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"Latar belakang. Bahaya merokok sudah diketahui secara luas, namun seorang perokok yang ingin berhenti merokok mengalami kesulitan karena terdapat pengaruh yang kuat aspek bio-fisio-psiko-sosio-demografi. Untuk itu, perpaduan metode berhenti merokok melalui pendekatan farmakologi dan non-farmakologi perlu dilakukan. Terapi kombinasi melalui farmakologi (vareniklin tartrat/VT) dan non-farmakologi (hipnosis kedokteran) diharapkan efektif membantu individu dengan ketergantungan nikotin untuk berhenti merokok.Metode. Desain penelitian ini adalah uji klinis eksperimental acak tersamar tunggal yang dilakukan pada 100 perokok sedang-berat yang dialokasi menjadi dua kelompok melalui randomisasi. Setelah randomisasi, 50 responden akan mengikuti intervensi VT+hipnosis kedokteran dan 50 responden akan mengikuti intervensi VT+edukasi yang dilakukan paralel, mengikuti modul hipnosis kedokteran dan edukasi selama 12 minggu, dilanjutkan pengamatan 12 minggu pasca terapi. Keberhasilan responden dinyatakan berdasarkan nilai EECOL dengan batas pisah ≤ 10 ppm pada salah satu minggu selama penelitian. Responden dikatakan relaps jika nilai EECOL kembali ditemukan >10 ppm setelah dinyatakan berhasil. Analisis faktor bio-fisio-psiko-sosio-demografi dilakukan untuk melihat peran faktor tersebut terhadap keberhasilan terapi kombinasi VT+hipnosis kedokteran.Hasil. Keberhasilan berhenti merokok jangka pendek kelompok VT+hipnosis kedokteran dan VT+edukasi adalah sebesar 78% dan 66% dengan NNT sebesar 8 (IK95%=3-18). Keberhasilan jangka panjang kedua kelompok sebesar 86% dan 68% (p=0,032). Angka relaps pada kelompok VT+hipnosis kedokteran ditemukan lebih rendah dibandingkan kelompok VT+edukasi (44,2% vs. 58,3%) dengan NNT sebesar 7 (IK95%=3-19). Tidak ditemukan adanya pengaruh aspek bio-fisio-psiko-sosio-demografi di dalam penelitian (p>0,05).Simpulan. Terapi kombinasi VT+hipnosis kedokteran memiliki tingkat keberhasilan yang lebih baik dan angka relaps yang lebih rendah dibandingkan dengan VT+edukasi walaupun tidak ditemukan adanya pengaruh aspek bio-fisio-psiko-sosio-demografi di dalam penelitian.

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Background. Smoking has been widely known for it’s dangers towards health. Despite of the danger, smokers find hard to stop smoking and therapy is needed to help them stop smoking. Combination therapy which covers pharmacology and non-pharmacology aspect is needed to help smokers to stop smoking. Varenicline tartrate (VT) and medical hypnosis as a combined therapy is used to cover the pharmacology and non-pharmacology aspect of individual with nicotine dependence to stop smoking.

Methods. The research was conducted as a random single-blind experimental study on 100 moderate to severe smokers, divided randomly into two groups of 50 respondents each. Each group correspondingly enrolled VT+medical hypnosis therapy and VT+education therapy based on medical hypnosis and education module for 12 weeks with follow up for another 12 weeks. The program was defined successful by EECOL value ≤ 10 ppm in any week during the research and relapse was defined by EECOL value greater than 10 ppm after a success was declared. Analysis on bio-physio-psycho-socio-demography aspect was done to assess influence of these factors on the success rate of VT+medical hypnosis group.

Results. The short term success rate of VT+medical hypnosis and VT+education combination therapy was 78% and 66% respectively with NNT of 8 (CI95%=3-18). Long term success rate of both group was 86% and 68% respectively (p=0,032). Relapse rate is lower in the VT+medical hypnosis group than VT+education group (42,2% vs. 58,3%) with NNT of 7 (CI95%=3-19). There is no evident on relation of bio-physio-psycho-socio-demography and the success rate in the experiment (p>0,05).

Conclusion. Intervention with VT+medical hypnosis for smoking cessation has higher success rate and lower relapse rate than control. There was no evident on relation of bio-physio-psycho-socio-demography and the success rate in the experiment."

"ABSTRAKLatar Belakang Bayi kurang bulan masih merupakan masalah karena mempunyai morbiditas dan mortalitas yang tinggi. Selain morbiditas yang tinggi, bayi kurang bulan juga sering mengalami pertumbuhan yang kurang baik jika dibandingkan dengan bayi cukup bulan. Gangguan yang berhubungan dengan saluran cerna ialah gagal tumbuh dan malnutrisi. Penyebab gagal tumbuh terbanyak pada bayi ialah masalah pada saluran cerna, terutama maldigesti, malabsorpsi, dan diare kronik. Bayi kurang bulan dengan imaturitas saluran cerna mempunyai aktivitas enzim yang rendah, yang akan menyebabkan digesti dan absorpsi nutrien yang rendah dan pada akhirnya akan mengganggu tumbuh kembangnya. Beberapa enzim pencernaan, yaitu laktase dan elastase 1 pankreas, akan diteliti. Laktase adalah enzim pencernaan yang terdapat di usus halus dan bekerja menghidrolisis laktosa yang merupakan karbohidrat utama pada susu. Elastase 1 pankreas dihasilkan oleh pankreas dan merupakan enzim pemecah protein.Apakah aktivitas enzim bayi kurang bulan yang rendah pada saat lahir akan dapat mencapai perkembangan aktivitas enzim bayi cukup bulan? Penelitian ini berusaha menjawab pertanyaan tersebut.MetodologiDilakukan studi prospektif observasional analitik pada 25 bayi kurang bulan dan 22 bayi cukup bulan di RSB Budi Kemuliaan Jakarta, dalam periode Agustus 2003 sampai dengan Juli 2004. Aktivitas laktase dilakukan pada bayi umur 1, 14, dan 28 hari, serta pemeriksaan kadar elastase 1 pankreas dilakukan pada umur 1, 7, dan 10 hari. Aktivitas laktase dinyatakan dalam rasio ekskresi laktulosa dan laktosa. Pemeriksaan aktivitas laktase dilakukan dengan cara memberi minum bayi dengan larutan laktulosa dan laktosa (1:1) setelah puasa 2 jam, kemudian urinenya ditampung. Penetapan kadar laktulosa dan laktosa dalam urine dilakukan dengan cara kromatografi cair kinerja tinggi. Kadar elastase 1 pankreas dalam tinja diukur dengan cara Elisa.Hasil PenelitianRerata aktivitas laktase bayi kurang bulan secara bermakna lebih rendah jika dibandingkan dengan bayi cukup bulan pada saat lahir. Pada umur 14 dan 28 hari, aktivitas laktase bayi kurang bulan sudah tidak berbeda bermakna dengan perkembangan aktivitas laktase bayi cukup bulan pada umur yang sama. Rerata kadar elastase 1 pankreas bayi kurang bulan secara bermakna lebih rendah jika dibandingkan dengan bayi cukup bulan pada saat lahir. Pada umur 7 dan 10 hari, kadar elastase 1 pankreas bayi kurang bulan sudah tidak berbeda bermakna dengan perkembangan kadar elastase 1 pankreas bayi cukup bulan.SimpulanPenelitian ini membuktikan bahwa aktivitas laktase bayi kurang bulan yang relatif rendah pada saat lahir sudah mencapai perkembangan aktivitas laktase bayi cukup bulan pada umur 14 hari. Kadar elastase 1 pankreas bayi kurang bulan yang relatif rendah pada saat lahir sudah mencapai perkembangan kadar elastase l pankreas bayi cukup bulan pada umur 7 hari.

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ABSTRACT

Premature infants are problematic. As they have a high morbidity and mortality rate. In addition, the growth and development of premature infants is often also not as good as that of full term infants. Problems related to digestion can cause failure to thrive and malnutrition. The most common cause of failure to thrive are problems in the digestive system particularly maldigestion, malabsorption and chronic diarrhea. Premature infants with immature digestive systems have low enzyme activity which can cause low digestion and absorption of nutrients which will eventually inhibit their growth. Several digestive enzymes i.e. lactase and pancreatic elastase I will be studied. Lactase is a digestive enzyme that is found in the intestinal viii and it hydrolyzes lactose which is the main carbohydrate in milk. Pancreatic elastase 1 is produced by the pancreas and is the enzyme that breaks down protein.

Will the low enzyme activity of premature infants at birth be able to reach the level of activity of full term infants? This research tries to answer that question.

Methodology

A prospective observational analytical study was carried out on 25 premature infants and 22 full term infants in Budi Kemuliaan Maternity Hospital over the period August 2003 to July 2004. Lactase activity was examined at age 1, 14 and 28 days. An examination of the concentration of pancreatic elastase I was done at age 1, 7, and 10 days, Lactase activity is expressed in a ratio of excretion of lactulosa and lactose. The study of lactase activity was done by feeding the infants a solution of lactulose and lactose (1:1) after a 2-hour fasting period. Urine samples were then taken. The determination of the concentration of lactulose and lactose in the urine was carried out using high performance liquid chromatography. The concentration of pancreatic elastase 1 in the stool was measured using the Elisa method.

Results

The average lactase activity in premature infants is significantly lower compared to that of full-term infants at the time of birth. At age 14 and 28 days, the lactase activity of premature infants is not significantly different from that of full-term infants of the same age. The average concentration of pancreatic elastase 1 of premature infants is significantly lower than that of full-term infants at birth. However, at age 7 and 10 days, the difference in concentration of pancreatic elastase 1 in premature infants and that of full term infants is not significant any more.

Conclusion

This study shows that the activity of lactase in premature infants which is relatively low at birth, will reach the development of lactase activity of full term infants of the same age at age 14 days. Whereas, the concentration of pancreatic Elastase 1 of premature infants, which is relatively low at birth, will reach the development of pancreatic elastase I concentration of full term infants of the same age at age 7 days."

"ABSTRAKPada pasien hemodialisis (HD), banyak penelitian di negara maju membuktikan hubungan yang erat antara inflamasi, komplikasi kardiovaskular, malnutrisi, dan mortalitas yang tinggi. Inflamasi yang ditandai dengan meningkatnya IL-6 dan CRP, serta berkurangnya sitokin anti-inflamasi IL-10, mempunyai peran utama dalam terjadinya berbagai komplikasi pada pasien HD di Indonesia, terdapat perbedaan pelaksanaan HD, yaitu HD yang lebih jarang (2 kali seminggu), banyak menggunakan dialiser selulosal diasetat, proses ulang, low flux, dan tanpa air yang sangat murni, yang kesemuanya menyebabkan risiko respons inflamasi yang tinggi. Pada kenyataannya, prevalensi inflamasi dan nilai rata-rata CRP di Indonesia lebih rendah. Polimorfisme gen IL-6-174G>C dan gen IL-10-1082G>A telah dibuktikan mempengaruhi tingkat produksi IL-6 dan CRP. Perbedaan proporsi alel G, C pada IL-6-174, dan alel G, A pada IL-1082, berbagai bangsa dan ras, mungkin menjadi penyebab perbedaan di atas. Sindrom inflamasi malnutrisi (SIM) pada pasien HD berbeda dengan malnutrisi pada populasi. Pada SIM, faktor inflamasi, uremia dan katabolisme protein lebih berperan. Hal ini memerlukan cara penilaian status malnutrisi yang berbeda. Penelitian ini dilakukan untuk mendapatkan frekuensi polimorfisme gen IL-6-174 dan IL-10-1082, mengetahui faktor yang berperan dalam SIM, mengetahui perbedaan prevalensi inflamasi pada pasien dengan malnutrisi dan sebagai validitas penilaian SGA.Telah dilakukan penelitian pada pasien yang menjalani HD 2 kali seminggu, 5 jam per kali HD, tanpa komplikasi penyakit lainnya, dan semua memakai dialiser selulosa diasetat yang diproses ulang. Dari 64 pasien yang diperiksa, didapatkan gen IL-6-74GG 95,31%, CC 3,13% dan GC 1,56%. Gen IL-1082AA 89,06%, GA 10,94%, dan GG tidak didapatkan. Proporsi alel ini hampir sama seperti yang didapatkan di Korea, Jepang dan Cina, berbeda dengan yang didapat di AS, ras Kaukasia, Amerika-Afrika, Hispanik dan Eropa (Kaukasia). Selain perbedaan pada proporsi gen, kami mendapatkan konsenlrasi CRP (6,23±5,57 mg/L), frekuensi malnutrisi (24,7%), dan skor MIS (6,7) yang lebih rendah dibanding dengan data dari AS dan Eropa. Mengingat sedikitnya alel C pada gen IL-6-174 dan alel G pada gen IL-10-1082, analisis statistik yang dilakukan tidak dapat memperlihatkan pengaruh perbedaan alel terhadap manifestasi klinik. Inflarnasi kronik mempengaruhi terjadinya malnutrisi (PR 3,03; 1K 95% 1,53-6,06; P = 0,012). Penilaian dengan skala SGA berkorelasi balk dengan parameter antropometri (IMT, LLA, LOLA, HGS), dan albumin serum. Albumin serum sebagai parameter inflamasi kronik berkorelasi balk dengan parameter nutrisi yang lain, sedangkan CRP tidak. Didapatkan kesan yang kuat bahwa pada pasien HD, gen IL-174GG bersifat protektif, sedangkan gen IL-1082AA tidak begitu berperan. Selain itu dibuktikan adanya pengaruh inflamasi terhadap malnutrisi dan SGA terbukti merupakan penilaian sindrom malnutrisi inflamasi yang cukup baik.

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ABSTRACT

Many studies on HD patients in developed countries have conferred strong evidence of closed correlation between inflammation, cardiovascular complication and high mortality rates. Inflammation, indicated by high levels of CRP and IL-6, has a major role in initiating and sustaining complications. Adapting to high cost, HD in Indonesia is conducted in a little different ways. Patients are dialyzed twice a week, 5 hours each, using reprocessed cellulose/diacetate membrane dialyzer, and without ultrapure water. All of these contribute to a high risk of inflammation, but in fact the prevalence of inflammation in Indonesia is relatively low. IL-6-174G>C and IL-10-1082G>A polymorphic gene have been proven to influence the production of IL-6 and CRP. The difference in the proportion of allele G, C in IL-6-174, allele G, A in IL-1082 in a variety of people's races might cause the difference in the prevalence and the level of inflammation. Malnutrition inflammation syndrome (MIS) on HD patients is different from malnutrition in general population. In MIS, the inflammatory factors, uremia, and protein catabolism of protein are more dominant. These matters probably require a different assessment method of malnutrition status. The purpose of this study was to obtain the frequency of polymorphic gene IL-6-174 and IL-10-1082 to find out the prominent factors in MIS, and to find out the difference in the inflammation prevalence in patients with malnutrition and to serve as validity of SGA assessment.

A study on patients who were on hemodialysis twice a week, 5 hours each session has been conducted. The subjects had no other co-morbidities and all of them used reprocessed diasetat cellulose dialyzers. Out of 64 patients examined, IL-6-174GG was obtained 95.31%, CC 3.13% and GC 1.56%, IL-1082AA 89.06%, GA 10.94%, but absence of GG genotype. The proportion of these alleles was almost similar to that obtained in Korea, Japan and China, but it was different from that obtained in the US for the Caucasian race, African Americans, Hispanic people, and the Caucasian people in Europe_ Besides the difference in gene proportion, it was obtained that CRP (6.23±5.57 mg/L), malnutrition (24.7%), and malnutrition inflammation score (6.7) were lower compared with the data from Europe and the United States. Considering the scanty amount of allele C in IL-6-174 gene and G allele in IL-10-1082 gene, based on the statistic analysis performed it did not revealed the influence of the difference in allele on the clinical manifestation. It was found that chronic inflammation influenced the occurrence of malnutrition (PR 3.03; CI 95% 1.53-6.06; P = 0,012). The scoring by the SGA scales correlated well with the anthropometric parameters (body mass indes, mid arm circumtance, midarm muscle circumference, hand grip strength and serum albumin. A very resolute impression was obtained in HD patients that IL-6-174GG gene was protective in nature whereas IL-10-1082 AA gene had a less considerable role. In addition to that, it was proven that there was influence of information on the occurence of malnutrition and SGA consitutes a good enough assessment for malnutrition inflammation syndrome."

"Bayi kurang bulan masih merupakan masalah karena mempunyai morbiditas dan mortalitas yang tinggi. Selain morbiditas yang tinggi, bayi kurang bulan juga sering mengalami pertumbuhan yang kurang baik jika dibandingkan dengan bayi cukup bulan. Gangguan yang berhubungan dengan saluran cerna ialah gagal tumbuh dan malnutrisi. Penyebab gagal tumbuh terbanyak pada bayi ialah masalah pada saluran cerna, terutama maldigesti, malabsorpsi, dan diare kronik. Bayi kurang bulan dengan imaturitas saluran cerna mempunyai aktivitas enzim yang rendah, yang akan menyebabkan digesti dan absorpsi nutrien yang rendah dan pada akhirnya akan mengganggu tumbuh kembangnya. Beberapa enzim pencernaan, yaitu laktase dan elastase 1 pankreas, akan diteliti. Laktase adalah enzim pencernaan yang terdapat di usus halus dan bekerja menghidrolisis laktosa yang merupakan karbohidrat utama pada susu. Elastase 1 pankreas dihasilkan oleh pankreas dan merupakan enzim pemecah protein.Apakah aktivitas enzim bayi kurang bulan yang rendah pada saat lahir akan dapat mencapai perkembangan aktivitas enzim bayi cukup bulan? Penelitian ini berusaha menjawab pertanyaan tersebut.MetodologiDilakukan studi prospektif observasional analitik pada 25 bayi kurang bulan dan 22 bayi cukup bulan di RSB Budi Kemuliaan Jakarta, dalam periode Agustus 2003 sampai dengan Juli 2004. Aktivitas laktase dilakukan pada bayi umur 1, 14, dan 28 hari, serta pemeriksaan kadar elastase 1 pankreas dilakukan pada umur 1, 7, dan 10 hari. Aktivitas laktase dinyatakan dalam rasio ekskresi laktulosa dan laktosa. Pemeriksaan aktivitas laktase dilakukan dengan cara memberi minum bayi dengan larutan laktulosa dan laktosa (1:1) setelah puasa 2 jam, kemudian urinenya ditampung. Penetapan kadar laktulosa dan laktosa dalam urine dilakukan dengan cara kromatografi cair kinerja tinggi. Kadar elastase 1 pankreas dalam tinja diukur dengan cara Elisa.Hasil PenelitianRerata aktivitas laktase bayi kurang bulan secara bermakna lebih rendah jika dibandingkan dengan bayi cukup bulan pada saat lahir. Pada umur 14 dan 28 hari, aktivitas laktase bayi kurang bulan sudah tidak berbeda bermakna dengan perkembangan aktivitas laktase bayi cukup bulan pada umur yang sama. Rerata kadar elastase 1 pankreas bayi kurang bulan secara bermakna lebih rendah jika dibandingkan dengan bayi cukup bulan pada saat lahir. Pada umur 7 dan 10 hari, kadar elastase 1 pankreas bayi kurang bulan sudah tidak berbeda bermakna dengan perkembangan kadar elastase 1 pankreas bayi cukup bulan.SimpulanPenelitian ini membuktikan bahwa aktivitas laktase bayi kurang bulan yang relatif rendah pada saat lahir sudah mencapai perkembangan aktivitas laktase bayi cukup bulan pada umur 14 hari. Kadar elastase 1 pankreas bayi kurang bulan yang relatif rendah pada saat lahir sudah mencapai perkembangan kadar elastase l pankreas bayi cukup bulan pada umur 7 hari.

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Premature infants are problematic. As they have a high morbidity and mortality rate. In addition, the growth and development of premature infants is often also not as good as that of full term infants. Problems related to digestion can cause failure to thrive and malnutrition. The most common cause of failure to thrive are problems in the digestive system particularly maldigestion, malabsorption and chronic diarrhea. Premature infants with immature digestive systems have low enzyme activity which can cause low digestion and absorption of nutrients which will eventually inhibit their growth. Several digestive enzymes i.e. lactase and pancreatic elastase I will be studied. Lactase is a digestive enzyme that is found in the intestinal viii and it hydrolyzes lactose which is the main carbohydrate in milk. Pancreatic elastase 1 is produced by the pancreas and is the enzyme that breaks down protein.

Will the low enzyme activity of premature infants at birth be able to reach the level of activity of full term infants? This research tries to answer that question.

Methodology

A prospective observational analytical study was carried out on 25 premature infants and 22 full term infants in Budi Kemuliaan Maternity Hospital over the period August 2003 to July 2004. Lactase activity was examined at age 1, 14 and 28 days. An examination of the concentration of pancreatic elastase I was done at age 1, 7, and 10 days, Lactase activity is expressed in a ratio of excretion of lactulosa and lactose. The study of lactase activity was done by feeding the infants a solution of lactulose and lactose (1:1) after a 2-hour fasting period. Urine samples were then taken. The determination of the concentration of lactulose and lactose in the urine was carried out using high performance liquid chromatography. The concentration of pancreatic elastase 1 in the stool was measured using the Elisa method.

Results

The average lactase activity in premature infants is significantly lower compared to that of full-term infants at the time of birth. At age 14 and 28 days, the lactase activity of premature infants is not significantly different from that of full-term infants of the same age. The average concentration of pancreatic elastase 1 of premature infants is significantly lower than that of full-term infants at birth. However, at age 7 and 10 days, the difference in concentration of pancreatic elastase 1 in premature infants and that of full term infants is not significant any more.

Conclusion

This study shows that the activity of lactase in premature infants which is relatively low at birth, will reach the development of lactase activity of full term infants of the same age at age 14 days. Whereas, the concentration of pancreatic Elastase 1 of premature infants, which is relatively low at birth, will reach the development of pancreatic elastase I concentration of full term infants of the same age at age 7 days."

"Pada pasien hemodialisis (HD), banyak penelitian di negara maju membuktikan hubungan yang erat antara inflamasi, komplikasi kardiovaskular, malnutrisi, dan mortalitas yang tinggi. Inflamasi yang ditandai dengan meningkatnya IL-6 dan CRP, serta berkurangnya sitokin anti-inflamasi IL-10, mempunyai peran utama dalam terjadinya berbagai komplikasi pada pasien HD di Indonesia, terdapat perbedaan pelaksanaan HD, yaitu HD yang lebih jarang (2 kali seminggu), banyak menggunakan dialiser selulosal diasetat, proses ulang, low flux, dan tanpa air yang sangat murni, yang kesemuanya menyebabkan risiko respons inflamasi yang tinggi. Pada kenyataannya, prevalensi inflamasi dan nilai rata-rata CRP di Indonesia lebih rendah. Polimorfisme gen IL-6-174G>C dan gen IL-10-1082G>A telah dibuktikan mempengaruhi tingkat produksi IL-6 dan CRP. Perbedaan proporsi alel G, C pada IL-6-174, dan alel G, A pada IL-1082, berbagai bangsa dan ras, mungkin menjadi penyebab perbedaan di atas. Sindrom inflamasi malnutrisi (SIM) pada pasien HD berbeda dengan malnutrisi pada populasi. Pada SIM, faktor inflamasi, uremia dan katabolisme protein lebih berperan. Hal ini memerlukan cara penilaian status malnutrisi yang berbeda. Penelitian ini dilakukan untuk mendapatkan frekuensi polimorfisme gen IL-6-174 dan IL-10-1082, mengetahui faktor yang berperan dalam SIM, mengetahui perbedaan prevalensi inflamasi pada pasien dengan malnutrisi dan sebagai validitas penilaian SGA.Telah dilakukan penelitian pada pasien yang menjalani HD 2 kali seminggu, 5 jam per kali HD, tanpa komplikasi penyakit lainnya, dan semua memakai dialiser selulosa diasetat yang diproses ulang. Dari 64 pasien yang diperiksa, didapatkan gen IL-6-74GG 95,31%, CC 3,13% dan GC 1,56%. Gen IL-1082AA 89,06%, GA 10,94%, dan GG tidak didapatkan. Proporsi alel ini hampir sama seperti yang didapatkan di Korea, Jepang dan Cina, berbeda dengan yang didapat di AS, ras Kaukasia, Amerika-Afrika, Hispanik dan Eropa (Kaukasia). Selain perbedaan pada proporsi gen, kami mendapatkan konsenlrasi CRP (6,23±5,57 mg/L), frekuensi malnutrisi (24,7%), dan skor MIS (6,7) yang lebih rendah dibanding dengan data dari AS dan Eropa. Mengingat sedikitnya alel C pada gen IL-6-174 dan alel G pada gen IL-10-1082, analisis statistik yang dilakukan tidak dapat memperlihatkan pengaruh perbedaan alel terhadap manifestasi klinik. Inflarnasi kronik mempengaruhi terjadinya malnutrisi (PR 3,03; 1K 95% 1,53-6,06; P = 0,012). Penilaian dengan skala SGA berkorelasi balk dengan parameter antropometri (IMT, LLA, LOLA, HGS), dan albumin serum. Albumin serum sebagai parameter inflamasi kronik berkorelasi balk dengan parameter nutrisi yang lain, sedangkan CRP tidak. Didapatkan kesan yang kuat bahwa pada pasien HD, gen IL-174GG bersifat protektif, sedangkan gen IL-1082AA tidak begitu berperan. Selain itu dibuktikan adanya pengaruh inflamasi terhadap malnutrisi dan SGA terbukti merupakan penilaian sindrom malnutrisi inflamasi yang cukup baik.

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Many studies on HD patients in developed countries have conferred strong evidence of closed correlation between inflammation, cardiovascular complication and high mortality rates. Inflammation, indicated by high levels of CRP and IL-6, has a major role in initiating and sustaining complications. Adapting to high cost, HD in Indonesia is conducted in a little different ways. Patients are dialyzed twice a week, 5 hours each, using reprocessed cellulose/diacetate membrane dialyzer, and without ultrapure water. All of these contribute to a high risk of inflammation, but in fact the prevalence of inflammation in Indonesia is relatively low. IL-6-174G>C and IL-10-1082G>A polymorphic gene have been proven to influence the production of IL-6 and CRP. The difference in the proportion of allele G, C in IL-6-174, allele G, A in IL-1082 in a variety of people's races might cause the difference in the prevalence and the level of inflammation. Malnutrition inflammation syndrome (MIS) on HD patients is different from malnutrition in general population. In MIS, the inflammatory factors, uremia, and protein catabolism of protein are more dominant. These matters probably require a different assessment method of malnutrition status. The purpose of this study was to obtain the frequency of polymorphic gene IL-6-174 and IL-10-1082 to find out the prominent factors in MIS, and to find out the difference in the inflammation prevalence in patients with malnutrition and to serve as validity of SGA assessment.A study on patients who were on hemodialysis twice a week, 5 hours each session has been conducted. The subjects had no other co-morbidities and all of them used reprocessed diasetat cellulose dialyzers. Out of 64 patients examined, IL-6-174GG was obtained 95.31%, CC 3.13% and GC 1.56%, IL-1082AA 89.06%, GA 10.94%, but absence of GG genotype. The proportion of these alleles was almost similar to that obtained in Korea, Japan and China, but it was different from that obtained in the US for the Caucasian race, African Americans, Hispanic people, and the Caucasian people in Europe_ Besides the difference in gene proportion, it was obtained that CRP (6.23±5.57 mg/L), malnutrition (24.7%), and malnutrition inflammation score (6.7) were lower compared with the data from Europe and the United States. Considering the scanty amount of allele C in IL-6-174 gene and G allele in IL-10-1082 gene, based on the statistic analysis performed it did not revealed the influence of the difference in allele on the clinical manifestation. It was found that chronic inflammation influenced the occurrence of malnutrition (PR 3.03; CI 95% 1.53-6.06; P = 0,012). The scoring by the..."

"Jalur metabolisme utama dari isoniazid INH adalah dengan asetilasi untuk membentuk asetil isoniazid AcINH . Kecepatan asetilasi dapat berbeda tergantung aktivitas N-asetiltransferase-2 NAT-2 . Pengobatan tuberkulosis dengan INH dapat menimbulkan risiko hepatotoksik, baik pada tipe asetilator cepat maupun lambat. Buah nans Ananas comosus Linn. Merr diketahui beraktivitas hepatoprotektor. Tujuan penelitian adalah untuk mempelajari kecepatan asetilasi INH pada etnis Melanesia dari Papua. Selain itu, penelitian bertujuan untuk mengetahui pengaruh jus nanas terhadap asetilasi INH. Kecepatan asetilasi INH ditentukan berdasarkan rasio kadar AcINH dan INH dalam plasma subjek. Kadar AcINH dan INH dalam plasm asubjek dianalisis dengan kromatografi cair kinerja tinggi. Kromatografi fase balik-pasngan ion yang telah divalidasi menunjukkan batas kuntifikasi terendah untuk INH dan AcINH berturut-turut yaitu 0,1258 dan 0,1188ug/mL. Subjek yang berpartisipasi pada studi penentuan asetilasi INH adalah 102 orang. Sebanyak 41 dari 102 subjek secara sukarela terlibat pada studi pengaruh jus buah nanas pada asetilasi INH. Hasil penelitian menunjukkan 70,59 subjek adalah asetilator lambat. Jus buah nanas matang diketahui memengaruhi kecepatan asetilasi INH berdasarkan analisis statistik Wilcoxon test for two related samples pada tingkat kepercayaan 95 . Dalam rangka mengurangi efek hepatotoksik INH, pemanfaatan jus nanas matang sebagai adjuvant dapat diteliti lebih lanjut pada pasien tuberkulosis.

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The major pathway of INH metabolism is by acetylation to form acetyl isoniazid AcINH . Acetylation rate may differ depends on N acetyltransferase 2 NAT 2 activity. Treatment of tuberculosis with INH may lead to the risk of hepatotoxicity, both in fast and slow acetylator types. Pineapple fruit Ananas comosus Linn. Merr has a hepatoprotector activity. The aim of this study was to study INH acetylation rate on Melanesia ethnicity from Papua, Indonesia. Furthermore, this study was to evaluate the influence of pineapple juice as hepatoprotector in INH acetylation. The acetylated rate of INH was determined based on the ratio of AcINH and INH levels in subject rsquo s plasma. The levels of INH and AcINH in the subject rsquo s plasma were analyzed by high performance liquid chromatography. Validated reversed phase ion pair chromatography showed the lower limit of quantification of INH and AcINH were 0.1258 and 0.1188 g mL, respectively. Participants in the study of INH acetylator status were 102 subjects. A total of 41 of 102 subjects were voluntarily implicated in the study of the effect of pineapple juice on acetylation of INH. The results showed that 70.59 of subjects were slow acetylators. Ripe pineapple fruit juice is known to affect the rate of acetylation INH based on statistical analysis of Wilcoxon test for two related samples at 95 confidence level. In order to reduce the effects of INH hepatotoxicity, the utilization of ripe pineapple juice as adjuvant can be further investigated in patients with tuberculosis."

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Karsinoma sel skuamosa rongga mulut (KSS-RM) merupakan keganasan yang

menempati urutan ke-6 dari seluruh kasus kanker di dunia. Pembedahanmerupakan terapi utama KSS-RM namun pada KSS-RM lanjut lokal,pembedahan merupakan tantangan bagi dokter bedah karena struktur anatomiyang rumit dan dampaknya terhadap kualitas hidup penderita Oleh karena itudipikirkan pemberian kemoterapi neoadjuvan (KN) pada KSS-RM stadium lanjutlokal untuk mengecilkan tumor. Kemoresistensi merupakan masalah pemberianKN pada KSS-RM stadium lanjut lokal akibat microenvironment yang hipoksikditandai dengan peningkatan ekspresi HIF-1α. Kemoresistensi juga diregulasi olehmiR-210 serta peningkatan ekspresi penanda sel punca CD44 dan CD133.Melatonin memiliki efek antioksidan kuat dan efek onkostatik sehinggadiharapkan dapat memperbaiki kondisi hipoksia tumor.Penelitian ini merupakan uji klinis dengan desain paralel acak tersamarpembanding plasebo, yang dilaksanakan pada bulan Juni 2017 hingga Juli 2018,bertujuan untuk mengetahui efektivitas melatonin dalam meningkatkan responsklinis penderita KSS-RM stadium lanjut lokal yang diberikan kemoterapineoadjuvan dan apakah melatonin dapat memperbaiki hipoksia yang ditandaidengan penurunan ekspresi HIF-1α, miR-210, CD44, dan CD133. Sebanyak 50pasien KSS-RM stadium lanjut lokal dari RSCM dan RSKD dirandomisasi.Sebanyak 25 pasien mendapat kombinasi melatonin dan KN (taksan, sisplatin,dan 5-fluorourasil) dan 25 pasien lainnya mendapat KN saja. Sebanyak 25 pasienyang menyelesaikan protokol penelitian (13 pasien kelompok melatonin dan 12pasien kelompok plasebo). Perubahan ekspresi HIF-1α, miR-210, CD44, danCD133 yang diukur dari jaringan biopsi sebelum terapi dan jaringan biopsi/eksisiluas pasca terapi, menggunakan metode qRT-PCR absolute quantification. Selainitu untuk menilai respons klinis digunakan RECIST 1.1 sebelum dan sesudah KN.Melatonin 20 mg perhari menurunkan ekspresi HIF-1α (p = 0,301), miR-210 (p =0,767), dan CD44 (p = 0,103) namun tidak bermakna jika dibandingkan plasebo.Ekspresi CD133 meningkat pada kedua kelompok melatonin dan plasebo (p =0,301) walaupun tidak bermakna. Melatonin 20 mg perhari selama 1 minggusebelum KN pertama dimulai sampai KN selesai tidak memberikan perbedaanrespons positif yang bermakna pada dua kelompok. Penurunan konsentrasi HIF-1a dan CD133 tidak diikuti penurunan persentase sisa tumor. Pada kelompokmelatonin, ekspresi CD44 dan miR-210 menurun diikuti penurunan persentasesisa tumor yang tidak bermakna dibandingkan plasebo. Pada kelompok yangmendapat melatonin, persentase sisa tumor 21,35% lebih rendah dibandingkankelompok plasebo meskipun tidak berbeda bermakna (p = 0,531).

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Squamous cell carcinoma of the oral cancer (OSCC) is the sixth most common

malignancy of all malignant tumors. Surgery is the mainstay of treatment for oralcavity cancers. Surgery in locally advanced OSCC presents many challengesprimarily because the head and neck region have many critical structures that canbe damaged by tumor or treatment. Damage to these structures can result insignificant structural, cosmetic and functional deficits that negatively impactquality of life. Therefore, it is thought that neoadjuvant chemotherapy (KN) inlocal advanced stage OSCC is to shrink the tumor. The chemoresistancy is aproblem of KN administration in locally advanced OSCC due to a hypoxicmicroenvironment characterized by increased expression of HIF-1α. Thechemoresistancy is also regulated by miR-210 as well as increased expression ofCD44 and CD133 stem cell markers. Melatonin has powerful antioxidant effectsand oncostatic effects that are expected to improve tumor hypoxia.This study is a double-blind, randomized clinical trial, which was carried out inJune 2017 to July 2018 to determine the effectiveness of melatonin in improvingthe clinical response of locally advanced OSCC patients given neoadjuvantchemotherapy and whether melatonin can improve hypoxia marked by decreasedexpression of HIF-1α, miR-210, CD44, and CD133. Only 25 patients hadcompleted the study protocol, 13 in melatonin group and 12 in placebo group. Thedifference in HIF-1α, miR-210, CD44, and CD133 expression were measured as adelta concentration using absolute quantification qRT-PCR. The concentration ofthe biomolecular markers within the tumor tissue taken from the first biopsy (pretreatment)were determined using qRT-PCR then subtracted from theconcentration of biomarkers taken from the second biopsy. The clinical responsewas assessed using RECIST 1.1.The administration of melatonin 20 mg/day decreased the expression of HIF-1α(p = 0,301), miR-210 (p = 0,767), and CD44 (p = 0,103) but not statisticallysignificant. CD133 expression increased in both group melatonin and placebo (p= 0,301). Melatonin 20 mg per day for 1 week before NC was started until NCwas completed did not give a significant difference in positive responses in thetwo groups. The decrease concentrations of HIF-1 and CD133 were not followedby a decrease in the percentage of remaining tumors. The melatonin groupshowed a decrement in CD44 and miR-210 followed by a decrement in thepercentage of remaining tumors that were not significant compared to placebo. Inthis study, melatonin did not increase the clinical response although there is21.35% decrement in tumor mass in melatonin group compare (p = 0,531).

"

"Manfaat madu untuk penyembuhan luka sudah banyak diteliti, namun informasi manfaatnya untuk penyembuhan luka timpanoplasti masih terbatas. Penelitian ini bertujuan mengevaluasi efek madu manuka (Mn) dan madu trigona (Tr) asli Indonesia pada re-epitelisasi membran timpani (MT) melalui potensi proliferasi fibroblas, keratinosit, sekresi KGF dan basic-FGF.Penelitian in vivo berupa uji klinis acak, tersamar ganda, pada 64 pasien dewasa otitis media supuratif kronik (OMSK) tipe aman tenang yang menjalani timpanoplasti di RSUPN dr. Cipto Mangunkusumo pada bulan Juni 2021–Agustus 2022. Pasien diacak dan disamarkan ke dalam dua kelompok, yaitu diberikan gelfoam plus gel Mn 100% medical grade (intervensi) atau hanya diberikan gelfoam (kontrol) di liang telinga saat timpanoplasti. Tampon telinga diangkat setelah dua minggu dan pasien diminta kontrol setiap minggu selama enam minggu. Penelitian in vitro dilakukan di Laboratorium Universitas YARSI. Kultur fibroblas dan keratinosit yang diisolasi dari pasien OMSK diberikan pajanan Mn dan Tr dengan tiga konsentrasi yaitu 0,04%, 0,1%, dan 0,25%, kemudian dilakukan uji proliferasi, KGF dan bFGF juga diukur dan dibandingkan dengan kelompok kontrol.Proporsi pengeringan luka pascatimpanoplasti kelompok intervensi lebih banyak secara bermakna dibandingkan kontrol pada minggu ke-3, ke-4, dan ke-6. Madu manuka dan Tr tidak meningkatkan jumlah sel kultur fibroblas, tetapi mempersingkat durasi doubling time. Jumlah sel kultur keratinosit lebih tinggi secara bermakna dibandingkan kontrol pada semua kelompok Mn dan Tr 0,04%. Sekresi KGF meningkat seiring pertambahan sel. Pada hari ke-6 dan hari ke-8, sekresi KGF lebih tinggi pada beberapa kelompok intervensi dibandingkan kontrol. Sebaliknya, kadar bFGF menurun seiring pertambahan sel. Terdapat korelasi positif antara lama pajanan kedua jenis madu dengan proliferasi fibroblas. Lama pajanan Mn 0,04%, 0,1%, dan Tr 0,04% berkorelasi positif dengan jumlah sel kultur keratinosit.Disimpulkan pemberian Mn saat timpanoplasti meningkatkan pencapaian re-epitelisasi MT sempurna melalui efeknya pada fibroblas dan keratinosit, serta berpotensi meningkatkan keberhasilan timpanoplasti. Penelitian ini juga menunjukkan efek positif Tr pada fibroblas dan keratinosit, sehingga potensi terapeutik madu ini dapat diteliti lebih lanjut

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Benefits of honey on wound healing have been widely reported, but information about its effect on the re-epithelialization of the tympanic membrane (TM) is limited. This study aims to evaluate the effect of manuka honey (MH) and trigona honey (TH) from Indonesia, on TM re-epithelization through their potential action on the proliferation of fibroblasts, keratinocytes, secretion of KFG and basic-FGF.

The in vivo study was a randomized, controlled, double-blind clinical trial on 64 adult patients with mucosal type chronic suppurative otitis media (CSOM) undergoing tympanoplasty at Cipto Mangunkusumo General Hospital from June 2021–August 2022. Patients were randomized and blinded into two groups, receiving either gel foam soaked in 100% medical grade MH (intervention group) gel or only gel foam (control group) placed in the external auditory canal during tympanoplasty. The ear tampon was removed after two weeks, and patients were followed up weekly for six weeks. The in vitro study was conducted at the YARSI University Laboratory. Fibroblast and keratinocyte cultures isolated from CSOM patients were exposed to MH and TH with three dilutions: 0.04%, 0.1%, and 0.25%. The cells were then subjected to proliferation assays, KGF and bFGF were also assessed and compared with the control group.

The intervention group had a significantly higher proportion of dry tympanoplasty wounds than control at the 3rd, 4th, and 6th visit. Manuka honey and TH did not increase the number of fibroblasts but shortened the doubling time duration. A significantly higher number of keratinocytes than control was observed in all MH groups and the 0.04% TH group. KGF secretion increased as the number of cells increased. On day 6 and day 8, KGF secretion was higher in some of the intervention groups compared with the control group. In contrast, fibroblast bFGF secretion decreased as the number of cells increased. There was a positive correlation between the exposure time of all intervention groups and the number of cells in the fibroblast culture. Prolonged exposure time to 0.04% MH, 0.1% MH, and 0.04% TH were positively correlated with the number of keratinocytes.

The application of MH during tympanoplasty increased complete TM re-epithelialization through its effect on fibroblasts and keratinocytes proliferation. MH has the potential to improve tympanoplasty outcomes. This present study also illustrated the positive effects of TH on fibroblasts and keratinocytes; thus, its potential therapeutic properties could be further explored."

"Pola makan tinggi serat, khususnya asupan sayur hijau diketahui erat hubungannya dengan rendahnya risiko diabetes tipe 2 dan perbaikan kontrol glikemik, namun perubahan pola makan yang merupakan perubahan gaya hidup menuntut modifikasi perilaku. Model Pemberdayaan bagi petugas kesehatan yang terdiri dari keterampilan coaching berdasarkan metode motivasional Porter and Lawler, Kotter’s leadership model dan creative kitchen telah dikembangkan, dan telah diujicobakan dengan disain mix method. Efektivitas model ini dibuktikan dengan melakukan penelitian kualitatif sebagai embedded design dalam studi kuantitatif yang merupakan randomised controlled trial. Subyek penelitian adalah karyawan atau keluarga karyawan PT Telkom Indonesia. Sampel diambil secara randomisasi kluster, 84 subyek yang memenuhi kriteria inklusi penelitian dibagi menjadi 42 orang di kelompok intervensi dan 42 orang di kelompok kontrol. Selama 12 minggu subyek kelompok intervensi mendapat Model Pemberdayaan dalam pertemuan seminggu sekali dengan petugas kesehatan. Subyek kelompok kontrol mendapat konseling konvensional seminggu sekali. Di akhir penelitian, terdapat 3 subyek drop out, 2 orang dari kelompok intervensi dan 1 orang dari kelompok kontrol. Terdapat perbedaan bermakna peningkatan asupan sayur pada kelompok intervensi dibanding kelompok kontrol (p<0.001). Demikian pula penurunan HbA1c pada kelompok intervensi berbeda bermakna dibanding kelompok kontrol (p=0.009). Di akhir penelitian terjadi perbedaan bermakna antara kelompok intervensi dan kontrol untuk penurunan kadar gula puasa (p=0.034), kadar gula darah 2 jam postprandial (p=0.006), dan penurunan lingkar pinggang (p=0.044). Studi kualitatif menunjukkan bahwa sikap petugas kesehatan yang positif menentukan sikap subjek sehingga menghasilkan sesi coaching dengan ciri-ciri: adanya dorongan dan penghargaan, hal-hal yang dipelajari oleh subjek, penghargaan atas proses, keterlibatan pasangan, rasa percaya diri, regulasi diri serta kemampuan untuk menjangkau keluar sebagai tokoh panutan agar orang lain terdorong ikut mengonsumsi sayur lebih banyak.

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Dietary pattern high in fibre and green leafy vegetable in particular have shown inverse association with lower risks of Type 2 Diabetes Mellitus and improved glycemic control. However dietary change is also considered as lifestyle change that requires behaviour modifications. The Empowerment Model for health provider consisting of coaching skill based on Porter and Lawler motivational method, Kotter’s leadership model and creative kitchen has been developed, established and pre-tested using a mix method study design. Qualitative study was an embedded design within the quantitative study which was a randomised controlled trial. Subjects of the study were employees of PT Telkom Indonesia or their family members. 84 subjects who met the inclusion criteria working in 8 office groups following clustered random sampling were divided into intervention and control groups with 42 subjects each. Subjects of the intervention group received the Empowerment Model in weekly meeting with trained health providers for 12 weeks. Conventional counselling was applied on the control group weekly for 12 weeks. At the end of the study, there were 3 drop-out subjects, 2 subjects from the intervention group and 1 subject from the control group. There was significant difference in change of vegetable intake of the intervention group compared to the control group (p<0.001). HbA1c decreased significantly in the intervention group compared to the control group (p=0.009). At the end of the study, the significant differences shown in the intervention group compared to the control group were: decreased fasting blood glucose (p=0.034), postprandial blood glucose (p=0.006), and decreased waist circumference (p=0.044). Qualitative study demonstrated that health provider’s positive attitudes defined subject’s attitudes in creating adherence during coaching sessions with the presence of encouragement and acknowledgment, learned lessons, process honouring, buddy’s involvement, confidence and self regulation, also outreaching ability being role model to enrol others in consuming more vegetables. "