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Majalah Kedokteran Bandung
Articles by issue : Vol 49, No 3 (2017)
10
Articles
Uji Toksisitas Akut yang Diukur dengan Penentuan LD50 Ekstrak Etanol Umbi Iles-iles (Amorphophallus variabilis Bl.) pada Tikus Putih Strain Wistar

Makiyah, Arfatul, Tresnayanti, Sumirat

Majalah Kedokteran Bandung Vol 49, No 3 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Tujuan penelitian ini adalah untuk menganalisis uji toksisitas akut ekstrak etanol umbi iles-iles  (Amorphophallus variabilis Bl.) dengan penentuan LD50 pada tikus putih strain Wistar. Penelitian ini merupakan studi eksperimental laboratorium pada tikus putih strain Wistar. Penelitian ini dilaksanakan di Laboratorium Farmakologi, Universitas Padjadjaran pada bulan April–Mei 2017. Tikus putih strain Wistar sebanyak 36 ekor dibagi menjadi 6 kelompok. Tikus putih strain Wistar pada setiap perlakuan diberikan secara oral ekstrak etanol umbi iles-iles selama 7 hari pada tanggal 20–27 April 2017. Parameter uji toksisitas akut ekstrak etanol umbi iles-iles dengan penentuan Lethal Doses (LD50) dengan dosis tunggal (limited doses) 2000 mg/kgBB menunjukkan tidak terjadi efek toksik dilihat dari bobot badan rata-rata sesudah perlakuan, perbandingan bobot badan antarkelompok sesudah perlakuan, kematian hewan coba (LD50 24 jam) dan gejala-gejala toksik klinis tikus putih strain Wistar. Hasil penelitian menunjukkan bahwa perubahan bobot badan tikus putih strain Wistar pada kelompok ekstrak etanol umbi iles-iles dosis 2000 mg/kgBB tidak menimbulkan efek toksik dibanding dengan kelompok ekstrak etanol umbi iles-iles dosis 220 mg/kgBB, 110 mg/kgBB dan 55 mg/kgBB (p<0,05), begitu juga jika dibanding dengan kelompok pembanding Na CMC 1% dan kontrol akuades (p<0,05). Dengan demikian, ekstrak etanol umbi iles-iles (Amorphophallus variabilis Bl.) tidak memiliki efek toksik pada gejala-gejala klinisnya. [MKB. 2017;49(3):145–55]Kata kunci: Bobot badan, Ekstrak etanol, LD50, uji toksisitas akut, umbi iles-iles  (Amorphophallus variabilis Bl.) Acute Toxicity Test of Ethanol Extract of Iles-Iles Tuber (Amorphophallus variabilis Bl.) by Measuring Its LD50 in Wistar White MiceThis study aimed to analyze the acute toxicity test of ethanol extract of iles-iles tubers (Amorphophallus variabilis Bl.) through the measurement of LD50 in Wistar White Mice. This study was a laboratory experimental study using Wistar white mice conducted at the Pharmacology Laboratory of Universitas Padjadjaran during the period of April to May 2017. Thirty six Wistar white mice were divided into 6 groups. The experimental Wistar mice in treatment group received oral ethanol extract of iles-iles tuber for 7 days between 20 and 27 April 2017. The acute toxicity test of the iles-iles tuber ethanol extract as measured using the Lethal Dose 50 (LD50) with a single dose (limited doses) of 2,000 mg/KgWt did not show any toxic effects as indicated by the mean body weight after treatment, weight ratio between groups after treatment, death of experimental animals (24 hours LD50), and clinical toxic symptoms of Wistar white mice. It was shown that the weight change in the mice receiving 2,000 mg/KgWt of iles-iles tuber ethanol extract did not lead to any toxic effect when compared to those receiving 220 mg/KgWt, 110 mg/KgWt, and 55 mg/KgWt (p<0,05). This was also true when compared to the comparison group of Na CMC 1% and aquadest control (p<0,05). Hence, iles-iles tuber (Amorphophallus variabilis Bl.) ethanol extract does not have any toxic effect based on the clinical symptoms.  [MKB. 2017;49(3):145–55]Key words: Acute toxicity test, body weight, ethanol extract, iles-iles tubers (Amorphophallus variabilis Bl.), LD50 

Pemberian Asam Valproat pada Induk Tikus Bunting Menghambat Sintesis Insulin pada Sel Otak Anak Tikus

Komariah, Komariah, Kiranadi, Bambang, Winanto, Adi, Manalu, Wasmen, Handharyani, Ekowati

Majalah Kedokteran Bandung Vol 49, No 3 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Asam valproat memengaruhi aktivitas histone deacetylase yang berperan dalam ekspresi gen selama organogenesis. Insulin berperan dalam proliferasi dan diferensiasi sel-sel saraf dentate gyrus hipokampus. Penelitian ini bertujuan mempelajari pengaruh pemaparan asam valproat pada induk bunting terhadap ekspresi gen insulin pada dentate gyrus. Penelitian dilakukan di UPHL IPB pada bulan Mei 2015 hingga Desember 2016 dengan  84 ekor anak tikus yang dilahirkan oleh induk tikus kontrol yang diberi asam valproat 250 mg pada umur kebuntingan 10, 13, dan 16 hari digunakan untuk pengamatan kadar glukosa, insulin, DNA, RNA, dan rasio RNA/DNA serta pengamatan mikroskopis otak. Pengamatan dilakukan selang waktu empat minggu, dimulai dari umur 4 sampai 32 minggu. Anak tikus yang dilahirkan oleh induk tikus yang diberi asam valproat selama kebuntingan mempunyai kadar glukosa otak yang lebih tinggi (p<0,01) dan insulin yang lebih rendah (p<0,05).  Selama periode pertumbuhan, anak tikus yang dilahirkan oleh induk tikus yang diberi asam valproat mengalami peningkatan kadar glukosa dan penurunan kadar insulin (p<0.05). Pengamatan mikroskopis sel-sel dentate gyrus menunjukkan degenerasi sel dan tidak terlihat reaksi imunoreaktif terhadap insulin, namun terjadi penurunan konsentrasi DNA, RNA, serta rasio RNA/DNA (p<0,05). Pemberian asam valproat pada induk tikus pada umur kebuntingan 10, 13, dan 16 hari memengaruhi organogenesis otak anak tikus sehingga menyebabkan kerusakan sel-sel saraf penghasil insulin otak yang ditunjukkan oleh  penurunan sekresi dan kadar insulin. [MKB. 2017;49(3):156–64]Kata kunci: Asam valproat, dentate gyrus, insulin, organogenesis Valproic Acid Administration in Pregnant Rats Inhibits Insulin Synthesis n in Brain Cells of the OffspringsValproic acid affects the activity of histone deacetylase which eventually affects gene expression during organogenesis. Insulin plays a role in regulating the proliferation and differentiation of the dentate gyrus. This experiment was designed to study the effects of valproic acid administration on the expression of insulin gene in the dentate gyrus of pregnant rats.  This study was carried out at the Laboratory Animal Management Unit (UPHL) of Bogor Agricultural University  from May 2015 to December 2016, with eighty four newborn rats from control rats and VA-administered rats at the age of 10, 13, and 16 days of pregnancy. The measurements were done for glucose, insulin, DNA, and RNA concentrations in dentate gyrus and to observe the microscopic condition of the brain at the ages of 4 to 32 weeks with 4 weeks interval.  Rats born form mothers administered by 250 mg valproic acid during pregnancy had higher glucose concentrations (p<0.01) and lower insulin concentrations (p<0.05) in the dentate gyrus. During the post-natal growth phase, rats born from mothers administered with valproic acid had increased glucose concentrations and decreased insulin concentrations (p<0.05). Microscopic observations of the dentate gyrus showed degeneration of nerve cells with no immunoreaction to insulin was seen in dentate gyrus cells. However, the concentrations of DNA, RNA, and the ratio of RNA/DNA in the dentate gyrus cells decreased (p<0.05). The administration of valproic acid to pregnant rats at the age of 10, 13, and 16 days of pregnancy destructs  brain organogenesis of the offsprings which eventually disturbs insulin production in the dentate gyrus indicated by decreased insulin secretion and concentrations.  [MKB. 2017;49(3):156–64]Key words: Dentate gyrus, insulin, organogenesis, valproic acid

Ekspresi Protein Deleted in Colorectal Cancer (DCC) dan p53 pada Keganasan Kolorektal

Suraya Adnyana, Ida Bagus Budhi, Rudiman, Reno

Majalah Kedokteran Bandung Vol 49, No 3 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Angka kejadian keganasan kolorektal pada usia muda semakin meningkat, tetapi belum ada data yang cukup menjelaskan mengenai hal tersebut, termasuk mutasi gen yang berperan. Tujuan penelitian mengetahui apakah ekspresi protein DCC dan p53 berperan pada keganasan kolorektal usia kurang dari 40 tahun. Dilakukan pemeriksaan imunohistokimia di Departemen Patologi Anatomi Fakultas Kedokteran Universitas Padjadjaran/ Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung periode Januari sampai Mei 2011 untuk melihat ekspresi protein DCC dan p53 pada sediaan blok parafin penderita keganasan kolorektal kelompok usia <40 tahun dan usia >40 tahun.  Bahan pemeriksaan dikumpulkan mulai bulan Januari sampai Mei 2011. Hasil penelitian menunjukkan bahwa pada keganasan kolorektal usia <40 tahun lebih banyak yang tidak didapatkan ekspresi kedua protein tersebut, 9 kasus pada kelompok usia >40 tahun, sedangkan pada usia lebih dari 40 tahun hanya ditemukan pada 2 kasus.  Simpulan, pada sebagian besar kasus keganasan kolorektal usia <40 tahun, protein DCC dan p53 sudah tidak terekspresi. [MKB. 2017;49(3):186–91]Kata kunci: Ekspresi DCC, ekspresi p53, keganasan kolorektal, usia  Deleted in Colorectal Cancer (DCC) and p53 Protein Expressions in Colorectal Cancer The incidence of colorectal cancer in young patients is currently increasing; however, no adequate data available to explain the increase, including the gene mutation involved in these cancer. This study aimed to discover the DCC and p53 protein expressions that play a role in colorectal cancer in people under 40 years old. Immunohistochemical examination was performed at the Department of Anatomy Pathology Faculty of Medicine of Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung in the period of January to May 2011 to look into DCC and p53 expressions in paraffin blocks of colorectal malignancy patients in the age group of <40 and >40 years old. The examination specimens were collected in the period of January to May 2011. The results of the study showed that in colorectal malignancy in <40 years old patients, the expression of the two proteins was rarely found while in the age group of 40 years old, the expressions were only found in 2 cases. It is concluded in most cases of colorectal cancer in the <40 years old group, the DCC and p53 are already not expressed. [MKB. 2017;49(3):186–91]Key words: Age, colorectal cancer, DCC expression, p53 expression

Eksplorasi Dosis Efektif Ekstrak Etanol Daun Kipahit sebagai Antipiretik Alami

Agustin, Firda, Andriyanto, Andriyanto, Manalu, Wasmen

Majalah Kedokteran Bandung Vol 49, No 3 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Tanaman kipahit merupakan salah satu tanaman yang berpotensi sebagai sediaan alami antipiretik. Penelitian bertujuan mengetahui dosis efektif ekstrak etanol daun kipahit (Tithonia diversifolia) sebagai antipiretik. Sebanyak 24 ekor tikus putih jantan galur Sprague–dawley dengan bobot badan 150–200 g dibagi menjadi 6 perlakuan dan 4 ulangan. Perlakuan tersebut ialah tikus percobaan tidak diinduksi demam dan tanpa pemberian sediaan antipiretik (kontrol 0), tikus percobaan diinduksi demam tanpa mendapatkan sediaan antipiretik (kontrol –), tikus percobaan diinduksi demam dan diberi sediaan ekstrak etanol daun kipahit (EEDK) dosis 100 mg/kg BB (perlakuan 1), 200 mg/kg BB (perlakuan 2), 300 mg/kg BB (perlakuan 3), dan 400 mg/kg BB (perlakuan 4). Induksi demam dilakukan dengan menyuntikkan vaksin DTP–HB–Hib dosis 0.2 mL/200 g BB IM. Pemberian EEDK dilakukan secara per oral pada 90 menit pascainduksi demam. Pengamatan dilakukan dengan mengukur suhu rektal tikus menggunakan termometer digital (tingkat ketelitian 0,1ºC) pada menit ke–0 (sebelum injeksi DTP–HB–Hib atau suhu normal), 90, 120, 150, dan 180 pascainduksi demam. Hasil penelitian menunjukkan bahwa pemberian EEDK mampu menurunkan suhu rektal tikus dibanding dengan kontrol negatif. Pemberian EEDK terbaik dalam menurunkan suhu rektal tikus percobaan terdapat pada dosis 100 dan 200 mg/kg BB. Simpulan, penelitian ini  menunjukkan bahwa daun kipahit memiliki aktivitas antipiretik. [MKB. 2017;49(3):139–44]Kata kunci: Daun, demam, ekstrak etanol, kipahit Exploration of Kipahit Leaf Ethanol Extracts as Natural AntipyreticsKipahit plant is one of the plants that have the potential to be used as natural antipyretics. This study was conducted to explore  the effective doses of ethanol extract of kipahit leaf (Tithonia diversifolia) as an antipyretics. Twenty four male sprague–dawley white rats weighed150–200 g were divided into 6 groups and replicated 4 times. The experiment included  experimental rats without fever induction and without administration of antipyretic substance (control 0), experimental rats with induced fever without administration of antipyretic substance (negative control), experimental rats with induced fever and  ethanol extract of kipahit leaf (EEDK) with various doses: 100 mg/kg BW (treatment 1), 200 mg/kg BW (treatment 2), 300 mg/kg BW (treatment 3), and 400 mg/kg BW (treatment 4). Fever was induced by injecting DTP–HB–Hib vaccines intramuscularly at a dose of 0.2 mL/200 g BW. Administration of EEDK was conducted orally at 90 minutes pos-injection of DPT–HB–Hib vaccines. The antipyretic effects of EEDK were observed by measuring rectal temperature by using digital thermometer (correction factor 0.1ºC) in 0 minute (before the injection of DTP–HB–Hib or normal temperature), 90, 120, 150, and 180 minutes post–fever induction. The result showed that the administration of EEDK decreased rectal temperature as compared to negative control. The optimum doses of EEDK administration that decreased rectal temperature were 100 and 200 mg/kg BW. It is concluded that the EEDK has an effect. [MKB. 2017;49(3):139–44]Key words: Ethanol extract, fever, kipahit, leaf

Efektivitas Penambahan Natrium Diklofenak terhadap Larutan Obat Dilatasi Pupil pada Pasien Retinopati Diabetik

Kartasasmita, Arief S., Sovani, Iwan, Setyohadji, Bambang, Karfiati, Feti, Prahasta, Andika

Majalah Kedokteran Bandung Vol 49, No 3 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Pemeriksaan fundus memerlukan akses visualisasi yang baik. Pada penderita diabetes melitus, pupil sulit lebar menggunakan obat pelebar pupil standar sehingga perlu ditambahkan agen pelebar pupil. Penelitian ini dilakukan di Rumah Sakit Mata Cicendo periode Januari sampai Juli 2014 menggunakan metode double masked rendomized cotrolled trial terhadap 64 mata dari 32 subjek penelitian yang telah didiagnosis menderita retinopati diabetika dengan tingkat yang sama antara mata kiri dan kanan. Dibuat larutan kombinasi campuran 10 mL tropikamid 0,5%/fenilefrin 0,5%, 10 mL fenilefrin 5% dan 10 ml 0,1% Na diklofenak (larutan I) dan campuran 10 mL tropikamid 0,5%/fenilefrin 0,5%, dan 10 mL fenilefrin 5% (larutan II). Setiap subjek mendapat salah satu larutan pada mata dan larutan yang lain pada sebelahnya secara acak. Dilakukan pemantauan dengan cara memotret pupil pada menit ke-15, 20, dan 25 pada kedua mata. Lebar pupil kedua kelompok perlakuan diukur dengan perangkat lunak khusus (image processing). Dari penenelitian terdapat perbedaan bermakna antara penggunaan larutan I dan larutan II dalam melebarkan pupil baik pada menit ke-15 (t=2,02; p=0,047), menit ke 20 (t=2,23; p=0,029), dan pada menit ke-25 (t=2,041; p=0,045). Larutan kombinasi fenilefrin, tropikamid, dan natrium diklofenak menghasilkan efek dilatasi pupil yang lebih baik dibanding dengan larutan kombinasi fenilefrin dan tropikamid saja pada kasus retinopati diabetes. [MKB. 2017;49(3):199–207]Kata kunci: Dilatasi pupil, natrium diklofenak, retinopati diabetika Effectiveness of Sodium Diclofenac Addition to Pupil Dilatation Agent on Diabetic Retinopathy PatientsFundus examination requires good visualization of fundus. In diabetic patients, it is difficult for the pupil to dilate using the standard pupilarry dilating agent. To achieve proper dilation, special agents have to be added to the standard dilation agent. The study was conducted in Cicendo Eye Hospital from January to July 2014, using double masked randomized controlled trial to 32 patients (64 eyes) who were diagnosed as suffering from diabetic retinopathy with the same grade on both eyes. Eye drop solutions were developed beforehand by mixing 10 mL of 0.5% tropicamide/0.5% phenylephrine, 10 mL of 5% phenylephrine, and 10 mL of 0.1% diclofenac-natrium (solution I) and also by mixing 10 mL of 0.5% tropicamide/0.5% phenylephrine and 10 mL of 5% phenylephrine (solution II). Every subject received one drop of one solution on one eye and the other solution on the other eye in randomly fashion. The observation was performed by taking photographs of the pupil on both eyes 15, 20, and 25 minutes of observation. The resulting pupil photographs were then analyzed and measured using special image processing software and compared. It was revealed that there were statistical differences in pupil dilation between solution I and solution II at 15 minutes (t=2.02; p=0.047), 20 minutes (t=2.23, p=0.029), and 25 minutes (t=2.041, p=0.045). Phenilefrine, tropicamide and diclofenac-natrium combination solution provides better dilation effect on the pupil compared to the combination of phenilefrine and tropicamide alone in diabetic retinopathy patient. [MKB. 2017;49(3):199–207]Key words: Diabetic retinopathy, natrium diclofenac, pupil dilatation

Pola Pemberian ASI dan Diare pada Anak Usia 6–24 Bulan

Wijaya, Dhandi, Dhamayanti, Meita, Gondodiputro, Sharon

Majalah Kedokteran Bandung Vol 49, No 3 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Diare merupakan salah satu penyebab utama kematian anak secara global. Air susu ibu (ASI) diketahui dapat mencegah diare pada anak sehingga World Health Organization merekomendasikan pemberian ASI eksklusif untuk seluruh bayi. Namun, cakupan ASI eksklusif di Indonesia masih rendah sehingga risiko diare pada anak masih tinggi. Penelitian ini bertujuan menilai hubungan pola pemberian ASI dan  diare pada anak usia 6–24 bulan. Penelitian observasional dengan studi potong lintang ini dilakukan tanggal 20 Januari–31 Januari 2017. pada 160 ibu dengan anak usia 6–24 bulan yang mendapat ASI yang datang ke posyandu di Puskesmas Talang Ubi, Kabupaten Penukal Abab Lematang Ilir. yang buka selama penelitian dilakukan, lahir tunggal, aterm, berat badan lahir ≥2.500 gram, gizi baik, tidak menderita kelainan kongenital. Data dikumpulkan menggunakan kuesioner untuk mengetahui pola pemberian ASI dan MP ASI serta prevalensi, periode, dan lama diare dalam tiga bulan terakhir. Data dianalisis dengan uji kai-kuadrat, Fisher eksak, Mann-Whitney U, Kruskal-Wallis, ANOVA, serta uji normalitas Kolmogorov Smirnov. Penelitian ini mendapatkan hubungan waktu inisiasi pemberian ASI, ASI eksklusif, lama pemberian ASI, serta frekuensi dan lamanya menyusui dengan prevalensi dan lama diare (p<0,05), tetapi tidak mendapatkan hubungan waktu inisiasi pemberian ASI, pemberian ASI eksklusif, lama pemberian ASI, frekuensi pemberian ASI, dan lama menyusui dengan frekuensi diare (p>0,05). Dapat disimpulkan bahwa pola pemberian ASI dapat menurunkan prevalensi dan mempersingkat lama diare pada anak usia 6–24 bulan. [MKB. 2017;49(3):165–71]Kata kunci: ASI, ASI eksklusif, diare, MP ASI  Breastfeeding Pattern and Diarrhea in Children Aged 6–24 MonthsDiarrhea is one of the leading causes of global childhood mortality. Breast milk was known to have a protective role against childhood diarrhea that the World Health Organization (WHO) recommendeds exclusive breastfeeding for all infants. However, the coverage of exclusive breastfeeding in Indonesia is still small, leading to a higher risk of childhood diarrhea. The aim of this study was to assess the correlation between breastfeeding pattern,  complementary feeding,  prevalence, frequency, and diarrhea duration in children aged 6–24 months. This observational cross-sectional study was conducted in the period of 20 January–31 January 2017 on 160 mothers who brestfed their child who was, at the time of the study, 6–24 months old. These were children who visited the Posyandu (Integrated Health Post) of Talang Ubi Public Health Center (Puskesmas Talang Ubi), Penukal Abab Lematang Ilir district at the time of the study, singleton, full term, birth weight ≥2,500 grams, well-nourished, and did not have any congenital abnormalities. Data were obtained through questionnaires that collected  information on breastfeeding pattern, complementary feeding, and the prevalence, frequency, and diarrhea duration in the last three months . Data were statistically analyzed using chi-square, Fisher’s exact, Mann-Whitney U, Kruskal-Wallis, and ANOVA tests as well as   Kolmogorov Smirnov normality test. This study found the correlation between breastfeeding initiation, exclusive breastfeeding, breastfeeding duration, frequency and duration of lactation, with the prevalence and diarrhea duration (p<0.05), but did not find the correlation between breastfeeding initiation, exclusive breastfeeding, breastfeeding duration, frequency and duration of lactation with diarrhea frequency (p>0,05). Therefore, this study concludes that the pattern of breastfeeding reduces the prevalence of diarrhea and shortens diarrhea duration in children aged 6–24 months. [MKB. 2017;49(3):165–71]Key words: Breastfeeding, complementary feeding, diarrhea, exclusive breastfeeding

Perbedaan Intensitas Penyengatan Meningeal Hasil MRI antara Sekuens T2 FLAIR Post Contrast dan T1WI Post Contrast Gadolinium-DTPA dalam Mendeteksi Penyangatan Meningeal pada Kasus Meningitis Tuberkulosis

Hendarin, Arie, Soetikno, Rista D., Nugraha, Harry Galuh

Majalah Kedokteran Bandung Vol 49, No 3 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Diagnosis meningitis TB terutama pada kasus possible dan probable sulit ditegakkan. Pemeriksaan MRI kepala dengan kontras Gadolinium-DTPA adalah modalitas radiologi yang paling sensitif untuk membantu mendiagnosis penyakit ini. Penyangatan meningeal di daerah basal merupakan gambaran MRI yang paling banyak ditemukan pada meningitis TB. Tujuan penelitian ini adalah mengetahui perbedaan peningkatan intensitas sinyal meningen sekuens T2-FLAIR dengan T1WI pada pasien meningitis tuberkulosis menggunakan pemeriksaan MRI kepala dengan kontras Gadolinium-DTPA di RSUP Dr. Hasan Sadikin Bandung pada bulan Januari 2015–Juni 2016. Subjek penelitian sebanyak 21 orang dengan meningitis TB dilakukan pemeriksaan MRI kepala dengan kontras Gadolinium-DTPA. Analisis statistik komparatif dilakukan untuk menguji perbedaan peningkatan intensitas sinyal meningen sekuens T2-FLAIR post contrast dengan T1WI post contrast. Hasil penelitian menujukkan rerata peningkatan intensitas sinyal meningen sekuen T2-FLAIR (∆T2-FLAIR) sebesar 360,59±182,19 aμ sedangkan T1WI (∆T1WI) sebesar 126,47±72,57 aμ. Hasil uji statistik menggunakan uji T pada derajat kepercayaan 95% menunjukkan perbedaan yang bermakna ∆T2-FLAIR dengan ∆T1WI pada nilai p=0,000. Sebagai simpulan didapatkan peningkatan intensitas sinyal meningen sekuens T2-FLAIR post contrast lebih besar daripada T1WI post contrast pada kasus meningitis TB.  [MKB. 2017;49(3):172–78]Kata kunci: Meningitis tuberkulosis, MRI sekuens T1WI dan T2-FLAIR, penyangatan meningealDifference between Gadolinium-DTPA Enhanced T2 FLAIR Sequence and T1WI Sequence MRI in Detecting Meningeal Enhancement in Tuberculous MeningitisThe diagnosis of TB meningitis, especially in possible and probable cases, is difficult. Contrast-enhanced MRI of the head with Gadolinium-DTPA is the most sensitive imaging modality that supports diagnosis of this disease. The most common presentation of TB meningitis in MRI is basal meningeal enhancement. The objective of this study was to determine the difference in the increase of T2-FLAIR and T1WI sequence meningeal signal intensity of in patients with tuberculous meningitis using contrast-enhanced MRI of the head with Gadolinium-DTPA in Dr. Hasan Sadikin General Hospital from January 2015–June 2016. Contrast enhanced MRI examination was conducted in 21 subjects with TB meningitis. Statistical analysis was performed to examine the difference in the increase in meningeal signal intensity of post contrast T2-FLAIR and post contrast T1WI. The result showed that the mean increases in meningeal signal intensity of T2-FLAIR (ΔT2-FLAIR) and T1WI (ΔT1WI) were  360.59±182.19 au and 126.47±72.57 aμ respectively. Statistical test results using T test at 95% confidence level indicated that there was a difference between ΔT2-FLAIR and ΔT1WI at p-value=0.000. In conclusion, the mean increase in meningeal signal intensity of post contrast T2-FLAIR is greater than in the post contrast T1WI in TB meningitis. [MKB. 2017;49(3):172–78]Key words: Meningeal enhancement, T1WI and T2-FLAIR sequence MRI, tuberculous meningitis

Perbedaan Kadar Vitamin E dan Tumor Necrosis Factor Alpha (TNF-α) berdasar atas Status Massa Lemak Pasien dalam Hemodialisis Kronik

Supriadi, Rudi, Christina, Christina, Soelaeman, M. Rachmat

Majalah Kedokteran Bandung Vol 49, No 3 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Sindrom malnutrisi-inflamasi merupakan masalah pada pasien dalam hemodialisis. Peningkatan inflamasi menyebabkan risiko malnutrisi meningkat. Massa lemak menggambarkan perubahan status nutrisi yang lebih baik pada pasien hemodialisis (HD). Peningkatan TNF-α menyebabkan produksi ROS lebih tinggi dan akan ditangkap oleh vitamin E. Vitamin E dan TNF-α keduanya disimpan di massa lemak dan bersikulasi dalam darah. Penelitian ini bertujuan mengetahui perbedaan kadar vitamin E dan TNF-α pada dua kelompok massa lemak berbeda pasien dalam HD kronik. Penelitian ini merupakan penelitian observasional analitik dengan metode potong lintang pada 42 pasien pria yang menjalani HD kronik di RS Dr. Hasan Sadikin Bandung periode September–Oktober 2016. Massa lemak diperiksa dengan alat BIA (bioelectric impedance analyzer) dan dibagi ke dalam dua kelompok, yaitu lebih dan normal/kurang. Vitamin E dan TNF-α diperiksa dengan kromatografi dan ELISA. Analisis statistik menggunakan uji beda dua kelompok tidak berpasangan. Hasil penelitian menunjukkan kadar vitamin E lebih tinggi pada massa lemak lebih daripada normal/kurang (p=0,042). Kadar TNF-α lebih rendah pada massa lemak lebih daripada normal/kurang namun tidak bermakna (p=0,443). Subjek usia>55 tahun, kadar vitamin E lebih tinggi pada massa lemak lebih daripada normal/kurang (p=0,029). Massa lemak lebih dengan lama HD >24 bulan, kadar vitamin E lebih rendah daripada HD ≤24 bulan (p=0,005). Massa lemak normal/kurang dengan lama HD >24 bulan, kadar TNF-α lebih tinggi daripada HD ≤24 bulan (p=0,031). Penelitian ini menyimpulkan, kadar vitamin E lebih tinggi pada kelompok subjek dengan massa lemak lebih daripada normal/kurang. Kadar vitamin E pada massa lemak lebih dengan lama HD >24 bulan, lebih rendah daripada ≤24 bulan. Tidak terdapat perbedaan kadar TNF-α pada kedua kelompok massa lemak, namun kadar TNF-α lebih tinggi pada massa lemak normal/kurang dengan lama HD >24 bulan daripada ≤24 bulan. [MKB. 2017;49(3):192–8]Kata kunci: HD kronik, massa lemak, sindrom malnutrisi-inflamasi, TNF-α, vitamin E Difference between Vitamin E and Tumor Necrosis Factor Alpha (TNF-α) Levels based on Fat Mass Status in Chronic Hemodialysis PatientsMalnutrition-inflammation syndrome is a problem frequently found in patients who undergo chronic hemodialysis (HD). Increased level of inflammation has a higher risk for malnutrition. Fat mass shows better nutritional status changes in HD patients. TNF-α will cause increased ROS production and will be scavenged by vitamin E that are both saved in fat mass. This study aimed to determine the difference between vitamin E  and TNF-α levels in two fat mass groups of chronic HD patients. This study was a cross-sectional observational-analytic study on 42 male chronic HD patients at Dr. Hasan Sadikin General Hospital Bandung in the period of September–October 2016. Fat mass was measured by BIA and divided in two fat mass groups, higher and normal/lower mass groups. Vit E and TNF-α levels were measured by chromatography and ELISA. Non-paired groups difference test was used as the statistical analysis. The results showed a higher level of vitamin E in higher fat mass group than normal/lower group (p=0.042). TNF-α level tended to be lower in higher fat mass group than in the normal/lower group;  however, the difference was not significant statistically (p=0.443). Subjects who were  >55 years showed a higher level of vitamin E in hifher fat mass group than in normal/lower (p=0.029). The higher fat mass group with HD duration  >24 months showed lower vitamin E level than those with the HD duration ≤24 months (p=0.005). Normal/lower fat mass group with a HD duration of  >24 months showed a higher TNF-α level than≤24 months(p=0.031). In conclusion, in chronic HD patients the vitamin E level is higher in the higher fat mass group than in the normal/lower group. The vitamin E level in the higher fat mass with HD duration of  >24 months is lower than in the HD duration of  ≤24 months. There is no significant difference in TNF-α level in the two fat mass groups; however, the TNF-α level is higher in normal/lower fat mass group with a duration of HD of >24 months than those with a duration of ≤24 months. [MKB. 2017;49(3):192–8]Key words: Chronic HD, fat mass, malnutrition inflammation syndrome, TNF-α, vitamin E

Gambaran Validitas Pemeriksaan Complex Specific Cocktail Antigen Mycobacterium tuberculosis (ESAT-6, CFP-10, MPT-64) Metode Rapid Immunochromatography pada Bahan Pemeriksaan Sputum dan Serum Penderita Tuberkulosis Paru

Subroto, Hendra, Parwati, Ida, Turbawaty, Dewi Kartika, Alisjahbana, Bachti

Majalah Kedokteran Bandung Vol 49, No 3 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Penegakan diagnosis tuberkulosis (TB) paru penting dalam mengurangi morbiditas dan mortalitas. Diagnosis laboratorium TB paru berdasar atas pemeriksaan BTA dan kultur M. tuberculosis memiliki sensitivitas rendah. Terdapat pemeriksaan cocktail antigen TB rapid immunochromatography (ICT) yang mendeteksi antigen ESAT-6, CFP-10, MPT-64 yang disekresikan oleh M. tuberculosis. Tujuan penelitian menganalisis validitas pemeriksaan cocktail antigen TB metode rapid ICT sputum dan serum penderita TB paru terhadap kultur Ogawa. Penelitian dilaksanakan Juli–Oktober 2014 di RSUP Dr. Hasan Sadikin Bandung. Bentuk penelitian adalah observasional deskriptif khusus dengan rancangan penelitian potong lintang. Subjek penelitian penderita yang datang ke Poliklinik Pulmonologi atau Poliklinik DOTS, didiagnosis TB paru. Sebanyak 68 sputum dan serum dari 33 kultur sputum M. tuberculosis positif dan 35 kultur negatif dilakukan pemeriksaan cocktail antigen TB rapid ICT. Angka positivitas cocktail antigen TB rapid ICT sputum 54,4%; serum tanpa pemanasan 0%. Pada serum dilakukan pemanasan pada suhu 56oC selama 30 menit untuk menghilangkan aktivitas antibodi dan didapatkan angka positivitas sebesar 19,1%. Nilai sensitivitas dan spesifisitas pemeriksaan untuk sputum 93,9% dan 82,8%, untuk serum tanpa pemanasan 0% dan 100%, serta serum dengan pemanasan 24,2% dan 85,7%.  Validitas pemeriksaan sputum memiliki sensitivitas tinggi dan spesifisitas sedang, untuk serum memiliki sensitivitas rendah dan spesifisitas tinggi. [MKB. 2017;49(3):178–85]Kata kunci: Cocktail antigen TB rapid ICT, kultur Ogawa, mikroskopik BTA, tuberkulosis paru, serum, sputum Validity of Complex Specific Cocktail Antigen Mycobacterium tuberculosis (ESAT-6, CFP-10, MPT-64) Rapid Immunochromatography Method on Sputum and Serum Samples from Patient with Pulmonary TuberculosisEarly diagnosis of pulmonary tuberculosis (TB) is very important in reducing morbidity and mortality. The current diagnosis of TB includes direct staining (acid fast bacilli) or M. tuberculosis culture, but these examinations have a low sensitivity. An assay using rapid ICT cocktail antigen TB is currently available for diagnosing TB. This method can detect ESAT-6, CFP-10, and MPT-64 antigen which is secreted by M. tuberculosis. The aim of this study was to analyze the validity of cocktail antigen TB rapid ICT using sputum and serum with Ogawa culture. This was a cross-sectional descriptive observational study. Sputum and serum were collected from patients who were diagnosed as lung TB suspects in the lung and DOTS Clinic of Dr. Hasan Sadikin General Hospital Bandung during the period of July–December 2014 in . Cocktail antigen TB detection assay using two kind of samples (sputum and serum) were evaluated. A total of 68 subjects of33 subjects presented positive culture and 35 presented negative cultures. Positivity rates for sputum and serum were 54.4% and 0%, respectively. Heated sputum assay had a sensitivity of 93.9% and specificity of 82.8%, Serum assay presented a sensitivity of 0% and specificity  of100%.  Serum were modified by heating at 56oC for 30 minutes. The positivity rate of heated serum was 19.1%. The result of modified serum assay showed a sensitivity  of 24.2% and specificity of 85.7%. Conclusion: the sensitivity of the sputum assay is high and the specificity is medium. The sensitivity of this serum assay is low and the specificity is high. [MKB. 2017;49(3):178–85]Key words: Acid fast bacilli, cocktail antigen TB rapid ICT, pulmonary tuberculosis, Ogawa culture, sputum, serum

Keberhasilan Terapi Kombinasi Menggunakan Metotreksat Injeksi dan Siklosporin pada Psoriasis Pustulosa Generalisata

Suwarsa, Oki, Devi Nursjamsi, Nadilla Carissa, Pangastuti, Miranti, Sutedja, Endang, Dharmadji, Hartati Purbo

Majalah Kedokteran Bandung Vol 49, No 3 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Psoriasis pustulosa generalisata (PPG) adalah bentuk khusus dari psoriasis yang bersifat akut dan berat. Etiologi yang belum diketahui secara pasti menyebabkan pengobatan PPG masih menjadi suatu tantangan. Terapi kombinasi dapat diberikan pada PPG yang berat maupun yang tidak memberikan respons terhadap terapi sistemik tunggal, selain itu terapi kombinasi juga dapat meningkatkan efektivitas dari obat tunggal. Dilaporkan satu kasus PPG pada seorang wanita yang diterapi dengan menggunakan kombinasi metotreksat (MTX)  injeksi dan siklosporin. Dari anamnesis dan pemeriksaan fisis didapatkan pustula berkelompok pada dasar makula eritem yang bergabung membentuk lake of pus, disertai gejala sistemik demam dan leukositosis. Keluhan tersebut sudah berulang sejak 13 tahun yang lalu. Pasien diberikan terapi kombinasi injeksi MTX dan siklosporin. Pustula pada pasien menghilang setelah tujuh hari pemberian obat. Terapi kombinasi dengan MTX injeksi dan siklosporin ini baru pertama kali dilakukan 19 Mei–26 Mei 2017 di Departemen Ilmu Kesehatan Kulit dan Kelamin Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung dan memberikan hasil yang baik. [MKB. 2017;49(3):208–12]Kata kunci: Metotreksat, metotreksat injeksi, psoriasis pustulosa generalisata, siklosporin Succesful Treatment of Generalized Pustular Psoriasis with a Combination of Methotrexate Injection and CyclosporineGeneralized pustular psoriasis (GPP) is a special form of acute and severe psoriasis. The definite etiology of GPP remains a challenge. Combination therapy may be given to severe GPP or GPP that does not respond to a single systemic therapy sincecombination therapy may also improve the effectiveness of a monotherapy drug. A GPP case was reported in a woman treated with a combination of methotrexate (MTX) and cyclosporine. From anamnesis and physical examination it was revealed that there were clustered  pustules on the base of erythematous macules that form a lake of pus accompanied by systemic symptoms of fever and leukocytosis. This was a recurrent complaint since 13 years ago. Patients were given combination therapy of MTX injection and cyclosporine. Pustules disappeared after seven days of drug administration. This case was the first combination therapy with MTX injection and cyclosporine used during the period of 19 May to 26 May 2017 at the Department of Dermatology and Venereology Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung, resulting in good results. [MKB. 2017;49(3):208–12]Key words: Cyclosporine, generalized pustular psoriasis, methotrexate, methotrexate injection