Hasil Pencarian  ::  Simpan CSV :: Kembali

"Latar belakang: Kondiloma akuminatum (KA) merupakan infeksi menular seksual tersering. Meskipun dinyatakan 90% lesi KA terkait HPV risiko rendah, tipe 6 dan 11, namun belum ada publikasi yang memaparkan tentang tipe HPV pada berbagai bentuk klinis KA di Indonesia. Tujuan: Mengidentifikasi tipe HPV pada berbagai bentuk klinis KA. Metode: Dilakukan penelitian potong lintang di Poliklinik Kulit dan Kelamin Rumah Sakit dr. Cipto Mangunkusumo, Indonesia, pada bulan April-Juli 2013, melibatkan 25 lelaki dan 12 perempuan berusia 20-57 tahun. Didapatkan 40 sampel DNA berasal dari 40 lesi KA pada 37 subyek penelitian (SP) dengan berbagai bentuk klinis. Identifikasi tipe HPV dilakukan dengan menggunakan HPV express matrix® yang mampu mendeteksi 21 tipe HPV baik risiko rendah maupun tinggi. Pemeriksaan ini mampu mengidentifikasi infeksi HPV multipel pada spesimen. Hasil: Pada 37 SP didapatkan berbagai bentuk klinis, 3 (8%) di antaranya ditemukan bentuk klinis multipel, sehingga keseluruhan lesi KA berjumlah 40. Tipe HPV teridentifikasi pada 34 lesi (85%). Terdapat 4 gambaran klinis KA dan tipe HPV terkait: (1) bentuk klasik 26 dari 40 lesi (65%): temuan terbanyak adalah HPV tipe risiko rendah pada 18 sampel, yaitu tipe 6, 11, 43, sementara pada 7 sampel terdapat ko-infeksi dengan tipe risiko rendah, dan pada 1 sampel tipe HPV tidak teridentifikasi, (2) bentuk keratotik 2 lesi (5%): pada 1sampel hanya ditemukan HPV tipe risiko tinggi yaitu tipe 35 dan pada 1 sampel tipe HPV tidak teridentifikasi, (3) papul dengan permukaan halus 9 lesi (22,5%): HPV tipe risiko rendah teridentifikasi pada 4 sampel, yaitu tipe 6, 11, 42, 43, sementara pada 3 sampel terdapat ko-infeksi dengan HPV tipe risiko rendah, dan pada 2 sampel tipe HPV tidak teridentifikasi, dan (4) papul datar-plak 3 lesi (7,5%): pada 2 sampel hanya ditemukan HPV tipe risiko tinggi, yaitu tipe 52 dan pada 1 sampel tipe HPV tidak teridentifikasi. Tipe HPV 6 dan atau 11 teridentifikasi pada 28 sampel (70%). Tipe HPV risiko rendah yang teridentifikasi adalah 6, 11, 42, dan 43, sedangkan tipe risiko tinggi yang teridentifikasi adalah 16, 31, 35, 39, 45, 52, 56, 66, dan 68. Kesimpulan: Penelitian ini adalah penelitian pertama di Indonesia yang mengidentifikasi tipe HPV pada berbagai bentuk klinis KA. Tipe yang paling banyak ditemukan pada KA tipe klasik adalah HPV risiko rendah tipe 6 dan 11. Beberapa tipe HPV risiko tinggi juga ditemukan pada beberapa lesi KA.

---

Background: Condyloma acuminatum (CA) is the most common sexually transmitted infection. Although, it is stated that low-risk HPV types 6 and 11 are associated with 90% of genital warts, but there is no publication in Indonesia about identification of HPV types in various CA clinical manifestations.

Purpose: To identify HPV type among various clinical pictures of anogenital warts.

Method: A cross-sectional study is conducted in Dermato-Venereology Clinic Dr. Cipto Mangunkusumo National Hospital, Jakarta. Twenty five men and 12 women (20-57year-old) from April to July 2013 were eligible in this study. Fourty DNA samples from 40 lesions of 37 subjects with various clinical pictures of CA were collected. The HPV typing was based on PCR and dot blot hybridization using the HPV express matrix® which detects 21 HPV types of high- and low-risk, able to identify multiple types from a single specimen.

Result: Multiple clinical manifestations were found on 3 of 37 subjects (8%). HPV types were identified among 34lesions (85%). Four clinical manifestations of CA and HPV typing were documented: (1) classic 26 of 40 lesions (65%): low-risk HPV types (6, 11, 43), predominated in 18 samples, while 7 samples were co-infected with the high risk types and another sample had unidentified HPV types. (2) keratotic 2 lesions (5%): 1 sample only harbour the high risk HPV type 52, while the other was unidentified. (3) smooth papule 9 lesions (22.5%): Low-risk HPV types (6, 11, 42, 43) were found in 4 samples, while 3 samples were co-infected with the high risk types, while 2 others were unidentified, and (4) flat top papule to plaque 3 lesion (7.5%): 2 samples were unidentified and the other was high risk HPV type 52. HPV 6 and 11 can be identified in 28 samples (70%). The low risk HPV type had been identified were 6, 11, 42, and 43, while the high risk type were 16, 31, 35, 39, 45, 52, 56, 66, and 68.

Conclusion: This is the first study in Indonesia which identified HPV types in various CA clinical manifestations. The HPV low risk types 6 and 11 were the most prevalent in classic CA. Several high risk HPV types were also found in some CA lesions."

"ABSTRAKLatar Belakang: Persistensi infeksi HPV onkogenik merupakan penyebab kanker serviks. Retinol sebagai mikronutrien antioksidan memiliki peran esensial dalam sistem imun mencegah persistensi. Retinol memodulasi sel T CD4+/CD8+ serta produksi sitokin. Tumor Necrosis Factor-Alpha (TNF-) adalah sitokin pro-inflamasi yang mampu mengendalikan HPV, namun pada infeksi persisten TNF- justru memicu karsinogenesis. Rasio sel T CD4+:CD8+ dan TNF- yang adekuat di awal infeksi HPV merupakan titik kunci klirens. Penelitian ini bertujuan untuk mengetahui tingkat kecukupan deposit retinol, ekspresi TNF-, dan rasio sel T CD4+:CD8+ pada kelompok serviks normal, infeksi subklinis HPV klirens, persisten, dan kanker serviks.Metode: Tingkat kecukupan deposit retinol diketahui berdasarkan pemeriksaan darah perifer dengan metode ELISA. Stimulasi spesifik epitop E6 HPV tipe 16 dilakukan pada sel sekret servikovaginal yang telah diinkubasi 24 jam, diamati ekspresi TNF- secara semikuantitatif dengan metode ELISpot. Pemeriksaan sel T CD4+ dan CD8+ dari sekret servikovaginal secara kuantitatif dengan metode flowsitometri.Hasil: Deposit retinol yang cukup pada kelompok serviks normal, infeksi subklinis HPV klirens, persisten, dan kanker serviks berturut-turut adalah 85%, 75% (OR 1,89), 33,3% (OR 11,33), dan 75% (OR 1,89). Ekspresi TNF- pada kelompok serviks normal adalah 10%, sedangkan kanker serviks 75% (OR 27,00; p<0,001). Tidak tampak ekspresi TNF- pada kelompok infeksi subklinis HPV klirens dan persisten. Rasio sel T CD4+:CD8+ yang tinggi pada kelompok serviks normal adalah 10% dan kanker serviks 25% (OR 0,33). Tidak terdapat rasio sel T CD4+:CD8+ yang tinggi pada kelompok infeksi subklinis HPV klirens (OR 1,22) dan persisten (OR 0,95). Tidak terdapat hubungan bermakna antara tingkat kecukupan deposit retinol dengan ekspresi TNF- (p=0,147), tingkat kecukupan deposit retinol dengan rasio sel T CD4+:CD8+ (p=0,726), dan rasio sel T CD4+:CD8+ dengan ekspresi TNF- (p=0,690).Kesimpulan: Penelitian ini mampu membuktikan bahwa tingkat kecukupan deposit retinol tertinggi dijumpai pada kelompok serviks normal dan ekspresi TNF- tertinggi pada kelompok kanker serviks (OR 27,00; p<0,001). Tingkat kecukupan deposit retinol terendah bukan pada kelompok kanker serviks, melainkan pada infeksi subklinis HPV persisten (OR 11,33). Tidak terdapat perbedaan bermakna pada tingkat kecukupan deposit retinol dan rasio sel T CD4+:CD8+. Terdapat perbedaan bermakna pada ekspresi TNF- antara kelompok kanker serviks dengan serviks normal (p<0,001), kanker serviks dengan infeksi HPV subklinis klirens (p=0,024), dan klirens dengan persisten (p=0,007). Tidak terdapat perbedaan bermakna ekspresi TNF- antara kelompok kanker serviks dengan infeksi HPV subklinis persisten (p=0,058). Tidak bermaknanya beberapa hasil terkait imunitas masih mungkin dikarenakan tingkat kecukupan deposit retinol kelompok kanker serviks pada penelitian ini sangat baik dimana bertentangan dengan kepustakaan.

---

ABSTRACT

Background: Persistency of oncogenic-HPV infection is the cause of cervical cancer. Retinol is one of antioxidant micronutrients that plays essential roles in immune system to prevent the persistency by modulating CD4+ and CD8+T cells and cytokines production. Tumor Necrosis Factor-Alpha (TNF-) is an acute pro-inflammatory cytokine which has many crucial roles in controlling HPV. In contrast, when persistent infection occurs, TNF- induces carcinogenesis. Ratio of CD4+:CD8+ T cells and adequate TNF- production in acute HPV infection are keypoints for clearance. The aim of this research is to analyze sufficency level of retinol deposit, expression of TNF-, and ratio of CD4+:CD8+ T cells in normal cervix, clearance and persistent HPV subclinical infection, and cervical cancer group.

Methods : Sufficiency level of retinol deposit was analyzed from peripheral blood by ELISA method. The cervicovaginal secretions which had 24 hours incubated were stimulated specifically by E6 epitope HPV type-16, measuring TNF- expression semiquantitatively by ELISpot method and CD4+/CD8+ T cells quantitatively by flowcytometry method.

Results: Sufficient level of retinol deposit in normal cervix, clearance HPV subclinical infection, persistent, and cervical cancer group was 85%, 75% (OR 1.89), 33.3% (OR 11.33), and 75% (OR 1.89), respectively. The expression of TNF- in normal cervix group was 10%, while in cervical cancer was 75% (OR 27.00; p<0.001). There were no expression in clearance and persistent HPV subclinical infection groups. High ratio of CD4+:CD8+ T cells in normal cervix and cervical cancer group was 10% and 25% (OR 0.33). There were no high ratio of CD4+:CD8+ T cells in clearance (OR 1,22) and persistent (OR 0.95) HPV subclinical infection groups. There was no significant correlation between sufficiency level of retinol deposit and TNF- expression (p=0.147), sufficiency level of retinol deposit and ratio of CD4+:CD8+ T cells (p=0.726), ratio of CD4+:CD8+ T cells and TNF- expression (p=0.690).

Conclusions: This study was able to prove that normal cervix group has the highest retinol deposit sufficiency level and cervical cancer group has the highest TNF- expression (OR 27,00; p<0,001). The lowest of retinol deposit sufficiency level was not in cervical cancer, but in persistent HPV subclinical infection group (OR 11.33). There was no significant correlation in sufficiency level of retinol deposit and ratio of CD4+:CD8+ T cells. There was significant correlation in TNF- expression between cervical cancer and normal cervix (p<0.001), cervical cancer and clearance subclinical HPV infection (p=0.024), and between clearance and persistent group (p=0.007). There was no significant correlation in TNF- expression between cervical cancer and persistent subclinical HPV infection group (p=0.058). Not significant some results related immunity that might be due to retinol deposit sufficiency level in cervical cancer group in this study was very good, which conflicted with literatures."

"This book provides a state-of-the-art approach to the molecular basis of hematologic diseases and its translation into improved diagnostics and novel therapeutic strategies. Several representative hemato-oncologic malignancies are analyzed in detail: acute lymphoblastic leukemia, acute myeloid leukemia, B-cell Non-Hodgkin lymphomas, multiple myeloma, chronic lymphocytic leukemia, chronic myeloid leukemia, myelodysplastic syndromes, and myeloproliferative neoplasms. Experts in the field describe the molecular methods applied for modern diagnostics and therapies, such as hematopoietic stem cell transplantation, donor recipient matching, banking of biological material, analyses of post-transplant chimerism, and minimal residual disease monitoring. The volume concludes with an extensive section comprising thorough step-by-step protocols of molecular techniques in hematology, all of them validated in the authors? own laboratories."

"ABSTRAKLatar belakang: Human papillomavirus (HPV) merupakan etiologi kanker serviks dan kanker oral. Berbeda dengan kanker serviks, data infeksi HPV oral di Indonesia belum diketahui. Prevalensi infeksi HPV oral yang pernah diteliti pada populasi normal sebesar 1,3−9,2% dan meningkat pada pasien dengan infeksi HPV serviks (18,1%). Tujuan: Mengetahui prevalensi infeksi HPV oral pada pasien kanker serviks dan distribusi tipe HPV, serta mengevaluasi faktor yang berperan dalam terjadinya infeksi. Metode: Penelitian desain potong lintang pada 30 subjek penelitian kanker serviks. Dilakukan pengambilan sampel dari rongga mulut dan orofaring dengan menggunakan brushing untuk mendeteksi DNA HPV dengan nested-PCR elektroforesis dilanjutkan pemeriksaan genotyping HPV metode hibridisasi. Hasil: Prevalensi infeksi HPV oral pada pasien kanker serviks 56,7% dengan tipe HPV risiko tinggi ditemukan 43,3%. HPV tipe 51, 16, dan 18 merupakan tipe HPV risiko tinggi yang paling sering ditemukan di mukosa oral. Tidak didapatkan lesi oral pada seluruh subjek penelitian. Terdapat 1 subjek yang mempunyai tipe HPV yang sesuai antara oral dan serviks (11,1%). Simpulan: Hasil prevalensi infeksi HPV oral yang tinggi menunjukkan perlunya deteksi infeksi HPV oral dan mengetahui faktor risiko yang berhubungan dengan infeksi, serta perkembangannya dalam proses keganasan.

---

ABSTRACTBackground: Human papillomavirus (HPV) is an etiologic agent for both oropharyngeal and cervical cancers. In contrast to cervical cancer, the data of oral HPV infection in Indonesia is not yet known. The prevalence of oral HPV infection in normal population is about 1,3−9,2% and increase in patients with cervical infection (18,1%). Objective: To evaluate the prevalence and type distributions of oral HPV infections in patients with cervical cancer, and evaluate the risk factor which contribute to its occurrence. Methods: Cross-sectional study on 30 subjects, previously diagnosed with cervical carcinoma. Oral mucosal cells were collected by brushing from their oropharyngeal area. HPV DNA detection was caried out using nested-PCR and the HPV Genotyping (HPV genoflow array test). Results: The prevalence of oral HPV infection of patients with cervical cancer is 56,7%, the high-risk HPV type prevalence is 43,3%. The HPV high risk 51, 16 and 18 were most found in oral mucosa. Clinically healthy oral mucosa without any lession was observed in all cases. Only one subject has same HPV type in oral and cervical mucosa (11,1%). Conclusion: Results show a high prevalence of oral HPV infection. It is important to detect HPV in oral and the risk factors associated with infection and progression to malignancy."