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The role of human papillomavirus in advanced laryngeal squamous cell carcinoma Fauziah Fardizza; Bambang Hermani; Susyana Tamin
Oto Rhino Laryngologica Indonesiana Vol 46, No 2 (2016): Volume 46, No. 2 July - December 2016
Publisher : PERHATI-KL

Background: Many studies had been conducted regarding the association of human papillomavirus (HPV) with laryngeal cancer. HPV was assumed to be one of the etiology of squamous cell carcinoma (SCC) besides smoking and alcohol consumption. Neck lymph node metastasis which is found in advanced laryngeal cancer could decrease the 5-year survival rate up to 50%. Purpose: This study aimed to investigate the role of HPV infections in the oncogenesis of the advanced laryngeal SCC and to evaluate the role of HPV in neck metastasis. Methods: Cross-sectional, double blind study with planned data collection. Data were taken from Formalin Fixed Paraffin Embedded (FFPE) of laryngeal cancer specimen after laryngectomy. Samples were analyzed by nested Polymerase Chain Reaction (PCR) and continuous flow-through hybridization for genotyping. Expression of Epidermal Growth Factor Receptor (EGFR), and Vascular Endothelial Growth Factor (VEGF) as metastasis biomarker were evaluated by immunohistochemistry. Results: Overall HPV proportion in laryngeal cancer was 28.7%. A total of 9% laryngeal cancer patients were infected with high risk HPV type and HPV 16 was found in 5 out of 7 samples. Mantel-Haenszel multivariate analysis found that HPV infection did not play a role in neck metastasis even though there were positive evidences of metastasis biomarker. On the contrary, in the absent of HPV, high expression metastasis biomarkers increased the risk of neck nodes metastasis: in EGFR 3.38 and VEGF 5.14 fold. Conclusion: HPV was found to be an oncogenic factor of laryngeal SCC, and HPV 16 was the most frequently observed type of HPV. HPV had protective function towards lymph node metastasis.Keywords: Human papillomavirus, advanced laryngeal squamous cell carcinoma, expression of epidermal growth factor receptor, vascular endothelial growth factor, formalin fixed paraffin embeddedABSTRAK Latar belakang: Berbagai penelitian telah dilakukan untuk melihat hubungan antara Human papillomavirus (HPV) dengan karsinoma sel skuamosa (KSS) laring. HPV dianggap sebagai etiologinya, selain dari merokok dan konsumsi alkohol. Metastasis kelenjar getah bening (KGB) leher merupakan salah satu faktor yang menurunkan angka kesintasan lima tahun sebanyak 50% dan sering kali terjadi pada KSS laring yang telah lanjut. Tujuan: Penelitian ini ingin mengetahui peran HPV sebagai faktor onkogenesis dan faktor risiko kejadian metastasis KGB leher pada KSS laring lanjut. Metode: Cross-sectional, double blind study dengan pengumpulan data sekunder dari rekam medis. Data diambil dari parafin blok pasien KSS laring yang telah dilaringektomi. Semua data dianalisis dengan nested Polymerase Chain Reaction (PCR), dilanjutkan dengan flow-through hybridization untuk identifikasi tipe virus HPV. Dilakukan juga pemeriksaan imunohistokimia terhadap biomarka penanda metastasis yaitu Expression of Epidermal Growth Factor Receptor (EGFR), dan Vascular Endothelial Growth Factor (VEGF). Hasil: Secara keseluruhan didapatkan proporsi HPV pada KSS laring sebanyak 28,7%. Terdapat infeksi HPV tipe risiko tinggi pada 9% KSS laring, dan HPV 16 ditemukan pada 5 dari 7 sampel. Analisis multivariat Mantel-Haenszel mendapatkan infeksi HPV tidak berperan terhadap kejadian metastasis leher, meskipun didapati adanya biomarka penanda metastasis yang tinggi. Sebaliknya, pada ketiadaan infeksi HPV, adanya ekspresi biomarka metastasis yang tinggi meningkatkan risiko terjadinya metatasis KGB lokoregional pada EGFR 3,38 kali dan VEGF 5,14 kali. Kesimpulan: HPV dianggap sebagai faktor onkogenik KSS Laring, dan HPV 16 merupakan tipe yang paling sering ditemukan. HPV mempunyai fungsi protektif terhadap kejadian metastasis KGB lokoregional.Kata kunci: Human papillomavirus, advanced laryngeal squamous cell carcinoma, expression of epidermal growth factor receptor, vascular endothelial growth factor, formalin fixed paraffin embedded

Management of Presbyphonia Fauziah Fardizza; Mirta Hediyati Reksodiputro
Oto Rhino Laryngologica Indonesiana Vol 50, No 1 (2020): Volume 50, No. 1 January - June 2020
Publisher : PERHATI-KL

Background: The proportion of individuals over 65 years of age in developed countries is increasing rapidly, due in large part to current and projected increases in life expectancy.Within the aging population, the incidence of vocal disorders is estimated to be between 12%-35%. Literature Review: Presbyphonia, or age-related dysphonia, is a diagnosis of exclusion. Patients’ other comorbidities must be evaluated completely. The complexity of presbyphonia involves the changes in the diverse tissues of the true vocal folds, musculature, and cartilage. Patients would get benefit from treatment of voice therapy or surgical laryngeal augmentation procedures. Purpose: The aim of this literature review is to describe presbyphonia and several kinds of its management. The primary treatment goal is to enhance glottal closure either by voice therapy or surgical interventions (phonosurgery) such as injection augmentation (IA) and bilateral thyroplasty surgery (BTS). Holistic physical evaluation had to be done to reach complete medical therapy. Conclusion: The best therapy for presbyphonia are voice therapy, or surgery followed by voice therapy and voice hygiene.Keywords: vocal disorder, presbyphonia, voice therapy, phonosurgery, management ABSTRAKLatar belakang: Prevalensi individu yang berusia diatas 65 tahun di negara maju semakin meningkat dengan cepat seiring dengan meningkatnya usia harapan hidup. Dalam populasi lanjut usia, angka kejadian gangguan fonasi diperkirakan antara 12%-35%. Tinjauan Pustaka: Presbifonia, atau disfonia terkait usia lanjut, membutuhkan evaluasi faktor komorbid secara lengkap. Kerumitan dari presbifonia adalah karena melibatkan perubahan jaringan, otot, dan tulang rawan di sekitar pita suara. Tatalaksana yang dilakukan adalah perawatan terapi suara dan prosedur bedah augmentasi pita suara. Tujuan: Untuk menggambarkan presbifonia serta berbagai jenis tatalaksananya. Keberhasilan utama penatalaksanaan presbifonia adalah meningkatnya penutupan glotis, baik dengan terapi suara atau intervensi bedah (phonosurgery) seperti injeksi augmentasi dan bedah tiroplasti bilateral. Dibutuhkan evaluasi fisik secara holistik untuk mencapai hasil terapi medis yang baik. Kesimpulan: Penatalaksanaan terbaik untuk presbifonia adalah terapi suara, atau pembedahan diikuti dengan terapi suara dan higiene suara.

Patogenesis dan diagnosis gangguan napas saat tidur dengan Drug Induce Sleep Endoscopy (DISE) Elvie Zulka Kautzia Rachmawati; Wresty Arief; Susyana Tamin; Rahmanofa Yunizaf; Fauziah Fardizza
Oto Rhino Laryngologica Indonesiana Vol 47, No 2 (2017): Volume 47, No. 2 July - December 2017
Publisher : PERHATI-KL

Latar belakang: Obstructive sleep apnea (OSA) ialah penyakit kronis yang terjadi akibat episode intermiten sumbatan jalan napas komplit atau sebagian saat tidur. OSA dapat menimbulkan komplikasi seperti hipertensi, diabetes melitus, stroke dan excessive daytime sleepiness yang dapat berakibat fatal. OSA merupakan bagian dari gangguan napas saat tidur. Tujuan: Mengindentifikasi letak atau level dan konfigurasi sumbatan pada saat tidur. Tinjauan pustaka: Cara untuk mendiagnosis OSA adalah nasofaringolaringoskopi dengan Muller`s maneuver, pemeriksaan polisomnography (PSG), dan drug induce sleep endoscopy (DISE). Pemeriksaan PSG merupakan standar baku emas untuk mendapakan nilai apnea-hipopnea index (AHI) yang menentukan derajat OSA. Pemeriksaan untuk mengidentifikasi lokasi sumbatan jalan napas yang menyebabkan peningkatan resistensi aliran udara adalah Muller`s maneuver dan DISE. Pada pemeriksaan DISE, digunakan propofol atau midazolam secara intravena untuk menstimulasi keadaan sumbatan pada saat tidur, dilanjutkan dengan pemeriksaan nasofaringolaringoskopi. Kesimpulan: Pemeriksaan ini merupakan cara yang sangat terpercaya untuk menentukan level sumbatan pada keadaan tidur, sehingga jenis tindakan operasi yang dilakukan menjadi lebih tepat. Kata kunci: Drug induced sleep endoscopy, midazolam, propofol, manuver Muller’s, obstructive sleep apnea, polisomnografi ABSTRACT Background: Obstructive sleep apnea (OSA) is a common chronic disorder caused by intermittent episodes of complete or partial upper airway obstruction during sleep. It may lead to complications such as hypertension, diabetes mellitus, stroke, as well as excessive daytime sleepiness which can be fatal. OSA is a part of sleep disorder breathing. Purpose: To identify the sites or the levels of obstruction and its configuration. Literature review: Muller’s maneuver upon nasopharyngoscopy, polysomnography (PSG), and drug-induced sleep endoscopy (DISE) are the modalities for diagnosing OSA. Polysomnography is the gold standard examination for OSA, one of the variables; the apnea-hipopnea index (AHI) is used to determine the presence and severity of OSA. Muller’s maneuver and DISE are the examination to identify the sites responsible for increase in airflow resistance. DISE technique uses intravena injection of propofol or midazolam to produce obstruction in a “natural sleep” condition followed by nasopharyngolaryngoscopy examination. Conclusion: DISE is considered as a very reliable means to define the level of obstruction during sleeping, thus could help to determine appropriate surgery. Keywords: Drug induced sleep endoscopy, midazolam, propofol, Muller’s maneuver, obstructive sleep apnea, polisomnography

Tonsilitis difteri dengan sumbatan jalan napas atas Syahrial Marsinta Hutauruk; Fauziah Fardizza; Sevi Aristya
Oto Rhino Laryngologica Indonesiana Vol 48, No 1 (2018): Volume 48, No. 1 January - June 2018
Publisher : PERHATI-KL

Latar belakang: Difteri adalah penyakit infeksi yang disebabkan oleh kuman bacillus grampositif Corynebacterium diphtheriae. Bakteri ini terutama menyebabkan infeksi pada saluran napasberupa tonsilofaringitis, laringitis, maupun keduanya secara bersamaan, ditandai dengan terbentuknyapseudomembran. Kematian pada anak dengan penyakit ini umumnya terjadi karena sumbatan jalannapas atas, ataupun efek sistemik toksin difteri. Tujuan: Melaporkan dan menganalisis kasus tonsilitisdifteri yang berakhir dengan kematian meskipun telah mendapat tatalaksana sumbatan jalan napas atas.Laporan kasus: Kasus anak perempuan usia 4 tahun, dan anak laki-laki usia 5 tahun dengan tonsilitisdifteri disertai sumbatan jalan napas atas. Metode: Telaah literatur berbasis bukti mengenai tonsilitisdifteri, komplikasi, dan status imunisasi melalui database Cochrane, Pubmed Medline, dan EBSCOHost Medline. Berdasarkan kriteria inklusi dan eksklusi didapatkan 3 jurnal yang relevan dengan kasusyang dilaporkan. Hasil: Studi tersebut menyatakan tonsilitis difteri sebagai penyakit dengan komplikasisumbatan jalan napas dan jantung. Komplikasi jantung adalah penyebab kematian tertinggi pada tonsilitisdifteri. Status imunisasi pada kasus meninggal sebagian besar tidak lengkap, dan cakupan imunisasi totalmasih rendah. Kesimpulan: Tonsilitis difteri merupakan kasus jarang dengan tingkat kematian tinggiakibat komplikasi sumbatan jalan napas dan jantung. Kematian dapat terjadi akibat efek sistemik toksindifteri, meskipun sumbatan jalan napas telah diatasi. Status imunisasi yang tidak lengkap dan rendahnyacakupan imunisasi pada wilayah tempat tinggal penderita meningkatkan mortalitas kasus tonsilitis difteri. Kata kunci: tonsilitis difteri, sumbatan jalan napas atas, imunisasi difteri, toksin sistemik ABSTRACTBackground: Diphtheria is an acute infectious disease caused by Corynebacterium diphtheriae, a gram-positive bacillus. The organism infects primarily the respiratory tract, where it causestonsillopharyngitis, laryngitis, or both, typically marked by the forming of pseudomembrane. In children,either the upper respiratory tract obstruction or the effects of diphtheria toxin are the most common causeof death. Purpose: To report and analyze tonsillitis diphtheria cases that ended up in fatality, althoughthe upper airway obstruction had been managed. Case report: Two cases of a 4-years girl and 5-yearsold boy with tonsillitis diphtheria with upper respiratory tract obstruction. Method: The evidence basedliterature regarding tonsillitis diphtheria, its complication and diphtheria immunization status wereconducted on Cochrane database, Pubmed Medline, and EBSCO Host Medline. Based on the inclusionand exclusion criteria, three studies were found relevant to our cases. Result: These studies stated thattonsillitis diphtheria is a disease with upper airway obstruction and cardiac complications. Cardiaccomplications are the leading cause of death. Immunization status in fatal cases was largely incompleteand total immunization coverage was still low. Conclusion: Tonsillitis diphtheria is a rare case with highmortality rate due to upper airway obstruction and cardiac complication. Systemic effect of diphtheriatoxin can lead to fatality although the airway obstruction had been managed. The incomplete immunizationstatus and the low immunization coverage increased the mortality of tonsillitis diphtheria. Keywords: tonsillitis diphtheria, upper airway obstruction, diphtheria immunization, systemic toxin

A novel diastolic dysfunction score: A proposed diagnostic predictor for left ventricular dysfunction in obese population Kamelia, Telly; Rumende, Cleopas M.; Makmun, Lukman H.; Timan, Ina S.; Djauzi, Samsuridjal; Prihartono, Joedo; Fardizza, Fauziah; Tabri, Nur A.
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.1564

Obesity-related diastolic dysfunction is an emerging contributor to heart failure and cardiovascular mortality. However, effective and accessible diagnostic tools are still limited. Current methods for assessing diastolic dysfunction are often invasive or technologically demanding, making them impractical for routine clinical use and community settings. The aim of this study was to develop a novel, non-invasive scoring system designed to predict diastolic dysfunction in obese adults, addressing this diagnostic gap. This community-based, prospective cross-sectional study was conducted in Jakarta, Indonesia, from March to November 2021, and included 82 participants aged 18 to 60 years, all with a body mass index (BMI) ≥25 kg/m². Patients with acute or critical illnesses, valvular heart diseases, or acute confusional states were excluded. Each participant underwent blood tests, polysomnography, and echocardiography. Of the study population, 80.5% were diagnosed with obstructive sleep apnea (OSA), and 12.2% exhibited diastolic dysfunction, all within the OSA group. The novel scoring system integrates four predictors: oxygen desaturation index (ODI) ≥39 (score 1; prevalence ratio: 4.31 (95% confidence interval (CI): 1.58–11.75)), HbA1C ≥5.95% (score 2; prevalence ratio: 6.32 (95%CI: 2.84–14.06)), pulmonary artery wedge pressure (PAWP) ≥10 mmHg (score 1; prevalence ratio: 5.95 (95%CI: 2.30–15.39)), and global longitudinal strain (GLS) ≥-16.95% (score 1; prevalence ratio: 4.32 (95%CI: 1.87–9.99)). A score of ≥2 predicted diastolic dysfunction with 90% sensitivity, with positive predictive value and negative predictive value of 40.91% and 98.33%, respectively. In conclusion, the diastolic dysfunction score is a simple and practical tool for the early detection of diastolic dysfunction in obese individuals without cardiovascular symptoms.

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