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Majalah Kedokteran Bandung
Published by Universitas Padjadjaran
ISSN : 0126074X     EISSN : 23386223     DOI : 10.15395/mkb
Core Subject : Health,
Medicine & Pharmacology
Majalah Kedokteran Bandung (MKB)/Bandung Medical Journal publishes peer-reviewed original articles and case reports in basic medical research, clinical research, and applied medical science. This journal is published quarterly (March, June, September, and December) by Faculty of Medicine Universitas Padjadjaran. Articles are original research that needs to be disseminated and written in English. All submitted manuscripts will go through the double-blind peer review and editorial review before being granted with acceptance for publication.
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Loop-Mediated Isothermal Amplification untuk Mendeteksi Gen blaTEM sebagai Penyandi Extended-Spectrum Beta-Lactamase pada Isolat Enterobacteriaceae Wilopo, Bayu A. P.; Sudigdoadi, Sunarjati; Sahiratmadja, Edhyana; Dewi, Intan M. W.
Majalah Kedokteran Bandung Vol 47, No 4 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Extended-spectrum beta-lactamase (ESBL) adalah suatu jenis enzim beta-laktamase yang mampu menghidrolisis penisilin, sefalosprin, dan monobaktam yang dapat dihambat oleh asam klavulanat. Enzim ini disandi oleh banyak gen, salah satunya adalah blaTEM. Untuk  mengamplifikasi gen blaTEM  selain digunakan metode polymerase chain reaction (PCR) dapat pula dilakukan metode loop-mediated isothermal amplification (LAMP) yang membutuhkan peralatan lebih sederhana dengan prosedur yang cepat dan pembacaan hasil yang  lebih mudah. Penelitian ini merupakan uji diagnostik yang bertujuan menilai sensitivitas dan spesifisitas metode LAMP serta melihat kesesuaian hasil antara metode LAMP dan metode PCR dalam mendeteksi gen blaTEM. Sebanyak 92 isolat Enterobacteriaceae diperiksa dengan metode PCR yang kemudian dibandingkan dengan metode LAMP. Didapatkan bahwa metode LAMP memiliki sensitivitas 91,4% dan spesifisitas 91,2%, serta nilai kesesuaian (kappa) sebesar 85,4%. Sebagai simpulan, metode LAMP memiliki validitas yang baik dan kesesuaian yang sangat baik dibanding dengan metode PCR. Oleh karena itu, metode LAMP dapat dijadikan pemeriksaan alternatif dalam mendeteksi gen blaTEM terutama di daerah dengan infrastruktur laboratorium terbatas.Kata kunci:  blaTEM, Enterobacteriaceae, ESBL, LAMP, PCR  Loop-Mediated Isothermal Amplification for Detecting blaTEM Gene that Encodes Extended-Spectrum Beta-Lactamase in Enterobacteriaceae IsolatesAbstractExtended-spectrum beta-lactamase (ESBL) is a beta-lactamase enzyme that is capable of hydrolyzing penicillin, cephalosporin, and monobactam, and can be inhibited by clavulanic acid. This enzyme is encoded by multiple genes, one of them is blaTEM. Polymerase chain reaction (PCR) is one of the DNA amplification methods that are frequently used; however, there are other methods that can be used including, among others, loop-mediated isothermal amplification (LAMP). LAMP requires simple equipment with quicker and easy-to-read results compared to PCR. This study was a diagnostic test to explore the sensitivity and specificity of LAMP method compared to PCR in detecting blaTEM gene. Furthermore, the concordance between LAMP and PCR methods was assessed. A total of 92 Enterobacteriaceae isolates were examined by PCR and LAMP methods and compared. The result showed that the LAMP method had a sensitivity of 91.4% and a specificity of 91.2% with a concordance value (kappa) of 85.4%. In conclusion, LAMP method has a good validity and a very good conformity compared to the PCR method. Therefore, LAMP method can be used as an alternative diagnostic test, especially in limited settings. [MKB. 2015;47(4):242–9]Key words: blaTEM, Enterobacteriaceae, ESBL, LAMP, PCR DOI: 10.15395/mkb.v47n4.618
PERBANDINGAN KERAPATAN KOLAGEN LIGAMENTUM SAKROUTERINA PADA PASIEN DENGAN DAN TANPA PROLAPS UTERI Silitonga, Intan Renata; Sukarsa, M. Rizkar A.; Pohan, Lasma R.; Armawan, Edwin; Handono, Budi
Majalah Kedokteran Bandung Vol 47, No 4 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Kerapatan kolagen merupakan satu faktor penting dalam kejadian prolaps uteri. Beberapa penelitian menunjukkan pasien prolaps uteri mempunyai kerapatan kolagen ligamentum sakrouterina yang rendah. Penelitian ini bertujuan mengukur perbedaan kerapatan kolagen ligamentum sakrouterina pada pasien dengan dan tanpa prolaps uteri. Penelitian ini adalah penelitian analitik komparatif dengan case control study terhadap 16 pasien prolaps uteri dan 16 pasien tanpa prolaps uteri di Rumah Sakit Dr. Hasan Sadikin Bandung dan RS jejaring. Bahan penelitian diambil dari ligamentum sakrouterina saat operasi histerektomi lalu dibuat sediaan dengan pewarnaan hematoksilin-eosin dan Masson?s trichrome. Uji kemaknaan menggunakan uji Mann-Whitney. Hasil penelitian didapatkan hubungan bermakna antara kerapatan kolagen dan kejadian prolaps uteri, yaitu kerapatan kolagen pada pasien prolaps uteri lebih rendah (15,3%) dibanding dengan tanpa prolaps uteri (48,75%). Cut-off point kerapatan kolagen ligamentum sakrouterina untuk prediksi prolaps uteri adalah ? 30%; sensitivitas 93,8%; spesifisitas 87,5%; dan akurasi 90,6%. Simpulan penelitian ini adalah bahwa kerapatan kolagen ligamentum sakrouterina pada pasien prolaps uteri lebih rendah dibanding dengan pasien tanpa prolaps uteri. Cut-off point kerapatan kolagen ligamentum sakrouterina yang dapat memprediksi prolaps uteri adalah ? 30%. [MKB. 2015;47(4):212?7]Kata kunci: Kerapatan kolagen, ligamentum sakrouterina, prolaps uteriThe Comparison of Uterosacral Ligament Collagen Density in Patients with and without Uterine ProlapseAbstractCollagen density is one important factor in uterine prolapse. Several studies has shown that uterine prolapse patients have lower uterosacral ligament collagen density. The purpose of this study was to reveal the uterosacral ligament collagen density differences in patients with and without uterine prolapse. This case control study was an analitic comparative research of 16 uterine prolapse patients and 16 patients without uterine prolapse who underwent hysterectomy in Dr. Hasan Sadikin General Hospital Bandung and its networking hospitals during November?December 2008. Uterosacral ligament was sampled and then stained using HE and Masson?s trichrome staining. The significance of the result was analyzed using Mann-Whitney. The study found a significant correlation between collagen density and uterine prolapse, with the collagen density of uterine prolapse patients was lower (15.3%) than patients without uterine prolapse (48.75%). The uterosacral ligament collagen density cut-off point in predicting women having uterine prolapse was ?30%; with 93.8% sensitivity, 87.5% specificity, and 90.6% accuracy. The conclusion of this study is that uterosacral ligament collagen density in patients with uterine prolapse is lower (15.3%) than patients without uterine prolapse (48.75%). The uterosacral ligament collagen density cut-off point in predicting a women having uterine prolapse is ?30%. [MKB. 2015;47(4):212?7] DOI: 10.15395/mkb.v47n4.624
PELUANG KEJADIAN OTOTOKSISITAS PADA PENGGUNAAN KANAMISIN DALAM PENGOBATAN TUBERKULOSIS RESISTEN OBAT GANDA SELAMA 1 BULAN Rakhmawati, Lussie; Agustian, Ratna Anggraeni; Wijana, -
Majalah Kedokteran Bandung Vol 47, No 4 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Obat ototoksik adalah obat yang berpotensi menimbulkan reaksi toksik pada struktur di koklea, vestibulum, kanalis semisirkularis, dan otolith. Kanamisin merupakan obat yang digunakan dalam pengobatan tuberkulosis resisten obat ganda (multidrug resistant/TB MDR) dan berpotensi ototoksik. Penelitian ini bertujuan mengetahui peluang terjadinya ototoksisitas sebagai langkah awal deteksi dini pada penggunaan kanamisin dalam pengobatan TB MDR. Penelitian ini berupa studi deskriptif yang dilakukan secara prospektif di RS Dr. Hasan Sadikin Bandung periode Januari?Juni 2014 dengan subjek adalah penderita TB MDR. Pemeriksaan awal, yaitu audiometri nada murni, timpanometri dan DPOAE dilakukan sebelum terapi, kemudian dilakukan pemeriksaan lanjutan dengan DPOAE setiap 3 hari selama 1 bulan pertama pengobatan.  Hasil penelitian menunjukkan gangguan koklea pada telinga kanan dan kiri mulai frekuensi 10.000 Hz pada hari ke-19?21, kemudian mengenai frekuensi 8.000 Hz pada hari ke-25?27. Terdapat hubungan negatif gangguan koklea akibat kanamisin dengan usia, namun tidak terdapat hubungan negatif gangguan koklea dengan jenis kelamin dan indeks masa tubuh. Simpulan, peluang kejadian ototoksik pada penderita TB MDR yang mendapat terapi kanamisin terjadi mulai pada akhir minggu kedua serta mengenai frekuensi tinggi terlebih dahulu serta berlanjut ke frekuensi yang lebih rendah. MKB. 2015;47(4):224?30]Kata kunci: Deteksi dini, kanamisin, ototoksik, TB MDRProbability of Kanamycin Ototoxicity in Multidrug Resistant Tuberculosis Patient during First Month TreatmentAbstractOtotoxic drugs are medicines that cause toxic reactions to structures in the cochlea, vestibule, semicircular canal, and otolith. Kanamycin is a drug used in the treatment of Multidrug Resistant Tuberculosis (MDR TB) and potentially ototoxic. This study aimed to determine the possibility of kanamycin ototoxicity as an initial step of early detection in MDR TB treatment . This study was a descriptive study conducted prospectively and performed in dr. Hasan Sadikin General Hospital Bandung during the period of January?June 2014. The study involved MDR TB patients. Preliminary examinations were performed using pure tone audiometry, tympanometry and DPOAE, which was then followed by further investigations using DPOAE examination every 3 days during the first month of treatment. The results showed cochlear disorders on the right and left ear started to 10,000 Hz frequency on days 19?21, then the frequency of 8,000 Hz on days 25?27. There was a negative relationship between cochlear disorders due to use of kanamycin with age, and no correlation between cochlear disorders with gender and body mass index. In conclusion, possibility of kanamycin ototoxicity in patients with MDR TB begins at the end of the second week, first on high frequency and continues to lower frequency. [MKB. 2015;47(4):224?30]Key words: Early detection, MDR TB, kanamycin, ototoxic DOI: 10.15395/mkb.v47n4.619
HUBUNGAN ANTARA INDEKS MASSA TUBUH DENGAN JUMLAH CD4 PADA PENDERITA HIV YANG MENDAPAT PENGOBATAN ARV Miftahrachman, -; Wicaksana, Rudi
Majalah Kedokteran Bandung Vol 47, No 4 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Efek merugikan obesitas pada populasi umum dalam hubungannya dengan mortalitas dan morbiditas untuk terjadi penyakit kardiovaskular telah diketahui dengan baik, namun pada penderita HIV hubungan berat badan dengan morbiditas dan mortalitas penyakit tersebut masih perlu dikaji lebih lanjut. Penelitian ini bertujuan mencari hubungan antara IMT dan CD4. Uji potong lintang dengan pendekatan deskriptif analitik dari data sekunder rekam medik penderita HIV yang berobat ke poliklinik Teratai RSUP Dr. Hasan Sadikin Bandung pada tahun 2007?2011. Variabel yang diteliti adalah IMT dan jumlah CD4 (p=0,0001) dengan uji korelasi Spearman dan uji Kruskal Wallis. Dari 936 penderita HIV rata-rata IMT 19,4 dan jumlah CD4 rata-rata 151 sel/mm3 . Terdapat hubungan positif antara IMT dengan nilai CD4, dengan kekuatan hubungan kategori sedang (r=0,409). Dengan mengkategorikan IMT, didapatkan perbedaan rata-rata CD4 antara keempat kategori IMT tersebut (p=0,0001), nilai CD4 rata-rata dan rentangnya dari yang terendah sampai yang tertinggi berturut-turut: underweight: 75 (1?1.329), normoweight: 229 (4?1.047), overweight: 259 (2?1.275), obese: 447 (71?654). Peningkatan IMT berhubungan dengan peningkatan jumlah CD4, menggambarkan penurunan morbiditas, mortalitas serta risiko progresivitas HIV. [MKB. 2015;47(4):237?41] Kata kunci: CD4, HIV, indeks massa tubuh (IMT)Correlation between Body Mass Index and CD4 Level in HIV Patients with Antiretroviral TherapyThe adverse consequence of overweight and obese condition in major population related to it?s mortality and morbidity of specific diseases like coronary heart disease has been well known. However, in immunocompromised patients, in the context of body weight with it?s morbidity and mortality needs further examination. The objective of this research was to find out the relationship between BMI and CD4 level, which describes disease progressivity from HIV patients whom already had antiretroviral (ARV) therapy. We conducted cross sectional method with descriptive analytic from secondary data of medical records from HIV patients who came to Teratai Polyclinic of Hasan Sadikin General Hospital Bandung from 2007 to 2011. From 936 HIV patients analyzed, median BMI was 19,4 with range between 12.1?36.2 kg/m2, median CD4 was 151 cells/mm3 with range between 1?1,329. The r value was 0.409, suggested positive correlation significance between BMI and CD4 value, CD4 value increased parallel with the increasing of BMI, with intermediate p value (p=0.0001). Since we categorized BMI, the median of CD4 between all categories (p=0.0001), range from the smallest to the highest was underweight:75 (1?1,329), normoweight: 229 (4?1,047), overweight: 259 (2?1,275), obese: 447 (71?654) cells/mm3, respectively. As conclusion, increasing of BMI related to enhancement of CD4 level, suggests reduction of HIV morbidity and mortality. [MKB. 2015;47(4):237?41]Key words: Body mass index (BMI), CD4, HIV DOI: 10.15395/mkb.v47n4.623
PERBEDAAN β-CROSSLAPS SERUM PENDERITA KARSINOMA PAYUDARA PASCAMENOPAUSE ANTARA YANG DIBERIKAN ANASTROZOL DAN TAMOKSIFEN Sebastian, Randy; Abdurahman, Maman; Rizki, Kiki A.
Majalah Kedokteran Bandung Vol 47, No 4 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Tamoksifen dan inhibitor aromatase sebagai terapi adjuvan memiliki peranan penting pada karsinoma payudara (KPD) pascamenopause dengan reseptor estrogen positif. Saat ini inhibitor aromatase dapat menggantikan tamoksifen karena memiliki keuntungan yang lebih baik dibanding dengan  tamoksifen. Inhibitor aromatase juga memiliki efek samping meningkatkan penyerapan tulang yang memicu osteoporosis dan fraktur dibanding dengan tamoksifen. Saat terjadi proses penyerapan tulang, matriks tulang yang 90% terdiri atas kolagen tipe I akan terurai sehingga salah satu hasil penguraiannya berupa ?-CrossLaps terdapat dalam darah dan dapat diukur kadarnya. Penelitian ini mengukur perbedaan kadar ?-CrossLaps serum baik pada pasien KPD pascamenopause yang diberikan anastrozol dan tamoksifen di Rumah Sakit Dr. Hasan Sadikin Bandung periode Januari?Juli 2013. Penelitian ini merupakan penelitian potong lintang. Terdapat 32 pasien, yaitu 16 pasien tiap kelompok. Hasil pengolahan data statistik dengan derajat kepercayaan 95% menunjukkan perbedaan yang bermakna kadar ?-CrossLaps serum KPD yang diberikan anastrozol dibanding dengan yang diberikan tamoksifen (p<0,05). Simpulan, kadar ?-CrossLaps rata-rata serum KPD yang diberikan anastrozol lebih tinggi dibanding dengan tamoksifen, artinya  pemberian obat anastrozol pada pasien KPD pascamenopause dalam jangka waktu >6 bulan meningkatan proses penyerapan tulang dibanding dengan yang diberikan tamoksifen. [MKB. 2015;47(4):207?11] DOI: 10.15395/mkb.v47n4.615Kata kunci: Anastrozol, ?-CrossLaps serum, tamoksifenComparison of ?-crosslaps Serum Levels between Postmenopausal Breast Carcinoma Patients Receiving Anastrozol and TamoxifenAbstractTamoxifen and inhibitor aromatases as adjuvant therapy plays an important role in postmenopausal breast cancer patients with positive estrogen receptor. Currently, inhibitor aromatases can replace tamoxifen because it has more advantages than tamoxifen. Inhibitor aromatases also have side effects which is increased bone resorption that triggers osteoporosis and fractures when compared to tamoxifen. During the process of bone resorption, bone matrix, composed of 90% type I collagen, were broken down resulting in ?-crosslaps content in the blood, which is measurable. This study measured the levels of serum ?-crosslaps in postmenopausal breast cancer patients who received anastrozol and tamoxifen in Dr. Hasan Sadikin General Hospital Bandung between January and July 2013. This was a cross-sectional study with comparative analytics to compare the mean levels of serum ?-crosslaps in postmenopausal breast cancer patients between the two groups. There were 32 patients in this study, 16 patients in each group. The results of data processing using statistical tests at 95% confidence level revealed that there was significant differences in serum levels of ?-crosslaps between the group who received anastrozol and those who received tamoxifen (p<0.05). In conclusion, the mean value of ?-crosslaps serum in anastrozol group is higher than in tamoxifen group. This means that postmenopausal breast cancer patients receiving anastrozol for more than 6 months could may experienced a higher degree of bone resorption compared to those receiving tamoxifen. [MKB. 2015;47(4):207?11]Key words: Anastrozol, serum ?-crosslaps, tamoxifen
Kadar Interleukin-18 pada Kultur Limfosit Penderita Dermatitis Atopik yang Distimulasi Staphylococcal Enterotoxin B (SEB) Suwarsa, Oki; Sudigdoadi, -; Sutedja, Endang; Idjradinata, Ponpon
Majalah Kedokteran Bandung Vol 47, No 4 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Staphylococcus aureus (S. aureus) mempunyai peranan penting pada patogenesis dermatitis atopik (DA). Peran S. aureus tersebut tidak hanya sebagai pencetus DA, tetapi juga menyebabkan inflamasi kronik. Peran tersebut berhubungan dengan dihasilkannya protein antara lain toksin poten oleh S. aureus, yaitu Staphylococcal enterotoxin B (SEB). Interleukin-18 (IL-18) merupakan regulator penting dari produksi sitokin Th-1 yaitu interferon-γ (IFN-γ).  Tujuan penelitian ini adalah mengetahui kadar IL-18 pada kultur limfosit pasien DA yang distimulus dengan SEB. Penelitian ini dilakukan pada 20 orang penderita DA (7 laki-laki dan 13 perempuan) dan 20 orang sehat (9 laki-laki dan 11 perempuan) di Rumah Sakit Dr. Hasan Sadikin Bandung, merupakan penelitian eksperimental secara in vitro pada kultur ilmfosit yang distimulus dengan SEB di Laboratorium Penelitian dan Pengujian Terpadu Universitas Gadjah Mada. Terjadi peningkatan kadar IL-18 rata-rata pada kultur limfosit antara sebelum dipapar dan setelah dipapar SEB, baik pada kelompok DA maupun kelompok kontrol. Setelah dilakukan uji statistik perbandingan antara kadar IL-18 rata-rata sebelum dan sesudah dipapar SEB antara kelompok DA dan kontrol, didapatkan hasil kadar IL-18 kelompok DA lebih tinggi bermakna dibanding  dengan kelompok kontrol (p<0,05) sehingga dapat disimpulkan kadar IL-18 meningkat tinggi pada kelompok DA yang dipapar SEB. [MKB. 2015;47(4):249–54]Kata kunci: Dermatitis atopik, interleukin-18 (IL-18), Staphylococcus enterotoxin BInterleukin-18 Levels in Lymphocytes Cultures from Atopic Dermatitis Patients Stimulated by Staphylococcal Enterotoxin BAbstractStaphylococcus aureus (S. aureus) has an important role in the pathogenesis of atopic dermatitis (AD). S. aureus acts as a triggering factor for AD and also causes chronic inflammation. These roles of S. aureus are related to various proteins such as Staphylococcal enterotoxin B (SEB) as a potent toxin. Interleukin-18 (IL-18) is an important regulator of cytokine production of Th-1, which is interferon-γ (IFN-γ). The aim of this study was to reveal the levels of IL-18 in cultured lymphocytes from AD patients exposed by SEB. This study was conducted on 20 people with DA (7 men and 13 women) and 20 healthy volunteers (9 men and 11 women) in dr. Hasan Sadikin General Hospital. The in vitro experimental study on cultured lympocytes exposed with SEB was performed at the Integrated Research and Testing Laboratory of Gadjah Mada University. The average levels of IL-18 in cultured lymphocytes before and after being exposed to SEB increased both in AD group and control group. After the statistical tests was performed on the ratio of the average levels of IL-18 before and after being exposed to SEB between AD and control groups, it was shown that the levels of IL-18 AD group was significantly higher than the control group (p <0.05). Therefore, it can be concluded that the levels of IL-18 increased higher in AD group exposed by SEB. [MKB. 2015;47(4):249–54]Key words: Atopic dermatitis , interleukin-18, Staphylococcal enterotoxin BDOI: 10.15395/mkb.v47n4.620
Perbedaan Kadar Osteoprotegerin Serum Penderita Diabetes Melitus Tipe 2 tanpa dan dengan Penyakit Jantung Koroner Nestiti, Ratri Dwitiya; Noormartany, -; Dewi, Nina Susana; Rachmayati, Sylvia
Majalah Kedokteran Bandung Vol 47, No 4 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Diabetes melitus (DM) tipe 2 merupakan diabetes yang disebabkan oleh resistensi insulin dan atau gangguan sekresi insulin sehingga menyebabkan hiperglikemia yang merupakan penyebab disfungsi endotel. Disfungsi endotel merupakan proses awal aterosklerosis dan merupakan salah satu faktor risiko yang menyebabkan penyakit jantung koroner (PJK). Sampai saat ini angiografi koroner digunakan sebagai baku emas PJK. Pemeriksaan osteoprotegerin (OPG) merupakan pemeriksaan alternatif sebagai penanda disfungsi endotel, kurang invasif, lebih dini, dan murah. Osteoprotegerin berhubungan dengan perkembangan plak arteri pada penderita DM tipe 2. Tujuan penelitian ini mengetahui perbedaan kadar OPG dalam serum penderita DM tipe 2 tanpa dan dengan PJK. Penelitian dilakukan pada September–Desember 2012 di Poliklinik Endokrin dan Instalasi Gawat Darurat RSUP Dr. Hasan Sadikin Bandung. Subjek penelitian sebanyak 102 orang, 51 orang penderita telah didiagnosis oleh klinisi sebagai penderita DM tipe 2 dengan PJK dan 51 orang penderita DM tipe 2 tanpa PJK, berusia 35–75 tahun. Pemeriksaan OPG menggunakan metode enzyme linked immunosorbent assay (ELISA). Bentuk penelitian adalah observasional komparatif dengan rancangan penelitian studi perbandingan potong lintang. Analisis statistik menggunakan uji Shapiro Wilk’s, independent T, dan Mann Whitney. Nilai median kadar OPG serum untuk penderita DM tipe 2 dengan PJK lebih tinggi, yaitu sebesar 6,1 pmol/L dan penderita DM tipe 2 tanpa PJK, yaitu sebesar 2,6 pmol/L (p=0.0001). Simpulan, terdapat perbedaan kadar OPG serum antara kelompok DM tipe 2 tanpa dan dengan PJK. [MKB. 2015;47(4):218–23]Kata kunci: Disfungsi endotel, DM tipe 2, osteoprotegerinDifferences of Osteoprotegerin Levels in Patients with Type 2 Diabetes Mellitus with and without Coronary Arterial DiseaseAbstractType 2 diabetes mellitus (DM) is caused by insulin resistance and/or impaired insulin secretion, thus causing hyperglycemia leading to endothelial dysfunction. Endothelial dysfunction is an early process of atherosclerosis and is one of the risk factors for coronary arterial disease (CAD). Currently, coronary angiography is used as the gold standard for diagnosing CAD. Examination of osteoprotegerin (OPG) is an alternative assay for endothelial dysfunction marker which is less invasive, has the ability to detect earlier, and less expensive. Osteoprotegerin is associated with the development of arterial plaque in patients with type 2 DM. The aim of this study was to determine the differences in serum OPG levels in patients with type 2 DM with and without CAD. The study was conducted in September–December 2012 in the Endocrine Clinic and Emergency Unit of Dr. Hasan Sadikin General Hospital Bandung on 102 patients aged between 35–75 years, with 51 subjects type 2 DM patients with CAD and 51 subjects with type 2 DM without CAD, both diagnosed by clinician. The method used was, OPG enzyme linked immunosorbent assay (ELISA) examination method. The study was an observational cross-sectional comparative study. Statistical analysis was performed using normality test with Shapiro Wilk’s, independent T and Mann Whitney test. The median value for patients with type 2 DM with CAD equaled to 6.1 pmol/L and the value for type 2 diabetic patients without CAD was 2.6 pmol/L. In this study, the OPG levels obtained in patients type 2 DM with CAD were higher than those without CAD. In conclusion, there is a significant difference in OPG levels between type 2 DM with and without CAD groups. [MKB. 2015;47(4):218–23]Key words: Endothelial dysfunction, type 2 diabetes, osteoprotegerin DOI: 10.15395/mkb.v47n4.616
Kloning Gen Melanoma Antigen 1 (Mage-1) dari Jaringan Testis untuk mendapatkan Plasmid Rekombinan Mage-1 Mastutik, Gondo; I’tishom, Reny; Hardjowijoto, Sunaryo; Putra, Suhartono Taat
Majalah Kedokteran Bandung Vol 47, No 4 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Gen Melanoma antigen-1 (Mage-1) diekspresikan oleh sel spermatogonia jaringan testis normal dan diekspresikan 60−80% oleh liver penderita karsinoma hepatoseluler (KH). Ekspresi Mage-1 merupakan penanda untuk diagnosis KH serta prediktor kanker lambung dan kolorektal. Isolasi messenger ribonucleid acid (mRNA) Mage-1 dari jaringan liver penderita KH sulit dilakukan sehingga dilakukan isolasi mRNA Mage-1 dari jaringan yang mengekspresikan Mage-1, yaitu jaringan testis normal. Penelitian ini merupakan penelitian eksploratif yang dilakukan di Lembaga Penyakit Tropis Universitas Airlangga, Agustus 2006–Agustus 2008. Tujuan untuk mengkloning seluruh area koding gen Mage-1 dari jaringan testis pada vektor dan mendapatkan plamid rekombinan Mage-1. Isolasi seluruh area koding gen Mage-1 dilakukan dengan teknik semi-nested polymerase chain reaction (PCR). Seluruh area koding gen Mage-1 diisolasi, kemudian dikloningkan ke plasmid pET101/D-TOPO dan ditransformasikan ke Escherichia coli (E. coli) Top10 untuk mendapatkan plasmid rekombinan Mage-1. Panjang pET101/D-TOPO adalah 5.753pb dan area koding gen penyandi Mage-1 927 bp sehingga total panjang plasmid rekombinan 6.680 bp (5.753+927). Hasil analisis restriksi dengan EcoRV menunjukkan pita 4.230 dan 2.450 (4.230+2.450 = 6.680). Analisis sekuens gen Mage-1 dari testis mempunyai homologi 100% dengan sekuens M77481 serta NM_004988, dan 99% dengan BC01755. Simpulan, berdasarkan hasil analisis restriksi dan sekuens maka diperoleh plasmid rekombinan pETGM/MAGE1-Testis yang mengandung seluruh area koding gen Mage-1 dan dapat digunakan untuk pengembangan kit diagnostik karsinoma.  [MKB. 2015;47(4):199–206]Kata kunci:  Jaringan testis, karsinoma hepatoseluler, kloning, melanoma antigen-1, pET101/D-TOPOCloning of Melanoma Antigen 1 (Mage-1) Gene from Testicular Tissue to Obtain the Recombinant Plasmid Mage-1Melanoma antigen-1 (Mage-1) is expressed by spermatogonia cells of normal testicular tissue and 60−80% is expressed by the liver of hepatocellular carcinoma (HC) patients. Mage-1 expression is a marker for diagnosing HC and predicting gastric and colorectal cancers. Isolation of messenger ribonucleid acid (mRNA) Mage-1 from the liver tissue of HC patients is difficult; therefore, Mage-1 mRNA isolates can be obtained from tissues that express Mage-1 such as normal testicular tissues . This is an explorative research that was conducted at the Institute of Tropical Diseases of Airlangga University during August 2006–August 2008. The aim was to clone the coding sequence of Mage-1 gene from testicular tissues into a vector and to get recombinant plasmid Mage-1. Isolation of the full-length Mage-1 was performed using semi-nested polymerase chain reaction (PCR) which was then cloned into plasmid pET101/D-TOPO and transformed into Escherichia coli (E. coli) Top10 to get recombinant plasmid Mage-1. The length of pET101/D-TOPO was 5,753 bp and Mage-1 was 927 bp. The length of recombinant plasmid was 6,680 bp (5,753+927). Restriction analysis using EcoRV showed 4,230 and 2,450 bp bands (4,230+2,450=6,680). Sequence analyses showed that Mage-1 was 100% homologous with M77481 and NM_004988, 99% homologous with BC01755. In conclusion, according to the results of the restriction and sequences analysis, the recombinant plasmid pETGM/MAGE1-Testis contains the full length coding region of Mage-1 and is useful for developing the hepatocellular carcinoma diagnostic kits. [MKB. 2015;47(4):199–206] DOI: 10.15395/mkb.v47n4.621
Hubungan antara Imunoekspresi Ki-67 dan Risiko Agresivitas Tumor pada Gastrointestinal Stromal Tumor Yulianti, Herry; Hernowo, Bethy S.
Majalah Kedokteran Bandung Vol 47, No 4 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Gastrointestinal stromal tumor (GIST)  merupakan tumor mesenkimal yang paling sering terjadi pada traktus gastrointestinal dan berasal dari intestinal cells of Cajal yang terdapat pada lapisan muskularis traktus gastrointestinal yang berfungsi sebagai pacemaker cell dalam mengatur motilitas intestinal. Diperkirakan insidensi GIST 3−5% dari seluruh soft tissue sarcoma. Gastrointestinal stromal tumor  dapat terjadi sepanjang traktus gastrointestinal, terbanyak pada usia pertengahan dan lebih tua, dengan usia rata-rata 50−60 tahun. Secara histologi, terdapat tiga kategori morfologi GIST, yaitu spindle cell, epitheloid, dan mixed type. Marker spesifik GIST adalah cluster of differentiation (CD117) yang mempunyai sensitivitas baik dan imunoreaktif pada 95% GIST. Ekspresi Ki-67 berhubungan dengan aktivitas proliferasi dan dapat dideteksi pada fase G1, S, G2, dan M dari siklus sel, kecuali pada fase G0. Tujuan  penelitian ini adalah mengetahui hubungan risiko agresivitas dengan aktivitas proliferasi yang diukur dengan Ki-67 pada tumor yang telah dikonfirmasi sebagai GIST dengan CD117. Penelitian ini merupakan penelitian analitik potong lintang terhadap 29 kasus GIST dari Departemen Patologi Anatomi Rumah Sakit Dr. Hasan Sadikin/Fakultas Kedokteran Universitas Padjadjaran, Rumah Sakit Santo Borromeus, Rumah Sakit Immanuel, dan Rumah Sakit Santosa Bandung pada tahun 2007−2012. Potongan blok parafin dari 55 kasus GIST diwarnai dengan hematoksilin eosin untuk evaluasi histologi dan evaluasi imunohistokimia menggunakan monoclonal CD117 antibody untuk konfirmasi diagnosis GIST. Terdapat 29 kasus  positif dengan CD117, kemudian diwarnai dengan monoclonal Ki-67 antibody. Sel yang dikategorikan positif CD117 memperlihatkan partikel coklat di dalam sitoplasma dan imunoekspresi Ki-67 dinilai dengan warna coklat pada inti sel tumor. Hasil penelitian  menunjukkan hubungan bermakna antara risiko agresivitas tumor dan imunoekspresi Ki-67 (p<0,001). Simpulan, semakin tinggi nilai ekspresi Ki-67 semakin tinggi skor risiko agresivitas sehingga pada GIST, pemeriksaan imunohistokimia Ki-67 dapat membantu menentukan apakah pasien akan mempunyai prognosis yang buruk. [MKB. 2015;47(4):231–7]Kata kunci: CD117, gastrointestinal stromal tumor, Ki-67Correlation between Ki-67 Immunoexpression and the Tumor Aggressivity Risk in Gastrointestinal Stromal TumorAbstractGastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract, and arises from intestinal cells of Cajal localized in the muscular layer of the digestive tract, which functions as pacemaker cells in regulating intestinal motility. The incidence of GIST is about 3−5% of all soft tissue sarcomas. Gastrointestinal stromal tumor can occur along the gastrointestinal tract and predominantly in middle-aged and older persons, with a median age between 50 and 60 years. Histologically, there are three categories of GIST morphology such as spindle cells, epitheloid, and mixed type. A spesific marker of GIST is cluster of differentiation (CD117), which has good sensitivity and immunoreactive in 95% of GIST. The expression of Ki-67 correlates with proliferative activities and can be detected in G1, S, G2, and M phases of cell cycle but not in G0 phase. The aim of this study was to assessthe correlation between the risk of aggressive behaviors and proliferative activities as measured by Ki-67 in tumors confirmed as GIST by CD117. The method of this study was cross-sectional, performed on 29 cases of GIST from the Department of Pathology Anatomy Dr. Hasan Sadikin General Hospital/Faculty of Medicine Universitas Padjadjaran, Santo Borromeus Hospital, Immanuel Hospital, and Santosa Hospital between 2007−2012. A section from paraffin embedded tissue of 55 cases of GIST was stained with hematoxylin eosin for histological and immunohistochemical evaluations using monoclonal antibody CD117 to confirm the diagnosis of GIST. There were 29 positive cases for CD117. Further staining was performed using monoclonal antibody Ki-67. The categorized positive cells of immunoexpression of CD117 showed brown particles inside cytoplasma and the immunoexpression of Ki-67 was assessed by identification of nuclear brown staining of neoplastic cells. The result showed that there were significant correlations between the risk of tumor aggressive behaviors and immunoexpression of Ki-67 (p<0.001). In conclusion, as the immunoexpression of Ki-67 value increases, the aggressivity risk score becomes higher. Therefore, in GIST, the Ki-67 immunohistochemical analysis may help to decide which patients will have the worst prognosis. [MKB. 2015;47(4):231–7]Key words: CD117, gastrointestinal stromal tumor, Ki-67 DOI: 10.15395/mkb.v47n4.617
Penatalaksanaan Oligodontia pada Anak 14 Tahun dengan Sindrom Ectodermal Dysplasia: Laporan Kasus Anie Apriani; Inne Suherna Sasmita
Majalah Kedokteran Bandung Vol 47, No 4 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Ectodermal dysplasia adalah kelainan herediter yang jarang didapatkan, lebih kurang 7.000 kasus di dunia. Pada kelainan ini terjadi gangguan perkembangan struktur organ-organ yang berasal dari lapisan ektodermal seperti rambut, gigi, kuku, dan kelenjar keringat. Dilaporkan kasus sindrom ectodermal dysplasia pada seorang anak perempuan berusia 14 tahun dengan manifestasi klinis berupa oligodontia (kehilangan gigi lebih dari 6 gigi pada rahang atas dan bawah), rambut tipis dan keriting, abnormalitas bentuk kuku kaki, dan gangguan ekskresi keringat. Tujuan perawatan pasien ini adalah mendapatkan fungsi estetik dan pengunyahan pasien yang terganggu akibat tidak terdapat benih gigi permanen, selain itu juga untuk menjaga supaya pertumbuhan rahang tetap berkembang normal. Penatalaksanaan oligodontia berupa pembuatan gigi tiruan lepasan dan mahkota akrilik pada seluruh gigi anterior rahang atas dan bawah. Simpulan yang didapatkan pada pasien ini adalah tercapainya perbaikan  estetika dan pengembalian fungsi pengunyahan serta pemeliharaan pertumbuhan rahang  dapat terjaga dengan baik.  [MKB. 2015;47(4):255–60]Kata kunci: Ectodermal dysplasia, gigi tiruan, oligodontiaOligodontia Management in Children 14 Years with Ectodermal Dysplasia Syndrome: Case ReportAbstractEctodermal dysplasia is a hereditary disorder that is rarely seen with approximately 7000 cases in the world. In this disorder, Ectodermal dysplasia occurs as a developmental disorder of organ structures derived from the ectodermal layer such as hair, teeth, nails, and sweat glands. This is a case report of ectodermal dysplasia in a 14-year-old girl with clinical manifestations of oligodontia (tooth loss, more than 6 teeth on the upper and lower jaw), thin and curly hair, abnormal toenail shape, and impaired excretion of sweat. The purpose of the treatment was to make the patient regains her esthetic and masticatory functions, which were disrupted by the absence of permanent tooth buds, as well as to maintain the normal growth of the developing jaws. Treatment for the patient’s with oligodontia included the use of removable denture in lower jaw and application of acrylic crowns on all upper and lower anterior teeth resulting in improved esthetics and masticatory function. It is concluded that the treatment has been able to improve the esthetics and to return the masticatory function of the patient while maintaining the normal growth of the jaws. [MKB. 2015;47(4):255–60]Key words: Ectodermal dysplasia, oligodontia, prothes DOI: 10.15395/mkb.v47n4.622

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