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Peran β-glucan dalam diagnosis rinosinusitis kronik jamur Dhaniel Abdi Wicaksana; Rus Suheryanto; Iriana Maharani
Oto Rhino Laryngologica Indonesiana Vol 48, No 1 (2018): Volume 48, No. 1 January - June 2018
Publisher : PERHATI-KL

Latar Belakang: Rinosinusitis kronik jamur merupakan permasalahan kesehatan terutama dinegara berkembang karena prevalensinya yang semakin meningkat, sulitnya penanganan medis, sertaberdampak besar terhadap penurunan kualitas hidup. Saat ini tengah dikembangkan teknologi untukmembantu penegakan diagnosis tanpa tindakan invasif, yaitu dengan memanfaatkan β-glucan sebagaikomponen terbesar penyusun dinding sel beberapa spesies jamur. Tujuan: Mengetahui hubungan antarakadar β-glucan jaringan sinus dan serum darah untuk diagnosis rinosinusitis kronik jamur. Metode:Penelitian cross sectional ini melibatkan 20 subjek penelitian. Dilakukan pengambilan sampel darah, danpembedahan sinus maksila untuk mengambil jaringan mukosa, yang kemudian dilanjutkan pemeriksaanpolymerase chain reaction (PCR) untuk identifikasi jamur pada mukosa sinus. Bila didapatkan spesiesjamur yang memiliki β-glucan, dilakukan pemeriksaan enzyme-linked immunosorbent assay (ELISA) untukpengukuran kadar β-glucan. Hasil: Aspergillus flavus merupakan jamur yang paling banyak ditemukan.Seluruh subjek melampaui batasan positif β-glucan (≥80 pg/mL) dari spesimen mukosa, dan hanya 1subjek memberikan hasil intermediate (60-79 pg/mL) dari darah. Uji t berpasangan mendapatkan kadarβ-glucan darah tidak berbeda bermakna dengan mukosa sinus (p=0,886), sehingga pemeriksaan β-glucanpada darah dapat menggambarkan kadar β-glucan pada sinus paranasal. Kesimpulan: β-glucan dapatdimanfaatkan untuk membantu memperoleh diagnosis rinosinusitis kronik jamur, sehingga diharapkandiagnosis dapat ditegakkan dengan cepat dan tepat tanpa memerlukan tindakan invasif, namun hasil inimembutuhkan penelitian lebih lanjut, khususnya terkait uji diagnostik. ABSTRACTBackground: Chronic fungal rhinosinusitis is a major health problem particularly in developingcountries due to its increasing prevalence, difficult medical treatment, and also could make a large impacton the quality of life. The current technology to establish diagnosis without invasive procedure is byutilizing β-glucan, the largest component of fungal cell wall in some fungal species. Purpose: To discoverthe correlation of β-glucan level in paranasal sinus tissue and blood serum as a potential diagnosismarker for chronic fungal rhinosinusitis. Methods: A cross sectional study involving 20 subjects. Bloodsampling and maxillary sinus surgery were performed, then fungi identification in the sinus mucosawas done by Polymerase Chain Reaction (PCR). If a fungal species with β-glucan was found, then theexamination was continued with the measurement of β-glucan by Enzyme-Linked Immuno Sorbent Assay(ELISA) technique in sinus and blood. Results: Aspergillus flavus is the most commonly found fungus. Allsubjects passed the positive β-glucan limit (≥80 pg/mL) of the mucosal sample, and only 1 subject hadintermediate results (60-79 pg/mL) from the blood. Paired t-test result showed no significant differencebetween the level of β-glucan in blood and mucosal sinus (p=0.886), so that β-glucan blood examinationcould illustrate β-glucan levels in paranasal sinuses. Conclusion: β-glucan may be used to establishthe diagnosis of fungal chronic rhinosinusitis with one hope that the diagnosis process can be obtainedquickly and accurately without invasive procedure, although it still requires more studies, particularlyrelated to diagnostic test.

Hubungan respons terapi dengan kualitas hidup penderita karsinoma nasofaring WHO tipe III setelah terapi Deviana Deviana; Pudji Rahaju; Iriana Maharani
Oto Rhino Laryngologica Indonesiana Vol 46, No 2 (2016): Volume 46, No. 2 July - December 2016
Publisher : PERHATI-KL

Latar belakang: Hasil terapi penderita kanker umumnya dinilai dari angka kelangsungan hidup dan angka kontrol penyakit secara lokal/regional. Penilaian ini dilakukan oleh dokter dan tidak menunjukkan bagaimana kepuasan penderita terhadap hasil terapi. Di Indonesia, karsinoma nasofaring (KNF) menempati peringkat keempat keganasan tertinggi, dengan tipe terbanyak adalah KNF WHO tipe III. Penilaian kualitas hidup penting dilakukan karena penyakit dan terapi KNF dapat mempengaruhi beberapa fungsi penting kehidupan (makan, komunikasi, dan hubungan sosial). Belum pernah dilaporkan penelitian mengenai kualitas hidup penderita KNF setelah terapi di Indonesia. Tujuan: Mengetahui hubungan antara respons terapi dengan kualitas hidup penderita KNF WHO tipe III setelah radioterapi atau kemoradioterapi. Metode: Penelitian observasional analitik dengan pendekatan cross-sectional. Dinilai respons terapi dan kualitas hidup 8 subyek dari kelompok radioterapi, dan 8 subyek dari kelompok kemoradioterapi, dengan waktu evaluasi minimal 3 bulan setelah terapi. Penilaian respons terapi berdasarkan hasil pemeriksaan terakhir: biopsi nasofaring, foto Rontgen toraks, ultrasonografi abdomen,biopsi aspirasi jarum halus kelenjar getah bening leher (jika ada indikasi), dan foto Rontgen torakolumbal (jika ada indikasi). Penilaian kualitas hidup menggunakan kuesioner EORTC QLQ-C30 dan EORTC QLQ-H&N35. Hasil: Tidak didapati perbedaan respons terapi antara kelompok radioterapi dan kemoradioterapi. Seluruh subyek memiliki respons terapi positif (tidak didapati tumor menetap, kambuh secara lokal dan regional, dan metastasis jauh). Penderita dengan respons terapi positif memiliki kualitas hidup tinggi. Uji perbedaan kualitas hidup menunjukkan perbedaan bermakna hanya dalam hal fungsi emosi (p=0,031). Kesimpulan: Penderita KNF WHO tipe III dengan respons terapi positif memiliki kualitas hidup tinggi. Tidak didapati perbedaan respons terapi antara kelompok radioterapi dengan kemoradioterapi. Penderita yang mendapatkan kemoradioterapi memiliki kualitas hidup lebih tinggi dalam hal fungsi emosi.Kata kunci: Karsinoma nasofaring, radioterapi, kemoradioterapi, respons terapi, kualitas hidupABSTRACT Introduction: The endpoint of medical care for cancer patients usually focused on the survival rate and locoregional control rate. These endpoints were assessed by doctor and not the patient’s satisfaction rate to treatment outcome. In Indonesia, nasopharyngeal carcinoma (NPC) is the fourth most common cancer, especially NPC type III WHO. Assessment of quality of life is important because both the disease and the therapy of NPC could affect several important functions in life (eating, communication, and social relationships). There was no study reported about quality of life of NPC patients after therapy in Indonesia. Purpose: To assess the relationship between treatment response and quality of life of NPC WHO type III patients after radiotherapy or chemoradiotherapy. Method: Analytic observational study with cross-sectional design assessed treatment response and quality of life in 8 subjects of radiotherapy group and 8 subjects of chemoradiotherapy group with minimal evaluation time 3 months after therapy. Treatment response was assessed by the latest examination result of nasopharyngeal biopsy, thorax plain photo, abdomen ultrasonography, fine needle aspiration biopsy of neck mass (if indicated), and thoracolumbal plain photo (if indicated). Quality of life was assessed by EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaire. Result: There was no treatment response difference between radiotherapy and chemoradiotherapy group. All subjects had positive treatment response (no cancer remained, no locoregional recurrence, and no distant metastasis). Subjects with positive treatment response had high quality of life. Statistical analysis on the quality of life only showed a marked difference in emotional function (p=0.031). Conclusion: NPC WHO type III patients with positive treatment response had high quality of life. There was no treatment response difference between radiotherapy and chemoradiotherapy subjects. Patients treated with chemoradiotherapy had a better quality of life in emotional function.Keywords: Nasopharyngeal carcinoma, radiotherapy, chemoradiotherapy, treatment response, quality of life

Korelasi IgE terhadap rasio neutrofil/eosinofil jaringan dan darah penderita rinosinusitis kronik Aspergillus fumigatus Fifin Pradina Duhitatrissari; Endang Retnoningsih; Iriana Maharani
Oto Rhino Laryngologica Indonesiana Vol 48, No 1 (2018): Volume 48, No. 1 January - June 2018
Publisher : PERHATI-KL

Latar Belakang: Prevalensi rinosinusitis kronik (RSK) jamur saat ini cenderung meningkat. Jamurberperan sebagai mikroorganisme dan merupakan salah satu penyebab RSK. Pemeriksaan immunoglobulinE (IgE) Aspergillus fumigatus (Af) digunakan untuk menegakkan diagnosis rinosinusitis jamur tanpa harusmelalui tindakan invasif. Perubahan rasio neutrofil/eosinofil (RNE) digunakan untuk memahami responinflamasinya. Tujuan: Mengetahui korelasi antara kadar IgE Af terhadap perubahan RNE mukosa dandarah pada penderita RSK jamur. Metode: Penelitian cross sectional, melibatkan 13 subjek penelitiandengan pengambilan darah dan mukosa sinus maksila untuk diidentifikasi Af dengan Polymerase ChainReaction (PCR), dilanjutkan ELISA untuk mengukur kadar IgE Af serta flowcytometry untuk mengukurkadar neutrofil dan eosinofil mukosa sinus maksila dan darah. Hasil: Rerata IgE Af mukosa 1,112±0,883kU/mL, darah 1,041±0,876 kU/mL (N<0,35 kU/L). Dengan uji T berpasangan didapatkan kesesuaian antarakadar IgE Af darah dan mukosa (p=0,852). Rerata eosinofil mukosa 3,9±1,92% (N:0,3-0,7%) dan darah4,88±2,02% (N:3-9%). Rerata neutrofil mukosa 4,28±2,04 (N:1,1-1,7%) dan darah 49,41±13,98% (N:55,8-59,6%). Rerata RNE mukosa 1,77±2,28 (N:2,8). Rerata RNE darah 12,12 ± 6,25 (N:9,6). Didapatkan93,3% mukosa subjek penelitian mengalami inflamasi eosinofilik, 53,3% mengalami inflamasi eosinofilikpada darah. Dengan uji T berpasangan terdapat ketidaksesuaian RNE mukosa dengan darah (p:0,000).Tes korelasi Pearson antara IgE Af dengan RNE mukosa, tidak terdapat korelasi bermakna (p:0,523) danantara IgE Af dengan RNE darah, tidak terdapat korelasi bermakna (p:0,607). Kesimpulan: Terdapatkesesuaian antara kadar IgE Af mukosa dan darah, tetapi tidak terdapat kesesuaian antara RNE mukosadan darah. Tidak terdapat korelasi antara peningkatan kadar IgE Af dengan RNE pada mukosa dan darah. ABSTRACTBackground: The prevalence of chronic fungal rhinosinusitis (CFR) nowadays tends to increase.Fungi act as microorganisms and is one of the causes of chronic rhinosinusitis. The examination ofimmunoglobulin E (IgE) Aspergillus fumigatus (Af) is applied to establish the diagnosis of CFR withouthaving to do invasive actions. Neutrophil/eosinophil ratio (NER) changes are used to understand theinflammatory response. Purpose: To determine the correlation between IgE Af levels on changes ofmucosal and blood NER in CFR patients. Method: A cross-sectional study, involving 13 subjects bytaking sample of the blood and maxillary sinus mucosa to identify Af with Polymerase Chain Reaction(PCR), followed by ELISA to measure the levels of IgE Af, and flowcytometry to measure the levels ofneutrophils and eosinophils of the blood and mucosa of maxillary sinuses. Results: The mean IgE ofmucosa: 1.112±0.883kU/mL, and of blood: 1.041± 0.876kU/mL (N<0.35kU/L). With paired T-test,there was a match between blood and mucosal IgE level (p=0.852). The mean eosinophil of mucosa:3.9±1.92%,(N:0.3-0.7%) and of blood 4.88±2.02% (N:3-9%). The mean neutrophil of mucosa:4.28±2.04%(N:1.1-1.7%) and of blood 49.41± 13.98%(N:55.8-59.6%). The mean NER of mucosa:1.77±2.28(N:2.8), and of blood: 12.12±6.25(N:9.6). It was revealed that 93.3% of mucosal subjects hadeosinophilic inflammation, 53.3% had eosinophilic inflammation in blood. With paired T-test there wasa mucosal NER mismatch with blood (p:0.000). The Pearson correlation-test between IgE Af and NERmucosa had no significant correlation (p:0.523), and between IgE Af with NER of blood there was no significant correlation (p:0.607). Conclusion: There was a correspondence between IgE Af of mucosaand blood levels, but there was no match between the mucosal and blood NERs. There was no correlationbetween elevated levels of IgE Af and NER in the mucosa and blood.

Pansinusitis kronis dengan komplikasi abses serebri dan selulitis preseptal: laporan kasus Iriana Maharani; David Santoso
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Background: Rhinosinusitis is an inflammation of the sinuses of the paranasal mucosa, while pansinusitis is an inflammatory process in several sinuses. Rhinosinusitis is one of the most prevalent health problems in the world. Although rare, rhinosinusitis can also lead to serious complications, including intracranial complications such as a cerebral abscess. This case report attempts to evaluate a cerebral abscess and preseptal cellulitis caused by chronic pansinusitis.Case Presentation: A 56 years old woman, after trepanation, was consulted by the neurosurgery department to the ear, nose, throat, head, and neck department at dr. Saiful Anwar Hospital. Patients with complaints of decreased consciousness. A gradual decrease in consciousness was felt 3 weeks before admission to the hospital (SMRS). CT scan showed a cerebral abscess with a single lesion located in the frontal (unilocular) lobe as a complication of chronic pansinusitis. In this case, there was also preseptal cellulitis due to the spread of infection from the ethmoid sinus to the orbit. Treatment with ceftriaxone, metronidazole, omeprazole, ketorolac, Levemir, Apidra, Levocin, and anterior ethmoidectomy showed clinical improvement.Conclusion: Cerebral abscess is a rare complication of chronic pansinusitis but has a high morbidity and mortality rate. Medical intervention and anterior ethmoidectomy showed clinical improvement in patients. Latar Belakang: Rinosinusitis adalah peradangan sinus mukosa paranasal sedangkan pansinusitis merupakan proses inflamasi pada beberapa sinus. Rinosinusitis adalah salah satu masalah kesehatan yang memiliki prevalensi besar di dunia. Meskipun jarang terjadi, rinosinusitis juga dapat mengakibatkan komplikasi serius termasuk komplikasi intrakranial seperti abses serebri. Laporan kasus ini berupaya untuk mengevaluasi abses serebri dan selulitis preseptal yang disebabkan oleh pansinusitis kronis.Presentasi Kasus: Seorang wanita berusia 56 tahun pasca trepanasi dikonsultasikan oleh departemen bedah saraf ke departemen telinga hidung tenggorok kepala leher (THT-KL) RSUD dr. Saiful Anwar Pasien dengan keluhan terjadi penurunan kesadaran. Penurunan kesadaran secara gradual dirasakan semenjak 3 minggu sebelum masuk rumah sakit (SMRS). Pemeriksaan CT-Scan menunjukkan keberadaan abses serebri dengan lesi tunggal yang terletak pada lobus frontalis (unilokuler) sebagai komplikasi pansinusitis kronis. Pada kasus ini juga didapatkan selulitis preseptal akibat penyebaran infeksi dari sinus ethmoidalis ke orbita. Pengobatan dengan pemberian ceftriaxone, metronidazole, omeprazole, ketorolac, Levemir, Apidra, Levocin, dan etmoidektomi anterior menunjukkan perbaikan klinis.Kesimpulan: Abses serebri adalah komplikasi yang jarang pada pansinusitis kronis tetapi memiliki angka morbiditas dan mortalitas yang tinggi. Intervensi medikamentosa dan etmoidektomi anterior menunjukkan perbaikan klinis pada pasien.

Pengaruh mometasone furoate terhadap kadar Interleukin 6 serum padapenderita hipertrofi adenoid Rus Suheryanto; Surya Parlaungan Harahap; Iriana Maharani
Oto Rhino Laryngologica Indonesiana Vol. 49 (2019): Volume 49, No. 2 July - December 2019
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v49i20.314

Latar belakang: Inflamasi adenoid ditandai dengan ditemukannya pembesaran ukuran adenoid atau hipertrofi adenoid. Telah banyak dilakukan penelitian yang mendukung IL-6 merupakan dasar patofisiologi terjadinya hipertrofi adenoid sehingga dibutuhkan terapi yang dapat mengurangi peran IL-6. Saat ini, kortikosteroid intranasal menjadi pilihan terapi pada hipertrofi adenoid karena memiliki efek anti inflamasi. Terdapat penelitian mengenai manfaat penggunaan kortikosteroid intranasal terhadap penderita hipertrofi adenoid, dimana terjadi penurunan kadar IL-6, tetapi pengaruhnya terhadap kadar IL-6 serum tidak diteliti. Tujuan: Mengetahui pengaruh pemberian mometasone furoate semprot hidung terhadap kadar IL-6 serum pada penderita hipertrofi adenoid. Metode: One group pre and post test design ini melibatkan 16 subjek. Dilakukan pemeriksaan foto polos skull lateral soft tissue dan pengambilan darah tepi untuk menghitung kadar IL-6 serum. Diberikan terapi mometasone furoatesemprot hidung selama 6 minggu. Setelah 2 minggu dan 6 minggu dilakukan pengambilan darah tepi untuk menghitung kadar IL-6 serum, serta evaluasi foto polos skull lateral soft tissue setelah 6 minggu. Hasil:Terdapat perbedaan bermakna antara kadar IL-6 serum sebelum dan sesudah perlakuan baik, pada minggu kedua maupun minggu keenam (p=0.00). Terdapat perbedaan bermakna antara nilai foto polos skull lateral soft tissue sebelum dan sesudah perlakuan (p=0.00). Berdasarkan uji Pearson, nilai kadar IL-6 serum darah berkorelasi secara signifikan yang bersifat negatif (p<0,05) dengan foto polos skull lateral sebelum dan sesudah perlakuan dengan hasil -0,819 dan -0,692. Kesimpulan: Mometasone furoatesemprot hidung dapat menurunkan kadar IL-6 serum pada penderita hipertrofi adenoid secara bermakna, disertai dengan mengecilnya ukuran adenoid, penurunan gejala dan keluhan penderita hipertrofi adenoid. Kata kunci: Hipertrofi adenoid, Interleukin 6, Mometasone FuroateABSTRACT Background:Adenoid inflammation is characterized by adenoid hypertrophy (AH). Numerous studies had stated that Interleukin 6 (IL-6) is the pathophysiological basis for the occurrence of AH, thus, a therapy is needed to reduce the role of IL-6. Intranasal corticosteroid (IC) is the drug-of-choice for AH for its anti-inflammatory nature. Previous research had shown a decrease in IL-6 levels in adenoid tissue after IC administration, but its effect on IL-6 serum level had not yet been studied. Purpose: To find out the effect of Mometasone Furoate (MF) on IL-6 serum level in AH patients. Methods: One group pre and post test design, involving 16 subjects, underwent a soft tissue skull lateral plain x-ray, also a peripheral blood examination for IL-6 serum level. Afterwards, subjects were treated with MF nasal spray for 6 weeks. The IL-6 serum level was evaluated after 2 and 6 weeks, and the soft tissue x- ray was assessed after 6 weeks. Results: There were significant differences between IL-6 serum levels before and after treatment both in the second and sixth week (p = 0.00). There were significant differences between the value of soft tissue skull lateral plain x-ray before and after treatment (p = 0.00). Based on the Pearson test, IL-6 serum levels correlated significantly negatively (p <0.05) with soft tissue skull lateral plain x-ray before and after treatment with results -0.819 and -0.692. Conclusion: MF nasal spray significantly reduce IL-6 serum levels in AH patients, reducing adenoid size and decreasing symptoms of AH patients.

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