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Abstrak :
ABSTRAK
Latar Belakang. Karsinoma Nasofaring (KNF) merupakan jenis tumor kepala dan leher yang paling sering ditemukan, dan angka kejadiannya di Indonesia sendiri terbilang cukup tinggi. Paresis saraf kranial III, IV, V, atau VI merupakan defisit neurologi yang sering dijumpai pada pasien KNF dan merupakan salah satu penanda infiltrasi intrakranial. Pemeriksaan neurologi klinis terhadap saraf kranial merupakan salah satu prosedur evaluasi pasien KNF pasca terapi standar. Metode. Penelitian ini merupakan studi observasional dengan desain pra-pasca. Subjek penelitian adalah semua pasien KNF dengan paresis saraf kranial III, IV, V, atau VI yang telah menjalani radioterapi lengkap di Departemen Radioterapi RSUPNCM antara 2 bulan – 6 bulan sebelumnya. Dilakukan wawancara, pengisian kuesioner serta pemeriksaan neuro-oftalmologi klinis. Dilakukan analisis data menggunakan perangkat SPSS 17.0. Hasil. Diperoleh 32 subjek pasien KNF dengan paresis saraf kranial III, IV, V, atau VI. Terapi standar KNF di RSUPNCM memberikan perbaikan pada paresis saraf kranial sebagai berikut: perbaikan paresis saraf kranial III sebesar 86% (membaik komplit 57%, membaik parsial 29%), perbaikan paresis saraf kranial IV sebesar 100%, perbaikan lesi saraf kranial V(1,2,3) sebesar 57% (membaik komplit 36%, membaik parsial 21%), dan perbaikan paresis saraf kranial VI sebesar 43%. Tidak didapatkan hubungan yang bermakna secara statistik antara perbaikan paresis saraf kranial III, IV, V, atau VI dengan faktor terkait penderita (usia dan jenis kelamin), faktor terkait penyakit (respons massa tumor KNF pasca radioterapi, durasi paresis saraf kranial, derajat keterlibatan saraf kranial dan subtipe histologi WHO), maupun dengan faktor terkait tatalaksana (teknik radioterapi dan pendekatan kemoterapi). Kesimpulan. Perbaikan paresis saraf kranial pasca radioterapi dapat dinilai secara objektif dengan pemeriksaan neurologi klinis sehingga perlu secara rutin dilakukan pemeriksaan neurologi klinis pra maupun pasca terapi sebagai salah satu standar evaluasi pasien KNF di RSUPN Cipto Mangunkusumo.

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ABSTRACT
Background. Nasopharyngeal Cancer (NPC) is the most prevalent head and neck cancer, and its incidence in Indonesia is quite high. Third, fourth, fifth, or sixth cranial nerves palsies are often found in NPC patients and signify intracranial infiltration. Clinical neurological examination for cranial nerves is one method of evaluating NPC patients after they receive standard management. Methods. This is an observational study with a pre-post design. The subject of this study were all NPC patients with third, fourth, fifth, or sixth cranial nerves palsies who receive full radiotherapy regimen at the Department of Neurology, Cipto Mangunkusumo National Hospital 2-6 months prior to evaluation. Patients were then interviewed, asked to fill in questionnaires and went through clinical neuro-ophthalmological evaluation. Data was analyzed using SPSS 17.0. Results. There were 32 NPC patients included in this study. Standard management at Cipto Mangunkusumo National Hospital improve the outcome of third cranial nerve palsy in 86% of subjects (57% complete recovery, 29% partial recovery), 100% improvement of the fourth cranial nerve palsy, 86% improvement of the fifth cranial nerve palsy (36% complete recovery, 21% partial recovery), and 43% improvement of the sixth cranial nerve palsy. However, there were no statistically significant correlations between the improvement of the cranial nerves with patients related factors (age and sex), with disease related factors (NPC primary tumor response to radiotherapy, duration of cranial nerves palsy, degree of cranial nerves involvement and WHO histological subtypes), or with treatment related factors (radiotherapy techniques and chemotherapy approaches). Conclusion. The recovery of cranial nerve palsy after radiotherapy could be objectively evaluated with clinical neurological examination. Therefore, clinical neurological examination should be viewed as the standard evaluation for NPC patients pre as well as post therapy.

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ABSTRAK
Latar Belakang. Lupus Eritematosus Sistemik (LES) merupakan penyakit autoimun multisistem mengenai multiorgan akibat produksi antibodi dan kompleks imun. Memiliki mortalitas 3 kali lebih tinggi dibandingkan populasi umum dimana saat awal berkaitan dengan infeksi dan inflamasi, sedangkan jangka panjang berkaitan dengan aterosklerosis. Adapun aterosklerosis yang terjadi timbul lebih cepat dan faktor risiko tradisional (diabetes melitus, hipertensi, hiperkolesterol, obesitas, merokok dan lainnya) dan terapi steroid belum dapat menjelaskan hal ini. Diduga kompleks OxLDL/β2GP1 memainkan peranan dalam proses imunopatologi terjadinya aterosklerosis dan trombosis yang dimediasi oleh adanya penyakit autoimun. Metode. Desain penelitian berupa studi potong lintang. Subyek penelitian adalah pasien LES poliklinik Imunologi RSUPN Ciptomangunkusomo Jakarta yang telah dilakukan pemeriksaan Carotid Duplex dan Transcranial Doppler, serta memenuhi kriteria inklusi dan eksklusi. Subyek diperoleh secara konsekutif. Pada subyek dilakukan wawancara, pengisian kuesioner, pemeriksaan fisik umum dan neurologi, dan pengambilan darah vena untuk diperiksa kompleks OxLDL/β2GP1. Dilakukan analisis data menggunakan perangkat SPSS 17.0 Hasil. Diperoleh 40 subyek pasien LES wanita tanpa drop out. Kadar kompleks OxLDL/β2GP1 pada pasien LES dengan aterosklerosis dan tanpa aterosklerosis masing-masing meannya 0,37 unit/ml dan 0,31 unit/ml. Berdasarkan beberapa faktor risiko tradisional aterosklerosis (usia, LDL, DM, hipertensi dan obesitas) didapatkan kadar kompleks OxLDL/β2GP1 pada pasien aterosklerosis maupun tidak, memiliki mean >0,25 unit/ml. Kesimpulan. Pasien LES dengan atau tanpa aterosklerosis memiliki kadar kompleks OxLDL/β2GP1 lebih dari 0,25 unit/ml namun tidak terdapat perbedaan bermakna. Demikian pula pada aterosklerosis yang disertai atau tanpa disertai faktor risiko tradisional.

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ABSTRACT
Background. Systemic Lupus Erythematous (SLE) is a multisystem autoimmune disease that can affect various organs due to production of antibodies and immune complexes. The mortality rate of SLE patients is three times higher than the general population. In early disease, mortality is related to infection and inflammation, whereas in advanced stage it is related to atherosclerosis. In SLE, atherosclerosis occurs faster; however the traditional risk factors (diabetes mellitus (DM), hypertension, hypercholesterolemia, obesity, smoking, etc.) and steroid therapy have not been able to explain this phenomenon. It is hypothesized that the OxLDL/β2GP1 complexes play roles in the immunopathological process of atherosclerosis and thrombosis that is mediated by the presence of autoimmune disease. Method. A cross-sectional study was conducted. The study subjects were SLE patients from immunology clinic of Cipto Mangunkusumo Hospital, Jakarta who previously have underwent carotid duplex and transcranial Doppler examination and also met the inclusion and exclusion criteria. Subjects were obtained consecutively; they were interviewed, asked to fill questionnaire, underwent general and neurological physical examination, and their venous blood samples were collected. Data analysis were done by using SPSS 17.0. Result. A total of 40 SLE patients were included in this study; all subjects were female and there were no drop out cases. The mean of OxLDL/β2GP1 complexes level in SLE patients with and without atherosclerosis were 0,37 unit/ml and 0,31 unit/ml, consecutively. Based on several traditional risk factors for atherosclerosis (age, LDL, DM, hypertension and obesity), the mean of OxLDL/β2GP1 complexes level in patients with and without atherosclerosis is > 0,25 unit/ml. Conclusion. SLE patients with or without atherosclerosis have level of OxLDL/β2GP1 complexes of more than 0,25 unit/ml, but there were no significant difference. Similar results were found in atherosclerosis with or without traditional risk factors.

Abstrak :
[Latar belakang—Metilasi dari gen promoter O6-methylguanine-DNA methyltransferase (MGMT) adalah salah satu faktor yang berperan pada karsinogenesis dan berkembang menjadi marker dalam menilai progresivisitas dan respons terapi astrositoma. Tujuan—Untuk mendapatkan gambaran frekuensi status metilasi gen promoter MGMT pada pasien astrositoma menggunakan methylation specific polymerase chain reaction (MS-PCR) dan methylation specific high resolution melting (MS-HRM). Metode—Dilakukan pengumpulan data klinis, imajing dan blok parafin jaringan astrositoma di RSCM dalam kurun waktu 2008-2012. Status metilasi gen promoter MGMT dianalisis menggunakan MS-PCR dan MS-HRM serta dihubungkan dengan berbagai faktor prognostik klinis. Penelitian ini adalah penelitian potong-lintang. Hasil— Didapatkan 13 sampel yang terdiri dari 7 astrositoma derajat rendah dan 6 astrositoma derajat tinggi. Metilasi gen promoter MGMT didapatkan pada 1/13 sampel astrositoma dengan MS-PCR dan 4/13 sampel dengan MS-HRM yang seluruhnya adalah astrositoma derajat rendah. Terdapat perbedaan yang bermakna antara status metilasi gen promoter MGMT dengan derajat keganasan astrositoma yaitu astrositoma derajat rendah 4/7 sampel, tanpa ditemukan pada astrositoma derajat tinggi (p=0.049) sedangkan faktor lain seperti usia, jenis kelamin, karnofsky performance scale (KPS), lokasi astrositoma dan derajat WHO tidak terdapat perbedaan yang bermakna (p= 1,000; p= 0,657; p= 0,354; p= 0,538). Simpulan—Penelitian saat ini menunjukkan frekuensi status metilasi gen promoter MGMT pada astrositoma sedikit berbeda dengan berbagai penelitian lain sebelumnya yaitu hipermetilasi hanya terjadi pada astrositoma derajat rendah. Penelitian ini merupakan penelitian pertama di Indonesia yang melaporkan gambaran status metilasi gen promoter MGMT pada pasien astrositoma. ......Background—Astrocytoma is the most common primary central nervous system tumor with difficult management as it requires a combination of surgery, chemotherapy and radiotherapy. This multimodal approach increases patients survival rate significantly, however chemotherapy resistance is now commonly seen. One of the potential causes of chemotherapy resistance is the epigenetic factors from O6 methylguanine-DNAmethyltransferase (MGMT) gene. MGMT gene has role in DNA repair and also have a protective effect against exyogen and endogeneous alkylating agent. The methylation of MGMT gene promoter leads to the decrease of MGMT protein, attenuating its function. Therefore, the methylation status of MGMT gene promoter can act as an indicator for astrocytomas progresivity and treatment aggressiveness. Objective—To determine the frequency of MGMT gene promoter methylation among patients with astrocytomas using methylation specific polymerase chain reaction (MS-PCR) and methylation sensitive high resolution melting (MS-HRM). Methods—Clinical data, imaging and parafin blocks from astrocytoma patients were collected in RSCM from 2008-2012. The methylation status of MGMT gene promoter was confirmed using MS-PCR and MS-HRM. This is cross-sectional study. Results—The total of 13 samples collected including 7 low-grade and 6 high-grade astrocytomas. The MGMT gene promoter was methylated in 1/13 cases using MS-PCR and 4/13 cases using MS-HRM. All methylated cases were low-grade astrocytoma. There was significant association between methylation status of MGMT gene promoter with degree of malignancy which is 4/7 samples hypermethylated in low-grade with no hypermethylation in high-grade astrocytomas (p=0.049). While other factors like age, sex, KPS and astrocytomas location have no significant association (p= 1,000; p= 0,657; p= 0,354; p= 0,538). Conclusions— The present study showed difference of methylation of MGMT gene promoter in astrocytomas with others studies which is hypermethylated MGMT only found in low grade astrocytomas. Our study was the first to report the frequency of MGMT promoter methylation among Indonesian astrocytoma patients., Background—Astrocytoma is the most common primary central nervous system tumor with difficult management as it requires a combination of surgery, chemotherapy and radiotherapy. This multimodal approach increases patients survival rate significantly, however chemotherapy resistance is now commonly seen. One of the potential causes of chemotherapy resistance is the epigenetic factors from O6 methylguanine-DNAmethyltransferase (MGMT) gene. MGMT gene has role in DNA repair and also have a protective effect against exyogen and endogeneous alkylating agent. The methylation of MGMT gene promoter leads to the decrease of MGMT protein, attenuating its function. Therefore, the methylation status of MGMT gene promoter can act as an indicator for astrocytomas progresivity and treatment aggressiveness. Objective—To determine the frequency of MGMT gene promoter methylation among patients with astrocytomas using methylation specific polymerase chain reaction (MS-PCR) and methylation sensitive high resolution melting (MS-HRM). Methods—Clinical data, imaging and parafin blocks from astrocytoma patients were collected in RSCM from 2008-2012. The methylation status of MGMT gene promoter was confirmed using MS-PCR and MS-HRM. This is cross-sectional study. Results—The total of 13 samples collected including 7 low-grade and 6 high-grade astrocytomas. The MGMT gene promoter was methylated in 1/13 cases using MS-PCR and 4/13 cases using MS-HRM. All methylated cases were low-grade astrocytoma. There was significant association between methylation status of MGMT gene promoter with degree of malignancy which is 4/7 samples hypermethylated in low-grade with no hypermethylation in high-grade astrocytomas (p=0.049). While other factors like age, sex, KPS and astrocytomas location have no significant association (p= 1,000; p= 0,657; p= 0,354; p= 0,538). Conclusions— The present study showed difference of methylation of MGMT gene promoter in astrocytomas with others studies which is hypermethylated MGMT only found in low grade astrocytomas. Our study was the first to report the frequency of MGMT promoter methylation among Indonesian astrocytoma patients.]

Abstrak :
Latar Belakang: Luaran pasien Sindroma Guillain-Barré (SGB) tidak sepenuhnya baik walaupun telah berkembang imunoterapi. Prediksi pasien SGB dengan luaran buruk harus dilakukan sedini mungkin untuk menentukan manajemen selanjutnya di rumah sakit dan perawatan di rumah. Sistem EGOS merupakan salah satu cara untuk memprediksi luaran pasien SGB. Sayangnya, penelitian EGOS selama ini dilakukan di luar negeri yang memiliki kondisi pasien dan lingkungan yang berbeda dengan di Indonesia. Penelitian ini bertujuan mengetahui gambaran luaran pasien SGB melalui skala disabilitas enam bulan pascaawitan dan EGOS di RSUPNCM. Metode: Penelitian ini berdesain potong lintang dengan mengambil data dari rekam medik pasien SGB yang menjalani perawatan inap di RSUPNCM sejak Januari 2010 hingga Desember 2014. Data mengenai karakteristik demografi, klinis, nilai EGOS, dan luaran pasien SGB saat enam bulan pascaawitan dikumpulkan pada penelitian ini. Hasil: Jumlah kasus baru SGB pertahun di RSUPNCM adalah 7,6 kasus. Kasus SGB terjadi di sepanjang tahun dan tidak mengenal musim. Rasio jenis kelamin laki-laki daripada perempuan adalah 1,2 : 1. Rerata usia pasien adalah 39,71 tahun. Varian SGB yang paling sering ditemukan pada penelitian ini adalah AIDP (31,6%), diikuti AMSAN (18,4%), AMAN (15,8%), dan SMF (13,2%). Durasi awitan - RS memiliki median 8,5 hari. Sebanyak 24 pasien mendapat imunoterapi PE, dimana sebanyak 83,3% pasien mendapatkannya pada ≥2 minggu pascaawitan. Proporsi pasien SGB dengan luaran baik sebesar 64,3%. Semakin besar nilai EGOS, maka semakin besar proporsi pasien SGB dengan luaran buruk. Simpulan: Proporsi luaran pasien SGB memiliki kecenderungan tren data yang sejalan dengan prediksi EGOS. Selain itu, proporsi luaran baik pasien SGB dapat lebih ditingkatkan lagi dengan mempercepat diagnosis dan pemberian imunoterapi. ......Background: The outcome of GBS is not completely well, despite of the development of immunotherapy. Patients with poor outcome have to be identified quickly in order to determine next management in hospital and home care planning. Erasmus GBS Outcome Score (EGOS) is a model to predict the outcome of patients at six months after onset. Unfortunately, the EGOS studies were conducted in foreign countries, which have different patient characteristics and environment. This study was conducted to describe the outcome characteristics and EGOS of GBS patients at Cipto Mangunkusumo Hospital. Method: A cross-sectional study was conducted to collect data from patient medical records who were admitted to the hospital between January 2010 and December 2014. Data collected included demographic and clinical characteristics, EGOS, and outcome of GBS patients. Results: New cases of GBS in this hospital were 7.6 cases/ year. Male-to-female ratio was 1.2:1. Mean age was 39.71 years old. The most frequent variant was AIDP (31.6%), followed by AMSAN (18,4%), AMAN (15.8%) and MFS (13.2%). Median duration of onset - hospital was 8.5 days. Twenty four patients were treated with plasma exchange, in which 83.3% got these two weeks after onset. Proportion of patients with good outcome was 64.3%. Higher score of EGOS tend to have higher proportion of patients with poor outcome. Conclusions: The proportion of GBS patient outcome in this study had a same data trend with EGOS. This proportion of patients with good outcome could be improved with early diagnosis and prompt immunotherapy.

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ABSTRAK
Latar belakang. Multipel Sklerosis MS dan Neuromyelitis Optica Spectrum Disorder NMOSD adalah penyakit autoimun yang mengakibatkan lesi inflamasi dan demielinisasi pada sistem saraf pusat. Salah satu manifestasi klinis yang paling menonjol pada kedua penyakit ini adalah neuritis optik NO . Penelitian ini bertujuan untuk mengetahui perbedaan struktur dan fungsi nervus optikus pada pasien MS dan NMOSD serta melihat hubungannya dengan derajat disabilitas yang dinilai dengan EDSS, durasi penyakit, dan jumlah relaps. Metode. Penelitian ini menggunakan desain potong lintang dengan jumlah sampel 30 mata MS dan 15 mata NMOSD di Rumah Sakit Cipto Mangunkusumo RSCM , tanpa riwayat neuritis optik dalam 6 bulan terakhir. Penelitian dilakukan pada bulan Desember 2017. Struktur nervus optikus dinilai dengan menggunakan optical coherence tomography yang menilai ketebalan GCL-IPL ganglion cell layer-inner plexiform layer dan RNFL retinal nerve fiber layer serta foto fundus. Sedangkan fungsi nervus optikus dinilai dengan ketajaman penglihatan logmar , sensitivitas kontras, dan latensi P100. Hasil. Rerata usia MS 30 6 tahun tahun dan NMOSD 23,19 7,25 tahun. Hanya terdapat satu orang laki-laki pada kelompok MS, sedangkan subjek NMOSD keseluruhannya adalah perempuan. Kelompok NMOSD memiliki ketebalan lapisan GCL-IPL, RNFL serta ketajaman penglihatan yang lebih rendah dibandingkan MS. Pada kelompok ini juga didapatkan korelasi positif antara nilai EDSS dengan ketajaman penglihatan r=0,74 dan korelasi negatif dengan rerata ketebalan lapisan GCL-IPL r=-0,67 dan RNFL r=-0,46 . Pada kelompok MS, subjek dengan nilai EDSS yang tinggi cenderung memiliki lapisan GCL-IPL yang lebih tipis. Korelasi negatif antara durasi penyakit dengan ketajaman penglihatan r=0,65 dan ketebalan lapisan GCL-IPL r=-0,63 terlihat pada kelompok NMOSD. Sedangkan pada MS didapatkan korelasi negatif antara durasi penyakit dengan sensitivitas kontras r=-0,42 serta ketebalan lapisan GCL-IPL r=-0,40 dan RNFL r=-0,38 . Jumlah relaps berkorelasi negatif dengan ketebalan lapisan RNFL r=-0,63 pada kelompok NMOSD. Pada kelompok MS, jumlah relaps tidak berkorelasi dengan parameter struktur dan fungsi nervus optikus. Kesimpulan. Ketebalan lapisan GCL-IPL dan RNFL lebih tipis pada kelompok NMOSD. Fungsi nervus optikus pada NMOSD juga lebih inferior dibandingkan MS. Derajat disabilitas dan durasi penyakit berkorelasi dengan parameter struktur dan fungsi nervus optikus pada pasien MS dan NMOSD. Sedangkan korelasi dengan jumlah relaps hanya didapatkan pada kelompok NMOSD.

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ABSTRACT<>br> Background. Multiple Sclerosis MS and Neuromyelitis Optica Spectrum Disorder NMOSD is an autoimmune disease that results in inflammatory lesions and demyelinization of the central nervous system. One of the most prominent clinical manifestations in both diseases is optic neuritis ON . This study aims to determine the differences in structure and function of the optic nerve in MS and NMOSD patients and to see its relationship with the degree of disability assessed by EDSS, duration of disease, and number of relapse. Method. This study used cross sectional design with 30 MS eyes 15 NMOSD eyes at Cipto Mangunkusumo Hospital RSCM , with no history of optic neuritis in the last 6 months. The study was conducted in December 2017. The optic nerve structure was assessed using optical coherence tomography by measuring the thickness of GCL IPL ganglion cell layer inner plexiform layer and RNFL retinal nerve fiber layer and fundus photography. While optic nerve function is assessed with visual acuity, contrast sensitivity, and P100 latency. Results. Mean age of MS subjects were 30 6 years and NMOSD 23.19 7.25 years. There is only one male in the MS group, while the entire NMOSD subject is female. The NMOSD group has lower GCL IPL and RNFL thickness and also lower visual acuity than MS. In this group there was also a positive correlation between EDSS value with visual acuity r 0.74 and negative correlation with mean GCL IPL r 0.67 and RNFL thickness r 0.46 . In the MS group, subjects with high EDSS values tend to have thinner GCL IPL. The positive correlation between disease duration and visual acuity r 0.65 and negative correlation with GCL IPL layer thickness r 0.63 was seen in the NMOSD group. While in MS, there was a negative correlation between duration of disease with contrast sensitivity r 0.42 and mean GCL IPL r 0.40 and RNFL thickness r 0.38 . The number of relapse were negatively correlated with mean RNFL thickness r 0.63 in the NMOSD group. In the MS group, the number of relapse was not correlated with the structural and functional parameters of the optic nerve. Conclusion. The thickness of the GCL IPL and RNFL is thinner in the NMOSD group. The optic nerve function in NMOSD is also inferior to MS. The degree of disability and duration of disease correlates with the structural and functional parameters of the optic nerve in MS and NMOSD patients. While the correlation with the number of relapse is only found in the NMOSD group.

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Latar belakang: Obstructive Sleep Apnea OSA berkorelasi dengan hipertensi. Pada OSA dengan hipertensi resisten ditemukan hiperaldosteronisme primer. Disfungsi gen Cryptochrome-1 Cry1 dan Cry2 menyebabkan peningkatan aldosteron dan hipertensi pada mencit. Neuroglobin Ngb diketahui mempengaruhi gen Per. Peneliti menduga penurunan kadar Cry pada OSA menyebabkan peningkatan aldosteron dan hipertensi, dan kadar neuroglobin serum mempengaruhi Cry.Metodologi: Subyek dikumpulkan secara konsekutif dari survei populasi Jakarta berusia 30-65 tahun yang menderita OSA sedang-berat dan hipertensi. OSA didiagnosis menggunakan portable monitor tipe 2 Alice Pdx unattended. Subyek didiagnosis hipertensi bila tekanan darah pagi hari lebih dari 140/90 mmHg atau minum obat anti hipertensi. Konsentrasi aldosteron, renin, neuroglobin, Cry1 dan Cry2 serum ditentukan dengan metode ELISA. Hiperaldosteronisme ditentukan dengan Aldosterone Renin Ratio ARR >20.Hasil Penelitian: Terdapat 40 subyek yang memenuhi kriteria, 26 laki-laki dan 14 perempuan dengan median usia 52,5 tahun, BMI 27,46 kg/m2, AHI 34.8 kali/jam. Ditemukan 16 subyek dengan hiperaldosteronisme primer HP dan 24 subyek nonHP. Tidak ditemukan perbedaan bermakna Cry1, Cry2 dan Ngb pada kedua kelompok. Walaupun secara statistik tidak bermakna terdapat kecenderungan penurunan kadar Cry1 dan Cry2 pada ARR tinggi pada HP, terutama Cry1. Ditemukan korelasi positif antara kadar Ngb dengan Cry1 pada HP Spearman rsquo;s rho= 0.455, p= 0.038 . Selain itu ditemukan hubungan bermakna antara Cry1 dan O2 nadir p= 0.026 . Cry1 menurun pada hipoksia berat. Pada HP terdapat kecenderungan penurunan Ngb pada kadar O2 nadir rendah, walaupun secara statistik tidak bermakna.Kesimpulan: Penurunan kadar Cry1 mungkin berhubungan dengan terjadinya kelebihan aldosteron pada OSA. Ngb tampak berperan pada penurunan Cry1. ...... Background Obstructive Sleep Apnea OSA patients with resistant hypertension also had primary hyperaldosteronism. Cryptochrome 1 Cry1 and Cry2 dysfunction were associated with increased aldosterone and hypertension. Neuroglobin Ngb is known to influence Per gene. In this study we want to investigate whether Cry decrease in moderate to severe OSA causes aldosterone increase and hypertension, also the possible role of Ngb on Cry expression.Methods Subjects were recruited consecutively from a population study of OSA in Jakarta, subjects aged 30 65 years with moderate to severe OSA and hypertension. OSA was diagnosed using unattended type 2 portable monitor Alice Pdx , hypertension was established when morning blood pressure exceed 140 90 mmHg or on anti hypertensive drugs. Serum aldosterone, renin, neuroglobin, Cry1 and Cry2 were determined using ELISA method. Primary hyperaldosteronism was determined by Aldosterone Renin Ratio ARR 20.Results Of the 40 subjects recruited, there were 26 males and 14 females, with median age 52.5 years, BMI 27.46 kg m2, and AHI 34.8 times hour. We found 16 subjects with primary hyperaldosteronism PH and 24 nonPH. No difference in Cry1, Cry2 and Ngb levels was found in these groups. Although statistically not significant Cry1 and Cry2 concentration decrease with higher ARR in PH, especially Cry1. There was a positive correlation between Ngb and Cry1 in PH Spearman rsquo s rho 0.455, p 0.038 . There was relationship between Cry1 and nadir O2 p 0.026 . Cry1 was decreased in severe hypoxia. Although statistically not significant, serum Ngb decreased in severe hypoxia.Conclusions Cry1 decrease might be the cause of increased aldosterone in OSA. Ngb decrease is associated with Cry1 decrease.

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Latar belakang: Pentoksifilin belum memberikan hasil yang konsisten pada pasien stroke iskemik akut sehingga pada penelitian ini dipakai suatu penanda spesifik untuk melihat efektifitas terapi yaitu adanya hiperviskositas darah. Metode: Penelitian ini merupakan penelitian uji klinis acak tersamar tunggal. Pasien stroke iskemik akut onset kurang dari 72 jam yang mengalami hiperviskositas darah diacak menjadi kelompok perlakuan n=22 dan kontrol n=22 . Terapi standar stroke akut diberikan pada semua subyek. Kelompok perlakuan mendapat terapi tambahan berupa pentoksifilin 1.200mg/hari intravena selama lima hari dan dilanjutkan dosis oral 2x400mg per hari selama 23 hari setelahnya. Pemeriksaan viskositas darah dan interleukin-6 dilakukan pada hari pertama dan ketujuh perawatan. Luaran klinis dinilai dengan menggunakan national institute of health stroke scale NIHSS , modified rankin score mRS dan indeks barthel pada hari ketujuh dan juga pada hari ke-30. Hasil: Kadar viskositas darah seluruh subyek mengalami penurunan pada hari ketujuh dan ketiga puluh. Pada kelompok perlakuan, rerata penurunan viskositas darah memiliki perbedaan bermakna pada subyek dengan faktor risiko merokok dan dislipidemia. Tidak didapatkan penurunan kadar interleukin-6 pada kedua kelompok. Kelompok perlakuan memiliki perbaikan defisit neurologis sebesar 32 risiko relatif [RR]1,00; 95 interval kepercayaan [IK] 0,421-3,556; p = 1,00 . Disabilitas dan kemandirian fungsional yang baik didapatkan pada 67 kelompok perlakuan RR 1,026; 95 IK 0,656-1,605; p = 0,9 . Pada kelompok perlakuan, luaran klinis berbeda bermakna pada subyek yang memiliki sakit jantung dan diabetes melitus. Kesimpulan: Setelah pemberian pentoksifilin didapatkan penurunan kadar viskositas dan perbaikan luaran klinis. Studi lanjutan dibutuhkan dengan kriteria yang lebih spesifik dan jumlah sampel yang lebih besar. ...... Background: The role of pentoxifylline in acute ischemic stroke lacks objective markers of its efficacy. Therefore, we used blood viscosity to determine the efficacy of pentoxifylline. Method: This was a randomized single blind, controlled trial. Acute ischemic stroke patients with blood hyperviscosity within 3 day onset were randomly allocated to the study n 22 or control n 22 group. All subjects received a standard treatment for acute ischemic stroke. The study group was administered with intravenous pentoxifylline 1,200 mg day for five consecutive days and continued with oral 800 mg in two divided doses for next twenty three days. Blood viscosity and interleukin 6 IL 6 were evaluated at the first and seventh day. Clinical outcomes were measured using the National Institutes of Health Stroke Scale NIHSS, modified Rankin Scale mRS, and barthel index BI at the seventh and thirtieth day. Result: The level of blood viscosity of all subjects tends to be decreased on the seventh and thirtieth day. In study group, the decrement of blood viscosity was significant for smoking and dyslipidemic subject. There was no decrement of the IL 6 on both group. The improvement of NIHSS in study group was 32 relative risk RR 1,00 95 CI 0,421 3,556 p 1,00 . At 1 month follow up, 67 of study group had a good functional outcome RR 1,026 95 CI 0,656 1,605 p 0,9 and the good functional outcome was statistically significant for diabetes mellitus and heart disease subject. Conclusion The decrement of blood viscosity and the improvement of clinical outcome were seen after pentoxifylline administration.

Abstrak :
Latar Belakang: Meningkatnya angka kejadian stroke dan beratnya disabilitas dari penderita stroke yang bertahan hidup, menjadikan diperlukannya terapi yang optimal untuk restorasi paska stroke. Neurorestorasi dengan transplantasi sel punca menjanjikan perbaikan luaran fungsional yang baik pada pasien stroke iskemik. Penelitian ini dibuat untuk mengamati efek transplantasi Stem Cell from Human Exfoliated Deciduous Teeth SHED pada luaran klinis dan rasio sel neuron mati pada model stroke iskemik, untuk mendapatkan terapi yang optimal untuk stroke iskemik. Metode: Pembuatan tikus model stroke iskemik dilakukan dengan oklusi arteri cerebri media (MCAO). Pada 48 jam setelah MCAO, dilakukan transplantasi sel mesenkimal asal SHED secara intravena, dengan dosis 2x106/kgBB. Dilakukan evaluasi fungsional tikus secara neurobehaviour dengan tes Y Maze, dan evaluasi sensorimotor tikus dengan tes silinder. Evaluasi rasio neuron mati dilakukan dengan pewarnaan Hematoksilin dan Eosin. Hasil: Terdapat perbaikan evaluasi neurobehaviour dengan Y Maze (p=0,04) dan evaluasi sensorimotor dengan tes silinder (p=0,04) pada 14 hari setelah transplantasi pada kelompok tikus yang ditransplantasi SHED dibandingkan kontrol. Terdapat pengurangan rasio sel neuron mati (p=0,0) pada tikus yang ditransplantasi SHED pada 21 hari setelah MCAO. Kesimpulan: Transplantasi SHED pada tikus model stroke iskemik pada fase akut stroke menunjukkan perbaikan klinis dan terdapat pengurangan rasio neuron mati pada otak tikus model stroke iskemik yang di transplantasi dengan sel mesenkimal asal SHED.

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Background: The incidence of stroke reaches 15 million cases worldwide, and 5 million stroke survivors suffered permanent disability. Ischemic stroke causes a burden on health problems particularly in Indonesia. The prevalence of stroke in Indonesia in 2013 is 7 per 1000 population. The optimal stroke restoration therapy required, and neurorestoration with stem cell transplantation is a promising therapy that provides functional improvements for ischemic stroke. This research was conducted to observe the effects of Stem Cell from Human Exfoliated Deciduous Teeth (SHED) transplantation on the clinical improvement and neuron death ratio in the brain of rats models with ischemic stroke. Methods: One group of normal rats and two groups (n=5) of male wistar rats undergone permenents Middle Cerebral Artery Occlusion (MCAO). SHED transplantation performed 48 hours after MCAO, by intravenous injection with a dose of 2x106 cells/kg. Functional evaluation conducted in rats with Y Maze and cylinder Test. Evaluation of the death neurons ratio in brain cortex area done by Hematoksilin and Eosin staining.Results : The functional evaluation using Y Maze and Cylinder Test was significantly improved in the treatment group compared to the control stroke group p < 0,05 14 days after MCAO. There was a reduction in the neuron death ratio p = 0.0 in rats transplanted with SHED.Conclusion : SHED transplantation in acute stroke showed clinical improvement and reduction in the neuron death ratio in the brain of rat models with ischemic stroke. Keywords: Cell transplantation, Ischemic Stroke, MCAO, SHED

Abstrak :
Hipertensi merupakan masalah kesehatan masyarakat, karena prevalensi yang tinggi dan merupakan salah satu faktor utama penyebab kematian yang disebabkan oleh penyakit jantung dan pembuluh darah. Banyak studi yang membuktikan bahwa hipertensi berkaitan dengan pola hidup, yang seharusnya dapat dicegah. Penelitian ini bertujuan untuk mengetahui peranan dari faktor komposisional (tingkat individu) serta determinan lingkungan (tingkat rumah tangga dan tingkat kabupaten/kota) terhadap kejadian hipertensi di Jawa Bali. Penelitian potong lintang dengan pendekatan analisis multilevel dilakukan untuk mengestimasi efek kontekstual, sehingga dapat menentukan skala prioritas implikasi program intervensi terhadap kejadian hipertensi. Dikarenakan adanya keterbatasan data dari Riskesdas 2007, Susenas 2007, Pendataan Sosial Ekonomi 2007 dan Podes 2008, analisis ini hanya meliputi 200.603 penduduk dengan kelompok umur 15-60 tahun dari 83.693 rumah tangga di 134 kabupaten/kota pada 7 Provinsi di wilayah Jawa Bali. Prevalensi hipertensi di Jawa Bali adalah 26,4% (95% CI: 26,2-26,6). Tampak ada perbedaan peranan di tingkat individu (84,9%), tingkat rumah tangga (6,4%) dan tingkat kabupaten/kota (8,7%). Pada tingkat individu, ada 3 variabel yang berperan cukup besar terhadap kejadian hipertensi di wilayah Jawa Bali yaitu IMT ≥ 25 Kg/m2 (OR: 2,02) dengan kontribusi 4,3%, obesitas abdominal (OR: 1,45) dengan kontribusi 2,4% dan tingkat pendidikan < SLTP (OR: 1,38) dengan kontribusi 1,6%. Apabila ketiga faktor risiko tersebut ditiadakan, maka dapat menurunkan prevalensi hipertensi di Jawa Bali dari 26,4% menjadi 18,1%. Pada tingkat rumah tangga, variabel yang berperan terhadap kejadian hipertensi adalah < 9 m2/orang (IOR: 1,56 - 1,74), 1,56 - 1,74) (IOR: 1,51-1,80). Sedangkan pada 1,00 - 1,62). Penelitian ini merekomendasikan program intervensi, terutama ditujukan untuk menurunkan berat badan dengan mempertahankan berat badan ideal dan meniadakan obesitas sentral, serta meningkatkan kerjasama lintas sektor non kesehatan dalam menangani masalah hipertensi. ......Hypertension is a public health problem, due to its high prevalence and also one of the main factors causing the deaths by heart and blood vessel disease. Many studies showed that hypertension is associated with lifestyle behavior that could have been prevented. The purpose of this study is to determine the role of compositional factors (individual level) and environmental determinants (the household level and at the district/city level), with the incidence of hypertension in Java Bali region. Cross-sectional study with a multilevel analysis is used to estimate the effects of contextual, so it can determine the implications priority intervention program on the incidence of hypertension. Because of limited data available from Riskesdas 2007, Susenas 2007, Social Economic Survey 2007, Podes and 2008, this analysis only covers 200.603 population with 15-60 years age group from 83.693 households at 134 districts / cities at 7 provinces in Java Bali region. The prevalence of hypertension in Java Bali region is 26.4% (95% CI: 26.2 to 26.6). It appears that there are differences in the role at the individual level (84.9%), household level (6.4%) and district/city level (8.7%). At the individual level, there are three main factors that contribute: BMI ≥ 25 kg/m2 (OR: 2.02) for 4.3%, abdominal obesity (OR: 1.45) for 2.4% and level of education < junior (OR: 1.38) for 1.6% on the incidence of hypertension in Java Bali region. If all three risk factors are exempted, it can decrease the prevalence of hypertension in Java Bali region, from 26.4% to 18.1%. Variable that contributes at the household level are the density of occupancy <9 m2/person (IOR: 1.56 - 1.74), expenditure per capita (IOR: 1.56 - 1.74), and the lack of support in sports activities (IOR: 1.51 - 1.80) on the incidence of hypertension. Meanwhile, at the district/ city level variable that contributes is from regions with high HDI score (IOR: 1.00 - 1.62). This study recommends intervention programs, primarily intended for weight loss by maintaining ideal body weight and eliminate central obesity also to increase cooperation across non-health sector in addressing the problem of hypertension.