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"ABSTRAKPendahuluan:Stroke iskemia menyebabkan cedera pada otak yang dapat menyebabkan malnutrisi dan disfagia. Risiko stroke meningkat jika ditemukan hipertensi dan dislipidemia. Tujuan tata laksana nutrisi adalah mencegah malnutrisi, menurunkan faktor risiko, dan mencegah risiko stroke berulang dan komplikasi pada pasien dengan faktor risiko.Presentasi Kasus:Pasien dalam serial kasus terdiri dari tiga pasien laki-laki dan satu pasien perempuan berusia antara 39-54 tahun yang didiagnosis stroke iskemia. Kasus pertama dan kedua memiliki faktor risiko hipertensi, sedangkan kasus kedua dan keempat memiliki faktor risiko dislipidemia. Hasil skrining gizi dengan MST pada pasien pertama adalah skor 2 dan diagnosis khusus, sedangkan tiga kasus lain termasuk dalam diagnosis khusus. Kebutuhan nutrisi dihitung dengan persamaan Harris-Benedict dengan faktor stres 1,5 pada kasus pertama karena terdapat ulkus dekubitus, sedangkan faktor stres tiga kasus lain adalah 1,3. Target pemberian protein adalah 1,3-1,5 g/kg BB/hari. Selama pemantauan, pemberian protein mencapai 1,3-1,4 g/kg BB/hari. Kasus kedua dan keempat mengalami disfagia, tetapi terdapat perbaikan disfagia pada pasien keempat sehingga jalur nutrisi diubah melalui oral, sedangkan pada kasus kedua tidak terdapat perbaikan disfagia sehingga pasien pulang dengan NGT. Terdapat riwayat hiponatremia berulang pada kasus pertama, sehingga dilakukan koreksi natrium dan restriksi cairan.Hasil:Terdapat perbaikan klinis pada keempat kasus dan perbaikan kapasitas fungsional, kecuali kapasitas fungsional kasus pertama.Kesimpulan:Tata laksana nutrisi adekuat pada pasien stroke iskemia dengan mempertimbangkan komorbiditas dapat menunjang perbaikan klinis dan kapasitas fungsional pasien.

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ABSTRACT

Background:

Ischemic stroke cause cerebral insult results in malnutrition and dysphagia. Risk factors of stroke are hypertension and dyslipidemia. The aim of nutrition management is malnutrition prevention, lowering the risk factors, and preventing of recurrent stroke and complication.

Case Presentation:

The four patients included in this serial case were three males and one female, 39-54 years old, diagnosed with ischemic stroke. The first and second case had history of hypertension and the third and fourth case had dyslipidemia. The result of MST score of first case was 2 and special diagnosed, whereas the other three cases were special diagnosed. Energy needs was based on Harris-Benedict equation with 1,5 of factor stress for first case (with pressure ulcers) and 1,3 for the other three cases. The target of protein needs is 1,3-1,5 g/kg. The protein intake during monitoring were 1,3-1,4 g/kg. Dysphagia were found at second and fourth case, but then the fourth case had recovery of dysphagia and nutrition route was transitioned to oral, while the second case did not had recovery of dysphagia during monitoring and discharged with NGT. Natrium correction and fluid restriction were done at first case due to history of repeated hyponatremia.

Result:

There were improvement of clinical outcome and functional capacity, except functional capacity of first case.

Conclusion:

Adequate nutritional management for ischemic stroke patients could support the recovery of clinical outcome and functional capacity and should consider patients? comorbidities."

"Latar Belakang: Kontak tubuh manusia dengan arus listrik dapat mengakibatkan trauma luka bakar. Pada Pasien luka bakar listrik, derajat keparahan trauma yang dialami pada organ dalam tidak sebanding dengan luka bakar di permukaan tubuh, sehingga dapat dikategorikan sebagai luka bakar berat. Terapi nutrisi merupakan bagian integral dalam tata laksana luka bakar sejak awal resusitasi hingga fase rehabilitasi. Saat ini sudah terdapat rekomendasi untuk tata laksana nutrisi luka bakar berat. Namun, belum terdapat rekomendasi yang spesifik mengenai tata laksana pada luka bakar listrik.Metode: Laporan serial kasus ini menjelaskan empat pasien kasus luka bakar listrik. Pasien mengalami berbagai penyulit yang kemudian mempengaruhi tata laksana nutrisi yang diberikan. Pasien pertama dengan trauma servikal, pasien kedua mengalami AKI dan penurunan fungsi hati, pasien ketiga mengalami syok sepsis, dan pasien keempat mengalami sepsis dan amputasi. Pemberian nutrisi dimulai sesuai dengan kondisi pasien. Target pemberian energi dihitung dengan menggunakan persamaan Harris-Benedict untuk kebutuhan basal, ditambah faktor stres 1,5-2. Protein diberikan 1,5-2 g/kg BB/hari hingga terjadi perbaikan. Karbohidrat dan lemak berturut-turut 60-65% dan <35%. Pemberian nutrisi diutamakan melalui oral dan enteral, sedangkan jalur parenteral hanya digunakan bila diperlukan untuk pemenuhan energi. Mikronutrien yang diberikan berupa multivitamin antioksidan, vitamin B kompleks dan asam folat.Hasil: Tiga pasien mengalami perbaikan klinis, kapasitas fungsional, dan laboratorium hingga diperbolehkan rawat jalan. Lama perawatan ketiga pasien tersebut berturut-turut 17 hari, 60 hari, dan 20 hari. Satu orang pasien meninggal akibat penyulit yang dialaminya yaitu syok sepsis yang menyebabkan gagal multi organ setelah dirawat selama 14 hari.Kesimpulan: Tatalaksana nutrisi yang optimal dan tepat sesuai dengan kondisi klinis pasien dapat menurunkan morbiditas dan mortalitas pasien dengan luka bakar listrik.

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Background: Contact to electricity can inflict burn injuries in human. In electrical burn injuries, the damages of the internal organs are not comparable to the burn injuries in the body's surface. Nutrition therapy is an integral part in burn management from the beginning of resuscitation to rehabilitation phase. Currently there have been several recommendations of nutrition management in severe burn injury. However there is still no recommendation that specifically recommend for nutrition management in patients with electrical burn injury.

Methods: The serial case report describes four patients with electrical burn injury. All patients had various complications that affected the nutrition management. First patient with cervical trauma, second patient had AKI and decreased liver function, third patient had septic shock, and fourth patient had sepsis and amputation. Nutrition was given individualy according to the patient clinical condition. Target of energy given calculated by Harris-Benedict equation for basal requirement with added stress factor 1,5-2. Protein was given 1,5-2 g/kg BW/day except patient with AKI protein restricted to 0,8-1 g/kg BW/day until improvement of renal function. Carbohydrates and lipids were given 60-65% and <35%, respectively. Oral or enteral nutrition was preferred while parenteral nutrition only given if required to meet the energy requirements. Micronutrients supplementation such as antioxidant vitamins, vitamin B complex, and folic acid were provided to patients.

Results: Three patients had the improvement in clinical condition, functional capacity, and laboratory results that allowed them to be discharged and had outpatient treatment. Length of stay of the patients were 17, 60, 20 days respectively. One patient died due to septic shock compilation that lead to multiple organ failure after 14 days of hospitalization.

Conclusion: Optimal and appropriate nutrition management adjusted to patient's clinical condition can reduced morbidity and mortality rate in the electrical burn injury patients."

"[Pendahuluan: Acute decompensated heart failure (ADHF) adalah penyebabutama rawat inap di RS karena morbiditas dan mortalitasnya yang tinggi.Perubahan metabolisme, pengaruh kongesti sistemik pada gastrointestinal, danefek samping terapi medikamentosa ADHF menyebabkan pasien ADHF rentanmengalami malnutrisi. Perbedaan faktor risiko ADHF juga mempengaruhi tatalaksana nutrisi. Tata laksana nutrisi yang adekuat sesuai dengan faktor risiko dankondisi klinis dibutuhkan untuk mencegah malnutrisi, menurunkan morbiditas danmortalitas.Presentasi Kasus: Pasien dalam serial kasus ini adalah dua perempuan dan dualaki-laki berusia 32–62 tahun dengan ADHF dan berbagai faktor risiko. Pasienpertama dengan diabetes melitus tipe 2, pasien kedua dengan dilatedcardiomyopathy, pasien ketiga dengan hipertensi, sedangkan pasien keempatdengan stenosis aorta. Target kebutuhan energi keempat pasien adalah sebesar130–140% kebutuhan energi basal yang dihitung dengan Harris-Benedict. Targetpemberian protein sebesar 0,8–1,4 g/kg BB/hari, kebutuhan lemak 25% darienergi total dengan komposisi lemak sesuai therapeutic lifestyle changes.Kebutuhan natrium 2400 mg/hari dengan restriksi cairan rata-rata sebesar 1500mL/hari. Pemberian mikronutrien dan nutrien spesifik berupa vitamin Bkompleks, C, B12, asam folat, seng, dan omega 3 disesuaikan dengan kondisipasien. Hasil: Pada keempat pasien didapatkan perbaikan kondisi klinis dan kapasitasfungsional.Kesimpulan: Tata laksana nutrisi yang adekuat pada pasien ADHF sesuai dengan faktor risiko dan kondisi klinis dibutuhkan untuk perbaikan outcome, menurunkan morbiditas dan mortalitas., Background: Acute decompensated heart failure (ADHF) is a leading cause forhospitalization due to its high morbidity and mortality. Metabolic changes,congestion effects on gastrointestinal, and side effects of therapy result inincreased risk of malnutrition in ADHF patients. Various risk factors and clinicalstatus also have great impact on nutritional management. An adequate nutritionalmanagement based on risk factor and clinical status is required to preventmalnutrition, reduce morbidity and mortality. Case Presentation: Two female and two male patients were included in this caseseries, aged 31–60 years old, and diagnosed as ADHF with various risk factors.The risk factor of ADHF for first patient was diabetes mellitus type 2, the secondpatient was dilated cardiomyopathy, the third patient was hypertension, and thefourth patient was aortic stenosis. Total energy requirement was 130–140% ofestimated basal energy requirement. Target of protein was 0.8–1.4 g/kg BW/day.Fat requirement was 25% of total energy with composition based on therapeuticlifestyle changes. Sodium intake was 2400 mg/day with fluid restriction averagedto 1500 mL/day. Micronutrient and specific nutrient supplementation such asvitamin B complex, C, B12, folic acid, zinc, and omega 3 were provided topatients based on clinical status. Result: There was improvement of clinical status and functional capacity in allpatients.Conclusion: An adequate nutritional management in ADHF patients based on risk factor and clinical status leads to better outcome and reduction of morbidity and mortality. ]"

"Pasien kanker kepala-leher berisiko tinggi mengalami malnutrisi disebabkan oleh perubahan metabolisme, lokasi tumor, serta gejala toksisitas akut akibat kemoradiasi. Terapi medik gizi secara dini sejak pasien terdiagnosis kanker untuk mencapai asupan energi dan protein yang adekuat, didukung asupan branched-chain amino acid (BCAA) dan eicosapentaenoic acid (EPA) sesuai target, serta aktivitas fisik dapat menjaga massa otot dan status gizi pasien. Acute kidney injury (AKI) merupakan efek toksisitas obat kemoterapi berbasis platinum yang sering dialami pasien. Kondisi tersebut dapat menghambat optimalisasi pemberian nutrisi khususnya protein pada pasien kanker. Tiga dari empat pasien serial kasus sudah mengalami penurunan berat badan drastis, juga pre-kaheksia atau kaheksia sebelum mendapat terapi medik gizi. Selama menjalani kemoradiasi, asupan keempat pasien mengalami penurunan akibat gejala toksisitas akut yang semakin memberat mulai minggu ke-2 radiasi, sehingga tiga dari empat pasien tidak dapat mencapai target asupan energi dan protein pada sebagian besar pemantauan, dengan kisaran antara 6–41 kkal/kgBB/hari dan 0,3–1,6 g/kgBB/hari. Pemberian oral nutrition supplements (ONS) dan nutrisi enteral melalui nasogastric tube (NGT) membantu pemenuhan makronutrien, mikronutrien, serta nutrien spesifik. Berbagai studi menyatakan bahwa pasien yang mendapat terapi medik gizi disertai konseling nutrisi rutin mengalami penurunan berat badan lebih sedikit selama menjalani kemoradiasi. Keempat pasien serial kasus ini mengalami penurunan berat badan >10% selama menjalani kemoradiasi, terutama dari penurunan massa otot. Pasien juga mengalami penurunan kapasitas fungsional dan kualitas hidup. Dua orang pasien yang mendapat terapi medik gizi sejak sebelum kemoradiasi disertai asupan nutrien spesifik sesuai target, dengan rentang asupan BCAA 3,5–16,2 g/hari dan EPA 1–1,38 g/hari, mengalami penurunan berat badan dan kualitas hidup relatif lebih sedikit dibanding dua pasien lainnya. Dibutuhkan asupan energi ≥30 kkal/hari dan asupan protein ≥1,2 g/hari disertai peningkatan aktivitas fisik untuk mempertahankan atau meningkatkan massa otot. Penurunan asupan masih dapat terjadi hingga beberapa minggu pascakemoradiasi, sehingga pemberian terapi medik gizi juga harus dilanjutkan setelah terapi kanker selesai.

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Patients with head and neck cancer are at risk of malnutrition as a result of the metabolic alteration, site of their cancer, also acute toxicity following chemoradiation therapy. Early nutrition intervention consisted of adequate energy, protein, BCAA, and EPA intake, including physical activity initiated immediately after diagnosis was made, may maintain skeletal muscle mass and nutritional status. Platinum-based chemotherapy drug-induced nephrotoxicity can hinder the optimization of protein intake in cancer patients. Three out of four patients in this case series had experienced severe weight loss, also pre-cachexia and cachexia before initiation of nutrition intervention. Energy and protein intake of three patients remained insufficient until the end of chemoradiation therapy, ranged from 6–41 kcal/kg/day and 0,3–1,6 g/kg/day. These inadequacies were mainly caused by acute radiation toxicities that worsen as radiation went on. Oral nutrition supplements and enteral tube feeding may help to achieve adequate macronutrient, micronutrient, and specific nutrient intake. A number of studies demonstrated that regular dietary counseling during chemoradiation was associated with less weight loss. All patients in this case series suffered from weight loss >10%, mainly from skeletal muscle loss. Functional status and quality of life during chemoradiation therapy were also reduced. Better quality of life and less weight loss were seen in two patients who received early nutrition intervention and reached the daily intake target of specific nutrient, ranged from 3,5–16,2 g/day for BCAA and 1–1,38 g/day for EPA. Energy intake ≥30 kcal/day and protein intake ≥1,2 g/day combined with increased physical activity are needed to maintain or increase muscle mass. Side effects of radiation can last for months after treatment; therefore, nutrition intervention should be continued to maintain good nutrition after radiation therapy."

"Latar Belakang: Stroke iskemik yang disertai dengan diabetes melitus merupakan kondisi yang sering terjadi. Serangan stroke iskemik akut seringkali terjadi bersamaan dengan kadar glukosa darah yang meningkat. Pemberian dukungan nutrisi diperlukan untuk membantu mengontrol glukosa darah dan membantu memperbaiki kapasitas fungsional pada pasien stroke iskemik dengan DM. Salah satu nutrisi yang dapat membantu mengontrol kadar glukosa darah adalah asam lemak tak jenuh tunggal (MUFA) yang berasal dari minyak zaitun. Metode: Serial kasus ini melaporkan empat pasien stroke iskemik yang disertai dengan diabetes melitus dengan rentang usia 52-66 tahun dan status gizi yang bervariasi. Terapi medik gizi diberikan sesuai dengan pedoman nutrisi untuk penderita stroke dan diabetes melitus, serta diberikan tambahan minyak zaitun untuk mencapai pemenuhan target MUFA dan suplementasi mikronutrien vitamin B kompleks, vitamin C, asam folat dan tablet seng. Hasil: Kadar glukosa darah keempat pasien selama perawatan berada dalam rentang 140-180 mg per dL, sesuai dengan rekomendasi. Kapasitas fungsional dua pasien mengalami peningkatan sedangkan dua pasien lainnya tidak mengalami perubahan. Kesimpulan: Dukungan nutrisi dengan penambahan bahan makanan sumber tinggi MUFA pada pasien stroke iskemik dengan diabetes melitus ikut membantu dalam proses penyembuhan pasien.

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Background: Ischemic stroke accompanied by diabetes mellitus is a common condition. Acute ischemic stroke often occurs together with the increase of blood glucose levels. Nutritional support is needed to control blood glucose and improve functional capacity. One of nutrient that can control blood glucose levels is monounsaturated fatty acids (MUFA), which derived from olive oil.

Methods: This case series reported four ischemic stroke patients accompanied by DM which age range of 52-66 years and varied nutritional status. Nutritional medical therapy was given in accordance with nutritional guidelines for stroke and DM. All of patients were given an additional olive oil to achieve the fulfillment of MUFA targets and supplementation of micronutrient such as vitamin B complex, vitamin C, folic acid and zinc tablets.

Results: The blood glucose levels of all patients during the treatment were in the range of 140-180 mg per dL, according to the recommendations. The functional capacity of the two patients has increased while the other two patients have not.

Conclusion: Nutritional support with the addition of high-source of MUFA food in ischemic stroke patients with diabetes mellitus may support the improvement of healing process."

"ABSTRAKPenyakit ginjal kronik (PGK) telah menjadi penyakit epidemik global dan prevalensinya di Indonesia terus meningkat. Hemodialisis (HD) merupakan terapi pengganti ginjal yang paling sering dilakukan pada pasien PGK stadium akhir. Pasien PGK yang menjalani HD rutin rentan mengalami protein energy wasting (PEW) sehingga memengaruhi status gizi. Lingkar otot lengan atas (LOLA) merupakan indeks yang dapat menggambarkan total protein tubuh dan massa otot. Terapi medik gizi komprehensif diperlukan untuk menghindarkan pasien dari PEW dan memperbaiki kualitas hidup pasien. Pemantauan terhadap empat pasien berusia 32-61 tahun dengan proporsi jenis kelamin sama, didiagnosis PGK stadium akhir dan menjalani HD rutin. Berdasarkan kriteria The American Society for Parenteral and Enteral Nutrition seluruh pasien mengalami malnutrisi. Dua pasien telah menderita PEW, dua lainnya berisiko PEW. Terapi medik gizi diberikan sesuai dengan keadaan klinis pasien dengan target protein yaitu 1,1-1,4 g/kgBB/hari. Asupan energi dan protein pada dua pasien telah lebih dari 35 kkal/kgBB/hari dan 1,2 kkal/kgBB/hari sejak awal, sedangkan dua pasien lainnya rendah pada awal pengkajian namun mengalami peningkatan di akhir pemantauan. Seluruh pasien memiliki nilai LOLA yang rendah dan diduga mengalami deplesi otot, namun dua pasien mengalami peningkatan LOLA di akhir pemantauan.

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ABSTRACTChronic kidney disease has become a global epidemic disease and the prevalence is increasing in Indonesia. Hemodialysis (HD) is the most common treatment for end stage renal disease (ESRD) patients. Patients who undergoing HD routinely are vulnerable to increase protein energy wasting (PEW) so nutritional status must be monitored closely. Mid upper arm muscle circumference (MUAMC) can be use to show total body protein and muscle mass. Medical nutrition therapy is needed to prevent patients from PEW and improve the quality of life. Four patients age range 32-61 years and same sex ratio, diagnosed with ESRD undergoing HD. Based on The American Society for Parenteral and Enteral Nutrition s criteria all patients were malnutrition. Two patients experienced PEW and the other had risk of PEW. Medical nutritional therapy is given according to clinical condition of each patient with target protein from 1.1-1.4 g/kgBW/day. Energy and protein intake in two patients was more than 35 kcal/kgBW/day and 1.2 kcal/kgBW/day at first assessment. Unfortunately the others patient intake were low at the first assessment but incresed at the end of monitoring. All patients had low MUAMC scores which indicate muscle depletion. Two patients had increased MUAMC at the end of monitoring."

"Pasien kanker dan infeksi rentan mengalami malnutrisi. Malnutrisi berat merupakan faktor risiko dari sindrom refeeding, suatu pergeseran cairan dan elektrolit yang berat akibat nutrisi yang diberikan pada pasien malnutrisi dan menimbulkan gangguan metabolik. Deplesi mineral intrasel (hipofosfatemia, hipomagnesemia, hipokalemia), gangguan cairan tubuh (refeeding edema), defisiensi tiamin, aritmia, gagal nafas, dan gagal jantung kongestif merupakan tanda dan gejala sindrom refeeding yang dapat meningkatkan morbiditas dan mortalitas. Dilaporkan empat pasien malnutrisi berat dengan tuberkulosis (TBC) paru dan karsinoma nasofaring (KNF) yang mengalami sindrom refeeding saat dirawat di rumah sakit. Terapi medik gizi dengan pemberian energi awal kurang dari 20 kkal/kgBB/hari lalu ditingkatkan bertahap, kadar elektrolit darah yang rendah dilakukan koreksi melalui oral atau intra vena, juga diberikan suplementasi tiamin dan mikronutrien lain. Pemantauan ketat klinis, tanda vital, keseimbangan cairan, dan kadar elektrolit darah dilakukan minimal 24 jam selama nutrisi diberikan. Pada akhir perawatan, terdapat perbaikan gejala dan tanda sindrom refeeding, serta kadar elektrolit darah. Lama perawatan pasien di rumah sakit 11-27 hari. Terapi medik gizi yang benar dan sesuai dapat mengurangi keparahan sindrom refeeding, memperbaiki klinis dan kadar elektrolit darah pasien.

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Patients with cancer or infection disease are vulnerable to malnutrition. Severe malnutrition is a risk factor for refeeding syndrome, profound shifts of fluid and electrolytes that is developed from refeeding and causes metabolic disturbances. Intracellullar mineral depletion (hypophosphatemia, hypomagnesemia, hypokalemia), body water imbalance (refeeding edema), thiamine deficiency, arrhythmia, respiratory failure and congestive heart failure are the signs and symptoms of refeeding syndrome which can increase morbidity and mortality. We report four severe malnutrition patients with pulmonary tuberculosis and nasopharyngeal carcinoma who developed refeeding syndrome while being treated for their underlying illness in hospital. Medical nutrition therapy started with energy less than 20 kcal/kg/day and increased slowly, low blood electrolytes levels were supplemented with oral or intravenous electrolytes. Patients were also given thiamine and another micronutrient supplementation. Patients were monitored closely for clinical conditions, vital signs, water balances and blood electrolytes levels minimum every 24 hours. Before discharge, improvement was seen in signs and symptoms of refeeding syndrome, and blood electrolytes levels. Hospital length of stay was 11 to 27 days. Appropriate medical nutrition therapy can reduce refeeding syndrome severity, give clinical and blood electrolytes levels improvement."

"Stress oksidatif merupakan dasar dari berbagai penyakit degeneratif dan kanker, termasuk asbestosis dan mesotelioma. Kedua penyakit tersebut terjadi akibat terinhalasinya serat asbes dalam jangka waktu lama dan jumlah pajanan yang tinggi. Penelitian potong lintang di Sekretariat Buruh Karawang bulan Oktober 2014 dilakukan untuk menilai korelasi asupan dan kadar vitamin C, E dengan kadar isoprostan. Lima puluh dua subjek yang bekerja di pabrik asbes selesai mengikuti seluruh protokol penelitian. Hasil menunjukkan bahwa asupan vitamin C dan kadar vitamin E berkorelasi negatif dengan kadar isoprostan, sedangkan asupan vitamin E dan kadar vitamin C berkorelasi positif dengan kadar isoprostan pekerja pabrik asbes. Korelasi tersebut secara statistik tidak bermakna. Penelitian lanjut diperlukan untuk menilai kadar isoprostan secara series, sehingga bila ada peningkatan yang signifikan dapat segera dikethui.

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Oxidative stress is the base of various degenerative diseases and cancers, including asbestosis and mesothelioma. Both of them occur due to prolonged inhalation of asbestos fibers and high level of exposure. A cross-sectional study at a labor secretariat in October 2014 was performed to assess the correlations between intakes and levels of vitamin C and vitamin E and isoprostane level. Fifty two subjects working at an asbestos factory finished the study. The result showed that vitamin C intake and vitamin E level were negatively correlated with isoprostane level. Meanwhile, vitamin E intake and vitamin C level were positively correlated with isoprostane level in asbestos factory workers. These correlations were statistically insignificant. Asbestos factory workers should be educated to increase their intakes of vitamin C and vitamin E."

"Serat asbes yang terinhalasi masuk ke dalam alveolus menyebabkan terjadinya peningkatan produksi reactive oxigen spesies (ROS) yang dapat memicu terjadinya reaksi inflamasi. Interleukin 6 merupakan penanda reaksi inflamasi akibat pajanan serat asbes. Vitamin C dan E merupakan antioksidan yang bekerja sebagai scavenger ROS. Vitamin C juga dapat menghambat aktivitas faktor transkripsi NFқB. Vitamin E selain dapat menghambat aktivitas faktor transkripsi JAK/STAT3 dan NFқB, juga dapat menghambat aktivitas COX2 dan LOX5. Penelitian potong lintang di sekretariat serikat buruh pabrik asbes X Kabupaten Karawang bulan Oktober 2014 dilakukan untuk menilai korelasi asupan vitamin C, E dengan kadar interleukin 6 pada pekerja pabrik asbes. Lima puluh dua pekerja pabrik asbes berhasil menyelesaikan protokol penelitian. Hasilnya menunjukkan tidak terdapat korelasi bermakna (p >0,05) antara asupan vitamin C dengan kadar IL-6 dan antara asupan vitamin E dengan kadar IL-6. Terdapat korelasi positif antara kadar vitamin C dengan kadar IL-6 (r = 0,31) dengan p <0,05, namun tidak terdapat korelasi antara kadar vitamin E dengan kadar IL-6.

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Asbestos fibers that are inhaled into the alveoli cause increased production of reactive oxygen species (ROS) which may trigger inflammation reaction. Interleukin 6 (IL-6) is a marker of inflammation reaction caused by asbestos fibers exposure. Vitamin C and vitamin E are antioxidants acting as ROS scavengers. Vitamin C can also inhibit the activity of transcription factor NFқB. Vitamin E can inhibit the activities of transcription factors JAK/STAT3 and NFқB as well as the activities of COX2 and LOX5.

A cross-sectional sudy at a labor union secretariat in Karawang Regency in October 2014 was conducted to evaluate the correlations between intakes and levels of vitamin C and vitamin E and level of IL-6 in asbestos factory workers. Fifty two asbestos factory workers finished the study. The result showed no significant correlation between vitamin C intake and IL-6 level or between vitamin E intake and IL-6 level. There was a moderate positive correlation between vitamin C level and IL-6 level (r = 0.31, p <0.05), but there was no correlation between vitamin E level and IL-6 level."

"ABSTRAKLatar Belakang: Tuberkulosis merupakan penyakit infeksi kronik yang tetap menjadi masalah kesehatan global terutama di negara berkembang dan menjadi penyebab kematian kedua terbesar pada kelompok penyakit menular. Selain paru, kuman tuberkulosis dapat menginvasi hingga ke organ ektrapulmoner salah satunya usus. Infeksi kuman pada mukosa usus karena tuberkulosis usus dapat menyebabkab ulserasi hingga nekrosis lapisan mukosa yang akan memengaruhi absorpsi nutrisi. Malabsorpsi dan anoreksia dapat menjadi penyebab malnutrisi pada tuberkulosis usus. Terapi medik gizi bertujuan untuk menyediakan nutrisi adekuat, meningkatkan status gizi, menurunkan risiko kematian, memperpendek lama rawat inap, mencegah terjadinya penurunan massa otot, mendukung proses kesembuhan penyakit, memenuhi kebutuhan mikronutrien yang adekuat, dan meningkatkan sistem imunitas. Metode:Pada serial kasus ini, dilaporkan 4 kasus tuberkulosis usus pada pasien laki-laki dan perempuan yang berusia antara 24-31 tahun, dengan 1 pasien koinfeksi HIV. Keempat pasien mengalami malnutrisi, 3 diantaranya adalah malnutrisi berat dan juga didiagnosis kaheksia. Pada 3 kasus awal, tatalaksana tuberkulosis usus disertai dengan pembedahan akibat komplikasi obstruksi usus mekanik, perdarahan, dan fistula sedangkan kasus terakhir hanya diberikan AOT. Masalah nutrisi terjadi pada keempat kasus terkait dengan perubahan anatomi saluran cerna, fungsi fisologis, dan pemberian mikronutrien yang kurang adekuat. Terapi medik gizi telah diberikan sesuai rekomendasi untuk pasien dengan tuberkulosis usus dengan malnutrisi. Hasil :Kasus pertama dan keempat mengalami perbaikan keadaan klinis hingga diperbolehkan rawat jalan. Namun, kasus kedua dan ketiga meninggal dunia masing-masing pada hari perawatan ke-54 dan 28 akibat sepsis dan perdarahan. Kesimpulan:Terapi medik gizi yang diberikan telah membantu perbaikan kondisi klinis pada pasien tuberkulosis usus dengan malnutrisi.

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ABSTRACTBackground:Tuberculosis is a chronic infection that remains a global health problem especially in developing countries and become the second leading cause of death in infectious diseases. Beside lung organ, the Mycobacterium tuberculosis can invade up to an extrapulmonary organ such as intestine. Infections in the intestinal mucosa due to intestinal tuberculosis may cause ulceration to necrosis of the intestinal mucose that will be affected to nutrient absorption. Malabsorption and anorexia can be the cause of malnutrition in intestinal tuberculosis. Nutritional medical therapy aims to provide adequate nutrition, improve nutritional status, reduce the risk of death, shorten the length of stay, prevent the decrease of muscle mass, support the wound healing, giving adequate micronutrients, and improve the immune system. Methods: In this series of cases, 4 cases of intestinal tuberculosis were reported in male and female patients between 24 and 31 years old, with 1 patient co-infected with HIV. The four patients were malnourished, 3 of them with severe malnourished and also diagnosed with cachexia. In the third initial cases, management of intestinal tuberculosis was surgery due to complications mechanical bowel obstruction, hemorrhage, and fistulas while the last one was given only DOT. Nutrition problems occur in all four cases associated with altered gastrointestinal anatomy, physiological function, and inadequate micronutrient administration. Medical nutrition therapy has been given as recommended for patients with intestinal tuberculosis with malnutrition. Result: The first and fourth cases had an improvement on clinical conditions. However, the second and third cases died on the 54th and 28th day of treatment due to sepsis and bleeding. Conclusion: Medical nutritional therapy has been provided to improve clinical conditions in intestinal tuberculosis patients with malnutrition. "