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Djoko Trihadi Lukmono Subagyo
Bagian Penyakit Dalam Fakultas Kedokteran Universitas Islam Sultan Agung Semarang
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Pengaruh Suplementasi Besi pada Tuberkulosis Paru dengan Anemia Defisiensi Besi (Kajian Respon Kesembuhan, Respon Imun, dan Resistensi)

Jurnal Sains Medika Vol 2, No 1 (2010)
Publisher : Fakultas Kedokteran UNISSULA

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Abstract

ABSTRACTBackground: Prevalence of Lung Tuberculosis (TB) in Indonesia is about 0.15% - 0.26%. Iron supplement onthe TB patients with iron deficiency anemia (IDA) has several effects such as activating macrophage derivedmonocyt (MDM) and interferon-gamma (IFN- ), with a positive feed-back mechanism pushing interleukin-12 (IL-12). The objective of this research is to find out the influence of iron supplement on recovery responses,immune responses, and resistance on the TB patients with IDA without chronic disease anemia, no acute orchronic infections, and good nutrition status.Design and method: The method of this study was Randomized Clinical Trial with Simple Randomized Pretest– Post-test Control Group Design on 252 respondents in a triple blind manner. The respondents are thosehaving the category 1 active pulmonary TB with IDA according the World Health Organization (WHO)standard, receiving the Directly Observed Treatment Shortcourse (DOTS) strategy treatment. Theexperimental group consists of 126 respondents, treated with a therapy of 2 RHZE / 4 R3H3 and 3 x 200 mgsulfate ferrosus containing 60 mg ferro-sulfate hepta-hydrate for the first 2 months, and 3 times a week forthe next 4 months. The control group consists of 126 respondents, treated with a therapy of 2 RHZE / 4 R3H3and placebo. Independent variable was iron supplementation, while dependent variable were AcidFastBaccili (AFB) smears, IFN-γ, IL-12, MDR-TB, hemoglobin, serum tranferrin Receptor (sTfR), and Body MassIndex (BMI). Data analysis is conducted with SPSS t-test Version 15 (2007).Result: The analysis results of delta data of study variables between the control group vs. experimentalgroup are: 1) increased sputum AFB conversion in the experimental group +100% (p<0,05). 2) increased IFN-γ in the experimental group +324,84% (p<0,05). 3) increased IL-12 in the experimental group +364,42%(p<0,05). 4) decreased MDR-TB in the experimental group -100% (p<0,05). 5) increased haemoglobin in theexperimental group +47,96% (p<0,05). 6) decreased sTfR in the experimental group -68,54% (p<0,05). 7)increased BMI in the experimental group +45,63% (p<0,05). 8) inhibited single - basa mutation CCT-Arginin,and multiple - basa mutation histidin-leusin GGC TGA DNA MTB. 9) haemoglobine threshold for MDR-TB riskwas 9,5gr%, sTfR 60,26 pg/ml, IFN-γ 14,58 pg/ml, IL-12 15,56 pg/ml, and BMI less than 18,5 kg/m2. 10)haemoglobine highest risk threshold was 15 gr% to prevent infection MTB worsening. The results oflogarithmic data t-test of all variables are highly significant (p<0.00), except BMI was significantly increases(p<0.05); Mann-Whitney test of delta data, highly significant differences were found (p<0.00).Conclusion: In the control group 9 multiple-basa mutations as the causes of MDR-TB were found. We concludethat iron supplement on the TB with IDA increases: sputum AFB conversion, IFN- , IL-12, hemoglobin, BMI,decreases sTfR and MDR-TB. In other group which no iron supplementation there are 9 multiple-basamutations as the causes of MDR-TB (Sains Medika, 2 (1):57-69).ABSTRAKPendahuluan: Prevalensi Tuberkulosis Paru (TBP) di Indonesia sekitar 0,15%-0,26%. Suplementasi besipada penderita TBP dengan anemia defisiensi besi (ADB) mempunyai efek antara lain mengaktivasimacrophage derived monocyt (MDM), dan interferon-gamma (IFN-γ), dengan mekanisme umpan balikpositif memacu interleukin-12 (IL-12). Tujuan penelitian ialah untuk mengetahui pengaruh suplementasibesi terhadap respon kesembuhan, respon imun, dan resistensi pada pasien TB dengan ADB tanpa anemia1 Bagian Penyakit Dalam RSUD Kota Semarang* Email: dr.trihadi@yahoo.com2 Bagian Penyakit dalam Fakultas Kedokteran Universitas Diponegoro Semarang3 Departemen Pulmonologi Fakultas Kedokteran Univeritas Indonesia Jakarta58 Vol. 2, No. 1, Januari - Juni 2010penyakit khronis, tidak ada infeksi akut atau kronis, dan status gizi baik.Metode penelitian: Metode penelitian ini adalah Randomized Clinical Trial dengan Simple randomizedthe Pre test-Post test Control Group Design pada 252 responden secara tersamar ganda (triple blind).Responden yaitu penderita TBP aktif kategori 1 dengan ADB sesuai dengan standar WHO yang mendapatpengobatan strategi Directly Observed Treatment Shortcourse (DOTS). Kelompok eksperimen 126responden diterapi 2 RHZE / 4 R3H3 dan sulfas ferrosus 3 x 200 mg yang mengandung ferro-sulfatheptahidrat 60 mg selama 2 bulan pertama, dan 3 kali seminggu selama 4 bulan selanjutnya. Kelompokkontrol 126 responden diterapi 2 RHZE / 4 R3H3 dan plasebo. Variabel bebas adalah suplementasi besi,variabel tergantung adalah konversi Bakteri Tahan Asam (BTA), IFN-γ, IL-12, Multi Drug-Resistant TB (MDRTB),hemoglobin, serum Transferrin Receptor (sTfR), dan Indeks Massa Tubuh (IMT). Analisis data denganuji-t SPSS Version 15.0 (2007).Hasil Penelitian: Hasil analisis data delta variabel penelitian antara kelompok kontrol dibandingkandengan kelompok eksperimen adalah: 1) peningkatan konversi BTA dahak pada kelompok eksperimensebesar +100% (p<0,05), 2) peningkatan IFN-γ pada kelompok eksperimen sebesar +324,84% (p<0,05), 3)peningkatan IL-12 pada kelompok eksperimen sebesar +364,42% (p<0,05), 4) penurunan MDR-TB padakelompok eksperimen sebesar –100% (p<0,05), 5) peningkatan hemoglobin pada kelompok eksperimensebesar +47,96% (p<0,05), 6) penurunan kadar sTfR pada kelompok eksperimen sebesar –68,54% (p<0,05),7) peningkatan IMT pada kelompok eksperimen sebesar +45,63% (p<0,05), 8) menghambat mutasi basatunggalCCT-Arginin, dan mutasi basa-berganda histidin–leusin GGC TGA DNA MTB, 9) batas nilai ambangrisiko terjadi MDR-TB pada kadar hemoglobin 9,5 gr%, sTfR 60,26 pg/ml, IFN-γ 14,58 pg/ml, IL-12 15,56 pg/ml,dan IMT kurang 18,5 kg/m2, 10) batas nilai ambang kadar hemoglobin tertinggi 15 gr% untuk mencegah makinberatnya infeksi MTB. Hasil uji test data logaritma semua variabel berbeda sangat bermakna (p<0,00), kecualiIMT meningkat bermakna (p<0,05), dan pada uji Mann-Whitney data delta didapatkan perbedaan sangatbermakna (p<0,00).Kesimpulan: Pada kelompok kontrol didapatkan 9 mutasi basa-ganda sebagai penyebab MDR-TB. Jadidapat disimpulkan bahwa suplementasi besi pada TB dengan ADB meningkatkan: konversi BTA sputum,IFN- , IL-12, hemoglobin, IMT, menurunkan sTfR, dan MDR-TB. Pada kelompok yang tidak diberisuplementasi besi didapatkan 9 mutasi basa-ganda sebagai penyebab MDR-TB (Sains Medika, 2 (1):57-69).

The Effect of Moringa Oleifera. Lam Leaf Extract on Bcl2 and Bax Expression in Paracetamol-induced Renal Tubular Apoptosis in Rats

Sains Medika: Jurnal Kedokteran dan Kesehatan Vol 8, No 2 (2017): July-Desember 2017
Publisher : Fakultas Kedokteran; Universitas Islam Sultan Agung (UNISSULA)

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Abstract

BACKGROUND: Paracetamol may cause apoptosis in the renal tubules. Moringa leaf (Moringa oleifera. Lam) has been shown to have antioxidanteffects due to its flavonoids. In addition, flavonoids also have biological effects to modulate the signal-transduction pathway. OBJECTIVE: to investigatethe effect of Moringa oleifera Lam extract on Bcl-2 and Bax expression on paracetamol-induced renal tubular injury.METHODS: in this post-test only control group design study, 24 rats were divided into 4 groups: AqC-G (aquades), EtC-G (70% ethanol), MoL1-Gand MoL2-G (moringa leaf extract at the dose of 1.075 g/Kg BW and 2.150 g/Kg BW respectively). Expression of Bcl2 and Bax was determined usingimmunohistochemical staining. The data on the number of Bcl2 and Bax expressions tested with One Way Anova followed by the Post Hoc LSD test.RESULTS: Post Hoc LSD test showed that the expression of Bcl-2 in the experimental groups ((MoL1-G (9.1) and MoL2-G (13,683)) was significantlyhigher compared to that of controls (p<0.001). Bax expression in the experimental groups (MoL1-G (6,85) and MoL2-G (2,633)) was significantly lowercompared to that of controls, p <0.001.CONCLUSION: The administration of Moringa leaf extract at the dose of 1,075 and 2,150 increases Bcl-2 expression and decreases Bax expression inparacetamol-induced renal tubular injury.

Fluid Balance, Interferon-Gamma, Interleukin- 12 and Tumor Necrosis as predictive factors of Survival in Severe Sepsis

Sains Medika Vol 4, No 1 (2012): Januari-Juni 2012
Publisher : Fakultas Kedokteran; Universitas Islam Sultan Agung (UNISSULA)

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Abstract

Background: The cardiovascular derangements of severe sepsis in human include arteriolar, venular dilation, capillary leak, and immunomodulatory response. Intravascular volume replacement during resuscitation most frequently converts the circulation to a high-out put hypotensive state. We hypothesized that patients with severe sepsis had any predicting factors to survive than those who do not.Design and Method: Randomized Clinical Trials were conducted of 110 patients suffered from severe sepsis in ICU/HCU. Admission APACHE II, SOFA scores, IFN- , IL-12, TNF-á, and fluid balance were computed from the extracted data. Patients allowed to severe sepsis treatment according with the International Consensus Committee. Summary estimates using both the Mantel-Haenszel test and precision based approaches were computed for statistical analysis.Result: Of 110 patients ranged in age from 46 to 71 years with a mean (± SE) age of 63.45 ± 3.97 years. The mean admission APACHE II score was 25.96 ± 3.65; and the day 1 SOFA score was 9.57 ± 1.24. Twenty one patients did not survive, Non-survival had higher mean APACHE II than survivals (29.85 vs 20.46), respectively (p < 0.01). Higher first day IFN- , IL-12, TNF-á, and SOFA scores (p< 0.01). Whereas 26 patients who achieved a negative fluid balance of > 500 mL on > of the first 3 days of treatment survived (RR 5.0; 95% CI : 2.3 to 10.7, p < 0.0001).Conclusion: These results suggest that at least 1 day of negative fluid balance (<-500mL), IFN- , IL-12, and TNF-á may be a good independent predictors of survival in patients with severe sepsis. These findings suggest the hypothesis that four independent predictors of severe sepsis portend a good prognosis for a larger prospective study (Sains Medika, 4(1):13-22).