. Analisis data menggunakan uji-T independen dan uji Chi-square. Hasil. Penelitian ini berhasil mengumpulkan 42 dari 60 subjek (70%) yang mengikuti penelitian hingga bulan ke-18. Tidak ada perbedaan yang bermakna rerata HbA1c antara kelompok intervensi dibandingkan kelompok kontrol (8,70 [±2,00] vs 9,02 [±1,71], p=0,334); dengan rerata HbA1c yang meningkat secara bermakna jika dibandingkan dengan rerata HbA1c bulan ke-6 (8,70 [±2,00] vs 7,83 [±1,80], p=0,016). Keluaran sekunder didapatkan perbedaan yang bermakna proporsi subjek yang mengalami penurunan kadar HbA1c ≥1% antara kelompok intervensi dibandingkan kelompok kontrol (41,4% [n=12] vs 10,3% [n=3], p=0,015); serta tidak ada perbedaan yang bermakna proporsi subjek yang mencapai target HbA1c <7% (13,8% [n=4] vs 6,9% [n=2], p=0,670). Kesimpulan. Health coaching tidak mampu mempertahankan perbaikan kendali glikemik pada pasien DM tipe 2 untuk jangka panjang jika coaching dihentikan, diperlukan pemberian coaching ulang agar perbaikan kendali glikemik dapat menetap. ......Background. Only one-third of type 2 DM patients achieved the expected HbA1c target. Several studies have shown that health coaching has been shown to be able to significantly reduce HbA1c levels, but it is not widely known the effects of long-term health coaching after coaching is stopped. Aim. This study was to determine the effect of education and health coaching in improving long-term glycemic control in outpatients with type 2 diabetes at a tertiary national health center. Method. This study is a follow-up observational study of 6 months RCT conducted in two tertiary national health centers to compare the combination of education and health coaching with education alone in type 2 diabetes mellitus patients with uncontrolled diabetes. Study subjects were followed at 6 and 18 months of baseline RCT. The primary outcome was the difference in the mean HbA1c between the two groups, and the secondary outcome was the difference in the proportion of subjects who experienced a decrease in HbA1c ≥1% from baseline and the difference in the proportion of subjects who achieved the HbA1c target <7%. Data analysis used independent T-test and Chi-square test. Result. This study managed to collect 42 out of 60 subjects (70%) who attended the study until the 18th month. There was no significant difference in the mean HbA1c between the intervention group and the control group (8.70 [± 2.00] vs 9.02 [± 1.71], p = 0.334); with the mean HbA1c which increased significantly when compared with the mean HbA1c at 6 months (8.70 [± 2.00] vs 7.83 [± 1.80], p = 0.016). Secondary outcomes showed a significant difference in the proportion of subjects who experienced a decrease in HbA1c levels ≥1% between the intervention group and the control group (41.4% [n = 12] vs 10.3% [n = 3], p = 0.015); and there was no significant difference in the proportion of subjects who achieved the HbA1c target <7% (13.8% [n = 4] vs 6.9% [n = 2], p = 0.670). Conclusion. Health coaching is unable to maintain improved glycemic control in type 2 DM patients for the long term when coaching is stopped, re-coaching is needed so that improved glycemic control can persist.

Abstrak :
Latar belakang.Kardiomiopati terimbas kemoterapi berbasis antrasiklin memiliki dampak signifikan terhadap pasien kanker. Pemantuan fungsi jantung berbasis fraksi ejeksi, yang saat ini menjadi standar, tidak dapat mengetahui kerusakan secara awal dan bila ditemukan kardiomiopati maka kerusakan sudah terlambat. Penggunaan biomarker dan teknik pencitraan ekokardiografi dengan strain dipikirkan dapat memberi gambaran kejadian kardiomiopati awal. Oleh karena itu, perlu dilakukan aplikasi dari penggunaan troponin dalam memprediksi kejadian kerusakan jantung pada pasien yang menjalani kemoterapi berbasis antrasiklin.

Tujuan. Untuk mengetahui hubungan antara peningkatan kadar high sensitivity troponin I dengan kejadian kardiomiopati subklinis pada pasien kanker yang yang menjalani kemoterapi berbasis antrasiklin

Metode. Studi kohort prospektif dilakukan pada Januari-September 2023. Pasien kanker berusia diatas 18 tahun yang mendapatkan kemoterapi berbasis antrasiklin di Rumah Sakit Cipto Mangunkusumo dan Rumah Sakit Kanker Dharmais direkrut untuk penelitian. Pemeriksaan high sensitivity troponin dilakukan pada 6 titik waktu pra dan pascasiklus pertama, kedua, dan ketiga. Pemantauan Global longitudinal strain dilakukan sebelum kemoterapi, pascakemoterapi siklus ke 2,  siklus ke 4 dan siklus ke 6.  Kardiomiopati subklinis didefinisikan sebagai penurunan GLS >15% dari data dasar. Dibuat kurva ROC dari nilai titik potong high sensitivity troponin I  terhadap kejadian kardiomiopati subklinis.  

Hasil. Dari 61 subjek, didapatkan insiden kardiomiopati subklinis sebesar 29,4% (95% IK 9,4-18,6). Tidak didapatkan titik potong dari perubahan high sensitivity troponin I dalam memprediksi kardiomiopati subklinis.

Kesimpulan. Tidak didapatkan hubungan antara kadar high sensitivity troponin I dengan kejadian kardiomiopati subklinis pada pasien kanker yang yang menjalani kemoterapi berbasis antrasiklin. ......Background. Chemotherapy based anthracycline induced cardiomyopathy has a significant impact on cancer patients. Monitoring heart function based on ejection fraction, which currently is the standard, cannot detect damage early and by the time cardiomyopathy is detected, the damage is already advanced. The use of biomarkers and echocardiographic imaging techniques with strain is thought to provide insight into early cardiomyopathy occurrences. Therefore, there is a need to apply troponin usage in predicting heart damage events in patients undergoing anthracycline-based chemotherapy.

Aim. To determine the relationship between an increase in high sensitivity troponin I levels and subclinical cardiomyopathy incidence in cancer patients undergoing anthracycline-based chemotherapy.

Method. A prospective cohort study was conducted from January to September 2023. Cancer patients over 18 years of age receiving anthracycline-based chemotherapy at Cipto Mangunkusumo Hospital and Dharmais Cancer Hospital were recruited for the research. High sensitivity troponin examinations were conducted at 6 pre- and post-cycle time points (first, second, and third cycles). Global longitudinal strain monitoring was performed before chemotherapy, after the second cycle, fourth cycle, and sixth cycle. Sublinical cardiomiopathy is defined as a reduction in GLS > 15% from baseline. An ROC curve was generated for the high sensitivity troponin I cutoff values against subclinical cardiomyopathy occurrences.

Results. Out of 61 subjects, incidence of subclinical cardiomyopathy was found to be 29.4% (95% CI 9.4-18.6). No cutoff point was found for changes in high sensitivity troponin I in predicting subclinical cardiomyopathy.

Conclusion. There was no relationship found between high sensitivity troponin I levels and subclinical cardiomyopathy occurrences in cancer patients undergoing anthracycline-based chemotherapy.

Abstrak :
Latar Belakang : Prevalensi ansietas dan depresi serta faktor risiko pada penyintas COVID-19 di seluruh dunia dan Indonesia masih tinggi dan berbeda beda dari setiap negara. Di Indonesia faktor risiko ansietas dan depresi belum pernah diteliti. Penelitian ini dilakukan untuk menentukan prevalensi dan faktor risiko gejala ansietas dan depresi pasca rawat inap COVID-19 di rumah sakit Cipto Mangunkusumo. Metode : Desain penelitian ini adalah Kohort retrospektif. Subjek penelitian diambil dari pasien pasca perawatan inap COVID-19 pada periode Januari 2022 sampai Maret 2023. Gejala ansietas dan depresi dinilai menggunakan Hospital Anxiety Depression Scale. Analisa bivariat digunakan menentukan faktor risiko dari variabel kategorik dan dilanjutkan ke analisa multivariat regresi logistik sampai didapatkan nilai P: 0,05. Hasil : Terdapat 209 subjek yang dilibatkan dalam penelitian ini dengan prevalensi gejala ansietas 20,57% dan gejala depresi 13,40%. Faktor risiko gejala ansietas adalah wanita RR (IK95%) 1,805 (1,017 – 3,204), p=0,043, Dukungan sosial sedang dan rendah dengan RR (IK95%) 1,935 (1,028 – 3,643), p=0,041 untuk dukungan sosial sedang dan RR (IK95%) 3,325 (1,314 – 8,411), p=0,011 untuk dukungan sosial rendah, Komorbid dengan RR (IK95%) 1,742 (1,019 – 2,977), p=0,042, Anosmia atau hipogeusia dengan RR (IK95%) 1,894 (1,045 – 3,433), p=0,035, gejala menetap pasca COVID-19 dengan nilai RR (IK95%) 2,885 (1,553 – 5,359), p=0,001. Faktor risiko gejala depresi adalah gejala menetap pasca COVID-19 RR (IK95%) 2,738 (1,300 – 5,770), p=0,008, kedia adalah aktifitas fisik ringan RR (IK95%) 6,556 (1,577 - 27,244), p=0,010. Kesimpulan : Faktor risiko gejala ansietas pasca perawatan COVID-19 yang bermakna adalah wanita, dukungan sosial, komorbid, anosmia atau hipogeusia, gejala menetap sedangkan faktor risiko gejala depresi adalah gejala menetap pasca COVID-19 dan aktifitas fisik ringan. ......Background: The prevalence of anxiety and depression, as well as risk factors for COVID-19 survivors worldwide and in Indonesia, is still high and varies from country to country. In Indonesia, the risk factors for anxiety and depression have not been studied. This study was conducted to determine the prevalence and risk factors for symptoms of anxiety and depression after hospitalization for COVID-19 at Cipto Mangunkusumo hospital. Methods: The study design was a retrospective cohort. The study subjects were taken from post-hospitalized COVID-19 patients from January 2022 to March 2023. Symptoms of anxiety and depression were assessed using the Hospital Anxiety Depression Scale. Bivariate analysis was used to determine risk factors from categorical variables and proceeded to multivariate logistic regression analysis until a P value of 0.05 was obtained. Results: There were 209 subjects involved in this study, with a prevalence of 20.57% anxiety symptoms and 13.40% depressive symptoms. Risk factors for anxiety symptoms are women RR (95% CI) 1.805 (1.017 – 3.204), P=0.043, Medium and low social support with RR (95% CI) 1.935 (1.028 – 3.643), P=0.041 for moderate social support, RR (95% CI 3.325 (1.314 – 8.411), P=0.011 for low social support, Comorbid with RR (95% CI) 1.742 (1.019 – 2.977), P=0.042, Anosmia or hypogeusia with RR (95% CI) 1.894 (1.045 – 3.433 ), P=0.035, persistent symptoms after COVID-19 with a RR (95% CI) 2.885 (1.553 – 5.359), P=0.001. Risk factors for depressive symptoms are persistent symptoms after COVID-19, RR (95% CI) 2.738 (1.300 – 5.770), P=0.008, lastly light physical activity RR (95% CI) 6.556 (1.577 - 27.244), P=0.010. Conclusion: Significant risk factors for anxiety symptoms post hospitalization for COVID-19 are women, social support, comorbidities, anosmia or hypogeusia, and persistent symptoms, while risk factors for depressive symptoms are persistent symptoms after COVID-19 and light physical activity

Abstrak :
Latar Belakang: Untuk tujuan kuratif, regimen D37 masih menjadi pilihan utama kemoterapi induksi remisi pada LMA yang bukan leukemia promielositik akut (LPA). Tercapainya remisi lengkap (CR) serta waktu yang diperlukan untuk mencapainya menentukan kesintasan. NCCN dan ESMO merekomendasikan pemeriksaan sumsum tulang hari ke-14 kemoterapi untuk memprediksi CR, namun metode ini bersifat invasif dan masih kurang akurat. Tujuan: Mengkaji peran nadir leukosit dalam memprediksi CR pada pasien LMA yang menjalani kemoterapi induksi remisi D3A7. Metode Penelitian: Studi prognostik dengan desain kohort retrospektif dilakukan di RS Dharmais PKN dan RSUPN Dr. Cipto Mangunkusumo berdasarkan data rekam medis pasien yang menjalani kemoterapi induksi remisi D3A7 dari 1 Januari 2015 sampai 31 Desember 2019. Peran prediktif kadar lekosit nadir dan waktu yang diperlukan untuk tercapainya terhadap CR dinilai melalui analisis kurva ROC. Hasil: Seratus satu subjek penelitian direkrut dengan median usia 39 tahun dan 55% pria. Sebanyak 55,4% subjek mencapai CR. Kadar leukosit nadir memiliki peran dalam memprediksi CR (AUC 0,63; IK 95% 0,52 – 0,74) namun tidak untuk waktu yang dibutuhkan untuk mencapainya. Kesimpulan: Kadar nadir leukosit memiliki peran dalam memprediksi CR namun tidak untuk waktu yang dibutuhkan untuk mencapainya pada pasien LMA non-LPA yang menjalani kemoterapi induksi remisi D3A7. ......Background: The D3A7 regimen is still the main choice of remission induction chemotherapy in AML. Achieving complete remission (CR) and the time required to achieve it determine survival. NCCN and ESMO recommend bone marrow examination on day 14 of chemotherapy to predict CR, but it is invasive and less accurate. Objective: To examine the role of the leukocyte nadir in predicting CR in AML patients undergoing D3A7 chemotherapy. Methods: A prognostic study with retrospective cohort design was conducted at Dharmais PKN Hospital and Dr. Cipto Mangunkusumo Public Hospital based on medical record data of patients underwent D3A7 remission induction chemotherapy from January 1, 2015 to December 31, 2019. The predictive role of nadir leukocyte level and the time required to achieve it was assessed. Results: One hundred and one subjects were recruited with median age 39 years and 55% men. A total of 55.4% subjects achieved CR. Nadir leukocyte level had a role in predicting CR (AUC 0.63; 95% CI 0.52 – 0.74) but not for the time required to achieve it. Conclusion: The nadir leukocyte level has a role in predicting CR but not for the time required to achieve it in non-APL AML patients undergoing D3A7 remission induction chemotherapy.

Abstrak :
Latar Belakang: Tingginya pertumbuhan kasus keganasan ginekologi dan organ panggul menyebabkan penggunaan terapi radiasi meningkat. Akan tetapi, terapi radiasi juga cukup banyak menimbulkan proktitis radiasi sebesar 30%. Tatalaksana menggunakan agen topikal seperti SCFA, sukralfat, steroid, formalin, dan 5-ASA diketahui memiliki hasil yang baik, namun belum banyak studi yang membandingkan terapi mana yang lebih superior. Tujuan: Menilai efektivitas beberapa terapi topikal terhadap perbaikan gejala klinis dan gambaran endoskopi pasien proktitis radiasi. Sumber Data: Pencarian utama dilakukan secara elektronik pada basis data PubMed, Cochrane/CENTRAL, Scopus, dan Science Direct antara September hingga November 2020. Pencarian sekunder dilakukan secara snowballing pada referensi studi yang terkait, dan melalui register uji klinis yang tersertifikasi lainnya seperti Global Index Medicus, Garba Rujukan Digital (GARUDA), ClinicalTrial.gov, dan International Clinical Trials Registry Platform (ICTRP) WHO. Seleksi Studi: Studi uji klinis acak terkontrol dengan intervensi terapi topikal dibandingkan plasebo atau terapi topikal lainnya atau kombinasi terapi medikamentosa, yang menilai luaran berupa respon gejala klinis dan gambaran endoskopi, serta dapat disertai luaran lain, ataupun tidak. Tidak ada batasan terhadap tahun publikasi dan bahasa. Penilaian judul, abstrak, dan studi dilakukan oleh dua orang peninjau independen. Dari total 1786 studi, didapatkan 9 studi memenuhi kriteria eligibilitas. Ekstraksi Data: Ekstraksi data dilakukan oleh dua peninjau independen dan dikonfirmasi pada peninjau ketiga. Konfirmasi data dilakukan dengan menghubungi peneliti dari studi terkait. Tidak didapatkan data tambahan. Hasil: Studi yang melaporkan efektivitas terapi berupa banyaknya jumlah subjek yang mengalami perbaikan atau penurunan skor klinis dan endoskopi dirangkum secara kualitatif. Masing-masing studi saling membahas antar terapi, dan memiliki heterogenitas yang tinggi. Dua studi mengenai formalin dapat dilakukan meta-analisis dengan hasil perbaikan klinis dan endoskopi, namun tidak bermakna terhadap dua studi tersebut (RR 0.97, 95% CI: 0.82-1.15) dan tidak terdapat terapi yang lebih superior dibanding terapi lain dalam meta-analisis tersebut. Empat studi yang membahas formalin 4% memiliki kualitas hasil studi menengah dengan risiko bias rendah. Terdapat 3 dari 9 studi yang membandingkan terapi SCFA dengan plasebo sehingga sulit untuk menyimpulkan terapi mana yang berefek lebih baik, dan memiliki risiko bias tidak jelas, namun dengan jumlah pasien yang sedikitsehingga kualitas studi rendah. Satu studi mengenai efektivitas sukralfat menunjukkan hasil bermakna dengan estimasi risiko rendah (RR 0.57, 95% CI: 0.35-0.92, P = 0.02). Akan tetapi studi mengenai 5-ASA topikal tidak ditemukan dalam inklusi telaah sistematis ini. Secara umum, kualitas hasil studi berdasarkan GRADE dapat dimasukkan ke dalam kategori sedang. Kesimpulan: Penggunaan terapi SCFA enema, formalin topikal, steroid topikal, dan sukralfat enema efektif dalam memperbaiki gejala klinis dan gambaran endoskopi proktitis radiasi. Namun, hingga saat ini belum ada studi klinis berkualitas baik sehingga sulit untuk menilai terapi yang terbaik. Sedangkan dari 2 studi formalin 4% yang dapat dilakukan meta-analisis, menunjukkan bahwa tidak ada terapi yang lebih superior dibandingkan lainnya. Selain itu, tidak ditemukan tidak ditemukan efek samping berat pada penggunaan terapi SCFA enema, formalin topikal, steroid topikal, dan sukralfat enema dalam mengobati proktitis radiasi. ......Background: The high incidence of gynecological and pelvic malignancies has led to the usage of radiation therapy. Nonetheless, radiation therapy also causes a significant complication, about 30% of radiation proctitis. Treatments using topical agents such as SCFA, sucralfate, steroids, formalin, and 5-ASA are known to have good results. However, there are only a few studies comparing the superiority of those therapies. Objectives: To assess the effectiveness of topical therapies in the clinical and endoscopic improvement of radiation proctitis patients. Data Sources: Primary searching was conducted on electronic databases such as PubMed, Cochrane/CENTRAL, Scopus, and Science Direct between September and November 2020. Secondary searching was done by snowballing method on the relevant study references and through other certified clinical trial registries (Global Index Medicus, Garba Digital Reference (GARUDA), ClinicalTrial.gov, and WHO's International Clinical Trials Registry Platform (ICTRP). Study Selection: A randomized controlled trial comparing topical therapies versus placebo or other topical therapies or combination with medical therapies that evaluating the clinical response and endoscopic response. There is no restriction regarding the year of publication and language. Each study were assessed by two independent reviewers. From a total of 1,786 studies identified, 9 studies met the eligibility criteria. Data Extraction: Data extraction was performed by two independent reviewers and confirmed by a third reviewer. Data confirmation was made by contacting the first researchers from related studies. No additional information was obtained. Results: Studies reporting the effectiveness of therapy in the form of a large number of subjects experiencing improvement or reduction in clinical symptoms and endoscopy were summarized qualitatively. Each study discussed the therapies and the heterogeneity that could not be calculated due to the different outcomes. Two studies on formalin were subject to meta-analysis with clinical and endoscopy improvement. However, they were not significant in the two studies (RR 0.97, 95% CI: 0.82-1.15), and no better treatment compared with others in those studies. Further, four studies discussing 4% formalin had medium study quality results with a low risk of bias. There are 3 out of 9 studies that compared SCFA therapy with placebo so it is difficult to conclude which therapy has a better effect, and has an unclear risk of bias, but with a small number of patients so that the quality of the study is low. One study using sucralfate showed significant results with a low-risk estimate (RR 0.57, 95% CI: 0.35-0.92, P = 0.02). However, the study of topical 5-ASA was not found in the inclusion of this systematic review. The level of evidence for the majority of outcomes was downgraded using GRADE to a moderate level, due to imprecision and study limitation. Conclusion: The usage of SCFA enema, topical formalin, topical steroid and sucralfate enema are effective in improving the clinical and endoscopic response in radiation proctitis patient. However, until now, there are no good quality studies, making it difficult to prove the best therapy. A meta-analysis from 2 studies using 4% formalin versus irrigation and antibiotics, shows no therapy is superior to another. Otherwise, no serious side effects were found in the usage of these topical therapies