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"Evaluasi ilmiah terhadap aktifitas farmakologi obat herbal memerlukan model pengujian dengan metode induksi tukak yang sesuai pada hewan coba. Dalam kajian ini, metode antiulserogenik diinvestigasi menggunakan beberapa induktor. Tikus putih jantan galur Sprague-Dawley dibagi ke dalam 5 kelompok model yang masing-masing diberiair suling, indometasin (48 mg/kg bb), aspirin-HCl (150 mg/kg bb), 96% etanol (1 ml/200 g bb), dan 80% etanol (1 ml/200 g bb) secara oral. Hasil penelitian menunjukkan bahwa kelompok yang diinduksi dengan 80% etanol memberikan indeks ulkus tertinggi. Pengujian secara histologi menunjukkan adanya abnormalitas sel-sel mukosa lambungpada kelompok model tukak lambung yang diinduksi dengan aspirin-HCl, 96% dan 80% etanol.

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AbstractScientific evaluation on pharmacological activity of medicinal herbs required reproducible and valid method-induced ulcer models in animal. In this study, the method of antiulcerogenic effect was investigated using several inducers. The male white Sprague-Dawley rats divided into five groups which were orally administrated water,indomethacin (48 mg/kg bw), aspirin-HCl (150 mg/kg bw), 96% ethanol (1 ml/200 g bw), and 80% ethanol (1 ml/200 g bw), respectively. The result of this study showed that the group was induced with 80% ethanol demonstrated the highest ulcer index. Histological examination of the stomach showed abnormality of mucosa cellson the aspirin-HCl, 96% ethanol, and 80% ethanol-induced gastric ulcer model in rats."

"Latar belakang: Perforasi tukak peptik PTP merupakan komplikasi penyakit tukak peptik yang memiliki angka morbiditas dan mortalitas yang cukup tinggi. Luaran pasien yang maksimal dapat dicapai dengan perawatan optimal disertai alokasi sumber daya yang sesuai dengan statifikasi pasien berdasarkan kelompok risikonya. Skor peptic ulcer perforation PULP merupakan sistem penilaian terbaru untuk prediksi prognosis pasien PTP. Penelitian ini bertujuan untuk mengetahui penerapan skor PULP dalam prediksi mortalitas pasien PTP di Rumah Sakit dr. Cipto Mangunkusumo RSCM. Metode penelitian: Studi potong lintang analitik dilakukan dengan mengambil total sampel 52 pasien PTP yang datang ke RSCM pada periode Januari 2011-Juni 2015. Pasien perforasi gaster/duodenum akibat trauma dan keganasan gaster/duodenum, pasien yang tidak menjalani pembedahan dan pasien yang sudah menjalani pembedahan di luar RSCM dieksklusi. Analisis statistik diolah dengan program SPSS 20 for windows, untuk menilai variabel apa yang secara independen memengaruhi mortalitas pasien PTP dan bagaimana akurasi skor PULP dalam prediksi mortalitas pasien PTP. Hasil penelitian: Variabel syok saat masuk rumah sakit dan awitan penyakit >24 jam merupakan prediktor independen mortalitas pasien PTP dengan nilai kemaknaan masing-masing 0,04 dan 0,03. Nilai area under the curve skor PULP dalam prediksi mortalitas pasien PTP mencapai 71,60 95 IK 53,80 -89,40. Kesimpulan: Penggunaan skor PULP dinilai cukup baik untuk prediksi mortalitas pasien PTP di RSCM. Kata kunci: Perforasi tukak peptik, skor peptic ulcer perforation PULP , mortalitas, syok, awitan penyakit.

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Background: Perforated peptic ulcer PPU is a complication of peptic ulcer disease with high rates of morbidity and mortality. Maximum outcomes could be achieved by optimal care combined with allocation of resources in accordance with patient's risk stratification. Peptic ulcer perforation PULP score is the newest scoring systems for predicting the prognosis of PPU patients. This study aims to determine the application of PULP score in predicting mortality of PPU patient in Cipto Mangunkusumo Hospital.

Method: A cross sectional analytical study carried out by taking the total sample of 52 patients who came with PPU to Cipto Mangunkusumo Hospital in the period of January 2011 June 2015. Those with perforation at stomach duodenum due to trauma and malignancy, those who did not undergo surgery and those who have undergone surgery outside Cipto Mangunkusumo Hospital were excluded. Statistical analysis is processed with SPSS 20 for windows, to determine which variables independently afffect the mortality of PPU patients and how is the accuracy of PULP score in predicting mortality of PPU patients.

Results: Shock on admission and onset of disease 24 hours were independent predictors of mortality in PPU patients p value 0.04 and 0.03 respectively. The value of area under the curve of PULP score in predicting mortality in PPU patients was 71.60 95 CI 53.80 89.40.

Conclusions: PULP score is considered good enough to predict mortality of PPU patients in Cipto Mangunkusumo Hospital. Keywords Perforated peptic ulcer, peptic ulcer perforation PULP score, mortality, shock, onset of disease."

"ABSTRAKLatar Belakang: Mortalitas pasien perforasi tukak peptik (PTP) masih stabil padaangka 20-50% dimana penyebab terbanyak adalah sepsis. Tantangan ini memicu paraahli bedah untuk meneliti faktor-faktor yang berhubungan dengan mortalitas danmorbiditas penyakit ini. Selain pembedahan untuk kontrol infeksi, antibiotikapreoperatif diketahui menurunkan angka mortalitas. Penelitian ini bertujuanmengetahui hubungan kesesuaian antibiotika empiris dengan hasil kultur sensitifitasantibiotika terhadap ketahanan hidup 30 hari pasien perforasi tukak peptik di RSUPNDr Cipto Mangunkusumo (RSCM) Jakarta. Metode: Studi kohort terhadap pasienPTP sejak Januari 2012 hingga Agustus 2015 di Departemen Bedah FKUI/RSCMJakarta, dimana PTP akibat keganasan dan trauma tembus dieksklusikan. Pola kumandan antibiotika pada pasien PTP disajikan sebagai studi pendahuluan. Hasil: dari 45pasien yang didapat, angka mortalitas pasien PTP di RSCM sebesar 31,1% danketahanan hidup sebesar 68,9%. Pola kuman pada pasien PTP adalah Escherichia colisebagai kuman Gram negatif terbanyak (35,85%) dan Streptococcus alfahemolyticsebagai kuman Gram positif terbanyak (15,09%). Antibiotika lini kedua yang sesuaiuntuk pasien PTP adalah Sulbactam/Ampicillin.Tidak terdapat hubungan antara skor Boey dan ketahan hidup, namun syok preoperatif memengaruhi ketahanan hidup(nilai OR 14,67). Begitu juga dengan komorbiditas memengaruhi ketahanan hidupsebesar 10,54 kali. Lama persiapan operasi tidak bermakna terhadap ketahanan hidup,sedangkan durasi operasi memengaruhi ketahanan hidup sebesar 7,5 kali. Antibiotikaempiris yang sesuai dengan hasil kultur memengaruhi ketahanan hidup sebesar 12,57kali. Kesimpulan: Pemberian antibiotika empiris yang tepat terbukti berhubungandengan ketahanan hidup pasien perforasi tukak peptik.;

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ABSTRACT

Background: Mortality of patients with peptic ulcer perforation (PUP) was stable at

20-50%, which is the most common cause is sepsis. This challenge prompted the

surgeon to examine the factors associated with mortality and morbidity of this

disease. In addition to surgery to control infection, preoperative antibiotics are

known to reduce mortality. This study aims to determine the suitability of empiric

antibiotics relationship with antibiotic sensitivity culture results to the 30 days

survival of perforated peptic ulcer patients in Dr Cipto Mangunkusumo General

Hospital (RSCM) in Jakarta. Methods: A cohort study of patients PUP since January

2012 to August 2015 at Department of Surgery Faculty of medicine/RSCM Jakarta,

where PUP due to malignancy and penetrating trauma were excluded. Patterns of

bacteria and antibiotics in PUP patients presented as a preliminary study. Results:

45 patients were obtained, the mortality rate of patients in RSCM PUP by 31.1% and

amounted to 68.9% survival. Patterns of bacteria in a patient PUP is Escherichia

coli as most Gram-negative bacteria (35.85%) and Streptococcus alfahemolytic as

most Gram-positive bacteria (15.09%). The second line antibiotics are appropriate

for the PUP patients is sulbactam/ampicillin. There was no relationship between

Boey?s score and survivability, but the preoperative shock affect survival (OR 14.67).

Likewise with comorbidities affecting the survival of 10.54 times. Time to surgery on

survival was not significant, while the duration of surgery affecting the survival of 7.5

times. Empiric antibiotics in accordance with the culture results affects survival of

12.57 times. Conclusion: The provision of appropriate empiric antibiotic shown to be

associated with survival in patients with peptic ulcer perforation. ;Background: Mortality of patients with peptic ulcer perforation (PUP) was stable at20-50%, which is the most common cause is sepsis. This challenge prompted thesurgeon to examine the factors associated with mortality and morbidity of thisdisease. In addition to surgery to control infection, preoperative antibiotics areknown to reduce mortality. This study aims to determine the suitability of empiricantibiotics relationship with antibiotic sensitivity culture results to the 30 dayssurvival of perforated peptic ulcer patients in Dr Cipto Mangunkusumo GeneralHospital (RSCM) in Jakarta. Methods: A cohort study of patients PUP since January2012 to August 2015 at Department of Surgery Faculty of medicine/RSCM Jakarta,where PUP due to malignancy and penetrating trauma were excluded. Patterns ofbacteria and antibiotics in PUP patients presented as a preliminary study. Results:45 patients were obtained, the mortality rate of patients in RSCM PUP by 31.1% andamounted to 68.9% survival. Patterns of bacteria in a patient PUP is Escherichiacoli as most Gram-negative bacteria (35.85%) and Streptococcus alfahemolytic asmost Gram-positive bacteria (15.09%). The second line antibiotics are appropriatefor the PUP patients is sulbactam/ampicillin. There was no relationship betweenBoey?s score and survivability, but the preoperative shock affect survival (OR 14.67).Likewise with comorbidities affecting the survival of 10.54 times. Time to surgery onsurvival was not significant, while the duration of surgery affecting the survival of 7.5times. Empiric antibiotics in accordance with the culture results affects survival of12.57 times. Conclusion: The provision of appropriate empiric antibiotic shown to beassociated with survival in patients with peptic ulcer perforation.;Background: Mortality of patients with peptic ulcer perforation (PUP) was stable at20-50%, which is the most common cause is sepsis. This challenge prompted thesurgeon to examine the factors associated with mortality and morbidity of thisdisease. In addition to surgery to control infection, preoperative antibiotics areknown to reduce mortality. This study aims to determine the suitability of empiricantibiotics relationship with antibiotic sensitivity culture results to the 30 dayssurvival of perforated peptic ulcer patients in Dr Cipto Mangunkusumo GeneralHospital (RSCM) in Jakarta. Methods: A cohort study of patients PUP since January2012 to August 2015 at Department of Surgery Faculty of medicine/RSCM Jakarta,where PUP due to malignancy and penetrating trauma were excluded. Patterns ofbacteria and antibiotics in PUP patients presented as a preliminary study. Results:45 patients were obtained, the mortality rate of patients in RSCM PUP by 31.1% andamounted to 68.9% survival. Patterns of bacteria in a patient PUP is Escherichiacoli as most Gram-negative bacteria (35.85%) and Streptococcus alfahemolytic asmost Gram-positive bacteria (15.09%). The second line antibiotics are appropriatefor the PUP patients is sulbactam/ampicillin. There was no relationship betweenBoey?s score and survivability, but the preoperative shock affect survival (OR 14.67).Likewise with comorbidities affecting the survival of 10.54 times. Time to surgery onsurvival was not significant, while the duration of surgery affecting the survival of 7.5times. Empiric antibiotics in accordance with the culture results affects survival of12.57 times. Conclusion: The provision of appropriate empiric antibiotic shown to beassociated with survival in patients with peptic ulcer perforation."

"Ulkus peptikum adalah hilangnya sel epitel yang mencapai atau menembus muskularis mukosa dengan diameter kedalaman < 5 mm. Ulkus dapat terjadi akibat produksi mukus yang terlalu sedikit atau produksi asam yang berlebihan. Lambung memiliki sistem pertahanan yang dimediasi oleh pelepasan CGRP dari serat saraf aferen dan pembentukan NO. Pada penelitian terdahulu, telah dibuktikan bahwa terdapat zat dalam capsaicin yang dapat membantu mempercepat proses penyembuhan ulkus peptikum. Capsaicin adalah suatu alkaloid yang larut dalam alkohol dan terdapat pada cabai. Capsaicin bekerja dengan merangsang pelepasan CGRP yang selanjutnya memicu pelepasan NO yang berfungsi untuk meningkatkan aliran darah ke lambung. Sedangkan dalam praktek dokter sehari-hari, terdapat beberapa obat yang dapat menimbulkan efek samping ulkus peptikum, salah satunya adalah indometasin. Indometasin mempengaruhi respon peradangan dengan menghambat enzim siklooksigenase sehingga berkurangnya sintesis prostaglandin dan leukotrien yang berfungsi sebagai suatu antiinflamasi. Namun, indometasin dalam dosis besar mempunyai efek samping merangsang produksi asam dan pepsin yang berlebihan di dalam lambung dan memudahkan timbulnya ulkus peptikum. Metode penelitian ini adalah eksperimental. Pada penelitian ini, dilakukan pemberian capsaicin bersamaan dengan suatu zat yang dapat menimbulkan ulkus seperti indometasin. Percobaan dilakukan dengan menginduksi ulkus pada lambung tikus kemudian tikus diberi capsaicin dan indometasin per oral pada hari yang sama. Hasil menunjukkan perbedaan luas ulkus pada tiap kelompok percobaan, rata-rata luas ulkus kelompok kontrol yaitu 5,3 mm2, kelompok capsaicin sebesar 2 mm2, kelompok indometasin sebesar 40,33 mm2, dan kelompok capsaicin dan indometasin sebesar 0 mm2. Hasil uji statistik: perbedaan bermakna (p = 0,034) terdapat antara kelompok yang diberi capsaicin dan kelompok yang diberi indometasin. Kesimpulan Capsaicin terbukti mampu mempercepat penyembuhan ulkus lambung pada tikus yang diberi paparan indometasin.

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Peptic ulcer is loss of epithelial cell through muscularis mucosa with diameter of depth less than 5 mm.Peptic ulcer is caused by lack of mucous or excess of acid production. Gaster has own self-defence mechanism which mediated by CGRP release from afferent nerve and produce nitric oxide (NO). On the previous research, it has been proven that there is a substance in capsaicin which can accelerate ulcer healing process. Capsaicin is a alcohol solved material which is contained in chilli. Capsaicin stimulates the release of CGRP moreover stimulates release of nitric oxide (NO) that function to increase blood supply to the gaster. In daily clinical practice, there are some drugs which it will lead to peptic ulcer, one of them is indometachin. Indomethacin influence an inflammatory reaction by inhibit cyclooxigenase enzyme, so that decrease the synthesis of prostaglandin and leukotrien which functioned as an anti-inflammatory. However, large amount of indomethacin has side effect to increase acid and pepsin production then induce peptic ulcer. The method of this research is experimental. In this research, given capsaicin with substance that can induce peptic ulcer such as indometachin. The test was started with induction of ulcer on rat?s stomach moreover it?s given with capsaicin and indometachin per oral in the same day. The results shows the difference wide of ulcer between control which are 5,3 mm2, capsaicin 2 mm2, indomethacin 40,33 mm2, and indometchacin combine by capsaicin 0 mm2. Statistic result shows the difference is significant (p = 0,034) between capsaicin and indomethacin. This research shows capsaicin plays role in healing process of gastric ulcer in rats exposured by indomethacin."

"Tukak lambung adalah salah satu gastrointestinal kronis yang paling umum. Penggunaan obat konvensional banyak menimbulkan efek samping, sehingga perlu adanya pendekatan terapi herbal. Salah satunya dengan menggunakan dedak padi yang berasal dari penggilingan padi. Dedak padi mengandung ?-oryzanol yang mempunyai berbagai aktivitas farmakologis. Salah satunya adalah sebagai anti tukak lambung.Tujuan dari penelitian ini adalah untuk menggunakan metode IL-MAE untuk meningkatkan ?-oryzanol dalam dedak padi dan mengevaluasi efektivitas ekstrak dedak padi sebagai gastroprotektif pada model tukak lambung yang diinduksi etanol pada tikus. Ekstrak dedak padi diperoleh dengan IL-BMIM[BF4] 0,7 M dengan MAE pada kondisi ekstraksi rasio sampel/pelarut 15 g/mL, waktu ekstraksi 15 menit dan daya mikrowave 10 . Tikus diberi perlakuan dengan ekstrak dedak padi pada dosis yang berbeda 100, 200, 400 mg/kgBB selama tujuh hari dan kemudian terpapar lesi lambung akut yang diinduksi 80 etanol 0,5 ml/200 gBB . Omeprazol 36 mg/kgBB digunakan sebagai obat anti-ulkus standar. Indeks ulkus, keasaman lambung dan pembentukan mukus diukur untuk menilai tingkat gastroproteksi.Hasil penelitian ini menunjukkan bahwa metode IL[BMIM]BF4-MAE dapat meningkatkan kadar ?-oryzanol sebesar 0,421 mg/g dibandingkan dengan metode isopropanol-MAE dan pemberian oral ekstrak dedak padi pada dosis 400 mg/kgBB secara nilai signifikan menghambat pembentukan lesi lambung sebesar 66,75 dan penurunan keasaman lambung. Selain itu, ekstrak dedak padi dapat melindungi mukosa lambung dari lesi lambung akibat etanol dengan meningkatkan pembentukan mukus lambung. Aplikasi metode IL[BMIM]BF4-MAE lebih efektif meningkatkan kadar ?-oryzanol pada ekstrak dedak padi dan ekstrak dedak padi 400 mg/kgBB mempunyai efektivitas sebagai gastroprotektif.

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Peptic ulcer is one of the most common chronic gastrointestinal. The use of conventional medicine causes many side effects, so the need for an approach of herbal therapy. One of them by using rice bran derived from rice milling. Rice bran contains oryzanol which has various pharmacological activities. One of them is as an anti gastric ulcer.The aim of this study was to use the IL MAE method to increase oryzanol in rice bran and evaluate the effectiveness of rice bran extract as gastroprotective in the ethanol induced peptic ulcer model in rats. The rice bran extract was obtained with IL BMIM BF4 0.7 M with MAE at ratio sample liquid of 15 g mL, extraction time 15 min and microwave power 10. The rats were treated with rice bran extract at different doses 100, 200, 400 mg kgBW for seven days and then exposed to acute induced gastric lesions 80 ethanol 0.5 ml 200 gBW. Omeprazole 36 mg kgBW is used as a standard anti ulcer drug. The ulcer index, gastric acidity and mucus formation were measured to assess the level of gastroprotection.The results of this study indicate that the method of IL BMIM BF4 MAE can increase the oryzanol level by 0.421 mg g compared with isopropanol MAE method and oral administration of rice bran at dose 400 mg kgBW significantly decreases gastric lesion formation by 66.75 and decreased gastric acidity. In addition, rice bran extract can protect the gastric mucosa from gastric lesions due to ethanol by increasing gastric mucus formation. The application of the IL BMIM BF4 MAE method more effectively increases the oryzanol content of rice bran extract 400 mg kgBW has effectiveness as gastroprotective."

"Ulkus peptik, yang disebabkan oleh infeksi Helicobacter pylori (H. pylori), merupakan masalah kesehatan global dengan prevalensi yang cukup tinggi, termasuk di Indonesia. Klaritromisin adalah salah satu obat yang dipakai untuk mengatasi infeksi bakteri ini sebagai bagian dari regimen tiga obat. Sediaan konvensional klaritromisin hanya bertahan 1-3 jam di lokasi aksi. Oleh karena itu, klaritromisin dibuat menjadi granul gastroretentif mukoadhesif dengan bantuan polimer untuk meningkatkan waktu singgah obat yang meningkatkan efektivitas terapi dan mengurangi insidensi resistensi. Polimer yang dipilih, yaitu hidroksietil selulosa (HEC), hidroksipropil selulosa (HPC), dan polimetakrilat mempunyai rekam jejak yang baik dalam aktivitas mukoadhesinya, namun masih belum ada studi yang mempelajari polimer berikut untuk sediaan mukoadhesi gastroretentif. Penelitian ini bertujuan untuk memformulasi granul gastroretentif dengan sifat fisik yang baik dan profil pelepasan obat, serta daya mukoadhesi granul secara in vitro. Granul dengan konsentrasi 1:1 tiap polimernya dibuat dengan metode granulasi basah yang dievaluasi dari karakterisasi fisiknya, fungsional, kadar, profil pelepasan, dan mekanisme pelepasannya. Hasil granul Klaritromisin : HEC (F1) = 1:1 menghasilkan hasil yang paling baik diantara ketiga formula. Granul yang dihasilkan memiliki rendemen 93,25% dan sifat alir excellent. Granul mengembang hingga 822,69%, mampu bertahan hingga 12 jam pada uji mukoadhesi in-vitro, dan daya adhesi yang terbaik dari ketiga formula. Dari uji disolusi, granul F1 memiliki kadar 77,58% dan profil pelepasannya adalah orde 0 difusi disolusi yang terdapat fenomena lag release. Oleh karena itu, granul F1 dapat digunakan untuk penelitian lebih lanjut seperti pada uji in vivo.

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Peptic ulcer, caused by Helicobacter pylori (H. pylori) infection, is a global health issue with a significant prevalence, including in Indonesia. Clarithromycin is one of the drugs used to treat this bacterial infection as part of a triple therapy regimen. Conventional clarithromycin formulations only remain active for 1-3 hours at the site of action. Therefore, clarithromycin was formulated into gastroretentive mucoadhesive granules using polymer assistance to prolong drug residence time, enhance therapeutic effectiveness, and reduce resistance incidence. The selected polymers hydroxyethyl cellulose (HEC), hydroxypropyl cellulose (HPC), and polymethacrylate have shown good track records in mucoadhesive activity, yet there are no studies on the latter polymer for gastroretentive mucoadhesive formulations. This research aims to formulate gastroretentive granules with good physical properties and drug release profiles, as well as in vitro mucoadhesive properties. Granules with a 1:1 concentration of each polymer were prepared using wet granulation method and evaluated for their physical and functional characteristics, drug content, release profile, and release mechanism. Among the three formulations, the Clarithromycin:HEC (F1) granules at a 1:1 ratio showed the most promising results. The resulting granules had a yield of 93.25% and excellent flow properties. They expanded up to 822.69%, could sustain for up to 12 hours in in-vitro mucoadhesion tests, and exhibited the best adhesion capability compared to the other formulations. Dissolution testing showed that F1 granules had a drug content of 77.58% and followed a zero-order release with lag release phenomenon. Hence, F1 granules are suitable for further research, such as in vivo studies."

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Berdasarkan data dari World Health Organization (WHO), kematian yang disebabkan oleh tukak lambung di Indonesia mencapai 0,99 persen yang didapat dari angka kematian 8,41 per 100.000 populasi. Untuk menghasilkan obat tukak lambung, maka alat gastroretentif dengan sistem administrasi oral yang memiliki waktu tinggal lebih lama di lambung, kelarutan yang rendah di pH alkalin, absorbsi yang cepat dapat dikembangkan. Oleh sebab itu, dibutuhkan sistem yang baik untuk mendapatkan kontrol rilis yang baik. Pada penelitian ini, obat terdiri dari curcuminoids yand didapat dari ekstrak Curcuma Longa dari metode maserasi menggunakan aseton sebagai solven. Sistem gastroretentif diformulasikan menggunakan polimer densitas rendah (HPMC K4M, HPMC E15, dan EC) serta agen efervesen yang dapat membentuk sistem apung pada tablet di lambung. Tablet apung tersebut dikarakterisasi tentang variasi massa, kekerasan, keregasan, loading, disolusi in vitro, dan waktu jeda mengapung.

 

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According to World Health Organization (WHO), the death from gastric ulcer in Indonesia reaches 0.99 percent which is obtained from the death rate 8.41 per 100,000 population. In order to create a gastric ulcer drug, the gastroretentive devices, a gastric-targeted drugs via oral administration which have longer retention in the stomach, poor solubility at an alkaline pH, and rapid absorption from the gastrointestinal tract need to be developed. Therefore, a prefect system to obtain long term and controlled release is required. In this research, the drug is consist of curcuminoids from  Curcuma Longa extracts from maceration method with acetone solvent. The gastroretentive devices is formulated with some other compound such as low density polymers (HPMC K4M, HPMC E15, and EC) and effervescent agent that can form a floating system in the gastric. The floating drug delivery tablets are characterized for their weight variation, hardness, friability, drug loading, in vitro dissolution studies, and floating lag time. The developed curcumin floating tablet system is a promising floating drug delivery system for oral sustained administration of curcumin.

 

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"Latar Belakang: Data GLOCOBAN tahun 2018 menunjukkan bahwa kanker lambung merupakan penyebab kematian akibat kanker nomor tiga di dunia. Hingga saat ini, belum terdapat deteksi dini untuk kanker lambung. Kanker lambung sering ditemukan dalam kondisi yang sudah berat, karena 25,8% kasus tidak terdiagnosis ketika dilakukan upper endoscopy. Sejumlah penelitian menunjukkan bahwa spektrofotometri dapat digunakan dalam mendeteksi jaringan kanker, antara lain spektroskopi Raman dan optik. Hingga saat ini belum ada penelitian yang mendeteksi jaringan kanker lambung berdasarkan spektrofotometri sederhana.Tujuan: Studi ini dilakukan untuk mengetahui ambang batas perbedaan panjang gelombang reflektansi pada jaringan kanker normal dengan jaringan pra-kanker dan jaringan kanker lambung serta menganalisis akurasi spektrofotometer dalam klasifikasi jaringan..Metode: Reflektansi jaringan mencit Mus musculus diukur menggunakan spektrofotometer konvensional pada panjang gelombang 431.5-705.2 mm. Hasil reflektansi kemudian digunakan dalam model machine learning untuk menentukan klasifikasi berdasarkan reflektansi.Hasil: Machine learning Tree menggunakan panjang gelombang 431,5, 494,2, dan 502.5 nm. Analisis Principal Component Analysis menunjukkan adanya penumpukkan antara jaringan prekanker dengan jaringan kanker. Metode Random Forest (CA: 0.857, precision: 0.872, recall: 0.857) lebih baik dalam mengklasifikasikan jaringan kanker lambung dibandingkan metode Tree (CA;0,607, precision:0,619, dan recall:0,607) dan logistic regression (CA:0,750, precision: 0,739, dan recall:0,750). Spektrofotometri reflektans sederhana memiliki sensitivitas sebesar 68.42%-89.47% dan spesifisitas sebesar 44-88.89% dalam mendeteksi jaringan pra-kanker dan jaringan kanker.Kesimpulan: Dengan rentang panjang gelombang 431,5, 494,2, dan 502.5 nm, spektrofotometri sederhana tidak dapat membedakan jaringan pra-kanker dan kanker karena terdapat penumpukan protein seperti miglobin, dan juga tingkat sensitivitas dan spesifisitas yang baik dalam membedakan jaringan normal dan tidak normal.

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Background: GLOCOBAN in 2018 shows that gastric cancer is the third leading cause of death for cancer-related disease. Until now, there’s no early detection for gastric cancer. This causes gastric cancer to be diagnosed at a later stage, because 25,8% gastric cancer cases are undiagnosed even with upper endoscopy 3 years before diagnosis.A number of study has shows that spectrophotometry can be used for detecting gastric cancer, such as Raman spectroscopy and optical. Until now, there is no research that detect gastric cancer using conventional spectrophotometer.

Objectives This study aims to understand the difference between wavelength of the reflectance from the normal gastric tissue, precancerous gastric tissue, and gastric cancer tissue and analyze the accuracy of conventional spectrophotometer to classify the tissues.

Methods The reflectance of the tissue of Mus musculus is evaluated using conventional spectrophotometer at the wavelength of 431.5-705.2 mm. The resulting data will then be used in a machine learning model to help classify the tissue based on the reflectance

Result: Wavelengths used by Tree is 431,5, 494,2, dan 502.5 nm. Analysis using Principal Component Analysis shows a grouping formed by the gastric precancer tissue and gastric cancer tissue. Random Forest (CA: 0.857, precision: 0.872, recall: 0.857) is proven to be better for classifying the tissue based on the reflectance compared to Tree (CA;0,607, precision:0,619, and recall:0,607) and Logistic regression (CA:0,750, precision: 0,739, and recall:0,750). Conventional reflectance spectrophotometry yielded a 68.42%-89.47% sensitivity and 44-88,89% specificity in differentiating normal gastric tissue with abnormal gastric tissue.

Conclusion: Within the wavelength of 431,5, 494,2, dan 502.5 nm, conventional spectrophotometer cannot differentiate precancerous lesion with gastric cancer tissue due to the abundance of protein such as myoglobin, and having a good sensitivity and specificity in differentiating normal and abnormal tissue."

"Latar belakang: Kanker lambung bertanggung jawab atas lebih dari 1.000.000 kasus kanker baru pada tahun 2020 dan diperkirakan 769.000 kematian atau sama dengan satu dari setiap 13 kematian secara global. Deteksi dini menjadi kunci penurunan angka kematian dan perbaikan prognosis, dengan baku emas berupa avaluasi histopatologi dari hasil biopsi endoskopi. Tetapi subjektivitas pemeriksan tersebut berpotensi menimbulkan kesalahan diagnosis terutama akibat kesalahan interpretasi ahli patologi. Untuk itu, diperlukan metode diagnostik kuantitatif yang dapat menilai secara objektif lesi prekanker atau inflamasi pada dinding lambung. Metode autofluoresensi sebelumnya sudah digunakan dalam upaya diagnostik kanker lambung. Namun, saat ini belum ada studi terkait penggunaan spektrofotometri autofluoresensi sebagai metode diagnostik kuantitatif dan objektif untuk kanker lambung. Tujuan: Studi ini dilakukan untuk mengetahui kemampuan spektrofotometri autofluoresensi dalam mengidentifikasi jaringan lambung normal, inflamasi dan prekanker berdasarkan intensitas fluoresensi jaringan.Metode: Studi ini menggunakan sediaan blok parafin jaringan lambung mencit (Mus musculus) normal, inflamasi dan prekanker. Intensitas fluoresensi jaringan diukur pada 640 panjang gelombang menggunakan spektrofotometer autofluoresensi sederhana dengan sumber cahaya ultraviolet. Analisis data dilakukan dengan SPSS untuk uji normalitas, homogenitas dan hipotesis. Dilanjutkan dengan pengelompokkan data secara kualitatif dengan Principal Component Analysis (PCA) dan secara kuantitatif dengan machine learning dengan 3-fold cross validation. Hasil analisis dengan PCA dinilai dengan scatter plot. Hasil pengolahan data secara kuantitatif dinilai dengan Area under the Curve (AUC),Classification Accuracy (CA), precision, recall, F1-score, sensitivitas dan spesifisitas. Hasil: Ditemukan dua panjang gelombang dengan intensitas fluoresensi bermakna untuk tiga kelompok jaringan dan 554 panjang gelombang yang bermakna untuk dua kelompok jaringan. Dalam pengelompokkan tiga variabel, ditemukan nilai AUC 0,900, CA 0,833, Skor F1 0,831, Precision 0,802, dan Recall 0,800. Dalam pengelompokkan dua variabel, ditemukan sensitivitas dan spesifisitas 100% untuk membedakan jaringan prekanker dengan normal. Sensitivitas 100% dan spesifisitas 80% untuk jaringan prekanker dengan inflamasi. Serta sensitivitas 80% dan spesifisitas 90% untuk jaringan inflamasi dengan normal. Kesimpulan: Spektrofotometeri autofluoresensi dapat membedakan jaringan lambung normal, inflamasi dan prekanker mencit Mus musculus dengan sensitivitas dan spesifisitas yang baik.

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Introduction: Gastric cancer was responsible for more than 1,000,000 new cancer cases in 2020 and an estimated 769,000 deaths or equal to one in every 13 deaths globally. Early detection is the key to reducing mortality and improving prognosis, with histopathological evaluation of endoscopic biopsy results as gold standard. However, the subjectivity of the examination has the potential to cause misdiagnosis, mainly due to the pathologist's misinterpretation. For this reason, quantitative diagnostic methods are needed that can objectively assess precancerous or inflammatory lesions in the gastric wall. The autofluorescence method has previously been used in the diagnostic effort of gastric cancer. However, there are currently no studies related to the use of autofluorescence spectrophotometry as a quantitative and objective diagnostic method for gastric cancer Objective: This study was conducted to determine the ability of autofluorescence spectrophotometry to identify normal, inflammatory and precancerous gastric tissue based on the intensity of tissue fluorescence.Method: This study used a paraffin block preparation of normal, inflammatory and precancerous mice (Mus musculus) gastric tissue. The intensity of tissue autofluorescence was measured at 640 wavelengths using simple autofluorescence spectrophotometer with ultraviolet light source. Data analysis was performed using SPSS to test for normality, homogeneity and hypotheses. Followed by grouping the data qualitatively with Principal Component Analysis (PCA) and quantitatively with machine learning with 3-fold cross validation. The results of the PCA analysis were assessed using a scatter plot. The results of quantitative data processing were assessed by Area under the Curve (AUC), Classification Accuracy (CA), precision, recall, F1-score, sensitivity and specificity. Result: Two wavelengths with significant fluorescence intensity were found for three tissue groups and 554 significant wavelengths for two tissue groups. In grouping the three variables, the AUC value was 0.900, CA 0.833, F1 score 0.831, Precision 0.802, and Recall 0.800. In grouping the two variables, 100% sensitivity and specificity were found to differentiate between precancerous and normal tissues. 100% sensitivity and 80% specificity for precancerous tissue with inflammation. As well as 80% sensitivity and 90% specificity for normal inflammatory tissue. Conclusion: Autofluorescence spectrophotometry can differentiate normal, inflammatory and precancerous gastric tissue in mice Mus musculus with good sensitivity and specificity."

"Inflamasi lambung (gastritis) merupakan salah satu penyakit dengan prevalensi yang cukup tinggi di Indonesia. Inflamasi tersebut dapat terjadi akibat proses infeksi atau noninfeksi. Jika tidak ditangani dengan baik, dapat terjadi komplikasi ulkus, perforasi, dan perdarahan lambung. Terapi farmakologi untuk gastritis belum cukup efektif karena terdapat risiko efek samping dan interaksi obat. Hal tersebut mendorong berbagai penelitian untuk menelusuri potensi zat lain sebagai antiinflamasi. Ekstrak kulit delima diketahui mengandung asam elagat dan elagitanin yang telah terbukti mampu menghambat inflamasi di sejumlah organ. Belum terdapat studi mengenai efek ekstrak kulit delima terhadap inflamasi di lambung, khususnya delima yang tumbuh di Indonesia.Penelitian dilakukan dengan menggunakan 25 mencit yang terbagi menjadi lima kelompok. Mencit pada kelompok Kontrol Negatif, Dosis-1 (diberikan ekstrak 240 mg/KgBB), Dosis-2 (diberikan ekstrak 480 mg/KgBB), dan Kontrol Positif (diberikan asam elagat 26 mg/KgBB) diinduksi dengan DSS 2% sebanyak tiga siklus. Gambaran histopatologi (pewarnaan hematoxylin-eosin) mukosa lambung diamati pada sepuluh lapang pandang tiap preparat.Uji statistik menyatakan terdapat pengaruh signifikan ekstrak kulit delima terhadap infiltrasi sel radang (p= 0,001) dengan dosis 480 mg/KgBB, hiperplasia (p= 0,002) dengan dosis 240 mg/KgBB dan 480 mg/KgBB, serta displasia (p= 0,002) dengan dosis 480 mg/KgBB. Namun, tidak terdapat pengaruh signifikan ekstrak kulit delima terhadap angiogenesis (p= 0,114). Efek ekstrak kulit delima terjadi karena kandungan asam elagat dan elagitanin yang menghambat jalur inflamasi NF-κB sehingga terjadi penurunan ekspresi sitokin dan mediator inflamasi.Penelitian lebih lanjut untuk mengetahui dosis optimal, toksisitas, dan uji klinis dibutuhkan untuk memastikan efikasi serta keamanan suplementasi ekstrak kulit delima.

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Gastric inflammation (gastritis) is one of the most prevalent disease in Indonesia. The etiologies are infection and noninfection factors. If not treated adequately, there can be complications, such as gastric ulcer, perforation, and bleeding. However, pharmacological treatments for gastritis have some risks of side effects and drug interactions. Many studies are conducted to discover potential of another substances as anti-inflammatory agents which have less side effects and drug interactions. Pomegranate peel extract contains ellagic acid and ellagitannin which have been proven to inhibit inflammation in some organs. Nevertheless, there has been no study proving its efficacy in inhibiting gastric inflammation.

This research used 25 mice which are divided into five groups. Mice in four groups consists of Negative Control, Dosage-1 (given the extract at a dose 240 mg/KgBW), Dosage-2 (given the extract at a dose of 480 mg/KgBW), and Positive Control (given ellagic acid at a dose of 26 mg/KgBW) were induced by DSS 2% in three cycles. Histopathological preparations were observed in ten microscopic fields (each slides) to examine the dependent variables.

There are significant differences in the amount of leukocyte infiltration (p= 0,001) at a dose of 240 mg/KgBW, hyperplasia (p= 0,002) at doses of 240 mg/KgBW and 480 mg/KgBW, and dysplasia (p = 0,002) at a dose of 240 mg/KgBW. However, there is no significant effect of pomegranate peel extract to the amount of angiogenesis (p= 0,114). It has anti-inflammatory effect because of the ellagic acid and ellagitannin contents inhibit the NF-κB inflammatory pathway which down regulate the inflammatory cytokines and mediators expressions.

Further researches to discover the optimal dose, toxicity, and clinical trials are necessary to ensure the efficacy and safety of pomegranate peel extract supplementation."