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All Journal CRJIM (Clinical and Research Journal in Internal Medicine) Jurnal Klinik dan Riset Kesehatan
Rakhman, Muhammad Farid
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Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health Other

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Pendekatan Diagnosa dan Tatalaksana Terkini Orbitopati Grave Ujianto, Michelle; Sari, Felita; Rakhman, Muhammad Farid
Jurnal Klinik dan Riset Kesehatan Vol 3 No 2 (2024): Edisi Februari
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.03.2.4

Abstract

Orbitopati Graves (Graves’ orbitopathy, GO), disebut juga thyroid eye disease atau thyroid-associated orbitopathy suatu kondisi terjadinya inflamasi, hipertrofi otot ocular, adipogenesis, dan edema (akibat akumulasi glikosaminoglikan), yang menyebabkan remodelling, ekspansi jaringan, dan/atau fibrosis jaringan fibroadiposa maupun otot ekstraokular di orbit, yang terjadi sebagai manifestasi ekstra tiroid dari penyakit tiroid autoimun, baik grave disease (GD) maupun tiroiditis Hashimoto. Dasar patofisiologi GO, adalah infiltrasi sel B, sel T dan fibroblas CD34+ pada orbita. Sel B menghasilkan IGF (insulin-like growth factor), dimana IGF dan TRab (Thyroid-Receptor antibodies) masing-masing merangsang kompleks reseptor IGF (insulin-like growth factor) dan reseptor tirotropin pada permukaan membran sel CD34+, yang menyebabkan perluasan jaringan orbital, penonjolan orbital, dan kompresi saraf optik dan mendorong bola mata sehingga terjadi eksoftalmus. Perjalanan penyakit alami GO terdiri atas fase aktif (dimana terjadi inflamasi dengan manifestasi yang tampak jelas), diikuti fase plateau (manifestasi GO menjadi stabil) dan perlahan-lahan meninggalkan tanda dan gejala sisa yang khas (fase tidak aktif); keseluruhan proses tersebut diyakini berlangsung 18-24 bulan pada pasien yang tidak diobati. Manifestasi penyakit GO ini sangat dipengaruhi pada fase apa penyakit tersebut saat ditemukan. Tujuan terapi GO adalah memperpendek fase aktif penyakit dan mengurangi manifestasi mata sisa pada fase inaktif, Secara garis besar, penanganannya terbagi atas penanganan umum dan penanganan sesuai derajat penyakit. Pengobatan GO seringkali belum memberikan hasil yang memuaskan dan terkadang diperlukan pembedahan untuk mengatasi manifestasi klinis sisa. Tinjauan ini dibuat untuk memberikan gambaran terbaru mengenai patogenesis, dan pengobatan GO, diharapkan dapat meningkatkan kualitas penanganan GO dan memberikan hasil yang lebih baik
The Potency of Mesenchymal Stem Cells as Viral Oncolytic Carriers Rakhman, Muhammad Farid
Clinical and Research Journal in Internal Medicine Vol. 5 No. 2 (2024): Volume 5 No 2, November 2024
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2024.005.02.10

Abstract

Oncolytic viruses (OVs) represent a category of viruses that selectively replicate within tumor cells, destroying cancer cells through a dual mechanism involving viral oncolysis and the stimulation of the host's anti-tumor immune response. This selectivity ensures the virus targets and eliminates cancer cells while sparing healthy cells. Oncolytic virus immunotherapy refers to treatments utilizing either native or genetically modified OVs designed to replicate within tumor cells selectively. Mesenchymal Stem Cells (MSCs) have demonstrated potential in facilitating the safe transportation and targeted release of oncolytic viruses at the tumor site due to their inherent tumor-specific homing capability. Utilizing MSCs as carriers for oncolytic viruses can enhance the delivery of these therapeutic agents to the tumor site, eliminating the need for direct tumor injection and reducing the associated side effects.
Pendekatan Diagnosa dan Tatalaksana Terkini Orbitopati Grave Ujianto, Michelle; Sari, Felita; Rakhman, Muhammad Farid
Jurnal Klinik dan Riset Kesehatan Vol 3 No 2 (2024): Edisi Februari
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.03.2.4

Abstract

Graves' Orbitopathy (GO), also known as thyroid eye disease or thyroid-associated orbitopathy is characterized by inflammation, ocular muscle hypertrophy, adipogenesis, and oedema (due to glycosaminoglycan accumulation). This condition leads to remodeling, tissue expansion, and/or fibrosis within the fibroadipose tissue or extraocular muscles of the orbit. GO manifests as an extrathyroidal aspect of autoimmune thyroid diseases in both Grave's disease (GD) and Hashimoto's thyroiditis. The pathophysiological foundation of GO entails the infiltration of B cells, T cells, and CD34+ fibroblasts in the orbit. B cells generate IGF (insulin-like growth factor), wherein IGF and TRab (Thyroid-Receptor antibodies) stimulate the IGF receptor complex and thyrotropin receptor (respectively) on the surface of CD34+ cells which triggers orbital tissue expansion, orbital protrusion, optic nerve compression, and eyeball displacement, resulting in exophthalmos. GO progress through an active phase (characterized by inflammation with visible manifestations), followed by a plateau phase (stabilization of GO manifestations), and a gradual resolution of distinctive residual signs and symptoms (inactive phase). This entire process spans between 18-24 months in untreated patients, where disease manifestations significantly depend on the phase during which the disease is identified. GO therapy is intended to shorten the active phase and supress its residual eye manifestations during the inactive phase. In general, GO therapy is categorized into general and disease severity-specific approaches. GO therapy often falls short of providing satisfactory results, prompting need of surgery to address lingering clinical manifestations. This review presents the latest insights into the pathogenesis and treatment of GO for better management and outcomes.
The Efficacy of Oral Cannabinoids for Neuropathy: A Systematic Review and Meta Analysis Rakhman, Muhammad Farid; Djamil, Putri Amelia; Aghna, Zhalif Zhafir
Clinical and Research Journal in Internal Medicine Vol. 7 No. 1: Volume 7 No 1, May 2026
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2026.007.01.10

Abstract

Background: Neuropathic pain remains difficult to treat despite multiple pharmacological options. Cannabinoids have been proposed as therapeutic agents, yet the efficacy of oral formulations remains uncertain. Aim: The aim of this study was to evaluate the efficacy of oral cannabinoids in reducing pain intensity among patients with peripheral neuropathic pain through a systematic review and meta-analysis. Methods: This study employed systematic review and meta-analysis designed in accordance with PRISMA 2020 reporting guidelines. PubMed, ScienceDirect, Scopus, and IEEE Xplore were searched through January 2026. Randomized controlled trials evaluating oral cannabinoids for peripheral neuropathic pain were included. Pain intensity was standardized to a 0-10 scale and pooled using mean differences. Results: Four randomized controlled trials comprising 174 participants met inclusion criteria. Individual studies reported variable analgesic effects. Pooled analysis demonstrated no statistically significant reduction in pain intensity compared with placebo (Mean difference -057; 95% CI -1.26 to 0.12) Moderate heterogeneity was observed (I2= 74.4%). Conclusion: Current evidence does not support oral cannabinoids as first line therapy for peripheral neuropathic pain. Larger, methodologically rigorous trials are required to clarify their clinical role.
Co-Authors Aghna, Zhalif Zhafir Djamil, Putri Amelia Sari, Felita Ujianto, Michelle