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"ABSTRAKLatar belakang: Sindrom nefrotik idiopatik (SNI) relaps anak terjadi karena ketidakseimbangan sel T-helper dan sel T-regulator. Perubahan komposisi bakteri usus besar dapat menyebabkan gangguan integritas usus, responsi imun, mungkin berperan terhadap relaps pada SNI.Tujuan: Untuk mengetahui jenis dan komposisi bakteri usus besar pada SNI remisi dan relaps, hubungan jenis dan komposisi bakteri usus besar dengan IL-8 serum SNI relaps, gangguan integritas usus besar pada SNI relaps.Metode: Penelitian prospektif di Departemen Ilmu Kesehatan Anak, FKUI- RSCM. Penelitian dua tahap yaitu SNI remisi yang diikuti sampai relaps. Diperiksa komposisi bakteri Enterococcus, Bacteroides, Escherichia, Clostridium, Lactobacillus, dan Bifidobacterium usus besar, alpha-1 antitrypsin dan calprotectin feses, IL-8 serum.Hasil: Terdapat 49 subjek yang relaps berumur 2?12 tahun. Proporsi Enterococcus, Bacteroides, Escherichia, Clostridium lebih tinggi pada SNI relaps daripada SNI remisi. Proporsi Bifidobacterium lebih tinggi pada SNI remisi daripada SNI relaps. Terdapat peningkatan alpha-1 antitrypsin pada 51% SNI remisi dan 48% SNI relaps, serta peningkatan calprotectin pada 91.8% SNI remisi dan 95.9% SNI relaps. Median IL-8 serum lebih tinggi pada SNI relaps (13.2 pg/mL) dibandingkan SNI remisi (11.8 pg/mL).Simpulan: Proporsi bakteri menguntungkan Bifidobacterium lebih tinggi pada SNI remisi dibandingkan SNI relaps. Proporsi bakteri patogen lebih tinggi pada SNI relaps dibandingkan dengan SNI remisi. Tidak terdapat hubungan antara jenis dan komposisi bakteri usus besar dengan peningkatan kadar IL-8 serum pada SNI relaps. Pada SNI relaps terdapat gangguan integritas usus besar.

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ABSTRACT

Backgound: Relapses in idiopathic nephrotic syndrome (INS) may occur due to imbalance of T-helper and regulator T-cells. Alteration of colonic bacteria composition may cause a defect in colonic mucosal integrity and activate the immune system, leading to INS relapse. The aim of this study are to determine the composition of gut bacteria in INS remission and relapse, serum IL-8 in INS relapse, and defective bowel integrity INS relapse.

Methods: This prospective study on children with INS was conducted in two phases, starting in remission and followed up to relapse. Both during remission and during relapse, we collected stool samples from all subjects to examine intestinal bacteria composition comprising Enterococci, Bacteroides, Escherichiae, Clostridia, Lactobacilli, and Bifidobacteria, fecal alpha-1 antitrypsin, and fecal calprotectin. We also collected peripheral blood to measure serum IL-8 levels during remission and relapse.

Results: The proportions of pathogenic bacteria Enteroccocus, Bacteroides, Escherichia, and Clostridium were higher in INS relapse compared to remission. The proportion of the beneficial Bifidobacteria was statistically higher in INS remission compared to relapse. There was an increase of alpha-1 antitrypsin in 51% of INS in remission and 48% in relapse. Fecal calprotectin was increased in 91.8% of INS in remission and 95.9% in relapse. Median serum IL-8 in INS relapse (13.2 pg/mL) was higher than in remission (11.8 pg/mL).

Conclusions: The proportion of Bifidobacteria is higher in INS remission than in relapse, while the proportion of pathogenic bacteria is higher in relapse than in remission. There is no association between the composition of gut bacteria with serum IL-8 increase in relapsing INS. There is a defect in mucosal integrity in relapsing INS as demonstrated by elevated fecal alpha-1-antitrypsin and calprotectin."

"Irritable bowel syndrome (IBS) merupakan kelainan fungsional saluran cerna berupa rasa nyeri atau tidak nyaman di abdomen yang timbul bersamaan dengan minimal dua dari tiga gejala, yaitu perbaikan keluhan setelah defekasi, perubahan frekuensi defekasi, atau perubahan konsistensi feses. IBS menjadi masalah kesehatan karena tata laksana yang belum optimal sehingga berbagai modalitas terapi dikembangkan, salah satunya akupunktur tanam benang. Penelitian ini bertujuan untuk mengetahui pengaruh terapi kombinasi akupunktur tanam benang dan medikamentosa terhadap gejala dan kualitas hidup penderita IBS. Uji klinis acak tersamar ganda dengan pembanding dilakukan pada 50 penderita IBS yang dialokasikan ke dalam kelompok kombinasi akupunktur tanam benang dan medikamentosa atau kelompok akupunktur sham dan medikamentosa. Skor IBS Symptom Severity Scale (IBS-SSS) dan IBS Quality of Life (IBS-QoL) digunakan untuk mengukur keluaran penelitian. Hasil penelitian menunjukkan perbedaan bermakna rerata skor IBS-SSS sebesar 71,60 lebih rendah (p = 0,000; 95% IK: - 96,36 sampai -30,15) dan skor IBS-QoL sebesar 13,08 lebih rendah (p = 0,000; 95% IK: -16,92 sampai -9,25) pada kelompok terapi kombinasi akupunktur tanam benang dan medikamentosa dibandingkan dengan kelompok akupunktur sham dan medikamentosa. Kesimpulan penelitian adalah terapi kombinasi akupunktur tanam benang dan medikamentosa lebih efektif mengurangi gejala dan meningkatkan kualitas hidup penderita IBS.

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IBS is a functional gastrointestinal disorder characterized by abdominal pain or discomfort associated with improvement with defecation and/or change of frequency or form of stool. Current medical treatments of IBS patients are still unsatisfying, hence other modalities are continuously being improved such as acupoint-catgut embedment.

The aim of this study was to establish the effect of acupoint-catgut embedment combined with medical treatment on symptoms and quality of life of IBS patients. A double blind randomized controlled trial involved 50 IBS patients randomly allocated into catgut embedding therapy with medication group or medication only group. Catgut embedding therapy was given three times at ST 25 Tianshu, ST 36 Zusanli, and ST 37 Shangjuxu every 10 days. IBS-SSS and IBS-QoL were used to measure the primary outcome.

There was a statistically significant difference between groups at one month; with IBS-SSS and IBS-QoL were 71.60 (p = 0,000; 95% CI: -96,36 to -30,15) and 13.08 point (p = 0,000; 95% CI: -16,92 to -9,25) lower in catgut embedding therapy with medication group. The results suggested that acupoint-catgut embedment combined with medical treatment is more effective than medical treatment in alleviating symptoms and enhancing the quality of life of IBS patients."

"Highly effective as a minimally invasive diagnostic and screening tool, CT colonography (CTC) is an important part of today's clinical armamentarium. In this concise, step-by-step guidebook, written by specialists who also run training courses in CT colonography, readers will find a wealth of information for everyday practice. From examination methods and image interpretation, to screening and reporting issues, to common mistakes and pitfalls to avoid, this compact book is all-inclusive, ideal for both beginners and more experienced examiners who want to deepen their knowledge of this powerful technique. Special Features: Full discussion of how to begin, including indications and contraindications, patient preparation, CT examination techniques, and patient risk profile; strategies for data analysis and clinical interpretation, including 2D and 3D applications ("virtual" visualization), polyp measurement, and computer-assisted detection of polyps; informative, point-by-point sections on clinical findings, starting with normal anatomy of the colon and moving on to common diseases, postoperative conditions, pitfalls and artifacts, and extracolonic involvement; more than 400 brilliant, fully labeled illustrations (176 in full-color), including normal CT scans and 2D and 3D reconstructions that demonstrate diagnostic criteria, possible differential diagnoses, and disease states; guidelines for standardizing reports and documenting findings; tips for setting up a virtual colonoscopy service in your clinic or practice."

"Contemporary coloproctology covers colorectal surgery, as practiced today, in an easily accessible format with emphasis on bringing key facts rapidly into focus. It is ideal reading both for the medical trainee and the practicing colorectal surgeon. As well as a succinct presentation of the current colorectal knowledge base, each chapter contains practical advice and pearls of wisdom from established practicing clinicians. A unique feature of the format is the identification of key references and questions and scenarios that present real life decisions in colorectal surgery."