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"ABSTRAKLatar belakang: Kemoterapi pilihan untuk Diffuse Large B Cell Lymphoma (DLBCL) adalah regimen yang mengandung doksorubisin. Doksorubisin merupakan obat kemoterapi golongan antrasiklin yang bekerja sebagai anti Topoisomerase II (Top2). Penelitian sebelumnya terhadap galur sel tumor menunjukkan bahwa ekspresi Topoisomerase IIα (Top2A) yang tinggi berhubungan dengan sensitifitas terhadap antrasiklin yang tinggi pula. Tujuan penelitian ini adalah untuk mengetahui ekspresi protein Top2A pada DLBCL dan hubungannya dengan respon terapi.Bahan dan cara kerja: Dilakukan studi analitik potong lintang terhadap 38 kasus DLBCL dengan pulasan CD20 positif dan telah mendapatkan kemoterapi minimal 4 siklus. Dilakukan pulasan imunohistokimia terhadap protein Top2A dan dinilai menggunakan H-score.Hasil: Secara keseluruhan ekspresi Top2A ditemukan pada 37 dari 38 kasus (97,4%) dengan nilai H-score sangat bervariasi yaitu antara 101,5 sampai dengan 215,0 dan median 124,1. H-score Top2A digolongkan tinggi jika H-score lebih dari 124,1. Analisis statistik menunjukkan bahwa ekspresi Top2A pada DLBCL tidak berhubungan bermakna dengan respon terapi (p=0,670).Kesimpulan: Tidak ditemukan hubungan bermakna antara ekspresi Top2A dengan respon terapi. Ekspresi Top2A tidak dapat dijadikan faktor prediktor respon terapi pada DLBCL.

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ABSTRACTBackground: Standard of chemotherapy for Diffuse Large B Cell Lymphoma (DLBCL) is a regimen containing doxorubicin. Doxorubicin is a component of anthracycline based chemotherapy that work as anti Topoisomerase II (Top2). Previous study on tumor cell lines showed that high expression of Topoisomerase IIα (Top2A) was related to higher sensitivity to anthracycline. The aim of this study is to know the expression of Top2A and its relation to treatment response. Material and methods: This is an analytic cross-sectional study on 38 CD20 positive DLBCL cases that have been treated with at least 4 cycles of chemotherapy. The immunohistochemical staining for Top2A protein was performed assesed using H-score.Result: Expression of Top2A protein were found in 37 of 38 (97,4%) cases (H-score range: 101.5-215.0 and median 124.1). Top2A was defined as high if H-score was higher than 124.1. Statistical analysis showed that Top2A expression in DLBCL was not significantly related to treatment response (p=0.670).Conclusion : There was no significant relation between Top2A expression to treatment response. Top2A expression in DLBCL cannot be used as a predictor of treatment response."

"PendahuluanKarsinoma nasofaring (KNF) merupakan jenis keganasan yang unik dengan distribusi geografis dan etnis tertentu. Daerah Cina Selatan dan Asia Tenggara memiliki insidens kejadian yang tinggi. Indonesia memiliki insidens 5,66 kasus per 100.000 penduduk per tahun. Salah satu penyebab kematian pasien dengan keganasan adalah trombosis. Kadar soluble Platelet-selectin (sP-selectin) yang tinggi dalam plasma, hasil dari aktivasi sel-sel endotel dan trombosit, adalah prediktor kejadian trombosis.TujuanMengetahui kadar sP-selectin pada berbagai stadium karsinoma nasofaring dan korelasinya dengan hitung trombosit.MetodeDilakukan studi potong lintang pada 60 kasus karsinoma nasofaring yang baru terdiagnosis di Rumah Sakit Cipto Mangunkusumo pada periode Maret hingga November 2012. Kadar sP-selectin diukur dengan teknik Enzyme Linked Immunosorbent Assay.HasilRerata usia adalah 43,9 tahun dengan rasio laki-laki terhadap perempuan 3:1. Jenis patologi terbanyak adalah karsinoma tidak berdiferensiasi (83,3%). Sepuluh persen pasien mengalami trombositosis. Median kadar sP-selectin adalah 45,73 ng/mL dengan rentang interkuartil: 42,02-57,66 ng/mL. Secara statistik terdapat perbedaan kadar sP-selectin diantara stadium IVC dengan stadium lainnya (stadium IVB, p = 0,001 dan kelompok stadium I-IVA, p < 0,001). Hitung trombosit tidak berkorelasi dengan sP-selectin (r: 0,185; p = 0,158).SimpulanTerdapat perbedaan kadar sP-selectin pada berbagai stadium karsinoma nasofaring. Hitung trombosit tidak berkorelasi dengan kadar sP-selectin.

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Background

Nasopharyngeal carcinoma (NPC) is an unique malignancy because of its geographical and ethnic patterns. South China and South East Asia have the highest incidence, while in Indonesia is about 5.66 cases per 100,000 populations per year. Thrombosis is one of the complications of malignancy. High plasma levels of soluble Platelet-Selectin (sP-selectin) produced by activated endothelial cells and platelets, are predictive of thrombosis.

Objective

To measure sP-selectin levels in various stages of nasopharyngeal carcinoma and its correlation with platelet count.

Methods

This was a cross sectional study including 60 patients with newly diagnosed nasopharyngeal carcinoma at Cipto Mangunkusumo Hospital, Jakarta, Indonesia in period of April to November 2012. Soluble P-selectin levels in various stages of NPC measured with Enzyme Linked Immunosorbent Assay was compared and correlated with platelets count.

Results

From 60 patients of NPC, the mean age was 43.9 years with ratio of men to women was 3:1. The most prevalence histopathology was undifferentiated carcinoma (83.3%). Ten percent of the patients had thrombocytosis. The median level of sP-selectin was 45.73 ng/mL (inter quartile range: 42.02-57.66). Soluble P-selectin levels were statistically significantly higher among patients with stage IVC than other stages (with stage IVB, p = 0.001 and with group of stage I-IVA, p < 0.001). There was no correlation between platelet count and sP-selectin levels (r = 0.185; p = 0.158).

Conclusion

There were different levels of sP-selectin between various stages of nasopharyngeal carcinoma. There was no correlation between platelets count and sP-selectin levels."

"Latar Belakang. Hemofilia selama ini diketahui menimbulkan komplikasi muskuloskeletal dan penurunan densitas tulang adalah salah satunya. Faktor risiko penurunan densitas tulang pada hemofilia belum diketahui secara pasti. Profil pasien hemofilia dengan penurunan densitas tulang di Indonesia juga belum diketahui.Tujuan. Mengetahui proporsi penurunan densitas tulang pada hemofilia dan karakteristik pasien hemofilia dengan penurunan densitas tulang.Metode. Studi ini merupakan studi deskriptif potong lintang yang dilakukan pada bulan Juni-November 2012. Subyek penelitian adalah pasien hemofilia dewasa berusia 19-50 tahun yang berobat ke Poliklinik Hematologi Onkologi Medik RS Cipto Mangunkusumo atau yang terdaftar di Tim Hemofilia Terpadu berdomisili di area Jabodetabek. Variabel yang dinilai adalah densitas massa tulang, usia, indeks massa tubuh, aktivitas fisik, artropati, penggunaan terapi substitusi, infeksi HIV dan HCV. Densitas tulang diukur dengan Lunar GE Scan. Penurunan densitas tulang didefinisikan sebagai Z-score -2 atau kurang. Aktivitas fisik dinilai dengan kuesioner Hemophilia Activities List. Artropati secara klinis dinilai dengan Hemophilia Joint Health Score. Artropati secara radiologis dinilai pada sendi lutut menggunakan Skor Arnold-Hilgartner. Data numerik dinyatakan dalam mean + SD atau median. Data kategorik dinyatakan dalam n dan persentase.Hasil. Sejumlah 63 subyek hemofilia dewasa berusia 19-46 tahun mengikuti studi ini dengan median usia 26 tahun. Proporsi penurunan densitas tulang pada hemofilia didapatkan sebesar 6,3%. Fraktur terjadi pada 14,3% subyek. Subyek dengan densitas tulang menurun memiliki usia lebih muda (19 tahun vs 26 tahun). Subyek dengan densitas tulang menurun memiliki IMT lebih rendah (18,6 + 2,8 kg/m2 vs 21,5 + 3,8 kg/m2). Subyek dengan densitas tulang menurun menggunakan terapi substitusi lebih banyak daripada subyek dengan densitas tulang normal (4047 IU/bulan vs 2000 IU/bulan). Infeksi HCV terjadi pada 25% subyek dengan densitas tulang menurun sedangkan pada densitas tulang normal sebesar 55,9%. Infeksi HIV hanya terjadi pada 1,6% subyek. Skor aktivitas ditemukan sama antara subyek dengan densitas tulang normal dan menurun. Skor artropati klinis ditemukan lebih baik pada subyek dengan densitas tulang menurun (18,7 + 4,4 vs 23,1 + 11,8).Simpulan. Penurunan densitas tulang pada subyek hemofilia ditemukan sebesar 6,3%. Subyek dengan densitas tulang menurun berusia lebih muda, memiliki IMT lebih rendah, skor sendi lebih baik, lebih sedikit mengalami infeksi transfusi, dan mengalami perdarahan lebih banyak dibandingkan subyek dengan densitas tulang normal.

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Background. Haemophilia can result in musculoskeletal complications and reduced bone density is one of the recently known musculoskeletal complications in haemophilia patients. Risk factors of reduced bone density in haemophilia have not been completely known yet. Moreover, profile of hemophilia patient with reduced bone density in Indonesia have not been studied.Objectives. To know the proportion of reduced bone density and characteristics of hemophilia patient with reduced bone density.Methods. A cross-sectional study on haemophilia patients aged 19-50 years old was conducted ini Haematology-Medical Oncology Clinic, Cipto Mangunkusumo Hospital from June-November 2012. Bone density, age, body mass index, physical activity, arthropathy, amount of replacement therapy, HIV and HCV infection are analyzed variables. Bone density was measured with GE Lunar Scan. Reduced bone density was defined as Z-score -2 or less. Physical activity was measured with Haemophilia Activities List questionnaire. Joint involvement was measured clinically with Haemophilia Joint Health Score. Joint involvement of the knee was measured radiologically with plain X-ray and graded according to Arnold-Hilgartner Score. Numerical data will be presented in mean + SD or median. Categorical data will be presented as n and percentage.Results. Sixty three haemophilia subjects aged 19-46 years old joined the study with median age 26 years old. Reduced bone density was found in 6,3% of the subjects. History of fractures was found in 14,3% patient. Subjects with reduced bone density have younger age (19 vs 26 years). Subjects with reduced bone density have lower BMI (18,6 + 2,8 kg/m2 vs 21,5 + 3,8 kg/m2). Subjects with reduced bone density used replacement therapy more than their normal counterparts (4047 IU/month vs 2000 IU/month). HCV infection happened in 25% of subjects with reduced bone density while only found in 55% of normal bone density subjects. HIV infection was only found in 1,6% patient. Activity score between normal and reduced bone density was about the same. Clinical arthropathy score was better in reduced bone density subjects (18,7 + 4,4 vs 23,1 + 11,8).Conclusion. Reduced bone density was found in 6,3% subjects. Subjects with reduced bone density have younger age, lower BMI, better joint score, less infection, and experienced more bleeding than subjects with normal bone density."

"ABSTRAKLatar belakang: Patomekanisme trombositopenia pada infeksi Dengue hingga saat ini masih belum jelas. Cheng dkk mendapatkan adanya mimikri molekul antara protein disulfida isomerase permukaan trombosit dengan protein NS1 virus Dengue, sehingga anti-NS1 mengenali PDI. Penelitian ini bertujuan untuk mengetahui adanya korelasi antara anti-NS1 dan anti-PDI permukaan trombosit sebagai salah satu mekanisme trombositopenia pada infeksi Dengue.Metode: Penelitian dengan disain potong lintang terhadap darah 19 pasien infeksi Dengue yang diambil pada demam hari ke 3, 5 dan 7. Jumlah trombosit dicatat, anti-NS1 dideteksi menggunakan metode ELISA phase padat, anti-PDI dideteksi menggunakan metode MAIPA direk, dan eksplorasi pengenalan antibodi serum pasien terhadap protein trombosit menggunakan western blot.Hasil: Didapatkan korelasi lemah antara OD anti-NS1 dengan jumlah trombosit. Pada analisis kinetika anti-NS1 dan anti PDI secara individual didapatkan pola yang bervariasi. Analisis pada 2 kelompok sampel didapatkan korelasi positif lemah yang kemudian menjadi korelasi negatif lemah pada demam hari ke5 dan ke7. Pada eksplorasi antibodi pada serum pasien ditemukan adanya kemungkinan pengenalan antibodi terhadap GPIIb, GPIIIa, dan ERp57.Kesimpulan: Terdapat korelasi negatif lemah antara OD anti-NS1 dan jumlah trombosit, ada korelasi positif lemah antara OD anti-NS1 dan anti-PDI trombosit, serta adanya kemungkinan pengenalan antibodi serum pasien terhadap GPIIb, GPIIa dan ERp57.

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ABSTRACT

Background: Patomechanism thrombocytopenia in Dengue infection still not clear. Cheng et all demonstrated molecular mimicry mechanism between PDI on platelet and region protein NS1-DV, so anti-NS1 recognize PDI on platelet and act like anti-PDI. In this study, we observed the correlation of anti-NS1 and anti-PDI on platelet as one of the mechanism of trombositopenia in Dengue infection

Materials and Method : We observed nineteen patients with Dengue infection by a cross sectional study. Patients blood were collected on day 3, 5 and 7 after the onset of fever. We collected data of platelet count, anti-NS1 were determined by using solid phase ELISA method, anti-PDI platelet were determined by using Direct MAIPA method, and the exploration of antibody activities in patient sera against PDI platelet were done using Western Blot method.

Result : There was no significant weak correlation between OD anti-NS1 and platelet count. In individually analysis of the kinetics of anti-NS1 and anti-PDI shows variation of patterns. Correlation analysis between 2 sampel group (>1x105/µl and ≤1x105/µl) we have weak correlation, but on 5th day after fever onset the correlation become weak negative correlation on 5th day and on 7th day after fever onset. Western blot analysis shows antibodies activity in patient serum that recognized GP IIb, GP IIIa, dan ERp 57, which is moleculer that content PDI.

Conclusion : We have weak negative correlation between OD anti-NS1 with platelet count that stronger in day 5th after the onset of fever. There was weak positive correlation between OD anti-NS1 and OD anti-PDI that the correlation change to negative correlation in day 5th after the onset of fever in IgG anti-Dengue positive (+) group. The recognize antibody in patient serum to GP IIb, GP IIIa, dan Erp 57, still not clear yet."

"ABSTRAKLatar Belakang: Eksaserbasi pada PPOK mempunyai kontribusi yang besar terhadap derajat keparahan dan progresivitas PPOK. Identifikasi faktor-faktor yang berhubungan dengan eksaserbasi PPOK banyak diteliti di luar negeri. Dengan mempertimbangkan terdapatnya perbedaan karakteristik pasien di Indonesia, maka perlu dilakukan penelitian tentang faktor-faktor yang berhubungan dengan eksaserbasi pada pasien PPOK di Indonesia.Tujuan: Mengetahui prevalensi eksaserbasi pada pasien PPOK di RSCM selama kurun waktu 1 Januari 2010 sampai dengan 31 Desember 2012 serta untuk mengidentifikasi faktor-faktor yang berhubungan dengan eksaserbasi pasien-pasien PPOK yang berobat di RSCM baik rawat jalan maupun rawat inap.Metode: Penelitian ini merupakan studi dengan desain potong lintang pada pasien PPOK yang berobat di RSCM selama tahun 2010–2012. Data klinis dan penunjang selama perawatan diperoleh dari rekam medis. Analisis bivariat dilakukan pada variabel kelompok usia, riwayat merokok, komorbiditas, derajat PPOK, riwayat pengobatan dengan kortikosteroid, dan frekuensi eksaserbasi dalam satu tahun sebelumnya.Variabel yang memenuhi syarat akan disertakan pada analisis multivariat dengan regresi logistik.Hasil: Sebanyak 184 pasien diikutsertakan dalam penelitian ini. Didapatkan prevalensi eksaserbasi PPOK sebesar 70,7%. Derajat PPOK , riwayat perokok, frekuensi eksaserbasi satu tahun sebelumnya, pengobatan kortikosteroid sistemik, dan komorbid merupakan variabel yang berbeda bermakna pada analisis bivariat. Faktor risiko independen yang bermakna pada analisis multivariat adalah frekuensi eksaserbasi PPOK dalam satu tahun sebelumnya ≥ 2 kali (OR 27,39; IK 95% 3,30 sampai 227,29; p = 0,002), perokok aktif (OR 5,11; IK 95% 1,07 sampai 24,35; p = 0,041), PPOK derajat III dan IV (OR 4,71; IK 95% 1,59 sampai 13,97; p = 0,005), dan komorbid dengan nilai Charlson Comorbid Index lebih dari dua (OR 4,09; IK 95% 1,37 sampai 12,18; p = 0,011). Sedangkan pengobatan dengan kortikosteroid sistemik merupakan faktor proteksi terhadap eksaserbasi PPOK (OR 0,12; IK 95% 0,03 sampai 0,54; p = 0,006).Simpulan: Prevalensi eksaserbasi pasien PPOK di RSCM pada tahun 2010 sampai dengan 2012 adalah 70,7%. Faktor risiko eksaserbasi PPOK adalah frekuensi eksaserbasi PPOK pada satu tahun sebelumnya lebih dari sama dengan dua kali, perokok aktif, PPOK derajat III dan IV serta komorbid dengan Charlson Comorbid Index . Sedangkan pengobatan dengan kortikosteroid sistemik merupakan faktor proteksi terhadap eksaserbasi PPOK.

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ABSTRACTBackground. Exacerbation in chronic obstructive pulmonary disease (COPD) contributes greatly to the severity and progression of COPD. Identification of factors associated with exacerbation of COPD has widely studied abroad with varying results. Due to difference in patient characteristic, it is necessary to study on the factors associated with exacerbation of COPD in Indonesia.Aim.To determine the prevalence of COPD exacerbations in RSCM during 2010 until 2012. And to identify factors associated with exacerbation of COPD patients who seek treatment at Cipto Mangunkusumo Hospital, both inpatient and outpatient.Methods. This study was a cross sectional study design in COPD patients who seek treatment at CiptoMangunkusumo Hospital, both inpatient and outpatient, during 2010-2012. Clinical data, supportive data, and outcome (exacerbation or stable) data during treatment were obtained from medical records. Bivariate analyses were performed on age, history of smoking, comorbidity, severity of COPD, history corticosteroids treatment, and frequency of exacerbations in the previous year. Variables that were eligible would be included in the multivariate analysis in the form of logistic regression.Results. A total of 184 patients enrolled in this study. Prevalence of COPD exacerbation was 70.7%. Severity of COPD, history of smoking, frequency of previous exacerbations, history of systemic corticosteroid treatment, and comorbidity were variables found to be significantly different in bivariate analysis. Independent risk factors that were found to be significant in multivariate analysis were ≥ 2 times of COPD exacerbation in the previous year (OR 27.39; 95% CI 3.30 to 227.29; p = 0.002), current smoker (OR 5.11; 95% CI 1.07 to 24.35; p = 0.041), grade III and IV of COPD (OR 4.71; 95% CI 1.59 to 13.97; p = 0.005), and comorbid with charlson comorbid index value more of two (OR 4.09; 95% CI 1.37 to 12.18; p = 0.011). While treatment with systemic corticosteroid is protective factor against COPD exacerbations (OR 0.12; 95% CI 0.03 to 0.54; p = 0.006).Conclusion. The prevalence of COPD exacerbations in RSCM during 2010 to 2012 is 70.7%. Risk factors for COPD exacerbation are more than or equal to two times of COPD exacerbation in the previous year, current smokers, grade III and IV of COPD and comorbid with charlson comorbid index value more of two. While treatment with systemic corticosteroid is protective factor against COPD exacerbations."

"Latar Belakang: Kanker Nasofaring (KNF) salah satu pilihan terapinya adalah kemoterapi neoajuvan. Respon kemoterapi ini, di pengaruhi oleh Epidermal Growth Factor Receptor(EGFR), faktor yang berperan pada pertumbuhan dan invasif tumor. Tujuan dari penelitian ini adalah untuk mengetahui perbandingan tingkat ekspresi EGFR dengan respon kemoterapi neoajuvan dan tingkat ekstensif tumor primer. Penelitian ini merupakan studi potong lintang deskriptif, dilakukan penilaian respon kemoterapi neoajuvan dan tingkat ekstensif tumor primer, pada pasien KNF yang telah mendapat kemoterapi dan dilakukan pemeriksaan ekspresi EGFR. Hasil penelitian: Proporsi ekspresi EGFR pada kanker nasofaring untuk ekspresi negatif, positif dan kuat, berturut-turut sebesar (10%), (70%) dan (20%). Pasien yang respon terhadap kemoterapi neoajuvan adalah 23 pasien (76,6%) dan tidak respon 7 pasien (23,4%). Kelompok pasien yang memberikan respon terhadap kemoterapi, 15 pasien ( 50%) memiliki intensitas EGFR yang lemah. Pasien dengan tingkat ekstensif T3-T4 , mempunyai ekspresi EGFR lebih besar dibandingkan T1-T2 tumor. Kesimpulan : Proporsi ekspresi EGFR pada kanker nasofaring di Indonesia sebesar 90 persen. Kemoterapi neoajuvan lebih respon pada tumor dengan ekspresi EGFR positif dan intensitas EGFR yang lemah. Tumor dengan tingkat ekstensif yang lebih tinggi, mempunyai ekspresi EGFR lebih tinggi.

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Background: Neoadjuvan chemotherapy is one option of treatment for nasopharyngeal cancer (NPC). The response of chemotherapy influenced by EGFR expression. EGFR is important factor for the growth and tumors invasion. Purpose of the study is compare of the EGFR expression level with response of neoadjuvan chemotherapy and extensive level of the primary tumor. The methods is cross-sectional descriptive study that assessment of response to neoadjuvan chemotherapy and extensive level of the primary tumor. The NPC patients who have received chemotherapy is examined of EGFR expression.

Result of the study is the proportion of EGFR expression in NPC for negative, positive and strong expression is 10%, 70%, and 20% respectively. Patients who responses to neoadjuvan chemotherapy are 23 patients(76.6%) and non-responses 7 patients (23.4%). The group patients who responses to chemotherapy, 15 patients (50%) have EGFR weak intensity. Patients with T3-T4 tumors (56,6%) have EGFR expression is greater than T1-T2 tumors(44,4%).

Conclusion: The proportion of EGFR expression in NPC in Indonesia is 90 percent. Neoajuvan chemotherapy is more response in tumors with positive EGFR expression and weak intensity. Tumors with high extensive levels have higher EGFR expression."

"Temozolomide (TMZ) seringkali dijadikan terapi standar glioblastoma multiforme (GBM). Namun, terdapat kejadian resistensi pada sel kanker terhadap TMZ. Adanya kejadian resistensi ini berhubungan dengan enzim MnSOD dan stress oksidatif yang mekanismenya tidak diketahui. Penelitian terbaru menyarankan untuk mengkombinasikan terapi kanker dengan senyawa aktif bahan alam untuk mencegah resistensi pada sel kanker. Andrografolida merupakan salah satu bahan aktif dalam ekstrak sambiloto yang memiliki sifat anti kanker. Menanggapi hal tersebut, penelitian ini menggunakan dua jenis sel yang secara intrinsik resisten terhadap temozolomide (T98G) dan sensitif terhadap temozolomide (U87MG). Terlebih dahulu dilakukan analisis viabilitas sel pada tiga jenis ekstrak sambiloto untuk mengetahui jenis ekstrak yang terbaik. Setiap perlakuan menggunakan terapi tunggal TMZ, andrografolida murni (AM), dan ekstrak kering (EK) serta terapi kombinasi TMZ+AM dan TMZ+EK menggunakan dosis CC₅₀ dan CC₂₅. Sel T98G diberikan perlakuan selama 48 jam sedangkan sel U87MG diberikan TMZ berulang hingga hari ke-17 dan diberikan terapi tunggal maupun terapi kombinasi mulai hari ke-17 hingga hari ke-21. Viabilitas sel, analisis ROS, penentuan aktivitas dan ekspresi mRNA MnSOD dilakukan. Diketahui bahwa pemberian terapi kombinasi ekstrak sambiloto dengan dosis CC₅₀ efektif mengatasi resistensi sel GBM. Pemberian terapi kombinasi dapat menurunkan ekspresi gen dan aktivitas MnSOD sehingga meningkatkan ROS dan menurunkan viabilitas sel.

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Temozolomide (TMZ) used as standard therapy for glioblastoma multiforme (GBM). However, there is an incidence of resistance in cancer cells with TMZ. This phenomenon is related with MnSOD enzyme and oxidative stress whose mechanism is unknown. Latest research suggests combining cancer therapy with natural active compounds to prevent resistance in cancer cells. Andrographolide is one of the active compounds in sambiloto extract which has anti-cancer properties. Therefore, this study used intrinsically resistant (T98G) and sensitive to temozolomide (U87MG) cells. Firstly, cell viability was analyzed on three types of sambiloto extract. Each treatment used single therapy TMZ, pure andrographolide (AM), and dry extract (EK) as well as combination therapy TMZ+AM and TMZ+EK using CC₅₀ and CC₂₅ doses. T98G cells were given treatment for 48 hours while U87MG cells were given TMZ repeatedly until the 17th day and given single therapy or combination therapy from the 17th day to the 21st day. Cell viability, ROS analysis, determination of MnSOD activity and expression were performed. It was known that the combination therapy of sambiloto extract with CC₅₀ dose was effective in overcoming the resistance of GBM cells. Combination therapy can reduce gene expression and MnSOD activity thereby increased ROS and decreased cell viability."

"Latar Belakang : Kanker ovarium merupakan penyebab kematian tertinggi pada kelompok kanker ginekologik dengan angka kekambuhan dua tahun sebesar 50%. Tujuan: mengetahui faktor yang berperan pada kekambuhan kanker ovarium. Metode : Penelitian ini menggunakan desain kohort retrospektif dengan teknik analisis kesintasan untuk melihat peran faktor ekspresi Human Epidermal Receptor (HER-2), residu tumor post operasi, jenis subtipe sel kanker dan tingkat diferensiasi sel kanker terhadap kekambuhan kanker ovarium epitelial. Analisis bivariat menggunakan metode log rank test digunakan untuk menilai hubungan antara 2 variabel. Hasil Penelitian : Sebanyak 65 pasien kanker ovarium epitelial (tahun 1998-2012) yang telah remisi diamati selama 24 bulan. Terlihat bahwa median usia 50 tahun dengan proporsi kekambuhan sebesar 36,9% pasien dan mean waktu kekambuhan pertama 19,15 bulan. Volume residu tumor post operasi berukuran lebih dari 1 cm meningkatkan Rasio Hazard kekambuhan dua tahun pasien kanker ovarium epitelial, nilai p: 0,02 dan HR 3,31 (IK95% 1,46-7,49) sementara jenis subtipe histologi dan tingkat diferensiasi sel kanker tidak berhubungan dengan terjadinya kekambuhan ini. Satu dari 38 pasien memperlihatkan adanya cytoplasmic staining pada pemeriksaan ekspresi HER-2 dengan metode imunohistokimia. Simpulan : Volume residu tumor post operasi yang berukuran lebih dari 1 cm meningkatkan Rasio Hazard kekambuhan dua tahun pasien kanker ovarium epitelial, sementara jenis subtipe histologi dan tingkat diferensiasi sel kanker tidak berperan pada kekambuhan ini. Pada pemeriksaan ekspresi HER-2, menggunakan teknik imunohistokimia dilaporkan 1 sampel memperlihatkan cytoplasmic staining.

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Background : Ovarian cancer was the leading cause of death in gynecologic cancer which had the two years recurrency rate of 50%.

Aim : to know factors that influenced on epithelial ovarian cancer recurrency.

Methods : We used retrospective cohort design with survival analysis technique for this study to examine the role of HER-2 expression, residual tumor post operation, cancer cell histological subtype and cancer cell grading on epithelial ovarian cancer recurrency. Bivariate analyze using log rank test methods were done to examine significance between two variables.

Results : Sixty-five epithelial ovarian cancer patient (1998-2012) who had achieved remission were observed for 24 months. We reported median age of 50 years with recurrency rate of 36.9% and mean time of recurrency was 19,15 months. Volume of post surgery residual tumor more than 1 cm increase Hazard Ratio of two years recurrency of epithelial ovarian cancer, p value 0.02 and HR of 3.31 (95% CI 1.46-7.49) but histology subtype and cancer cell grading did not influence the recurrency. One of 38 patients showed cytoplasmic staining in HER-2 expression examination by imunohistochemistry methods.

Conclusion : Volume of post surgery residual tumor more than 1 cm increase Hazard Ratio of two years recurrency of epithelial ovarian cancer while histology subtype and cancer cell grading did not influence the recurrency. One sample showed cytoplasmic staining on HER-2 examination by imunohistochemistry methods."

"Latar belakang: Tromboemboli vena (TEV) dapat bermanifestasi sebagai trombosis vena dalam (TVD) ataupun emboli paru (EP). EP sebagai komplikasi TVD dapat berakibat fatal. TVD umumnya terjadi disebabkan multipel faktor risiko seperti penyakit penyerta (komorbid), faktor provokasi, gangguan hemostasis dll. Gangguan fungsi hemostasis berupa keadaan protrombotik sudah dimulai dari awal stadium penyakit ginjal kronik (PGK). Menurunnya laju filtrasi glomerulus berkolerasi dengan peningkatan TEV. Mekanisme pasti bagaimana terjadinya TVD pada penderita PGK sampai saat ini masih belum jelas. Tujuan: Untuk mengetahui profil hemostasis dan faktor risiko yang berhubungan dengan TVD pada pasien PGK. Metode : Penelitian potong lintang retospektif dengan memakai data sekunder pada pasien PGK stadium 3-5 yang dirawat inap selama 1.5 tahun antara Oktober 2011- April 2013. Faktor risiko TVD yang diteliti meliputi DM, CHF, stroke iskemik, faktor provokasi, usia lanjut dan penurunan LFG. Analisis bivariat dan multivariat dilakukan dengan regresi logistik untuk mendapatkan faktor risiko yang paling berhubungan dengan terjadinya TVD pada pasien PGK. Adanya perbedaan proporsi pada kedua kelompok dinilai dengan analisis bivariat. Hasil: Proporsi TVD kasus baru yang telah dikonfirmasi dengan USG Doppler ditemukan sebesar 8% (91 dari 1115 pasien). Subyek penelitian sebanyak 160 pasien terdiri atas kelompok TVD 75 orang dan kelompok Non TVD 85 orang, subyek juga terbagi dalam kelompok Dialisis 77 orang dan Non Dialisis 83 orang. Pada pemeriksaan hemostasis ditemukan persentase rasio APTT <0.8 (1.9%), rasio PT <0.8 (0%), INR <0.8 (0%), fibrinogen >400 mg/dl (56.2%) dan D-Dimer >500 μg/l (87.5%) pada keseluruhan pasien PGK. Kadar fibrinogen lebih tinggi pada kelompok TVD daripada Non TVD. Tidak ada perbedaan hemostasis antara kelompok Dialisis dan Non Dialisis. Dari beberapa faktor risiko TVD yang diteliti, DM merupakan faktor risiko yang bermakna sesuai p <0.001, OR 4.5 (95% KI 2.3-8.8). Kesimpulan: Sebagian besar pasien PGK cenderung mengalami hiperkoagulasi. Pasien PGK dengan DM berisiko untuk mengalami TVD. DM bersama faktor risiko lain dapat menjadi predisposisi terjadinya TVD pada PGK.

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Background: Venous thromboembolism (VTE) may manifest as deep vein thrombosis (DVT) or pulmonary embolism (PE). PE as a major complication of DVT and can lead to potentially fatal. DVT can occur as the result of multiple risk factors such as comorbidities, provoked factors, abnormal hemostasis functions and others. Chronic kidney disease (CKD) is typically associated with a prothrombotic tendency in the early stages of the disease. The declining of glomerular filtration rate (GFR) is correlated with increasing of VTE. The exact mechanism of how DVT develops in CKD patients remains unclear.

Aim: To determine the hemostasis profiles and risk factors associated with DVT in CKD patients.

Methods: Retrospective cross sectional study was hold by review the medical records from stage 3-5 CKD patients that hospitalized during 1.5 years (October 2011 - April 2013). Multiple risk factors for TVD such as CHF, stroke ischemic, provoked factors, elderly and decreasing of eGFR were examined. Bivariate and multivariate analysis with logistic regression performed to obtain the most risk factors associated with the occurrence of TVD in CKD patients. The differences of proportion between both groups were assessed by bivariate analysis.

Results: The proportion of first DVT confirmed by doppler ultrasound was 8% (91 of 1115 patients). 160 patients were divided into groups. 75 and 85 patients comprised the group with DVT-Non DVT as well as 77 and 83 patients comprised the group with Dialysis-Non Dialysis. We found the APTT ratio <0.8 (1.9 %), PT ratio <0.8 (0 %), INR <0.8 (0 %), fibrinogen level >400 mg/dl (56.2 %) and DDimer level >500 μg/l (87.5 %) in all CKD patients. The level of fibrinogen was higher when DVT group compared to Non DVT group. There was no significant differences of hemostasis functions between Dialysis and Non Dialysis group. Multivariate analysis demonstrated that diabetes mellitus (p<0.001, OR: 4.5; 95% CI: 2.3 to 8.8) was associated with DVT in CKD patients among all risk factors.

Conclusion: Most CKD patients tend to have hypercoagulation. Diabetes was associated with DVT risk in CKD patients. Diabetes with other risk factors could be as predispotition factors for DVT in CKD in this study."

"[ABSTRAKLatar Belakang : Atherosklerosis adalah suatu proses penyakit yang difus, dengan adanya satu pembuluh darah yang rusak akan memprediksikan adanya kelainan pada pembuluh darah lain. Ankle Brachial Indeks (ABI) dan Toe Brakhial Indeks (TBI) adalah test non invasif terbukti sensitive dan spesifik untuk mendeteksi beratnya penyakit arteri perifer.Tujuan : Mengetahui hubungan derajat Penyakit Arteri Perifer (PAP) Asimtomatis dengan beratnya Penyakit Jantung Koroner (PJK) stabilMetode : Dilakukan studi potong lintang pada tujuh puluh tiga pasien PJK stabil yang menjalani angiografi koroner. Derajat stenosis arteri coroner dinilai dengan skor Gensini > 40 (berat) dan < 40 (ringan-sedang). PAP dinilai dengan pemeriksaan ABI dan TBI dengan metode Oscillomtreic. Analisis menggunakan uji Spearman correlation test dan uji Pearson correlation test.Hasil : Proporsi PAP asimtomatis pada PJK stabil 47 pasien (64,4%). Nilai median ABI adalah 1,07 (kisaran 0,57-1,27), nilai rerata TBI adalah 0,57 (SB 0,155) dan nilai rerata skor Gensini adalah 46,60 (SB 33,64). Analisis bivariat ABI dengan skor Gensini menunjukkan tidak terdapat korelasi (r=-0,099, p 0,407) dan analis bivariate TBI dengan skor Gensini juga menunjukkan tidak terdapat korelasi (r= -0,153, p= 0,196)Simpulan : ABI dan TBI dengan metode Oscillometric tidak berkorelasi dengan derajat stenosis arteri koroner berdasarkan skor Gensini. ABI dan TBI tidak memiliki kemampuan yang baik untuk membedakan pasien PJK ringan-sedang dan berat berdasarkan skor Gensini.

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ABSTRACTIntroduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.;Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.;Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.;Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.;Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores., Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.]"