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"Kanker paru-paru menduduki posisi ketiga jenis kanker tertinggi di Indonesia. Nyeri kanker adalah salah satu gejala paling umum yang terjadi pada pasien kanker. Pemberian opioid sebagai pereda nyeri memiliki banyak efek samping yang dapat bersifat fatal seiring meningkatnya dosis opioid. Oleh sebab itu, alternatif yang dapat dilakukan adalah mengombinasikan adjuvan pada terapi opioid. Gabapentin adalah antikonvulsan yang sering dipakai sebagai adjuvan terapi opioid. Penelitian ini bertujuan untuk mengetahui pengaruh pemberian gabapentin sebagai adjuvan opioid terhadap dosis opioid dan intensitas nyeri kanker pada pasien kanker paru-paru. Jumlah sampel yang diperoleh untuk kelompok terapi opioid adalah 43 pasien dan jumlah sampel yang diperoleh untuk kelompok opioid dengan gabapentin adalah 34 pasien. Tidak menemukan adanya perbedaan dosis opioid dan intensitas nyeri yang signifikan antara kelompok pasien yang menerima opioid saja dan yang menerima opioid dengan gabapentin. Mayoritas pasien (44,15%) dari keseluruhan pasien mengalami bebas nyeri pada akhir terapi. 79,06% pasien yang diterapi dengan opioid dan 88,24% pasien pada kelompok opioid dengan gabapentin mengalami penurunan intensitas nyeri > 50% pada akhir terapi. Peran gabapentin dalam menurunkan dosis opioid dan menurunkan intensitas nyeri pasien kanker paru-paru masih perlu diteliti lebih lanjut.

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Lung cancer is the third most prevalent cancer in Indonesia. Cancer pain is one of the most common symptoms experienced by cancer patients. Opioids as treatment of cancer pain has numerous adverse effects which may be fatal along with the increase of its doses. Therefore, combining opioids with its adjuvant serves as an alternative to minimize its negative effects. This study aims to determine the effects of gabapentin as opioid adjuvant on opioid dose and pain intensity in lung cancer patients. The sample size obtained for the opioid group is 43 patients and 34 for the opioid with gabapentin group. No significant difference of opioid dose and pain intensity between patients who received opioid and patients who received opioid with gabapentin. The majority of patients (44,15%) of all included patients are pain-free at the end of their therapy. 79,06% of patients with opioid therapy and 88,24% patients with opioid and gabapentin have a > 50% decrease of pain intensity at the end of their therapy. The role of gabapentin in decreasing opioid dose and pain intensity in lung cancer patients need to be studied further."

"Kanker payudara adalah kanker dengan prevalensi tertinggi di Indonesia. Dengan prevalensi sebesar 30–50%, nyeri kanker adalah salah satu komplikasi kanker tersering yang dapat menurunkan mutu hidup penderitanya. Nyeri kanker, yang merupakan sejenis nyeri campuran, dapat diakibatkan oleh perjalanan penyakit atau terapi antikanker. Umumnya nyeri kanker ditangani dengan pemberian opioid dengan/tanpa adjuvan. Namun, opioid memiliki efek samping yang bersifat dose-dependent sehingga penggunaannya harus tepat guna agar memaksimalkan manfaatnya sekaligus meminimalisasi risikonya. Studi ini meneliti efek dari pemberian adjuvan gabapentin terhadap intensitas nyeri dan dosis opioid pasien dengan nyeri kanker payudara. Data rekam medis dari 58 pasien dengan nyeri kanker payudara dari dua rumah sakit rujukan di Jakarta diinklusi untuk studi kohort retrospektif ini. Data yang diambil meliputi profil klinis pasien, derajat nyeri, dan dosis opioid. Analisis statistik tidak menemukan adanya perbedaan yang signifikan dalam median intensitas nyeri maupun median dosis opioid antara kelompok pasien dengan nyeri kanker payudara yang menerima adjuvan gabapentin dengan yang tidak. Masih diperlukan penelitian lebih lanjut untuk menentukan peran gabapentin sebagai adjuvan dalam tata laksana nyeri kanker. Penelitian-penelitian selanjutnya disarankan untuk memperbanyak jumlah pasien dan mengendalikan faktor-faktor perancu seperti status opioid dan pemberian adjuvan lain.

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Breast cancer is the most prevalent cancer in Indonesia. With a prevalence of 30–50%, cancer pain is a frequent complication of cancer which may lower patient quality of life. Cancer pain, a type of mixed pain, may develop from cancer progression or anticancer therapy. Opioids with/without adjuvants are usually administered to manage cancer pain. However, opioids are associated with dose-dependent side effects. Hence, the administration of opioids should be efficient to maximize benefit and minimize risks. This research studied the effect of adjuvant gabapentin administration on the severity of pain and opioid dose of patients with breast cancer pain. This retrospective cohort study included medical records from 58 patients with breast cancer pain from two tertiary hospital in Jakarta. Patients’ clinical profile, pain severity level, and opioid doses were collected. Statistical analyses did not find a significant difference in median pain severity level and median opioid dose between patients with breast cancer pain who received gabapentin and those who do not. Further research is warranted to determine the role of gabapentin as adjuvant in the management of cancer pain. Future studies should increase the sample size and control confounders such as opioid status and the administration of other adjuvants."

"Latar Belakang Kanker nasofaring menduduki peringkat keempat kanker terbanyak di Indonesia. Di antara gejala-gejalanya, sakit kepala sering dilaporkan dan terkadang menjadi satu- satunya keluhan. Opioid telah lama menjadi pendekatan utama untuk mengatasi nyeri kanker neuropatik; namun efektivitasnya sering kali dianggap kurang optimal. Akibatnya, obat-obatan tambahan, termasuk Gabapentin, sering kali diintegrasikan ke dalam rejimen pengobatan untuk meningkatkan manajemen nyeri. Penelitian ini bertujuan untuk membandingkan kemanjuran terapi opioid saja dan terapi kombinasi dalam pengobatan nyeri kanker. Metode Sebuah studi kohort retrospektif dilakukan dengan meninjau rekam medis dari dua rumah sakit di Jakarta, Indonesia. Penelitian ini mencakup sampel 139 pasien yang didiagnosis menderita kanker nasofaring. Ekstraksi data meliputi demografi pasien, resep opioid awal dan akhir, intensitas nyeri awal dan akhir yang dinilai dengan Numerical Rating Scale (NRS), jenis kanker nasofaring, dan peresepan gabapentin. Hasil Analisis statistik menunjukkan perbedaan yang signifikan dalam rata-rata penurunan NRS. Pasien dalam kelompok terapi kombinasi, termasuk gabapentin sebagai bahan pembantu, mengalami penurunan rata-rata skor Numerical Rating Scale (NRS) sebesar 2,141, sedangkan pasien pada kelompok opioid saja mengalami penurunan rata-rata skor NRS sebesar 0,894. Kesimpulan Studi ini menyoroti penurunan signifikan secara statistik pada rata-rata skor NRS, yang menegaskan potensi kemanjuran gabapentin sebagai bahan tambahan opioid dalam mengurangi nyeri kanker di antara pasien kanker nasofaring.

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Introduction Nasopharyngeal cancer ranks as the fourth most prevalent cancer in Indonesia. Among its symptoms, headaches are frequently reported and, at times, can be the sole complaint. Opioids have long been the primary approach to managing neuropathic cancer pain; nonetheless, their effectiveness is often considered suboptimal. As a result, adjuvant medications, including Gabapentin, are frequently integrated into treatment regimens to augment pain management. This study aims to compare the efficacy of opioid-only and combination therapy in the treatment of cancer pain. Method A retrospective cohort study was undertaken by reviewing medical records from two hospitals in Jakarta, Indonesia. The study encompassed a sample of 139 patients diagnosed with nasopharyngeal cancer. Data extraction included patient demographics, initial and final opioid prescriptions, initial and final pain intensity assessed by the Numerical Rating Scale (NRS), type of nasopharyngeal cancer, and the prescription of gabapentin. Results Statistical analysis demonstrated a significant difference in mean NRS reduction. Patients in the combination therapy group, including gabapentin as an adjuvant, experienced a mean reduction of 2.141 in Numerical Rating Scale (NRS) scores, while those in the opioid-only group had a mean reduction of 0.894 in NRS scores. Conclusion The study highlighted the statistically significant reduction in mean NRS scores, affirming the potential efficacy of gabapentin as an adjuvant to opioids in alleviating cancer pain among nasopharyngeal cancer patients."

"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: Tumor sistem saraf pusat (SSP) meningkatkan tekanan intrakranial dan menyebabkan berbagai gangguan neurologis yang dapat memengaruhi status gizi pasien. Status gizi memengaruhi imunitas bawaan dan adaptif. Pada hampir semua jenis keganasan kadar asam amino rantai cabang (AARC) didapatkan rendah. Asam amino rantai cabang meningkatkan imunitas dengan meningkatkan fagositik neutrofil, proliferasi limfosit, sintesis protein, menjaga jalur pensinyalan yang sensitif terhadap nutrisi. Rasio neutrofil limfosit (RNL) menggambarkan keseimbangan sistem imunitas dengan inflamasi. Peningkatan RNL dihubungkan dengan penurunan respon imun tubuh, terapi, harapan hidup dan prognosis. Penelitian ini dilakukan untuk mengetahui hubungan asupan AARC terhadap RNL pada pasien tumor SSP.Metode: Penelitian ini merupakan studi potong lintang pada pasien tumor SSP yang dirawat di RSCM. Karakteristik subjek berupa usia, jenis kelamin, jenis tumor, defisit neurologis, status performa karnofsky, indeks massa tubuh (IMT), status gizi berdasarkan ASPEN, penyakit komorbid, status infeksi, kemoterapi, radiasi, dan atau kemoradiasi, terapi glukokortikoid, asupan energi dan protein, asupan AARC, serta nilai RNL. Dilakukan analisis hubungan antara dua kelompok asupan AARC yang dibagi sesuai median populasi penelitian terhadap RNL.Hasil: Terdapat 66 subjek penelitian dengan median usia 48 tahun, mayoritas subjek perempuan (56,1%), dengan jenis tumor sekunder sebanyak 38 subjek (57,6%). Defisit neurologis tertinggi berupa nyeri kepala (60,6%), proporsi status performa karnofsky terganggu sedang-berat (60,6%). Proporsi IMT estimasi normal sebanyak 34,8%, rerata IMT 23,46 ± 4,95 kg/m2, dengan mayoritas malnutrisi (54,5%) berdasarkan kriteria ASPEN. Mayoritas subjek tidak memiliki komorbid (65,2%), tidak infeksi (80,3%), tidak menjalani kemoterapi, radiasi dan atau kemoradiasi (84,8%), serta tidak mendapat glukokortikoid (71,2%). Rerata asupan energi 1519 kkal, protein 65 g/hari, median AARC 9 g/hari. Terdapat perbedaan bermakna nilai RNL (p=0,047) pada kelompok asupan AARC <9 g/hari (median RNL 4,9); pada kelompok asupan AARC ≥9 g/hari (median RNL 3,1).

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Background: Central nervous system (CNS) tumors increase intracranial pressure and cause various neurological disorders that can affect the nutritional status of patients. Nutritional status influences both innate and adaptive immunity. In almost all malignancies, low levels of branched-chain amino acids (BCAA) are observed. Branched-chain amino acids enhance immunity by increasing neutrophil phagocytosis, lymphocyte proliferation, protein synthesis, and maintaining nutrient-sensitive signaling pathways. The neutrophil lymphocyte ratio (NLR) reflects the balance of the immune system with inflammation. An elevated NLR is associated with decreased body immune response, therapy outcomes, life expectancy, and prognosis. This study aims to determine the relationship between BCAA intake and NLR in CNS tumor patients.

Method: This is a cross-sectional study on CNS tumor patients treated at RSCM. Subject characteristics include age, gender, tumor type, neurological deficits, Karnofsky performance status, body mass index (BMI), nutrition status based on ASPEN, comorbidities, infection status, chemotherapy, radiation, and/or chemoradiation, glucocorticoid therapy, energy, and protein intake, BCAA intake, and NLR values. The analysis examines the relationship between two groups of BCAA intake divided according to the study population's median with NLR.

Results: There were 66 study subjects with a median age of 48 years, mostly female subjects (56,1%), with 38 subjects (57,6%) having secondary tumors. The highest neurological deficit was headache (60,6%), and the majority have a moderately to severely impaired Karnofsky performance status (60,6%). The proportion of estimated normal Body Mass Index (BMI) was 34.8%, with a mean BMI of 23,46 ± 4,95 kg/m2, and the majority were malnourished (54,5%) based on ASPEN criteria. Most subjects had no comorbidities (65,2%), no infections (80,3%), did not undergo chemotherapy, radiation, and/or chemoradiation (84,8%), and did not receive glucocorticoids (71.2%). The mean energy intake was 1519 kcal, protein intake 65 g/day, and the median BCAA was 9 g/day. There was a significant difference in the NLR values (p=0,047) between the group with BCAA intake <9 g/day (median NLR 4,9) and the group with BCAA intake ≥9 g/day (median NLR 3,1).

Conclusion: BCAA intake is related to NLR values in CNS tumor patients. Higher BCAA intake is associated with lower NLR values."

"Latar Belakang: Diperkirakan 20-40% pasien kanker mengalami metastasis ke sistem saraf pusat (SSP). Kondisi inflamasi sistemik pada kanker yang dimediasi sitokin berkaitan dengan penurunan massa otot. Pada kondisi inflamasi, sel hepatosit terstimulasi untuk memproduksi protein fase akut c-reative protein (CRP). Kadar CRP di sirkulasi mengalami peningkatan pada lebih dari 50% pasien keganasan. CRP diperkirakan berhubungan dengan penurunan massa otot dan menjadi prediktor dini dalam kehilangan jaringan lean. Penelitian ini dilakukan untuk mengetahui hubungan kadar CRP dengan indeks massa otot skeletal (skeletal muscle mass index, SMI) pada pasien metastasis SSP. Metode: Penelitian ini adalah studi potong lintang pada pasien kanker dengan metastasis SSP di RSCM. Karakteristik subjek berupa usia, jenis kelamin, tipe metastasis, lokasi tumor primer, defisit neurologis, status performa Karnofsky, penyakit komorbid, penyakit infeksi, terapi glukokortikoid, sedang menjalani kemoterapi, radioterapi, dan tindakan bedah, indeks massa tubuh (IMT), status gizi berdasarkan IMT dan kriteria ASPEN, asupan energi, asupan protein, kadar CRP, dan nilai SMI. Dilakukan analisis hubungan kadar CRP dengan SMI.Hasil: Terdapat 57 pasien yang mengalami metastasis SSP. Mayoritas subjek perempuan (56,1%). Median usia 47 tahun. Lokasi metastasis lebih banyak ditemukan di otak (56,1%), tipe metastasis berdasarkan lokasi susunan saraf terbanyak adalah sinkronus (86%), seluruh subjek merupakan oligometastasis, dan lokasi tumor primer mayoritas berasal dari nasofaring (17,5%), payudara (15,8%), dan paru (14%). Defisit neurologis terbanyak yaitu nyeri kanker (68,4%), nyeri kepala (56,1%), dan kelemahan anggota gerak (43,9%). Kelemahan anggota gerak mayoritas hemiparesis (22,8%). Sebagian besar status performa Karnofsky pasien terganggu sedang (45,6%), 63,2% subjek tidak memiliki penyakit komorbid, 68,4% tidak memiliki penyakit infeksi, 52,6% tidak dalam terapi glukokortikoid, 75,4% subjek tidak sedang menjalani kemoterapi, masing-masing 1,8% subjek sedang menjalani radioterapi dan tindakan bedah. Rerata IMT estimasi 21,28 kg/m2 dan mayoritas status gizi berdasarkan IMT estimasi adalah berat badan normal (43,9%). Berdasarkan kriteria ASPEN, mayoritas termasuk malnutrisi sedang (49,1%) dan berat (31,6%). Rerata asupan energi 19 kkal/kgBB dan median asupan protein 0,6 g/kgBB. Median kadar CRP 46,6 mg/L dan 96,5% subjek mengalami peningkatan kadar CRP. Rerata SMI seluruh subjek yaitu 6,17 kg/m2, rerata SMI laki-laki 7,2 kg/m2 sedangkan rerata SMI perempuan 5,4 kg/m2. Terdapat korelasi negatif lemah (r=-0,373) yang bermakna secara statistik (p=0,005) antara kadar CRP dengan SMI pasien metastasis SSP .Kesimpulan: Terdapat korelasi yang bermakna antara kadar CRP dengan SMI pada pasien metastasis SSP.

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Background: It is estimated that 20-40% of cancer patients experience metastases to the central nervous system (CNS). Systemic inflammatory conditions in cancer mediated by cytokines are associated with a decrease in muscle mass. In inflammatory conditions, hepatocyte cells are stimulated to produce the acute-phase protein called c-reactive protein (CRP). Circulating CRP levels increase in over 50% of cancer patients. CRP is believed to be related to a decrease in muscle mass and serves as an early predictor in lean tissue loss. This study was conducted to determine the relationship between CRP levels and the skeletal muscle mass index (SMI) in patients with CNS metastases. Methods: This study is a cross-sectional study on cancer patients with CNS metastases at RSCM. Subject characteristics include age, gender, metastases type, primary tumor location, neurological deficits, Karnofsky performance status, comorbidities, infectious diseases, glucocorticoid therapy, undergoing chemotherapy, radiotherapy, and surgery, body mass index (BMI), nutritional status based on BMI and ASPEN criteria, energy intake, protein intake, CRP levels, and skeletal muscle mass index (SMI). An analysis of the relationship between CRP levels and SMI was conducted.

Results: There were 57 patients with CNS metastases. Most subjects were female (56.1%). The median age was 47 years. Metastases was more commonly found in the brain (56.1%), and the most common type of metastasis based on the nervous system location was synchronous (86%). All subjects had oligometastasis, and most primary tumor locations were in the nasopharynx (17.5%), breast (15.8%), and lungs (14%). The most common neurological deficits were cancer pain (68.4%), headaches (56.1%), and limb weakness (43.9%). Most limb weakness was hemiparesis (22.8%). Most Karnofsky performance status was moderately impaired (45.6%), 63.2% had no comorbidities, 68.4% had no infectious diseases, 52.6% were not on glucocorticoid therapy, 75.4% were not undergoing chemotherapy, and 1.8% each were undergoing radiotherapy and surgery. The estimated mean BMI was 21.28 kg/m2, with the majority having a normal weight (43.9%). According to ASPEN criteria, the majority were moderately malnourished (49.1%) and severely malnourished (31.6%). The mean energy intake was 19 kcal/kgBW, and the median protein intake was 0.6 g/kgBW. The median CRP level was 46.6 mg/L, with 96.5% of subjects experiencing an increased CRP level. The mean SMI for all subjects was 6.17 kg/m2, with male subjects having a mean SMI of 7.2 kg/m2 and female subjects having a mean SMI of 5.4 kg/m2. There was a weak negative correlation (r=- 0.373) that was statistically significant (p=0.005) between CRP levels and SMI in patients with CNS metastases.

Conclusion: CRP levels are correlated with SMI in patients with CNS metastasis. Higher CRP levels are associated with lower SMI in patients with CNS metastases."

"Latar Belakang : Inflamasi kronik berhubungan dengan tumor dan menyebabkan prognosis yang buruk pada pasien kanker. Salah satu penanda inflamasi yang meningkat pada tumor adalah C-Reactive Protein (CRP). Kadar CRP meningkat pada lebih dari 50% pasien keganasan. Peningkatan CRP berhubungan kuat dengan keparahan penyakit pada beberapa kanker. Salah satu zat gizi dalam inflamasi adalah asam lemak omega-3. Asam lemak omega-3 dapat meningkatkan pembentukan specialized pro-resolving mediators (SPM) yang berfungsi meningkatkan mediator antiinflamasi, melindungi blood brain barrier, menurunkan sitokin proinflamasi, menurunkan apoptosis neuron. Penelitian ini bertujuan untuk menilai hubungan asupan asam lemak omega-3 dengan CRP pada pasien tumor sistem saraf pusat.Metode : Studi potong lintang ini dilakukan pada subjek berusia 18-65 tahun di RSUPN Cipto Mangunkusumo pada bulan November hingga Desember 2023. Pengukuran CRP menggunakan metode immunoturbidimetric assay. Pengambilan asupan asam lemak omega-3 menggunakan Food Frequency Questionnaires semikuantitatif. Analisis bivariat digunakan untuk menilai hubungan antara variabel bebas dan terikat.Hasil : Dari total 63 subjek penelitian, sebanyak 35 subjek (55,6%) pada kelompok asupan asam lemak omega-3 < 2 g/hari dan 28 subjek (44,4%) pada kelompok asupan asam lemak omega-3 ≥ 2 g/hari. Nilai median CRP 8,3 (0,6 – 71,5) mg/L. Tidak terdapat hubungan yang bermakna (p = 0,714) antara asupan asam lemak omega-3 dengan CRP pada pasien tumor sistem saraf pusat.Kesimpulan : Tidak terdapat hubungan bermakna antara asupan asam lemak omega-3 dengan CRP pada pasien tumor sistem saraf pusat.

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Background: Chronic inflammation is associated with tumors and causes poor prognosis in tumor patients. One of the inflammatory markers that increase in tumors is C-Reactive Protein (CRP). CRP levels are elevated in more than 50% of patients with malignancies. Elevated CRP is associated with disease severity in some cancers. One of the nutrients in inflammation is omega-3 fatty acids. Omega-3 fatty acids can increase the formation of specialized pro-resolving mediators (SPM) which function to increase anti-inflammatory mediators, protect the blood brain barrier, reduce pro-inflammatory cytokines, reduce neuron apoptosis. This study aims to assess the relationship between omega-3 fatty acid intake and CRP in patients with central nervous system tumors.

Methods: This cross-sectional study was conducted on subjects aged 18-65 years at Cipto Mangunkusumo Hospital from November to December 2023. CRP measurement using immunoturbidimetric assay method. Omega-3 fatty acid intake was collected using semiquantitative Food Frequency Questionnaire. Bivariate analysis was used to assess the relationship between independent and dependent variables.

Results: From the total 63 research subjects, 35 subjects (55,6%) in the omega-3 fatty acid intake group < 2 g/day and 28 subjects (44,4%) in the omega-3 fatty acid intake group ≥ 2 g/day. The median CRP value was 8.3 (0.6 - 71.5) mg/L. There was no significant relationship (p = 0,714) between omega-3 fatty acid intake and CRP in patients with central nervous system tumors.

Conclusion: There is no significant relationship between omega-3 fatty acid intake and CRP in patients with central nervous system tumors."

"Tujuan: Menilai kesintasan pasien Glioblastoma Multiform (GBM) di RSCM dan mengidentifikasi faktor-faktor yang dapat mempengaruhi kesintasan pasien dengan GBM. Metode: dilakukan studi retrospektif pada 55 pasien GBM yang terdiagnosa secara histopatologis dan menjalani radiasi/kemoradiasi di RSCM pada Januari 2015-Desember2019. Hasil: Mayoritas pasien adalah laki-laki dengan rasio 1,3:1 dibandingkanperempuan, rerata usia 45 tahun. Lokasi tumor tersering di lobus frontal (31,5%), lobuspariteal (26,3%) dan lobus temporal (24,2%). Median ekstensi reseksi tumor (EOR) 77%dan median volume residu tumor 50cm3. Median interval operasi-radiasi 42 hari denganmedian total dosis radiasi 60 Gy. 69,1% telah mendapatkan terapi sesuai dengan panduanpenatalaksanaan kanker (PPK). Median kesintasan hidup keseluruhan (OS) 13 bulan danmedian kesintasan bebas progresifitas (PFS) 9 bulan. Median OS pasien dengan RTOGRPA kelas III, kelas IV dan kelas V-VI adalah 18 bulan, 13 bulan dan 6,7 bulan (p<0,001).Faktor yang memperburuk OS adalah usia ≥50 tahun (p=0,02), KPS<70 (p<0,001),volume residu tumor >20,4cm3 (p=0,001), interval waktu operasi-radiasi <4minggu(p=0,01) dan letak tumor di lobus parietal (p=0,02) pada uji univariat. Faktor yangmemperburuk PFS adalah KPS <70 (p=0,001), volume residu tumor>20,4cm3 (p=0,02),terapi yang tidak sesuai PPK (p=0,004) dan letak tumor di lobus parietal (p=0,03). KPSmerupakan faktor independen yang mempengaruhi OS dan PFS pada uji multivariat.Kesimpulan: KPS merupakan faktor prognostik independen yang mempengaruhikesintasan pasien GBM.

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Aims: This study was done to assess the survival of patients with glioblastoma multiform

in RSCM and to identify factors that can affect patient survival. Materials and methods:

From January 2015 to December 2019, 55 patients with histopathologically confirmed

glioblastoma multiform and received adjuvant radiation/chemoradiation in our

department were retrospectively analyzed. Results: Most of the patiens in this study were

men 1,3 times compared to women. Mean ages was 45 years old. The most common

tumors site was frontal lobe (31,5%) followed by parietal lobe (26,3%) and temporal lobe

(24,2%). Median extend of resection (EOR) was 77% with median residual tumor volume

was 50cm3. Most of the patients (69,1%) already treated according to practice guidelines.

The median total radiation dose was 60Gy. Median time to initiate adjuvant radiotherapy

was 42 days. Median overall survival (OS) was 13 months and median progression free

survival (PFS) was 9 months. Median OS in patients with RTOG RPA class III, class IV

and class V-VI were 18 months, 13 months and 6,7 months respectively (p<0,001).

Age≥50 (p=0,02), KPS<70 (p<0,0001), residual tumor volume >20,4cm3 (p=0,001), time

to initiate adjuvant radiotherapy <4 weeks (p=0,01) and parietal lobes tumor site

(p=0,02) were significantly associated with unfavorable OS in univariate analysis.

KPS<70 (p=0,001), residual tumor volume >20,4cm3 (p=0,02), treatment that not in

accordance with practice guidelines (p=0,004) and parietal lobes tumor site (p=0,03)

associated with unfavorable PFS in univariate analysis. KPS was found to be the only

independent factor that affected OS and PFS in multivariate analysis. Conclusions: The

only factor that independently affected OS and PFS was KPS."

"Tujuan: Studi ini dilakukan dengan tujuan untuk mengevaluasi asosiasi antara peningkatan ekspresi c-Met dengan kesintasan pasien glioblastoma multiform (GBM). Metode: Telaah sistematis dan meta-analisis dilakukan pada artikel terkait dari pangkalan data PubMed, EBSCOhost, Scopus, dan Cochrane. Pencarian berakhir pada 31 Oktober 2020. Sejumlah total 7 studi dikutsertakan dalam telaah sistematis dan analisis. Hasil: Seluruh studi dalam telaah sistematis ini menggunakan imunohistokimia dalam menentukan ekspresi protein c-Met. Hasil memperlihatkan bahwa laju positifitas peningkatan c-Met terdeteksi pada sekitar 33,9%-60,5% pasien GBM. Peningkatan ekspresi c-Met berhubungan dengan kesintasan hidup OS (HR: 1,74; 95% CI: 1,482-2,043; Z=6,756; p<0,001) dan kesintasan bebas progresifitas (HR: 1,66; 95% CI: 1,327-2,066; Z=4,464; p<0,001) yang lebih pendek pada pasien GBM. Heterogenitias subjek yang rendah tampak pada analisis kedua kesintasan ini, nilai I2 7,8% dan 0,0%. Kesimpulan: Peningkatan ekspresi c-Met berhubungan signifikan dengan kesintasan hidup keseluruhan dan kesintasan bebas progresifitas pada pasien GBM, sehingga c-Met dapat dijadikan indikator prognostik potensial pada GBM.

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Objective: The aim of this study is to evaluate the association of c-Met overexpression with survival of glioblastoma multiforme (GBM) patients. Method: A systematic review with meta-analyses was conducted on related articles from PubMed, EBSCOhost, Scopus, and Cochrane databases with last updated search on October 31, 2020. A total of 7 studies regarding c-Met overexpression and overall survival (OS) and/or progression free survival (PFS) are included in this study. Result: All studies used immunohistochemistry to examine the expression of c-Met protein. The results showed that the positive rate of c-Met overexpression was detected in approximately 33,9% - 60,5% of GBM patients. c-Met overexpression was related to worse OS (HR: 1,74; 95% CI: 1,482-2,043; Z=6,756; p<0,001) and PFS (HR: 1,66; 95% CI: 1,327-2,066; Z=4,464; p<0,001) in GBM patients. Low heterogeneity of subjects was found in both OS and PFS analyses, I2 values were 7,8% and 0,0%, respectively. Conclusion: In conclusion, c-Met overexpression is significantly related to shorter OS and PFS in GBM patients, so c-Met can be considered as a potential prognostic indicator in GBM."

"Latar belakang: Nyeri kepala sekunder karena variasi anatomi pada mukosa hidung, konka, dan septum dikategorikan dalam lampiran pada International Classification of Headache Disorders – 3. Posisi ini berbeda dan lebih lemah dibanding dengan nyeri kepala sekunder akibat rinosinusitis akut atau eksaserbasi akut pada rinosinusitis kronik. Variasi anatomi pada rongga hidung dan sinus paranasal menjadi stimulasi mekanik berupa kompresi antar mukosa intranasal dan perubahan tekanan barometrik dalam rongga sinus. Studi ini bertujuan untuk mengetahui kecenderungan peran variasi anatomi septum deviasi, konka bulosa, dan sinus etmo-maksila (SEM) sebagai faktor risiko nyeri kepala rinogenikMetode: Penelitian ini dilakukan dengan menggunakan desain potong lintang pada pasien nyeri kepala rinogenik di Departemen THT RSUPN Dr. Cipto Mangunkusumo, RSUP Persahabatan dan RSUP Fatmawati periode Desember 2022 – Februari 2023. Parameter yang dinilai adalah skor NPRS, NOSE, dan ESS.Hasil: Proporsi variasi anatomi septum deviasi sebesar 73,8%, konka bulosa sebesar 52,3%, dan sinus etmomaksila sebesar 47,7% pada pasien nyeri kepala rinogenik di RSCM, RSF, dan RSP yang dievaluasi melalui tomografi komputer sinus paranasal. Terdapat perbedaan rerata yang bermakna antar kelompok derajat septum deviasi dan klasifikasi Mladina terhadap skor NPRS, NOSE, ESS (p<0,05). SEM tipe 2 memiliki rerata skor NPRS yang lebih tinggi dibanding SEM tipe 1 namun tidak bermakna secara statistik. Tipe SEM memiliki perbedaan rerata yang bermakna antar kelompok terhadap skor NOSE dan ESS (p<0,05). Jumlah variasi anatomi dan skor ESS memiliki kecenderungan hubungan yang bermakna terhadap skor NPRS (p<0,05). Odds ratio regresi logistik jumlah variasi anatomi dan skor ESS adalah 4,98E9.Kesimpulan: Proporsi variasi anatomi septum deviasi ditemukan paling banyak pada populasi nyeri kepala rinogenik. Derajat septum deviasi dan klasifikasi Mladina memiliki kecenderungan terhadap derajat nyeri kepala rinogenik. Tipe SEM memiliki kecenderungan hubungan dengan sumbatan hidung dan gangguan napas saat tidur. Jumlah variasi anatomi dan skor ESS menjadi faktor prediktor untuk derajat nyeri kepala rinogenik.

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Background: Secondary headaches due to anatomic variations in the nasal mucosa, turbinates, and septum are categorized in the appendix to the International Classification of Headache Disorders – 3. This position is different and weaker than secondary headaches due to acute rhinosinusitis or acute exacerbations of chronic rhinosinusitis. This study aims to determine the trend of the role of anatomical variations of septum deviation, concha bullosa, and ethmo-maxillary sinus (SEM) as risk factors for rhinogenic headache.

Methods: This study was conducted using a cross-sectional design in rhinogenic headache patients at the ENT Department of RSUPN Dr. Cipto Mangunkusumo, Friendship Hospital and Fatmawati Hospital for the period December 2022 - February 2023. The parameters assessed were the NPRS, NOSE, and ESS scores.

Results: ¬The proportion of anatomical variations of septum deviation was 73.8%, concha bullosa was 52.3%, and ethmomaxillary sinus was 47.7% in patients with rhinogenic headaches at RSCM, RSF, and RSP which were evaluated by computer tomography of the paranasal sinuses. There was a significant mean difference between the groups with the degree of septum deviation and the Mladina classification on the NPRS, NOSE, and ESS scores (p<0.05). SEM type 2 has a higher average NPRS score than SEM type 1 but it is not statistically significant. The SEM type had a significant difference between groups in the NOSE and ESS scores (p<0.05). The number of anatomic variations and the ESS score tended to have a significant relationship with the NPRS score (p<0.05). The logistic regression odds ratio for the number of anatomic variations and the ESS score is 4.98E9.

Conclusion: The proportion of anatomical variations of septum deviation was found to be the highest in the rhinogenic headache population. The degree of septal deviation and the Mladina classification tend to the degree of rhinogenic headache. The SEM type tends to be associated with nasal obstruction and difficulty breathing during sleep. The amount of anatomic variation and ESS score are predictors for the degree of rhinogenic headache.

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