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Majalah Kedokteran Bandung
Articles by issue : Vol 48, No 2 (2016)
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Articles
Penggunaan Genogram dalam Deteksi Dini Faktor Risiko Penyakit Degeneratif dan Keganasan di Masyarakat

Arisanti, Nita, Gondodiputro, Sharon, Djuhaeni, Henni

Majalah Kedokteran Bandung Vol 48, No 2 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Penyakit tidak menular (PTM) dapat dimulai sejak usia produktif. Umumnya masyarakat baru memeriksakan diri setelah timbul gejala, padahal deteksi dini penyakit penting dilakukan. Sebagian penyakit bersifat familial atau diturunkan yang dapat dideteksi dini dengan menggali riwayat penyakit individu dan keluarga. Genogram merupakan salah satu alat untuk menggali faktor risiko dalam keluarga. Tujuan penelitian ini adalah mengetahui sejauh mana fungsi genogram dalam mendeteksi dini faktor risiko penyakit keganasan dan degeneratif. Penelitian kuantitatif dilakukan terhadap 231 pasien di puskesmas se-Kota Bandung. Kriteria inklusi adalah pengunjung puskesmas, berusia 18 tahun ke atas, kooperatif, dan bersedia diwawancara. Teknik pemilihan sampel menggunakan cluster sampling. Pengambilan data menggunakan kuesioner genogram yang mencatat faktor risiko PTM dari 3 generasi. Dilakukan analisis genogram dan disajikan dalam tabel distribusi frekuensi. Penelitian ini dilakukan pada bulan Agustus–September 2013. Hasil penelitian menunjukkan, sebanyak 183 dari 231 responden mempunyai faktor risiko penyakit degeneratif dan keganasan yang tergambar dari genogram. Dari riwayat keluarga, penyakit terbanyak adalah hipertensi dan penyakit jantung yang didapatkan dari generasi bapak. Penelitian ini memperkuat penelitian mengenai fungsi genogram yang efektif untuk mendeteksi secara cepat faktor risiko penyakit degeneratif dan keganasan pada individu dan keluarga. [MKB. 2016;48(2):118–22]Kata kunci: Degeneratif, deteksi dini, faktor risiko, genogram, keganasan Genogram as An Early Detection Method for the Risk Factors of Degenerative Diseases and Malignanciesy in the CommunityNon-communicable diseases (NCDs) can be found at young age and the people are not aware about the diseases. People seek medical care after symptoms occurred. Most of NCDs are familial or hereditaryy; hence, require family explorationin the detection that should be detected by exploring family history. Genogram is tool for describing multigenerational risks. The purpose of this study was to determine the functions of genogram in the early detection of risk factors for degenerative diseases and malignanciesy. A quantitative study was conducted on 231 patients who visited primary health centers (Puskesmas) in Bandung with the inclusion criteria were of patients at visited the selected Puskesmas, aged 18 years, and more, cooperative, and willing to be interviewed. Sampling technique used was cluster sampling. Data collecting were performed using questionnaires that recorded genogram and risk factors from three previous generations of the family. Interpretation of genogram was used to analyze the risk factors. This study was conducted from August to September 2013. The results showed that 183 of 231 respondents have risk factors for degenerative diseases and malignancies, which was reflected from the family genogram. Based on family history, most of respondents had have risk factors for hypertension and heart disease, specifically obtainedespecially from the father’s side.  from father’s generation. This research study confirms the results of previous research studystudies that the on the function of genogram that is effectiveo for in detecting the risk factors for degenerative diseases and malignancies in individuals and families in the community. [MKB. 2016;48(2):118–22]Key words: Degenerative diseases, early detection, genogram, malignancy, risk factors 

Pengaruh Hemodialisis Terhadap Kejadian Kurang Pendengaran Sensorineural Pada Penderita Gagal Ginjal Kronik

Ulfa, Loriana, Muyassaroh, Muyassaroh, Naftali, Zulfikar, Arwanto, Arwedi, Murbani, Ita

Majalah Kedokteran Bandung Vol 48, No 2 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Kurang pendengaran sensorineural (KPSN) dapat terjadi pada kasus gagal ginjal kronik (GGK) yang dilakukan hemodialisis (HD). KPSN akibat HD terjadi pada berbagai frekuensi. Faktor yang diduga dapat mempengaruhi adalah usia, hipertensi, diabetes melitus (DM). Menganalisis pengaruh HD terhadap kejadian KPSN pada penderita GGK. Penelitian kohort pada 52 penderita GGK yang memenuhi kriteria inklusi. Terdiri dari dua kelompok, 26 penderita GGK mendapat HD dan 26 penderita GGK tanpa HD. Kelompok HD dilakukan pemeriksaan timpanoaudiometri sebelum HD dan setelah HD III. Kelompok tanpa HD dilakukan pemeriksaan timpanoaudiometri dalam waktu yang sama. Data usia, hipertensi, DM diperoleh dari rekam medik. Analisis menggunakan uji Chi-Square. Didapatkan 30,7% penderita KPSN dari kelompok HD, terdiri dari 26,9% derajat ringan dan 3,8% derajat sedang. Rerata penurunan NAP adalah 8,13 ± 5,30. Tidak didapatkan KPSN pada kelompok tanpa HD. Hemodialisis berpengaruh terhadap kejadian KPSN (p=0,004). Usia (p=0,084), hipertensi (p=0,215), DM (p=0,683) tidak berpengaruh terhadap kejadian KPSN. Hemodialisis berpengaruh terhadap kejadian KPSN. Usia, hipertensi dan DM tidak berpengaruh terhadap kejadian KPSN. [MKB. 2016;48(2):98–104]Kata kunci: Gagal ginjal kronik, hemodialisis, kurang pendengaran sensorineuralThe Effect of Hemodialysis on Sensorineural Hearing Loss in  Chronic Renal Failure PatientsSensorineural hearing loss (SNHL) can occur in patients with chronic renal failure (CRF) who receive hemodialysis (HD). SNHL is caused by hemodialysis occured in any frequency. The factors affect the disease include, among others, age, hypertension, and diabetes mellitus (DM).  The effect of hemodialysis onSNHL occurrence in patients with CRF was analyzed in this study. It was a cohort study on 52 patients with CRF who met the inclusion criteria. The sample consists of two groups, 26 patients with CRF who received hemodialysis and 26 patients with CRF who did not received hemodialysis. Timpanoaudiometry was performed on HD group (patient with HD) before the first HD and after the third HD. Timpanoaudiometry was performed on HD group (patient without HD) at the same time with  the first group. The data on age, hypertension, and DM were obtained from medical records. The results were analyzed with Chi-Square test. It was found that 30.7% SNHL patients  were in the HD group consisting of 26.9% mild degree patients and 3.8% moderate degree patients . Mean of hearing threshold decrease was 8.13 ± 5.30. There was no patient with SNHL in the non-HD group. Analysis with Chi-Square test showed that hemodialysis affects SNHL occurrence (p=0.004). Age (p=0.084), hypertension (p=0.215), and DM (p=0.683) do not affect SNHL occurrence. It is concluded that hemodialysis affects SNHL occurrence whileage, hypertension, and DM do not. [MKB. 2016;48(2):98–104]Key words: Chronic renal failure, hemodialysis, sensorineural hearing loss

Efek Imunostimulasi Ekstrak Etanol Umbi Iles-iles Terhadap Aktivitas Fagositosis Sel Makrofag pada Tikus Putih Strain Wistar yang Diinokulasi Staphylococcus aureus

Makiyah, Arfatul, Husin, Usep Abdullah, Sadeli, Ramlan

Majalah Kedokteran Bandung Vol 48, No 2 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Penelitian ini dilakukan untuk menguji aktivitas makrofag, karena makrofag berperan penting dalam respons imun dan untuk menganalisis aktivitas fagositosis karena efek flavonoid dan polisakarida umbi iles-iles pada respons imun tersebut. Tujuan penelitian ini adalah menganalisis efek imunostimulasi ekstrak etanol umbi iles-iles terhadap aktivitas fagositosis sel makrofag pada tikus putih strain Wistar yang diinokulasi Staphylococcus aureus. Penelitian ini merupakan studi eksperimental laboratorium rancang acak lengkap terhadap tikus putih strain Wistar. Penelitian ini dilaksanakan di Laboratorium Patologi Klinik RSUP Dr. Hasan Sadikin Bandung dan dilaksanakan bulan Januari–Maret 2012. Tikus putih strain Wistar sebanyak 30 ekor dibagi menjadi 5 kelompok. Tikus putih strain Wistar pada setiap perlakuan diberikan secara oral selama 7 hari pada tanggal 1–7 Januari 2012. Parameter efek imunostimulan ekstrak etanol umbi iles-iles terhadap aktivitas makrofag secara mikroskopis adalah peningkatan jumlah makrofag, indeks fagositosis, dan secara makroskopis adalah peningkatan indeks hati, limpa, serta timus. Secara mikroskopis melalui gambaran makrofag yang dinilai setelah 1, 3 jam, dan 6 jam inokulasi S. aureus. Hasil penelitian menunjukkan bahwa jumlah makrofag pada kelompok ekstrak etanol umbi iles-iles dosis 220 mg/kgBB pada perlakuan setelah 1, 3, dan 6 jam lebih tinggi dibanding dengan kelompok ekstrak etanol umbi iles-iles dosis 110 mg/kgBB dan 55 mg/kgBB (p<0,05), begitu juga jika dibanding dengan kelompok pembanding Zymosan A dan kontrol (p<0,05). Simpulan, ekstrak etanol umbi iles-iles (Amorphophallus variabilis BL.) memiliki efek imunostimulan dan memiliki efektivitas peningkatan respons imun lebih baik dibanding dengan kontrol pembanding zymosan A 35 mg/kgBB.  [MKB. 2016;48(2):68–77]Kata kunci: Ekstrak etanol, indeks fagositosis, indeks hati, makrofag, umbi iles-ilesThe Effect of Iles-iles Tubers Ethanol Extract Immunostimulant on Macrophages Cell Phagocytic Activities in Wistar Strain White Rat Inoculated by Staphylococcus aureusAbstractThis study was conducted to test the activity of macrophages based on the notion that macrophages play an important role in the immune response. This study analyzed the phagocytic activities due to the effects of flavonoids and polysaccharides iles-iles tubers in the immune response. The aim of this study was to analyze the immunostimulation effect of iles-iles tubers ethanol extract on phagocytic activities of macrophages in Wistar strain white rat inoculated with Staphylococcus aureus. This study used a complete randomized design with wistar strain white rat. This study was conducted at the Clinical Pathology Laboratory of Dr. Hasan Sadikin General Hospital from January–March 2012. Wistar strain white rats (n=30) were divided into 5 groups. Wistar strain white rats in each treatment group were given treatment that was administered orally for 7 days from 1–7 January 2012. The result shows that the number of macrophages in iles-iles tubers ethanol extract group that received  220 mg /kgBW dose after 1 hour, 3 hours, and 6 hours of treatment was higher than that of the tuber-iles iles ethanol extract that received 110 mg /kgBW and 55 mg/kgBW (p<0.05), both for Zymosan A comparison group and control group (p<0.05). Conclusion of this study is iles-iles tubers ethanol extract (Amorphophallus variabilis BL.) is effective for immune-stimulatory healing activity and has better effectiveness for improving immune response compared to zymosan A 35 mg/ kgBW. [MKB. 2016;48(2):68–77]Key words: Ethanol extract, iles-iles tubers, liver index, macrophages, phagocytic index DOI: 10.15395/mkb.v48n2.759

Effect of Treadmill Exercise Using 80% Intensity of Six Minute Walk Test on Walking Distance and Quality of Life in Moderate Stage Chronic Obstructive Pulmonary Disease Patients

Arisanti, Farida, Vitriana, Vitriana, Santoso, Prayudi

Majalah Kedokteran Bandung Vol 48, No 2 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Skeletal muscle dysfunction poses as one of the systemic manifestation of chronic obstructive pulmonary disease (COPD) in the impact of inactivity and deconditioning from early fatigue to the end of declining quality of life (QoL). Giving pulmonary rehabilitation program of treadmill exercise will overcome the problem, but standard method for moderate stage of COPD is not yet available. This study aimed to evaluate the effect of treadmill exercise using 80% intensity of six minute walk test on walking distance and QoL in moderate stage COPD in order to overcome muscle dysfunction. Samples were taken from Physical Medicine and Rehabilitation and Respirology subdivision of Internal Medicine outpatient clinic of Dr. Hasan Sadikin General Hospital Bandung, from March 2012–April 2013. Data analysis was tested using t-test for comparison of two independent mean data. Otherwise, non parametric test of Mann Whitney and Wilcoxon Match Pair test. Thirty three subjects of moderate stage COPD were divided into 2 groups (intervention and control). Intervention group received treadmill exercise with 80% intensity from preliminary 6MWT for 30–60 minutes/session, 3 session/week for 6 weeks. Significant increase on walking distance was found in intervention group (70.66 m) compared to control group (7.43 m) after 6 weeks (p≤0.05). QoL using St. George Respiratory Questionnaire (SGRQ) showed significant decrease in intervention group for all components in the end of 6 weeks (total p=0.0038, symptoms p=0.0162, activities p=0.0043 and impact p=0.0057, p≤0.05). Eighty percent intensity of 6MWT in treadmill exercise for 6 weeks was well tolerated and could overcome skeletal muscle dysfunction in moderate stage COPD. It also revealed higher values in aerobic capacity and QoL compared to previous studies. In conclusion, treadmill exercise using 80% intensity of 6MWT provides further walking distance and higher QoL compared to control  in moderate stage COPD. [MKB. 2016;48(2):105–11]Key words: Moderate stage COPD, quality of life, treadmill exercise, 6MWDPengaruh Latihan Erobik Menggunakan Treadmill dengan Intensitas 80% Uji Jalan 6 Menit terhadap Jarak Tempuh dan Kualitas Hidup Pasien PPOK Derajat SedangDisfungsi otot rangka merupakan salah satu manifestasi sistemik penyakit paru obstruktif kronik (PPOK), menyebabkan penderita mengalami inaktivitas dan dekondisi akibat kelelahan dini sehingga menurunkan kualitas hidupnya. Latihan erobik menggunakan treadmill merupakan modalitas dalam rehabilitasi PPOK untuk mengatasinya, namun hingga saat ini belum ada metode baku pada PPOK derajat sedang. Penelitian ini bertujuan menilai pengaruh latihan erobik menggunakan treadmill dengan intensitas 80% uji jalan 6 menit terhadap jarak tempuh dan kualitas hidup pada pasien PPOK derajat sedang. Penelitian ini dilakukan di Departemen Ilmu Kedokteran Fisik dan Rehabilitasi Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung periode Maret 2012–April 2013. Naracoba berjumlah 33 orang, dibagi menjadi kelompok kontrol dan perlakuan. Latihan dilakukan dengan intensitas 80% kecepatan uji jalan 6 menit, 30–60 menit/sesi, 3x/minggu selama 6 minggu. Terjadi peningkatan bermakna jarak tempuh (p≤0,05) dan penurunan nilai St. George Respiratory Questionnaire (SGRQ) di seluruh komponennya (total, dampak, gejala dan aktivitas, p≤0,05) kelompok perlakuan dibanding dengan kontrol setelah 6 minggu latihan. Latihan erobik menggunakan treadmill dengan intensitas 80% kecepatan uji jalan 6 menit selama 6 minggu ditoleransi dengan baik dan dapat memperbaiki disfungsi otot rangka pada pasien PPOK derajat sedang. Simpulan, latihan erobik menggunakan treadmill dengan intensitas 80% dari uji jalan 6 menit memberikan peningkatan jarak tempuh dan kualitas hidup dibanding dengan kontrol pada PPOK derajat sedang. [MKB. 2016;48(2):105–11]Kata kunci: Jarak tempuh uji jalan 6 menit, kualitas hidup, latihan treadmill, PPOK derajat sedang

Aspergillus Fumigatus pada Sputum Penderita Batuk Kronik Menggunakan Metode PCR dan Kultur

Thristy, Isra, Siregar, Yahwardiah

Majalah Kedokteran Bandung Vol 48, No 2 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Kecepatan tumbuh jamur yang bertambah pada manusia dapat terjadi akibat berbagai penggunaan obat-obatan, alat-alat kesehatan invasif, juga terdapat faktor predisposisi berupa penyakit kronik yang berat termasuk penyakit keganasan. Aspergilus fumigatus merupakan salah satu spesies jamur sistemik yang dapat menginfeksi manusia. Penggunaan polymerase chain reaction (PCR) untuk mendeteksi jamur merupakan diagnostik yang optimal. Tujuan penelitian ini adalah menganalisis Aspergillus fumigatus menggunakan PCR dan kultur pada sputum penderita batuk kronik. Penelitian ini menggunakan 51 sampel sputum penderita batuk kronik yang berasal dari Rumah Sakit Haji Adam Malik Medan, periode Mei 2012–Februari 2013 diteliti dengan metode deskriptif cross-sectional. Sputum diperiksa menggunakan metode PCR dan dilakukan kultur sebagai gold standard pemeriksaan jamur. Hasil penelitian dari 51 sampel didapatkan pemeriksaan PCR positif 35 sampel (69%) dan PCR negatif 16 sampel (31%). Pada hasil kultur dijumpai kultur positif 29 sampel (57%) dan kultur negatif 22 sampel (43%). Simpulan dari hasil penelitian ini adalah dari 51 sputum penderita batuk kronik ternyata 69% mengandung jamur Aspergillus fumigatus dan keadaan ini diperkuat dengan hasil kulturnya. Pemeriksaan PCR dapat dipergunakan sebagai salah satu pemeriksaan jamur yang cepat dan tepat. [MKB. 2016;48(2):78–83]Kata kunci: Aspergillus fumigatus, batuk kronis, kultur, PCRAspergillus Fumigatus in Sputum of Patients with Chronic Cough Using PCR and Culture MethodAbstractThe increasing prevalence of fungal growth in humans may occur as a result of the use of various drugs, invasive medical devices, and also the presence of predisposing factors like severe chronic diseases, including malignant disease. Aspergillus fumigatus is a systemic fungal species that can infect human beings. Polymerase chain reaction (PCR) is the most optimum diagnostic method to detect fungus. The purpose of this study was to analyze the presence of Aspergillus fumigatus by using PCR and culture method in sputum of patients with chronic cough.  The sample of this study consisted of sputum from 51 patients who visited Haji Adam Malik Hospital in Medan. The examination applied the cross-sectional descriptive method. Sputum was examined using PCR and culture as the gold standard fungal examination. The results from the 51 samples showed that positive PCR results (69%) were found in 35 patients and negative results were found in 16 patients (31%). The culture results showed that positive cultures were seen in 29 samples (57%) and negative cultures were found in 22 samples (49%).  it is concluded that from 51 patients with chronic cough sputum, 69%  turn out to have Aspergillus fumigatus fungus and this result is reinforced by the culture results. PCR can be used as a quick and precise inspection method for detecting fungus. [MKB. 2016;48(2):78–83]Key words: Aspergillus fumigatus, chronic cough, culture, PCR

Pengaruh Prednison terhadap Perbaikan Pendengaran Penderita Lupus Eritematosus

Wijana, Wijana, Mutiara, Ira Agustine, Agustian, Ratna Aggraeni

Majalah Kedokteran Bandung Vol 48, No 2 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Lupus eritematosus sistemik (LES) merupakan penyakit kronik mengenai multisistem, merupakan gangguan autoimun yang ditandai oleh produksi autoantibodi dan deposisi kompleks imun di jaringan. Manifestasi klinis dapat meliputi berbagai organ termasuk telinga. Pada telinga dapat menimbulkan gangguan dengar, tinitus, dan vertigo. Gangguan dengar terjadi bilateral pada frekuensi tinggi. Prednison merupakan kortikosteroid oral yang memiliki efek glukokortikoid yang bersifat anti-inflamasi dan imunosupresif. Penelitian ini bertujuan mengetahui pengaruh prednison terhadap perbaikan pendengaran penderita LES. Penelitian dilakukan periode Maret–Mei 2013 di Poliklinik Gangguan Dengar dan Bicara, Telinga Hidung Tenggorok Bedah Kepala dan Leher Rumah Sakit Dr. Hasan Sadikin Bandung menggunakan metode quasi-experimental dengan rancangan one group pretest-posttest design dan hasilnya dihitung secara statistik menggunakan uji Rank Spearman. Pada 28 subjek pasien LES dilakukan anamnesis, pemeriksaan fisis, laboratorium, audiometri nada murni, timpanometri, dan distortion production otoacoustic emissions. Subjek diberi prednison 1 mg/kgBB/hari (dosis maksimal 60 mg/hari) selama 4 minggu, kemudian dilakukan evaluasi ulang. Sebelum terapi, 26 subjek mengalami gangguan dengar sedang pada frekuensi tinggi, simetris. Sesudah terapi, 24 subjek ambang dengar menjadi normal dan 4 subjek tetap mengalami gangguan dengar (Rs=0,734; p<0,01). Simpulan, prednison dapat memperbaiki status pendengaran penderita LES.  [MKB. 2016;48(2):112–7]Kata kunci: Gangguan dengar, lupus eritematosus sistemik, prednisonPrednisone Effect to on Hearing Status of Systemic Lupus Erythematosus PatientsSystemic lupus erythematosus (SLE) is a chronic, multi-system, autoimmune disorder characterized by the production of autoantibodies and immune complexes deposition in tissue. Clinical manifestations may include skin, mucosa, joints, blood, heart, lungs, kidneys, central nervous system (CNS), immune system, and ears. SLE Iin the ears can caused sensorineural hearing loss, tinnitus, and vertigo. This hearing disorder is commonly bilateral and has high frequencies. Prednisone is an oral corticosteroid with glucocorticoid and mineralocorticoid effects. Glucocorticoids have anti-inflammatory and immunosuppressive effects. The aim of this study was to evaluate the effect of prednisone in improving the degree of hearing loss in patients with SLE. This study was conducted in from March–May 2013, at tThe Hearing and Speech Disorder Clinic of Ear Nose Throat-Head and Neck Surgery, Dr. Hasan Sadikin Hospital Bandung, using quasi-experimental method with pre-post design in which the results were statistically calculated using Rank Spearman test. This study involved 28 subjects who had been diagnosed for SLE. Anamnesis, physical examination, and laboratory test were performed, followed by pure tone audiometry, tympanometry, and distortion product optoacoustic emissions (DPOAE). Subjects were given prednisone 1 mg/kgBW/day with a maximum dose of 6o mg/day. Re-evaluation was performed after 4 weeksof treatment. Before treatment, 26 subjects had mild hearing loss and 2 subjects had symmetric moderate hearing loss at high frequencies symmetrically. After therapy, 24 subjects became normal and 4 subjects still had hearing loss (Rs=0.734, p<0.01). In conclusion, prednisone can improve hearing status of SLE patients. [MKB. 2016;48(2):112–7]Key words: Hearing loss, prednisone, systemic lupus erythematosus DOI: 10.15395/mkb.v48n2.765

Korelasi Ekspresi Reseptor Vitamin D (VDR) dengan Derajat Diferensiasi dan Stadium Adenokarsinoma Kolorektal

Usman, Hermin Aminah, Erida, Yulie, Yulianti, Herry, Hassan, Abdul Hadi

Majalah Kedokteran Bandung Vol 48, No 2 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Keganasan terbanyak ketiga di dunia pada organ kolorektal adalah karsinoma yang berasal dari lapisan epitel mukosa. Modalitas yang digunakan untuk terapi karsinoma kolorektal stadium lanjut selain operasi adalah kemoterapi dan saat ini dikembangkan terapi target sebagai alternatif terapi, yaitu metabolit aktif vitamin D, calcitriol. Calcitriol bekerja sinergis dengan agen kemoterapi yang aktivitasnya dimediasi oleh vitamin D reseptor (VDR). Penelitian ini bertujuan mengetahui korelasi imunoekspresi VDR dengan stadium dan derajat diferensiasi (grading) pada adenokarsinoma kolorektal. Menggunakan 35 blok parafin adenokarsinoma kolorektal yang diambil dari kolektomi, di Departemen Patologi Anatomi Rumah Sakit Dr. Hasan Sadikin Bandung periode 1 Januari 2009–30 Juni 2014, terbagi dalam 3 kelompok stadium (I, II, dan III) dan 3 kelompok derajat diferensiasi (well, moderately, dan poorly differentiated). Imunohistokimia dilakukan pada sampel untuk melihat ekspresi VDR pada massa tumor menggunakan antibodiprimer VDR. Data dianalisis menggunakan uji statistika korelasi Rank Spearman. Terdapat korelasi imunoekspresi VDR dengan stadium (p=0,045; R=-0,341) dan derajat diferensiasi (p=0,000; R=0,558). Pada penelitian ini VDR berperan dalam menentukan stadium dan derajat diferensiasi adenokarsinoma kolorektal. Hal ini dapat dijadikan pertimbangan dalam pemberian calcitriol sebagai bagian dari terapi target pada adenokarsinoma kolorektal dan acuan untuk penelitian selanjutnya dalam perkembangan terapi target. [MKB. 2016;48(2):123–8]Kata kunci: Adenokarsinoma kolorektal, derajat diferensiasi, stadium, imunoekspresi VDRCorrelation of Vitamin D Receptor (VDR) Expression with Differentiation Staging and Grading in Colorectal AdenocarcinomaColorectal carcinoma (CRC) is a malignancy from mucosal epithelium of the colon/rectum. The treatment modalities used for advance stage colorectal carcinoma therapy is chemotherapy, in addition to surgery. Targeted therapy is currently being developed as an alternative therapy. One of the agents used in this therapy is calcitriol. Calcitriol is an active metabolite of vitamin D. Calcitriol works synergistically with chemotherapeutic agents and its activity is mediated by the vitamin D receptor (VDR). VDR plays a role in the inhibition of tumor progression via induction of cellular differentiation and proliferation inhibition. In this study, imunoexpression of vitamin D receptor was examined in conjunction with the staging and degree of differentiation (grading) of colorectal adenocarcinoma. The study objects include 35 colorectal adenocarcinoma paraffin blocks created from colectomy which were collected at the Department of Patology Anatomic of Dr. Hasan Sadikin General Hospital Bandung from January 2009–June 2014. The blocks were divided into three groups of staging (I, II, and III) and  three groups of grading: well, moderately, and poorly differentiated. Immunostaining was used to evaluate the VDR immunoexspression by histo-score. The data were tested using rank spearman test. There was a weak negative correlation between VDR imunoexpression and staging(p=0.045, R=-0.341), and a moderate positive correlation between VDR imunoexpression and grading (p=0.000, R=0.558). It is concluded that a significant correlation of VDR imunoexpression with staging and grading of colorectal adenocarcinoma is found and this finding can be used as a reference for further studies in the development of targeted therapies. [MKB. 2016;48(2):123–8]Key words: Adenocarcinoma colorectal, grading, staging, VDR imunoexpression

Hubungan Derajat Skor CURB-65 Saat Awal Masuk dan Nilai Antitrombin III pada Pasien Pneumonia Komunitas

Andriyani, Sari, Keliat, E.N., Abidin, Alwinsyah

Majalah Kedokteran Bandung Vol 48, No 2 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Pada penderita pneumonia komunitas (PK) dilakukan penilaian derajat keparahan pada awal pasien masuk sangat penting sebab akan menentukan beratnya penyakit dan rencana tata laksana selanjutnya. Antitrombin III (AT-III) sebagai biomarker koagulasi berguna untuk menilai tingkat keparahan PK pada saat awal masuk. AT-III dapat berperan dalam diagnosis, memutuskan pemberian antibiotik, dan prognosis penderita PK. Penelitian ini betujuan mengetahui hubungan skor confusion, urea, respiratory rate, blood pressure, age >65 years (CURB-65) dan nilai AT-III pada saat awal pasien PK datang ke rumah sakit. Desain penelitian adalah potong lintang. Penelitian dilakukan di Rumah Sakit H. Adam Malik Medan pada bulan Februari–Maret 2013. Subjek dengan PK yang masuk dari instalasi gawat darurat, pasien rawat jalan setelah memenuhi kriteria dilakukan penilaian skor CURB-65, laboratorium darah, serta kultur sputum dan darah. Selanjutnya, skor CURB-65 dihubungkan dengan AT-III dan parameter lainnya. Sebanyak 55 subjek penelitian yang tergolong dalam skor CURB-65 berat (3–5) sebanyak 23 orang (42%), skor sedang (2) sebanyak 17 orang (31%) dan skor ringan (0–1) sebanyak 15 orang (27%). Setelah dilakukan uji korelasi Spearman diperoleh hubungan signifikan antara derajat skor CURB-65 dan nilai AT-III (p= 0,0001). Simpulan, AT-III merupakan biomarker koagulasi yang memiliki hubungan dengan derajat keparahan PK yang dinilai dengan skor CURB-65 sehingga AT-III dapat digunakan untuk menentukan prognosis pasien PK sejak awal masuk rumah sakit. [MKB. 2016;48(2):92–8]Kata kunci: Antitrombin III (AT-III), pneumonia komunitas (PK), prognosis, skor CURB-65 Correlation between CURB-65 and Antithrombin III Scores in Community Acquired Pneumonia at Early Admission in HospitalThe assessment of the level of severity in patients with community acquired pneumonia (CAP) is very important to determine the next steps in the disease management. Antithrombin III (AT-III) is known as one of the coagulation biomarkers that may be useful for predicting the severity of CAP at early admission in hospital. The AT-III is known to be used in diagnosis to help clinicians decide the antibiotic treatment to be given and to make prognosis. The aim of this cross-sectional study was to determine the correlation between confusion, urea, respiratory rate, blood pressure, age >65 years (CURB-65) score and AT-III in CAP patients at early admission in hospital. The method of study . The data were collected in Adam Malik Hospital from February to March 2013. CAP subjects were examined with CURB-65 score, AT-III, other laboratory assessments, sputum, and blood cultures at the early admission in the emergency room and outpatient clinic. The CURB-65 score was correlated with AT-III to determine the prognostic use of AT-III. A total of CAP 55 subjects  were assessed with 23 subjects (42%) with  severe CURB-65 scores (3–5), 17 subjects (31%) with moderate scores (2) , and15 subjects (27%) with mild scores (0–1). A significant correlation between CURB-65 and AT-III was found through the use of Spearman correlation test (p=0.0001). In conclusion, AT-III is a coagulation biomarker that correlates with the CURB-65 clinical scoring system. AT-III can be used to determine the prognosis in CAP at early admission in hospital. [MKB. 2016;48(2):92–8]Key words: Antithrombin III (AT-III), community acquired pneumonia (CAP), CURB-6 score,  prognosis DOI: 10.15395/mkb.v48n2.762

Potensi Bayam Merah (Amaranthus tricolor L) sebagai Antioksidan pada Toksisitas Timbal yang Diinduksi pada Mencit

Wiyasihati, Sundari Indah, Wigati, Kristanti Wanito

Majalah Kedokteran Bandung Vol 48, No 2 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Seiring dengan peningkatan industrialisasi dan transportasi, polusi logam berat yang ditimbulkan pun semakin meningkat. Timbal merupakan toksin yang paling bermakna di antara logam berat lain yang memiliki kecenderungan untuk mengkatalisis reaksi oksidasi dan menimbulkan terbentuknya Reactive Oxygen Species (ROS). Bayam merah (Amaranthus tricolor L) mengandung komponen antioksidan yang berpotensi menurunkan kadar timbal dalam darah dan mencegah toksisitasnya. Penelitian dilaksanakan di Laboratorium Biokimia Fakultas Kedokteran Universitas Airlangga selama bulan Agustus–September 2012. Penelitian eksperimental laboratoris ini menggunakan posttest only control group design. Tiga puluh ekor mencit dibagi menjadi tiga kelompok: K0 sebagai kelompok kontrol yang diberikan akuades dan plasebo, K1 sebagai kelompok perlakuan yang diberikan timbal asetat 0,75 mg/10 gBB dan plasebo, K2 sebagai kelompok perlakuan yang diberikan timbal asetat 0,75 mg/10 gBB dan 382,2 mg/10 gBB jus bayam merah selama 28 hari. Darah diambil dari vena ekor tikus untuk pemeriksaan superoxide dismutase (SOD) dan malondialdehyde (MDA). Hasil pemeriksaan kadar SOD rata-rata darah mencit pada K0 (n=10) 55,91 ± 9,61%, K1 (n=10) 31,29 ± 12,87%, dan K2 (n=10) 34,83 ± 10,12% (p=0,000). Nilai kadar MDA rata-rata darah mencit pada K0 9,9 nmol/mL, K1 12,04 nmol/mL, dan K2 11,05 nmol/mL (p=0,002). Berdasarkan uji ANOVA, disimpulkan bahwa bayam merah dapat meningkatkan SOD dan menurunkan MDA plasma pada toksisitas yang diinduksi timbal asetat pada mencit. [MKB. 2016;48(2):63–7]Kata kunci: Amaranthus tricolor linn, antioksidan, bayam merah, toksisitas timbal The Potency of Red Spinach (Amaranthus tricolor L) as an Antioxidant for Lead-Induced Toxicities in MiceAbstractAlong with the increasing industrialization and transportation, the generated heavy metal pollution is increasing. Lead is the most significant toxin among heavy metals and has a tendency to catalyze the oxidation reaction and lead to the formation of Reactive Oxygen Species (ROS). Red spinach (Amaranthus tricolor L) contains antioxidant properties which have a potential to reduce the blood lead level and prevent the lead-induced toxicities. The study was conducted at the Laboratory of Biochemistry Faculty of Medicine, Universitas Airlangga, during August–September 2012. This laboratory experimental study used pos-ttest only control group design. Thirty mice were divided into 3 groups: K0 as the control group with aquadest and placebo; K1 as the treatment group with lead acetate 0.75 mg/10 gBW and placebo treatment; and K2 as the treatment group with  lead acetate 0.75 mg/10 gBW and 382.2 mg/10 gBW red spinach juice treatment for 28 days. Blood was drawn from the mouse’s tail vein for examination of superoxide dismutase (SOD) and malondialdehyde (MDA). Mean blood SOD value in K0 (n=10) was 55.91 ± 9.61%, K1 (n=10) was 31.29 ± 12.87%, and K2 (n=10) was 34.83 ± 10.12% (p=0.000). Mean blood MDA value for K0 was 9.9 nmol/mL, K1 was 12.04 nmol/mL, and K2 was 11.05 nmol/mL (p=0.002). Based on ANOVA test, it is concluded that the administration of red spinach can increase SOD and decrease MDA plasma on lead-induced toxicity in mice. [MKB. 2016;48(2):63–7]Key words: Amaranthus tricolor linn, antioxidant, lead-induced toxicities, red spinach

Potensi Gen Oncoprotein Human Papillomavirus Tipe 16 Sebagai Kandidat Vaksin Kanker Serviks

Taupiqurrohman, Opik, Yusuf, Muhammad, Nuswantara, Sukma, Subroto, Toto

Majalah Kedokteran Bandung Vol 48, No 2 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Kanker serviks menduduki peringkat dua besar penyebab kematian pada wanita dengan jumlah penderita meningkat setiap tahunnya. Kanker ini banyak diakibatkan oleh infeksi human papillomavirus (HPV) dan tipe prevalensi terbesar di Indonesia adalah tipe HPV 16. Vaksin HPV telah dikembangkan dan diproduksi secara komersial, namun perlu dicari alternatif lain vaksin dengan basis gen penyandi E (early) protein. Gen E6 dan E7 merupakan onkogen penting pada proses terjadinya kanker serviks. Penelitian ini dilaksanakan di Laboratorium Kimia Komputasi dan Bioinformatika, Universitas Padjadjaran, dari bulan Desember 2015 sampai Februari 2016. Pada studi ini, penemuan kandidat vaksin peptida HPV dilakukan dengan pendekatan imunoinformatika. Analisis in silico HPV tipe 16 menunjukkan bahwa gen E7 merupakan sumber kandidat vaksin yang potensial karena tidak homolog dengan genom manusia dan diprediksi memiliki afinitas yang baik terhadap major histocompability complex (MHC). Hasil analisis in silico menunjukkan bahwa kandidat vaksin HPV dari gen E7 adalah peptida YMLDLQPET dan HVDIRTLEDLLMGTL. [MKB. 2016;48(2):84–91]Kata kunci: HPV tipe 16, imunoinformatika, in silico, kanker serviksHuman Papillomavirus Type 16 Oncoprotein Genes as the Candidate of Cervical Cancer VaccineCervical cancer is the second largest cause of death for Indonesian women, with increasing number of cases every year. This cancer is mostly caused by human papillomavirus (HPV) infection, in which HPV 16 is the most prevalent type in Indonesia. Although HPV vaccine has been developed and commercially available, the other alternative of vaccine based on E (early) gene is required. Genes of E6 and E7 are important oncogenes in the development of cervical cancer. This study was conducted at the Laboratory of Computational Chemistry and Bioinformatics, Universitas Padjadjaran, from December 2015 to February 2016. In this study, the candidates of HPV peptide vaccine were discovered using immunoinformatics method. In silico-analysis of HPV type 16, it  was shown gene E7 is not homologous with human genome and it is predicted to have a good affinity with major histocompability complex (MHC). Hence, it was proposed as a potential source of peptide vaccine. It is concluded that he candidates forHPV vaccine from E7 peptides are YMLDLQPET  and HVDIRTLEDLLMGTL. [MKB. 2016;48(2):84–91]Key words: Cervical cancer HPV 16, immunoinformatics, in silico