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"ABSTRAKTerapi metformin berpotensi untuk memperbaiki sindrom frailty dengan memodifikasi resistensi insulin, inflamasi, dan konsentrasi miostatin.Penelitian ini bertujuan untuk mengkaji peran metformin terhadap kekuatan genggam tangan, kecepatan berjalan, konsentrasi miostatin serum, dan kualitas hidup terkait kesehatan pada pasien usia lanjut dengan pre-frail.Uji klinis acak tersamar ganda dilakukan pada pasien rawat jalan berusia 60 tahun dengan status pre-frail yang direkrut secara konsekutif Maret 2015 ndash;Juni 2016 di RSCM. Pasien dieksklusi bila menyandang diabetes melitus, skor Geriatric Depression Scale ge; 10, skor Abbreviated Mental Test < 8, fase akut penyakit, dan kontraindikasi terhadap metformin. Evaluasi luaran penelitian dilakukan sebelum dan pasca-intervensi selama 16 minggu.Randomisasi terhadap 120 subjek menempatkan 60 subjek untuk tiap kelompok perlakuan. Sebanyak 43 subjek kelompok metformin 3 x 500 mg dan 48 subjek kelompok plasebo menyelesaikan penelitian. Terdapat peningkatan kecepatan berjalan yang bermakna dengan rerata sebesar 0,39 0,77 detik atau 0,13 0,24 meter/detik pada kelompok metformin dan tetap bermakna setelah dilakukan penyesuaian terhadap faktor prognostik penting yang tidak setara p = 0,024 . Pada analisis ITT ada tidaknya peningkatan kecepatan berjalan > 0,1 meter/detik didapatkan ARR 8,3 IK95 -7,9 ndash;24 , dengan NNT sebesar 12. Tidak terdapat perbedaan bermakna kekuatan genggam tangan, konsentrasi miostatin serum, dan kualitas hidup terkait kesehatan antara kedua kelompok perlakuan. Konsentrasi miostatin serum berkorelasi negatif lemah r = -0,247; p = 0,018 dengan kecepatan berjalan, namun tidak berkorelasi dengan kekuatan genggam tangan. Skor indeks EQ-5D berkorelasi positif sedang dengan kecepatan berjalan r = 0,566; p = 0,000 dan berkorelasi positif lemah dengan kekuatan genggam tangan r = 0,355; p = 0,001.Sebagai simpulan, pemberian metformin 3 x 500 mg selama 16 minggu secara statistik dan klinis bermakna dalam meningkatkan kecepatan berjalan sebagai salah satu dimensi kualitas hidup terkait kesehatan, namun belum dapat meningkatkan skor indeks EQ-5D, tidak meningkatkan kekuatan genggam tangan, dan belum menurunkan konsentrasi miostatin serum.Kata kunci. kecepatan berjalan, kekuatan genggam tangan, kualitas hidup terkait kesehatan, metformin, miostatin, pre-frail, usia lanjut.

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ABSTRACT

Metformin is considered to have potential effects to improve frailty syndrome by modifying insulin resistance, inflammation, and myostatin serum level.

This study aimed at investigating the effect of metformin on handgrip strength, gait speed, myostatin serum level, and health related quality of life HR QoL in pre frail elderly.

A double blind randomized controlled trial was conducted on elderly outpatients aged 60 years and older with pre frail status consecutively recruited from March 2015 to June 2016 at Cipto Mangunkusumo Hospital. Patients with history of diabetes mellitus, Geriatric Depression Scale score ge 10, Abbreviated Mental Test score 8, acute phase of diseases, and contraindication s to metformin were excluded. The measurement of study outcomes was conducted at baseline and after 16 weeks of intervention.

One hundred twenty subjects were randomized and equally assigned into metformin 3 x 500 mg or placebo group. There were 43 subjects in metformin group and 48 subjects in placebo group completed the intervention. The mean gait speed in metformin group significantly improved by 0.39 0.77 second or 0.13 0.24 meter second, even after adjusted for importance prognostic factors p 0,024 . Intention to treat analysis on the presence or absence of increased gait speed 0.1 meter second showed ARR 8.3 95 CI 7.9 ndash 24 , with NNT of 12. There were no significant differences on handgrip strength, myostatin serum level, and HR QoL between the two intervention groups. Myostatin serum level had weak negative correlation with gait speed r 0.247 p 0.018 , but did not correlate with handgrip strength. EQ 5D index had moderate positive correlation with gait speed r 0.566 p 0.000 and weak positive correlation with handgrip strength r 0.355 p 0.001.

In conclusion, metformin 3 x 500 mg for 16 weeks significantly improved gait speed as one of the HR QoL dimensions, but not significantly improved the EQ 5D index score and handgrip strength nor decreased myostatin serum level.

Keywords. gait speed, handgrip strength, health related quality of life, metformin, myostatin, pre frail, elderly."

"Background: sarcopenia contributes to the development of frailty syndrome. Frailty syndrome is potentially improved by modifying insulin resistance, inflammation, and myostatin level. This study is aimed to investigate the effect of metformin on handgrip strength, gait speed, myostatin serum level, and health related quality of life (HR-QoL) among non diabetic pre frail elderly patients.Methods: a double blind randomized controlled trial study was conducted on non-diabetic elderly outpatients aged >60 years with pre frail status based on phenotype and/ or index criteria (Cardiovascular Health Study and/ or Frailty Index 40 items) consecutively recruited from March 2015 to June 2016 at Cipto Mangunkusumo Hospital. One hundred twenty subjects who met the research criteria were randomized and equally assigned into 3 x 500 mg metformin or placebo group. The study outcomes were measured at baseline and after 16 weeks of intervention.Results: out of 120 subjects, 43 subjects in metformin group and 48 subjects in placebo group who completed the intervention. There was a significant improvement on the mean gait speed of metformin group by 0.39 (0.77) second or 0.13 (0.24) meter/second that remained significant after adjusting for important prognostic factors (p = 0.024). There was no significant difference on handgrip strength, myostatin serum level, and HR QoL between both groups.Conclusion: 3 x 500 mg metformin for 16 weeks was statistically significant and clinically important in improving usual gait speed as one of the HR QoL dimensions, but did not significantly improve the EQ 5D index score, handgrip strength, nor myostatin serum level."

"Latar belakang : Kejadian jatuh yang tinggi pada usia lanjut berhubungan erat dengan penurunan kekuatan otot. Seiring bertambahnya usia terjadi sarkopenia dimana massa otot berkurang sebesar 1-2% setiap tahun dan menyebabkan penurunan kekuatan otot sebesar 3%. Vitamin D mempunyai aksi biologis pada otot sehingga menjadi salah satu modalitas terapi sarkopenia. Walaupun peran vitamin D pada kekuatan otot masih kontroversial, namun studi sebelumnya menunjukkan analog vitamin D (alfacalcidol) dapat meningkatkan kekuatan otot dengan memakai luaran kekuatan otot ekstremitas bawah.Tujuan : Menentukan pengaruh alfacalcidol terhadap kekuatan otot ekstremitas atas yang diukur dengan pemeriksaan kekuatan genggam tangan pada perempuan usia lanjut Indonesia.Metode : Studi ini merupakan uji klinis acak tersamar ganda yang dilakukan selama bulan April-September 2012 di poliklinik Geriatri RS. Cipto Mangunkusumo, Jakarta. Subjek penelitian adalah perempuan berusia ≥ 60 tahun dengan kekuatan genggam tangan £ 22 kg yang diukur dengan dinamometer. Subjek dirandomisasi dalam dua kelompok yaitu kelompok yang menerima alfalcalcidol 1x0,5 mg dan kelompok kontrol menerima plasebo. Masing-masing kelompok mendapat kalsium laktat 500 mg dan diamati selama 90 hari. Pada akhir penelitian dilakukan pemeriksaan kekuatan genggam tangan.Hasil : Sebanyak 122 subjek direkrut, namun terdapat 27 subjek yang mempunyai kriteria eksklusi sehingga randomisasi membagi 95 subjek masing-masing 47 subjek pada kelompok alfacalcidol dan 48 subjek pada kelompok plasebo. Sebanyak 88 subjek menyelesaikan penelitian hingga akhir (7 drop out) dan dianalisis dengan uji Mann Whitney. Terdapat perbedaan peningkatan kekuatan otot yang bermakna antara kelompok alfacalcidol dibanding kelompok plasebo (15,50 kg vs. 13,75 kg ; p= 0,003).Kesimpulan: Analog vitamin D (alfacalcidol) dapat meningkatkan kekuatan otot perempuan usia lanjut Indonesia yang mempunyai kekuatan genggam tangan yang rendah dibandingkan pemberian plasebo.

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Background : The age-related increase in falls is strongly associated with a decline in muscle strength. Sarcopenia develops in concomitant with aging, where muscle mass decrease 1-2% annually, lead to 3% reduction in muscle strength. Vitamin D was known to have a biological action on muscle, so it was used as one of the therapy for sarcopenia. Although the role of vitamin D on muscle strength was still controversial, previous studies in vitamin D analog (alfacalcidol) reveal a promising effect in lower extremity muscle strength.Objective : To determine the effect of alfacalcidol on upper extremities muscle strength in elderly ambulatory Indonesian women.Methods : This was a randomized, double-blind clinical trial, which was conducted at Geriatrics Outpatient Clinic of Cipto Mangunkusumo General Hospital Jakarta, during April to September of 2012. The study subject consists of elderly women (aged ≥60 years old) with handgrip strength of ≤ 22 kg, measured with a handheld dynamometer. Subject was then randomized to two groups, one receiving alfacalcidol 1x0.5 mcg and the other receiving identically packaged placebo. Each group also received 500mg calcium lactate daily and then was observed for 12 weeks. At the end of the observation period, a second measurement of handgrip by using handheld dynamometer was performed.Outcome : A total 122 subjects were enrolled in this study. There were 95 subjects fulfilled the eligible criteria consist of 47 subjects receiving alfacalcidol and 48 subjects as a control. A number of 88 subjects were able to complete the intervention period and then the results were analyzed with Mann Whitney test. The study showed a significant increase of muscle strength in the intervention group compared to placebo (15.50 kg vs. 13.75 kg; p = 0.003).Conclusion : Daily doses of 0.5 mg alfacalcidol significantly improved muscle strength in elderly Indonesian women with low handgrip strength compared to placebo."

"Prevalensi pre-frail tinggi pada usia lanjut dan kondisi tersebut dapat berubah menjadi frail. Kolekalsiferol diduga memiliki potensi untuk memperbaiki sindrom frailty pada usia lanjut. Penelitian ini bertujuan mengkaji pengaruh kolekalsiferol terhadap kekuatan genggam tangan, kecepatan berjalan serta reseptor vitamin D (vitamin D receptor/VDR), interleukin-6 (IL-6), dan insulin-like growth factor-1 (IGF-1) monosit pada usia lanjut dengan pre-frail. Uji klinis acak tersamar ganda dilakukan di Poliklinik Geriatri RSCM pada bulan April–Desember 2021. Sebanyak 120 subjek dirandomisasi menjadi kelompok yang mendapat kolekalsiferol 4.000 IU/hari (60 subjek) serta kelompok yang mendapat plasebo/hari (60 subjek). Seluruh subjek mendapat suplementasi kalsium laktat 500 mg /hari. Pengamatan dilakukan selama 12 minggu. Terdapat 57 subjek pada kelompok kolekalsiferol dan 56 subjek pada kelompok plasebo yang menjalani penelitian hingga selesai. Analisis intention to treat dilakukan untuk mengevaluasi luaran kekuatan genggam tangan dan kecepatan berjalan, sedangkan analisis per protokol untuk mengevaluasi VDR, IL-6 dan IGF-1 monosit. Pada akhir pengamatan, tidak terdapat perbedaan bermakna pada kekuatan genggam tangan (p = 0,228), kecepatan berjalan (p = 0,734), VDR monosit (p = 0,45), IL-6 monosit (p = 0,57) dan IGF-1 monosit (p = 0,72) antara kedua kelompok perlakuan. Tidak ada korelasi antara perubahan VDR, IL-6 dan IGF-1 monosit dengan kekuatan genggam tangan dan kecepatan berjalan. Terdapat peningkatan kadar 25(OH)D yang bermakna pada masing-masing kelompok perlakuan dan peningkatan bermakna pada kelompok kolekalsiferol dibandingkan plasebo. Pemberian kolekalsiferol 4.000 IU pada usia lanjut pre-frail 12 minggu meningkatkan kadar 25(OH)D secara bermakna, namun belum terbukti dapat memperbaiki kekuatan genggam tangan, kecepatan berjalan, meningkatkan VDR dan IGF-1 monosit serta menurunkan IL-6 monosit. Fungsi ginjal memiliki pengaruh terhadap efek kolekalsiferol pada IGF-1 monosit. Kolekalsiferol meningkatkan jumlah monosit dengan IGF-1+ pada eGFR > 90, namun tidak pada eGFR 30–59.

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Pre-frail prevalence is higher in the elderly. Frailty status is a dynamic condition. Pre-frail can fall into a frail condition. Cholecalciferol is regarded to have potential effect to improve frailty syndrome in the elderly. This study aimed to determine the effect of cholecalciferol on hand grip strength, walking speed, vitamin D receptors, IL-6, and IGF-1 monocyte in pre-frail elderly. A randomized double-blind clinical trial study at the RSCM Geriatric Polyclinic was conducted from April to December 2021. A total of 120 subjects were randomized into groups receiving 4000 IU cholecalciferol/day (60 subjects) and groups receiving placebo/day (60 subjects). All subjects received calcium lactate supplementation 500 mg/day. Observations were made for 12 weeks. There were 57 subjects in the cholecalciferol group and 56 subjects in the placebo group who completed the study. An intention to treat analysis was performed to evaluate the output of hand grip strength and walking speed, while a per protocol analysis was performed to evaluate monocyte VDR, IL-6 and IGF-1.There were no significant differences in hand grip strength (p = 0,228), walking speed (p = 0,734), VDR monocyte (p = 0,45), IL-6 monocyte (p = 0,57) and IGF-1 monocyte (p = 0,72) between treatment groups. There were no correlation between changes in the VDR, IL-6 and IGF-1 monocytes with changes in hand grip strength and walking speed. There was a significant increase in 25(OH)D levels in each group and a significant difference between groups. Supplementation of cholecalciferol 4.000 IU daily for 12 weeks increased serum 25(OH)D level significantly, however it did not improve hand grip strength and walking speed, and did not affect VDR, IL-6 and IGF-1 monocytes in pre-frail elderly. Kidney function had an influence on the effect of cholecalciferol on monocyte IGF-1. Cholecalciferol increased the number of monocytes with IGF-1+ at eGFR > 90, but not at eGFR 30–59."

"TUJUAN: Mengetahui efek metformin atau DLBS3233 terhadap kadar AMH. LATAR BELAKANG: SOPK merupakan sindrom yang diketahui berkaitan dengan resistensi insulin dalam patofisiologi dan peranan AMH dalam patogenesis. Maka salah satu bagian dari tatalaksana SOPK adalah dengan pemberian insulin sensitizing agent ISA. ISA yang telah banyak digunakan yaitu metformin yang terbukti dalam memperbaiki siklus haid, namun obat ini juga menimbulkan efek samping seperti keluhan gastrointestinal yang cukup berat. Sehingga perkembangan obat herbal seperti fraksi bioaktif DLBS3233 memberikan harapan akan ISA yang efektif, namun memiliki efek samping minimal. Peranan ISA dalam efek perubahan AMH masih kontroversial, dan hanya ditemui penelitian yang meneliti metformin. DESAIN DAN METODE: Penelitian ini menggunakan desain uji klinis acak tersamar ganda yang berlangsung pada bulan Maret 2013 hingga Juni 2015 di klinik Yasmin, RSCM Kencana dan RS Hasan Sadikin, Bandung. Subjek penelitian akan mendapatkan metformin sebanyak 2x750mg atau DLBS3233 1x100mg per hari selama enam bulan. Evaluasi kadar AMH akan dilakukan sebanyak dua kali, sebelum dan sesudah pengobatan. HASIL: Sebanyak 20 subjek mendapati metformin dan 18 subjek mendapati DLBS3233. Rerata kadar AMH sebelum pengobatan didapati 9,30 5,06 ng/mL dan 11,27 6,47 ng/mL. Pasca pengobatan, didapati penurunan kadar AMH yang signifikan sebesar 1,52 0,07 p < 0,001. Penurunan kadar AMH didapati lebih tinggi pada grup metformin bila dibandingkan dengan DLBS3233 ? AMH = 1,83 ng/mL vs 1,15 ng/mL. Namun, metformin menimbulkan efek samping yang lebih signifikan dibandingkan DLBS3233 p=0,01. Sebanyak 7 pasien 18,42 hamil selama penelitian ini. Namun efek samping pengobatan jauh dirasakan oleh subjek yang mendapatkan metformin dibandingkan DLBS3233 p=0,01. KESIMPULAN: Baik metformin atau fraksi bioaktif DLBS3233 dapat menurunkan kadar AMH, dan DLBS3233 merupakan pilihan terapi SOPK dengan efek samping yang minimal.

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OBJECTIVE: To determine the effect of metformin and DLBS3233 on serum AMH level.

BACKGROUND: PCOS is known to be associated with insulin resistance in the pathophysiology and Anti Mullerian Hormone AMH in the pathogenesis. Thus, one of management of PCOS is to give insulin sensitizing agent ISA. Type of ISA which has been widely used is metformin which proven to improve menstrual cycle, but this medication cause major side effect such as gastrointestinal problems. So, the development of herbal medicine such as Bioactive Fraction DLBS3233, offer effective medicine, with minimal side effects. To date, the role of ISA to effects the changes in AMH still controversial, and studies only examine the effect of metformin to the level of AMH.

METHOD: Double blind randomized controlled trial was conducted in Yasmic Clinic, Cipto Mangunkusumo General Hospital, Kencana and Hasan Sadikin hospital, Bandung within March 2013 until June 2015. PCOS patient diagnosed using Rotterdam All participant get daily dose of metformin 2x750mg or DLBS3233 1x100mg for six months. Evaluation of serum AMH level was conducted twice prior therapy and after the completion of the therapy. Protocol analysis was carried out upon differences of AMH using SPSS 20.

RESULTS: 20 subjects received metformin, while 18 subject received DLBS3233. Level of AMH prior medication was known to be 9,30 5,06 ng mL and 11,27 6,47 ng mL. After six months of therapy, there is significant decrease of AMH level of 1,52 0,07 p 0,001. The decrease level of AMH was observed higher in metformin group compared to DLBS3233 AMH 1,83 ng mL vs 1,15 ng mL. However, metformin causing more side effects compared to DLBS3233 p 0,01. There are total of 7 subjects 18,42 pregnant during the studies.

CONCLUSION: There rsquo s a significant decrease of AMH level after administration of either metformin or DLBS3233. "

"Hipertensi merupakan penyakit kardiovaskular yang paling umum dan paling banyak diderita, terutama oleh lanjut usia (lansia). Beberapa penelitian menunjukkan vitamin D berperan dalam tekanan darah. Pada lansia kadar 25(OH)D menurun karena kurangnya paparan sinar matahari dan asupan makanan yang mengandung vitamin D. Kekurangan vitamin D dapat dicegah, salah satunya dengan suplementasi. Penelitian ini merupakan penelitian eksperimental dengan desain uji acak terkendali tersamar ganda pada lansia di Panti Sosial Tresna Werdha Budi Mulia 1 bulan April sampai Juni 2023 dengan tujuan menganalisis pengaruh suplementasi vitamin D terhadap kadar 25(OH)D dan tekanan darah. Kadar 25(OH)D serum diperiksa menggunakan metode Chemiluminescent Immunoassay (CLIA), tekanan darah diperiksa menggunakan sphygmomanometer digital. Suplementasi diberikan 1 kali perhari selama 8 minggu, untuk kelompok kontrol diberikan plasebo sedangkan untuk kelompok perlakuan diberikan vitamin D dengan dosis 2000IU (subjek Insufisiensi) dan 4000IU (subjek defisiensi). 62 subjek penelitian berusia 60-89 tahun (median 67 tahun) ikut serta dalam penelitian ini dan terbagi secara random menjadi 30 subjek kelompok kontrol dan 32 subjek kelompok perlakuan. Peningkatan kadar 25(OH)D pada kelompok kontrol 23 ± 4,87 ng/mL menjadi 27,3 ± 7,34 ng/mL (p=0,000), pada kelompok perlakuan 17,9 ± 4,38 ng/mL menjadi 36,07 ± 9,84 ng/mL (p=0,000). Analisis rerata perubahan menunjukkan bahwa suplementasi vitamin D meningkatkan kadar 25(OH)D secara bermakna (D = 4,2 ± 2,47 ng/mL pada kelompok kontrol dan D = 18,17 ± 5,46 ng/mL pada kelompok perlakuan; p = 0.000). Penurunan tekanan darah sistolik pada kelompok kontrol 133,9(121 – 159,5) mmHg menjadi 129,3(96 – 159) mmHg (p=0,027), pada kelompok perlakuan 135,3(121 - 180) mmHg menjadi 126(101 - 153) mmgHg (p=0,000). Penurunan tekanan darah diastolik pada kelompok kontrol 89,6(80 - 105) mmHg menjadi 82,4(64 - 103) mmHg (p=0,000), pada kelompok perlakuan 89,2(81,5 – 98,5) mmHg menjadi 80,8 (67 – 90) mmHg (p=0,000). Akan tetapi, analisis rerata perubahan menunjukkan bahwa suplementasi vitamin D tidak menyebabkan penurunan tekanan darah sistolik (D = -4,6(-25 - -0,5) mmHg pada kelompok kontrol dan D = -9,2 (-20 - -27) mmHg pada kelompok perlakuan; p = 0.109) dan tekanan darah diastolik secara bermakna (D = -7,2 (-16 - -2) mmHg pada kelompok kontrol dan D = -8,4 (-14,5 - -8,5) mmHg pada kelompok perlakuan; p=0,559). Suplementasi vitamin D dapat meningkatkan kadar 25(OH)D secara bermakna, tetapi tidak menurunkan tekanan darah sistolik dan diastolik secara bermakna pada lansia.

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Hypertension is the most common cardiovascular disease, especially in the elderly. Previous studies have reported that vitamin D play a role in blood pressure. In elderly, serum 25(OH)D levels decrease due to lack of sun exposure and intake of food sources of vitamin D. Vitamin D deficiency can be prevented by supplementation. This is an experimental study with double-blind randomized placebo-controlled trial (RCT) on elderly subjects at the Tresna Werdha Budi Mulia 1 Social Institution from April until June 2023 to analyze the effect of vitamin D supplementation on serum 25(OH)D levels and blood pressure. Serum 25(OH)D levels were examined using Chemiluminescent Immunoassay (CLIA) method, blood pressure was checked using digital sphygmomanometer. Supplementation was given once per day for 8 weeks, control group was given a placebo while treatment group was given vitamin D3 supplementation at dose of 2000IU (insufficiency subjects) and 4000IU (deficiency subjects). A total of 62 research subjects aged 60-89 years (median 67 years) participated in this study and randomized into 30 control group subjects and 32 treatment group subjects. The increase in serum 25(OH)D levels in the control group was 23 ± 4,87 ng/mL to 27,3 ± 7,34 ng/mL (p = 0.000), the treatment group was 17,9 ± 4,38 ng/mL to 36,07 ± 9,84 ng/mL (p = 0.000). Data analysis showed that vitamin D supplementation significantly increased 25(OH)D levels in the treatment group compared to the control group (D = 4,2 ± 2,47 ng/mL for control group and D = 18,17 ± 5,46 ng/mL for treatment group; p = 0.000). The decrease in systolic blood pressure in the control group was 133,9(121 – 159,5) mmHg to 129,3(96 – 159) mmHg (p = 0.027), the treatment group was 135,3(121 - 180) mmHg to 126(101 - 153) mmgHg (p = 0.000). The decrease in diastolic blood pressure in the control group was 89,6(80 - 105) mmHg to 82,4(64 - 103) mmHg (p = 0.000), the treatment group was 89,2(81,5 – 98,5) mmHg to 80,8 (67 – 90) mmHg (p = 0.000). However, data analysis showed that vitamin D supplementation did not cause a significant reduction in systolic blood pressure (D = -4,6(-25 - -0,5) mmHg for control group and D = -9,2 (-20 - -27) mmHg for treatment group; p = 0.109) and diastolic blood pressure in the treatment group compared to the control group (D = -7,2 (-16 - -2) mmHg for control group and D = -8,4(-14,5 - -8,5) mmHg for treatment group; p = 0.559). Vitamin D supplementation significantly increase serum 25(OH)D levels, but not significantly reduce systolic and diastolic blood pressure in the elderly."

"Latar belakang: Diabetes tipe 2 ditandai dengan resistensi dan defisiensi insulin, selain itu seiring dengan penuaan kejadian resistensi insulin juga semakin meningkat. Pada studi-studi klinis, resistensi insulin dan diabetes tipe 2 terbukti meningkatkan kejadian sindrom frailty pada usila. Obat antidiabetik oral metformin telah dikaitkan dengan penghambatan proses penuaan. Namun demikian, sampai saat ini belum ada data yang menunjukkan manfaat terapi metformin terhadap kejadian sindrom frailty. Penelitian ini bertujuan untuk melihat apakah ada efek protektif metformin terhadap sindrom frailty. Metodologi: Studi ini dilakukan secara kasus kontrol pada subyek berusia ≥60 tahun yang berobat di poliklinik Geriatri dan Diabetes FKUI-RSCM, bulan Maret-Juni 2013. Diagnosis frailty dilakukan dengan menggunakan indeks frailty-40 item (FI-40). Analisis statistik dilakukan dengan metode chi-square untuk analisis bivariat dan regresi logistik untuk analisis multivariat, semua data disertai dengan interval kepercayaan 95%. Hasil: Sindrom frailty didapatkan pada 25% (n=59) subyek penelitian, sedangkan pre-frail pada 72% (n=170) subyek dan sisanya fit. Metformin ditemukan mempunyai hubungan dengan sindrom frailty pada usila dengan diabetes mellitus tipe 2, yang tetap bermakna setelah dilakukan analisis multivariat (adjusted OR 0,043; IK 95% 0,019 – 0,099; p<0,001).

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Background: Type 2 diabetes (T2DM) was characterised with insulin resistance and deficiency, furthermore with advancing age the was also an increase in insulin resistance. Clinical studies has proven that insulin resistance and T2DM increase the incidence of frailty syndrome in the elderly. Oral antidiabetics metformin was associated with the inhibition of aging process. Eventhough, there was no data that showed the relationship of metformin therapy to frailty syndrome. This study aimed to explore the possibility of metformin protective effect on frailty syndrome.

Methodology: This was a case control study conducted in subjects ≥60 years old who visited the Geriatrics and Diabetes outpatient clinic of Cipto Mangunkusumo National Referral Hospital between March and June 2013. Diagnosis of frailty was established using the FI-40 item criteria. Statistical analysis was done with chi-square method for bivariate and logistic regression method in multivariate analysis, all data was accompanied with 95% confidence interval.

Results: Frailty syndrome was found in 25% of subjects (n=59), with median age of 72 years old (SD 6.27) and median of FI-40 item score was 0.18 (SD 0.085). Metformin was found to have a significant relationship with frailty syndrome in the elderly diabetics, which retained significant value after multivariate analysis (adjusted OR 0.043; 95% CI 0.019-0.099; p<0.001).

Conclusion: Metformin was shown to have protective effect against frailty syndrome in elderly diabetics."

"Salah satu faktor penyebab kulit kering pada lanjut usia adalah penurunan konsentrasi asam hialuronat pada epidermis dan dermis. Asam hialuronat berat molekul kecil dianggap lebih efektif melembapkan kulit dibandingkan asam hialuronat berat molekul besar. Penelitian ini merupakan uji klinis acak terkontrol tersamar ganda yang dilakukan pada 36 orang berusia 60-80 tahun dengan kulit kering di Panti Sosial Tresna Werdha Budi Mulia 3. Setelah prakondisi selama satu minggu, setiap subjek penelitian mendapatkan tiga pelembap yang berbeda secara acak pada tiga lokasi di tungkai bawah, yang dioleskan dua kali sehari. Penilaian skin capacitance (SCap), transepidermal water loss (TEWL), dan skor SRRC dilakukan pada minggu ke-0, 2, dan 4. Nilai SCap lebih tinggi pada area pengolesan asam hialuronat berat molekul kecil dibandingkan dengan asam hialuronat berat molekul besar (56,37 AU vs 52,37 AU, p=0,004) dan vehikulum (56,37 AU vs 49,01 AU, p<0,001). Tidak terdapat perbedaan nilai TEWL dan skor SRRC yang bermakna antara ketiga kelompok perlakuan. Tidak ditemukan efek samping subjektif dan objektif pada ketiga kelompok perlakuan. Pelembap yang mengandung asam hialuronat berat molekul kecil meningkatkan SCap lebih tinggi secara bermakna daripada asam hialuronat berat molekul besar dan vehikulum serta memiliki keamanan yang sama dalam mengatasi kulit kering pada populasi lansia.

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A contributing cause to dry skin is a reduced concentration of hyaluronic acid (HA) in both the epidermis and dermis. Low molecular weight HA (LMWHA) is believed to be more effective in replenishing skin hydration in aging skin compared to High Molecular Weight HA (HMWHA). A double-blind, randomized controlled trial was conducted on 36 residents of a nursing home in Jakarta, aged 60 and 80 years with dry skin. Following a week of preconditioning, each test subject was administered three distinct, randomized moisturizing lotions, to be topically applied to three separate sites on the leg. Skin capacitance (SCap), transepidermal water loss (TEWL), and SRRC scores were measured at weeks 0, 2, and 4. After four weeks of therapy, area that was treated with LMWHA showed greater SCap values compared to the area treated with HMWHA (56.37 AU vs 52.37 AU, p=0.004) and vehicle (56.37 AU vs 49.01 AU, p<0.001). All groups did not show any significant differences in TEWL and SRRC scores. No side effects were found in all groups. The application of a moisturizer containing LMWHA to the dry skin of elderly resulted in significant improvements in skin hydration compared to moisturizers containing HMWHA and vehicle. Furthermore, these moisturizers demonstrated similar safety in treating dry skin in the elderly."

"ABSTRAKKualitas hidup pada usia lanjut akan semakin menurun seiring dengan bertambahnya usia. Menurunnya kualitas hidup pada usia lanjut dapat disebabkan oleh penurunan massa otot, kekuatan otot, dan aktivitas fisik yang dikenal sebagai sarkopenia atau penyakit kronik-degeneratif. Salah satu bentuk skrining sarkopenia adalah menilai kekuatan genggam tangan. Kekuatan genggam tangan diduga dapat memprediksi kualitas hidup populasi usia lanjut. Penelitian ini bertujuan untuk mengetahui korelasi kekuatan genggam tangan yang diukur dengan dinamometer Jamar dengan kualitas hidup yang diukur dengan kuesioner EQ-5D dan EQ-5D VAS pada pasien usia lanjut. Penelitian ini menggunakan desain cross-sectional dan dilakukan pada 123 pasien usia lanjut di Poli Klinik Geriatri Terpadu RSUPN Cipto Mangunkusumo. Hasil analisis dengan uji Spearman menunjukkan bahwa terdapat korelasi bermakna antara kekuatan genggam tangan dan kualitas hidup yang diukur dengan kuesioner EQ-5D r = 0,219; p = 0,015 maupun EQ-5D VAS r = 0,266; p = 0,003 . Sebagai kesimpulan, kekuatan genggam tangan memiliki korelasi bermakna dengan kualitas hidup pada pasien usia lanjut.

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ABSTRAKThe quality of life in elderly will decrease with age. Declining quality of life in elderly due to decreased muscle mass, muscle strength, and physical activity is known as sarcopenia and suffering from chronic degenerative diseases. One form of sarcopenia screening is assessing the hand grip strength. Hand grip strength could be expected to predict the quality of life of the elderly population. This study aimed to determine the correlation of hand grip strength measured by Jamar dynamometer with the quality of life measured by the EQ 5D and EQ 5D VAS questionnaire in elderly patients. This study used cross sectional design and conducted on 123 elderly patients in Integrated Geriatric Poly Clinic Cipto Mangunkusumo General Hospital. The results of the analysis with Spearman test showed a significant correlation between hand grip strength with quality of life as measured by the EQ 5D questionnaire r 0.219 p 0.015 and EQ 5D VAS questionnaire r 0.266 p 0.003 . In conclusion, there are significant correlation between hand grip strength with quality of life in elderly patients."

"ABSTRAKLatar Belakang : Aphanizomenon Flos Aquae merupakan suatu spesiesganggang biru-hijau yang dimanfaatkan sebagai suplemen nutrisi di seluruh duniatermasuk di Indonesia dan diketahui memiliki banyak aktivitas biologisbermanfaat seperti efek anti-inflamasi, anti-oksidan dan analgetik. Osteoartritis(OA) lutut merupakan permasalahan yang cukup sering didapatkan pada lanjutusia (lansia) namun sampai saat ini belum tersedia modalitas farmakologik sebagai terapi ajuvan yang sesuai dan aman pada kelompok lansia. Aphanizomenon Flos Aquae dapat menjadi alternatif yang baik sebagai terapiajuvan dalam tatalaksana pasien lansia dengan OA lutut. Tujuan Penelitian : Mengkaji pengaruh AFA terhadap perbaikan klinis OA lututpada lansia berdasarkan indeks WOMAC.Metode : Dilakukan uji klinis acak tersamar ganda mulai November 2014 hinggaMei 2015 terhadap pasien lanjut usia dengan OA lutut di poliklinik Geriatri danReumatologi di RSUP Hasan Sadikin Bandung. Subjek dibagi menjadi 2kelompok yaitu satu kelompok mendapat kapsul berisi AFA 2 kali 2 kapsul (1,28g/hari) dan kelompok lainnya mendapat plasebo selama 60 hari. Skor IndeksWOMAC dinilai pada hari ke-1 dan hari ke-60 untuk menilai luaran klinis pasienOA. Perbedaan skor indeks WOMAC pada akhir penelitian dianalisis dengan ujiMann-Whitney. Hasil : Dari total 254 subjek didapatkan 98 subjek yang memenuhi kriteria awalpenelitian dan kemudian dilakukan randomisasi menjadi kelompok perlakuan danplasebo, masing-masing terdiri dari 49 subjek. Kedua kelompok sebanding padaseluruh faktor prognostik penting. Setelah analisis, skor indeks WOMACkomposit kelompok AFA berbeda secara bermakna (p<0,001) dibanding plasebopada akhir penelitian dengan masing-masing skor 8 (median,RIK 3-18) vs. 18(median,RIK 8-32). Tidak ditemukan adanya efek samping yang serius selamapenelitian. Simpulan : Aphanizomenon Flos Aquae dapat memperbaiki klinis berdasarkanskor indeks WOMAC serta aman diberikan pada pasien lansia dengan OA lutut.

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ABSTRACTBackground: Aphanizomenon Flos Aquae is a species of blue-green algae whichis commonly used as nutritional supplement in the world, including in Indonesiaand is known to have many beneficial biological activities such as antiinflammatory,anti-oxidantand analgesics. Osteoarthritis (OA) knee is a problemthat is quite common in the older people but until now there has not beenpharmacologic modalities as a adjunctive therapy available which are suitable and safe. Aphanizomenon Flos Aquae may become a good alternative as an adjunctive therapy in older patients with knee OA.Objective : To determine the effect of AFA on the improvement of clinicaloutcome of Knee OA in older patients based on WOMAC index scores.Methods : A double-blind randomized clinical trial was conducted fromNovember 2014 until May 2015 to older adult patients with Knee OA at theGeriatric and Rheumatology clinic in Hasan Sadikin General Hospital. Thesubjects were divided into groups, each group received capsules containing AFA2 times 2 capsules (1.28 gr/day) and the other received placebo for 60 days.WOMAC Index scores were assessed at day 1 and day 60. The difference inassessment of WOMAC index scores of each group at the end of the study wereanalyzed by Mann-Whitney. Results : Out of total 254 subjects, there were 98 patients who met the initialcriteria and were randomized into two groups, AFA and placebo group with eachconsisting of 49 subjects. Both groups were comparable in all importantprognostic factors. The composite WOMAC Index scores in AFA group wassignificantly different than the placebo group at the end of the study (p <0.001),with each score of 8 (IQR,median 3-18) vs. 18 (IQR,median 8-32) respectively.There was no serious adverse events found throughout the study. Conclusion : Aphanizomenon Flos Aquae was able to show clinical improvement based on WOMAC scoring index and safe to use in the older adults with Knee OA.;Background: Aphanizomenon Flos Aquae is a species of blue-green algae whichis commonly used as nutritional supplement in the world, including in Indonesiaand is known to have many beneficial biological activities such as antiinflammatory,anti-oxidantand analgesics. Osteoarthritis (OA) knee is a problemthat is quite common in the older people but until now there has not beenpharmacologic modalities as a adjunctive therapy available which are suitable and safe. Aphanizomenon Flos Aquae may become a good alternative as an adjunctive therapy in older patients with knee OA.Objective : To determine the effect of AFA on the improvement of clinicaloutcome of Knee OA in older patients based on WOMAC index scores.Methods : A double-blind randomized clinical trial was conducted fromNovember 2014 until May 2015 to older adult patients with Knee OA at theGeriatric and Rheumatology clinic in Hasan Sadikin General Hospital. Thesubjects were divided into groups, each group received capsules containing AFA2 times 2 capsules (1.28 gr/day) and the other received placebo for 60 days.WOMAC Index scores were assessed at day 1 and day 60. The difference inassessment of WOMAC index scores of each group at the end of the study wereanalyzed by Mann-Whitney. Results : Out of total 254 subjects, there were 98 patients who met the initialcriteria and were randomized into two groups, AFA and placebo group with eachconsisting of 49 subjects. Both groups were comparable in all importantprognostic factors. The composite WOMAC Index scores in AFA group wassignificantly different than the placebo group at the end of the study (p <0.001),with each score of 8 (IQR,median 3-18) vs. 18 (IQR,median 8-32) respectively.There was no serious adverse events found throughout the study. Conclusion : Aphanizomenon Flos Aquae was able to show clinical improvement based on WOMAC scoring index and safe to use in the older adults with Knee OA."