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Menopause menyebabkan hipoestrogenisme dan mengakibatkan penuaan kulit. Fitoestrogen dari biji T. foenum-graecum (klabet) diharapkan dapat mengatasi penuaan kulit pascamenopause. Penelitian ini bertujuan untuk mengetahui konsentrasi optimal ekstrak klabet dalam menstimulasi sekresi COL1A1 dan COL3A1, cara kerjanya melalui jalur reseptor estrogen α (REα) atau REβ, dan peran klabet dalam mengurangi kerutan serta meningkatkan ketebalan kulit wajah.

Studi in vitro menggunakan human dermal fibroblast (HDF) tua yang diperoleh dari kultur sel fibroblas kulit perempuan pascamenopause dan HDF muda dari prepusium, dilakukan di Laboratorium Universitas YARSI. Sekresi COL1A1 dan COL3A1 diperiksa dengan ELISA lalu ditambah antagonis REa dan b. Penelitian in vivo merupakan uji klinis acak tersamar ganda berdurasi 12 minggu, di RSCM, Januari–November 2019. Subjek 50 perempuan pascamenopause yang dibagi dua: kelompok perlakuan mendapat krim klabet 5% dan kelompok plasebo mendapat krim dasar. Skor kerutan dahi, crow’s feet, dan nasolabial diukur dengan skoring atlas skin aging Bazin dan tebal dermis dengan high resolution ultrasound (HRU) 18 MHz.

Ekstrak klabet 2 µg/mL merupakan konsentrasi optimal dalam meningkatkan sekresi COL1A1 dan COL3A1 pada HDF tua dan muda dibandingkan tanpa perlakuan dan 5 nM estradiol. Uji inhibisi menunjukkan hambatan REα 50%; REβ dan RE α,β sampai 75%. Penurunan skor kerutan dahi, crow’s feet, dan nasolabial berbeda bermakna pada kedua kelompok minggu ke-4, ke-8, dan ke-12.  Peningkatan selisih skor kerutan dahi, crow’s feet, dan nasolabial tidak bermakna pada kedua kelompok antara baseline, minggu ke-4, ke-8, dan ke-12. Ketebalan dermis meningkat bermakna pada minggu ke-4 dibandingkan baseline. Pada minggu ke-8 dibandingkan minggu ke-4 dan pada minggu ke-12 dibandingkan minggu ke-8, ketebalan dermis menurun bermakna pada kedua kelompok. Peningkatan selisih ketebalan dermis pada minggu ke-4 dan ke-8 tidak bermakna.

Simpulan: Ekstrak klabet 2 µg/mL meningkatkan COL1A1 dan COL3A1 lebih banyak dibandingkan kelompok tanpa perlakuan dan estradiol 5 nM. Klabet bekerja terutama melalui REβ. Penurunan skor kerutan kulit dan peningkatan ketebalan kulit wajah tidak bermakna dibandingkan plasebo. Diduga, krim klabet konsentrasi 5% tidak tepat untuk mengurangi kerutan dan menambah ketebalan kulit. Perlu penelitian lebih lanjut untuk mengetahui konsentrasi optimal klabet sebagai terapi penuaan kulit wajah pascamenopause.

 

Kata kunci: COL1A1, COL3A1, kerutan kulit, ketebalan dermis, klabet, pascamenopause, penuaan kulit wajah, Trigonella foenum-graecum.

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Hypoestrogenism in menopause leads to skin aging, for which phytoestrogen originated from the seeds of T. foenum-graecum (fenugreek) is expected to be a solution. This study aims to show the effect of phytoestrogen from fenugreek extract in stimulating COL1A1 and COL3A1 through its mechanism of action on estrogen receptor (ER) ERa or ERb and its role in diminishing facial wrinkles and increasing dermal thickness.

The in vitro study was carried out in YARSI University Laboratory throughout March 2017–March 2018. This study looks into the effect of fenugreek extract on collagen level secretion in old and young human dermal fibroblast (HDF) compared to control. The in vivo study was a randomized, double-blind, 12-week trial conducted in RSCM from January–November 2019. Fifty postmenopausal women divided into two groups: the intervention group was given 5% fenugreek cream while the placebo group was given base cream.

The in vitro study showed that a concentration of 2 mg/mL was the optimal dose to stimulate COL1A1 and COL3A1 secretion in both old and young HDF compared to control (no treatment) and 5 nM estradiol. The inhibition test demonstrated suppression of ERa by 50%; ERb and ERa,b by up to 75%, indicating that the fenugreek activates both receptors, especially ERb. However, the success of the in vitro study did not translate into the in vivo study. Both the intervention group and the placebo group were able to achieve statistically significant in facial wrinkle scores from all focus areas without any significant disparity between both groups at all timepoints. Dermal thickness of facial skin showed similar results for both groups with significant improvements in the 8^thweek compared to baseline and significant decrease by the 12^thweek.

Conclusion: Fenugreek extract with a concentration of 2 mg/mL increased COL1A1 and COL3A1 secretion more potently compared to control and estradiol 5 nM. However, the decrease in facial skin wrinkles scores and the increase in dermal thickness were not significant compared to placebo. We suspect that a concentration of 5% was not adequate for the expected antiaging effects. Further studies are necessary to determine a more appropriate fenugreek concentration to permit clinical use as a postmenopausal antiaging therapy.

 

Keywords: COL1A1, COL3A1, dermal thickness, fenugreek, postmenopausal women, facial skin aging, skin wrinkles, Trigonella foenum-graecum.

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"[ABSTRAKTuberkulosis (TB) paru anak merupakan masalah kesehatan global yangterabaikan (neglected), terlebih dengan proporsi 7,32% dari seluruh kasus TB diIndonesia (Balitbangkes, 2013). TB paru anak selalu diakibatkan oleh infeksi TBdari populasi di lingkungan sekitar, khususnya adanya orang dewasa yg sakit TBserumah. Namun, tidak selalu TB paru dewasa mampu menularkan kesakitan padaanak serumah. Penelitian ini bertujuan untuk mengkaji faktor-faktor yang didugamenurunkan risiko anak tidak sakit TB paru ketika tinggal serumah denganpenderita dewasa. Metode dengan desain kasus kontrol berdasarkan data rekammedis di sembilan rumah sakit rujukan TB anak dan puskesmas di ProvinsiDaerah Istimewa Yogyakarta (DIY). Kondisi hunian khususnya kamar tidur yangbaik dan intensitas paparan TB paru dewasa yang jarang serta di pengaruhikondisi variabel lain merupakan faktor yang dapat melindungi anak agar tetapsehat meskipun kontak dengan penderita TB paru dewasa serumah;

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ABSTRACTTB disease in children is a global health problem that still neglected, moreoverwith 7,32% proportion of TB cases at Indonesia (Balitbangkes, 2013). Childrenwith TB disease is most always impacted from TB infection at environmentpopulation especially from adult TB household contacts. However, children notalways get the disease as bad as TB adult then. The objective of this study was tofind protective factors that can keep healthy children who had adult TB householdcontacts. A case-control study conducted at nine referred hospital of TB childrenand several health centers based on medical records at Special Region ofYogyakarta Province. The study found that healthy houses, especially withhealthy bedroom and fewer exposures with adult TB in order influenced byconfounders variables. Those variables were reduced the risk of childhood TBdisease eventhough they exposed with adult TB in their environment;TB disease in children is a global health problem that still neglected, moreoverwith 7,32% proportion of TB cases at Indonesia (Balitbangkes, 2013). Childrenwith TB disease is most always impacted from TB infection at environmentpopulation especially from adult TB household contacts. However, children notalways get the disease as bad as TB adult then. The objective of this study was tofind protective factors that can keep healthy children who had adult TB householdcontacts. A case-control study conducted at nine referred hospital of TB childrenand several health centers based on medical records at Special Region ofYogyakarta Province. The study found that healthy houses, especially withhealthy bedroom and fewer exposures with adult TB in order influenced byconfounders variables. Those variables were reduced the risk of childhood TBdisease eventhough they exposed with adult TB in their environment, TB disease in children is a global health problem that still neglected, moreoverwith 7,32% proportion of TB cases at Indonesia (Balitbangkes, 2013). Childrenwith TB disease is most always impacted from TB infection at environmentpopulation especially from adult TB household contacts. However, children notalways get the disease as bad as TB adult then. The objective of this study was tofind protective factors that can keep healthy children who had adult TB householdcontacts. A case-control study conducted at nine referred hospital of TB childrenand several health centers based on medical records at Special Region ofYogyakarta Province. The study found that healthy houses, especially withhealthy bedroom and fewer exposures with adult TB in order influenced byconfounders variables. Those variables were reduced the risk of childhood TBdisease eventhough they exposed with adult TB in their environment]"

"ABSTRAKDisertasi ini membahas tentang determinan infeksi tuberkulosis laten pada wargabinaan pemasyarakatan di Rutan klas 1 Bandung. Penelitian ini menggunakandesain cross sectional dan dianalisis dengan regresi logistik berganda. Hasilpenelitian ini menunjukan prevalensi infeksi TB laten sebesar 76,9 dan TB aktif2,3 . Risiko tinggi dan faktor yang paling dominan berhubungan dengan kejadianinfeksi TB laten yaitu kebiasan merokok sering sebesar 12,99 kali dan kebiasanmerokok kadang-kadang sebesar 9,34 kali. Determinan lainnya yang berisikomengalami infeksi TB laten yaitu riwayat kontak TB diluar rutan sebesar 3,02kali, status gizi kurang dari normal sebesar 2,64 kali dan status gizi lebih darinormal sebesar 0,21 kali, penahanan lebih dari 1 kali sebesar 0,44 kali, usia lebihdari 26-34 tahun sebesar 0,23 kali, usia 34-42 tahun sebesar 0,41 kali dan usialebih dari 42 tahun sebesar 0,63 kali. TB laten sangat tinggi sehingga diperlukanskrining TB laten agar dapat memutus mata rantai TB. Determinan utama TBlaten adalah merokok sehingga perlu pembatasan penjualan rokok dan membuatregulasi hingga kebiasaan merokok warga binaan pemasyarakatan berhenti. Selainitu, juga perlu meningkatkan status gizi sesuai dengan angka kecukupan gizi.

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ABSTRACTThis dissertation discusses the determinant latent tuberculosis infection ofprisoners in state prison class 1 Bandung. This study used cross sectional designand analyzed by multiple logistic regression. The results of this study show theprevalence of latent TB infection is 76.9 and active TB is 2.3 . The highest riskand the most dominant factors associated with the incidence of latent TB infectionwho have smoking habits frequently are 12.99 times and intermitent smokinghabits are 9.34 times. Other determinants who have risk of latent TB infectioninclude a history of TB contact outside the prison is 3.02 times, less nutritionalstatus from normally is 2.64 and nutritional status more than normally is 0.21times, incarceration more than once is 0,44 times, age range of 26 34 years old is0.23 times, the age 34 42 years is 0.41 times and the age more than 42 years is0.63 times. The occurence of latent TB is very high that latent TB screening isnecessary to be able to cut the transmission of TB. The main determinant of latentTB is smoking so it is necessary to restrict the sale of cigarettes and make aregulation to stop smoking habits of prisoners. In the other hand, it also needs toimprove nutritional status in accordance with the nutritional adequacy rate."

"Penelitian ini membahas pengaruh kadar vitamin D dan kalsium terhadap panjang dan berat lahir bayi. Jenis penelitian cross sectional melibatkan 144 ibu hamil trimester 3 dan bayi yang dilahirkan. Pemeriksaan vitamin D menggunakan biomarker 25(OH)D dan kalsium menggunakan kalsium total dari serum darah tali pusat. Pengukuran panjang dan berat lahir dilakukan terstandar segera setelah lahir dengan alat merk Seca tipe 231/231. Analisis menggunakan uji korelasi, t test, ANOVA dan analisis regresi linier ganda untuk melihat pengaruh status vitamin D dan kalsium terhadap panjang dan berat lahir dengan memperhatikan variabel pengganggu (umur, paritas, tinggi badan ibu dan ayah, kesesuaian penambahan berat badan ibu selama hamil sesuai IMT pra hamil, status anemia, aktifitas fisik, kecukupan gizi ibu dan merokok).Hasil yang diperoleh: rata-rata panjang dan berat lahir adalah normal 48.7 cm dan 3090.4 gram, panjang lahir pendek 31.2 % dan BBLR 8.3%. Rata-rata kadar serum 25(OH)D adalah 27.6 ng/dL, status vitamin D kurang mencapai 62,5%. Rata-rata kadar kalsium 10 ng/mL dan hipokalsemia 24.3%. Kadar vitamin D dan kalsium berpengaruh bermakna terhadap panjang lahir setelah dikontrol tinggi badan ibu, kadar haemoglobin dan kecukupan asupan energi ibu. Setiap peningkatan 10 ng/dL kadar vitamin D akan menambah panjang lahir sebesar 0,4 cm dan setiap kenaikan 10 ng/mL kadar kalsium akan menambah 2,22 cm. Kadar vitamin D dan kalsium berpengaruh bermakna terhadap berat lahir setelah dikontrol tinggi badan ibu, kadar haemoglobin, kecukupan asupan energi ibu dan kesesuaian penambahan berat badan ibu selama hamil. Setiap peningkatan 10 ng/dL kadar vitamin D akan menambah 100,9 gram berat lahir dan setiap peningkatan 10 ng/mL kadar kalsium akan menambah 448 gram berat lahir bayi. Hasil penelitian menyarankan ibu hamil perlu meningkatkan asupan vitamin D dan kalsium termasuk zat gizi lain sesuai standar kecukupan gizi ibu hamil dan mendorong agar kulit mendapatkan paparan sinar matahari.

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This study discusses the effect of vitamin D and calcium levels on the length and birth

weight of babies. This type of cross sectional study involved 144 third trimester pregnant women and babies born. Vitamin D examination using biomarkers of 25(OH)D and calcium using total calcium from cord blood serum. Measurements of length and birth weight are standardized immediately after birth with the Seca brand type 231/231. Analysis using correlation test, t test, ANOVA and linear regression analysis to see the effect of vitamin D and calcium status on length and birth weight by considering confounding variables (age, parity, maternal and paternal height, suitability of maternal weight gain during pregnancy according to BMI pre pregnancy, anemia status, physical activity, nutritional adequacy of mother and family smoking).

Results obtained: the average length and birth weight were normal 48.7 cm and 3090.4 grams, short birth length 31.2% and LBW 8.3%. The average serum level of 25(OH)D is 27.6 ng/dL, vitamin D status is less than 62.5%. The average calcium content is 10 ng /mL and 24.3% hypocalcemia. Vitamin D and calcium levels had a significant effect on birth length after control of maternal height, hemoglobin level and adequacy of maternal energy intake. Every 10 ng/dL increase in vitamin D levels will increase the birth length by 0.4 cm and every 10 ng/mL increase in calcium levels will add 2.22 cm. Vitamin D and calcium levels had a significant effect on birth weight after control of maternal height, hemoglobin level, adequacy of maternal energy intake and suitability of maternal weight gain during pregnancy. Every 10 ng/dL increase in vitamin D levels will add 100.9 grams of birth weight and each 10 ng/mL increase in calcium levels will add 448 grams of baby's birth weight. The results suggest that pregnant women need to increase their intake of vitamin D and calcium, including other nutrients according to the nutritional adequacy standards of pregnant women and encourage the skin to get sun exposure."

"Relaps masih menjadi masalah dalam eradikasi malaria vivaks. Primakuin adalah satu-satunya antihipnozoit yang saat ini tersedia di pasaran. Efikasi primakuin diperoleh oleh farmakokinetik dan farmakodinamik obat. Kemampuan CYP2D6 memetabolisme primakuin menjadi bentuk aktif akan memengaruhi kadar primakuin dan efikasi klinisnya. Pada penelitian ini dilakukan analisis farmakokinetik dan farmakodinamik primakuin dengan pendekatan populasi pada subjek dengan malaria vivaks; serta menganalisis hubungan variasi jumlah salinan gen CYP2D6 dengan kejadian relaps.Subjek studi adalah 174 orang Tentara Nasional Indonesia yang terinfeksi malaria vivaks dan diterapi dengan kombinasi skizontisida dan primakuin selama 14 hari. Kejadian relaps diamati selama satu tahun. Model farmakokinetik-farmakodinamik primakuin yang dikembangkan dengan metode mixed effect non linier menggunakan piranti lunak NONMEM versi 7.4.1. Kuantifikasi jumlah salinan gen CYP2D6 dilakukan pada 49 subjek. Jumlah salinan ditentukan berdasarkan nilai Cq hasil amplifikasi intron 6 dengan qPCR real-time. Jumlah salinan dihitung sesuai dengan rumus 2-ΔΔCq x jumlah salinan DNA Kalibrator, ΔΔCq = ΔCq (kalibrator)  ΔCq (sampel) dan ΔCq = Cq (CYP2D6) - Cq (RNAse P). Hubungan jumlah salinan gen CYP2D6 dan kejadian relaps malaria vivaks dianalisis dengan uji Chi-square.Hasil penelitian menunjukkan bahwa kadar primakuin plasma paling baik dideskripsikan oleh model satu kompartemen dengan penyerapan orde pertama. Berat badan diimplementasikan sebagai fungsi alometrik pada clearance (CL) dan distribusi volume (Vd). Piperakuin maupun pironaridin menurunkan CL dan Vd primakuin sebesar 3354%. Faktor genetik CYPD6 tidak memengaruhi CL primakuin. Risiko kejadian relaps malaria vivaks dideskripsikan dengan model constant hazard pada model time-to-event. Peningkatan satu poin skor aktivitas gen CYP2D6 menurunkan risiko relaps sebesar 88,3%, sehingga dapat disangkal bahwa faktor genetik CYP2D6 menjadi salah satu faktor yang dapat memengaruhi risiko kambuh vivaks malaria. Tidak didapatkan hubungan antara AUC primakuin dan kejadian relaps, sehingga hasil ini tidak dapat digunakan untuk menghitung dosis primakuin yang optimal. Kuantifikasi jumlah salinan gen CYPD6 dilakukan pada 21 subjek relaps dan 28 subjek kontrol. Mayoritas subjek memiliki jumlah salinan ≥ 2 (39 dari 49 orang). Tidak ditemukan hubungan antara jumlah salinan gen CYP2D6 dan kejadian relaps (p = 0,155).Relapse is still a problem in vivax malaria eradication. Primakuine is the only antihipnozoite currently available on the market. The efficacy of primaquine is obtained by the pharmacokinetics and pharmacodynamics of the drug. The ability of CYP2D6 to metabolize primaquine to its active form will affect primakuine levels and clinical efficacy. In this study, a pharmacokinetic and pharmacodynamic analysis of primaquine was carried out with a population approach in subjects with vivax malaria; and to analyze the relationship between variations in the number of copies of the CYP2D6 gene with the incidence of relapse.Study subjects were 174 Indonesian National Armed Forces infected with vivax malaria and treated with a combination of schizonticides and primaquine for 14 days. Relapse incidence was observed for one year. The primakuine pharmacokinetic-pharmacodynamic model was developed using a non-linear mixed effect method using NONMEM software version 7.4.1. Quantification of the number of copies of the CYP2D6 gene was performed in 49 subjects. The number of copies is determined based on the Cq value of the intron 6 amplification with real-time qPCR. The number of copies is calculated according to the formula 2-ΔΔCq x number of copies of the DNA Calibrator, ΔΔCq = ΔCq (calibrator)  ΔCq (sample) and ΔCq = Cq (CYP2D6) - Cq (RNAse P). The association between copy number of CYP2D6 gene and the incidence of vivax malaria relapse was analyzed using Chi-square test.The results showed that plasma primquine levels were best described by a one-compartment model with first-order absorption. Body weight is implemented as an allometric function on clearance (CL) and volume distribution (Vd). Piperakuine and pyronaridin reduce CL and Vd primakuin by 3354%. CYPD6 genetic factor does not affect CL primaquine. The risk of vivax malaria relapse was described using the constant hazard model in the time-to-event model. One point increase in the CYP2D6 gene activity score reduced the risk of relapse by 88.3%, so it can be denied that CYP2D6 genetic factor is one of the factors that can affect the risk of malaria vivax relapse. There was no relationship between AUC of primaquine and the incidence of relapse, so these results cannot be used to calculate the optimal primquine dose. CYPD6 gene copy count quantification was performed in 21 relapsed subjects and 28 control subjects. The majority of subjects had a number of copies ≥ 2 (39 of 49 people). No association was found between the number of copies of the CYP2D6 gene and the incidence of relapse (p = 0.155)."

"Penelitian ini membahas pengaruh dukungan sosial terhadap kualitas hidup Pasien Tuberkulosis (TBC) di Kota Depok, Provinsi Jawa Barat, dengan pendekatan kuantitatif dan kualitatif menggunakan desain studi longitudinal (pengukuran berulang) dan Rapid Assessment Procedure (RAP). Pengumpulan data kuantitatif dengan wawancara kepada responden menggunakan kuesioner WHOQOL-BREF untuk data kualitas hidup dan Multidimensional Scale of Perceived Social Support (MSPSS) untuk data dukungan sosial. Pengumpulan data kualitatif dengan kelompok diskusi terarah (DKT) dan wawancara mendalam. Analisis data menggunakan analisis regresi logistik untuk pengukuran data berulang yaitu General Estimation of Equotion (GEE). Hasil penelitian menunjukkan bahwa dukungan sosial mempunyai pengaruh kuat terhadap kualitas hidup Pasien TB; pengaruh dukungan sosial terhadap kualitas hidup Pasien TBC terus meningkat mulai bulan ke-2 sampai akhir bulan ke-6; sumber dukungan sosial yang berpengaruh untuk meningkatkan kualitas hidup Pasien TBC adalah keluarga, teman dan orang terdekat lainnya; bentuk dukungan sosial yang berpengaruh untuk meningkatkan kualitas hidup Pasien TBC adalah dukungan emosional, informasi dan persahabatan. Kesimpulan: dukungan sosial kepada Pasien TBC yang diberikan selama masa pengobatan sampai pasien sembuh memberikan dampak terhadap kualitas hidupnya. Studi ini merekomendasikan untuk peningkatan dukungan sosial dari keluarga, teman dan orang terdekat lainnya dalam bentuk dukungan emosional, informasi dan persahabatan agar kualitas hidup Pasien Tuberkulosis lebih baik.

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This study discusses the influence of social support on the quality of life of tuberculosis (TBC) patients in Depok, West Java, with quantitative and qualitative approaches using the design of longitudinal studies (repeated measurements) and Rapid Assessment Procedure (RAP). Quantitative data collection with interviews to respondents using the WHOQOL-BREF questionnaire for quality of life data and Multidimensional Scale of Perceived Social Support (MSPSS) for social support data. Qualitative data collection with focus groups discussion (FGD) and in-depth interviews. Data analysis using logistical regression analysis for repeated data measurement is General Estimation of Equotion (GEE). The results showed that social support has a strong influence on the quality of life of TBC patients; The influence of social support on TBC patients quality of life continues to increase from the 2nd month to the end of the 6th month; An influential source of social support to improve the quality of life of TBC patients are family, friends and other nearby people; An influential form of social support to improve the quality of life of TBC patients is emotional support, information and friendship. Conclusion: Social support to TBC patients given during the period of treatment until the patient is healed to have an impact on the quality of his life. This study recommends improving the social support of families, friends and significants other in the emotional support, information support and companionship support in order to make a better quality of life of tuberculosis patient."

"Manfaat madu untuk penyembuhan luka sudah banyak diteliti, namun informasi manfaatnya untuk penyembuhan luka timpanoplasti masih terbatas. Penelitian ini bertujuan mengevaluasi efek madu manuka (Mn) dan madu trigona (Tr) asli Indonesia pada re-epitelisasi membran timpani (MT) melalui potensi proliferasi fibroblas, keratinosit, sekresi KGF dan basic-FGF.Penelitian in vivo berupa uji klinis acak, tersamar ganda, pada 64 pasien dewasa otitis media supuratif kronik (OMSK) tipe aman tenang yang menjalani timpanoplasti di RSUPN dr. Cipto Mangunkusumo pada bulan Juni 2021–Agustus 2022. Pasien diacak dan disamarkan ke dalam dua kelompok, yaitu diberikan gelfoam plus gel Mn 100% medical grade (intervensi) atau hanya diberikan gelfoam (kontrol) di liang telinga saat timpanoplasti. Tampon telinga diangkat setelah dua minggu dan pasien diminta kontrol setiap minggu selama enam minggu. Penelitian in vitro dilakukan di Laboratorium Universitas YARSI. Kultur fibroblas dan keratinosit yang diisolasi dari pasien OMSK diberikan pajanan Mn dan Tr dengan tiga konsentrasi yaitu 0,04%, 0,1%, dan 0,25%, kemudian dilakukan uji proliferasi, KGF dan bFGF juga diukur dan dibandingkan dengan kelompok kontrol.Proporsi pengeringan luka pascatimpanoplasti kelompok intervensi lebih banyak secara bermakna dibandingkan kontrol pada minggu ke-3, ke-4, dan ke-6. Madu manuka dan Tr tidak meningkatkan jumlah sel kultur fibroblas, tetapi mempersingkat durasi doubling time. Jumlah sel kultur keratinosit lebih tinggi secara bermakna dibandingkan kontrol pada semua kelompok Mn dan Tr 0,04%. Sekresi KGF meningkat seiring pertambahan sel. Pada hari ke-6 dan hari ke-8, sekresi KGF lebih tinggi pada beberapa kelompok intervensi dibandingkan kontrol. Sebaliknya, kadar bFGF menurun seiring pertambahan sel. Terdapat korelasi positif antara lama pajanan kedua jenis madu dengan proliferasi fibroblas. Lama pajanan Mn 0,04%, 0,1%, dan Tr 0,04% berkorelasi positif dengan jumlah sel kultur keratinosit.Disimpulkan pemberian Mn saat timpanoplasti meningkatkan pencapaian re-epitelisasi MT sempurna melalui efeknya pada fibroblas dan keratinosit, serta berpotensi meningkatkan keberhasilan timpanoplasti. Penelitian ini juga menunjukkan efek positif Tr pada fibroblas dan keratinosit, sehingga potensi terapeutik madu ini dapat diteliti lebih lanjut

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Benefits of honey on wound healing have been widely reported, but information about its effect on the re-epithelialization of the tympanic membrane (TM) is limited. This study aims to evaluate the effect of manuka honey (MH) and trigona honey (TH) from Indonesia, on TM re-epithelization through their potential action on the proliferation of fibroblasts, keratinocytes, secretion of KFG and basic-FGF.

The in vivo study was a randomized, controlled, double-blind clinical trial on 64 adult patients with mucosal type chronic suppurative otitis media (CSOM) undergoing tympanoplasty at Cipto Mangunkusumo General Hospital from June 2021–August 2022. Patients were randomized and blinded into two groups, receiving either gel foam soaked in 100% medical grade MH (intervention group) gel or only gel foam (control group) placed in the external auditory canal during tympanoplasty. The ear tampon was removed after two weeks, and patients were followed up weekly for six weeks. The in vitro study was conducted at the YARSI University Laboratory. Fibroblast and keratinocyte cultures isolated from CSOM patients were exposed to MH and TH with three dilutions: 0.04%, 0.1%, and 0.25%. The cells were then subjected to proliferation assays, KGF and bFGF were also assessed and compared with the control group.

The intervention group had a significantly higher proportion of dry tympanoplasty wounds than control at the 3rd, 4th, and 6th visit. Manuka honey and TH did not increase the number of fibroblasts but shortened the doubling time duration. A significantly higher number of keratinocytes than control was observed in all MH groups and the 0.04% TH group. KGF secretion increased as the number of cells increased. On day 6 and day 8, KGF secretion was higher in some of the intervention groups compared with the control group. In contrast, fibroblast bFGF secretion decreased as the number of cells increased. There was a positive correlation between the exposure time of all intervention groups and the number of cells in the fibroblast culture. Prolonged exposure time to 0.04% MH, 0.1% MH, and 0.04% TH were positively correlated with the number of keratinocytes.

The application of MH during tympanoplasty increased complete TM re-epithelialization through its effect on fibroblasts and keratinocytes proliferation. MH has the potential to improve tympanoplasty outcomes. This present study also illustrated the positive effects of TH on fibroblasts and keratinocytes; thus, its potential therapeutic properties could be further explored."

"Banyak faktor pemicu terjadinya depresi pada lansia yang sudah terdokumentasi dengan baik melalui berbagai literatur, namun belum ada kajian antar kelompok lansia perkotaan dan perdesaan di Indonesia. Kajian antar kelompok ini diperlukan agar penatalaksanaan masalah depresi pada lansia dapat lebih tepat sasaran. Peran biopsikososial dipertimbangkan sebagai kajian holistik yang saling terkait untuk memeriksa sejauh mana hubungannya dengan depresi pada lansia. Kajian dilakukan menggunakan data Indonesia Family Life Survey gelombang 4 dan 5. Hasil menunjukkan terdapat perubahan faktor biopsikososial dengan depresi lansia di perkotaan dan perdesaan Indonesia. Perubahan kondisi fisik dan kesejahteraan subyektif menjadi risiko depresi lansia di perkotaan. Sedangkan untuk lansia perdesaan, ditemukan perubahan kondisi fisik, perubahan rasa saling percaya, perubahan partisipasi masyarakat dan perubahan status marital sebagai risiko depresi lansia.

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There are several well-documented factors that contribute to elderly depression, however there haven't been any research in Indonesia comparing elderly populations in urban and rural areas. In order to better effectively manage depression issues in the elderly, a research across groups is required. The role of biopsychosocial is viewed as an interrelated holistic study to determine the extent of its impact on depression in the elderly using data from the Indonesian Family Life Survey waves 4 and 5. The results show that there are differences in the risk of depression in the elderly in urban and rural Indonesia. Changes in physical condition and subjective well-being are risks of depression in urban elderly people. Meanwhile, for rural elderly, changes in physical condition, changes in mutual trust, changes in community participation and changes in marital status were found as risks for elderly depression."

"Rendahnya cakupan penemuan kasus TB di Indonesia berdampak padaberlanjutnya proses transmisi infeksi Mycobacterium Tuberculosis M.tb dimasyarakat. Pondok pesantren merupakan populasi rentan dan berisiko dengankarakteristik hunian relatif padat, sanitasi lingkungan kurang sehat. Beberapakasus TB terjadi di pondok pesantren, akibat rendahnya kesadaran santri terhadapgejala TB sehingga berdampak pada akses layanan kesehatan. Perlu upayapengendalian TB dengan melibatkan masyarakat sebagai solusi ketika pemerintahkurang memiliki kapasitas menyediakan layanan dan menjangkau penderita TB. Permasalahan yang sama terjadi di Kabupaten Garut, yaitu terbatasnya sumberdaya kesehatan untuk menjaring dan mengawasi penderita TB. Kegiatanpemberdayaan santri sebagai kader TB di pondok pesantren merupakan inovasidalam upaya menjembatani suspek dan penderita TB untuk mendapatkan akses kefasilitas kesehatan atau active case finding TB. Penelitian ini bertujuan untukmengetahui dampak positif pemberdayaan santri kader TB terhadap aksesibilitaslayanan TB di fasilitas kesehatan. Metode yang digunakan adalah metodekuantitatif dengan menggunakan desain quasi eksperimen rancangan 'nonequivalent control group design', dan metode kualitatif menggunakan wawancaramendalam. Studi ini dilakukan di enam pondok pesantren dengan jumlah sampel493 orang, masing-masing tiga pondok pesantren intervensi sampel 232 orang dantiga pondok pesantren non-intervensi jumlah sampel 236 orang. Penelitian ini membuktikan bahwa pemberdayaan santri kader TB padapondok pesantren di Kabupaten Garut memberikan pengaruh yang signifikanyaitu peningkatan proporsi aksesibilitas layanan TB di fasilitas kesehatan sebesar41.4 pada kelompok intervensi. Santri yang tinggal di pondok pesantrenintervensi berpeluang 3.9 kali lebih besar untuk mengakses layanan TB di fasilitaskesehatan dibandingkan yang tinggal di non-intervensi. Intervensi ini jugaberhasil menemukan 14 kasus TB positif di pondok pesantren dengan tingkatkeberhasilan convertion rate dan cure rate masing-masing sebesar 100 .Program ini perlu direplikasi di wilayah lain mengingat di Indonesia terdapatpondok pesantren dengan kondisi tidak jauh berbeda dengan lokasi dan kondisipenelitian ini.

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The low coverage of cases of TB in Indonesia has an impact on the continuation of the process of transmission of infection with Mycobacterium tuberculosis M.tb in the community. Students in Islamic Boarding Schools are vulnerable and are at risk populations with relatively dense residential characteristics and poor environmental sanitation. Some cases of TB occurred inthe boarding school due to the low knowledge TB symptoms among students.This problem, in turn, leads to low access to health care. There is a need for involving the community when the government lacks the capacity to provide services and reach out to people with TB. The same problems occur in Garut, namely the limited health resources and workforce to recruit and supervise TB patients. The empowerment of students as a cadre of TB in a boarding school is an effort to bridge suspected TB patients to gain access to a health facility or active TB case finding.

This study aims to determine the positive impact of empowering students as TB Cadre on the accessibility of TB health services. The method used is quantitative by using a quasi experimental design non equivalent control group design, and qualitative method in the form of interviews. The study was conducted in six boarding schools with a sample size of 493 people, The intervention group consists of three boarding schools with 232 students, while the rest of the boarding schools with 236 students was chosen as the non intervention group.

This study proves that the empowerment of students cadre of TB in the boarding school in Garut has a significant and positive impact. It is observed that there was an increased in the proportion of service accessibility TB in health facilities as much as 41.4 in the intervention group. Students who live in the intervention group were 3.9 times more likely to access TB services in health facilities compared to those living in non intervention. This intervention also managed to find 14 positive TB cases in the boarding school with a conversion rate and cure rate of 100 . This program needs to be replicated in other regions in Indonesia, considering that there are many boarding schools with similar conditions across Indonesia."

"Menurut Survei Depkes tahun 1993-1996 prevalens OMSK di Indonesia sebesar 3,1%. Di RS. Dr. Cipto Mangunkusumo dilaporkan 64 kasus OMSK dengan kolesteatoma pertahun pada periode 1998-2002. Angka kejadian kolesteatoma residu dan rekuren pascaoperasi masih cukup tinggi. Peran respons inflamasi pada pertumbuhan kolesteatoma telah dibuktikan, antara Iain interleukin-1α (IL-Iα) dan tumor necrosis factor-α (TNF-α). Efek hambatan kortikosteroid terhadap kolesteatoma pada hewan coba tetah diteliti. Mekanisme molekular hambatan pertumbuhan kolesteatoma mungkin terjadi melalui kematian sel (apoptosis) yang terlihat sebagai penurunan proliferasi sel, produksi IL-1α, dan TNF-α. Penelitian ini ingin mengetahui efek kerja kortikosteroid, dalam hal ini deksametason terhadap pertumbuhan kolesteatoma, serta pengaruhnya terhadap produksi IL-1α dan TNF-α oleh sel keratinosit kolesteatoma.Penelitian dilakukan secara in vitro pada biakan keratinosit jaringan kolesteatoma, yang diperoleh dari pasien OMSK dengan kolesteatoma. Proliferasi sel dihitung dengan cara biakan sel keratinosit yang terdiri atas kontrol dan kelompok perlakuan. Pada biakan 24 jam, kelompok pertakuan diberikan deksametason dengan berbagai dosis, yaitu dosis 1 μg/mL, 10 μg/mL, 40 μg/mL, 80 μg,/mL, dan 100 μg/mL. Pemanenan sel diiakukan 24 jam kemudian dan dihitung jumlah sel, tingkat reduksi sel, serta vialibitas kelompok kontrol dan kelompok perlakuan. Untuk pengukuran kadar IL-lα dan TNF-α bahan yang diperiksa adalah supernatan biakan sel keratinosit kolesteatoma 48 dan 60 jam setelah perlakuan. Pengukuran kadar IL-1α dan TNF-α dilakukan secara ELISA, dengan menggunakan kit dari R & D Systems dengan nomor katalog DLA 50 untuk IL-1α dan HSTAOOC untuk TNF-α.Pada penelitian ini selelah 48 jam biakan dan setelah 24 jam ditambahkan deksametason, tampak bahwa rerata jumlah sel pada kelompok perlakuan menurun dibandingkan dengan kelompok kontrol Dosis 1 μg /mL tidak berbeda bermakna dengan kelompok kontrol, tetapi mulai dosis 10 μg/mL hingga dosis 100 μg/mL perbedaan tersebut bemakna. Pemberian dosis tertinggi, yaitu 100 μg/mL menyebabkan kelompok dosis tersebut berbeda bermakna dengan semua kelompok Iainnya. Pada penelilian ini pemberian deksametason dengan berbagai dosis menyebabkan peningkatan rerata kadar IL-1α yang sangat kecil, yaitu antara 0,04-0,37 pg/mL, secara statistik peningkatan tersebut tidak bermakna. Rerata kadar TNF-α kelompok kontrol dibandingkan dengan kelompok perlakuan pada biakan 48 jam tidak berbeda berrnakna, sedangkan pada biakan 60 jam berbeda bermakna antara kelompok kontrol dengan kelompok perlakuan. Kemaknaan tersebut terjadi pada dosis 100 μg/mL.Sebagai kesimpulan dapat dituliskan bahwa deksametason dapat menghambat proleferasi sel pada biakan keratinosit kolesteatoma dengan dosis minimal 10 μg/mL. Penambahan dosis deksametason hingga dosis 100 μg/mL akan meningkatan efek hambatan. Deksametason tidak terbukti menurunkan kadar lL-1α. Kadar TNF-α menurun setelah ditambahkan deksametason, yang terjadi pada biakan 60 jam dengan dosis 100 μg/mL (p=0,036).

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According to the Survey by the Department of Health, Republic of Indonesia, in 1993-1996, the prevalence of chronic suppurative otitis media in indonesia was 3.1%. ln Cipto Mangunkusumo Hospital, Jakarta, there are 64 cases of chronic suppurative otitis media (CSOM) with cholesteatoma per year during 1998-2002. Post-operative residual and recurrence rate of cholesteatoma is high. It has been proven that inflammatory response, such as interleukin-1α (lL-lα) and tumor necrosis factor-α (TNF-α), play a role in the development of cholesteatoma. The inhibition effect of corticosteroid on cholesteatoma in animal model has been shown. Molecular mechanism of cholesteatoma growth inhibition is probably through apoptosis which may lead to decrease in cell proliferation as well as lL-α and TNF-α production. This study was conducted to find out corticosteroid (dexamethasone) effect on cholesteatoma growth, and its effect on IL-1α and TNF-α production by cholesteatoma keratinocyte cells.The study was conducted in vitro on cholesteatoma keratinocyte culture obtained from patients suffering from CSDM with cholesteatoma. Cell proliferation was measured by counting keratinocyte culture cells in both control and dexamethasone experimental groups. Dexamethasone was given to the 24-hour culture tissue in several doses: 1 μg/mL, 10 μg/mL, 40 μg/mL, 80 μg/mL, 100 μg/mL. Cell harvesting was carried out in the next 24 hours. Cells were counted and cell reduction level and viability were analyzed in both control and experimental groups. The level of IL-1α and TNF-α in the supematant of the 48 and 60 hours cholesteatoma keratinocyte culture cells, were measured by ELISA methods, using R&D System kit catalog DLA 50 for lL-α and HSTAOOC for TNF-α.This study found that the mean cell count in the experimental group was less than that of the control group after 48-hour culture and 24-hour dexamethasone treated. There was no significant difference in the cell count between the group of 1 μg/mL dexamethasone and the control group, but starting from 10 μg/mL to 100 μg/mL, significant difference was shown. In addition, the highest doses of dexamethasone 100 μg/mL gave significant difference of cell count compared to the other close groups. Several doses of dexamethasone given in this study caused minimal or non significant increase of IL-1α level, 0.04-0.37 pg/mL. There was no significant difference of the mean level of TNF-α between the control and the study groups in the 48 hours culture. However, there is significant difference in the 60 hours culture between these two groups at the dose of 100 μg/mL dexamethasone.The conclusions of this study are that dexamethasone will inhibit cell proliferation in keratinocyte cholesteatoma culture with minimal inhibitory dose of 10 μg/mL. Increase of the dexamethasone dose to 100 μg/mL will increase this inhibitory effect. It was not proven that dexamethasone can decrease IL-1α production. Dexamethasone 100 μg/mL can decrease TNF-α production in the 60 hours culture."