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"Inflamasi akut yang tidak terkontrol serta keberadaan patogen yang presisten dapat menyebabkan terjadinya inflamasi kronis. Pengembangan bahan alam untuk pengobatan inflamasi kronis kolon (kolitis) menjadi penting karena efek samping yang rendah. Pada penelitian ini digunakan ekstrak etanol kulit buah delima (Punica granatum) yang dimuat dalam nanopartikel kitosan untuk menganalisis sel Th1, Th2 dan Treg yang berperan penting pada kejadian kolitis. Desain penelitian ini merupakan studi eksperimental in vivo menggunakan hewan coba mencit jantan galur Balb/c sebanyak 24 ekor terbagi dalam 6 kelompok. Kelompok normal (KN), Kelompok DSS (DSS), Kelompok asam elagat (ASE), P1 (nanopartikel kulit buah delima 240 mg/kg/hari), P2 (nanopartikel kulit buah delima 480 mg/kg/hari) dan P3 (ekstrak kulit delima 480 mg/kg/hari). Seluruh mencit di dekapitasi pada minggu ke delapan dan sel-sel limfosit yang berasal dari Limpa diisolasi dan dilakukan analisis menggunakan flow cytometry. Hasil analisis menunjukkan, semua kelompok perlakuan dosis tidak mampu menurunkan jumlah sel Th1. Disisi lain nanopartikel kulit buah delima dengan dosis 480 mg/kgBB mampu meningkatkan jumlah sel Th1, Th2 dan sel Treg secara bermakna pada mencit Balb/c model inflamasi kolon. Penggunaan nanopartikel kitosan kulit buah delima dapat berfungsi sebagai imunomodulator yang menyebabkan keseimbangan antara Th1, Th2 dan Treg yang penting dalam mengontrol inflamasi.

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Acute inflammation that is not restrained due to persistent pathogens so that the inflammatory response occurs excessively can lead to chronic inflammation. Analysis of Th1, Th2, and Treg cells are important because of their involvement in inflammatory bowel conditions. This study used the ethanol extract of pomegranate peel (Punica granatum) coated in chitosan nanoparticles. The research design used an in vivo experimental study using 24 Balb/c strain male mice divided into six groups. Normal group (KN), DSS group (DSS), ellagic acid group (ASE), P1 (240 mg/kg/day pomegranate peel nanoparticles), P2 (480 mg/kg/day pomegranate peel nanoparticles), and P3 (480 pomegranate peel extract) mg/kg/day). Mice's spleen was isolated, and flow cytometry analysis was carried out. The analysis showed that all dose treatment groups could not reduce the number of Th1 cells. On the other hand, pomegranate peel nanoparticles at a dose of 480 mg/kgBW significantly increased the number of Th1, Th2, and Treg cells in the Balb/c mice model of colon inflammation. Using pomegranate peel chitosan nanoparticles can work as an immunomodulator that causes a balance between Th1, Th2, and Treg, which is important in controlling inflammation."

"Polarisasi makrofag ke arah tipe 1 (M1) atau tipe 2 (M2) sangat penting dalam perbaikan inflamasi kolon. Penggunaan bahan alam seperti kulit buah delima (Punica granatum L) dalam kıtosan diharapkan dapat menginduksi M2 peritoneal dan memperbaiki kondisi inflamasi kolon. Penelitian ini bertujuan mengetahui perbedaan efek pemberian ekstrak kulit buah delima (Punica granatum L.) dalam nanopartikel kitosan untuk menginduksi polarisasi makrofag peritoneal pada mencit yang diinduksi dekstran sodium sulfat (DSS). Analisis spektrum FTIR dilakukan pada sampel nanopartikel kitosan, sodium tripolifosfat (STTP), pomegranate peel extract (PPE), dan nanopartikel kitosan-PPE. Selanjutnya, mencit Balb/c dibagi secara acak menjadi 6 kelompok: normal, asam elagat 26 mg/kgBB/hari (kontrol positif), DSS 2% b/v (kontrol negatif), nanopartikel kitosanPPE dosis 480 mg/kgBB/hari (P2), nanopartikel kitosan-PPE dosis 240 mg/kgBB/hari (P1), PPE dosis 480 mg/mgBB/hari (P3), semua kelompok diberikan DSS 2% selama 2 siklus kecuali kelompok normal. Pada akhir percobaan, cairan peritoneal diambil dan dianalisis jumlah makrofag M1 dan M2 dengan flow cytometry. Dibandingkan dengan kontrol negatif, nanopartikel kitosan-PPE dengan dosis 240 mg/kgBB tidak menurunkan jumlah makrofag M1, namun meningkatkan jumlah makrofag M2 (p<0,05). Sedangkan nanopartikel kitosan-PPE dan PPE murni dengan dosis yang sama 480 mg/kgBB dapat menurunkan jumlah makrofag M1 dan meningkatkan jumlah makrofag M2 secara bermakna dibandingkan kontrol negatif (p<0,05).

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Macrophage polarization towards type 1 (M1) or type 2 (M2) is critical in the repair of colonic inflammation. The use of natural materials such as pomegranate peel (Punica granatum L) in chitosan is expected to induce peritoneal M2 and improve colon inflammatory conditions. The aims of this study is to compare the effects of pomegranate peel extract (Punica granatum L.) in chitosan nanoparticles on the macrophages polarization in peritoneal fluid of DSS-induced mice. The FTIR spectra of chitosan nanoparticles, sodium tripolyphosphate (STTP), pomegranate peel extract (PPE), and chitosan-PPE nanoparticles was analyzed. In addition, Balb/c mice were randomly separated into 6 groups: normal, elagic acid 26 mg/kgBW/day (positive control), 2% w/v DSS (negative control), chitosan-PPE nanoparticles dose of 480 mg/kgBW/day (P2), chitosan nanoparticles-PPE dose of 240 mg/kgBW/day (P1), and PPE dose of 480 mg/mgBW/day. Flow cytometric analysis was performed on peritoneal fluid at the conclusion of the experiment to determine the number of M1 and M2 macrophages. Compared to the negative control, chitosan-PPE nanoparticles at a dose of 240 mg/kg BW did not decrease the number of M1 macrophages, but increased the number of M2 macrophages (p<0,05). Whereas a dose of 480 mg/kgBW of chitosan-PPE nanoparticles and pure PPE decreased the number of M1 macrophages and raised the number of M2 macrophages significantly compared to negative controls (p<0.05)."

"Latar Belakang. Douleur Neuropathique 4 (DN4) merupakan kuesioner penilaian nyeri neuropatik dengan sensitivitas dan spesifisitas yang baik dalam berbagai bahasa. Penelitian ini bertujuan untuk melakukan uji validitas, reliabilitas, dan akurasi DN4 ke dalam Bahasa IndonesiaMetode. Dilakukan translasi dan adaptasi lintas budaya sesuai kaidah WHO, kemudian dilakukan uji validitas dan reliabilitas pengukuran sensitivitas dan spesifisitas skor DN4-Ina. Studi potong lintang dilakukan pada populasi pasien dengan nyeri kronik di poli saraf RSUPN Dr. Cipto Mangunkusumo mulai Juli-Desember 2023. Pengambilan sampel dilakukan dengan metode konsekutif sampling dan total 201 pasien memenuhi kriteria inklusi dan eksklusi. Data karakteristik demografi disajikan dalam bentuk tabel distribusi frekuensi. Analisis sensitivitas dan spesifisitas menggunakan tabel silang 2x2, dan kurva ROC. Sebanyak 79 pasien memiliki hasil pemeriksaan elektrofisiologi dan dibandingkan masing-masing dengan DN4 dan painDETECT. Semua analisis data menggunakan SPSS versi 25.0Hasil. Mayoritas subjek adalah perempuan (68,15%), dengan rerata usia 52,49+12,83 tahun, intensitas nyeri sedang (rerata NRS 4,67+1,93), dan durasi nyeri 13,23+4,17 bulan. Diagnosis terbanyak adalah radikulopati lumbal (35,32%), diikuti dengan polineuropati DM (15,42%), radikulopati servikal (10,94%), dan sindroma terowongan karpal (9,45%). Pada uji validitas DN4- Ina semua pertanyaan memiliki r-hitung lebih besar dibandingkan r-tabel (0,312). Hasil uji reliabilitas antar pemeriksa menggunakan intraclass correlation coefficient sebesar 0,99 dan Cronbach’s Alpha sebesar 0,746. Hasil sensitivitas 100% dan spesifisitas 83,17%. Saat DN4 dan painDETECT dibandingkan terhadap hasil elektrofisiologi, keduanya memiliki spesifisitas 100%, tetapi sensitivitas DN4 lebih unggul dibandingkan dengan painDETECT (90,32% vs 75,80%)Kesimpulan. Skor DN4-Ina valid, reliabel, dan memiliki akurasi baik untuk menilai nyeri neuropatik.

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Background. Douleur Neuropathique 4 (DN4) is a neuropathic pain assessment questionnaire with good sensitivity and specificity in various languages. This study aims to test the validity, reliability and accuracy of DN4 into Indonesian Language.

Methods. Translation and cross-cultural adaptation were carried out according to WHO rules, then validity and reliability tests were carried out to measure the sensitivity and specificity of the scores DN4-Ina. A cross-sectional study was conducted on a population of patients with chronic pain at the Neurology Clinic of RSUPN Dr. Cipto Mangunkusumo starting July-December 2023. Sample collection was carried out using the consecutive sampling method and a total of 201 patients met the inclusion and exclusion criteria. Demographic characteristic data is presented in the form of a frequency distribution table. Sensitivity and specificity analysis using a 2x2 cross table, and ROC curve. A total of 79 patients had electrophysiological examination results and were compared respectively with DN4 and painDETECT. All data analysis used SPSS version 25.0.

Results. The majority of subjects were female (68.15%), with a mean age of 52.49+12.83 years, moderate pain intensity (average NRS 4.67+1.93), and pain duration 13.23+4.17 months. The most common diagnosis was lumbar radiculopathy (35.32%), followed by DM polyneuropathy (15.42%), cervical radiculopathy (10.94%), and carpal tunnel syndrome (9.45%). In the DN4-Ina validity test, all questions had an r-count greater than the r-table (0.312). The results of the inter- examiner reliability test used an intraclass correlation coefficient of 0.99 and Cronbach's Alpha of 0.746. The sensitivity results were 100% and specificity 83.17%. When DN4 and painDETECT were compared to electrophysiological results, both had 100% specificity, but the sensitivity of DN4 was superior to painDETECT (90.32% vs 75.80%).

Conclusion. The DN4-Ina score is valid, reliable and has good accuracy for assessing neuropathic pain"

"Latar Belakang: Inflamasi usus halus (enteritis) memiliki etiologi infeksi atau non infeksi. Salah satu etiologi enteritis kronis non infeksi adalah inflamasi akibat penyakit Chron (PC) sebagai salah satu subtipe dari Inflammatory Bowel Disease (IBD) yang secara klinis dapat menyerang 0,5-4% dari semua pasien PC. Saat ini, pilihan terapi standar enteritis akibat IBD adalah 5-ASA dan kortikosteroid yang memiliki keterbatasan akibat efek samping yang ditimbulkan. Sementara itu, diketahui potensi terapeutik ekstrak etanol kulit buah delima yang menunjukkan efek antiinflamasi pada sejumlah penyakit kronis.Tujuan: Untuk mengetahui efek hambatan inflamasi ekstrak etanol kulit buah delima terhadap enteritis kronis yang diinduksi Dextran Sodium Sulfate (DSS) melalui analisis histopatologi sembilan parameter inflamasi usus halus dengan pewarnaan hematoksilin eosin (HE).Metode: Dua puluh lima mencit Swiss-Webster terbagi dalam 5 kelompok, yaitu kelompok normal (KN), kelompok kontrol positif asam elagat murni (ELG), kelompok kontrol negatif (DSS), kelompok mencit yang menerima ekstrak etanol kulit buah delima dosis 240 mg/kgBB per hari (DOSIS-1), dan kelompok mencit yang menerima ekstrak etanol kulit buah delima dosis 480 mg/kgBB per hari (DOSIS-2). Semua mencit menerima DSS 2% (3 gram per hari) selama 3 siklus (satu siklus mencit meminum DSS 2%  selama 7 hari, dilanjutkan minum air biasa selama 7 hari berikutnya). Di akhir percobaan, sampel usus halus dicuci dengan air dan difiksasi menggunakan buffered neutral formalin (BNF) 10%. Selanjutnya jaringan usus halus ditanam pada medium parafin untuk analisis histopatologi dengan pewarnaan HE.Hasil: Dibandingkan kontrol normal, pemberian DSS 2% menunjukkan adanya inflamasi usus halus mencit berupa peningkatan signifikan empat parameter inflamasi yakni peningkatan hiperplasia epitel usus halus, angiogenesis, fokus perdarahan (p < 0,05), dan sel Goblet (p < 0,01). Efek DSS 2% pada lima parameter inflamasi lainnya tidak signifikan (p > 0,05) dibandingkan kontrol normal, tetapi mampu menunjukkan peningkatan pada parameter jumlah infiltrasi sel inflamatorik villi, sel migratorik di ruang antar kriptus Liberkuhn, fokus nekrosis dan/atau erosi mukosa, villi menumpul, dan gambaran mitosis di kriptus Liberkuhn. Dibandingkan kontrol negatif, ekstrak etanol kulit buah delima dosis 240 mg/kgBB atau 480 mg/kgBB, keduanya mampu memberikan efek antiinflamasi secara signifikan (p < 0,05) pada tiga parameter, dengan menurunkan jumlah hiperplasia epitel (935,80 ± 326,60 VS 413,80 ± 244,55 dan 410,20 ± 69,98); sel Goblet (148,00 ± 60,62 VS 92,00 ± 30,42 dan 78,40 ±  24,03); dan fokus perdarahan (21,00 (15,00-22,00) VS 12,00 (2,00-18,00) dan 9,00 (7,00-18,00). Sementara itu, hanya pemberian dosis 480 mg/kgBB yang mampu menurunkan parameter angiogenesis secara signifikan (32,60 ± 26,54 VS 10,08 ± 8,47). Efek antiinflamasi ekstrak etanol kulit buah delima tidak bergantung pada peningkatan dosis. Sementara itu, baik DOSIS-1 maupun DOSIS-2 juga memberikan efek penurunan lima parameter inflamasi lainnya meskipun tidak signifikan (p > 0,05).Kesimpulan: Melalui analisis histopatologi sembilan parameter peradangan, diketahui DSS 2% dapat menginduksi inflamasi ringan usus halus. Adapun pemberian ekstrak etanol kulit buah delima menunjukkan efektivitas hambatan enteritis kronis model IBD yang diinduksi DSS 2% pada parameter peningkatan hiperplasia epitel, sel Goblet, angiogenesis, dan fokus perdarahan.

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Background: Small intestine inflammation (enteritis) has an etiology of infection or non-infection. One of non-infectious chronic enteritis is inflammation due to Chron's disease (CD) as a subtype of Inflammatory Bowel Disease (IBD). At present, the standard treatment option for enteritis due to IBD is 5-ASA and corticosteroids which have limitations due to side effects. Meanwhile, it is known the therapeutic potential of pomegranate peel extract which shows anti-inflammatory effects on a number of chronic diseases.

Objective: To determine the inflammatory inhibitory effect of pomegranate peel extract on chronic enteritis induced by Dextran Sodium Sulfate (DSS) through histopathological analysis of nine inflammatory parameters of the small intestine.

Methods: Twenty-five Swiss-Webster mice were divided into 5 groups, namely the normal group (KN), the positive control group which receiving pure ellagic acid (ELG), the negative control group (DSS), the mice group receiving pomegranate peel ethanol extract dose of 240 mg/kg.bw/day (DOSIS-1), and the mice group receiving pomegranate peel ethanol extract dose of 480 mg/kg.bw/day (DOSIS-2). All mice received 2% DSS (3 g/day) for 3 cycles (one cycle of mice taking 2% DSS for 7 days, continued drinking plain water for the next 7 days). At the end of the experiment, the small intestine sample was washed with water and fixed using 10% buffered neutral formalin. Afterwards, the small intestine tissue was embedded on paraffin medium for histopathological analysis with hematoxylin eosin (HE) staining.

Results: Administration of 2% DSS significantly improve four inflammatory parameters of the chronic enteritis. Compared to normal controls, administration of 2% DSS increased significantly four inflammatory parameters, namely increased epithelial hyperplasia, angiogenesis, focus of bleeding (p<0.05), and Goblet cells (p<0.01). The effect of 2% DSS on five other inflammatory parameters was not significant, but it was able to increase inflammatory cell infiltrations in villi, migratory cells in the space between Lieberkuhn crypts, focus of necrosis and/or mucosal erosion, villus blunting, and mitotic figures in Liberkuhn crypts (p>0.05) indicating mild small intestinal inflammation. Compared to negative controls, administration of pomegranate peel ethanol extract 240 mg/kg.bw or 480 mg/kg.bw was able to provide a significant anti-inflammatory effect (p<0.05) on three parameters, by reducing the number of epithelial hyperplasia (935.80 ± 326.60 VS 413.80 ± 244.55 and 410.20 ± 69.98); Goblet cells (148.00 ± 60.62 VS 92.00 ± 30.42 and 78.40 ± 24.03); and focus of bleeding (21.00 (15.00-22.00) VS 12.00 (2.00-18.00) and 9.00 (7.00-18.00). Meanwhile, only the dose of 480 mg/kgBB which is able to reduce angiogenesis parameters significantly (32.60 ± 26.54 VS 10.08 ± 8.47). The anti-inflammatory effect of pomegranate peel extract did not depend on increasing doses. Both of DOSIS-1 and DOSIS-2 of pomegranate peel ethanol extract also reduced the increase of five other inflammatory parameters, although not significant (p>0.05).

Conclusion: Through histopathological analysis of nine inflammatory parameters, it is known that 2% DSS can induce mild small intestinal inflammation. Pomegranate peel ethanol extract show effectiveness in inhibiting chronic enteritis model IBD induced by 2% DSS on the parameters of increased epithelial hyperplasia, Goblet cells, angiogenesis, and focus of bleeding."

"Latar belakang: Penyakit Crohn adalah sebuah penyakit kronis inflamasi usus (IBD) yang dapat mengenai di beberapa bagian usus. Penyakit ini semakin meningkat insidensinya di negara berkembang, seperti Asia, karena terdapat perubahan pola gaya hidup. Di Indonesia, insidensi penyakit ini didapatkan 0,33 per 100.000 kasus. Penyakit ini disebabkan oleh tiga faktor utama, yaitu genetik, respons imun usus, dan mikroba, yang dipengaruhi oleh paparan lingkungan. Faktor-faktor inilah yang menentukan pengobatan penyakit Crohn. Pengobatan lini pertama penyakit ini adalah 5-ASA, antibiotik, dan kortikosteroid. Akan tetapi, karena berbagai efek samping yang ditimbulkan, banyak pasien beralih ke pengobatan alternatif, seperti konsumsi megavitamin atau suplementasi herbal. Salah satunya adalah kulit buah delima yang mengandung asam elagat yang diketahui mempunya efek sebagai anti-inflamasi.Tujuan: Penelitian ini dilakukan untuk menilai efektivitas ekstrak etanol kulit buah delima sebagai anti-inflamasi terhadap jaringan kolon atau usus halus mencit yang diinduksi DSS melalui pengukuran caspase-3.Metode: Penelitian ini menggunakan bahan biologis tersimpan dengan desain eksperimental in vivo pada mencit yang diinduksi DSS 2%. Setiap kelompok (kelompok tanpa perlakuan, kelompok kontrol negatif, kelompok kontrol positif dengan aspirin, kelompok kontrol positif dengan asam elagat, serta kelompok ekstrak kulit buah delima dosis 240 mg/KgBB/hari dan 480 mg/KgBB/hari) akan dinilai caspase-3 dengan menggunakan image-J yang kemudian akan dibandingkan setiap kelompoknya untuk menilai keefektifan ekstrak kulit buah delima sebagai anti-inflamasi.Hasil: Berdasarkan analisis post hoc Tukey, didapatkan perbedaan bermakna pada N terhadap KN, KP-1, KP-2, KD-1, dan KD-2 (p<0,05). KD-1 dan KD-2 memiliki rerata skor histologis yang lebih tinggi dibandingkan KN (p>0,05) serta lebih rendah dibandingkan KP-1 dan KP-2 (p>0,05).Simpulan: Pemberian ekstrak kulit buah delima memiliki kecenderungan meningkatkan ekspresi protein caspase-3 pada sel epitel usus halus mencit yang diinduksi oleh DSS 2%.

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Background: Crohn's disease is a chronic inflammatory bowel disease (IBD) that can affect several parts of the intestine. This disease has an increasing incidence in developing countries, such as Asia, due to changes in lifestyle patterns. In Indonesia, the incidence of this disease is 0.33 per 100,000 cases. This disease is caused by three main factors, namely genetics, intestinal immune response, and microbes, which are influenced by environmental exposure. These factors determine the treatment of Crohn's disease. The first line of treatment for this disease is 5-ASA, antibiotics, and corticosteroids. However, because of the various side effects that have been caused, many patients turn to alternative treatments, such as taking a megavitamin therapy or herbal supplementation. One of them is pomegranate peel which contains elagic acid compounds which is known to have anti-inflammatory effects.

Objective: This study was conducted to measure the effectiveness of the ethanol extract of pomegranate peel as an anti-inflammatory against DSS-induced mice small intestine tissue through caspase-3 measurement.

Method: This study used stored biological material with in vivo experimental design on mice induced by 2% DSS. Each group (the untreated group, the negative control group, the positive control group with aspirin, the positive control group with ellagic acid, and the pomegranate peel extract group at a dose of 240 mg / KgBW / day and 480 mg / KgBB / day) will be measured caspase-3 using image-J that will be compared each group to measure the effectiveness of the pomegranate peel extract as an anti-inflammatory.

Result: Based on Tukey's post hoc analysis, there were significant differences in N against KN, KP-1, KP-2, KD-1, and KD-2 (p <0.05). KD-1 and KD-2 had a higher mean histological score than KN (p> 0.05) and lower than KP-1 and KP-2 (p> 0.05)

Conclusion: The administration of pomegranate peel extract has a tendency to increase the expression of caspase-3 protein in mice small intestinal epithelial cells induced by 2% DSS."

"[ABSTRAKOsteoporosis pada wanita menopause terjadi karena menurunnya hormon estrogen, pada kondisi ini dikaitkan dengan peningkatan resorpsi tulang oleh osteoklas serta penurunan kadar kalsium tulang. Kulit buah delima diketahui mengandung asam elagat yang diduga berpotensi sebagai selective estrogen receptor modulators (SERMs) alami. Tujuan penelitian ini untuk melihat potensi yang terkandung dalam fraksi air dari ekstrak metanol kulit buah delima dalam menurunkan aktivitas osteoklas dan meningkatkan kadar kalsium tulang. Metode ekstraksi menggunakan pelarut metanol dilanjutkan dengan fraksinasi bertingkat yang dimulai dari pelarut n-heksan, etil asetat kemudian air. Studi eksperimental dengan rancangan acak lengkap in vivo pada tikus betina (Sprague-Dawley) sebanyak 42 tikus yang dibagi secara acak kedalam 7 kelompok terdiri dari: sham; OVX; ES (OVX+estradiol 0,1 mg/kg BB, p.o); TAM (OVX+tamoxifen 10 mg/kg BB, p.o); PI (OVX+fraksi air kulit buah delima 50 mg/kg BB, p.o); PII (OVX+ fraksi air kulit buah delima 100 mg/kg BB, p.o); PIII (OVX+ fraksi air kulit buah delima 200 mg/kg BB, p.o). Perlakuan dilakukan setiap hari selama 28 hari. Hasil penelitian yang diperoleh bila dibandingkan dengan kelompok OVX, kelompok PIII (2,55 ± 0,70) memiliki jumlah sel osteoklas yang lebih rendah dibandingkan OVX (10,45 ± 1,55), sedangkan pada kadar kalsium tulang pemberian dosis 200 mg/kg BB pada kelompok PIII juga mengalami peningkatan sebesar 2005,96 ± 404,91 bila dibandingkan dengan OVX yang memiliki kadar kalsium tulang sebesar 1277,69 ± 322,59. Kesimpulan yang diperoleh adalah pemberian fraksi air kulit buah delima pada dosis 200 mg/kg BB mampu menurunkan jumlah sel osteoklas dan meningkatkan kadar kalsium tulang pada pada tikus yang diovariektomi.

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ABSTRACTOsteoporosis in postmenopausal women occurs because of decreased estrogen, This condition is due to the increasment of bone resorption by osteoclasts and the decreasment of bone calcium levels. Pomegranate peel consist of ellagic acid which potentially work as a natural SERMs. The purpose of this study is to investigate the potential contained in the water fraction of the methanol extract of pomegranate peel in reducing the number of osteoclasts and increasing the bone calcium levels. The extraction method was conducted using methanol solvent followed by fractionation terraced that is began from solvent n-hexane, ethyl acetate and then methanol. The number of rats female samples in this experimental studies in vivo (Sprague-Dawley) were 42 rats, which is divided into 7 groups induced by ovariectomy (OVX) except the sham group. The group consists of sham; OVX; ES (OVX + estradiol 0.1 mg / kg, body weight p.o); TAM (OVX + tamoxifen 10 mg / kg, body weight p.o); PI (OVX + water fraction of pomegranate peel 50 mg / kg, body weight p.o); PII (OVX + water fraction of pomegranate peel 100 mg / kg, body weight p.o); PIII (OVX + water fraction of pomegranate peel 200 mg / kg, body weight p.o). The treatment is done every day for 28 days. The results of the PIII group is 2,55 ± 0,70 which is lower than the OVX group (10,45 ± 1,55), whereas in bone calcium levels, dosage of 200 mg / kg body weight in PIII group showing an increase of 2005.96 ± 404.91 compared to OVX the bone calcium levels by 1277.69 ± 322.59. The conclusion is water fraction of pomegranate peel application at a dose of 200 mg / kg body weight able to reduce the num;Osteoporosis in postmenopausal women occurs because of decreased estrogen, This condition is due to the increasment of bone resorption by osteoclasts and the decreasment of bone calcium levels. Pomegranate peel consist of ellagic acid which potentially work as a natural SERMs. The purpose of this study is to investigate the potential contained in the water fraction of the methanol extract of pomegranate peel in reducing the number of osteoclasts and increasing the bone calcium levels. The extraction method was conducted using methanol solvent followed by fractionation terraced that is began from solvent n-hexane, ethyl acetate and then methanol. The number of rats female samples in this experimental studies in vivo (Sprague-Dawley) were 42 rats, which is divided into 7 groups induced by ovariectomy (OVX) except the sham group. The group consists of sham; OVX; ES (OVX + estradiol 0.1 mg / kg, body weight p.o); TAM (OVX + tamoxifen 10 mg / kg, body weight p.o); PI (OVX + water fraction of pomegranate peel 50 mg / kg, body weight p.o); PII (OVX + water fraction of pomegranate peel 100 mg / kg, body weight p.o); PIII (OVX + water fraction of pomegranate peel 200 mg / kg, body weight p.o). The treatment is done every day for 28 days. The results of the PIII group is 2,55 ± 0,70 which is lower than the OVX group (10,45 ± 1,55), whereas in bone calcium levels, dosage of 200 mg / kg body weight in PIII group showing an increase of 2005.96 ± 404.91 compared to OVX the bone calcium levels by 1277.69 ± 322.59. The conclusion is water fraction of pomegranate peel application at a dose of 200 mg / kg body weight able to reduce the num, Osteoporosis in postmenopausal women occurs because of decreased estrogen, This condition is due to the increasment of bone resorption by osteoclasts and the decreasment of bone calcium levels. Pomegranate peel consist of ellagic acid which potentially work as a natural SERMs. The purpose of this study is to investigate the potential contained in the water fraction of the methanol extract of pomegranate peel in reducing the number of osteoclasts and increasing the bone calcium levels. The extraction method was conducted using methanol solvent followed by fractionation terraced that is began from solvent n-hexane, ethyl acetate and then methanol. The number of rats female samples in this experimental studies in vivo (Sprague-Dawley) were 42 rats, which is divided into 7 groups induced by ovariectomy (OVX) except the sham group. The group consists of sham; OVX; ES (OVX + estradiol 0.1 mg / kg, body weight p.o); TAM (OVX + tamoxifen 10 mg / kg, body weight p.o); PI (OVX + water fraction of pomegranate peel 50 mg / kg, body weight p.o); PII (OVX + water fraction of pomegranate peel 100 mg / kg, body weight p.o); PIII (OVX + water fraction of pomegranate peel 200 mg / kg, body weight p.o). The treatment is done every day for 28 days. The results of the PIII group is 2,55 ± 0,70 which is lower than the OVX group (10,45 ± 1,55), whereas in bone calcium levels, dosage of 200 mg / kg body weight in PIII group showing an increase of 2005.96 ± 404.91 compared to OVX the bone calcium levels by 1277.69 ± 322.59. The conclusion is water fraction of pomegranate peel application at a dose of 200 mg / kg body weight able to reduce the num]"

"ABSTRAKLatar Belakang: Nyeri panggul kronik merupakan suatu gejala yang dialami oleh perempuan terutama di usia reproduksi. Kondisi ini menggangu aktivitas harian dan menurunkan kualitas hidup hingga membuat penderita mengalami depresi. Prevalensi nyeri panggul kronis pada perempuan berkisar 3,8 ndash; 40 di seluruh dunia. Kondisi ini merupakan suatu entitas yang masih belum dipelajari dengan baik dan dapat menyebabkan morbiditas yang serius. Proses inflamasi juga berperan dalam mencipatakan rasa nyeri. Hs ndash; CRP merupakan sebuah penanda inflamasi yang nilainya meningkat pada saat terjadi reaksi tersebut.Tujuan: Penelitian ini bertujuan untuk mengetahui prevalensi dan berbagai aspek yang berhubungan dengan nyeri panggul kronik pada perempuan di RSUP Cipto Mangunkusumo.Metode: Penelitian dilakukan dengan desain potong lintang di poliklinik rawat jalan ginekologi dan laboratorium di RSCM selama Januari ndash; Maret 2016. Pasien yang mengeluh nyeri panggul lebih dari 6 bulan dilakukan anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang dan pemeriksaan hs ndash; CRP serum. Dilakukan penghitungan prevalensi dan deskripsi karakteristik klinis dan diagnosis pasien. Kualitas hidup dan kadar hs ndash; CRP dibandingkan antara kelompok derajat nyeri ringan dan berat.Hasil: Didapatkan prevalensi sebesar 9,78 dari total pasien di poliklinik ginekologi RSCM. Ditemukan 96,9 kelainan ginekologi, 1 kelainan urologi, dan 2,1 kelainan muskulo-skeletal. Diagnosis tersering adalah endometriosis. Karakteristik klinis pasien yang ditemukan adalah 62,9 menderita lama nyeri selama 6 bulan ndash; 1 tahun dengan intensitas nyeri VAS 7 ndash; 10 sebanyak 51,5 . Kadar hs ndash; CRP serum sebesar 1,99 0,00 ndash; 404, 53 . Terjadi penurunan kualitas hidup dari domain fisik 56 38 - 81 ; domain psikologi 56 31 - 100 ; domain hubungan sosial 25 - 75 ; domain lingkungan 56 31 - 94 .Kesimpulan: Nyeri panggul kronik pada perempuan dijumpai pada usia reproduksi dengan penyebab tersering endometriosis. Nyeri tersebut menyebabkan penurunan kualitas hidup.

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ABSTRACT Background Chronic pelvic pain is a symptom which experienced by women, especially in the reproductive age. These condition interferes with daily activities and decreses quality of life from the patient who suffers it. The prevalences of chronic pelvic pain in women range from 3.8 to 40 worldwide. This condition is an entity that has not been studied well and can cause serious morbidity. Inflammatory process also plays a role in the creation of pain. Hs CRP is a marker of inflammation that increases in value in the event of such reactions.Purpose This study aimed to determine the prevalence and various aspects that associated with female chronic pelvic pain at Cipto Mangunkusumo hospital. Methods The study was conducted with a cross sectional design in gynecology outpatient polyclinic and laboratory at RSCM during January to March 2016. Patients who complain pelvic pain for more than 6 months. We take the history and was performed physical examination and investigations including hs CRP serum examination. We calculate the prevalence and describe the clinical characteristics and diagnosis of the patient. Quality of life and levels of hs CRP were compared between the group of mild and severe pain. Results The prevalence was 9.78 from the total patients in the RSCM gynecology outpatient clinic. We found 96.9 of gynecological disorders, 1 of urological disorders, and 2.1 of musculo skeletal disorders. The most common diagnosis is endometriosis. The Clinical characteristics of patients were found 62.9 suffer for 6 months 1 year with the intensity of pain VAS 7 10 as much as 51.5 . Levels of hs CRP serum was around 1.99 0.00 404, 53 . We found a decreased in the quality of life of the patient. The physical domain score was 56 38 81 the psychology domain score was 56 31 100 the domain of social relationships was 59 25 75 and the environmental domain score was 56 31 94 . Conclusion Endometriosis is the most common diagnosis in female chronic pelvic pain of reproductive age. The Pain causes a decreased in quality of life who suffer from it. "

"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."

"Pendahuluan: Penyakit Crohns merupakan subtipe penyakit radang usus kronis (IBD) yang umumnya terdapat di usus halus. Prevalensi penyakit ini adalah 100 kasus per 100.000 orang. Pengobatan lini pertama untuk IBD adalah kortikosteroid dan asam 5-aminosalisilat (5-ASA). Namun, ada efek samping yang mungkin ditimbulkan, pengobatan alternatif dari bahan alami dapat dipertimbangkan sebagai pengobatan. Konsumsi asam elagat yang terdapat pada kulit buah delima dapat menjadi alternatif pengobatan anti inflamasi.Tujuan: Penelitian ini dilakukan untuk mengetahui efektivitas ekstrak etanol kulit buah delima sebagai anti inflamasi yang difokuskan pada ekspresi NF-κB pada usus halus mencit yang diinduksi DSS.Metode: Penelitian ini menggunakan desain eksperimental in vivo dengan menggunakan simpanan bahan biologis jaringan usus halus mencit yang telah diberi perlakuan: tanpa intervensi (N); kontrol negatif (K-) menyebabkan DSS 2%; kontrol positif 1 (KA +) menginduksi DSS 2% dan aspirin; kontrol positif 2 (KE +) menginduksi DSS 2% dan asam elagat; kelompok dosis 1 (D1) diinduksi DSS2% dan ekstrak kulit buah delima dalam dosis kecil (240 mg / kgBB), dan kelompok dosis 2 (KD2) diinduksi oleh DSS2% dan ekstrak kulit buah delima dalam dosis tinggi (480mg / kgBW).Hasil: Hasil uji One Way ANOVA menunjukkan hasil yang signifikan. Hasil uji Post Hoc Games Howell menunjukkan bahwa terdapat perbedaan yang signifikan antara KN dan K- (p = 0,018), KA + (p = 0,024), KE + (p = 0,034); Kelompok uji D1 dan K- (p = 0,004), KA + (p = 0,001), KE + (p = 0,005); Kelompok uji D2 dan K- (p = 0,020), dan KA + (p = 0,030).Kesimpulan: Pemberian etanol kulit buah delima dapat menurunkan ekspresi NF-κB pada sel epitel usus halus mencit yang diinduksi oleh DSS 2%.

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Introduction: Crohns disease is a chronic inflammatory bowel disease (IBD) subtype that commonly located in the small intestine. The prevalence of this disease is 100 cases per 100.000 individuals. The first-line treatment for IBD is corticosteroids and 5-aminosalicylic acid (5-ASA). However, there are side effects that may be caused, alternative medicines from natural ingredients can be considered as the treatment. The consumption of elagic acid, which is found in pomegranate peels, can be an alternative anti-inflammatory treatment.Objective: This study was conducted to determine the effectiveness of pomegranate peel ethanol extract as an anti-inflammatory focused on the NF-κB expression on mice small intestine induced by DSS.Method: This study used an in vivo experimental design using stored biological material of mice small intestine tissue which had been treated: without intervention (N); negative control (K-) induced DSS 2%; positive control 1 (KA +) induced DSS 2% and aspirin; positive control 2 (KE +) induced DSS 2% and elagic acid; dose 1 group (D1) induced DSS2% and pomegranate peel extract in a small dose (240 mg/kgBW), and the dose 2 group (KD2) induced by DSS2% and pomegranate peel extract in a high dose (480mg / kgBW).Results: The One Way ANOVA test results showed significant results. The results of the Post Hoc Games Howell test showed that there were significant differences between KN and K- (p = 0.018), KA + (p = 0.024), KE + (p = 0.034); D1 test group and K- (p = 0.004), KA + (p = 0.001), KE + (p = 0.005); D2 test group and K- (p = 0.020), and KA + (p = 0.030).Conclusion: The administration of pomegranate peel ethanol can reduce the expression of NF-κB in mice small intestinal epithelial cells induced by DSS 2%."

"Myofascial Pain Syndrome (MPS) adalah salah satu keluhan muskuloskeletal terbanyak dalam pelayanan kesehatan. MPS diduga dapat menyebabkan gangguan pada koordinasi otot-otot skapula. Penelitian ini bertujuan untuk membuktikan adanya hubungan terhadap kejadian MPS upper trapezius dengan ketidakseimbangan eksitasi otot upper trapezius, otot lower trapezius dan serratus anterior.Penelitian ini adalah studi potong lintang observasional. Sebanyak 34 subjek penelitian yang terdiri dari 17 subjek dengan MPS kronis dan 17 subjek non-MPS berusia 18-59 tahun dikumpulkan. Pengambilan data dilakukan menggunakan alat EMG permukaan Neurotrac MyoplusPro 4. Pengukuran eksitasi otot dilakukan pada otot upper trapezius, lower trapezius, dan serratus anterior. Pengukuran tersebut dilakukan pada saat bahu abduksi 0-180° tanpa beban, 25% beban maksimal, dan 50% beban maksimal. Pengukuran dilakukan tiga kali dan diambil reratanya. Rerata eksitasi diambil rasio perbandingan antara ketiga otot tersebut dan dibandingkan antara populasi MPS dengan populasi non-MPS. Uji statistik yang digunakan adalah uji T tidak berpasangan jika data pada sebaran normal. Jika sebaran tidak normal maka digunakan Mann-Whitney test. Hasil penelitian ini menemukan bahwa terdapat perbedaan rasio eksitasi yang bermakna pada otot upper trapezius dengan lower trapezius pada penderita MPS kronis dibandingkan dengan non-MPS pada ketiga tingkatan beban yang dilakukan, ditemukan perbandingan antara kedua kelompok tersebut dengan rata-rata perbedaan 2:1. Sedangkan, tidak terdapat perbedaan bermakna dari rasio otot upper trapezius dengan serratus anterior, dan lower trapezius dengan serratus anterior antara kedua populasi tersebut.

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Myofascial Pain Syndrome (MPS) is one of the most common musculoskeletal complaints in health services. MPS is suggested to cause a discoordination of the scapula muscles. This study aims to prove that there is a relationship between the incidence of upper trapezius MPS and the imbalance of excitation of the upper trapezius, lower trapezius and serratus anterior muscles.

This study was an observational cross-sectional study. A total of 34 study subjects consisting of 17 subjects with chronic MPS and 17 non-MPS subjects aged 18-59 years were collected. Data were collected using the Neurotrac MyoplusPro 4 surface EMG device. Muscle excitation was measured on the upper trapezius, lower trapezius, and serratus anterior muscles. These measurements were carried out when the shoulder was abducted 0-180° with no load, 25% of the maximum load, and 50% of the maximum load. Measurements were made three times and the average was taken. The average excitation ratio was taken between the three muscles and compared between the MPS population and the non-MPS population. The statistical test used was the unpaired T test if the data were in a normal distribution. If the distribution is not normal, then the Mann-Whitney test is used.

The results of this study found that there was a significant difference in the excitation ratio of the upper trapezius and lower trapezius muscles in patients with chronic MPS compared to non-MPS at the three levels of load carried out, a comparison between the two groups was found with an average ratio of 2:1. Meanwhile, there was no significant difference in the ratio of the upper trapezius muscle to the serratus anterior, and the lower trapezius to the serratus anterior between the two populations."