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Oktania Sandra Puspita

Deteksi gen penyandi Secretion System ATPase type III (ssaN) Salmonella enterica subsp.enterica pada spesimen darah pasien demam tifoid = Detection of Gene Encoding Secretion System ATPase type III (ssaN) in Salmonella enterica subsp.enterica from Blood Specimen of Typhoid Fever Patients / Oktania Sandra Puspita

"Demam tifoid adalah penyakit infeksi umum akut yang disebabkan oleh Salmonella typhi. Penyakit yang tersebar hampir di seluruh dunia ini merupakan penyakit tropik sistemik, bersifat endemis dan masih merupakan problem kesehatan masyarakat di dunia, terutama di negara-negara berkembang, termasuk Indonesia. Uji Widal merupakan salah satu uji serologis yang sampai saat ini masih digunakan secara luas, khususnya di negara berkembang termasuk Indonesia. Uji serologi Widal memiliki sensitivitas dan spesifisitas yang rendah serta sering memberikan hasil positif palsu maupun negatif palsu. Oleh karena itu dilakukan deteksi molekuler real time PCR terhadap gen penyandi secretion system ATPase type III ssaN Salmonella enterica subsp.enterica dari spesimen darah pasien demam tifoid.

Uji spesifisitas teknik real time PCR didapatkan bahwa primer dan probe yang digunakan tidak bereaksi silang terhadap mikroorganisme lain yang diuji pada penelitian ini. Pada uji sensitivitas teknik didapatkan kemampuan deteksi minimal adalah 10 cfu/ml pada spesimen darah. Pada penerapan uji terhadap spesimen darah, didapatkan real time PCR dapat mendeteksi 19 38 sampel positif Salmonella enterica subsp.enterica dari 50 spesimen darah pasien yang diduga terinfeksi demam tifoid. Sebelas sampel dengan serologi Widal negatif memberikan hasil positif pada real time PCR. Dengan demikian, uji real time PCR terhadap target gen ssaN yang digunakan dalam penelitian ini dapat meningkatkan tingkat pengujian positif sebesar 22 dibandingkan uji Widal.

Typhoid fever is an acute infectious disease caused by Salmonella typhi. Diseases spread almost all over the world is a tropical disease systemic, endemic and remains a public health problem in the world, especially in developing countries, including Indonesia. In areas where typhoid fever occur, the clinical diagnosis of typhoid fever is inadequate, because the symptoms are not specific and overlapping with other febrile illnesses. Diagnosis of typhoid fever is often enforced only based on clinical symptoms and serological tests alone. Widal test is a serological test which is still widely used, particularly in developing countries, including Indonesia. Widal serological test has a very low sensitivity and specificity and often give false positives or false negatives result. Therefore, were performed detection of gene encoding secretion system ATPase type III ssaN in Salmonella enterica subsp.enterica from blood specimen of typhoid fever patients.
Specificity test of real time PCR technique showed that the primers and probes used are not cross react against other microorganisms tested in this study. On the sensitivity test techniques obtained minimal detection is at least 10 cfu ml of blood specimen. On the application of test in blood clinical specimens, real time PCR could detect 19 38 Salmonella enterica subsp.enterica positive samples of 50 blood specimen from suspected typhoid fever patients. Eleven samples with negative Widal serology gives positive results in real time PCR. Thus, real time PCR test with the ssaN gene target used in this study could increase rate of positive testing about 22 compared with Widal test."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016

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Eifel Faheri

Perbandingan tingkat ekspresi epidermal growth factor receptor dengan respon kemoterapi neoajuvan dan tingkat ekstensif tumor primer pada pasien kanker nasofaring stad = Comparison of epidermal growth factor receptor expression level with response of neoajuvan chemotherapy and extensive level of tumor primer on advanced nasopharyngeal

"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.

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."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016

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T. Robertus

Karakterisasi enterobacteriaceae penghasil enzim ampc ?-lactamases ampc yang diisolasi dari pasien dewasa yang dirawat di unit perawatan intensif RS Cipto Mangunkusumo Jakarta periode April hingga September 2015 = Characterization of ampc lactamases ampc producing enterobacteriaceae isolated from adult patients hospitalized in the intensive care unit of Cipto Mangunkusumo Hospital Jakarta in April to September 2015 / T. Robertus,

"Indonesia merupakan negara dengan tingkat resistensi antibiotik yang tinggi. Tingkat resistensi yang tinggi ini terutama didapatkan pada bakteri batang Gramnegatif famili Enterobacteriaceae. Tujuan penelitian ini adalah untuk mengetahui proporsi dan karakteristik Enterobacteriaceae patogen penghasil AmpC di Unit Perawatan Intensif RS Cipto Mangunkusumo Jakarta. Spesimen berasal dari pasien dewasa yang didiagnosis mengalami infeksi organ atau sistem tertentu. Spesimen berupa darah, sekret saluran pernafasan bawah, urin, swab dasar luka, aspirat abses, dan jaringan luka operasi. Identifikasi dilakukan menggunakan VITEK® 2. Pola kepekaan ditentukan dengan VITEK® 2 dan metode difusi cakram sesuai kriteria CLSI tahun 2014. Deteksi AmpC dan ESBL dilakukan menggunakan metode double disc synergy test. Famili gen pengkode AmpC ditentukan dengan metode PCR multipleks. Enterobacteriaceae patogen yang berhasil dikumpulkan berjumlah 45 isolat, terdiri dari Klebsiella pneumoniae (n=32), Escherichia coli (n=6), Enterobacter cloacae (n=5), dan Enterobacter aerogenes (n=2). Proporsi Enterobacteriaceae penghasil AmpC adalah 9 isolat di antara 45 isolat, terdiri dari 4 isolat penghasil AmpC dan 5 isolat penghasil AmpC dan ESBL. Gen pengkode AmpC ditemukan pada 7 isolat, yang terbanyak adalah DHA (n=4) diikuti EBC (n=2) dan CIT (n=1). Secara in vitro, Enterobacteriaceae penghasil AmpC menunjukkan kepekaan yang baik terhadap gentamisin, tobramisin, amikasin, sefepim, meropenem, siprofloksasin, levofloksasin, tetrasiklin, dan kotrimoksasol sementara penghasil AmpC dan ESBL hanya terhadap amikasin.

Antibiotic resistance has become a problem in Indonesia, in which the high resistance has been found mainly in Gram-negative bacilli Enterobacteriaceae. This study aimed to find out the proportion and characteristics of pathogenic AmpC-producing Enterobacteriaceae in the ICU of Cipto Mangunkusumo Hospital Jakarta. Spesimens collected were blood, lower respiratory tract secretions, urine, wound swab, abscess aspirate, and soft tissue taken from adult patients with infection. Identification were conducted using VITEK® 2. Susceptibility tests were conducted using VITEK® 2 and diffusion technique according to CLSI 2014 guidelines. Double disc synergy test method were employed to detect AmpC activity. The presence of ampC genes were detected using multiplex PCR. Forty five isolates were collected. Klebsiella pneumoniae was predominant, followed by Escherichia coli, Enterobacter cloacae, and Enterobacter aerogenes. AmpC activity was detectable in nine isolates. Five of the 9 isolates produced both AmpC and ESBL. In vitro, AmpC-producing Enterobacteriaceae showed good susceptibility to gentamicin, tobramycin, amikacin, cefepime, meropenem, ciprofloxacin, levofloxacin, tetracycline, and cotrimoxazole. While the AmpC and ESBL-producing only to amikacin. ampC genes were detected in seven isolates and the most prevalent gene family was DHA (n=4) followed by EBC (n=2) and CIT (n=1)."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016

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Herna

Efek kombinasi antibiotik in vitro terhadap pseudomonas aeruginosa resisten golongan carbapenem = In vitro antibiotic combination effect against carbapenem resistant pseudomonas aeruginosa

"Pseudomonas aeruginosa merupakan salah satu patogen terpenting yang menyebabkan infeksi nosokomial. Isolat P. aeruginosa sudah banyak yang resisten terhadap carbapenem yang juga berkaitan dengan resistensi terhadap antibiotik lain. Adanya P. aeruginosa yang resisten multiobat menyebabkan kesulitan dalam memilih pengobatan yang tepat. Terapi kombinasi dapat menjadi salah satu alternatif untuk menanggulangi keterbatasan monoterapi. Tujuan penelitian ini untuk mengetahui adanya sinergisme pada beberapa kombinasi antibiotik yang digunakan pada penelitian ini terhadap bakteri P. aeruginosa resisten carbapenem. Spesimen klinis yang terdiri dari sputum, bilasan bronkoalveolar, apusan luka, dan urin diambill dari ruang perawatan intensif Rumah Sakit Cipto Mangunkusumo. Isolat bakteri yang berasal dari spesimen klinis kemudian diidentifikasi dan diuji kepekaan. Isolat yang memenuhi kriteria inklusi diuji dengan metode checkerboard mikrodilusi untuk mempelajari efek kombinasi antibiotik antara amikacin dan ceftazidime, ceftazidime dan ciprofloxacin, serta amikacin dan ciprofloxacin. Dari 187 spesimen yang berasal dari 140 pasien diperoleh 16 isolat P. aeruginosa resisten carbapenem. Dari 16 Isolat P. aeruginosa yang resisten carbapenem yang diperiksa dengan uji checkerboard mikrodilusi sebanyak 13 isolat. Sebanyak 3 isolat yang terpapar kombinasi ceftazidime dan amikacin menunjukkan sinergisme dan 1 isolat yang terpapar kombinasi ceftazidime dan ciprofloxacin. Pada semua isolat yang terpapar kombinasi amikacin dan ciprofloxacin memperlihatkan indifference. Tidak ada antagonisme ditemukan pada ketiga kombinasi antibiotik ini. Berdasarkan penelitian ini, kombinasi ceftazidime dan amikacin masih dapat dipertimbangkan pada pasien dengan infeksi P. aeruginosa resisten carbapenem.

Pseudomonas aeruginosa is one of the important nosocomial pathogens. Currently, many P. aeruginosa isolates are resistant to carbapenem and other antibiotics. The occurrence of multidrug resistance in P. aeruginosa, causes difficulties in choosing the appropriate treatment of infection by this bacteria. Combination therapy could be an alternative to overcome the limitations of monotherapy. The objective of this study is to observe the occurrence of synergistic effect in the antibiotic combinations that are used in this study in carbapenem resistant P. aeruginosa. Clinical specimens consisting of sputum, bronchoalveolar lavage, wound swab, blood and urine were obtained from the ICU of Cipto Mangunkusumo Hospital. Bacterial isolates from the clinical specimens were identified and examined for susceptibility pattern. Isolates that fulfill inclusion criteria was tested with checkerboard microdilution method to study the antibiotic combination effect between amikacin and ceftazidime, ceftazidime and ciprofloxacin, amikacin and ciprofloxacin. There From 187 specimens that were collected from 140 patients, 16 carbapenem resistant P. aeruginosa isolates were obtained. From 16 carbapenem resistant P. aeruginosa isolates, there were 13 isolates that tested with checkerboard microdilution method. The results showed synergistic effect in 3 isolates that were exposed to ceftazidime and amikacin combination, and in 1 of the isolates that were exposed to ceftazidime and ciprofloxacin combination. Indifference was observed in all isolates that were exposed to amikacin and ciprofloxacin combination. No antagonism was found among the three antibiotic combinations. Based on this study, ceftazidime and amikacin combination could be considered in patient with carbapenem resistant P. aeruginosa infection."

Jakarta: Fakultas Kedokteraan Universitas Indonesia, 2016

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Noto Dwimartutie

Model prediksi mortalitas 30 hari pasien usia lanjut di ruang rawat akut geriatri menggunakan domain pendekatan paripurna pasien geriatri (P3G) = Prediction model of 30 day mortality in elderly patients admitted to geriatric acute ward using comprehensive geriatric assessment (CGA) domain

"ABSTRAK

Latar Belakang. Mortalitas usia lanjut yang dirawat cukup tinggi. Belum ada model prediksi mortalitas 30 hari pasien usia lanjut yang dirawat di ruang rawat akut geriatri menggunakan domain P3G. Tujuan. Mendapatkan dan menentukan performa model prediksi mortalitas 30 hari pasien usia lanjut di rawat di ruang rawat akut geriatri menggunakan domain P3G.

Metode. Penelitian dengan desain kohort retrospektif menggunakan status rekam medik pasien usia lanjut (> 60 tahun) yang dirawat di ruang rawat akut (RRA) geriatri RSCM dalam dalam kurun waktu Januari 2011 ? Desember 2013. Prediktor yang dianalisis yaitu usia, jenis kelamin, sindrom delirium akut, komorbiditas (CIRS-G), kadar albumin, status fungsional (ADL Barthel), status kognitif, status psikoafektif, dan status nutrisi (MNA). Analisis multivariat dengan cox regression untuk mendapatkan Hazzard Ratio (HR) dilakukan pada prediktor yang bermakna. Model prediksi didapatkan dari prediktor yang bermakna pada analisis multivariat. Kemampuan kalibrasi model prediksi ditentukan dengan uji Hosmer Lameshow dan kemampuan diskriminasinya ditentukan dengan menghitung AUC dari kurva ROC.

Hasil. Terdapat 530 subjek penelitian dengan rerata usia 70,27 (SB 6,9) tahun. Mortalitas 30 hari didapatkan sebesar 28,1%. Analisis multivariat mendapatkan sindrom delirium akut (HR 4,11 ; IK95% 1,83-9,11), kadar albumin < 3 g/dl (HR 2,18 ; IK95% 1,23-3,85), ADL Barthel < 9 (HR 2,21 ; IK95% 1,23-3,85), dan malnutrisi (MNA < 17) (HR 1,77 ; IK95% 1,19-2,63) sebagai prediktor dalam model prediksi. Model prediksi berdasarkan jumlah skor dari sindrom delirium akut (skor 2,5), kadar albumin < 3 g/dl (skor 1,5), ADL Barthel < 9 (skor 1), dan malnutrisi (skor 1). Stratifikasi mortalitas menjadi kelompok risiko rendah (skor < 2; 4,4%), risiko sedang (skor 2-4; 24,8%), dan risiko tinggi (skor > 4; 64,3%). Uji Hosmer-Lemeshow menunjukkan presisi yang baik (p=0,409) dan AUC menunjukkan kemampuan diskriminasi yang baik [0,84 (95%CI 0,81-0,88)].

Kesimpulan. Model prediksi mortalitas 30 hari menggunakan prediktor sindrom delirium akut, kadar albumin < 3 g/dl, status fungsional dengan ADL Barthel < 9, dan malnutrisi distratifikasi menjadi 3 kelas risiko (rendah, sedang, dan tinggi). Model ini memiliki presisi dan diskriminasi yang baik.

ABSTRACT
Background. Mortality of hospitalized elderly patients is still high. To our knowledge, no prediction model that predict 30-day mortality in elderly patients admitted to geriatric acute ward using Comprehensive Geriatric Assessment (CGA) domain Aim. To develop a prediction model of 30-day mortality in elderly patients hospitalized in geriatric acute ward using CGA domain.
Method. A retrospective cohort study was conducted using medical records of elderly patients (> 60 years) hospitalized in acute geriatric ward of Cipto Mangunkusumo General Hospital from January 2011 ? December 2013. Nine predictors [age, sex, delirium, comorbidity (CIRS-G), albumin level, psychoaffective status, cognitive status, and nutritional status (MNA)] were analyzed. Multivariate analysis using cog regression of significance predictors was conducted to determined hazard ratio (HR) for each predictor. Prediction model was developed from significance predictors in multivariate analysis. The model?s calibration performance was determined by Hosmer-Lameshow test and its discrimination ability was determined by calculating area under the receiver operating characteristic curve (AUC).
Result. Subjects consist of 530 patients, with mean of age 70,27 (SD 6,9) years old. The 30-day mortality was 28,1%. Delirium (HR 4,11 ; 95%CI 1,83-9,11), albumin < 3 g/dl (HR 2,18 ;95%CI 1,23-3,85), Barthel index < 9 (HR 2,21 ; 95%CI 1,23-3,85), and malnutrition (MNA < 17) (HR 1,77 ; 95%CI 1,19-2,63) were significance predictors in multivariate analysis. Prediction model based on total score of delirium (2,5 poin), albumin < 3 g/dl (1,5 poin), ADL Barthel < 9 (1 poin), and malnutrition (1 poin). Mortality was stratified into 3 groups; low risk (score < 2; 4,4%), intermediate risk (score 2-4; 24,8%), and high risk (score > 4; 64,3%). The Hosmer-Lemeshow showed a good precission (p=0,409) and the AUC revealed good discrimination ability [0,84 (95%CI 0,81-0,88)].
Conclusion. A prediction model of 30-day mortality using predictors : delirium, albumin < 3 g/dl, Barthel index < 9, and malnutrition was stratified into 3 groups (low risk, intermediate risk, and high risk). The model has good precision and discrimination."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014

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Okto Dewantoro

Korelasi antara hepatocyte progenitor cell dengan haematopoietic stem cell berdasarkan derajat metavir dari sel hati penderita hepatitis B kronik = Correlation between hepatocyte progenitor cell hpc with haematopoietic stem cell hsc based metavir degree of liver cells of patients with chronic hepatitis B / Okto Dewantoro

"ABSTRAK

Latar Belakang : Hepatocyte Progenitor Cell(HPC) merupakan stem cell dari hati yang akan muncul bila terjadi kerusakan hati yang kronis hingga sirosis hati seperti pada penderita hepatitis B kronik. Aktifnya HPC sebagai usaha untuk meregenerasi sel hati akan diikuti oleh migrasi dari Haematopoietic Stem Cell(HSC) ke sel hati dengan tujuan membantu proses regenerasi sel hati

Tujuan : Penelitian ini bertujuan mengetahui adakah korelasi antara HPC dan HSC pada derajat Metavir baik nekroinflamasi ataupun fibrosis sebagai dasar untuk melakukan terapi stem cell pada penderita hepatitis B kronik dengan menggunakan HPC dan HSC.

Metode : Penderita hepatitis B kronik yang sudah memenuhi kriteria inklusi dan sudah menjalani biopsi hati diperiksa parafin bloknya kemudian dibagi berdasarkan derajat metavirnya yaitu ringan-sedang dan berat. Kemudian dilakukan pewarnaan immunohistokimia untuk HPC dengan CK-19 dan HSC dengan CD34+. setelah itu dihitung jumlah HPC dan HSC dan kemudian dianalisis datanya.

Hasil : Didapatkan 17 penderita dengan fibrosis ringan-sedang dan 13 dengan fibrosis berat, serta 21 dengan nekroinflamasi ringan-sedang dan 9 dengan nekroinflamasi berat. Pada fibrosis ringan-sedang dan berat didapatkan perbedaan kadar HPC yang signifikan dgn p=0.003 dan perbedaan kadar HSC yang signifikan dengan p=0.001. Pada nekroinflamasi ringan-sedang dan berat didapatkan perbedaan kadar HPC yang signifikan dengan p=0.014 dan perbedaan kadar HSC yang signifikan dengan p=0.012. Hanya korelasi antara HPC dan HSC pada fibrosis ringan-sedang yang signifikan dengan p=0.003

Kesimpulan : Rerata HPC dan HSC pada nekroinflamasi berat lebih tinggi dibandingkan pada nekroinflamasi ringan-sedang. Rerata HPC dan HSC pada fibrosis berat lebih tinggi dibandingkan pada fibrosis ringan-sedang Tidak didapatkan korelasi antara HPC dan HSC pada nekroinflamasi ringan- sedang dan berat. Terdapat korelasi antara HPC dengan HSC pada derajat fibrosis ringan-sedang. Tidak didapatkan korelasi antara HPC dan HSC pada derajat fibrosis berat.

ABSTRACT

Background :

Hepatocyte progenitor Cell (HPC) is a stem cell from the liver that will arise in the event of chronic liver damage such as chronic hepatitis B to cirrhosis of the liver. HPC as an active attempt to regenerate liver cells followed by migration of Haematopoietic Stem Cell (HSC) to liver cells with the goal of helping the regeneration of liver cells.

Aims :

This study aims to determine the correlation between HPC and HSC as the basis for the conduct of stem cell therapy in patients with chronic hepatitis B by using the HPC and HSC.

Methods:

Patients with chronic hepatitis B who meet the inclusion criteria which had undergone liver biopsies examined paraffin blocks which divided by degrees of metavir as mild and severe. Then performed immunohistochemical staining for HPC with CK-19 and HSC with CD34+ .After the calculated amount of HPC and HSC and then analyzed the data.

Results:

There were 17 patients with mild-moderate fibrosis and 13 with severe fibrosis, and 21 with mild-moderate nekroinflamasi and 9 with severe nekroinflamasi. In mild- moderate and severe fibrosis obtained mean significant HPC with p = 0.003 and mean significant HSC with p = 0.001. In nekroinflamasi obtained mean mild- moderate and severe HPC significant with p = 0.014 and the mean HSC significant with p = 0.012. There is a statistically significant correlation between HPC and HSC on mild-moderate fibrosis with p = 0.003.

Conclusions:

Average of HPC and HSC in severe nekroinflamasi is higher than in mild - moderate nekroinflamasi . Average of HPC and HSC in severe fibrosis is higher than in mild - moderate fibrosis There were no correlation between HPC and HSC on nekroinflamasi mild- moderate and severe . There is a correlation between HSC and HPC in the mild - moderate fibrosis . There were no correlation between HPC and HSC on the degree of severe fibrosis."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014

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Kostermans, Deskian

Efek suplementasi seng pada pasien dewasa dengan diare akut di Rumah Sakit Pusat Pertamina Jakarta = Effect of zinc supplementation on acute diarrhea in hospitalized adults patients in Pertamina Central Hospital Jakarta

"[ABSTRAK

Latar Belakang: Diare akut adalah masalah umum di negara berkembang seperti

Indonesia; penyakit ini banyak ditemukan dalam praktek sehari-hari dengan angka

morbiditas dan mortalitas yang cukup tinggi. Pada beberapa Rumah Sakit di

Jakarta ditemukan bahwa pasien diare akut dewasa mengalami defisiensi kadar

seng sebesar 69.3%.

Pemberian seng sudah terbukti bermanfaat untuk pengobatan diare akut pada

anak.

Tujuan: Mengetahui dampak suplementasi seng sebagai terapi alternatif /

adjuvant untuk pengobatan diare akut pada pasien dewasa, dengan

membandingkan lama berlangsung dan berat-ringan gejala pada kelompok pasien

yang diberikan dan yang tidak diberikan suplementasi seng.

Metode: Double blind randomized controlled trial dilakukan pada penelitian ini

untuk mengetahui efek suplementasi seng terhadap durasi dan gejala

gastrointestinal pada pasien diare akut rawat inap di RS Pusat Pertamina di Jakarta

selama periode Januari-Desember 2013. Analisis data dilakukan dengan

menggunakan uji chi-square (x2) untuk perbandingan durasi diare dan uji general

linear model (GLM) untuk menilai tren perubahan gejala penyerta diare.

Hasil: Analisis data dari 84 pasien yang dikelola: 30 pasien pria [seng 19,

plasebo 11] dan 54 pasien wanita [seng 23, plasebo 31] ~ (p 0.111)

memperlihatkan pemberian suplementasi seng bermakna mengurangi durasi diare

akut (p 0.027) dan bermakna mengurangi gejala mual (p 0.032). Selain itu ada

tren perbaikan pada sebagian gejala penyerta diare akut, seperti sakit perut,

frekuensi b.a.b., konsistensi feses, gejala muntah, kembung, dan gangguan

aktivitas sehari-hari.

Simpulan: Pemberian suplementasi seng bermakna membuat durasi diare akut

lebih singkat dan bermakna mengurangi gejala mual, serta perbaikan pada

sebagian gejala gastrointestinal.

ABSTRACT

Background: Acute diarrhea is a common problem in developing countries such

as Indonesia; which is found in everyday practice with quite high morbidity and

mortality rate. It was revealed in adult acute diarrhea patients in several hospitals

in Jakarta the levels of zinc deficiency was 69.3%. Zinc has been proven to be

beneficial in the treatment of acute diarrhea in pediatric patients.

Objective: To discover the effectiveness of zinc supplementation as an adjuvant

therapy in acute diarrhea for adult patients by comparing the duration and the

severity of signs and symptoms of acute diarrhea between the zinc and placebo

group.

Methods: A double blind randomized controlled trial is done to find out about

the effect of zinc supplementation to the duration, signs and symptoms on acute

diarrheal in hospitalized adults patients in Pertamina Central Hospital in Jakarta

from January-December 2013. The data is analyzed using chi-square test (x2) for

comparing the duration of diarrhea and general linear model (GLM) to assess

trend changes accompanying symptoms of diarrhea.

Results: Analysis of the data from 84 patients: 30 males [19 zinc, 11 placebo]

and 54 females [23 zinc, 31 placebo] ~ (p 0.111) obtained zinc supplementation

significantly reduced the duration of acute diarrhea (p 0.027) and significantly

reduce the symptoms of nausea (p 0.032). In addition there is trend of

improvement in some acute diarrhea associated symptoms, such as abdominal

pain, frequency of diarrhea, stool consistency, vomiting, bloating, and disruption

of daily activities.

Conclusion: Zinc supplementation significantly reduce the duration of diarrhea,

significantly reduce the symptoms of nausea; besides, improving some symptoms

accompanying acute diarrhea.;Background: Acute diarrhea is a common problem in developing countries such

as Indonesia; which is found in everyday practice with quite high morbidity and

mortality rate. It was revealed in adult acute diarrhea patients in several hospitals

in Jakarta the levels of zinc deficiency was 69.3%. Zinc has been proven to be

beneficial in the treatment of acute diarrhea in pediatric patients.

Objective: To discover the effectiveness of zinc supplementation as an adjuvant

therapy in acute diarrhea for adult patients by comparing the duration and the

severity of signs and symptoms of acute diarrhea between the zinc and placebo

group.

Methods: A double blind randomized controlled trial is done to find out about

the effect of zinc supplementation to the duration, signs and symptoms on acute

diarrheal in hospitalized adults patients in Pertamina Central Hospital in Jakarta

from January-December 2013. The data is analyzed using chi-square test (x2) for

comparing the duration of diarrhea and general linear model (GLM) to assess

trend changes accompanying symptoms of diarrhea.

Results: Analysis of the data from 84 patients: 30 males [19 zinc, 11 placebo]

and 54 females [23 zinc, 31 placebo] ~ (p 0.111) obtained zinc supplementation

significantly reduced the duration of acute diarrhea (p 0.027) and significantly

reduce the symptoms of nausea (p 0.032). In addition there is trend of

improvement in some acute diarrhea associated symptoms, such as abdominal

pain, frequency of diarrhea, stool consistency, vomiting, bloating, and disruption

of daily activities.

Conclusion: Zinc supplementation significantly reduce the duration of diarrhea,

significantly reduce the symptoms of nausea; besides, improving some symptoms

accompanying acute diarrhea., Background: Acute diarrhea is a common problem in developing countries such

as Indonesia; which is found in everyday practice with quite high morbidity and

mortality rate. It was revealed in adult acute diarrhea patients in several hospitals

in Jakarta the levels of zinc deficiency was 69.3%. Zinc has been proven to be

beneficial in the treatment of acute diarrhea in pediatric patients.

Objective: To discover the effectiveness of zinc supplementation as an adjuvant

therapy in acute diarrhea for adult patients by comparing the duration and the

severity of signs and symptoms of acute diarrhea between the zinc and placebo

group.

Methods: A double blind randomized controlled trial is done to find out about

the effect of zinc supplementation to the duration, signs and symptoms on acute

diarrheal in hospitalized adults patients in Pertamina Central Hospital in Jakarta

from January-December 2013. The data is analyzed using chi-square test (x2) for

comparing the duration of diarrhea and general linear model (GLM) to assess

trend changes accompanying symptoms of diarrhea.

Results: Analysis of the data from 84 patients: 30 males [19 zinc, 11 placebo]

and 54 females [23 zinc, 31 placebo] ~ (p 0.111) obtained zinc supplementation

significantly reduced the duration of acute diarrhea (p 0.027) and significantly

reduce the symptoms of nausea (p 0.032). In addition there is trend of

improvement in some acute diarrhea associated symptoms, such as abdominal

pain, frequency of diarrhea, stool consistency, vomiting, bloating, and disruption

of daily activities.

Conclusion: Zinc supplementation significantly reduce the duration of diarrhea,

significantly reduce the symptoms of nausea; besides, improving some symptoms

accompanying acute diarrhea.]"

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014

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Wika Hanida

Korelasi aspek spiritual dengan kadar interleukin-6 serum pada pasien hemodialisis kronik = Correlation between spiritual aspect and interleukin-6 serum level in chronic hemodialysis patients

"[ABSTRAK

Latar Belakang. Pendekatan holistik di bidang Psikosomatik menekankan faktor spiritualitas dan dukungan pada sisi spiritualitas dapat meningkatkan pelayanan serta memperbaiki kondisi psikologis pada pasien. Selama prosedur hemodialisis respon inflamasi akan meningkat dibuktikan dengan peningkatan konsentrasi interleukin-6 (IL- 6). Aspek spiritual yang dapat menurunkan respon inflamasi masih perlu diteliti.

Tujuan. Untuk mengetahui gambaran aspek spiritual pasien yang menjalani hemodialisis kronik dan untuk mengetahui korelasi aspek spiritual dengan kadar IL-6 serum pada pasien yang menjalani hemodialisis kronik.

Metode. Penelitian ini merupakan studi cross sectional dilakukan pada 51 pasien hemodialisis kronik di unit Hemodialisis RSUP. H. Adam Malik dan RSU. Dr. Pirngadi Medan mulai bulan Juli-Agustus 2014. Pemeriksaan kadar IL-6 serum diukur dengan metode quantitative enzyme-linked immunosorbent assay (ELISA) dilakukan pengambilan sampel darah dan pengukuran spiritual dilakukan dengan pengisian kuesioner FACIT Sp-12 pada pagi hari 30 menit sebelum hemodialisis berlangsung.

Hasil. Skor subskala meaning (makna) 10.67 (SB 2.66), peace (damai) 9.63 (SB 2.19) dan faith (iman) 11.47 (SB 2.91). Nilai median kadar IL-6 serum pada penelitian ini adalah adalah 5,63 (1,48-28,88) pg/mL. Nilai median FACIT Sp-12 adalah 30,00 (18-48). Hasil uji korelasi antara tingkat spiritual dengan kadar IL-6 serum menunjukkan koefisien korelasi -0,330 dengan nilai p = 0,018 yang secara statistik menunjukkan korelasi negatif yang lemah.

Simpulan. Spiritual pada pasien hemodialisis kronik tinggi. Terdapat korelasi negatif yang lemah antara aspek spiritual dengan kadar IL-6 pada pasien hemodialisis kronik.

ABSTRACT

Background: Holistic approach in psychosomatic focus on spirituality factor and spiritual support is expected to improve services and psychological condition of the patients. Inflammatory response during haemodialysis procedure hence increased with the evidence of increasing level of serum interleukin-6 (IL-6). Further research is still needed to see the spiritual factors that can decrease the inflammatory factors.

Objective: To assess spiritual aspect of chronic haemodialysis patients and to assess correlation between serum IL-6 level and spiritual aspect in chronic haemodialysis patients.

Methods: Cross sectional study on 51 chronic haemodialysis patients at RSUP. H. Adam Malik and RSU dr. Pirngadi Medan between July-August 2014. Serum IL-6 was measured using quantitative enzyme-linked immunosorbent assay (ELISA) methods. Blood samples and spiritual aspect assessment by handing out FACIT

Sp-12 questionnaire to patients were taken in the morning, 30 minutes before haemodialysis.

Results: . Subscale meaning 10.67 (SB 2.66), peace 9.63 (SB 2.19) and faith 11.47 (SB 2.91). Median serum IL-6 level is 5,63 ( 1,48-28,88 ) pg/mL. Median FACIT Sp-12 is 30,00 (18-48). Correlation test between serum IL-6 level and spiritual aspect have shown statistically weak negative correlation (correlation coefficient -0,330, p = 0.018).

Conclusion: spirituality level in chronic hemodialysis patients are higher. Weak negative correlation between serum IL-6 level and spiritual level on chronic haemodialysis patients was found in this study.;Background: Holistic approach in psychosomatic focus on spirituality factor and spiritual support is expected to improve services and psychological condition of the patients. Inflammatory response during haemodialysis procedure hence increased with the evidence of increasing level of serum interleukin-6 (IL-6). Further research is still needed to see the spiritual factors that can decrease the inflammatory factors.

Objective: To assess spiritual aspect of chronic haemodialysis patients and to assess correlation between serum IL-6 level and spiritual aspect in chronic haemodialysis patients.

Sp-12 questionnaire to patients were taken in the morning, 30 minutes before haemodialysis.

Conclusion: spirituality level in chronic hemodialysis patients are higher. Weak negative correlation between serum IL-6 level and spiritual level on chronic haemodialysis patients was found in this study., Background: Holistic approach in psychosomatic focus on spirituality factor and spiritual support is expected to improve services and psychological condition of the patients. Inflammatory response during haemodialysis procedure hence increased with the evidence of increasing level of serum interleukin-6 (IL-6). Further research is still needed to see the spiritual factors that can decrease the inflammatory factors.

Objective: To assess spiritual aspect of chronic haemodialysis patients and to assess correlation between serum IL-6 level and spiritual aspect in chronic haemodialysis patients.

Sp-12 questionnaire to patients were taken in the morning, 30 minutes before haemodialysis.

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015

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Yosephine Yossy

Faktor faktor yang beruhubungan dengan kadar testosteron bebas pada pria dengan HIV dalam terapi Antiretroviral = Factors associated with free testosterone level of HIV infected male on antiretroviral therapy

"[ABSTRAK

Latar Belakang. Penderita HIV/AIDS di Indonesia semakin meningkat, sedangkan infeksi HIV/AIDS maupun terapi ARV dapat menyebabkan penurunan kadar testosteron yang sangat memengaruhi kualitas hidup penyandang HIV/AIDS. Gejala dan tanda penurunan kadar testosteron pada pria dengan HIV sangat tidak spesifik, sedangkan pemeriksaan laboratorium sangat mahal, sehingga perlu diketahui faktor-faktor pada pasien yang dapat memprediksi penurunan kadar testosteron.

Tujuan. Mengetahui apakah jumlah CD4 awal, lamanya terapi ARV, jenis ARV, lipodistrofi dan besarnya lingkar pinggang memengaruhi kadar testosteron bebas pada pria dengan HIV yang mendapat ARV.

Metode. Penelitian potong lintang dilakukan pada bulan Maret 2015 di Unit Pelayanan HIV Terpadu RSCM, Jakarta. Subjek adalah pria dengan HIV berusia 18-40 tahun, mendapat ARV teratur sekurangnya dalam 1 tahun terakhir. Pemeriksaan meliputi anamnesis, pengukuran lingkar pinggang dan lipodistrofi, pemeriksaan kadar testosteron total, SHBG dan testosteron bebas (Free Testosteron Index: FTi). Uji regresi linier digunakan untuk menilai faktor-faktor yang berhubungan dengan kadar testosteron bebas pada penelitian ini.

Hasil. Dari 54 subjek, didapatkan median usia 35,11 tahun (21-40), median lamanya ARV 59 bulan (16-129), median CD4 awal 57/mm3 (3-443), rerata lingkar pinggang 82,4cm (SB 10,33). Subjek yang mengalami lipodistrofi sebanyak 17 orang (32%). Subjek yang menggunakan ARV lini pertama 48 orang. Median kadar testosteron bebas 30,87% (9,78-85,64) dan subjek yang memiliki kadar testosteron bebas rendah sebanyak 32 orang(59%). Terdapatnya lipodistrofi (p=0,003, OR= -12,25) dan lamanya menggunakan ARV (p=0,002, OR=-0,182) berhubungan dengan kadar testosteron bebas pada penelitian ini.

Simpulan : Pada pria dengan HIV yang mendapat terapi ARV, adanya lipodistrofi dan lamanya terapi ARV berhubungan dengan kadar testosteron bebas. Kadar CD4 awal, jenis ARV dan lingkar pinggang tidak berhubungan dengan kadar testosteron bebas.

ABSTRACT

Background. There are increasing numbers of people living with HIV/AIDS in Indonesia. HIV/AIDS infection could cause a decrease in testosterone level which affect patients? quality of life. Symptoms of decreasing testosterone level in HIV infected male are very unspecific, while laboratory tests are costly. Therefore it is important to know factors that could predict a decrease in HIV patient?s testosterone level.

Purpose. To know the correlation between initial CD4 count, duration and type of ARV, lipodystrophy, size of waist circumference with free testosterone level of HIV infected male on ARV.

Method. A cross-sectional study was conducted March 2015 in HIV Integrated Clinic, RSCM, Jakarta. The subjects were 18-40 years old, got regular ARV therapy for at least 1 year. Examination includes measuring waist circumference, presence of lipodystrophy, examination of total testosterone, SHBG and free testosterone level (Free Testosterone Index:FTi). Linear regression used to analyze factors associated with free testosterone level in this study.

Results. Of 54 subjects examined, the median age was 35.11 years (21-40), median duration of antiretroviral therapy was 59 months (16-129), mean of waist circumference was 82.4 cm (SB 10.33), median of initial CD4 level was 57/mm3 (3-443). Total subjects with lipodystrophy were 17 subjects (32%), subjects who used first-line combination were 48 and 6 subjects used a second line combination. Median level of free testosterone levels was 30.87% (9.78-85.64) and there were 32 subjects with a low free testosterone level (59%). The presence of lipodystrophy (p=0,003, OR=-12,225) and duration of antiretroviral therapy (p=0,002, OR=-0,182) are associated with free testosterone level.

Conclusions. Among HIV infected male who receiving antiretroviral therapy, the presence of lipodystrophy and duration of antiretroviral therapy are associated with free testosterone levels. There were no association between initial CD4 count, type of antiretroviral therapy and waist circumference with free testosterone levels.;Background. There are increasing numbers of people living with HIV/AIDS in Indonesia. HIV/AIDS infection could cause a decrease in testosterone level which affect patients? quality of life. Symptoms of decreasing testosterone level in HIV infected male are very unspecific, while laboratory tests are costly. Therefore it is important to know factors that could predict a decrease in HIV patient?s testosterone level.

Purpose. To know the correlation between initial CD4 count, duration and type of ARV, lipodystrophy, size of waist circumference with free testosterone level of HIV infected male on ARV.

Conclusions. Among HIV infected male who receiving antiretroviral therapy, the presence of lipodystrophy and duration of antiretroviral therapy are associated with free testosterone levels. There were no association between initial CD4 count, type of antiretroviral therapy and waist circumference with free testosterone levels., Background. There are increasing numbers of people living with HIV/AIDS in Indonesia. HIV/AIDS infection could cause a decrease in testosterone level which affect patients? quality of life. Symptoms of decreasing testosterone level in HIV infected male are very unspecific, while laboratory tests are costly. Therefore it is important to know factors that could predict a decrease in HIV patient?s testosterone level.

Purpose. To know the correlation between initial CD4 count, duration and type of ARV, lipodystrophy, size of waist circumference with free testosterone level of HIV infected male on ARV.

2015

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Rivia Gina Rahmawaty

Profil Mikrobioma Nasal Pasien Covid-19 Dengan dan Tanpa Anosmia = Profile of Nasal Microbiome of COVID-19 With and Without Anosmia

"Anosmia merupakan salah satu gejala COVID-19 yang spesifik. Mekanisme anosmia pada COVID-19 belum dapat dijelaskan dengan pasti. Beberapa studi melaporkan perubahan kemampuan penciuman disertai perubahan komposisi mikrobioma nasal. Saat ini studi mikrobioma nasal pasien COVID-19 yang mengalami gejala anosmia masih kurang. Penelitian ini bertujuan untuk mengetahui profil mikrobioma nasal pasien COVID-19 dengan dan tanpa anosmia di Laboratorium Mikrobiologi Klinik FKUI tahun 2021. Studi potong lintang ini dilakukan di Laboratorium Mikrobiologi Klinik FKUI Juli sampai September 2021 yang memenuhi kriteria inklusi dan tidak memenuhi kriteria eksklusi. Diagnosis anosmia ditegakkan menggunakan metode subjektif. Pengambilan spesimen usap nasofaring dan orofaring untuk pemeriksaan RT-PCR COVID-19 dan usap nasal untuk pemeriksaan mikrobioma dilakukan pada pasien tersangka COVID-19. Bila didapatkan hasil RT-PCR positif, maka pada spesimen usap nasal dilakukan pemeriksaan sekuensing 16S RNA-Next Generation Sequencing. Didapatkan 17 spesimen usap nasal dari subjek yang mengalami gejala anosmia dan 8 spesimen yang tidak mengalami gejala anosmia. Pada mikrobioma nasal pasien COVID-19 yang mengalami gejala anosmia terjadi berupa penurunan kelimpahan filum Actinobacteria, Ordo Propionibacteriales, Famili Propionibacteriaceae, genus Cutibacterium dan Peptoniphilus. Dari penelitian ini, terdapat perubahan komposisi mikrobioma nasal pada pasien COVID-19 dengan gejala anosmia.

Anosmia is a specific symptom of COVID-19. The mechanism of anosmia in COVID-19 cannot be explained with certainty. Changes in nasal microbiome composition are associated with olfactory function. SARS-CoV-2 infection alters the respiratory microbiota and influence the susceptibility to COVID-19 infection. There are also changes in the composition of nasal microbioms of COVID-19 patients experiencing anosmia. Studies of the nasal microbiome in COVID-19 patients who experience symptoms of anosmia are rare. The aim of this study is to determine the nasal microbiome profile of COVID-19 patients with and without anosmia.
This cross-sectional study was conducted at the Clinical Microbiology Laboratory of the FKUI from July to September 2021 which met the inclusion criteria and did not meet the exclusion criteria. Anosmia is determined subjectively. Nasopharyngeal and oropharyngeal swab specimens for RT-PCR COVID-19 examination and nasal swabs for microbiome are collected from patients. If a positive RT-PCR result is obtained, then the nasal swab specimen is subjected to a RNA-Next Generation Sequencing. There were 17 nasal swab specimens from subjects with anosmic symptoms and 8 specimens without anosmic symptoms. In the nasal microbiome of COVID-19 patients who experience symptoms of anosmia, there is a decrease in the abundance of the Actinobacteria, Propionibacteriales, Propionibacteriaceae, Cutibacterium and Peptoniphilus. From this study, there were changes in the composition of the nasal microbiome in COVID-19 patients with anosmia symptoms."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023

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