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Abstrak :

 Leptin berfungsi untuk menjaga keseimbangan energi untuk mencegah penambahan berat badan dalam menurunkan risiko resistensi leptin. Peningkatan leptin dipengaruhi oleh jumlah simpanan lemak dan perubahan akut dari asupan makanan. Asupan energi mempengaruhi sekresi leptin untuk menjaga keseimbangan energi. Healthy eating index (HEI) tinggi diartikan kualitas diet yang baik mencegah penyimpanan lemak dan peningkatan berat badan. Kami bertujuan untuk mengetahui hubungan antara HEI dan asupan energi total dengan kadar leptin pada orang dewasa perkotaan Jakarta. Teknik pengambilan sampel adalah metode konsekutif dan diperoleh 110 subjek yang memenuhi kriteria penelitian. Pengambilan data melalui 3 kali 24 jam food recall, pengukuran antropometri dan pengambilan serum darah. Asupan energi total rata-rata 1894 ± 482 kkal. Hasil skor HEI 36,5 (31,7-41,2). Hasil kadar leptin 15,7 (7,6-26,1) ng/ml. Hubungan signifikan negatif antara asupan energi total dengan kadar leptin (β -0,8, p=0,008) sebelum disesuaikan dengan usia, jenis kelamin dan IMT. Hubungan antara HEI dengan kadar leptin tidak didapatkan hubungan yang signifikan. ......The function of leptin is to maintain energy balance to prevent weight gain and reduce the risk of leptin resistance. High leptin is influenced by the amount of fat stores and acute changes in food intake. Energy intake affects leptin secretion to maintain energy balance. A high healthy eating index (HEI) means a good quality diet prevents fat storage and weight gain. We aimed to determine the relationship between HEI and total energy intake with leptin levels in Jakarta urban adults. The sampling technique was the concecutive method and obtained 110 subjects who met the research criteria. Data were collected through 3 times 24 hours of food recall, anthropometric measurements and taking blood serum. Average total energy intake was 1894 ± 482 kcal. HEI score 36.5 (31.7-41.2). The results of leptin levels were 15.7 (7.6-26.1) ng/ml. There was a significant negative relationship between total energy intake and leptin levels (β -0.8, p=0.008) before adjusting for age, sex and BMI. There was no significant relationship between HEI and leptin levels.

Abstrak :
Pendahuluan. Gagal jantung merupakan penyakit kronik dengan angka perawatan ulang satu tahun yang tinggi. Program Multidisiplin (multidisciplinary program, MDP) yang melibatkan tenaga medis dan nonmedis termasuk dokter kardiologi, dokter bedah jantung, dokter rehabilitasi medik, dokter gizi klinik, perawat dan fisioterapis mampu menurunkan angka perawatan ulang satu tahun sebesar 74%. Klinik Gagal Jantung Instalasi Pelayanan Jantung Terpadu (PJT) RSCM yang mengusung penerapan MDP telah berdiri sejak bulan Nopember 2018, tetapi belum ada data yang tersedia mengenai pengaruh MDP pada angka perawatan ulang pasien gagal jantung kronik. Penelitian ini bertujuan untuk mengetahui peranan MDP terhadap penurunan angka perawatan ulang satu tahun pasien gagal jantung kronik di RSCM. Metode. Penelitian menggunakan desain studi kohort retrospektif yang menggunakan data sekunder pasien gagal jantung kronik kelas NYHA II-IV yang menjalani rawat jalan di poliklinik PJT RSCM tahun 2017 dan 2019. Pasien diikuti hingga satu tahun pasca kontrol pertama untuk dinilai apakah mengalami perawatan ulang di rumah sakit. Dilakukan analisis bivariat untuk melihat pengaruh dari MDP terhadap angka perawatan ulang rumah sakit satu tahun dan analisis multivariat untuk menilai apakah pengaruh tersebut dipengaruhi oleh usia, jenis kelamin, kelas fungsional NYHA, komorbid, kepatuhan berobat, obesitas, anemia dan pembiayaan. Hasil. Dari 133 subjek penelitian, sebagian besar subjek adalah laki-laki dengan median usia adalah 57 tahun. Angka perawatan ulang satu tahun sebelum penerapan MDP adalah 47,54%, sedangkan sesudah MDP adalah 38,89%, dengan penurunan angka perawatan ulang satu tahun pada kelompok yang sudah menjalani MDP sebesar 8,65% dan NNT 12. Dibandingkan dengan kelompok yang belum MDP, terjadi penurunan risiko perawatan ulang satu tahun pada kelompok yang sudah menjalani MDP sebesar 18,2%. Tidak didapatkan pengaruh yang bermakna secara statitistik antara MDP dan angka perawatan ulang satu tahun dengan nilai RR 0,818 (IK95%: 0,553 – 1,210, p=0,315). Faktor usia, jenis kelamin, kelas NYHA, komorbid, obesitas, anemia, kepatuhan, dan pembiayaan tidak menjadi faktor perancu pengaruh program MDP terhadap angka perawatan ulang satu tahun pasien gagal jantung kronik di RSCM. Kesimpulan. Penerapan program multidisiplin (MDP) menyebabkan penurunan risiko perawatan ulang satu tahun pasien gagal jantung kronik di RSCM sebesar 18,2%, namun diperlukan penelitian lebih lanjut dengan sampel yang lebih besar untuk meningkatkan kekuatan statistik. ...... Introduction. Heart failure is a chronic disease with high readmission rate. The multidisciplinary program (MDP), involving medical and non-medical personnel including cardiologists, cardiac surgeons, cardiac rehabilitation doctors, clinical nutritionists, nurses and physiotherapists is known to reduce the one-year readmission rate by 74%. The Heart Failure Clinic in PJT RSCM has implemented MDP since November 2018, but there is no data available regarding the effect of MDP on the readmission rate of chronic heart failure patients. This study aims to determine the effect of MDP on reduction of the one-year readmission rate of chronic heart failure patients in RSCM. Method. This retrospective cohort study is conducted using medical record from NYHA class II-IV chronic heart failure patients undergoing outpatient care in RSCM Polyclinic in year 2017 and 2019. Patients were followed up in one year after the first control to assess whether they experienced readmission or not. Bivariate analysis was performed to analyze the impact of MDP on the incidence of one-year hospital readmission and multivariate analysis to assess whether the impact was influenced by age, sex, NYHA functional class, comorbidities, medication adherence, obesity, anemia and funding. Results. Of the 133 research subjects, most were male with a median age 57 age years old. The readmission rate before MDP was 47.54%, while after MDP it was 38.89%, with absolute reduction on incidence of 8,65%. Compare to subjects before MDP, subjects whose had MDP has a reduction of one-year readmission risk of 18,2% and NNT of 12. There is no statistically significance of MDP regards to one-year readmission rate of chronic heart failure patients in RSCM with RR value of 0.818 (IK95: 0.553 – 1.210, p=0.315). Age, gender, NYHA class, comorbidities, obesity, anemia, adherence, and funding were not as confounding factors for the effect of the MDP program on one-year readmssion of chronic heart failure patients in RSCM. Conclusion. The multidisciplinary program (MDP) reduced risk of one-year readmission of chronic heart failure by 18.2%, however further studies with larger samples are needed to improve statistical power.

Abstrak :
Latar Belakang: Penurunan massa bebas lemak dan status fungsional akan mempengaruhi prognosis pada pasien kanker kepala leher. Pembentukan massa bebas lemak dipengaruhi berbagai hal termasuk nutrisi. Salah satu zat gizi yang berperan dalam adalah asam amino rantai cabang. Karnofsky Performance Scales (KPS) adalah salah satu parameter status fungsional yang dinilai secara rutin untuk pasien kanker Penelitian ini bertujuan untuk melihat korelasi antara asupan asam amino rantai cabang dengan massa bebas lemak dan status fungsional pada pasien kanker kepala dan leher. Metode: Studi potong lintang ini dilakukan pada subjek dewasa dengan kanker kepala leher secara consecutive sampling method di poliklinik radioterapi RSCM. Wawancara dilakukan untuk mengumpulkan data karakteristik dasar, data asupan zat gizi dan penilaian status fungsional. Pengukuran komposisi tubuh massa bebas lemak dengan alat bioimpedance analysis single Frequency. Pengukuran status fungsional dengan KPS. Hasil: Sebanyak 77 subjek penelitian dengan rerata usia 52 tahun, dengan sebagian besar berjenis kelamin laki-laki, 61 % berpendidikan menengah dan sebagian besar bekerja. Lokasi kanker terbanyak pada nasofaring dengan jenis karsinoma sel skuamosa dan stadium IV. Rerata subjek memiliki status gizi normal. Penilaian 3 x24-h Food Recall didapatkan dengan rerata asupan energi 27,44 kkal/kgBB dan protein 1,33 g/kgBB. Penilaian rerata asupan AARC dengan FFQ semi kuantitatif pada subjek penelitian didapatkan sebesar 10,99 gram. Pada penelitian ini didapatkan rerata nilai massa bebas lemak 42,10 kg dengan sebanyak 46 % subjek penelitian laki- laki memiliki index massa bebas lemak < 17 kg/m2 sedangkan pada subjek penelitian wanita terdapat 16 % dengan index massa bebas lemak <15 kg/m2 Status fungsional dengan menggunakan KPS subjek penelitian dengan median 90 dengan nilai minimum 40. Sekitar 11,6% subjek penelitian yang memiliki nilai KPS kurang dari sama dengan 70. Terdapat korelasi lemah antara asupan asam amino rantai cabang dengan massa bebas lemak (r=0,238, p=0,037).Tidak terdapat korelasi antara asupan AARC dengan status fungsional (r=0.147; p>0.05) Kesimpulan: Terdapat korelasi bermakna yang lemah antara asupan AARC dengan massa bebas lemak dan tidak terdapat korelasi antara asupan AARC dengan status fungsional pada subjek kanker kepala leher ......Background: Decreased fat-free mass and functional status will affect the prognosis in head and neck cancer patients. The formation of fat-free mass is influenced by various things including nutrition. One of the nutrients that play a role in is branched chain amino acids. Karnofsky Performance Scales (KPS) is a functional status parameter that is routinely assessed for cancer patients. Methods: This cross-sectional study was conducted on adult subjects with head and neck cancer by consecutive sampling method at the radiotherapy polyclinic RSCM. Interviews were conducted to collect data on basic characteristics, data on nutrient intake and assessment of functional status. Measurement of body composition fat-free mass using a single Frequency bioimpedance analysis tool. Functional status measurement using the KPS. Results: A total of 77 study subjects with an average age of 52 years, with most of them being male, 61% having secondary education and most of them working. Most cancer locations in the nasopharynx with the type of squamous cell carcinoma and stage IV. On average, the subjects had normal nutritional status. The 3 x24-h Food Recall assessment was obtained with an average energy intake of 27.44 kcal/kgBW and protein 1.33 g/kgBW. The assessment of the average BCAA intake with semi-quantitative FFQ on research subjects was 10.99 grams. In this study, the average fat-free mass value was 42.10 kg with as many as 46% of male research subjects having a fat-free mass index <17 kg/m2 while in female research subjects there were 16% with a fat-free mass index <15 kg/m2. Functional status using KPS of research subjects with a median of 90 with a minimum value of 40. Approximately 11.6% of study subjects had a KPS value of less than 70. There was a weak correlation between intake of branched-chain amino acids and fat-free mass (r=0.238, p=0.037. There was no correlation between BCAA intake and functional status (r=0.147; p>0.05) Conclusion: There is a weak significant correlation between BCAA intake and fat-free mass and there is no correlation between BCAA intake and functional status in head and neck cancer subjects

Abstrak :
Respons antibodi spesifik SARS-CoV-2 dapat diperoleh dari paparan virus ketika infeksi ataupun dari vaksinasi. Studi mengenai rasio CD4+/CD8+ sebagai penanda status imunitas masih belum banyak dilakukan pada dewasa sehat. Vitamin D yang memiliki efek imunomodulatori pada sistem imun adaptif dan alamiah, mampu memodulasi pembentukan antibodi dan regulasi dari sel T. Penelitian ini bertujuan melihat hubungan kadar 25(OH)D serum terhadap titer antibodi SARS-CoV-2 dan rasio CD4+/CD8+ sebagai penanda status imunitas individu. Studi potong lintang ini dilakukan terhadap tenaga kesehatan di tiga rumah sakit rujukan COVID-19 di Jakarta dan Depok pada periode Juli–Desember 2021. Pengambilan data yang dilakukan berupa wawancara kuesioner data sosiodemografik, pemeriksaan tanda-tanda vital, pengukuran antropometri, dietary assessment menggunakan 24-h food recall dan SQ-FFQ. Pengambilan sampel darah dilakukan untuk menilai kadar 25(OH)D serum, rasio CD4+/CD8+, dan titer antibodi SARS-CoV-2. Didapatkan 154 tenaga kesehatan usia 22-53 tahun dalam kondisi sehat dan tanpa riwayat penyakit kronis. Median asupan vitamin D subjek penelitian sebesar 2,42 mcg/hari (1,23–4,00) dengan 94,7% subjek memiliki asupan vitamin D yang kurang. Median kadar serum 25(OH)D pada subjek sebesar 14,4 ng/mL (9,50–18,62) dengan 81,8% subjek mengalami defisiensi dan 14,9% subjek mengalami insufisiensi vitamin D. Median rasio CD4+/CD8+ 1,14 (0,88–1,34), 85,7% subjek memiliki titer antibodi SARS-CoV-2 >250 U/mL dan 14,3% subjek memiliki titer antibodi ≤250. Tidak ditemukan adanya hubungan yang siginifikan antara kadar 25(OH)D dengan titer antibodi SARS-CoV-2 (p 0,209 OR 4,101 95% CI 0,45–37,04) dan Rasio CD4/CD8 (p 0,385 𝛃 -0,005 95% CI -0,0015–0,006). Asupan dan kadar vitamin D pada subjek penelitian masih tergolong rendah. Penelitian ini tidak berhasil membuktikan adanya hubungan antara kadar serum 25(OH)D dengan rasio CD4+/CD8+ dan titer antibodi SARS-CoV-2. ......SARS-CoV-2 specific antibody response can be generated from exposure to the virus during infection or from vaccination. There is limited data on CD4+/CD8+ ratio in healthy individuals as a marker of immunity status. Vitamin D, which has an immunomodulatory effect on both  innate and adaptive immune systems, is able to modulate antibody formation and regulation of T cells. This study aimed to examine the association between serum 25(OH)D levels and SARS-CoV-2 antibody titers along with CD4+/CD8+ ratio as a marker of immunity status. This cross-sectional study was conducted on healthcare workers at three COVID-19 referral hospitals in Jakarta and Depok in the period of July–December 2021. Data collection was carried out using questionnaire, examination of vital signs, anthropometric measurements, dietary assessment using 24-h food recall, and SQ-FFQ. Blood samples were taken to assess serum 25(OH)D levels, CD4+/CD8+ ratio, and SARS-CoV-2 antibody titers. 154 healthcare workers aged 22-53 years who were in good health and had no history of chronic disease were examined in this study. The median intake of vitamin D was 2.42 mcg/day (1.23-4.00), with 94.7% of participants having insufficient intake of vitamin D. The median serum 25(OH)D level was 14.4 ng/mL (9.50-18.62), with 81.8% participants are vitamin D deficiency and 14.9% are insufficient. Median CD4+/CD8+ ratio was 1.14 (0.88 to 1.34). 85.7% participants had SARS-CoV-2 antibody titers >250 U/mL, while 14.3% were below 250 U/mL. There was no significant relationship of serum 25(OH)D levels to SARS-CoV-2 antibody titers (p 0.209 OR 4.101 95% CI 0.45–37.04) and CD4+/CD8+ ratio (p 0.385 o-0.005 95% CI -0.0015–0.006). Vitamin D intake and serum 25(OH)D levels are relatively low. This study disproves relationship between serum 25(OH)D levels with CD4+/CD8+ ratio and SARS-CoV-2 antibody.

Abstrak :
Pasien rawat inap banyak yang mengalami malnutrisi di rumah sakit (RS). Malnutrisi dihubungkan dengan berbagai komplikasi, seperti risiko yang lebih tinggi mengalami infeksi, memperpanjang masa rawat (length of stay), meningkatkan biaya rawat, serta meningkatkan risiko morbiditas dan mortalitas. Variabilitas prevalensi malnutrisi masih banyak terjadi, akibat banyaknya instrumen skrining dan asesmen serta batas ambang penentuan malnutrisi. Kriteria malnutrisi terbaru menurut Global Leadership Initiative on Malnutrition (GLIM) mengusulkan model dua langkah untuk mendiagnosis malnutrisi di RS. Penelitian ini bertujuan untuk menguji kesahihan kriteria diagnosis GLIM dibandingkan dengan ASPEN dalam mendiagnosis malnutrisi pada pasien rawat inap dewasa. Penelitian menggunakan desain potong lintang pada subjek dewasa yang dirawat inap di RSCM. Setiap pasien didiagnosis menggunakan kriteria GLIM dan ASPEN oleh dokter yang berbeda. Sebanyak 100 subjek penelitian dengan median usia 44,5 tahun, mayoritas perempuan, diagnosis malnutrisi menurut kriteria GLIM paling banyak didapatkan pada pasien penyakit saluran cerna, hepatobilier dan pankreas 69% (20 dari 29 subjek) yang diikuti dengan penyakit keganasan 47% (10 dari 21 subjek). Menurut kriteria ASPEN, terdapat 48% pasien malnutrisi dengan rincian 22% malnutrisi sedang dan 26% malnutrisi berat. Menurut kriteria GLIM, terdapat 63% pasien dengan malnutrisi. Kriteria malnutrisi GLIM memiliki sensitivitas 97,9%, spesifisitas 69,2%, NPP 74,6%, dan NPN 97,3%. Uji chi square menunjukkan adanya perbedaan signifikan (p = 0.000) antara GLIM dan ASPEN. Uji Cohen’s Kappa menunjukkan nilai k = 0,663 dan nilai p = 0.071 yang menunjukkan kesepakatan antara diagnosis GLIM dengan ASPEN dengan tingkat sedang (nilai k = 0,61-0,8) dan tidak signifikan. Median total lymphocyte count (TLC) adalah 1,725/mm3 dengan TLC terendah 340/mm3 dan tertinggi 15,660/mm3. Median kadar albumin adalah 3,85 g/dl dengan nilai terendah 1,1 g/dl dan tertinggi 5,4 g/dl. ......Many inpatients are malnourished in the hospital (RS). Malnutrition is associated with various complications, such as a higher risk of infection, length of stay, increased hospitalization costs, and increased risk of morbidity and mortality. There is still a lot of variability in the prevalence of malnutrition, due to the large number of screening and assessment instruments and the threshold for determining malnutrition. The latest malnutrition criteria according to the Global Leadership Initiative on Malnutrition (GLIM) proposes a two-step model for diagnosing malnutrition in hospitals. This study aimed to examine the validity of the GLIM diagnostic criteria compared to ASPEN in diagnosing malnutrition in adult hospitalized patients. The study used a cross-sectional design on adult subjects who were hospitalized at RSCM. Each patient was diagnosed using the GLIM and ASPEN criteria by a different physician. A total of 100 patients with a median age of 44.5 years participated in the study, the majority were women, the diagnosis of malnutrition according to the GLIM criteria was mostly found in patients with gastrointestinal, hepatobiliary, and pancreatic diseases 69% (20 of 29 subjects) followed by malignancy 47% (10 of 21 subjects). According to ASPEN criteria, there were 48% of malnourished patients, 22% moderate malnutrition and 26% severe malnutrition, meanwhile according to the GLIM criteria, there are 63% of patients with malnutrition. The GLIM malnutrition criteria had a sensitivity of 97.9%, specificity of 69.2%, PPV 74.6%, and NPV 97.3%. The chi square test showed a significant difference (p = 0.000) between GLIM and ASPEN. Cohen's Kappa test showed a value of k = 0.663 and a value of p = 0.071 which indicated a moderate (k = 0.61-0.8) and insignificant agreement between the diagnosis of GLIM and ASPEN. The median total lymphocyte count (TLC) was 1.725/mm3 with the lowest TLC of 340/mm3 and the highest of 15,660/mm3. The median albumin level was 3.85 g/dl with the lowest value 1.1 g/dl and the highest 5.4 g/dl.