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Hypoxia-preconditioned mesenchymal stem cells attenuate peritoneal adhesion through TGF-Î² inhibition Trisnadi, Setyo; Muhar, Adi Muradi; Putra, Agung; Kustiyah, Azizah Retno
Universa Medicina Vol 39, No 2 (2020)
Publisher : Faculty of Medicine, Trisakti University

BackgroundPeritoneal adhesions (PAs) are generally described as fibrous bands between intra-abdominal organs following an abdominal surgical operation. The definitive treatments of PAs are currently ineffective yet. Hypoxia-mesenchymal stem cells (H-MSCs) have a higher capability to survive at the site of injury than normoxia-MSCs (N-MSCs) to repair injured tissue without fibrosis. This study aimed to analyze the effect of H-MSCs in controlling formation of PAs by reducing TGF-Î² level in a rat model. Methods A study of post-test only control group design was conducted, involving eighteen PA rat models weighing 250 Â± 25 g that were randomly assigned into 3 groups, comprising control group (C), and groups T1 and T2 receiving H-MSC treatment at doses of 3 x 106 and 1.5 x 106, respectively. To induce H-MSCs, MSCs were incubated in hypoxic conditions at 5% O2 and 37oC for 24 hours. Expression level of TGF-Î² was analyzed by enzyme-linked immunosorbent assay (ELISA) at 450 nm and adhesion formation was described macroscopically. The Kruskal-Wallis variance analysis was used to analyze significant differences among the groups.ResultsThe results of this study showed that H-MSCs in group T1 inhibited TGF-Î² expression significantly on day 8 (p<0.001) and day 14 (p<0.05). Moreover, there was almost no adhesion apparent following H-MSC administration in group T1. ConclusionsBased on this study, we conclude that H-MSCs may attenuate PA formation following inhibition of TGF-Î² expression in the PA rat model.

Changes In Glutamic Oxaloacetic Transaminase Serum (SGOT) and Glutamic Pyruvic Transaminase Serum (SGPT) Value In Laparoscopic Cholecystectomy Patient at USU Hospital Aziizah Gita; Muhar, Adi Muradi
Sumatera Medical Journal Vol. 3 No. 2 (2020): Sumatera Medical Journal (SUMEJ)
Publisher : Talenta Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/sumej.v3i2.3273

Background. Laparoscopic cholecystectomy has become more widely used choice compared to laparotomy cholecystectomy. Laparoscopic cholecystectomy has now become the gold standard of abdominal surgery for abdominal surgery for gallbladder abnormalities, more than 90% of patients with gallstone disease are treated surgically by laparoscopy, but several studies have revealed an increase in SGOT &SGPT values in these surgical procedures. SGPT itself occurs due to the procedure of laparoscopy. In the procedure, there is a temporary increase in the pneumoperitoneum, the pressure on the pneumoperitoneum and its duration affect the severity of ischemia by causing an increase in this liver enzyme. Among several studies, one of them revealed that at 48 hours after laparoscopic cholecystectomy surgery an enzyme increase. Objective. The purpose of the study, this research was conducted to see the changes in SGOT & SGPT values in laparoscopic cholecystectomy surgery. Method. This research method is analytic with cross sectional study design conducted at North Sumatera University Hospital. This research was conducted by looking at secondary data, namely the medical record of patients with gallstones who underwent laparoscopic cholecystectomy surgery from January 2019 to November 2019. The sample was selected by using total sampling method. Data were then analyzed using statistical application software. The number of samples was 45 samples with a diagnosis of gallstones who performed laparoscopic cholecystectomy. Results. Wilcoxon test results showed a significant change between SGOT and SGPT levels before performing operations with SGOT and SGPT levels after surgery with p=0.000 (p<0,05). Conclusion. There are changes in SGOT & SGPT in laparoscopic cholecystectomy.

Hypoxic mesenchymal stem cell‐conditioned medium accelerates wound healing by regulating IL‐10 and TGF‐β levels in a full‐thickness‐wound rat model Adi Muradi Muhar; Faizal Mukharim; Dedy Hermansyah; Agung Putra; Nurul Hidayah; Nur Dina Amalina; Iffan Alif
Indonesian Journal of Biotechnology Vol 27, No 4 (2022)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijbiotech.63914

Full‐thickness wound healing is a complex process requiring a well‐orchestrated mechanism of various factors, including cytokines, particularly interleukin (IL)‐10 and transforming growth factor (TGF)‐β. IL‐10 and TGF‐β act as robust anti‐inflammatory cytokines in accelerating the wound healing process by regulating myofibroblasts. Hypoxic mesenchymal stem cell‐conditioned medium (hypMSC‐CM) containing cytokines potentially contribute to accelerate wound repair without scarring through the paracrine mechanism. This study aims to observe the role of hypMSC‐CM in controlling TGF‐β and IL‐10 levels to accelerate full‐thickness wound repair and regeneration. A total of 24 male Wistar rats were used in this study. Six healthy rats as a sham group and 18 rats were created as full‐thickness‐wound animal models using a 6 mm punch biopsy. The animals were randomly assigned into three groups (n = 6) consisting of two treatment groups treated with hypMSC‐CM at a low dose (200 µL hypMSC‐CM with 2 g water‐based gel added) and a high dose (400 µL hypMSC‐CM with 2 g water‐based gel added) and a control group (2 g water‐based gel only). The IL‐10 and TGF‐β levels were examined by ELISA. The results showed a significant increase in IL‐10 levels on day 3 after hypMSC‐CM treatment, followed by a decrease in platelet‐derived growth factor (PDGF) levels on days 6 and 9. In line with this finding, the TGF‐β levels also increased significantly on day 3 and then linearly decreased on days 6 and 9. HypMSC‐CM administra‐ tion may thus promote wound healing acceleration by controlling IL‐10 and TGF‐β levels in a full‐thickness‐wound rat model.

Sindrom Pasca-Kolesistektomi Zulkhairi; Muhammad Aflah; Adi Muradi Muhar
Cermin Dunia Kedokteran Vol 49 No 10 (2022): Oftalmologi
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v49i10.306

Tujuan umum tindakan kolesistektomi adalah menyembuhkan atau meringankan gejala yang mengganggu atau bahkan dapat mematikan. Namun pascakolesistektomi dapat timbul keluhan, dikenal sebagai sindrom pasca-kolesistektomi (SPK). Angka kejadian SPK pada kolesistektomi laparatomi antara 25% - 40% untuk gejala ringan hingga sekitar 10% untuk gejala berat. Keluhan SPK dapat terjadi setelah 2 hari hingga 25 tahun pasca-kolesistektomi. Keluhan umumnya berupa nyeri abdomen kuadran kanan atas, dengan atau tanpa nyeri alih, mirip nyeri sebelum kolesistektomi. Penatalaksanaan SPK terdiri dari intervensi bedah dan non-bedah, farmakoterapi, dan pengaturan nutrisi. The general goal of cholecystectomy is to cure or relieve the disturbing symptoms or even lethal. However, the procedure may be complicated by postcholecystectomy syndrome (PCS). The incidence of PCS in laparoscopic cholecystectomy varies from 25% to 40% for mild symptoms to about 10% for severe symptoms. PCS can occur in 2 days to 25 years after cholecystectomy. Most patients present with right upper quadrant abdominal pain, with or without referred pain, similar to the pain experienced before cholecystectomy. The management of PCS consists of surgical and non-surgical interventions, pharmacotherapy, and nutritional management.

Perianal Fistula Due to Tuberculosis Infection: A Case Report Sinaga, Bintang Yinke Magdalena; Siagian, Novi Andriani; Siagian, Parluhutan; Muhar, Adi Muradi
Journal of Endocrinology, Tropical Medicine, and Infectious Disease (JETROMI) Vol. 6 No. 3 (2024): Journal of Endocrinology, Tropical Medicine, and Infectious Disease (JETROMI)
Publisher : TALENTA Publisher, Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/jetromi.v6i3.15613

Introduction: Approximately 5% of all cases of tuberculosis are extrapulmonary. A rare extrapulmonary variant of the disease is known as perianal tuberculosis, which accounts for 0.001% of all extrapulmonary tuberculosis cases. Case Report: A 28-year-old male presented with intermittent chronic anal pain and purulent discharge from the anal for 6 months, without respiratory complaints. Chest X-Ray examination shows minimal infiltrate on the right lung apex and broncho vascular pattern partially covered with infiltrate. Fistulotomy has been done three times in this patient within 6 months. Colonoscopy examination shows recti polyp, and the histopathology result from biopsy specimen taken from the last fistulotomy is tuberculosis-specific chronic inflammatory process. The Human Immunodeficiency Virus test is negative. This patient has been treated with anti-tuberculosis treatment for 7 months and 2 months after consuming it the wound on the perianal is healing and the patientâ€™s weight is gaining 10 kgs within 7 months. Conclusion: The diagnosis of perianal tuberculosis is challenging, especially in the absence of pulmonary focus. Tuberculosis should be considered in the differential diagnosis of perianal ulcers and fistulas, mainly in non-healing and recurrent anal lesions, especially in regions where tuberculosis is endemic. Management with anti-tuberculosis treatment can provide complete recovery.

Association Between Recurrence Rates of Colorectal Cancer and Carcinoembryonic Antigen Levels, Histopathological Features, Tumor-Infiltrating Lymphocytes, and Lymphatic Invasion at H. Adam Malik Central General Hospital, Medan Mohammad, Fawzan; Muhar, Adi Muradi; Siregar, Edwin Saleh
The Indonesian Journal of General Medicine Vol. 4 No. 1 (2024): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/eqs5ry48

Introduction: In Indonesia, colorectal cancer ranks fourth in cancer incidence, with an estimated over 30,000 new cases each year. This study aims to investigate the association between colorectal cancer recurrence rates and CEA levels, histopathology, tumor-infiltrating lymphocytes, and lymphatic invasion at H. Adam Malik Central General Hospital, Medan. Methods: This cross-sectional study investigates the correlation between colorectal cancer recurrence and clinical parameters such as CEA levels, histopathology, TIL, and lymphatic invasion using retrospective data from patients at H. Adam Malik Central General Hospital in North Sumatra. Results: Out of 75 patients identified, 45 met the inclusion criteria. The study found significant relationships between recurrence and CEA levels (p=0.007), histopathological grade (p<0.001), and lymphovascular invasion (p=0.026), while tumor-infiltrating lymphocytes showed no significant correlation (p=0.358). Conclusion: Colorectal cancer recurrence are primarily shown in male patients with rectal and sigmoid tumors, predominantly adenocarcinoma at stage IIb. Significant CEA levels, moderate histological differentiation, tumor-infiltrating lymphocytes, and lymphovascular invasion were identified.

Konsensus Perhimpunan Dokter Spesialis Bedah Digestif Indonesia tentang Pedoman Diagnosis dan Tatalaksana Batu Saluran Empedu Rivai, Muhammad Iqbal; Lalisang, Arnetta Naomi Louise; Nugroho, Adianto; Wibowo, Agung Ary; Handaya, Adeodatus Yuda; Arifin, Fransiscus; Situmorang, Indah; Prabowo, Erik; Irwan, Irwan; Mayasari, Maria; Tendean, Michael; Rudiman, Reno; Setyadi, Kunsemedi; Niam, Muhammad Shobachun; Suprapto, Bambang; Putra, Jeffri; Lesmana, Tommy; Mazni, Yarman; Muhar, Adi Muradi; Mulyawan, I Made; Warsinggih, Warsinggih; Lalisang, Toar Jean Maurice
Majalah Kedokteran Indonesia Vol 74 No 2 (2024): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.74.2-2024-1188

Introduction: Choledocholithiasis, the presence of stones in the common bile duct (CBD), is a challenge in the field of digestive surgery due to the wide range of cases with varying levels of difficulty. Until now, the options for diagnostic and therapeutic modalities have been increasingly evolving, ranging from non-invasive to invasive procedures. Therefore, the Indonesian Society of Digestive Surgeons provides recommendations for the management of CBD stone cases in Indonesia.Method: The consensus was developed using the Delphi survey method involving digestive surgery experts from various cities in Indonesia. Several issues related to the diagnosis and management of CBD stones were formulated and answered based on current research, while also considering the opinions of the experts.Result: This consensus consists of two parts: 15 recommendations related to the selection of diagnostic modalities and 10 recommendations related to management options. Recommendations regarding diagnosis include the use of ultrasonography, abdominal CT-scan, and magnetic resonance cholangiopancreatography (MRCP). In addition to standard therapeutic procedures, this consensus also provides recommendations regarding contemporary procedures such as endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic common bile duct exploration (LCBDE), and open common bile duct exploration (OCBDE).Conclusion: These recommendations are aimed to assist digestive surgery experts in providing the best management for CBD stone cases.

Sindrom Pasca-Kolesistektomi Zulkhairi; Muhammad Aflah; Adi Muradi Muhar
Cermin Dunia Kedokteran Vol 49 No 10 (2022): Oftalmologi
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v49i10.306

Tujuan umum tindakan kolesistektomi adalah menyembuhkan atau meringankan gejala yang mengganggu atau bahkan dapat mematikan. Namun pascakolesistektomi dapat timbul keluhan, dikenal sebagai sindrom pasca-kolesistektomi (SPK). Angka kejadian SPK pada kolesistektomi laparatomi antara 25% - 40% untuk gejala ringan hingga sekitar 10% untuk gejala berat. Keluhan SPK dapat terjadi setelah 2 hari hingga 25 tahun pasca-kolesistektomi. Keluhan umumnya berupa nyeri abdomen kuadran kanan atas, dengan atau tanpa nyeri alih, mirip nyeri sebelum kolesistektomi. Penatalaksanaan SPK terdiri dari intervensi bedah dan non-bedah, farmakoterapi, dan pengaturan nutrisi. The general goal of cholecystectomy is to cure or relieve the disturbing symptoms or even lethal. However, the procedure may be complicated by postcholecystectomy syndrome (PCS). The incidence of PCS in laparoscopic cholecystectomy varies from 25% to 40% for mild symptoms to about 10% for severe symptoms. PCS can occur in 2 days to 25 years after cholecystectomy. Most patients present with right upper quadrant abdominal pain, with or without referred pain, similar to the pain experienced before cholecystectomy. The management of PCS consists of surgical and non-surgical interventions, pharmacotherapy, and nutritional management.

Exosome Hypoxic-MSCs, Glutathione, and Vitamin C: Effect on IL-10 Levels and CD-163 Expression Utami, Wulan Dyah; Muhar, Adi Muradi; Sumarawati, Titiek; Putra, Agung; Setiawan, Eko; Ibrahim, Sugeng; Taskworo, Dodik; Haitamy, Mohammad Nurrizki
Indonesian Journal of Pharmaceutical Science and Technology Vol 12, No 3 (2025)
Publisher : Indonesian Journal of Pharmaceutical Science and Technology

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/ijpst.v12i3.60941

Hyperpigmentation of the skin is a result of ultraviolet B (UVB) exposure, which causes oxidative stress due to increased reactive oxygen species (ROS), leading to various skin problems, including melanin accumulation. Exosomes can affect melanocyte activity. Exosomes, as small vesicles released by cells, can affect melanocyte activity and play an important role in various hyperpigmentation processes. The study aims to determine the effect of exosome mesenchymal stem cell hypoxia (EH-MSC) and glutathione with vitamin C on IL-10 levels and CD163 expression. IL-10 gene expression was measured using qRT-PCR, while CD163 expression was analyzed via immunohistochemical staining. A total of 30 male C57BL/6 mice were used and randomly assigned to five different treatment groups. The highest expression of IL-10 was observed in the EH-MSCs-treated group (K4), although the difference was not statistically significant compared to the control (p = 0.135). In contrast, the group receiving a combination of EH-MSCs with glutathione and vitamin C (K5) exhibited the highest percentage of CD163 expression, with a statistically significant difference (p = 0.00). These findings demonstrate that the administration of EH-MSC and glutathione with vitamin C significantly increased the expression of CD163, but insignificantly increased IL-10 in C57BL/6 mice with a UVB-induced hyperpigmentation model.

Sindrom Pasca-Kolesistektomi Zulkhairi; Aflah, Muhammad; Muhar, Adi Muradi
Cermin Dunia Kedokteran Vol 49 No 10 (2022): Oftalmologi
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v49i10.306

Tujuan umum tindakan kolesistektomi adalah menyembuhkan atau meringankan gejala yang mengganggu atau bahkan dapat mematikan. Namun pascakolesistektomi dapat timbul keluhan, dikenal sebagai sindrom pasca-kolesistektomi (SPK). Angka kejadian SPK pada kolesistektomi laparatomi antara 25% - 40% untuk gejala ringan hingga sekitar 10% untuk gejala berat. Keluhan SPK dapat terjadi setelah 2 hari hingga 25 tahun pasca-kolesistektomi. Keluhan umumnya berupa nyeri abdomen kuadran kanan atas, dengan atau tanpa nyeri alih, mirip nyeri sebelum kolesistektomi. Penatalaksanaan SPK terdiri dari intervensi bedah dan non-bedah, farmakoterapi, dan pengaturan nutrisi. The general goal of cholecystectomy is to cure or relieve the disturbing symptoms or even lethal. However, the procedure may be complicated by postcholecystectomy syndrome (PCS). The incidence of PCS in laparoscopic cholecystectomy varies from 25% to 40% for mild symptoms to about 10% for severe symptoms. PCS can occur in 2 days to 25 years after cholecystectomy. Most patients present with right upper quadrant abdominal pain, with or without referred pain, similar to the pain experienced before cholecystectomy. The management of PCS consists of surgical and non-surgical interventions, pharmacotherapy, and nutritional management.

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