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"Obstructive sleep apnea adalah salah satu komorbid asma yang saat ini menjadi perhatian karena menyebabkan hipoksia intermiten akibat OSA sehingga terjadi kerusakan lapisan endotel, terbentuknya mikropartikel, dan inflamasi. Penurunan arus puncak ekspirasi (APE) dan kualitas hidup (PAQLQ) juga berkaitan dengan asma sehingga perlu dilakukan penelitian untuk mengevaluasi pengaruh inflamasi terhadap APE dan PAQLQ pada anak asma disertai komorbid OSA.Penelitian cross-sectional komparatif dilakukan di Banding pada anak asma usia 7–15 tahun disertai dan tanpa OSA, pada bulan Agustus 2020 sampai Juni 2021. Penjaringan asma klinis berdasarkan gejala dan riwayat pengobatan dilakukan berdasarkan kuesioner ISAAC, diagnosis asma dengan peak flow meter, dan diagnosis OSA dengan polisomnografi. Sitokin pro-inflamasi diperiksa dengan metode enzyme-linked immunosorbent assay (ELISA) dan mikropartikel endotel diperiksa menggunakan flow cytometer. Data diolah menggunakan program SPSS 20.0 dan diuji dengan uji t tidak berpasangan, uji Mann-Whitney, uji korelasi Pearson dan Spearman Rho. Uji path analysis (Structural Equation Modeling, SEM) menggunakan program JASP versi 0.16.1.Jumlah subjek adalah 32 anak asma disertai OSA dan 48 anak asma tanpa OSA. Terdapat perbedaan bermakna pada indeks masa tubuh/IMT (p = 0,01), hipertrofi tonsil (p = 0,009), persentase APE (p = 0,02), semua domain nilai PAQLQ, dan kadar mikropartikel endotel antara kedua kelompok. Eosinofil dan neutrofil berpengaruh pada APE, sedangkan interleukin-6, eosinofil, neutrofil, CD62E+/CD31- mikropartikel, dan APE berpengaruh pada penurunan nilai PAQLQ pada kelompok anak asma disertai OSA. Disimpulkan mikropartikel endotel berperan pada patomekanisme asma dengan komorbid OSA.

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Obstructive sleep apnea is comorbid of asthma causes intermittent hypoxia due to damage the endothelial layer, release of microparticles, and inflammation. Decreased peak expiratory flow rate (PEFR) and quality of life (PAQLQ) are also associated with asthma. The aim of this study was to evaluate the influence of inflammation on PEFR and PAQLQ in asthmatic children with comorbid OSA.

A cross-sectional study was conducted in asthmatic children aged 7–15 years with and without OSA, from August 2020 to June 2021. Asthma symptoms and therapeutic history were carried out using the ISAAC questionnaire, diagnosis of asthma by a peak flow meter, and diagnosis of OSA by polysomnography. Pro-inflammatory cytokines were examined using the ELISA method and endothelial microparticles were examined using a flow cytometer. Statistical analysis using SPSS program v.20.0 and analyzed by unpaired t-test, Mann-Whitney U-test, Pearson and Spearman Rho test. Path analysis test (Structural Equation Modeling, SEM) using JASP v.0.16.1.

The number of subjects was 32 asthmatic children with OSA and 48 asthmatic children without OSA. There were significant differences in body mass index/BMI (p = 0.01), tonsil hypertrophy (p = 0.009), PEFR percentage (p = 0.02), all domains of PAQLQ values, and endothelial microparticle levels between the two groups. Eosinophils and neutrophils have an effect on PEFR, whereas interleukin-6, eosinophils, neutrophils, CD62E+/CD31- microparticles, and PEFR have an effect on decreasing PAQLQ values ​​in the group of asthmatic children with OSA. It is concluded that endothelial microparticles have an influence on the pathomechanism of asthma with comorbid OSA."

"Irritable Bowel Syndrome (IBS) merupakan penyakit terbanyak pada anak dan remaja pada gangguan saluran cerna fungsional dengan subtipe diare, konstipasi, campuran dan unclassified. Mekanisme patofisiologi belum jelas dan memerlukan pembuktian adanya keterlibatan organik. Tujuan penelitian ini adalah untuk mengetahui epidemiologi IBS, peran infestasi Blastocystis hominis dan integritas mukosa usus dalam etiopatogenesis IBS, dampak IBS terhadap kualitas hidup, serta membuat sistem model prediksi IBS pada remaja. Penelitian ini berbasis komunitas dengan pendekatan potong lintang komparatif dua kelompok pada remaja dari enam SMA di Palembang. Kriteria Roma III digunakan untuk menegakkan diagnosis IBS beserta kuesioner untuk menentukan faktor risiko. Secara multistage random sampling dibandingkan 70 subjek IBS dan 70 subjek nonIBS. Dilakukan pencatatan riwayat medis, pemeriksaan fisis, pemeriksaan parasit dan biomarker tinja serta kuesioner IBSQOL. Pemeriksaan tinja segar dengan mikroskop untuk mengetahui infestasi Blastocystis hominis. Pemeriksaan kadar alfa-1 antitripsin dan kalprotektin tinja dengan ELISA untuk melihat adanya gangguan integritas mukosa usus. Dampak IBS terhadap kualitas hidup dinilai dengan kuesioner IBSQOL. Terdapat 454 subjek dengan prevalens IBS 30,2%, terdiri dari subtipe terbanyak yaitu subtipe diare 36,5%, dan yang paling sedikit subtipe konstipasi 18,9%. Uji regresi logistik mendapatkan faktor risiko utama IBS adalah dibully, perempuan, usia 14-16 tahun, riwayat konstipasi, makan tiga jenis kacang, minuman kemasan, dan riwayat diare (kisaran OR 2,86-1,81). Blastocystis hominis ditemukan pada masing-masing grup sebesar 51,4 vs. 28,6%, dengan perbedaan bermakna (p = 0,006). Tidak ada hubungan bermakna untuk kerusakan mukosa (p = 0,734), tetapi bermakna dengan inflamasi usus (p = 0,039). Terbukti IBS secara bermakna menyebabkan rendahnya kualitas hidup (p = 0,001). Didapatkan 2 model prediksi skoring, yaitu model 1 yang dapat diaplikasikan pada layanan kesehatan primer yang bertujuan sebagai uji tapis dengan menilai faktor risiko. Model 2 diperuntukkan sebagai layanan terapi terkait infestasi Blastocystis pada layanan kesehatan tersier. Simpulan, prevalens IBS pada remaja di Palembang tinggi dan memiliki faktor risiko utama dibully, perempuan, usia 14-16 tahun, riwayat konstipasi, makan 3 jenis kacang, minuman kemasan, riwayat diare. Terdapat hubungan yang bermakna antara Blastocystis hominis dan inflamasi usus dengan kejadian IBS pada remaja, serta dampaknya terhadap kualitas hidup membutuhkan penanganan yang komprehensif.

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Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder and commonly present in children and adolescences, presented as diarrhoea, constipation, mixed or unclassified type. The pathophysiological mechanisms of  IBS are unclear, and still challenging to determine organic disorders. The aim of this study was to investigate the epidemiology of IBS, the role of 'Blastocystis hominis' infestation and intestinal mucosal integrity in the etiopathogenesis of IBS, the impact of quality of lifes, and apply a scoring system to predict the occurrence of IBS among adolescences.

A community-based survey with comparative cross sectional approach was done from six high schools in Palembang. Subjects were recruited using the multistage random sampling divided into two groups (70 subjects IBS and 70 subjects nonIBS). The Rome III criteria were used to establish a diagnosis of IBS along with a questionnaire to determine risk factors,  analyzed for association with 'Blastocystis hominis' infestation, intestinal mucosal integrity, and its impact on quality of life. Direct microscopic stool examination to identify single 'Blastocystis' infection was performed, followed by culture in Jones medium, PCR and Sequencing of 18S rRNA to determine 'Blastocystis' subtype. Examination of antitrypsin alpha-1 and fecal calprotectin levels by ELISA was done to determine impaired intestinal mucosal integrity. Impact of IBS on quality of life was done with the IBSQOL questionnaire.

Of the 454 subjects, the prevalence of IBS was 30.2%, consisting of diarrhea subtypes 36.5%, 21.9% mixed, 22.6% Unclassified and 18.9% constipation. The major risk factors for IBS were bullying, girls, ages 14-16 years, history of constipation, eat three kinds of nuts, drink beverages, and history of diarrhea (range OR 2.86-1.81). 'Blastocystis hominis' was detected in each group of 51.4 vs. 28.6% (p = 0.006). There was no significant association for intestinal mucosal permeability (p = 0.734), but it was significant with intestinal inflammation (p = 0.039). Significant impairment of quality of life among IBS adolescences was found (p = 0.001). The IBS prediction score model had 2 models. Model 1 is more applicable in primary health care for sreening IBS based on risk factors. Model 2 only usable for tertiary health care, as management of 'Blastocystis' infestation.

Conclusion, the prevalence IBS among adolescence was high with major risk factors to IBS consisted of bullying, female gender, age between 14-16 years, previous illness of constipation, diet three nuts, drink beverages, previous illness diarrhoea. Significant association with 'Blastocystis hominis' infestation, intestinal inflammation were found, comphrehensive management is needed as for its impact on quality of life."

"ABSTRACTKesulitan dalam penegakan diagnosis definitif efusi pleura tuberkulosis berdasarkan metode konvensional ataupun biopsi menyebabkan berbagai usaha untuk mencari alternatif strategi diagnostik lainnya. Kriteria diagnostik yang direkomendasikan adalah apabila pasien terdapat gejala klinik tuberkulosis dan pemeriksaan cairan pleura menunjukkan eksudat berdasarkan kriteria Light, aktivitas adenosin deaminase (ADA) > 40 U/l, dan rasio limfosit/neutrofil > 0.75, maka diagnosis efusi pleura tuberkulosis boleh ditegakkan yang dibuktikan dengan respon terapi. Tujuan penelitian ini adalah mendapatkan nilai diagnostik real time polymerase chain reaction (RT PCR) pada efusi pleura tersangka tuberkulosis yang memenuhi kriteria diagnostik. Penelitian uji diagnostik prospektif menggunakan 43 sampel cairan pleura dari tersangka tuberkulosis yang dipilih secara konsekutif. Diagnosis efusi pleura tuberkulosis ditegakkan berdasarkan respon terapi positif atau kultur positif. Kultur cairan pleura menggunakan media Lowenstein-Jensen. RT PCR dikerjakan menggunakan primer yang dapat mengenali gen IS6110 dan gen MPB64.Dari 43 sampel tersebut, Mycobacterium tuberculosis dapat dideteksi oleh RT PCR pada 7 sampel, 4 diantaranya dengan kultur positif. Dengan demikian, sensitivitas RT PCR adalah 16.3% yang lebih tinggi daripada sensitivitas berdasarkan kultur saja yaitu 9.3%. Nilai duga positif dan nilai duga negatif RT PCR berturut-turut adalah 100% dan 0%. Spesifisitas, rasio kemungkinan positif, dan rasio kemungkinan negatif RT PCR tidak dapat dinilai karena semua subyek penelitian memiliki respon terapi positif atau kultur positif. RT PCR memiliki keunggulan yaitu dapat digunakan untuk menegakkan diagnosis definitif efusi pleura tuberkulosis lebih sensitif dan cepat dibandingkan kultur. Dengan demikian, penelitian ini mendapatkan bahwa pada pasien yang memenuhi kriteria diagnosis efusi pleura TB, maka RT PCR merupakan pilihan metode untuk identifikasi infeksi Mycobacterium tuberculosis secara definitif, karena sensitivitas yang rendah maka tidak dapat digunakan sendiri (tunggal).

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ABSTRACTThe difficulty to confirm the definitive diagnosis of tuberculous pleural effusion (TBPE) based on conventional laboratory methods and pleural biopsy have lead to the searching of alternative diagnostic strategies. The recommended diagnostic criteria approach for TBPE diagnosis are if a patient has clinical feature of tuberculosis (TB) and the pleural fluid analysis showed exudate based on Light criteria, the adenosine deaminase (ADA) activity > 40 U/l, and lymphocyte/neutrophil ratio > 0.75, then the diagnosis of TBPE is actually established. The aim of this study is to investigate the diagnostic value of RT PCR on suspected TBPE that fullfiled the recommended diagnostic criteria. The diagnostic study with prospective design assessed 43 pleural fluid samples of suspected TBPE that were selected consecutively. The diagnosis of TBPE was confirmed based on positive response therapy or positive culture of the pleural fluid. Pleural fluid culture was performed using Lowenstein-Jensen medium. Real time polymerase chain reaction (RT PCR) was carried out using the primer that detect IS6110 and MPB64 gene.Among 43 samples of suspected TBPE, Mycobacterium tuberculosis could be detected by RT PCR in 7 samples with 4 of them had positive culture. The sensitivity of RT PCR therefore was 16.3%, it was higher than the sensitivity based on culture only which was 9.3%. Positive predictive value and negative predictive value of RT PCR were 100% and 0%, respectively. The specificity, positive likelihood ratio, and negative likelihood ratio of RT PCR could not be defined because all subjects had positive response therapy or positive culture. RT PCR has an advantage that it can be used to establish definitive diagnosis of TB earlier compared to culture. Therefore, when the patient fulfilled the recommended criteria of tuberculous pleural effusion, RT PCR is the method of choice for definitive identification of Mycobacterium tuberculosis infection. However, due to the low sensitivity, it can not be used alone."

"ABSTRAK Latar belakang: Refluks laringofaring (RLF) dipertimbangkan sebagai salah satu faktor risiko karsinoma laring dengan proporsi yang cukup tinggi. Pemeriksaan ELISA pepsin dapat menjadi pemeriksaan penunjang untuk RLF yang tidak invasif dengan nilai sensitifitas dan spesifisitas yang tinggi. Tujuan: Mengetahui sebaran karakteristik pasien karsinoma laring, proporsi RLF berdasarkan kadar pepsin pada pasien karsinoma laring dan hubungan RLF berdasarkan kadar pepsin dengan karakteristik pasien karsinoma laring. Metode: Desain penelitian observasional analitik dengan jumlah subjek karsinoma laring sebanyak 26 orang. Subjek diminta untuk mengumpulkan sputum sebanyak 2 kali (pepsin I dan pepsin II) untuk kemudian dilakukan pemeriksaan ELISA pepsin. Hasil: Didapatkan 24 dari 26 subjek berjenis kelamin laki-laki dengan rerata usia 60,65±8,41 tahun, 7 subjek peminum alkohol berat, 12 subjek perokok berat dan 24 subjek merupakan stadium lanjut karsinoma laring. Semua subjek didapatkan menderita RLF dan didapatkan hubungan yang bermakna antara kadar pepsin I (daytime/ provoked RLF) dengan konsumsi alkohol serta perbedaan bermakna kadar pepsin I dengan perokok berat dan ringan. Kesimpulan: Refluks laringofaring dapat menjadi faktor risiko bersamaan dengan konsumsi alkohol dan rokok pada pasien karsinoma laring. ELISA pepsin dapat menjadi pemeriksaan penunjang adanya RLF terutama pada pasien dengan karsinoma laring mengingat sifatnya yang tidak invasif dan cukup murah.

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ABSTRAK Background: Laryngopharyngeal Reflux (LPR) is suspected to be a risk factor for laryngeal cancer with a high prevalence according to recent studies. ELISA pepsin can be used in diagnosing LPR as it is a noninvasive technique with great sensitivity and specificity. Objectives: To find the characteristics of laryngeal cancer patient, proportion of LPR based on the pepsin value and correlation between LPR based on the pepsin value and the characteristics of laryngeal cancer patient. Methods: Observational analytic study with 26 subjects of laryngeal cancer. All subjects were asked to collect the sputum twice (pepsin I and pepsin II) to evaluated later with ELISA. Result: Twenty four out of 26 subjects were male with mean age 60,65±8,41 years, 7 subjects were severe drinkers, 12 subjects were severe smokers and 24 subjects were late stage laryngeal cancer. All of the subjects were diagnose with LPR and there was a significant correlation between the value of pepsin I (daytime/ provoked LPR) with alcohol consumption and also a significant difference of the value of pepsin I in heavy and light smoker. Conclusion: LPR could be considered as a risk factor together with alcohol consumption and smoking status. ELISA pepsin could be a supporting examination for LPR especially in laryngeal cancer patient as it is a noninvasive and inexpensive method."

"ABSTRAKDiare persisten merupakan masalah kesehatan serius dan sering menyebabkan malnutrisi. Kerusakan mukosa pada diare diduga menyebabkan penurunan hormon sekretin dan kolesistokinin sehingga mengurangi stimulasi ke pankreas dan memperberat diare persisten dan malnutrisi.Penelitian ini bertujuan untuk mengetahui fungsi eksokrin pankreas pada anak diare persisten, anak malnutrisi, mendapatkan nilai referensi pemeriksaan fecal elastase-1 FE-1 anak Indonesia, dan mengetahui kehandalan analisis feses dan steatokrit dalam mendeteksi insufisiensi eksokrin pankreas.Penelitian potong lintang pada tahap pertama dilakukan untuk mendapatkan sebaran nilai FE-1 pada anak normal, membandingkan nilai FE-1 subjek diare persisten dan malnutrisi dengan anak normal, dan mengetahui sensitivitas, spesifisitas, dan kemampuan diskriminasi analisis feses dan steatokrit dalam mendeteksi insufisiensi eksokrin pankreas. Tahap kedua uji klinis dua kelompok paralel tersamar ganda dilakukan untuk menguji efek suplementasi enzim pankreas 8371 USP unit tiga kali sehari selama sebulan pada anak diare persisten. Penelitian dilakukan di 5 Rumah Sakit di Jakarta Januari 2015 minus;Juli 2016 pada anak berusia 6 ndash;60 bulan.Sebanyak 182 anak usia 6 ndash;60 bulan direkrut sebagai subjek yang terdiri dari 31 anak dengan diare persisten, 31 anak dengan malnutrisi, dan 120 anak normal. Nilai cut-off FE-1 yang didapatkan pada penelitian ini adalah 307 mcg/g feses. Terdapat perbedaan bermakna nilai FE-1 antara subjek diare persisten dan anak normal. Tidak ditemukan perbedaan bermakna nilai FE-1 antara subjek malnutrisi dan anak normal. Terdapat perbedaan bermakna lama diare sekitar 7 hari antara kedua kelompok. Kadar FE-1 dan prealbumin antara baseline dan endpoint pada kelompok plasebo dan perlakuan tidak berbeda bermakna. Uji kehandalan masing-masing komponen analisis feses dan steatokrit menunjukkan hasil sensitivitas dalam rentang 5 ndash;32 , spesifisitas 73 ndash;98 , nilai prediksi positif 1 ndash;43 , dan nilai prediksi negatif 87 ndash;89 . Nilai AUC analisis feses dan steatokrit masing-masing adalah 0,664 IK 95 0,539 ndash;0,788 dan 0,501 IK 95 0,372 ndash;0,629 sedangkan AUC gabungan sebesar 0,671.Kesimpulannya, pada penelitian ini didapatkan adanya insufisiensi eksokrin pankreas pada anak dengan diare persisten. Suplementasi enzim pankreas terbukti dapat memperpendek lama diare secara bermakna. Analisis feses dan/atau steatokrit memiliki sensitivitas yang rendah, spesifisitas yang tinggi, dan kemampuan diskriminasi kurang.Kata kunci: anak, diare persisten, fungsi eksokrin pankreas, malnutrisi, suplementasi enzim pankreas

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ABSTRACTPersistent diarrhea is a serious health problem and is closely related to malnutrition. Prolonged mucosal injury in diarrhea is thought to cause reduced secretin and cholecystokinin CCK secretion, which decreases stimulation to the pancreas and further aggravate persistent diarrhea and malnutrition.This research aims to study pancreatic exocrine function in children with persistent diarrhea and children with malnutrition, to obtain reference values of fecal elastase 1 FE 1 in Indonesian children, and to assess the ability of stool analysis and steatocrit in detecting exocrine pancreatic insufficiency.Cross sectional study was done to obtain FE 1 distribution in healthy children, to study FE 1 levels in children with persistent diarrhea and children with malnutrition, and to study the sensitivity, specificity, and discriminative capacity of stool analysis and steatocrit in detecting exocrine pancreatic insufficiency. A randomized, two double blind parallel group, placebo controlled clinical trial was conducted to evaluate the effects of 8371 USP units of pancreatic enzyme replacement therapy PERT 3 times daily for 1 month in children with persistent diarrhea. This study involved children age 6 ndash 60 months in 5 hospitals in Jakarta from January 2015 to July 2016.As much as 182 children 6 ndash 60 months of age consisting of 31 children with persistent diarrhea, 31 children with malnutrition, and 120 healthy children were recruited as subjects. Cut off point of FE 1 in this study was 307 mcg g faeces. Significant difference of FE 1 was found between children with persistent diarrhea and healthy children. The FE 1 difference between subjects with malnutrition and healthy children was not significant. Duration of diarrhea was 7 days significantly shorter in the PERT group. Changes of FE 1 and prealbumin values between baseline and endpoint in placebo and treatment group were found to be statistically insignificant. The diagnostic value of each stool analysis component and steatocrit test showed that the sensitivity was within range of 5 ndash 32 , specificity 73 ndash 98 , positive predictive value 1 ndash 43 and negative predictive value 87 ndash 89 . The AUC values of stool analysis and steatocrit were 0.664 95 CI 0.539 ndash 0.788 and 0.501 95 CI 0.372 ndash 0.629 , respectively, and the combined AUC 0,671.In conclusion, exocrine pancreatic insufficiency was observed in children with persistent diarrhea, and PERT has been proven to significantly shorten the duration of diarrhea by 1 week. Stool analysis and or steatocrit has low sensitivity, high specificity, and low discrimination capacity.Keywords children, exocrine pancreatic function, malnutrition, pancreatic enzyme supplementation, persistent diarrhea"

"Cedera otak pada perdarahan intraserebral spontan (PIS) terdiri dari cedera primer kerusakan struktural karena proses mekanis dan cedera sekunder akibat respons patofisiologis subklinis mencakup inflamasi, stress oksidatif dan sitotoksik terhadap komponen serta produk degradasi darah. Proses subklinis PIS yang sedang berlangsung tersebut masih belum terpantau secara lengkap, sehingga penelitian ini ditujukan untuk mengidentifikasi perjalanan proses subklinis cedera otak sekunder perdarahan intraserebral spontan dan pengaruhnya terhadap perubahan luaran respons klinis kasus (LRK) PIS pasca-intervensi bedah saraf. Penelitian ini menggunakan desain observasional prospektif, mulai Agustus 2016-April 2018 terhadap 20 subjek yang baru pertama kali mengalami perdarahan intraserebral spontan yang disertai perdarahan intraventricular dan menjalani intervensi bedah saraf external ventricular drainage (EVD). Data tercatat mencakup skor Full Outline of UnResponsiveness (SF), TIK, dan kadar hari ke-1 dan hari ke-7 Tumor Necrosis Factor alpha (TNFα), Superoxide Dismutase (SOD) dan zat besi dalam LSS. Analisis bivariat menggunakan uji Ttak berpasangan atau uji Mann-Whitney. Data skala kategorik diuji dengan Chisquare atau Fisher's exact test, dan untuk data kategorik berpasangan dengan uji McNemar.TIK pasca-intervensi semua subjek menurun secara gradual menjadi normal dan ada lima subjek yang tidak mengalami perbaikan LRK SF hari 1-7. Semua subjek kelompok 'tanpa perbaikan' mempunyai kadar TNFα LSS hari ke-1 tinggi, sebaliknya yang kadarnya normal mengalami perbaikan LRK (P=0,003). Selisih nilai peningkatan TNFα hari 1-7 juga lebih besar bermakna pada yang 'tanpa perbaikan' (P=0,005). Kadar SOD LSS hari ke-1 dan perubahannya tidak terbukti berbeda bermakna antara kedua kelompok. Pengamatan klinis memperlihatkan 80% subjek 'perbaikan', mempunyai kadar zat besi LSS hari ke-1 normal dalam status saturasi transferin < 50%. Semua subjek yang mempunyai kadar zat besi hari ke-1 tinggi dalam status saturasi transferin ≥ 50% mengalami LRK 'tanpa perbaikan'. Terdapat perbedaan bermakna dari selisih peningkatan status saturasi transferin antara kedua kelompok subjek. (P=0,05). Penelitian ini menyimpulkan bahwa subjek PIS dengan kadar TNFα LSS hari ke-1 tinggi dan/atau zat besi LSS tinggi dalam status saturasi transferin ≥ 50%, mempunyai LRK 'tanpa perbaikan'. Semakin besar peningkatan kadar TNFα LSS pada hari ke-7 dan/atau kadar zat besi yang disertai peningkatan saturasi transferrin, mempunyai LRK 'tanpa perbaikan'. Kadar SOD hari ke-1 dan perubahan kadar hari 1-7 belum dapat dimanfaatkan sebagai penanda prognosis dan proses subklinis PIS.

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Brain injury of spontaneous intracerebral hemorrhage caused by primary injury of structural damage due to mechanical processes and secondary injuries resulting from subclinical pathophysiological responses of inflammation, oxidative stress and cytotoxicity to components and blood degradation products including iron. The subclinical pathophysiology processes still cannot be monitored explicitly. This study is aimed at identifying the course of ICH subclinical secondary brain injury process and finding its relations with the days 1-7 trend of clinical response outcomes after neurosurgical intervention. This study is a prospective observational designed study done from August 2016 until April 2018. Twenty subjects were diagnosed as spontaneous intracerebral hemorrhage and underwent neurosurgical intervention external ventricular drainage (EVD). Recorded data consist of everyday Full Outline of UnResponsiveness (FOUR) score, intracranial pressure, and cerebro-spinal fluid (CSF) Tumor Necrosis Factor alpha (TNFα), Superoxide Dismutase (SOD), iron and transferrin saturation at day-1 and day-7. Bivariate analysis performed with unpaired T-test or Mann-Whitney test. Unpaired categorical scale data tested by Chi-square or Fisher's exact test, and McNemar test for paired categorical data.All 'unimproved' subjects had high levels of day-1 CSF TNFα, whereas all subjects with normal TNFα have clinical improvement response (P=0.003). Subsequently those subjects had significantly greater increasing levels (P=0.005). No significant difference of CSF SOD between of 'unimproved' and 'improved' group. Clinical observation clearly showed that 80% of 'improved' subjects have normal day-1 iron levels in controlled by transferrin saturation < 50%. There will be no improvement of those high iron levels with transferrin saturation ≥ 50%. A significant difference results were also noted of increasing transferrin saturation status (P=0,05). This study concluded that SICH with high level of day-1 CSF TNFα and/or high CSF iron with transferrin saturation ≥ 50%, would have an 'unimproved' trend of clinical response outcome. Greater increasing level of those biomarkers in days 1-7, tend to have an unimproved outcome. CSF SOD could not to be use as a significant clinical prognostic and process biomarker."

"ABSTRAKStunting merupakan kondisi malnutrisi pada anak yaitu tinggi badan menurut usia lebih dari minus 2 simpang baku. Indonesia menempati urutan kelima di dunia. Stunting berkorelasi dengan asupan makanan terutama protein, IGF-1 dan protein pengikat Insulin like Growth Factor Binding Protein IGFBP-3 , dan Zinc Zn . Kualitas protein dinilai dari profil asam amino bebas plasma Plasma Free Amino Acid = PFAA dan kuantitas dinilai dari jumlah asupan protein harian. Beberapa penelitian menemukan kadar IGF-1 dipengaruhi oleh polimorfisme SNP rs5742612, rs35767 dan rs35766. Penelitian ini bertujuan untuk menganalisis peran profil PFAA, IGF-1, IGFBP-3, polimorfisme IGF-1, Insulin, dan Zn pada anak.Penelitian ini merupakan studi comparative cross sectional dilakukan di RS Cipto Mangunkusumo, Lembaga Biomolekular Eijkman, dan Labkesda DKI Jakarta. Subjek penelitian adalah anak usia 1 ndash;3 tahun berasal dari UPTD Puskesmas Jatinegara dibagi menjadi 2 kelompok yaitu 101 anak stunted dan 101 anak nonstunted.Pada penelitian ini didapatkan kadar 8 dari 9 AA esensial, 2 AA esensial kondisional, dan 2 AA nonesensial lebih rendah bermakna kelompok stunted dibandingkan nonstunted. Profil PFAA yaitu jumlah anak di bawah nilai rujukan berbeda bermakna antara kelompok stunted dan nonstunted. Terdapat korelasi 8 AA esensial, 1 AA esensial kondisional, dan 2 AA nonesensial dengan tinggi badan anak. Pada kelompok anak stunted, IGF-1, IGFBP-3, insulin, Zn, energi total dan protein lebih rendah bermakna dari kelompok anak nonstunted. Terdapat korelasi bermakna AA esensial dengan IGF-1 dan IGFBP-3. Polimorfisme rs35766 genotipe AG kodominan memiliki pengaruh terhadap kadar IGF-1 pada kelompok nonstunted. Faktor yang memengaruhi kejadian stunting adalah energi atau protein, IGF-1 yang berinteraksi dengan genotipe kodominan AG, IGFBP-3, dan Zn.Simpulan: PFAA, IGF-1 yang berinteraksi dengan SNP rs35766 genotipe kodominan AG, memiliki pengaruh terhadap kejadian stunting. Perlu penelitian lebih lanjut mengenai pemberian pola makan yang tepat untuk mencegah dan mengatasi anak stunted. Kata kunci: AA esensial, AA nonesensial, IGFBP-3, insulin, PFAA, stunting, Zn

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ABSTRACTStunting is a malnourished condition in children defined by height for age is under minus 2 standard deviation. Indonesia ranked fifth in world for this condition. Stunting mainly corelates with low protein intakes, IGF-1 and its binding protein Insulin-like Growth Factor Binding Protein/IGFBP-3 , and zinc Zn . Plasma free amino acid profile PFAA measures quality of protein intake, whilst its quantity measured by daily protein intake records. Previous studies found IGF-1 level affected by single nucleotide polymorphism SNP on rs5742612, rs35767 and rs35766. This study aims to analyze the role of PFAA, IGF-1, IGFBP-3, and IGF-1 polymorphism, insulin, and Zn in children.This study is a comparative cross-sectional study held in Cipto Mangunkusumo National General Hospital, Eijkman Institute for Molecular Biology, and Jakarta Provincial Public Health Laboratory. Subjects were children age 1 ndash;3 years old from Jatinegara Region Public Health Centre divided into two groups of 101 stunted children and 101 non-stunted children.Eight essential AA levels, 2 conditional essential AAs, 2 nonessential AAs were significantly lower in stunted groups than non-stunted. There was significant difference of profile PFAA below normal range between stunted and non-stunted group. Eight essential amino acids, 1 conditional essential amino acid, and 2 non-essential amino acid correlate with children rsquo;s height. IGF-1, IGFBP-3, insulin, Zn, total energy, and protein were significantly lower in stunted children compare to non-stunted children. Significant correlations found for all essential amino acids with IGF-1 and IGFBP-3. The rs35766 AG codominant polymorphism affects IGF-1 level in non-stunted group. Factors affects stunting condition were total energy or protein intake, IGF-1 that interacts with AG codominant genotype, IGFBP-3, and Zn.Conclusion: PFAA and IGF-1 that interacts with SNP rs35766 AG codominant genotype affect stunting. Further study needed to determine appropriate dietary habit for stunting prevention and treatsment. Keywords: Essential amino acid, IGFBP-3, insulin, non-essential amino acid, plasma free amino acid profile, stunting, zinc"

"Asam amino menjadi zat gizi baru yang diduga berhubungan dengan pertumbuhan linier ketika banyak penelitian menemukan bahwa asupan protein cukup dan intervensi zat gizi mikro menunjukkan hasil yang tidak memuaskan. Kondisi stunting terjadi bersamaan dengan wasting karena kemungkinan berbagi jalur yang sama. Oleh karena itu, studi mengenai stunting dapat memiliki hasil yang berlebihan ketika wasting tidak dijadikan pengecualian. Studi potong lintang komparatif 2 fase ini bertujuan untuk membandingkan asupan asam amino dan konsentrasinya dalam darah antara anak stunted non-wasted (SNW) dan non-stunted non-wasted (NSNW) yang berusia 12-23 bulan dan menggunakan hasil dari fase 1 untuk mengembangkan rekomendasi pemberian makan dan makanan campuran (MC) dengan menggunakan makanan yang tersedia secara lokal yang kurang dimanfaatkan. Stunting didefinisikan sebagai panjang badan menurut umur (PB/U) dalam Z skor <-2 SD sedangkan untuk non-stunting dengan PB/U ≥-1 SD. Kedua kelompok memiliki Z skor berat badan menurut panjang badan yang normal (BB/PB antara -2 SD hingga +1SD). Pemrograman linier digunakan untuk pengembangan rekomendasi pemberian rekomendasi pemberian makan (Optifood) dan CG (Nutrisurvey2004). Sebanyak 151 data dianalisis. Tidak ada perbedaan signifikan pada asam amino dan asupan gizi makro mikro kecuali proporsi protein yang berisiko kekurangan lebih tinggi pada kelompok SNW. Arginin merupakan satu-satunya konsentrasi darah yang berbeda antar kelompok. Histidin menjadi sebuah masalah gizi mutlak pada kelompok SNW dan NSNW, sedangkan riboflavin dan zink rendah dalam kelompok stunting tetapi cukup pada kelompok normal. Selain itu, zat gizi makro dan mikro lainya kurang dalam kedua kelompok kecuali protein dan vitamin A. Zat gizi yang kurang adalah Ca, Vit C, Thiamin, Riboflavin, Niasin, B6, Folat, B12, Besi, Zink, dan Histidin. Rekomendasi yang diusulkan dapat memenuhi Vit C, Riboflavin, Besi, dan Zink tetapi tidak dapat mencukupi Ca, Thiamin, Niasin, B6, Folat, B12, dan Histidin. Dengan memasukkan kacang tunggak, buncis batik, ikan wader, dan susu sapi dalam pengembangan CG, zat gizi yang sebelumnya kurang dapat tercukupi.

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Amino acids be the emerging nutrients that hypothesized to be associated with linear growth when many studies found that protein intake is considerably adequate and micronutrient intervention showed an unsatisfactory result. Stunting condition concurrently occurred with wasting as they may share similar pathways. Therefore, studies on stunting may have an exaggerated results when wasting was not an exclusion. This 2 phases comparative cross sectional study aimed to compare amino acid intake and its concentration in blood between stunted non-wasted (SNW) and non-stunted non-wasted (NSNW) children aged 12-23 months and using the results of phase 1 to develop a complementary feeding recommendation (CFR) and food multi-mix (FMM) by incorporating underutilized locally available foods. Stunted was defined as length for age z-score (LAZ) <-2 SD whereas for non-stunted with LAZ ≥-1 SD. Both groups have normal weight for length z-score (WLZ between -2 SD to +1SD). Linear programming was used for CFR (Optifood) and FMM development (Nutrisurvey 2004). A total of 151 data was analyzed. No significant different on the amino acid and macro micronutrients intake except the proportion protein at risk of inadequacy was significantly higher among SNW group. Arginine was the only blood concentration that significantly different between the groups. Histidine was an absolute problem nutrient in SNW and NSNW group, whereas riboflavin and zinc were inadequate among stunted group but adequate among normal group. In addition, other macro and micronutrients were inadequate in both groups except for protein and vitamin A. The inadequate nutrients were Ca, Vit C, Thiamin, Riboflavin, Niacin, B6, Folate, B12, Iron, Zinc and histidine. With the proposed recommendations, it can fulfil Vit C, Riboflavin, Iron and Zinc. But it cannot fulfil Ca, Thiamin, Niacin, B6, folate, B12 and histidine. With the incorporation of the selected underutilized cowpea, buncis batik, wader fish and cows’ milk in the FMM development, the nutrients that are challenging in CFR development, can be fulfilled."

"Kelebihan beban cairan pascaresusitasi dihubungkan dengan luaran buruk sehingga diperlukan deresusitasi. Tekanan vena sentral (TVS) rendah penting untuk menjamin aliran balik darah, meningkatkan curah jantung dan memperbaiki perfusi jaringan. Penelitian ini bertujuan menilai efektivitas deresusitasi dengan target TVS 0–4 mmHg pada pasien pascaresusitasi renjatan sepsis di ICU. Penelitian menggunakan desain randomized controlled trial dan dilakukan di RSUPN dr. Cipto Mangunkusumo pada bulan September 2019–Oktober 2020. Subjek berusia 18–60 tahun dengan renjatan sepsis pascaresusitasi. Kriteria eksklusi adalah gangguan jantung primer, gagal jantung kanan, penyakit jantung bawaan, penyakit paru obstruksi menahun berat, efusi pleura berat, batu atau tumor ginjal dan gagal ginjal kronik. Subjek penelitian dibagi menjadi dua kelompok dengan target TVS 0–4 mmHg dan 8–10 mmHg dan dilakukan dideresusitasi. Target TVS dicapai dengan furosemid drip dan loading kristaloid. Parameter luaran adalah perbedaan hasil PVD, stadium AKI, indeks curah jantung, lama penggunaan ventilator, dan lama hari perawatan di ICU. Data dianalisis program SPSS versi 20.0 meliputi analisis deskriptif dan inferensial memakai uji yang sesuai. Dari 44 subjek, 1 subjek dikeluarkan karena menjalani hemodialisis karena gagal ginjal kronik pada kelompok dengan target TVS 8–10 mmHg. Karakteristik dasar pasien berupa stadium AKI, ureum, kreatinin dan nilai TVS inisial berbeda bermakna pada kedua kelompok. Deresusitasi dengan target TVS 0–4 mmHg tidak berbeda bermakna pada nilai PVD, perbaikan AKI, CI, lama penggunaan ventilator, dan perawatan ICU (p>0,05). Tiga subjek meninggal sebelum selesai follow up pada kelompok dengan target TVS 0–4 mmHg dan 6 subjek meninggal sebelum selesai follow up, pada kelompok dengan target TVS 8–10 mmHg. Simpulan: Tidak didapatkan perbedaan efektivitas antara target deresusitasi TVS 0‒4 mmHg dengan target TVS 8‒10 mmHg terhadap nilai PVD sublingual, perubahan stadium AKI KDIGO, indeks curah jantung, lama penggunaan ventilator, lama perawatan ICU

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Post-resuscitation fluid overload is associated with a poor outcome in critically patient and thus requires deresuscitation (aggressive fluid removal). Low central venous pressure (CVP) is important to ensure the venous return, increase cardiac output and improve tissue perfusion. This study aims to assess the effectiveness of deresuscitation with a CVP target of 0–4 mmHg in post-septic shock resuscitation patients in the emergency department and ICU. This study used a randomized controlled trial design at RSUPN Dr. Cipto Mangunkusumo in September 2019–October 2020. The study sample was patients 18–60 years old with septic shock in the post-resuscitation ICU. Exclusion criteria were patients with primary heart failure, right heart failure, congenital heart disease, severe chronic obstructive pulmonary disease, severe pleural effusion, kidney stones or tumors, and chronic renal failure. The study subjects were deresuscited and divided into two CVP target groups (0–4 mmHg and 8–10 mmHg). Furosemide drip and cristaloid were given to reach target of CVP. Outcome parameters were differences in PVD, AKI stage, cardiac index (CI), ventilator duration, and length of stay in ICU. Statistical analysis includes descriptive and inferential analysis testing the appropriate test. Data analysis was performed using the SPSS version 20.0 statistical program. Results: There were 44 subjects, 1 subject were excluded due to hemodialysis in CVP target of 8–10 mmHg. Baseline characteristics have significant difference in ureum, creatinine, AKI stage and initial CVP value between two groups. Deresuscitation with a CVP target of 0–4 mmHg did not have a significant difference in the value of PVD, improvement in AKI, CI, ventilator duration, and length of ICU stay (p > 0.05). Three subjects died before 7 days of follow up in CVP target of 0–4 mmHg and 3 subjects died before 7 days of follow up in CVP target of 8–10 mmHg."

"Beban kompleks ventrikel prematur (KVP) memiliki tiga jenis ritme sirkadian, yaitu tipe cepat, tipe lambat, dan tipe independen. Nukleus suprakiasmatikus merupakan bagian dari hipotalamus dan berperan sebagai pusat yang mengatur ritme sirkadian tubuh. Nukleus suprakiasmatikus berhubungan dengan sumbu hipotalamus-pituitari-adrenal (HPA), sistem saraf autonom, dan aspek psikologis. Hubungan ketiga sistem ini dengan ritme sirkadian beban KVP belum diketahui. Oleh karena itu, perlu dilakukan penelitian untuk menganalisis hubungan sumbu HPA, sistem saraf autonom, dan aspek psikologis dengan ritme sirkadian beban KVP. Studi observasional potong lintang ini merekrut subjek penelitian di RS Jantung dan Pembuluh Darah Harapan Kita, RSUD Pakuhaji, dan RS Bun. Waktu penelitian adalah dari Juli 2022 sampai Desember 2022. Kriteria inklusi adalah pasien KVP idiopatik dengan beban ≥ 5%. Sebanyak 23 subjek KVP tipe-cepat, 20 subjek KVP tipe-lambat, 22 pasien KVP tipe-independen, dan 5 subjek kontrol diikutsertakan pada penelitian. Setiap subjek menjalani pemeriksaan Holter 24 jam untuk evaluasi beban KVP dan heart rate variability, mengumpulkan saliva untuk pemeriksaan kortisol dan norepinefrin pada pukul 06:00–07:00, 10:00–11:00, dan 22:00–23:00, serta mencatat skala kesehatan subjektif. Selanjutnya, dilakukan analisis univariat dan regresi linier multipel untuk menganalisis hubungan antara ritme sirkadian variabel independen dan ritme sirkadian beban KVP. Hasil pemeriksaan Holter menunjukkan bahwa rerata beban KVP idiopatik tipe-cepat adalah 15,7%; tipe-lambat 8,4%; dan tipe-independen 13,6%. Regresi liner multipel menunjukkan bahwa tingginya beban KVP idiopatik-tipe-cepat berhubungan dengan kadar kortisol yang lebih tinggi dan tonus sistem saraf parasimpatis yang lebih rendah. Di samping itu, tingginya beban KVP idiopatik-tipe-lambat berkaitan dengan kadar kortisol dan tonus sistem saraf simpatis yang lebih rendah atau tonus sistem saraf parasimpatis yang lebih tinggi. Sementara itu, pada KVP idiopatik-tipe-independen tingginya beban KVP berhubungan dengan kadar kortisol dan tonus sistem saraf simpatis yang lebih tinggi atau tonus sistem saraf parasimpatis yang lebih rendah serta skala kesehatan subjektif yang lebih rendah. Disimpulkan bahwa pola sirkadian beban KVP idiopatik tipe cepat, lambat, dan independen masing-masing berhubungan secara khas dengan sumbu HPA, sistem saraf autonom dan mekanisme psikologis. Penilaian tipe ritme sirkadian KVP idiopatik perlu dilakukan secara rutin mengingat perbedaan mekanisme yang mendasarinya dan kemungkinan perbedaan pada prognosisnya.

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Recent data show that premature ventricular complex (PVC) burden exhibits one of the three circadian patterns, namely fast-type, slow-type, and independent-type PVC. The suprachiasmatic nucleus is part of the hypothalamus and serves as the center of circadian rhythm regulation. The suprachiasmatic nucleus is related to the hypothalamus-pituitary-adrenal (HPA) axis, the autonomic nervous system, and psychological aspects. The relationship between these three systems and the circadian rhythm of PVC is unknown. Therefore, it is important to evaluate the relationship between the HPA axis, the autonomic nervous system, and psychological aspects with the circadian rhythm of PVC burden. This cross-sectional observational study recruited 23 fast-, 20 slow-, and 22 independent-type idiopathic PVC subjects, as well as 5 control subjects. Each subject underwent a 24-hour Holter to examine PVC burden and heart rate variability, collected saliva for cortisol and norepinephrine level measurement at 6–7 am, 10–11 am, and 10–11 pm, and recorded their self-rated health scales. Furthermore, univariate and multiple linear regression were conducted to investigate the associations between circadian rhythms of the independent variables and circadian rhythms of PVC burden. The results of the Holter monitor showed that the average PVC burden was 15.7%, 8.4%, and 13.6% respectively in fast-, slow-, and independent-type idiopathic PVCs. Multiple linear regression showed that the high burden of fast-type idiopathic PVC was assosciated with higher cortisol levels and lower parasympathetic nervous system tone. On the other hand, the high burden of slow-type idiopathic PVC was associated with lower cortisol levels and lower sympathetic nervous system tone. Meanwhile, in independent-type idiopathic PVC, the high burden was associated with higher cortisol levels and sympathetic nervous system tone as well as lower self-rated health scales. The results of this study indicate that each circadian pattern of idiopathic PVC burden is uniquely related to the HPA axis, the autonomic nervous system and psychological mechanisms. Assessment of idiopathic PVC circadian rhythm types needs to be carried out routinely considering the differences in the underlying mechanisms and the possible differences in the prognosis."