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Majalah Kedokteran Bandung
Articles by issue : Vol 49, No 1 (2017)
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Articles
Perbedaan Parameter Hematologi pada Penderita Tuberkulosis Paru Terinfeksi Mycobacterium Tuberculosis Galur Beijing dengan Galur Non-Beijing

Sundari, Rini, Parwati, Ida, Mose, Johanes Cornelius, Setiabudiawan, Budi

Majalah Kedokteran Bandung Vol 49, No 1 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Tuberkulosis (TB) merupakan penyakit inflamasi kronik, tingginya kasus TB dapat disebabkan oleh perbedaan virulensi antargalur Mycobacterium tuberculosis (MTB). Penelitian ini bertujuan untuk menganalisis berbagai manifestasi hematologi yang terjadi pada penderita TB paru yang terinfeksi  galur Beijing dan non-Beijing MTB. Sampling penelitian dilakukan di Rumah Sakit Dr. H.A. Rotinsulu Bandung, RSU Cibabat Cimahi, Balai Besar Kesehatan Paru Masyarakat (BBKPM) Bandung, Puskesmas Batujajar, Puskesmas Padalarang, dan Puskesmas Cimareme pada Juni 2014–Januari 2015. Penelitian diikuti oleh 74 penderita TB paru BTA (+) terdiri atas 61% pria dan 39% wanita yang berusia 18–63 tahun. Berdasar atas spoligotyping diperoleh 24 (32%) terinfeksi galur Beijing dan 50 (68%) galur non-Beijing. Pemeriksaan laju endap darah (LED) menggunakan metode Westergreen, parameter hematologi lain menggunakan haematology analyzer. Kadar hemoglobin galur Beijing 8,6–14,8 g/dL dan galur non-Beijing 8,1–16,5 g/dL, anemia ini lebih banyak ditemukan pada penderita yang terinfeksi galur Beijing (17 dari 24) dibanding dengan galur non-Beijing 31 dari 50. Nilai absolut eritrosit tidak ada perbedaan, kecuali red blood cell distribution width (RDW). Hasil antara Beijing dan non-Beijing didapatkan hasil LED 94,0 (35,03) vs 89,9 (29,96) mm; leukositosis tidak berbeda namun 67% neutrofilia dan 17% limfopenia pada galur Beijing, 0% dan 30% pada galur non-Beijing; jumlah trombosit 46% (416,3+161,7)x1.000 sel/mm3 vs 122-834 (407,0+154,8)x1.000 sel/mm3 dengan trombositosis 63% vs 46%. Penderita terinfeksi galur Beijing menunjukkan anemia, LED, dan trombositosis lebih tinggi dibanding dengan non-Beijing; hal ini berarti penderita terinfeksi galur Beijing mengalami inflamasi yang lebih berat. [MKB. 2016;49(1):35–41]Kata kunci: Beijing, non-Beijing, profil hematologiThe Differences of Haematology Profile in Patients with Lung Tuberculosis Infected by Mycobacterium tuberculosis Beijing Strain and non-Beijing StrainTuberculosis (TB) is a chronic inflammation disease; a high numbers of tuberculosis cases can be caused by virulence potential of each Mycobacterium tuberculosis (MTB) strain. The event of inflammation process influences the hematopoietic system which gives various hematology examination results. This study was conducted in order to analyze various forms of hematological manifestation occur in patients with lung TB caused by MTB Beijing strain and non-Beijing strain infections.  This study was performed on 74 lung TB-infected patients with positive acid-fast bacilli, consisting of 61% males dan 39% females whose age ranged from 18 to 63 (32.6+12.2) years old. Spoligotyping was performed, resulting in 24 (32%) Beijing strain and 50 (68%) non-Beijing strain infections. Hematological examination was performed using hematology analyzer and erythrocyte sedimentation rate (ESR) with Westergreen method. Hemoglobin level ranged from 8.6 to14.8 (11.8) g/dL and 8.1-16.5 (12.0) g/dL from Beijing strain and non-Beijing strain, respectively, with more anemia was found in Beijing strain patients (71%) compared to non-Beijing strain (62%). There was no differences in absolute erythrocyte count, except in red blood cell distribution width (RDW).  The comparison of ESR result between Beijing and non-Beijing in ESR resulting in 94.0 (35.03) vs 89.9 (29.96) mm with no difference in leukocytosis, yet 66.7% neutrophilia and 16.7% lymphopoiesis in Beijing strain patients, 0% and 30% consecutively in non-Beijing strain. The number of thrombocyte is 68-882 (416.3+161.7)x1000 cells/mm3 vs 122–834 (407.0+154.8)x1000 cells/mm3 with thrombocytosis in 63% vs 46%. Beijing strain patients shows anemia, and higher ESR and thrombocytosis. These show that patients infected by Beijing strains experience more severe inflammation. [MKB. 2016;49(1):35–41]Key words: Beijing strain, non-Beijing strain, haematology profile

Pengaruh Puasa terhadap Kejadian Contrast-Media Induced Nephropathy (CIN) pada Pemeriksaan CT-Scan Setelah Pemberian Kontras Intravena

Ruhimat, Undang, Kuntara, Atta, Togatorop, Mariana Rosalinda

Majalah Kedokteran Bandung Vol 49, No 1 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Pasien puasa sebelum dilakukan prosedur CT-scan dengan kontras untuk mencegah aspirasi yang mungkin terjadi akibat efek samping kontras. Puasa menyebabkan gangguan hidrasi ditambah dengan risiko nefropati yang diinduksi kontras contrast-media induced nephropathy (CIN). Peningkatan kreatinin setelah pemeriksaan dapat memprediksi timbulnya nefropati akibat kontras. Penelitian ini bertujuan mengetahui pengaruh puasa terhadap kejadian CIN. Penelitian merupakan studi deskriptif analisis dengan rancangan penelitian kasus kontrol. Subjek penelitian diambil melalui teknik consecutive random sampling pasien di Departemen Radiologi Rumah Sakit Dr. Hasan Sadikin Bandung dari bulan April–September 2012. Sebanyak 28 pasien dibagi 2 kelompok, yaitu kelompok yang mengalami peningkatan kreatinin setelah penyutikan kontras dalam 48–72 jam sebagai kelompok kasus dan kelompok yang tidak mengalami peningkatan kreatinin setelah penyuntikan kontras sebagai kelompok kontrol.Hasil penelitian menunjukkan, tidak terdapat perbedaan bermakna pada pasien puasa setelah dilakukan CT-scan dengan media kontras yang mengalami peningkatan kreatinin dan yang tidak mengalami peningkatan kreatinin (p=0,91). Terdapat hubungan usia dengan CIN pada pasien yang menjalani pemeriksaan CT dengan kontras intravena (p=0,008), dan tidak terdapat hubungan antara lama puasa dan CIN (p=0,967). Simpulan, tidak terdapat pengaruh kejadian CIN pada pasien yang menjalani pemeriksaan CT-scan dengan kontras intravena pada usia muda dan terdapat pengaruh pada usia lanjut. [MKB. 2016;49(1):55–60] Kata kunci: CT-scan, CIN, peningkatan kreatinin, puasa Effect of Fasting on the Contrast Media-Induced Nephropathy (CIN) Occurrence in CT Scan Examination after Intravenous Contrast Injection Fasting before contrast enhanced CT-scan procedure is applied to prevent aspiration that may occur as a side effect of intravenous contrast. Fasting causes hydration disruption with the risk of contrast-induced nephropathy (CIN). Increased creatinine immediately after examination using contrast can predict the incidence of contrast nephropathy. The research subject was taken through consecutive random sampling technique at Department of Radiology Dr. Hasan Sadikin General Hospital Bandung from April–September 2012. This descriptive analysis study with case-control study design aimed to determine the effect of fasting on the occurrence of CIN. Subjects were recruited through consecutive random sampling technique. A total of 28 patients were divided into 2 groups: group experienced an increase in creatinine after contrast injection within 48–72 hours as the case group and the group that did not experience an increase in creatinine after intravenous contrast injection as the control group. Results showed no significant differences between fasting patients who experienced increased creatinine and who did not experience increased creatinine (p=0.910) after a CT scan with contrast medium There was a relationship between age and CIN in patients undergoing CT-scan with intravenous contrast (p=0.008) and there was no relationship between long fasting and CIN (p=0.967). It is concluded statistically that fasting in patients undergoing CT-scan with intravenous contrast at a young age does not affect the incidence of CIN; however, effect is seen in elderly patients. [MKB. 2016;49(1):55–60]Key words: CT scan, CIN, fasting, increased creatinine

Pengaruh Pemberian Ekstrak Rimpang Temulawak (Curcuma Xanthorrhiza Roxb.) dan Jintan Hitam (Nigella Sativa) terhadap Profil Lipid Tikus Sprague Dawley Dislipidemia

Budiarto, Andika Agus, Wibowo, Alem Pramudita, Putri, Stella Andriana, Shabrina, Nadine Nurani, Ngestiningsih, Dwi, Tjahjono, Kusmiyati

Majalah Kedokteran Bandung Vol 49, No 1 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Terapi jangka panjang dislipidemia dengan simvastatin dapat menimbulkan berbagai efek samping sehingga perlu alternatif terapi, salah satunya dengan temulawak dan jintan hitam. Kandungan curcumin pada temulawak dan thymoquinon pada jintan hitam diperkirakan dapat memperbaiki profil lipid pasien dislipidemia. Tujuan dari penelitain adalah membuktikan efek pemberian ekstrak temulawak dan ekstrak jintan hitam terhadap profil lipid tikus Sprague dawley dislipidemia. Penelitian menggunakan true experimental design dengan post test randomized controlled group design. Penelitian ini dilakukan di Laboratorium Penelitian dan Pengujian Terpadu (LPPT)–Layanan Pra Klinik Pengembangan Hewan Percobaan (LP3HP) Universitas Gajah Mada Yogyakarta dan di Laboratorium Biologi Fakultas Sains dan Matematika Universitas Negeri Semarang periode 18 Februari–8 Maret 2016. Sebanyak 42 ekor tikus Sprague dawley dibagi menjadi 6 kelompok, yaitu kelompok K1 (kontrol normal), kelompok K2 (kontrol dislipidemia), kelompok P1 (200 mg/kgBB ekstrak temulawak), kelompok P2 (400 mg/kgBB ekstrak jintan hitam), kelompok P3 (0,18 mg/200 gramBB simvastatin), dan kelompok P4 (200 mg/kgBB ekstrak temulawak dan 400 mg/kgBB ekstrak jintan hitam). Kadar kolesterol LDL, HDL dan kolesterol total diukur dengan CHOD-PAP. Hasil penelitian menunjukkan kelompok K2 memiliki kadar tertinggi kolesterol total (69,1 ± 2,41) dan LDL (25,9 ± 2,16), serta memiliki kadar terendah HDL (30,68 ± 5,25). Uji ANOVA pada kolesterol total dan LDL menunjukan perbedaan bermakna (p<0,05), sedangkan pada HDL tidak bermakna (p>0,05). Disimpulkan, ekstrak temulawak dan ekstrak jintan hitam berpotensi menurunkan kadar LDL dan kolesterol total, serta menaikkan kadar HDL pada tikus Sprague Dawley dislipidemia. [MKB. 2016;49(1):8–14]Kata kunci: Jintan hitam, profil lipid, temulawak Effects of Temulawak (Curcuma xanthorrhiza Roxb.) and Black Cumin (Nigella sativa) Extracts on Lipid Profile: A Study on Dyslipidemic Sprague Dawley Rats The use of Simvastatin for a long term therapy of dyslipidemia can cause unwanted side effects; therefore, alternative therapies are needed, including therapy using temulawak and black cumin extracts. Curcumin in temulawak and thymoquinon in black cumin could modify the lipid profile of patients with dyslipidemia. The aim of study was to determine the effect of temulawak and black cumin extracts on serum lipid profile of dyslipidemic Sprague dawley rats. This research was conducted at Integrated Research and Testing Laboratory (PPT) -Profit Clinical Trials (LP3HP) Gadjah Mada University Yogyakarta and in Biology Laboratory Faculty of Science and Mathematics State University of Semarang period 18 February-8 March 2016. This study used true experimental design with post-test randomized controlled group design. Forty two Sprague dawley rats were divided into 6 groups: K1 for normal control, K2 for dyslipidemic control, P1 received 200mg/kgBW Temulawak extract, P2 received 400mg/kgBW black cumin extract, P3 received 0.18mg/200grBW simvastatin, and P4 received a combination of 200mg/kgBW Temulawak extract and 400mg/kgBW black cumin extract. LDL, HDL, and total cholesterol levels were determined by CHOD-PAP. The results of this study showed that K2 group had the highest level of total cholesterol (69.1 ± 2.41) and LDL (25.9 ± 2.16) but the lowest level of HDL(30.68 ± 5.25) when compared to the other groups. ANOVA analysis of total cholesterol and LDL showed a significant difference (p<0.05), while the sama analysis on HDL showed a non-significant difference (p>0.05). From the results, it is concluded that temulawak extract and black cumin extract can potentially decrease the level of LDL and total cholesterol as well as increasing the level of HDL in dyslipidemic Sprague Dawley rats. [MKB. 2016;49(1):8–14]Key words: Black cumin, lipid profile, temulawak

Peningkatan Kemampuan Berjalan dan Energy Expenditure pada Palsi Serebral yang Menjalani Latihan Penguatan dengan Metode Periodisasi

Sari, Dian Marta, Shanti, Marietta, Hilmanto, Dany

Majalah Kedokteran Bandung Vol 49, No 1 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Pada tahun 2014, Bandung memiliki angka kasus demam dengue (DD) tertinggi dari 27 kabupaten/kota di Jawa Barat. Upaya pengendalian DD telah dilaksanakan sejak beberapa dekade yang lalu. Salah satu upaya adalah dengan mengeliminasi tempat perkembangbiakan nyamuk melalui peran serta masyarakat. Penelitian ini bertujuan menilai partisipasi masyarakat Kota Bandung dengan mengetahui tempat-tempat perkembangbiakan Aedes aegypti baik di dalam maupun di luar rumah. Sampling dilakukan di 16 kelurahan di Kota Bandung yang telah dipilih berdasar atas angka kejadian DD, kepadatan penduduk, ketinggian permukaan, dan status sosial-ekonomi periode 2015. Populasi penelitian adalah rumah-rumah yang terdapat di 16 kelurahan tersebut. Jumlah sampel penelitian ini adalah 1.983 rumah yang merupakan perwakilan dari tiap kelurahan. Sampling jentik dilakukan pada berbagai tempat penampungan air, baik penampungan alami maupun buatan di sekitar pemukiman penduduk. Jentik yang ditemukan dimasukkan ke dalam wadah dan dibawa ke laboratorium untuk diidentifikasi dan dihitung jumlahnya. Hasil menunjukkan tempat perkembangbiakan nyamuk yang paling dominan adalah bak mandi (50%), talang air (24%), dan dispenser (15%). Data entomologi diperoleh hasil House index (HI) 24%, Container index (CI) 12%, dan Breteau index (BI) 36%. Hasil tersebut menunjukkan masih kurangnya peran serta masyarakat untuk mencegah DD dengan membasmi tempat perkembangbiakannya dan Kota Bandung masih berpotensi untuk terjadi penyebaran penyakit DD. [MKB. 2016;49(1):42–7]Kata kunci: Aedes aegypti, Bandung, demam dengue, tempat perkembangbiakan, partisipasi masyarakat Community Participation on Vector Control Based on Aedes aegypti’s Breeding Sites in BandungIn 2014, Bandung has the highest number of Dengue Fever cases of 27 districts and cities in West Java. Dengue Fever control efforts have been implemented for several decades. One of the efforts is the eradication of the vector breeding site with community participation. The aim of this study was to assess community participation by identifying Aedes aegypti’s breeding sites, both indoor and outdoor, in Bandung area. Sampling was conducted on houses in 16 villages throughout Bandung area. The sampling points were selected according to the Dengue Fever event number, population density, height, and socio-economic status. The total sample points were 1983 houses. Larvae from sample points were collected from various water containments, both natural and manmade, around the settlement. The larvae samples were then brought to the laboratory to be identified and counted. Results indicated the dominant breeding sites were bathtub (50%), gutter (24%), and dispenser (15%). Entomological survey resulted in 24% HI, 12% CI, and 36% BI. This indicates the lack of community participation in preventing DF by eradicating vector’s breeding sites and Bandung is still potential for DF outbreak. [MKB. 2016;49(1):42–7]Key words: Aedes aegypti, Bandung, breeding site, dengue fever, community pasticipation 

Perbandingan Aktivitas Antioksidan dan Toksisitas Antara Drop Vitamin A dari Karotenoid Kulit Pisang Ambon dan ß-Karoten

Prasetya, Harka, Isradji, Israhnanto, Suparmi, Suparmi, Hardec, Adrian, Fahryzal, Muhammad, Azizah, Laili Durotul, Ashar, Dita Ferwina Utari

Majalah Kedokteran Bandung Vol 49, No 1 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Pemanfaatan kulit pisang akibat peningkatan konsumsi pisang ambon perlu dilakukan, salah satunya sebagai alternatif sumber vitamin A alami (SUVITAL) untuk mengatasi kasus kekurangan vitamin A (KVA). Potensi karotenoid kulit pisang ambon sebagai SUVITAL belum banyak diteliti. Penelitian ini bertujuan menguji aktivitas antioksidan dan toksisitas terhadap hati dan ginjal dari drop vitamin A karotenoid kulit pisang ambon (DKKP) dibanding dengan β karoten (DBKM) pada kelinci (Oryctolagus cuniculus) galur New Zealand White. DKKP dan DBKM dibuat sesuai formula vitamin A per 50.000 IU/mL. Penelitian ini dilakukan di Laboratorium Biologi Fakultas Kedokteran Universitas Islam Sultan Agung selama September–Oktober 2015. Sebanyak 12 ekor kelinci jantan dibagi menjadi 3 kelompok: kontrol, DKKP, dan DBKM. Drop diberikan per oral sebanyak 5 mL/ekor/hari selama 7 hari. Efek antioksidan diuji berdasar atas kadar malondialdehyde (MDA) dan retinol serum darah, sedangkan toksisitas terhadap hati dan ginjal ditentukan berdasar derajat kerusakan hepatosit dan sel epitel tubulus proksimal ginjal. Hasil uji LSD menunjukkan bahwa kadar MDA dan retinol serum darah kelinci yang diberi DKKP tidak berbeda signifikan (p>0,05) dibanding dengan DBKM, demikian juga dengan skor kerusakan hepatosit dan sel epitel tubulus proksimal ginjal. Aktivitas antioksidan drop vitamin A dari karotenoid kulit pisang ambon sama dengan drop β-karoten murni. Drop vitamin A dari karotenoid kulit pisang tidak toksik terhadap histopatologi hati dan tubulus proksimal ginjal. [MKB. 2016;49(1):1–7]   Kata kunci: Antioksidan, drop vitamin A, karotenoid, kulit pisang ambon, toksisitasAntioxidant Activity and Toxicity of Vitamin A Drop from Ambon Peel Carotenoid and Pure ß-carotene   The increased consumption of ambon banana has resulted in increased amount of banana peel; which opens an opportunity to use them as a natural vitamin A alternative source to prevent vitamin A deficiency (VAD). The potential use of banana peel as a vitamin A supplement has not been much investigated. This study was conducted to measure the antioxidant activities and toxicity of vitamin A drop from carotenoids of Ambon banana peel (DKKP) in comparison with the vitamin A drop containing pure β-carotene (DBKM) on New Zealand White rabbits’ liver and kidney (Oryctolagus cuniculus) . The DKKP and DBKM were formulated according to the formula of vitamin A per 50,000 IU/ml. Twelve male rabbits were divided into 3 groups, i.e., control, DKKP, and DBKM. DKKP and DKKP groups received 5 ml/day oral dose for 7 days. Malondialdehyde (MDA) and retinol from blood serum were measured as the parameters of antioxidant activities while the hepatocyte and proximal tubule epithelium damage score were used to detect toxicity in liver and kidney. LSD test results showed that the levels of MDA and retinol in the blood serum of the DKKP group were not significantly different (p> 0.05) from those of the DBKM group. A similar situation was also seen for the hepatocyte damage score of the liver and proximal tubular epithelial cells of kidney. The antioxidant activities of vitamin A drop from banana peel carotenoid was equal to that of the vitamin A drop from pure β-carotene. Vitamin A drop from carotenoid of banana peel is safe to be consumed and have no effect on hepatic histopathology and renal proximal tubules. [MKB. 2016;49(1):1–7]   Key words: Ambon banana peel, antioxidant, carotenoid, toxicity, vitamin A drop

Gambaran Partisipasi Masyarakat terhadap Pengendalian Vektor Melalui Kajian Tempat Perkembangbiakan Aedes aegypti di Kota Bandung

Faridah, Lia, Respati, Titik, Sudigdoadi, Sunarjati, Sukandar, Hadyana

Majalah Kedokteran Bandung Vol 49, No 1 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Original Source | Check in Google Scholar | Full PDF (184.081 KB)

Abstract

Pada tahun 2014, Bandung memiliki angka kasus demam dengue (DD) tertinggi dari 27 kabupaten/kota di Jawa Barat. Upaya pengendalian DD telah dilaksanakan sejak beberapa dekade yang lalu. Salah satu upaya adalah dengan mengeliminasi tempat perkembangbiakan nyamuk melalui peran serta masyarakat. Penelitian ini bertujuan menilai partisipasi masyarakat Kota Bandung dengan mengetahui tempat-tempat perkembangbiakan Aedes aegypti baik di dalam maupun di luar rumah. Sampling dilakukan di 16 kelurahan di Kota Bandung yang telah dipilih berdasar atas angka kejadian DD, kepadatan penduduk, ketinggian permukaan, dan status sosial-ekonomi periode 2015. Populasi penelitian adalah rumah-rumah yang terdapat di 16 kelurahan tersebut. Jumlah sampel penelitian ini adalah 1.983 rumah yang merupakan perwakilan dari tiap kelurahan. Sampling jentik dilakukan pada berbagai tempat penampungan air, baik penampungan alami maupun buatan di sekitar pemukiman penduduk. Jentik yang ditemukan dimasukkan ke dalam wadah dan dibawa ke laboratorium untuk diidentifikasi dan dihitung jumlahnya. Hasil menunjukkan tempat perkembangbiakan nyamuk yang paling dominan adalah bak mandi (50%), talang air (24%), dan dispenser (15%). Data entomologi diperoleh hasil House index (HI) 24%, Container index (CI) 12%, dan Breteau index (BI) 36%. Hasil tersebut menunjukkan masih kurangnya peran serta masyarakat untuk mencegah DD dengan membasmi tempat perkembangbiakannya dan Kota Bandung masih berpotensi untuk terjadi penyebaran penyakit DD. [MKB. 2016;49(1):42–7]Kata kunci: Aedes aegypti, Bandung, demam dengue, tempat perkembangbiakan, partisipasi masyarakat Community Participation on Vector Control Based on Aedes aegypti’s Breeding Sites in BandungIn 2014, Bandung has the highest number of Dengue Fever cases of 27 districts and cities in West Java. Dengue Fever control efforts have been implemented for several decades. One of the efforts is the eradication of the vector breeding site with community participation. The aim of this study was to assess community participation by identifying Aedes aegypti’s breeding sites, both indoor and outdoor, in Bandung area. Sampling was conducted on houses in 16 villages throughout Bandung area. The sampling points were selected according to the Dengue Fever event number, population density, height, and socio-economic status. The total sample points were 1983 houses. Larvae from sample points were collected from various water containments, both natural and manmade, around the settlement. The larvae samples were then brought to the laboratory to be identified and counted. Results indicated the dominant breeding sites were bathtub (50%), gutter (24%), and dispenser (15%). Entomological survey resulted in 24% HI, 12% CI, and 36% BI. This indicates the lack of community participation in preventing DF by eradicating vector’s breeding sites and Bandung is still potential for DF outbreak. [MKB. 2016;49(1):42–7]Key words: Aedes aegypti, Bandung, breeding site, dengue fever, community pasticipation

Gambaran eGFR Menurut CKD-EPI pada Penderita Thalassemia Mayor di Rumah Sakit Dr. Hasan Sadikin Bandung

Doloksaribu, Rismauli, Husna, Rizka, Oehadian, Amaylia

Majalah Kedokteran Bandung Vol 49, No 1 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Peningkatan harapan hidup penderita thalassemia menyebabkan manifestasi penyakit pada berbagai organ, termasuk ginjal. Estimated glomerular filtration rate (eGFR) adalah penghitungan untuk mendeteksi gangguan dini fungsi ginjal, cara ini lebih dipercaya dibandingkan nilai kreatinin serum. The National Kidney Foundation merekomendasikan Chronic Kidney Disease  Epidemiology Collaboration (CKD-EPI) untuk mengestimasi laju filtrasi glomerulus. Penelitian ini bertujuan mengetahui gambaran eGFR menurut CKD-EPI  pasien thalassemia. Penelitian menggunakan metode deskriptif. Data diambil dari penderita thalassemia mayor rawat jalan di Klinik  Hematologi Onkologi Medik, Rumah Dr. Sakit Hasan Sadikin Bandung, mulai 1 Februari sampai dengan 31 Maret 2016. Diperiksa kadar kreatinin serum dan penghitungan eGFR berdasar atas CKD-EPI. Dari 108 subjek penelitian, didapatkan usia rata-rata 18 tahun dengan jumlah wanita sebanyak 61,1 %. Gambaran eGFR berdasarkan CKD-EPI: menunjukkan hiperfiltrasi glomerulus pada mayoritas pasien dengan eGFR >120 mL/menit.  Pemeriksaan fungsi ginjal pasien thalassemia diperlukan untuk memantau gangguan fungsi ginjal dan untuk pemilihan penggunaan jenis kelasi besi. [MKB. 2016;49(1):22–7]Kata kunci: CKD–EPI, eGFR, thalassemia eGFR Profile Based on CKD-EPI of Thalassemia Mayor Patients in Dr. Hasan Sadikin General Hospital BandungIncreased life expectancy of thalassemia patients has a consequence of various manifestations of the diseases in many organs including kidney. Estimated glomerular filtration rate (eGFR) can be used for detecting early renal dysfunctions due to the fact that this calculation is more accurate compared to creatinine serum measurement. The National Kidney Foundation recommends Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) for estimating GFR. The aim of this descriptive study was to describe eGFR profile based on CKD-EPI in thalassemia patients. Data were collected from ambulatory patients visiting the Hematology Oncology Medical Clinic of Dr. Hasan Sadikin General Hospital during the period of February 1, 2016 to March 31, 2016. Subjects were patients with thalassemia major. Creatinine serum level  and calculated eGFR based on CKD-EPI were evakyated.  One hundred and eightsubjects with a median age of 18 years participated in this study with 61.1%  of them were female. According to the Kidney Disease Improving Global Outcomes  ( KDIGO) 2012, the eGFR calculation based on CKD-EPI showed that the majority of patients experience glomerular hyperfiltration (eGFR >120 ml/mnt). In this study, most Thalassemia major patients showed glomerular hyperfiltration. Renal function test is needed to monitor renal function abnormalities and to choose  the type of iron chelation therapy to be implemented. [MKB. 2016;49(1):22–7]Key words: CKD-EPI, eGFR, thalassemia

Status Asetilator Gen NAT2 pada Pasien Tuberkulosis dan Tuberkulosis dengan Diabetes Melitus di Kupang, Nusa Tenggara Timur

Pramono, Alvinsyah Adhityo, Penggoam, Simeon, Sahiratmadja, Edhyana, Utami, Novi Vicahyani, Achmad, Tri Hanggono, Panigoro, Ramdan

Majalah Kedokteran Bandung Vol 49, No 1 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Indonesia adalah negara dengan jumlah penderita tuberkulosis (TB) terbanyak kedua  di dunia. Diabetes melitus (DM) merupakan salah satu komorbid TB. Arylamine N-acetyltransferase 2 (NAT2) adalah enzim yang berfungsi memetabolisir isoniazid (INH) yang disandi oleh gen NAT2. Gen NAT2 memiliki sejumlah polimorfisme dan dapat menentukan kemampuan seseorang untuk memetabolisir obat yang disebut status asetilator. Pada individu dengan status asetilator lambat, INH dimetabolisir dengan lambat sehingga memungkinkan terjadi intoksikasi hati. Pada TB dengan DM (TBDM) status asetilator lambat dapat membuat pengobatan TB maupun DM menjadi kurang optimal. Penelitian ini bertujuan mengeksplorasi status asetilator pasien TBDM di RSUD Prof. WZ Johannes Kupang periode Juni–November 2011. Pada penelitian potong lintang ini DNA dari darah 122 pasien TB diisolasi dan gen NAT2 kemudian diamplifikasi dan disekuensing untuk diketahui status asetilatornya. Hasil penelitian menunjukkan terdapat 5 pasien yang memiliki glukosa serum >200 mg/dL yang dikategorikan sebagai pasien TBDM. Pada pasien TBDM didapatkan seorang dengan status asetilator cepat (NAT2*4/NAT2*4), 2 orang dengan status asetilator sedang (NAT2*13A/NAT2*6J), dan 2 orang dengan status asetilator lambat (NAT2*5/NAT2*5G, NAT2*6A/ NAT2*6A, NAT2*7B/ NAT2*7B). Pada pasien TB yang dipilih secara random berdasar usia dan jenis kelamin serupa dengan TBDM didapatkan 2 orang dengan status asetilator cepat (NAT2*4/NAT2*4) dan 3 orang dengan asetilator sedang (NAT2*4/NAT2*6A, NAT2*13A/NAT2*6J). TBDM yang memiliki status asetilator lambat berpotensi memiliki masalah ganda dalam terapi, selain dapat terjadi toksisitas hati akibat terapi dengan INH, juga dapat mengakibatkan pengobatan DM menjadi tidak optimal. Perlu dilakukan peneltian lebih lanjut terkait farmakogenetik pada TBDM. [MKB. 2016;49(1):61–6]Kata kunci: Asetilator, isoniazid, NAT2, farmakogenetik, tuberkulosis NAT2 Gene Acetylator Status of Tuberculosis and Tuberculosis with Diabetes Mellitus Patients in Kupang, Nusa Tenggara TimurIndonesia is the second highest country with TB patients in the world. Diabetes mellitus (DM) is a comorbid of TB. Arylamine N-acetyltransferase 2 (NAT2), encoded by the NAT2 gene, is an enzyme that metabolizes isoniazid (INH). NAT2 gene has some polimorphysims that may play a role in INH acetylating process. Those who are slow acetylators may develop liver intoxication as a consequence of slow INH metabolism process. Slow acetylator TBDM patients may complicate both TB and DM treatment, causing them to be less optimal. The aim of this study was to explore the acetylator status of TBDM patients in Kupang, Indonesia. A cross-sectional study was conducted by obtaining DNA of 122 TB patients in Kupang in June–November 2011. NAT2 gene was amplified and sequenced to determine the acetylator status. There were 5 TB patients who had a glucose serum level of >200mg/dL and was catagorized as TBDM. Result showed that there was 1 TBDM patient who was a rapid acetylator (NAT2*4/NAT2*4), 2 patients as intermediate acetylators (NAT2*13A/NAT2*6J), and 2 patients as slow acetylators (NAT2*5/NAT2*5G, NAT2*6A/ NAT2*6A, NAT2*7B/ NAT2*7B). Meanwhile,  there were 2 TB patients who was rapid acetylators (NAT2*4/NAT2*4) and 3 patients as intermediate acetylators (NAT2*4/NAT2*6A, NAT2*13A/NAT2*6J). Slow NAT2 acetylator TBDM patients potentially face more problems during therapy. As INH may cause liver intoxication, these patients may also experience unoptimum DM treatment. Therefore, it is strongly recommended to do a study on the role of pharmacogenomics in TBDM. [MKB. 2016;49(1):61–6]Key words: Acetylator, isoniazid, NAT2, pharmacogenetics, tuberculosis

Aktivitas Antijamur Fraksi Air Sarang Semut Myrmecodia Pendens Pada Candida Albicans ATCC 10231

Balafif, Felisha Febriane, Satari, Mieke Hemiawati, Dhianawaty, Diah

Majalah Kedokteran Bandung Vol 49, No 1 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Penggunaan tanaman herbal untuk pengobatan dan pencegahan penyakit semakin populer sehingga penelitian mengenai senyawa aktif dari tumbuhan yang berkhasiat semakin menjadi perhatian. Umbi sarang semut (Myrmecodia pendens) mengandung senyawa aktif berupa terpenoid, tanin, fenol, flavonoid, dan saponin yang memiliki efek antijamur pada Candida albicans. Penelitian ini bertujuan mengukur konsentrasi hambat minimum (KHM) dan konsentrasi bunuh minimum (KBM) fraksi air M. pendens dan menguji perbedaan efek antijamur antara fraksi air M. pendens dan nistatin pada C. albicans ATCC 10231. Penelitian dilaksanakan pada bulan Juni–Juli 2015 di Laboratorium Penelitian Jurusan Kimia Fakultas MIPA Universitas Padjadjaran. Penelitian ini menggunakan metode mikrodilusi dan nilai KHM diukur dengan  enzyme linked immunosorbent assay reader dan nilai KBM diukur dengan pengujian pada media agar. Data dianalisis menggunakan uji-t dengan level signifikan p<0,05 untuk menentukkan perbedaan efek antijamur fraksi air M. pendens dengan nistatin pada C. albicans. Hasil penelitian menunjukkan bahwa nilai KHM ialah 1.250 μg/mL dan nilai KBM ialah 2.500 μg/mL. Simpulan penelitian ini ialah nilai KHM serta KBM fraksi air M. pendens ialah 1.250 dan 2.500 μg/mL dan terdapat perbedaan efek antijamur antara fraksi air dan nistatin terhadap C. albicans. [MKB. 2016;49(1):28–34]Kata kunci: Candida albicans, fraksi air, konsentrasi bunuh minimum, konsentrasi hambat minimum, Myrmecodia pendensAntifungal Activity of Ant Hill Myrmecodia Pendens Water Fraction against Candida Albicans ATCC 10231The use of herbal plant for treatment and prevention of diseases is getting more popular, emphasizing the need for studies on active compounds from plants. Ant hill (Myrmecodia pendens) contains active compounds such as terpenoid, tannin, phenol, flavonoid, and saponin which have antifungal effects on Candida albicans. The objectives of the study were to measure the value of minimum inhibitory concentration (MIC) and the minimum fungicidal concentration (MFC) of water fraction of M. pendens and antifungal effect of water fractions of M. pendens against C. albicans compared to nystatin. This study used microdilution and the effects were measured with enzyme linked immunosorbent assay reader to determine MIC value, followed by agar media assay to determine  MFC. Data were analyzed using T test with significant level p < 0.05 to determine antifungal effect of water fractions of M. pendens against C. albicans compared to nystatin. The result showed that MIC value was 1.250 μg/ml and MFC value was 2.500 μg/ml. T test showed significant difference of % inhibition cells growth effect between M. pendens water fraction and nystatin (p=0.014 < 0.05). It is concluded that the M. pendens water fraction has an antifungal effect against C. albicans with MIC and MFC values of 1.250 and 2.500 μg/ml.There are differences in antifungal effects between water fraction of M. pendens and nystatin against C. albicans. [MKB. 2016;49(1):28–34]                                        Key words: Candida albicans, minimum fungicidal concentration, minimum inhibitory concentration,  Myrmecodia pendens, water fraction

Efek Interval Training terhadap Indeks Lee, Kadar Adiponektin, dan IL-6 pada Tikus Model Obesitas

Zein, Endang Mulyana, T. Lubis, Vita Murniati, Purba, Ambrosius

Majalah Kedokteran Bandung Vol 49, No 1 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Kenaikan berat badan pada tikus model obesitas yang tetap diberikan pakan tinggi lemak terus berlangsung, akan tetapi jenis aktivitas fisik yang tepat mungkin dapat memperlambatnya. Penelitian ini bertujuan mengetahui perbedaan efek interval training tipe cepat, interval training tipe lambat, dan continuous training intensitas sedang terhadap berat badan, nilai indeks Lee, serta kadar adiponektin dan IL-6. Penelitian ini dilakukan di Laboratorium Farmakologi dan Terapi Fakutas Kedokteran Unpad pada bulan April–Mei 2014. Penelitian ini menggunakan posttest-only control group design pada 28 ekor tikus model obesitas (indek Lee >0,30), kadar adiponektin dan IL-6 plasma diperiksa dengan metode ELISA. Hasil penelitian menunjukkan perlakuan interval training tipe lambat lebih baik dibanding dengan interval training tipe cepat, continuous training intensitas sedang dan kontrol, yaitu kenaikan berat badan (2,34% vs 10,79% vs 4,49% vs 7,58%, p=0,000), penurunan kadar adiponektin (9,04 vs 10,27 vs 10,57 vs 7,24 ng/mL, p=0,000), glukosa (101,91±7,1 vs 113,63±6,4 vs 144,03±9,0 vs 82,24±5,9 mg/dL, p=0,000), trigliserida (28,07±3,3 vs 34,14±5,7 vs 42,00±4,9 vs 17,34±2,7 mg/dL, p=0,000), peningkatan kadar IL-6 (60,29±3,1 vs 54,55±2,1 vs 50,76±4,1 vs 56,36±2,9 pg/mL, p=0,000), dan penurunan nilai indeks Lee (7,3% vs 3,6% vs 6,4% vs 5,2%, p=0,000). Penelitian ini menyimpulkan bahwa aktivitas fisik interval training tipe lambat lebih baik dalam memperlambat kenaikan berat badan dan menurunkan nilai indeks Lee akibat peningkatan penggunaan adiponektin dan IL-6. [MKB. 2016;49(1):15–21]Kata kunci: Adiponektin, IL-6, Indeks Lee, interval training, obesitas  Effects of Interval Training on Lee Index, Adiponectine, and Il-6 in Obese Rat ModelWeight gain increase in obese rats that are continuously fed with fat rich chow may be slowed downs by putting them on a training regimen. This study aimed to determine the differences between the effects of fast-type interval training, slow-type interval training, and moderate-intensity continuous training on weight gain, Lee index, adiponectine, and IL-6. Using a post-test only control group, this study involved 28 obese rats (Lee index values >0.30). Adiponectin and IL-6 levels were tested using ELISA. This research was conducted in Pharmacology and Therapeutic Laboratory of Faculty of Medicine Unpad in April–May 2014. The results showed that the slow-type interval training was the most effective training compared to the fast-type interval training, continuous training of moderate intensity, and control in slowing down the weight gain (2.34% vs 10.79% vs 4.49% vs 7.58%, p=0.000), which was also accompanied by the lowest level of blood glucose level (101.91±7.1 vs 113.63±6.4 vs 144.03±9.0 vs 82.24±5.9 mg/dL, p=0.000), triglyceride (28.07±3.3 vs 34.14±5.7 vs 42.00±4.9 vs 17.34±2.7 mg/dL, p=0.000) and adiponectin (9.04±0.5 vs 10.27±0.7 vs 10.57±0.7 vs 7.24±0.8 ng/ml, p=0.000) as well as the highest level of IL-6 (60.29±3.1 vs 54.55±2.1 vs 50.76±4.1 vs 56.36±2.9 pg/mL, p=0.000) and lowest Lee index score (7.3% vs 3.6% vs 6.4% vs 5.2%, p=0.000). The study concludes that the slow-type interval training is the best training when compared to other types of training in slowing down weight gain and lowering Lee index and increasing the use of adiponectin and IL-6. [MKB. 2016;49(1):15–21]Key words: Adiponectin, IL-6, interval training, Lee index, obese