cover
Filter by Year
Majalah Kedokteran Bandung
Articles by issue : Vol 48, No 1 (2016)
10
Articles
Perancangan Hewan Coba Model untuk Karsinoma Payudara HER-2 Positif Menggunakan Agen Imunosupresan

Hidayat, Basuki, Massora, Stepanus, Ramli, Martalena, Susilo, Veronika Yulianti, Arianto, Agus, Masjhur, Johan S.

Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar | Full PDF (176.904 KB)

Abstract

Pengembangan obat terapi keganasan di Indonesia sering kali terkendala karena ketidakmampuan menyediakan hewan model untuk uji preklinis. Hewan model tersebut adalah hewan model dengan massa keganasan yang mempunyai karakteristik khusus, bukan sekedar dengan massa tumor. Pada umumnya untuk tujuan tersebut digunakan hewan model yang tidak mempunyai daya tahan tubuh dan dipelihara dalam lingkungan yang steril. Fasilitas sistem perkandangan yang steril ini yang belum ada di Indonesia. Tujuan penelitian ini mengembangkan metode penyediaan hewan model mencit pengganti nude mice dengan daya tahan tubuh yang rendah, tetapi mampu hidup dalam lingkungan fasilitas pemeliharaan yang tidak steril. Penelitian dilakukan di Laboratorium Hewan dan Laboratorium Sitogenetik Pusat Teknologi Radioisotop dan Radiofarmaka, Batan, Serpong sejak bulan Juli sampai November 2014. Galur sel SKBR-3 diinokulasi pada 2 kelompok mencit sehat (Mus musculus) strain Balb/c, yaitu kelompok perlakuan dan kontrol, masing-masing 8 ekor. Cyclosporine A, agen penurun daya tahan tubuh hanya diberikan pada kelompok perlakuan sebelum dan setelah inokulasi. Pada kedua kelompok, pertumbuhan tumor secara makroskopik tidak terlihat di tempat inokulasi, tetapi tampak perbedaan bermakna antara kelompok perlakuan dan kontrol pada kadar leukosit (p:0,01), limfosit (p:0,01), monosit (p:0,01), dan segmen neutrofil (p:0,01). Pada 2 mencit kelompok perlakuan didapatkan gambaran sel degenerasi bengkak keruh di hati. Metode ini terbukti dapat menurunkan daya tahan tubuh hewan coba mencit (Mus musculus) strain Balb/c, walaupun belum mampu menumbuhkan keganasan. [MKB. 2016;48(1):39–44]Kata kunci: Ca payudara HER2 positif, hewan coba model onkologiDesigning Animal Models for HER2 Positive Breast Cancer Using Immunosuppressive AgentAbstractThe development of therapeutic drug for malignancy in Indonesia is often constrained because of the inability to provide animal models for preclinical study. These animal models are an animal model with a malignancy mass which have special characteristics, not just the tumor mass. Animal models that are usually used for this purpose is immunodeficient animals. This animal must be kept in sterile animal care, but the facility is not readily available in Indonesia. The purpose of this study was to develop a method for providing an animal model of nude mice replacement that has fairly low immunity but are still able to live in non-sterile animal care facilities. The study was conducted at the Laboratory Animal and Cytogenetics, Center for Radioisotope and Radiopharmaceuticals Technology, Batan, Serpong in the period of July to November 2014. SKBR-3 cell lines were inoculated on two groups of immunocompetent mice (Mus musculus) strain Balb/c, namely the treatment group (n=8) and controls (n=8). Cyclosporine A as an immunosupressan agent was given only to the treatment group before and after SKBR 3 inoculation. No macroscopically visible tumor growth at the site of inoculation in both of groups. There was a significant difference between the treatment group and the control group in leukocyte levels (p: 0.01), lymphocytes (p: 0.01), monocytes (p: 0.01), and neutrophil segments (p: 0.01). Two treatment groups of mice obtained cloudy degeneration in the liver. This method has significantly reduced the immunity of mice (Mus musclus) strain Balb/c but still cannot grow malignancies in experimental animals. [MKB. 2016;48(1):39–44]Key words: HER2 positive breast cancer, oncology animal models DOI: 10.15395/mkb.v48n1.732

Gambaran Subtipe HIV-1 dengan Kadar CD4, Stadium Klinis, dan Infeksi Oportunistik Penderita HIV/AIDS di Kota dan Kabupaten Jayapura, Papua

Widiyanti, Mirna, Sandy, Semuel

Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar | Full PDF (173.632 KB)

Abstract

Jumlah kasus HIV/AIDS di Indonesia akhir Maret 2013 tercatat 103.759 kasus dan 43.347 kasus AIDS yang tersebar di Indonesia. Papua merupakan provinsi ketiga yang memiliki jumlah kasus HIV/AIDS cukup tinggi, yaitu 10.881 kasus HIV dan 7.795 kasus AIDS. Tujuan penelitian ini melihat distribusi subtipe HIV-1 yang dominan di Papua dan mengetahui hubungan subtipe HIV-1 dengan kadar CD4, stadium klinis, dan infeksi oportunistik penderita HIV/AIDS. Penelitian menggunakan rancangan potong lintang. Pemeriksaan subtipe HIV-1 menggunakan RT-PCR dan sekuensing. Penelitian dilaksanakan di RSUD Dok II, RS Abepura, dan RSUD Yowari Kabupaten Jayapura pada bulan November–Desember 2012. Data CD4, stadium klinis, dan jenis infeksi oportunistik dicatat melalui rekam medis pasien. Data dianalisis menggunakan uji statistik chi-kuadrat. Subtipe HIV-1 yang dominan ditemukan, yaitu CRF01_AE sebanyak 51 orang (54%) dan subtipe B sebanyak 43 orang (46%). Dari 94 pasien HIV sebanyak 62 orang (66%) menderita infeksi oportunistik TB paru dan beberapa menderita lebih dari satu jenis infeksi oportunistik. Uji statistik menunjukkan tidak ada hubungan bermakna subtipe HIV-1 dengan kadar CD4 dan stadium klinis, tetapi menunjukkan korelasi bermakna terhadap infeksi oportunistik. Simpulan ditemukan subtipe HIV-1 yang dominan di Papua adalah CRF01_AE dan infeksi oportunistik terbanyak pada penderita adalah tuberkulosis. [MKB. 2016;48(1):1–6]Kata kunci: CD4, infeksi oportunistik, stadium klinis, subtipe HIV-1 Overview of HIV-1 Subtype with CD4 Levels, Clinical Stage and Opportunistic Infections HIV/AIDS in City and Regency of Jayapura-PapuaAbstractThe number of HIV/AIDS cases recorded in March 2013 in Indonesia is 103,759 HIV cases and 43,347 AIDS cases. Papua is the province that has the third highest number HIV/AIDS cases with 10,881 HIV cases and 7,795 AIDS cases. The aim of this study was to identify the distribution of HIV-1 subtypes which are dominant in Papua and to identify opportunistic infections related to HIV/AIDS and their relationship with HIV-1 subtypes. This study is a cross-sectional study. The identification of HIV-1 was performed using nested-PCR and sequencing to look for HIV-1 subtypes. The study was conducted in Dok II, Abepura and Yowari VCT Hospital in Jayapura District during the period of November–December 2012. CD4 and opportunistic infections were retrieved from patient medical records. Data were analyzed statistically using chi-square test. The dominant HIV-1 subtypes found were subtype CRF01-AE, which was found in 51 people (54%), and subtype B, which was found in 43 people (46%). Of 94 HIV patients, 62 (66%) respondents suffered from pulmonary tubeculosis opportunistic infection and some patients suffered more than one type of opportunistic infections. There was no significant difference found between the HIV-1 subtypes, CD4 level, and clinicial stage. However, a significant correlation with opportunistic infections was found. It is concluded that the dominant HIV-1 subtype in Papua is CRF01_AE with tuberculosis as the most frequent opportunistic infection. [MKB. 2016;48(1):1–6]Key words: CD4, clinical stage, HIV-1 subtypes, opportunistic infection 

Perbandingan Skor DECAF dengan Skor BAP-65 terhadap Kematian dalam Tiga Puluh Hari pada Pasien PPOK Eksaserbasi Akut di RSUP H. Adam Malik Medan

Lubis, Siti Taqwa Fitria, Keliat, E. N., Abidin, Alwinsyah

Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar | Full PDF (208.821 KB)

Abstract

Pada penderita penyakit paru obstruksi kronik (PPOK) eksaserbasi akut, penilaian derajat keparahan pada awal masuk penting dalam menentukan risiko kematian rawat inap rumah sakit, memutuskan perawatan bangsal atau Intensive Care Uni,t dan penatalaksanaan selanjutnya. Skor Dyspnoea, Eosinopenia, Consolidation, Acidaemia, Atrial Fibrillation (DECAF) dan skor elevated BUN, Altered mental status, Pulse 109 beats/min, age >65 years (BAP-65) dapat digunakan sebagai alat prognostik. Penelitian ini bertujuan membandingkan skor DECAF dengan skor BAP-65 memprediksi kematian dalam 30 hari pada pasien PPOK eksaserbasi akut. Penelitian dengan desain kohort, subjek adalah pasien PPOK eksaserbasi akut di Instalasi Gawat Darurat dan rawat inap RSUP H. Adam Malik Medan, pada bulan Februari–Juni 2013. Dinilai skor DECAF dan skor BAP-65. Dihitung sensitivitas dan spesifisitas kedua skor dan dibandingkan kekuatannya. Sebanyak 40 subjek direkrut, rata-rata (±SB) usia 61,07±12,42 tahun. Sembilan subjek (23%) meninggal saat penelitian. Uji chi-kuadrat mendapatkan hasil signifikan skor DECAF p 0,003 dan skor BAP-65 p=0,0026. Sensitivitas dan spesifisitas skor DECAF dan skor BAP-65, masing-masing 100% dan 16%, 100% dan 39%. Simpulan, skor DECAF dan skor BAP-65 memiliki hubungan dengan kematian dalam 30 hari pada pasien PPOK eksaserbasi akut. Tingginya sensitivitas dan rendahnya spesifisitas menyebabkan kedua skor ini belum dapat digunakan sebagai alat prognostik. Diperlukan penelitian dengan subjek yang lebih besar untuk mendapatkan keakuratan kematian. [MKB. 2016;48(1):7–14]Kata kunci: PPOK eksaserbasi akut, prognosis, skor BAP-65, skor DECAFComparison between DECAF Score and BAP-65 Score in Predicting Thirty Days Mortality in Acute Exacerbations COPD Patients in H. Adam Malik General HospitalAbstractThe assessment of severity level in patient with acute exacerbation chronic obstructive pulmonary disease (AECOPD) at early admission is important to determine the risk of in-hospital mortality, to decide hospitalization or requirement of Intensive Care Unit setting and further management. Dyspnea, Eosinopenia, Consolidation, Acidaemia, Atrial Fibrillation (DECAF) score, and elevated BUN. Altered mental status, pulse 109 beats/min, age >65 years (BAP-65) can be used as prognostic tools. The aim of this study was to investigate the comparison between DECAF score and BAP-65 score in predicting 30 days-mortality in AECOPD patients. This was a cohort study, subjects were AECOPD patients in emergency unit and inpatient in H. Adam Malik General Hospital, from February to June 2013. DECAF score and BAP-65 score were assessed. We calculated sensitivity and specificity of both scores to compare the stronger predictor. Fourty subjects were recruited, mean (±SD) age was 61.07±12.42 years. Nine subjects (23%) died during the study. This study presented significant result with p=0,003 for DECAF score and p=0,0026 for BAP-65 score, using chi-square test. Sensitivity and specificity of DECAF score and BAP-65 score were 100% and 16%, 100% and 39%, respectively. In conclusion, DECAF score and BAP-65 score have correlations with 30-days mortality in AECOPD patients. High sensitivity and low specificity prevent the use of these scores as prognostic tools. A larger study is required to determine the accuracy on mortality. [MKB. 2016;48(1):7–14]Key words: Acute exacerbation COPD, BAP-65 score, DECAF score, prognostic

Perbedaan Manifestasi Klinis dan Laboratorium Kolestasis Intrahepatal dengan Ekstrahepatal pada Bayi

Prasetyo, Dwi, Ermaya, Yudith Setiati, Martiza, Iesje

Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar | Full PDF (165.671 KB)

Abstract

Ikterus fisiologis sering didapatkan pada bayi dan kebanyakan gejalanya ringan. Gejala ikterik biasanya akan menghilang dalam 2 minggu setelah lahir. Pada ikterus yang terkonjugasi terjadi defek produksi intrahepatal, transpor transmembran dari empedu, yaitu kolestasis intrahepatal (IH) atau obstruksi kolestasis ekstrahepatal (EH) yang mengakibatkan hambatan empedu. Penelitian ini dilakukan untuk melihat perbedaan manifestasi klinis dan laboratorium kolestasis IH dengan EH pada bayi. Studi potong lintang dilakukan pada 72 bayi dengan kolestasis yang datang ke Rumah Sakit Dr. Hasan Sadikin Bandung, periode Januari 2014–Desember 2015. Analisis data dilakukan dengan uji Pearson Chi-kuadrat dan Mann-Whitney. Subjek terdiri atas 43 (60%) laki-laki dan 29 (40%) perempuan, kolestasis IH sebanyak 61 orang (85%), dan EH sebanyak 11 (15%). Pada penelitian ini didapatkan perbedaan bermakna manifestasi klinis asites antara kolestasis IH dan EH (p=0,047), sedangkan venektasi, hepatomegali, dan splenomegali tidak didapatkan perbedaan bermakna. Pada pemeriksaan warna feses tidak didapatkan perbedaan bermakna (p=0,936), demikian juga hasil laboratorium bilirubin total, bilirubin direk, glutamat oksaloasetat transaminase, glutamat piruvat transaminase, alkali fosfatase, dan gama glutamil transferase serum tidak berbeda bermakna. Simpulan, didapatkan perbedaan manifestasi klinis asites, sedangkan manifestasi klinis yang lain dan hasil laboratorium tidak didapatkan perbedaan antara kolestasis IH dan EH. [MKB. 2016;48(1)45–50]Kata kunci: Kolestasis ekstrahepatal, kolestasis intrahepatal, laboratorium, manifestasi klinisDifferences of Clinical Manifestation and Laboratory Findings in Intra-Hepatic and Extra-Hepatic Cholestasis in InfantsAbstractPhysiological jaundice found in infants and most symptoms are often mild. Jaundice symptoms usually disappear within 2 weeks after birth. In conjugated jaundice defects in intra-hepatic production, transmembran transport from bile, i.e. cholestasis intra hepatic (IH), or extra-hepatic (EH) obstruction/cholestasis occur, resulting in bile barriers. This study was conducted to look at the differences in the clinical and laboratory manifestations of IH and EH cholestasis in infants. A cross-sectional study was performed on 72 infants with cholestasis who came to Dr. Hasan Sadikin General Hospital Bandung, during the period of January 2014–December 2015. Data analysis was performed with Pearson Chi-square test and Mann-Whitney. Subjects consisted of 43 (60%) infant boys and 29 (40%) infant girls, IH cholestasis were 61 (85%) and EH cholestasis were 11 (15.3%). Significant differences in the clinical manifestations of acites with IH and EH cholestasis were found (p=0.047), whereas insignificant differences in venectation, hepatomegaly and splenomegaly were observed. On examination of stool color, no significant difference was found (p=0.936). The same was true for laboratory results of total bilirubin, direct bilirubin, serum glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase and gamma glutamyl transferase. In conclusion, we found differences in clinical manifestation of acites, while for other clinical manifestations and laboratory results no differences were found between IH and EH cholestasis. [MKB. 2016;48(1)45–50]Key words: Clinical manifestation, extra-hepatic cholestasis, intra-hepatic colestasis, laboratory

Deteksi Natrium/Iodide Symporter (NIS) pada Galur Sel Kanker Payudara SKBR3 dengan Imunositofluoresens

Elliyanti, Aisyah, Wikayani, Tenny Putri, Noormartany, Noormartany, Masjhur, Johan S., Achmad, Tri Hanggono

Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar | Full PDF (317.631 KB)

Abstract

Galur sel SKBR3 adalah model kanker payudara positif human epidermal growth factor receptor2 (HER2). Pemberian kemoterapi memperlihatkan respons lengkap hanya pada 50% pasien kanker payudara dengan tipe positif HER2. Kemampuan jaringan tumor menangkap dan mengakumulasi iodium radioaktif dihubungkan dengan ekspresi natrium/iodide symporter (NIS). Tujuan penelitian ini adalah menilai ekspresi dan distribusi NIS pada galur sel SKBR3 serta menilai efek induksi epidermal growth factor (EGF) pada ekspresi NIS menggunakan imunositofluoresens-ISF. Penelitian ini dilakukan di Laboratorium Kultur Sel, Fakultas Kedokteran Universitas Padjadjaran (FKUP) mulai bulan September 2013 sampai dengan April 2014. Sel SKBR3 ditumbuhkan pada plat kultur dan ditunggu hingga konfluen 70%. Sel dibagi atas dua kelompok, yaitu kelompok yang diberi induksi dan kontrol. Induksi EGF diberikan dengan dosis 50 ng/mL. Pemeriksaan ISF menggunakan antibodi primer rabbit polyclonal antibody anti NIS dan antibodi sekunder goat anti rabbit IgG polyclonal antibody. Data hasil pengamatan dinilai secara semikuantitatif. Natrium/iodide symporter tampak terekspresi dan terdistribusi di sitoplasma. Sel yang diinduksi dengan EGF memperlihatkan peningkatan ekspresi NIS di sitoplasma dan distribusinya di membran sel secara bermakna. Sel SKBR3 mengekspresikan NIS yang terdapat di sitoplasma. Induksi EGF meningkatkan ekspresi NIS dan distribusinya di membran sel. Temuan ini dapat mengarah potensi kemampuan sel kanker payudara menangkap dan mengakumulasikan iodium radioaktif. [MKB. 2016;48(1):15–8] Kata kunci: Ekspresi NIS , galur sel SKBR3, kanker payudara, imunositofluoresensDetection of Natrium/Iodide Symporter (NIS) in SKBR-3 Breast Cancer Cell Line Using ImmunocytofluoresenceAbstractSKBR-3 cell line is a breast cancer model for human epidermal growth factor receptor2 (HER2) positive. Only 50% of patients of this type have fully responded to chemotherapy. Natrium iodide symporter expression correlates with the uptake and ability of cells to accumulate radioiodine. The aim of this study was to examine natrium/iodide symporter (NIS) expression and its distribution with and without epidermal growth factor (EGF) treatment using immunocytofluoresence (ICF). This study was conducted at the Cell Culture Laboratory, Faculty of Medicine, Universitas Padjadjaran from September 2013 to April 2014. SKBR3 cells were cultured until 70% confluent. Cells were then divided into two groups: treatment group and control group. The treatment group was treated with EGF 50 ng/mL. Cells were incubated with primary antibody rabbit polyclonal antibody anti-NIS, and then were followed with secondary-antibody goat polyclonal antibody to rabbit. Data from the observation were then assessed semi-quantitatively. Natrium/iodide symporter was seen to be expressed and distributed in the cytoplasm. Cells induced by EGF showed significant increase in NIS expression in cytoplasm and its distribution in cell membrane. It is concluded that the SKBR3 cells express NIS in cytoplasm and that EGF induction increases NIS expression and distribution in cell membrane. This finding leads to a potential ability of breast cancer cells to uptake and accumulate radioiodine. [MKB. 2016;48(1):15–8]Key words: Breast cancer, cell line SKBR-3, immunocytofluoresence, NIS expression DOI: 10.15395/mkb.v48n1.728

Potensi Suplementasi Resveratrol dalam Mengatasi Efek Negatif Hormon Tiroid pada Terapi Obesitas: Uji Preklinik

Ruslami, Rovina, Rosalita, Renny, Yolanda, Raesa, Agustin, Agnes, Sudigdoadi, -

Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar | Full PDF (641.029 KB)

Abstract

Terapi obesitas menggunakan hormon tiroid menurunkan berat badan dengan nyata, namun menyebabkan berbagai efek negatif seperti stres oksidatif, kerusakan DNA, dan muscle wasting. Penelitian ini bertujuan mengkesplorasi potensi resveratrol (RSV), polifenol alami yang mempunyai efek antioksidan, anti-inflamasi, dan antiobesitas. Uji preklinik dengan rancangan acak sederhana dilakukan di Lab Hewan Fakultas Kedokteran Universitas Padjadjaran menggunakan 40 ekor tikus Wistar yang diinduksi obesitas. Hewan model obesitas dialokasikan secara acak ke dalam dua kelompok selama periode Agustus–November 2014. Kelompok perlakuan mendapat hormon tiroid 3 (HT3) dan RSV, serta kelompok kontrol mendapat HT3 saja selama 14 hari. Hewan coba yang mendapat HT3 dan RSV memiliki bobot badan lebih besar (290,5 g vs 251 g, p=0,016), massa otot lebih berat (2,57 g vs 2,25 g, p=0,036), indeks adiposit lebih kecil (0,89% vs 1,02%, p=0,026), dan area under the curve (AUC) gukosa lebih kecil (1.849,2 mg.mnt/dL vs 2.591,7 mg.mnt/dL, p<0,001) dibanding yang mendapat HT3 saja. Tidak terdapat perbedaan kadar MDA plasma (0,49 nmol/mL vs 0,44 nmol/mL, p=0,430) dan kerusakan DNA (19,7 pixel vs 22,0 pixel, p=0,657) pada kedua kelompok yang mungkin berhubungan dengan dosis dan lama pemberian resveratrol. Suplementasi resveratrol berpotensi mengatasi efek negatif hormon tiroid pada hewan model obesitas. Perlu penelitian lanjutan untuk mengetahui dosis optimal resveratrol sebagai antioksidan pada pengobatan obesitas menggunakan hormon tiroid. [MKB. 2016;48(1):51–7]Kata kunci: Hormon tiroid, obesitas, resveratrol, uji preklinikResveratrol Supplementation Potential in Managing Negative Effects of Thyroid Hormone during Obesity Treatment: a Pre-Clinical TrialAbstractTreatment of obesity using thyroid hormone could give significant result in decreasing body weight, but it also causes various negative effects such as oxidative stress, DNA damage, and muscle wasting. This sudy aimed to explore the potential of resveratrol, a natural polyphenol, that has anti-oxidant, anti-inflammatory, and anti-obesity effects, in managing negative effects of thyroid hormone used as anti-obesity. A preclinical trial was conducted at the animal laboratory, Faculty of Medicine, Universitas Padjadjaran. Forty male Wistar rats underwent obesity induction before randomly allocated into intervention and control groups in August–November 2014. The intervention group received a 14-days of triiodothyronine (T3) and resveratrol (RSV), while the control group received T3 only. Obese rats treated with T3 and RSV were heavier (body weight of 290.5 g vs 251.0 g, p<0.016), had a heavier muscle mass (2.57 g vs 2.25 g, p=0.036), smaller adipocyte index, (0.89% vs 1.02%, p=0.026) and smaller glucose area under the curve (AUC) (1,848.2 mg.mnt/dL vs 2,591.7 mg.mnt/dL, p<0.001) than those who were treated with T3 only. There was no significance difference in MDA plasma levels (0.49 nmol/mL vs 0.44 nmol/mL, p=0.0430) and DNA damage (19.7 pixel vs 22.0 pixel, p=0.657) between groups, probably due to insufficient dosage of resveratrol. Our results indicate that resveratrol supplementation could counter negative effects of thyroid hormone used as anti-obesity in obese-rats model treated with T3. More research is needed to determine the adequate dosage of resveratrol to elicit anti-oxidant effect that could minimize the negative effects of thyroid hormone as anti-obesity. [MKB. 2016;48(1):51–7]Key words: Obesity, preclinical trial, resveratrol, thyroid hormone DOI: 10.15395/mkb.v48n1.734

Validitas Kidney Injury Molecule-1 Urin Metode Mikro Enzyme-Linked Immunosorbent Assay Sebagai Penanda Dini Gangguan Ginjal Akut pada Sepsis

Balqis, Lulu Fahrizah, Noormartany, Noormartany, Gondodiputro, Rubin Surachno, Rita, Coriejati

Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar | Full PDF (241.556 KB)

Abstract

Gangguan ginjal akut (GgGA) adalah penurunan fungsi ginjal ditandai peningkatan kreatinin serum ≥0,3 mg/dL atau >1,5 kali dibanding dengan kadar sebelumnya atau penurunan urine output <0,5 mL/jam lebih dari 6 jam. Sepsis merupakan penyebab tersering GgGA (20–50%). Kidney injury molecule-1 (KIM-1) adalah glikoprotein transmembran tipe-1. Kadar KIM-1 urin penderita GgGA akibat sepsis meningkat lebih awal dibanding dengan kreatinin serum. Penelitian bertujuan mengetahui validitas KIM-1 urin sebagai penanda dini GgGA pada sepsis, dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung periode Februari–Mei 2013. Bentuk penelitian observasional analitik khusus dengan rancangan potong lintang. Subjek penelitian adalah penderita sepsis yang didiagnosis klinisi sesuai kriteria The American College of Chest Physician/The Society of Critical Care Medicine 2001, berdasarkan consecutive admission sampling. Metode yang digunakan mikro enzyme-linked immunosorbent assay. Analisis dengan chi-kuadrat, Mann-Whitney, tabel 2x2, dan kurva receiver operating curve untuk menghitung validitas. Subjek terdiri atas 25 penderita sepsis dengan GgGA dan 25 penderita sepsis tanpa GgGA. Kadar KIM-1 urin penderita sepsis dengan GgGA meningkat dibanding dengan tanpa GgGA. Kadar KIM-1 urine cut-off >0,8 ng/mL memiliki sensitivitas 96%, spesifisitas 60%, nilai duga positif 70,6%, nilai duga negatif 93,8%, dan akurasi 78%. Simpulan, sensitivitas KIM-1 urin tinggi, spesifisitas sedang sehingga dapat digunakan sebagai skrining GgGA pada penderita sepsis. [MKB. 2016;48(1):19–25]Kata kunci: GgGA, KIM-1, sepsis, validitas Validity of Urinary Kidney Injury Molecule-1 Using Micro Enzyme-Linked Immunosorbent Assay Method as an Early Marker of Acute Kidney Injury in Sepsis PatientsAAcute kidney injury (AKI) is a rapid decline in renal function marked by increased serum creatinine of ≥0.3 mg/dL or >1.5 times higher than the previous levels or decreased urine output of <0.5 mL/hour for more than 6 hours. Sepsis is the most common cause of AKI (20–50%). Kidney injury molecule-1 (KIM-1) is a type-1 transmembrane glycoprotein. Urinary KIM-1 levels of sepsis patients due to AKI increases earlier than the serum creatinine levels; thus KIM-1 may serve as an AKI marker. This study aimed to determine the validity of urinary KIM-1 as the early marker in sepsis patients with AKI. The study was a specific observational analytical study with cross-sectional design, conducted in Dr. Hasan Sadikin General Hospital Bandung in February–May 2013. Subjects were patients diagnosed with sepsis by clinicians according to the criteria of the The American College of Chest Physician/The Society of Critical Care Medicine 2001 and were selected by consecutive sampling admissions. Urinary KIM-1 levels were measured by micro enzyme-linked immunosorbent assay. The data were analyzed by chi-square, Mann-Whitney, 2x2 tables, and receiver operating curve to measure validity. Subjects consisted of 25 sepsis patients with AKI and 25 sepsis patients without AKI. Urinary KIM-1 level of sepsis patient with AKI increased compared to patients without AKI. Level of urinary KIM-1 with a cut-off of >0.8 ng/mL presented 96% sensitivity, 60% specificity, 70.6% positive predictive value, 93.8% negative predictive value and 78% accuracy. In conclusion, the level of urinary KIM-1 has high sensitivity and moderate specificity thus can be used for AKI screening in sepsis patients. [MKB. 2016;48(1):19–25]Key words: AKI, KIM-1, sepsis, validity

Teknik Rekonstruksi Turndown Flap Tendon Achilles dan Flap Fasiokutan Sural pada Ruptur Tendon Achilles yang Disertai Kerusakan Masif Jaringan Lunak: Laporan Kasus

Rasyid, Hermawan Nagar, Primadhi, Andri, Prasetia, Renaldi

Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar | Full PDF (1747.579 KB)

Abstract

Ruptur tendon achilles adalah cedera yang paling sering terjadi pada tendon ekstremitas bawah, meskipun merupakan tendon yang terbesar dan terkuat. Penelitian ini bertujuan menjelaskan teknik operasi dengan modifikasi augmentation pada penatalaksanaan ruptur tendon Achilles yang disertai kerusakan pada jaringan lunak yang luas. Kasus pada penelitian ini adalah seorang pasien (usia 30 tahun) dengan ruptur terbuka tendon Achilles akut dan terinfeksi, serta hilangnya tendon sampai dengan 5 cm, kecacatan tendon yang tidak menempel di bagian distal dan hilangnya sebagian tulang calcaneus. Kerusakan kulit diukur setelah dilakukan debridemen dengan rentan antara 8 cmx5 cm sampai dengan 15 cmx10 cm. Ruptur pada tendon dijahit dengan gastrosoleus turn down flap ke tulang calcaneus. Reverse sural artery digunakan untuk menutupi kulit. Flap yang dibuat berhasil hidup. Pasien dapat berjalan normal, dapat berdiri dengan ujung kaki, fleksi plantar yang aktif, dan dapat kembali beraktivitas dalam 2 bulan setelah operasi. Pasien memiliki rentang gerak penuh ke segala arah. Simpulan, debridemen, rekonstruksi tendon dalam satu tahap, dan reverse flow sural artery flap memberikan hasil yang memuaskan pada kasus robekan luas tendon Achilles dan kerusakan jaringan lunak yang luas. [MKB. 2016;48(1):58–62]Kata kunci: Gastrosoleus turn down flap, ruptur, sural artery flap, tendon Achilles Achilles Tendon Turndown Flap Reconstruction and Fasciocutanous Sural Flap in Severe Tendon Achilles Loss with Massive Tissue Defect: a Case ReportAbstractAchilles tendon rupture is the most common ruptur of tendon in the lower limb despite being one of the toughest tendons. This rupture presents a complex problem to the treating surgeon especially if it is associated with tendon and soft tissue loss. The case in this study is one patient (male, age 30-year old) with a spectrum of acute and infected open tendon-achilles rupture that includes loss of tendon of up to 5 cm, tendon defect with no distal attachment, and partial loss of the calcaneum. The skin defect measured after debridement ranged from 8 x 5 cm to 15 x 10 cm. The ruptured tendon was sutured using gastrocnemius-soleus turn down flap technic to calcaneus bone. A reverse sural artery was used to provide soft tissue cover. The flap survived. The patient had normal gait, were able to stand on tip toes, had active plantar flexion, and had returned to his original occupation 2 months after reconstruction. He had full range of movement at the ankle. Augmented repair of Achilles tendon rupture with large soft tissue defect using gastrocnemius- soleus turn down flap and sural artery flap are stable enough to allow early weight-bearing with favorable clinical result for this patient. Conclusions is single stage tendon reconstruction and reverse flow sural artery flap give good functional outcome in complex Achilles tendon rupture with tendon and soft tissue loss. [MKB. 2016;48(1):58–62] Key words: Achilles tendon, gastrocnemius-soleus turn down flap, rupture, sural artery flap

Korelasi Jumlah Cluster of Differentiation 4 dengan Jenis Bakteri Penyebab Infeksi Paru dari Kultur Bilasan Bronkoalveolar pada Pasien Human Immunodeficiency Virus

Melindah, Melindah, Santoso, Prayudi, Supriatna, Yana Akhmad, Turbawati, Dewi Kartika

Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar | Full PDF (252.827 KB)

Abstract

Infeksi paru bakteri adalah penyebab utama morbiditas dan mortalitas pasien human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Infeksi HIV menyebabkan disfungsi sistem kekebalan yang dimanifestasikan penurunan jumlah cluster of differentiation 4 (CD4). Tujuan penelitian menentukan hubungan jumlah CD4 dengan jenis bakteri penyebab infeksi paru dari kultur bilasan bronkoalveolar pasien HIV di RS Dr. Hasan Sadikin Bandung. Penelitian analitik observasional dengan rancangan potong lintang. Pengambilan sampel sejak November 2011 sampai Oktober 2013 di Departemen Ilmu Penyakit Dalam RS Dr. Hasan Sadikin Bandung. Subjek 39 orang memenuhi kriteria inklusi, didapatkan usia rata-rata 32 tahun. Jumlah median CD4 18 (rentang, 0–190) sel/mm3. Hasil kultur jenis bakteri batang gram negatif 29/39 sampel dan kokus gram positif 10/39 sampel. Spesies terbanyak Pseudomonas aeruginosa 11/39 sampel, Klebsiella pneumoniae 11/39 sampel dan Streptococcus viridans 10/39 sampel. Analisis statistik berdasarkan point biserial correlation terdapat korelasi lemah (r=0,232) dan tidak bermakna antara CD4 dan jenis bakteri penyebab dengan nilai p=0,209 (p>0,05). Arah korelasi menunjukkan semakin kecil jumlah CD4 semakin besar kemungkinan bakteri batang gram negatif sebagai penyebab infeksi paru. Penelitian ini menunjukkan korelasi lemah antara jumlah CD4 dan jenis bakteri penyebab infeksi paru dari bilasan bronkoalveolar pada pasien infeksi HIV di RS Dr. Hasan Sadikin Bandung. [MKB. 2016;48(1):32–8]Kata kunci: Bilasan bronkoalveolar, human immunodeficiency virus (HIV), infeksi paru bakteri, jumlah CD4Correlation between Cluster of Differentiation 4 Cell Counts and Types of Bacteria Causing Lung Infection from Cultured Washing of Bronchoalveolar Lavage in Human Immunodeficiency Virus PatientsAbstractBacterial lung infection is the leading cause of morbidity and mortality of patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). HIV infection causes immune system dysfunction, which is manifested by decreased cluster of differentiation 4 (CD4) cell counts. The purpose of this study was to determine the correlation between CD4 cell counts and the type of bacteria that caused lung infection from cultured washing of bronchoalveolar lavage in HIV patients in Dr. Hasan Sadikin Hospital Bandung. This was an observational analytic study with a cross-sectional design. Subjects were collected from November 2011 to October 2013 in Internal Departement Dr. Hasan Sadikin Hospital Bandung. There were 39 subjects enrolled with the average age of patients was 32 years. The median CD4 cell counts was 18 (range, 0–190) cell/mm3. The type of gram-negative rods bacteria was 29/39 samples and gram-positive cocci was 10/39 samples. Most species were Pseudomonas aeruginosa 11/39 samples, Klebsiella pneumoniae 11/39 samples and Streptococcus viridans 10/39 samples. Statistical analysis based on a point biserial correlation showed weak (r=0.232) and no significant correlation between CD4 cell counts and the type of bacteria (p>0.05). The weak correlation was the smaller the number of CD4 cell counts, the greater possibility of the gram-negative rod bacteria being the cause of the infection. This study concluded that there is only a weak and no correlation between the number of CD4 cell counts and the type of bacteria causing the lung infection obtained from bronchoalveolar lavage in patients with HIV in Dr. Hasan Sadikin Hospital Bandung. [MKB. 2016;48(1):32–8]Key words: Bacterial lung infection, bronchoalveolar lavage, CD4 cell counts, human immunodeficiency virus

Hubungan Kadar Leptin Serum dengan Kompleksitas Lesi Koroner berdasarkan Skor SYNTAX pada Penderita Penyakit Arteri Koroner Stabil

Ashari, Fajar, Aprami, Toni Mustahsani, Akbar, Muhammad Rizki, Purnomowati, Augustine, Martha, Januar Wibawa, Achmad, Chaerul, Martanto, Erwan

Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar | Full PDF (165.975 KB)

Abstract

Leptin memiliki peran penting dalam pembentukan plak ateroskleosis dengan mengaktifkan respons sel imun dan respons inflamasi ataupun peran langsung terhadap dinding pembuluh darah koroner. Penelitian terdahulu mengenai hubungan antara kadar leptin serum dan kompleksitas lesi koroner masih menunjukkan kontroversi. Penelitian ini bertujuan mengetahui hubungan antara kadar leptin serum dan kompleksitas lesi koroner berdasarkan skor SYNTAX pada penderita penyakit arteri koroner stabil. Metode penelitian berupa observasional, deskriptif, dan analisis korelasi dengan rancangan potong lintang. Subjek penelitian sebanyak 44 orang penderita penyakit arteri koroner (PAK) stabil yang memenuhi kriteria inklusi, menjalani pemeriksaan angiografi koroner di Rumah Sakit Dr. Hasan Sadikin Bandung selama bulan Januari–Mei 2014. Pengambilan sampel darah untuk pemeriksaan kadar leptin serum dilakukan sebelum tindakan angiografi. Kompleksitas lesi arteri koroner dinilai menggunakan skor SYNTAX. Hasil penelitian didapatkan subjek penelitian 84% laki-laki dengan usia rata-rata 54,68 (+10,24) tahun. Indeks massa tubuh rata-rata 24,71 (+ 3,05) kg/m2. Faktor risiko terbanyak adalah dislipidemia (84%), merokok (72%), hipertensi (38,4%), diabetes melitus (22,7%), dan obesitas (4,5%). Median kadar leptin serum 7.242 (780–36.929) pq/mL, nilai rata-rata skor SYNTAX sebesar 19,52 (+9,93). Analisis menggunakan uji korelasi rank-Spearman tidak didapatkan hubungan (p=0,61; r= 0,078). Perbedaan hasil penelitian ini dengan penelitian sebelumnya disebabkan oleh perbedaan subjek dan kriteria penilaian kompleksitas lesi arteri koroner. Simpulan, tidak terdapat hubungan antara kadar leptin serum dan kompleksitas lesi koroner berdasarkan skor SYNTAX pada penderita penyakit arteri koroner stabil. [MKB. 2016;48(1):26–31]Kata kunci: Kompleksitas lesi koroner, leptin serum, penyakit arteri koroner stabil, skor SYNTAXCorrelation between Serum Leptin Levels and Complexity of Coronary Artery Lesion based on SYNTAX Score in Patients with Stable Coronary Artery DiseaseAbstractLeptin has been shown to play a potential role in the atherosclerotic plaque formation by activating immune and inflammatory cells or directly acting on the vessel wall. Earlier reports of the correlation of serum leptin levels with the degree of coronary lesion stated are still controversial. This study determined the correlation between serum leptin levels and complexity of coronary artery lesion in patients with stable coronary artery disease (SCAD). This is an observational cross-sectional study. Data were collected from January to May 2014 in Dr. Hasan Sadikin Central General Hospital Bandung. Blood samples were collected before angiography procedures. The complexity of coronary artery lesion was assessed using SYNTAX score. There were 44 patients who met inclusion criteria, male 84%, median age 54.68 (+10.24) years. Mean body mass index 24.71 (+ 3.05) kg/m2. Dyslipidemia was the most common risk factor (84%), followed by smoking (72%), hypertension (38.4%), diabetes mellitus (22.7%), and obesity (4.5%). Median leptin level was 7,242 (780-36,929) pq/mL. Mean SYNTAX score was 19.52 (+9.93). Leptin level had no correlation with the complexity of coronary artery lesion (p=0.61, r=0.078). The difference between this study from prior studies might be caused by differences in subject selection and criteria used for complexity of coronary artery lesion. In conclusion, there is no correlation between serum leptin levels and complexity of coronary artery lesion in patients with stable coronary artery disease. [MKB. 2016;48(1):26–31]Key words: Complexity of coronary artery lesion, leptin, stable coronary artery disease, SYNTAX score