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"ABSTRAKLatar Belakang: Kanker tiroid merupakan keganasan endokrin yang paling sering ditemukan dan insidennya semakin meningkat. Meskipun metode biopsi aspirasi jarum halus memiliki sensitivitas yang baik dalam mendiagnosis nodul tiroid, sebanyak 10-40 masih memberikan hasil inkonklusif dalam penentuan keganasan. Hal ini sering merugikan pasien karena harus mengalami re-operasi apabila terdapat keganasan pada hasil histopatologi.Tujuan Penelitian: Mengetahui proporsi dan mendapatkan nilai diagnostik dari pemeriksaan mutasi BRAF, NRAS, dan promoter TERT pada spesimen BAJAH untuk meningkatkan akurasi diagnosis kanker tiroid.Metode Penelitian: Studi retrospektif dengan mengikutsertakan 50 pasien nodul tiroid yang memerlukan pembedahan. Spesimen diambil pada saat proses BAJAH atau pasca operasi. Deteksi mutasi BRAF, NRAS, dan promoter TERT menggunakan metode DNA sekuensing Sanger . Hasil mutasi akan dibandingkan dengan pemeriksaan baku emas histopatologi.Hasil: Dari 50 kasus yang ikut dalam analisis, terdapat 39 kasus 78 merupakan keganasan tiroid. Nilai proporsi mutasi BRAF, NRAS, dan pTERT berturut-turut sebesar 31 , 18 , dan 13 . Uji diagnostik mutasi BRAF menghasilkan sensitivitas, spesifisitas, nilai duga positif, dan nilai duga negatif berturut-turut 31 , 100 , 100 , 29 terhadap kanker tiroid. Untuk mutasi NRAS sebesar 18 , 100 . 100 , 26 . Sedangkan untuk mutasi pTERT sebesar 13 , 100 , 100 , 24 . Jika ketiga mutasi tersebut dikombinasikan, maka nilainya akan meningkat menjadi 49 , 100 , 100 , 35 . Kesimpulan: Pemeriksaan mutasi BRAF, NRAS dan promoter TERT pada kanker tiroid masing-masing memiliki spesifisitas yang tinggi. Jika ketiganya dikombinasikan maka akan meningkatkan sensitivitas untuk membantu dalam meningkatkan akurasi diagnosis keganasan tiroid.

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ABSTRACTBackground Thyroid cancer is the most common endocrine malignancy and it rsquo s incidence is on the rise. Although the fine needle aspiration biopsy FNAB has a good sensitivity in the diagnosis of thyroid nodules, as much as 10 40 still gives inconclusive results in malignant determination. This is often detrimental to patients having to undergo re surgery if there is a malignancy in the histopathologic outcome.Aim To establish the proportion and diagnostic value of BRAF, NRAS, and TERT promoter mutation detection on FNAB specimens to improve the accuracy of thyroid cancer diagnosis.Methods The retrospective study by involving 50 patients with thyroid nodules surgery. Specimens were taken during the FNAB or postoperative process. Detection of BRAF, NRAS, and TERT promoter mutation using DNA sequencing method Sanger . The mutation results will be compared with the histopathologic gold standard examination.Resuts Of the 50 cases involved in the analysis, there were 39 cases 78 of thyroid malignancies. The proportion of BRAF, NRAS, and pTERT mutations was 31 , 18 , and 13 , respectively. BRAF mutation diagnostic test results in sensitivity, specificity, positive predictive value, and negative predictive value were 31 , 100 , 100 , 29 respectively. For NRAS mutation were 18 , 100 . 100 , 26 . As for pTERT mutation were 13 , 100 , 100 , 24 . If the three mutations are combined, then the value will increase to 45 , 100 , 100 , 35 .Conclusion Detection mutations of BRAF, NRAS and TERT promoters in thyroid cancer have a high specificity. If all three are combined it will increase the sensitivity to improve the accuracy of the diagnosis in thyroid malignancy."

"ABSTRAKLatar belakang : Fine Needle Aspiration Cytology FNAC adalah teknik yang cepat, murah, dengan komplikasi yang minimal untuk mendiagnosis tumor tulang. FNAC memiliki kapasitas untuk membedakan lesi jinak dan ganas. Namun FNAC memiliki keterbatasan di sisi teknik dan cara interpretasi.Tujuan : mengevaluasi akurasi FNAC sebagai salah satu prosedur preoperasi diagnosis tumor tulang. Metode : Sampel diambil dari arsip rekam medis pasien curiga tumor tulang yang diperiksa dengan FNAC dan histopatologi di Departemen Patologi Anatomi FKUI/RSCM dari tahun 2011 sampai 2014. Uji diagnostik dilakukan untuk mengetahui sensitivitas, spesifisitas, PPV, NPV, dan akurasi dari FNAC. Hasil : Terdapat 78 pasien kasus curiga tumor tulang yang diperiksa dengan FNAC dan Histopatologi di Departemen Patologi Anatomi FKUI/RSCM pada tahun 2011 ndash; 2014. Empat puluh sembilan kasus dilaporkan tumor tulang ganas dengan 5 kasus diskrepansi subtipe ganas dan 20 kasus tumor tulang jinak dengan 1 kasus diskrepansi subtype jinak. Selain itu, terdapat 8 kasus negatif semu dan 1 kasus positif semu. Secara keseluruhan, hasil yang didapatkan adalah sensitivitas 86 , spesifisitas 95.2 , PPV 98 , NPV 71.4 , dan akurasi sebesar 88.5 .Kesimpulan : Penelitian ini menunjukkan bahwa FNAC memiliki kualitas yang baik untuk mendiagnosis tumor tulang, dibuktikan dengan tingginya angka sensitivitas dan spesifisitas 86 dan 95.2 .

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ABSTRACTBackground Fine Needle Aspiration Cytology FNAC is a rapid, inexpensive, minimum invasive technique with less complication in diagnosing bone neoplasm. FNAC is able to differentiate between neoplasm and non neoplasm cases. However, there are limitations of FNAC technique and interpretation.Aim to evaluate the accuracy of FNAC as one of diagnostic approach in preoperative or diagnosing bone neoplasm.Method Samples were obtained from archives of medical records data of patients who clinically suspected of bone neoplasm and undergo FNAC Histopathology in Anatomical Pathology Department FKUI RSCM from 2011 to 2014. The diagnostic test will be conducted in order to obtain the sensitivity, specificity, PPV, NPV, and accuracy of FNAC.Results There are 78 patients of bone neoplasm were undergo Fine Needle Aspiration Cytology and Histopathology examination from the archives Anatomical Pathology Department in 2011 to 2014. Forty nine cases were reported as malignant bone neoplasm with 5 discrepancy type and 20 cases were benign with 1 discrepancy type. Furthermore, there were 8 false negative cases, and 1 false positive case. The sensitivity, specificity, positive predictive value PPV , negative predictive value NPV , accuracy were 86 . 95.2 . 98 , 71.4 , and 88.5 respectively.Conclusions FNAC shows a good quality as one of diagnostic approach in bone neoplasm as can be seen in a high sensitivity and specificity 86 and 95.2 in this study. "

"Latar Belakang: Penegakkan diagnosis sedini dan setepat mungkin menjadi hal utama dalam penatalaksanaan kanker paru. Beberapa penelitian sebelumnya tentang biopsi transtorakal dengan panduan USG menunjukkan akurasi diagnosis yang cukup baik. USG dinilai sebagai modalitas radiologi yang mudah digunakan secara aman, bedside, real-time, mobile dan bebas pajanan radiasi. Saat ini di RSUP Persahabatan Jakarta belum terdapat penelitian tentang biopsi jarum halus transtorakal dengan panduan USG.Metode Penelitian:  Studi observasional dengan pendekatan potong lintang terhadap subjek dengan tumor paru atau tumor mediastinum yang dilakukan biopsi jarum halus transtorakal dengan panduan ultrasononografi toraks pada bulan April-September 2021. Pengambilan sampel dilakukan secara consecutive sampling. Peneliti melakukan observasi terhadap karakteristik lesi, karakteristik prosedur dan komplikasi. Diagnosis akhir berdasarkan hasil sitologi biopsi jarum halus transtorakal dengan panduan USG.Hasil Penelitian: Dari 46 subjek, rerata usia subjek adalah 52 tahun dan didominasi jenis kelamin laki-laki (69,6%) dan jenis tumor terbanyak adalah tumor paru (80,4%). Proporsi kepositifan sitologi biopsi jarum halus transtorakal dengan panduan USG toraks adalah 78,3%. Karakteristik lesi pada subjek dengan hasil sitologi TTNA positif antara lain memiliki rerata diameter lesi 9,61 ± 2,27 cm, lesi di anterosuperior paru (63,9%), memiliki gambaran ekogenitas hipoekoik heterogen (58,3%) dan memiliki kontak dengan pleura (77,8%). Karakteristik prosedur pada subjek dengan hasil sitologi TTNA positif antara lain dilakukan teknik aspirasi (77,8%), pengambilan TTNA sebanyak < 3 set (58,3%), rerata jumlah gelas objek yang terpakai adalah 15 ± 4 dan median kedalaman insersi adalah 4 (2 – 6) cm. Komplikasi pasca tindakan terjadi pada dua subjek yaitu hemoptisis (4%).Kesimpulan: Biopsi jarum halus transtorakal merupakan metode diagnostik yang invasif minimal dengan proporsi kepositifan yang tinggi (78,3%) dan angka komplikasi yang rendah (4%).

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Background: Treatment of multidrug-resistant tuberculosis (MDR-TB) using second-line drugs is known to have more side effects. Recent studies have shown concern about bedaquiline and delamanid that can cause a prolonged QT interval. This condition is a known risk factor for Torsades de Pointes, a lethal cardiac arrhythmia. This study sought to observe the condition among such patients treated in the study location.

Methods: This study was a prospective cohort study  of MDR-TB patients receiving bedaquilin in the outpatient clinic and inpatient ward of National Respiratory Referral Hospital Persahabatan, Jakarta, Indonesia between February 2020 to February 2021. Patients received 400 mg on week 0-2 (intensive phase) and followed by 200 mg 3 times per week (continuation phase) of bedaquiline. Sampling was carried out by consecutive sampling and data on subjects who met the inclusion criteria were taken from medical records.

Result: From a total of 71 subjects, all of them met the inclusion criteria. Prolonged QT interval was experienced in 18.3% patients. From eleven patients who experienced prolonged QT interval, two patients required hospitalization: one presented with nausea and gastric upset and one patient presented with dyspnea and palpitation. Prolonged QT interval occurred in initial phase and correlated with drug dosing. A mycobacterial culture conversion at month-6 was observed in those receiving multidrug regimens which include bedaquiline, quinolone, and clofazimine. There was a correlation between prolonged QT interval and hypocalemia. Treatment success rate was 46.5% without prolonged QT. Other outcomes included 4.2% died, 26.8% loss-to-follow up, and 4.1% treatment failed.

Conclusion: The use of bedaquiline MDR-TB appeared to be effective and safe across different settings, although the certainty of evidence was assessed as very low. Hypokalemia was correlated with the outcomes of patients receiving bedaquiline, particularly in those experienced prolonged QT interval."

"Tujuan. Penelitian ini dibuat untuk mengetahui peranan mutasi BRAF V600E dan TERT dalam kejadian metastasis kelenjar getah bening (KGB) leher pada pasien kanker tiroid papiler (KTP)Metode. Penelitian ini merupakan studi potong lintang, melibatkan pasien KTP di RSUPN Dr. Cipto Mangunkusumo, DKI Jakarta. Data-data diperoleh secara retrospektif berdasarkan catatan rekam medis, kecuali untuk mutasi BRAF V600E dan Promoter TERT. Spesimen jaringan tumor pasien kanker tiroid papiler ditransfer ke Laboratorium Terpadu FKUI. DNA diekstrasi menggunakan QIAamp DNA FFPE Tissue Kit sebanyak 3-8 potongan dengan ketebalan FFPE 5-10 mikrometer. Multiplikasi gen BRAF dilakukan dengan KOD One Polymerase Chain Reaction (PCR) Master Mix (Toyobo KMM–201), sementara multiplikasi gen TERT dilakukan dengan PCR Master Mix (2X MyTaq HS Red Mix, primer forward, reverse, dan Nuclear-free water). Analisis data dilakukan dengan SPSS versi 20. Hasil. Peneliti menginklusi 42 pasien KTP dengan 19 (45%) mengalami mutasi BRAF, 20 (48%) mengalami mutasi TERT, dan 20 (48%) mengalami metastasis KGB. Mutasi BRAF ditemukan berhubungan dengan kejadian metastasis KGB [p<0,001, OR = 25,333 (IK95% 4,924–130,340)], sementara mutasi TERT ditemukan tidak berhubungan. Pasien yang mengalami mutasi BRAF tanpa TERT memiliki risiko 18,000 (IK95% 2,012–161,051) lebih tinggi untuk mengalami metastasis KGB dibandingkan pasien tanpa kedua mutasi. Lebih lanjut, adanya mutasi TERT yang berbarengan dengan mutasi BRAF membuat risiko meningkat menjadi 60,000 (4,718–763,043) lebih tinggi dibandingkan pasien tanpa kedua mutasi. Kesimpulan. Mutasi BRAF berhubungan dengan metastasis KGB pasien KTP, namun tidak dengan mutasi TERT. Namun, kehadiran mutasi TERT pada pasien KTP dengan mutasi BRAF meningkatkan risiko metastasis KGB.

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Objective. This study was designed to determine the role of BRAF V600E and TERT mutations in the incidence of neck lymph node (LN) metastasis in patients with papillary thyroid cancer (PTC). Methods. This was a cross-sectional study, involving KTP patients at Dr. Cipto Mangunkusumo Hospital, DKI Jakarta. Data were obtained retrospectively based on medical records, except for BRAF V600E and TERT promoter mutation. Tumor tissue specimens of PTC’s patients were transferred to the Laboratorium Terpadu FKUI. DNA was extracted using QIAamp DNA FFPE Tissue Kit for 3-8 pieces with FFPE thickness of 5-10 micrometers. BRAF gene multiplication was performed with KOD One Polymerase Chain Reaction (PCR) Master Mix (Toyobo KMM-201), while TERT gene multiplication was performed with PCR Master Mix (2X MyTaq HS Red Mix, primers forward, reverse, and Nuclear-free water). Data analysis was performed with SPSS version 20. Results. We included 42 PTC’s patients with 19 (45%) patients had BRAF mutation, 20 (48%) patients had TERT mutation, and 20 (48%) patients had LN metastasis. BRAF mutation was associated with the LN metastasis [p<0.001, OR = 25.333 (95% CI 4.924-130.340)], while TERT mutation was not. Patients with BRAF+ and TERT- had an 18,000 (IK95% 2,012-161,051) higher risk of LN metastasis than patients with BRAF- and TERT-. Furthermore, the presence of TERT mutation along with BRAF mutation increased the risk to 60,000 (4,718-763,043) higher than patients with BRAF- and TERT-. Conclusion. BRAF mutation was associated with LN metastasis in PTC’s patients, but not TERT mutations. However, the presence of TERT mutation in PTC’s patients with BRAF mutation increased the risk of LN metastasis.

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"Latar belakang: Kasus baru kanker paru semakin bertambah dan mulai banyak dialami usia muda. Pendekatan skrining dalam upaya deteksi dini dilanjutkan tindakan diagnostik yang cepat dan akurat memberikan penderita memeroleh kualitas hidup yang lebih baik dalam perjalanan penyakitnya. Biopsi paru transtorakal menggunakan jarum halus dan core menghasilkan akurasi berkisar 85%-90% dengan keunggulan tindakan minimal invasif. Variasi akurasi diagnostik dan belum terdapat data proporsi hasil biopsi transtorakal di RS Persahabatan, membuat kami melakukan penelitian ini. Metode: Kami melakukan pencatatan data sampel periode Januari 2021-September 2023 pada bulan Januari-Februari 2024. Data yang dicatat yaitu karakteristik pasien keganasan rongga toraks belum tegak jenis yang dilakukan tindakan biopsi jarum halus dan core transtorakal dengan panduan CT scan. Sebanyak 765 pasien dalam periode tindakan didapatkan 563 pasien yang sesuai kriteria inklusi dan eksklusi. Data kemudian dianalisis untuk menilai kepositifan biopsi jarum halus dan core transtorakal serta faktor yang memengaruhinya. Hasil: Sejumlah 563 subjek terdiri atas laki-laki 67,9% dan perempuan 32,1%. Usia paling muda 18 tahun dan paling tua 88 tahun dengan median usia 56 tahun. Subjek dengan keluhan respirasi 83,7% dan nonrespirasi 16,3%. Perokok merupakan mayoritas subjek sebesar 58,4%. Lokasi target biopsi paling banyak di paru 75,3% sedangkan mediastinum 24,7%. Nilai HU kami kelompokkan menjadi ≥ 30 sebanyak 91,3% dan < 30 sebanyak 8,7%. Panjang minimal kedalaman tusuk 0,7 cm dan maksimal 11,21 cm dengan median 4,2 cm. Posisi saat tindakan biopsi yaitu terlentang 67,5%, tengkurap 24,5% dan lateral dekubitus 8%. Proporsi kepositifan biopsi jarum halus 80,8% sementara biopsi core 77,6%. Selanjutnya karakteristik tersebut kami lakukan analisis bivariat didapatkan nilai HU memengaruhi kepositifan biopsi jarum halus (p < 0,05). Kesimpulan: Proporsi biopsi jarum halus dan core transtorakal di RS Persahabatan sangat baik. Nilai HU memengaruhi kepositifan biopsi TTNA namun, tidak pada biopsi core. Kedalaman tusuk dan posisi bukan faktor yang memengaruhi kepositifan biopsi TTNA dan core.

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Background: New cases of lung cancer are increasing and are starting to occur at a young age. A screening approach in an effort for early detection followed by rapid and accurate diagnosis provides patients with a better quality of life throughout their disease. Transthoracic lung biopsy using a fine needle and core produces an accuracy of around 85%-90% with the advantage of being minimally invasive. Variations in diagnostic accuracy and no database availability yet on the proportion of transthoracic biopsy results at Persahabatan Hospital prompted us to conduct this research. Methods: We recorded data from January 2021-September 2023 in January-February 2024. The data recorded were the characteristics of patients with unconfirmed type thoracic cavity malignancies who underwent fine needle and transthoracic core biopsies CT scan guided. A total of 765 patients during the action period 563 patients met the inclusion and exclusion criteria. The data is then processed to assess the positivity of transthoracic fine needle and core biopsies and the factors that influence it. Result: A total of 563 subjects consisted of 67.9% men and 32.1% women. The youngest age is 18 years and the oldest is 88 years with a median age of 56 years. Subjects with respiratory complaints were 83.7% and non-respiratory 16.3%. Smokers constituted the majority of our subjects at 58.4%. The most common biopsy target locations were the lungs, 75.3%, while the mediastinum was 24.7%. Hounsfield units are divided into ≥ 30 as many as 91.3% and < 30 as many as 8.7%. The minimum length of the puncture depth is 0.7 cm and the maximum is 11.21 cm with 4.2 cm as the median. The position during the biopsy was supination 67.5%, prone 24.5%, and lateral decubitus 8%. The positive proportion of fine needle biopsy was 80.8% while core biopsy was 77.6%. We conducted a bivariate analysis of these characteristics and found that the HU value influenced the positivity of fine needle biopsy (p < 0.05). Conclusion: The proportion of fine needle and core transthoracic lung biopsies at Persahabatan Hospital is decent. The HU value influences the positivity of TTNA biopsy but not core biopsy. Puncture depth and position were not a factor influencing the positivity of TTNA and core biopsies."

"ABSTRAKV600E adalah perubahan genetik yang paling banyak terjadi pada kanker tiroid, dan telah menjadi penanda diagnostik penting pada jenis histopatologi ganas, khususnya karsinoma papiler. Tujuan dari penelitian ini adalah untuk mengembangkan dan memvalidasi teknik screnning BRAF V600E pada kanker tiroid menggunakan metode high resolution melting (HRM). Sebanyak 57 pasien dengan kelainan nodul tiroid dikumpulkan secara retrospektif di Rumah Sakit Kanker Dharmais yang dikoleksi dari tahun 2012-2014. Mutasi gen BRAF V600E dianalisis dari sampel fine needle aspiration biopsy (FNAB) menggunakan teknik HRM reagen MeltDoctor HRM Master Mix (Applied Biosystem) yang divalidasi dengan teknik Sanger Sequencing. Penelitian ini berhasil mengoptimalisasi metode HRM dengan membedakan melting curve sampel kontrol positif mutasi gen BRAF V600E dengan sampel normal. Berdasarkan hasil validasi dengan teknik Sanger Sequencing, diperoleh hasil gambaran elektroferogram pada gen BRAF ekson 15 yang mengalami mutasi titik pada basa nukleotida ke 1799 T>A (V600E). Hasil screening menunjukkan bahwa terdapat 13 sampel terdeteksi positif mutasi gen BRAF V600E pada jenis histopatologi ganas karsinoma tiroid papiler (12) dan karsinoma anaplastik (1). Tidak ditemukan satu pun mutasi gen BRAF V600E pada sampel dengan histopatologi jinak ataupun kontrol normal. Berdasarkan hasil tersebut, dapat disimpulkan bahwa teknik HRM dapat digunakan untuk screening mutasi gen BRAF V600E pada kanker tiroid.

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ABSTRACTBRAF V600E gene mutation is the most common genetic alteration that found in thyroid cancer and has been an important diagnostic marker for malignant histopathology, specifically papillary carcinoma. The aim of this study is to develop and validate BRAF V600E gene mutation screening technique on thyroid cancer patients using high resolution melting (HRM) method. Retrospectively 57 patients with thyroid nodules abnormalities were collected in Dharmais Cancer Hospital collected in 2012-2014. Mutation in BRAF V600E gene were analyze from fine needles aspiration biopsy (FNAB) using MeltDoctor HRM Master Mix (Applied Biosystem) as the HRM reagen and validated using Sanger sequencing. This Study have optimalize HRM method by differentiating positive control BRAF V600E gene melting curve mutaion with normal sampel. Validation using Sanger sequencing depict electropherogram of BRAF gene on exon 15 point mutation on nucleotide 1799 T>A (V600E). Screening shows 13 samples detected positive on BRAF V600E gene mutation on malignant histopathology thyroid papillary carcinoma (12) and anaplastic carcinoma (1). No mutation found on benign histopathology samples and normal samples. The conclusion of this study is HRM technique can be use to screen mutation BRAF V600E on thyroid cancer. "

"Latar Belakang: Kanker tiroid adalah keganasan yang paling sering terjadi pada sistem endokrin. Kanker tiroid yang paling sering terjadi adalah karsinoma tiroid papiler (KTP), dengan sebagian besar kasus dapat disembuhkan dengan angka kesintasan >95% selama 20 tahun. Namun, apabila terjadi kekambuhan, maka angka mortalitasnya yang meningkat. Skoring prognostik penting sebagai penentu pengobatan yang bertujuan untuk mengelompokkan pasien ke dalam kelompok risiko yang sesuai sehingga memungkinkan pasien untuk mendapatkan optimalisasi modalitas pengobatan. Skoring prognosis yang umum digunakan adalah skoring AMES, MACIS, dan AGES. Mutasi gen BRAF V600E dihubungkan dengan prognosis yang buruk karena persistensi dan kekambuhan penyakit. Suatu studi menambahkan pemeriksaan mutasi BRAF V600E kedalam skoring prognosis dan bermakna secara statistik sedangkan studi lainnya tidak memiliki kemaknaan secara statistik. Metode: Studi ini merupakan studi potong lintang terhadap pasien KTP di RSUPN Cipto Mangunkusumo menggunakan data sekunder berupa status mutasi BRAF V600E dan data untuk mengkalkulasi skoring prognosis (Usia, USG preoperatif, CT-Scan atau MRI, data histopatologi, dan data laporan pembedahan). Parameter yang diukur meliputi proporsi dan hubungan antara mutasi BRAF V600E dengan skoring prognosis (AMES, MACIS, dan AGES). Hasil: Proporsi mutasi BRAF V600E pada skoring prognosis yaitu: Skoring AMES: High Risk: 71,4% dan Low Risk: 28,6%, Skoring MACIS: Skor ³ 8: 38,1%; Skor 7 – 7,99: 9,5%; Skor 6 – 6,99: 19%; dan Skor < 6: 33,3%, dan Skoring AGES: Skor ³ 6: 61,9%; Skor 5 – 5,99: 0%; Skor 4 – 4,99: 4,8%; dan Skor < 4: 33,3%. Analisis bivariat menunjukan mutasi BRAF V600E bermakna secara statistik dengan skoring MACIS dengan Odd Ratio (OR) 2,96 (p Value = 0,044, Confidence Interval (CI) 95% = 1,01 – 8,64), sedangkan skoring AMES dan AGES tidak bermakna secara statistik. Kesimpulan: Mutasi BRAF V600E dengan hasil positif meningkatkan prognosis buruk pada skoring MACIS sebanyak 2,96 kali.

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Introduction: Thyroid cancer is the most common malignancy of the endocrine system. The most common type of thyroid cancer is papillary thyroid carcinoma (PTC), and most cases are curable, with a 20-year survival rate of more than 95%. However, when it recurs, it has a high mortality rate. Prognostic scoring systems are important as treatment determinants that aim to classify patients into appropriate risk groups to optimize treatment modalities. Commonly used prognostic scoring systems are the AMES, MACIS, and AGES. Mutation of BRAF V600E is associated with a poor prognosis due to disease persistence and recurrence. One study added the BRAF V600E mutation to the prognosis scoring, and it was statistically significant, while another study showed no statistical significance. Methods: This study was a cross-sectional study of PTC patients at Cipto Mangunkusumo Hospital using secondary data, such as BRAF V600E mutation status and data to calculate prognosis scoring systems. Parameters measured included the proportion and association between the BRAF V600E mutation and prognosis scoring systems (AMES, MACIS, and AGES). Results: The proportion of BRAF V600E mutations in prognosis scoring systems was as follows: AMES - High Risk: 71.4% and Low Risk: 28.6%; MACIS Scoring - Score ≥ 8: 38.1%; Score 7–7.99: 9.5%; Score 6–6.99: 19%; and Score < 6: 33.3%; and AGES - Score ≥ 6: 61.9%; Score 5–5.99: 0%; Score 4–4.99: 4.8%; and Score < 4: 33.3%. Bivariate analysis showed that the BRAF V600E mutation was statistically significant with MACIS scoring, with an Odd Ratio (OR) of 2.96 (p Value = 0.044, Confidence Interval (CI) 95% = 1.01–8.64), while AMES and AGES scoring were not statistically significant. Conclusion: A positive BRAF V600E mutation result increases the poor prognosis on MACIS scoring by 2.96 times."

"Mutasi gen HRAS, KRAS, NRAS, dan BRAF telah dilaporkan terjadi pada kanker kolorektal. Multiplex Ligation-Dependent Probe Amplification (MLPA) merupakan metode yang mampu mendeteksi variasi copy number dari suatu gen spesifik dan memiliki kelebihan dibandingkan metode lain. Deteksi mutasi gen HRAS, KRAS, NRAS, dan BRAF pada kanker kolorektal menggunakan metode MLPA di Indonesia belum dilaporkan. Tujuan dari penelitian ini adalah untuk mengoptimasi metode MLPA dan mendeteksi mutasi gen HRAS, KRAS, NRAS, dan BRAF secara simultan pada kanker kolorektal menggunakan metode MLPA. Sampel penelitian berupa jaringan sebanyak 41 sampel yang berasal dari pasien kanker kolorektal di Rumah Sakit Kanker Dharmais. Sampel penelitian telah dikumpulkan sejak tahun 2017 dan disimpan dalam biobank. Mutasi gen HRAS, KRAS, NRAS, dan BRAF dianalisis dari sampel jaringan menggunakan metode MLPA dengan Kit SALSA MLPA Probemix P298-A1 BRAF-HRAS-KRAS- NRAS (MRC-Holland) kemudian dilakukan fragment Analysis menggunakan mesin Capillary Electrophoresis [3500xL genetic analyzer]. Data hasil fragment analysis selanjutnya dianalisis menggunakan perangkat lunak Coffalyser.Net. Hasil penelitian menunjukkan optimasi metode MLPA berhasil dilakukan serta mutasi gen HRAS, KRAS, NRAS, dan BRAF berhasil dideteksi dengan membandingkan perubahan jumlah copy number pada ratio chart sampel jaringan kanker dan sampel jaringan normal. Berdasarkan hasil yang diperoleh, metode MLPA berhasil dioptimasi dan mutasi pada gen HRAS, KRAS, NRAS, dan BRAF berhasil terdeteksi. Mutasi gen HRAS, KRAS, NRAS, dan BRAF terdeteksi dari seluruh 41 sampel dengan persentase masing-masing 17.07%, 26.82%, 2.43%, dan 19.51%. Mutasi yang terdeteksi adalah mutasi duplikasi dan delesi.

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HRAS, KRAS, NRAS, and BRAF gene mutation has been reported in colorectal cancer. Multiplex Ligation-Dependent Probe Amplification (MLPA) is a method capable of detecting copy number variation of a specific gene. This method has advantages over other methods, however, the detection of gene mutation in colorectal cancer using MLPA in Indonesia has not been reported so far. The aim of this study is to optimize MLPA method and detect HRAS, KRAS, NRAS, and BRAF gene mutation simultaneously on colorectal cancer using the MLPA method. Research samples consist of 41 fresh colorectal cancer tissues collected from colorectal cancer patients in Dharmais Cancer Hospital. Research samples has been collected and stored in a biobank since 2017. HRAS, KRAS, NRAS, and BRAF gene mutation are analyzed from the research samples using the MLPA method with SALSA MLPA Probemix P298-A1 BRAF-HRAS-KRAS-NRAS (MRC-Holland) kit. Afterwards, fragment analysis is done using the Capillary Electrophoresis [3500xL genetic analyzer] machine. The results are then analyzed using the Coffalyser.Net software. This research succeeds in optimizing the detection of HRAS, KRAS, NRAS, and BRAF gene mutation on colorectal cancer using MLPA method and detecting the gene mutation of HRAS, KRAS, NRAS, dan BRAF by comparing the ratio chart of a normal and cancer tissue. The MLPA method was successfully optimized and the HRAS, KRAS, NRAS, and BRAF gene mutation successfully detected. The HRAS, KRAS, NRAS, and BRAF gene mutation successfully detected from 41 samples, with percentages of 17.07%; 26.82%; 2.43%; and 19.51%. The detected mutations are duplication and deletion."

"Kanker adalah pertumbuhan sel baru yang tidak terkontrol, mampu menyebar danmenginvasi sehingga mengancam kehidupan. Insiden kanker dilaporkan daritahun ke tahun terjadi peningkatan. Berbagai upaya telah dilakukan untukmenurunkan morbiditas dan mortalitas kanker. Karya Ilmiah Akhir KIA iniadalah sebagai laporan praktik residensi keperawatan medikal bedah peminatanonkologi di RS Kanker Dharmais Jakarta. Karya ilmiah ini berisi tentang: 1 penerapan teori Konservasi Levine pada pasien kanker Tiroid, 2 IntervensiMenghirup Aromaterapi untuk mengurangi kerusakan kelenjar ludah selama dansetelah pemberian Terapi Radioactif Iodine 3 proyek inovasi manajemen edukasipre intra dan pasca ablasi pada pasien kanker tiroid yang menjalani terapiradioactive iodine I-131. Kesimpulan: bahwa teori Konservasi Levin tepatdigunakan untuk meningkatkan ketersediaan energy pada pasien kanker tiroid.Intervensi menghirup aromaterapi kombinasi citrus lemon dan jahe dapatdigunakan sebagai salah satu alternatif pilihan manajemen unuk mengurangikerusakan kelenjar ludah pada pasien kanker tiroid selama dan setelah pemberianterapi radioactive iodine. Edukasi berbasis multi median pre inra dan pasca ablasidiharapkan mampu memberikan pendidikan kesehatan yang bermanfaat bagipasien kanker tiroid yang akan menjalani terapi radiactif iodine.

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Cancer is the growth of new cells that are not controlled, capable of spreading andinvading so life threatening. The increase of incidence cancer is reported fromyear to year. Various attempts have been made to reduce cancer morbidity andmortality. This Final Scientific Work is a practice report of medical oncologymedical residency of oncology in Dharmais Jakarta Cancer Hospital.

This scientific work contains 1 the application of Levine Conservation theory inThyroid cancer patients, 2 Aromatherapy Inhalation Intervention to reducesalivary gland damage during and after the administration of Radioactive IodineTherapy 3 innovation project management of intra and post Ablation educationin patients Thyroid cancer through radioactive iodine I 131 therapy.

Conclusion Levin conservation theory is appropriately used to increase theavailability of energy in patients rsquo thyroid cancer. Interventions inhalingaromatherapy combinations of citrus lemon and ginger can be used as analternative management option to reduce salivary gland damage in patients withthyroid cancer during and after administration of radioactive iodine therapy. Preintraand post ablative multimedia based education is expected to provide a usefulhealth education for patients with thyroid cancer who will radiodic iodine therapy."

"Concurrently, there have been a number of recent advances in surgical treatment, as well as diagnostic modalities that allow us to detect small amounts of residual local and metastatic disease. Additionally, a reexamination of past treatment regimens has led to new recommendations regarding the use of radioactive iodine, and to new therapeutic options, such as targeted therapy which have supplanted the use of more toxic chemotherapy for metastatic cancer. Multiple academic organizations have developed consensus guidelines for the management of thyroid cancer, occasionally with conflicting recommendations. In Thyroid cancer, a renowned group of authors presents a broad overview of the pathology, pathophysiology, diagnosis, and management of thyroid cancer, with an emphasis on recent evidence-based information. "