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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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Articles 651 Documents
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Tingkat Ketepatan Audiometer Skrining Medan Bebas untuk Mendeteksi Gangguan Dengar Anak Sekolah Dasar dengan Otitis Media Hartanto, Widya W.; Boesoirie, Thaufiq S.; Poerwana, Ratna A. S.
Majalah Kedokteran Bandung Vol 45, No 1 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Skrining pendengaran pada anak sekolah dapat mengetahui lebih dini gangguan dengar akibat otitis media sehingga hasil pengobatannya akan lebih baik. Audiometer skrining medan bebas merupakan alat skrining pendengaran yang sederhana, terjangkau, ringkas, mudah dan singkat, tetapi belum diukur tingkat ketepatannya untuk anak sekolah dasar. Penelitian ini bertujuan untuk menguji tingkat ketepatan audiometer skrining medan bebas untuk mendeteksi gangguan dengar pada anak sekolah dasar yang menderita otitis media. Penelitian uji diagnostik dengan rancangan penelitian potong silang dilakukan di Sekolah Dasar Sejahtera dan Poliklinik Departemen Ilmu Kesehatan Telinga Hidung Tenggorok–Bedah Kepala dan Leher RS Dr. Hasan Sadikin Bandung periode bulan Juni–Agustus 2011. Dari 479 anak sekolah dasar, didapatkan 86 subjek sesuai kriteria inklusi. Terdapat gangguan dengar pada 56 anak yang diperiksa audiometer skrining medan bebas dan 51 anak yang diperiksa audiometri nada murni. Hasil uji diagnostik audiometer skrining medan bebas didapatkan sensitivitas 90,2%; spesifisitas 71,4%; indeks Kappa 0,630. Perbandingan pemeriksaan pendengaran antara audiometri skrining medan bebas dan audiometri nada murni didapatkan p=0,302. Simpulan, tingkat ketepatan audiometer skrining medan bebas sama dengan audiometer nada murni untuk mendeteksi gangguan dengar anak sekolah dasar yang menderita otitis media. [MKB. 2013;45(1):62–8]Accuracy of Portable Screening Audiometer for Detecting Hearing Loss in Elementary School Children with Otitis MediaHearing skrining in school children can detect hearing loss due to otitis media earlier therefor treatment will give better outcome. Portable screening audiometer is a device which are simple, less expensive, brief, easy to use and has shorter examination time but has not been measured its accuracy for hearing screening in elementary school children. The objective of this study was to measure the accuracy of portable screening audiometry for detecting hearing loss in elementary school children with otitis media. A diagnostic test study with cross-sectional method was conducted at Sejahtera Elementary School and at Out-patient Clinic Otorhinolaryngology-Head and Neck Department Dr. Hasan Sadikin Hospital Bandung period June until August 20011. From 479 children, there were 86 children match with inclusion criteria. Hearing loss was found in 56 children examined using portable screening audiometer and in 51 children using pure tone audiometry. Diagnostic test result for portable screening audiometer were 90.2% sensitivity, 71.4% specificity, with Kappa index 0.630 and p value was 0.302 compared to pure tone audiometry. In conclusion, the accuracy of portable screening audiometer is as good as pure tone audiometry in order to detect hearing loss in elementary school children with otitis media. [MKB. 2013;45(1):62–68] DOI: http://dx.doi.org/10.15395/mkb.v45n1.141
Perbandingan Skor DECAF dengan Skor BAP-65 terhadap Kematian dalam Tiga Puluh Hari pada Pasien PPOK Eksaserbasi Akut di RSUP H. Adam Malik Medan Lubis, Siti Taqwa Fitria; Keliat, E. N.; Abidin, Alwinsyah
Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (208.821 KB) | DOI: 10.15395/mkb.v48n1.727

Abstract

Pada penderita penyakit paru obstruksi kronik (PPOK) eksaserbasi akut, penilaian derajat keparahan pada awal masuk penting dalam menentukan risiko kematian rawat inap rumah sakit, memutuskan perawatan bangsal atau Intensive Care Uni,t dan penatalaksanaan selanjutnya. Skor Dyspnoea, Eosinopenia, Consolidation, Acidaemia, Atrial Fibrillation (DECAF) dan skor elevated BUN, Altered mental status, Pulse 109 beats/min, age >65 years (BAP-65) dapat digunakan sebagai alat prognostik. Penelitian ini bertujuan membandingkan skor DECAF dengan skor BAP-65 memprediksi kematian dalam 30 hari pada pasien PPOK eksaserbasi akut. Penelitian dengan desain kohort, subjek adalah pasien PPOK eksaserbasi akut di Instalasi Gawat Darurat dan rawat inap RSUP H. Adam Malik Medan, pada bulan Februari–Juni 2013. Dinilai skor DECAF dan skor BAP-65. Dihitung sensitivitas dan spesifisitas kedua skor dan dibandingkan kekuatannya. Sebanyak 40 subjek direkrut, rata-rata (±SB) usia 61,07±12,42 tahun. Sembilan subjek (23%) meninggal saat penelitian. Uji chi-kuadrat mendapatkan hasil signifikan skor DECAF p 0,003 dan skor BAP-65 p=0,0026. Sensitivitas dan spesifisitas skor DECAF dan skor BAP-65, masing-masing 100% dan 16%, 100% dan 39%. Simpulan, skor DECAF dan skor BAP-65 memiliki hubungan dengan kematian dalam 30 hari pada pasien PPOK eksaserbasi akut. Tingginya sensitivitas dan rendahnya spesifisitas menyebabkan kedua skor ini belum dapat digunakan sebagai alat prognostik. Diperlukan penelitian dengan subjek yang lebih besar untuk mendapatkan keakuratan kematian. [MKB. 2016;48(1):7–14]Kata kunci: PPOK eksaserbasi akut, prognosis, skor BAP-65, skor DECAFComparison between DECAF Score and BAP-65 Score in Predicting Thirty Days Mortality in Acute Exacerbations COPD Patients in H. Adam Malik General HospitalAbstractThe assessment of severity level in patient with acute exacerbation chronic obstructive pulmonary disease (AECOPD) at early admission is important to determine the risk of in-hospital mortality, to decide hospitalization or requirement of Intensive Care Unit setting and further management. Dyspnea, Eosinopenia, Consolidation, Acidaemia, Atrial Fibrillation (DECAF) score, and elevated BUN. Altered mental status, pulse 109 beats/min, age >65 years (BAP-65) can be used as prognostic tools. The aim of this study was to investigate the comparison between DECAF score and BAP-65 score in predicting 30 days-mortality in AECOPD patients. This was a cohort study, subjects were AECOPD patients in emergency unit and inpatient in H. Adam Malik General Hospital, from February to June 2013. DECAF score and BAP-65 score were assessed. We calculated sensitivity and specificity of both scores to compare the stronger predictor. Fourty subjects were recruited, mean (±SD) age was 61.07±12.42 years. Nine subjects (23%) died during the study. This study presented significant result with p=0,003 for DECAF score and p=0,0026 for BAP-65 score, using chi-square test. Sensitivity and specificity of DECAF score and BAP-65 score were 100% and 16%, 100% and 39%, respectively. In conclusion, DECAF score and BAP-65 score have correlations with 30-days mortality in AECOPD patients. High sensitivity and low specificity prevent the use of these scores as prognostic tools. A larger study is required to determine the accuracy on mortality. [MKB. 2016;48(1):7–14]Key words: Acute exacerbation COPD, BAP-65 score, DECAF score, prognostic
Perbandingan Angka Kejadian Batuk Pascabronkoskopi pada Kelompok Premedikasi Kombinasi Kodein 10 mg dan Klorfeniramin Maleat 4 mg dengan Premedikasi Tunggal Kodein 10 mg Saputra, Maulidar; Zulfariansyah, Ardi; Rismawan, Budiana
Majalah Kedokteran Bandung Vol 50, No 4 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v50n4.1512

Abstract

Bronkoskopi merupakan tindakan esensial dalam penegakan diagnosis maupun terapetik pada saluran pernapasan. Beberapa penelitian menunjukkan kejadian batuk yang tinggi baik selama tindakan maupun setelah bronkoskopi. Saat ini belum ada konsensus tentang pemberian premedikasi yang optimal mengurangi kejadian batuk pada pasien yang menjalani bronkoskopi. Tujuan penelitian ini adalah mengetahui perbedaan efektivitas pemberian premedikasi kodein dengan kombinasi kodein-klorfeniramin maleat (CTM) dalam mengurangi batuk setelah bronkoskopi. Penelitian ini merupakan penelitian eksperimental yang dilakukan secara prospektif terhadap 52 subjek penelitian yang menjalani bronkoskopi di Rumah Sakit Paru Rotinsulu pada bulan Desember 2017–Februari 2018. Pada penelitian ini data numerik diuji dengan uji t tidak berpasangan, untuk data kategorik diuji dengan uji chi-square. Hasil penelitian ini didapatkan angka kejadian batuk pascabronkoskopi pada kelompok pasien yang diberikan premedikasi dengan kombinasi kodein 10 mg dan CTM 4 mg lebih rendah dibanding dengan kelompok yang diberikan premedikasi tunggal dengan kodein 10 mg pada semua pengukuran dengan perbedaan bermakna (p<0,05). Simpulan penelitian ini adalah pemberian premedikasi dengan kombinasi kodein 10 mg dan CTM 4 mg lebih efektif menurunkan kejadian batuk pascabronkoskopi dibanding dengan premedikasi tunggal Kodein 10 mg.Kata kunci: Batuk pascabronkoskopi, premedikasi kodein, premedikasi kodein-CTM Comparison of Postbronchoscopic Cough Incidence betweeb Patients Premedicated with 10 mg Codeine  and 4 mg Chlorpheniramine Maleate Combination and premedicated with 10 mg Codeine OnlyBronchoscopy is an essential airway procedure for diagnostic and therapeutic purposes that could cause discomfort and complications. Some studies have shown that cough complaint is often made during and after the procedure. There is no consensus that explains how to optimally premedicate a patient to reduce cough. The objective of this study was to understand the difference in the effectiveness of codeine and codeine and chlorpheniramine maleat (CTM) combination as a premedication to prevent coughing after bronchoscopy. This was a double blind, prospective experimental study in Rotinsulu Pulmonary Hospital from December 2017 to February 2018. Fifty two patients who were undergoing bronchoscopy under general anesthesia were randomly allocated to codeine group (n=26) and  Codeine-CTM Group (n=26). It was showed that the incidence of cough after bronchoscopy in the group using combination of 10 mg Codeine and 4 mg CTM premedication was lower than in the group with 10 mg Codeine premedication in all measurements. Therefore, premedication using 10 mg codeine and 4 mg CTM combination is more effective to reduce the incidence of cough after bronchoscopy when compared to the single premedication with codeine 10 mg.Key words: Postbronchoscopic cough, premedication with codeine, premedication with codeine-CTM
Efek Hepatoprotektif Rosella (Hibiscus sabdariffa L.) pada Tikus Model Hepatitis Husen, Ike Rostikawati; Sastramihardja, Herri S.
Majalah Kedokteran Bandung Vol 44, No 2 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Hepatitis disebabkan oleh polutan yang menimbulkan stres oksidatif. Secara tradisional rosella (Hibiscus sabdariffa L.) mengandung flavonoid, suatu antioksidan yang digunakan untuk mengobati penyakit hati. Penelitian bertujuan menentukan efek hepatoprotektif ekstrak etanol bunga rosella segar (EEBRS) terhadap kadar malondialdehid (MDA) hati, serum glutamic piruvic transaminase (SGPT), dan kerusakan morfologi hepatosit tikus model hepatitis dibandingkan dengan efek vitamin E. Telah dilakukan penelitian ekperimental laboratorik di Departemen Farmakologi dan Terapi Fakultas Kedokteran Universitas Padjadjaran-Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Agustus 2009 dengan menggunakan 25 ekor tikus Wistar jantan dibagi dalam 5 kelompok. Kelompok 1/kontrol negatif, kelompok 2/kontrol positif (model hepatitis-karbon tetraklorida/CCl4), kelompok 3 dan 4 merupakan model hepatitis yang selama 8 hari sebelumnya mendapat EEBRS 125 mg/kgBB/hr (kelompok 3) dan vitamin E 2,7 IU/hari per oral (kelompok 4), sedangkan kelompok 5 mendapat EEBRS. Pengamatan dilakukan 48 jam setelah induksi dengan CCl4. Analisis statistik menggunakan uji analysis of varian (ANOVA) dan uji Tukey. Hasil penelitian menunjukkan bahwa EEBRS mencegah kenaikan kadar MDA hati dan SGPT, berbeda secara bermakna dibandingkan dengan kontrol positif (MDA p=0,00; SGPT p=0,041) dan tidak berbeda bermakna dibandingkan dengan kelompok 4 (MDA p=1,00; SGPT p=0,192). Gambaran histopatologi hati kelompok 3 berupa vakuolisasi makrovesikular, pada tikus model hepatitis berupa vakuolisasi mikrovesikular, sedangkan vitamin E menghambat kerusakan morfologi. Simpulan, EEBRS memiliki efek hepatoprotektif sebagai antioksidan pada tikus model hepatitis namun efeknya tidak lebih baik dibandingkan dengan vitamin E. [MKB. 2012;44(2):83–9].Kata kunci: Hepatosit, MDA, rosella, SGPT The Hepatoprotective Effect of Rosella (Hibiscus sabdariffa L.) on Hepatitis Model Rats Hepatitis is initiated by pollutant which caused oxidative stress. Rosella (Hibiscus sabdariffa L.) contain flavonoid, an antioxidant which has been used traditionally in treating liver disease. The study aims to define the hepatoprotective effects of fresh rosella calyx ethanol extract (FRCEE) on hepatitis model rats with liver malondialdehyde (MDA) and serum glutamic piruvic transaminase (SGPT) level and hepatocyte morphology damage compared to vitamin E’s effects. The laboratory experimental study has been conducted on August 2009 at Department Pharmacology and Therapy Faculty of Medicine Padjadjaran University/Dr. Hasan Sadikin Hospital in 25 male Wistar rats, divided into 5 groups. Group 1 was negative control, group 2 was positive control (carbon tetrachloride/CCl4-hepatitis model rats), group 3 and 4 were hepatitis model rats that subsequently given 125 mg/kgBW of FRCEE (group 3) and 2.7 IU of vitamin E (group 4) for 8 days; group 5 was given FRCEE. Observations were done 48 hours after CCL4 induction. The results were analyzed by analysis of varian (ANOVA) and Tukey. The result showed that FRCEE inhibited increasing of liver MDA and SGPT level significantly different compared to positive control (MDA p=0.00, SGPT p=0.041) but not significantly different to group 4 (MDA p=1.00, SGPT p=0.192). Histological features showed macrovesicular on group 3, microvesicular vacuole on group 2; whereas vitamin E inhibited morphological damage. In conclusion, FRCEE has hepatoprotective effect on hepatitis model rats as antioxidant, but not superior compared to vitamin E. [MKB. 2012;44(2):83–9].Key words: Hepatocyte, MDA, rosella, SGPT DOI: http://dx.doi.org/10.15395/mkb.v44n2.128
Potensi Asam Lemak Pada Minyak Kelapa Murni Dalam Menghambat Candida Albicans Secara In Vitro Novilla, Arina; Nursidika, Perdina; Resmelia, Meyli
Majalah Kedokteran Bandung Vol 48, No 4 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (253.101 KB) | DOI: 10.15395/mkb.v48n4.910

Abstract

Kandidiasis merupakan penyakit infeksi Candida baik primer maupun sekunder. Penyebab utama kandidiasis adalah Candida albicans (C. albicans). Pengobatan kandidiasis dilakukan dengan pemberian obat anti jamur, terutama nistatin, amfoterisin-B dan azole, tetapi toksisitas dan resistensi obat ini menjadi masalah potensial. Diperlukan pemakaian obat lain yang lebih aman. Salah satunya adalah pemanfaatan bahan alami yaitu minyak kelapa murni. Tujuan penelitian ini adalah untuk mengetahui potensi asam lemak minyak kelapa murni dalam menghambat pertumbuhan C. albicans. Desain penelitian eksperimental. Penelitian menggunakan difusi Kirby Bauer untuk mendapatkan konsentrasi hambat minimum minyak kelapa murni dalam menghambat C. albicans. Penelitian dilakukan pada bulan September–Oktober 2010 di Laboratorium Kimia dan Mikrobiologi Sekolah Tinggi Ilmu Kesehatan Jenderal Achmad Yani Cimahi. Hasil menunjukkan asam lemak dalam fraksi n-heksan dan metanol hasil hidrolisis berpotensi dalam menghambat pertumbuhan C. albicans. Fraksi n-heksan konsentrasi minimal yang memberikan hambatan yaitu 75% dengan diameter hambatan rata-rata sebesar 3,3 mm, sebanding dengan antibiotik nistatin 195 unit. Fraksi metanol memberikan hambatan dimulai pada konsentrasi 75% dengan diameter hambatan rata-rata sebesar 4 mm, sebanding dengan antibiotik nistatin 195 unit. Hasil konsentrasi hambat minimum masing-masing asam lemak untuk fraksi metanol konsentrasi 25% dan fraksi n-heksan 100%. Simpulan, asam lemak pada minyak kelapa murni dapat menghambat C. albicans. [MKB. 2016;48(4):200–4]Kata kunci: asam lemak, Candida albicans, in vitro, minyak kelapa murniPotential Of Virgin Coconut Oil Fatty Acid to Inhibit the Growth of Candida Albicans In VitroAbstractCandidiasis is Candida infection both primary or secondary diseases. The main cause of candidiasis is Candida albicans (C. albicans). Candidiasis is treated by antifungal drug treatment, especially nistatin, amphotericin-B, and azole, but toxicity and drug resistance become potential problems. Therefore, other method is needed as safer treatment. One of natural resources which has antifungal is virgin coconut oil. Research design was experimental. The objective of study was determine the potential of fatty acid in virgin coconut oil to inhibit C. albicans. This study used Kirby Bauer Method to determine minimum inhibition concentration. The study was performed in September-October 2010 at Chemistry and Microbiology Laboratory School of Health Sciences Jenderal Achmad Yani Cimahi. The result showed the fatty acid of n-hexane and methanol fractions after hydrolysed were potential to inhibit the growth of C. albicans. Minimum inhibitory concentration against C. albicans was 75% with average diameter of inhibiting zone 3.3 mm was equal to nistatin 195 units. The methanol fraction inhibited C. albicans start from 75% with average diameter 4 mm or equal to nistatin 195 units. Minimum fungicidal concentration showed C. albicans inhibited by methanol fraction 25% and n-hexane fraction with concentration 100%. In conclusion, fatty acid of virgin coconut oil was able to inhibit C. albicans. [MKB. 2016;48(4):200–4]Key words: Candida albicans, fatty acids, in vitro, virgin coconut oil
Kadar Hypoxia Inducible Factor-1α pada Penderita Diabetes Melitus Tipe 2 Disertai Mikroalbuminuria dan Retinopati Hoo, Yumilia; Permana, Hikmat; Soetedjo, Nanny Natalia M; Arifin, Augusta Y. L.
Majalah Kedokteran Bandung Vol 46, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Diabetes melitus tipe 2 (DMT2) sampai saat ini masih menjadi masalah kesehatan karena bersifat progresif dan menimbulkan komplikasi. Menurut data epidemiologi dari International Diabetes Federation (IDF) tahun 2011, dinyatakan bahwa retinopati diabetik sering kali mendahului mikroalbuminuria. Komplikasi tersebut diawali oleh disfungsi endotel yang akan meningkatkan sekresi sitokin yang menginduksi angiogenesis dan limpangiogenesis. Pada keadaan hipoksia akibat perubahan mikrovaskular, hypoxia inducible factor-1 alpha (HIF-1α) disekresikan dan akan merangsang produksi vascular endothelial growth factor (VEGF) yang menginduksi angiogenesis. Penelitian ini bertujuan untuk mengetahui hubungan kadar HIF-1α plasma penderita DMT2 dengan mikroalbuminuria dan retinopati diabetik. Penelitian menggunakan rancangan studi potong lintang terhadap 158 penderita DMT2 yang berobat di poliklinik endokrinologi Rumah Sakit Dr. Hasan Sadikin Bandung periode Juli─Desember 2012. Data dianalisis menggunakan uji-t, Mann Whitney, dan multivariate analysis of variance (MANOVA). Subjek penelitian terdiri atas 82 orang pria (51,9%) dan 76 orang wanita (48,1%). Delapan puluh orang (50,6%) normoalbuminuria dan 78 orang (49,4%) mikroalbuminuria. Pada penelitian ini didapatkan 38 orang dengan retinopati diabetik (24,1%). Median kadar HIF-1α kelompok mikroalbuminuria adalah 0,103 (0,041–0,735) ng/mL dan pada normoalbuminuria 0,144 (0,041–0,481) ng/mL (p=0,257). Median kadar HIF-1α kelompok retinopati positif 0,041 (0,041–0,33) ng/mL, sedangkan kelompok tanpa retinopati 0,167 (0,041–0,735) ng/mL dengan p<0,01. Simpulan, kadar HIF-1α plasma yang rendah atau normal bergantung pada derajat retinopati diabetik. Kadar HIF-1α plasma yang tinggi pada penderita tanpa retinopati diabetik, menunjukkan akan terjadi retinopati diabetik di masa mendatang. [MKB. 2014;46(2):100–5]Kata kunci: Hypoxia inducible factor-1α, mikroalbuminuria, retinopati diabetikHypoxia Inducible Factor-1α in Type 2 Diabetes Mellitus with Microalbuminuria and RetinopathyType 2 diabetes mellitus (T2DM) is still considered a major problem in healthcare, mainly for its progressivity and complications. According to the epidemiological data from the International Diabetes Federation (IDF) in 2011, it is stated that microalbuminuria often precedes the onset of diabetic retinopathy. Complications are preceded by endothelial dysfunction that will increase the secretion of cytokines inducing angiogenesis and limpangiogenesis. In hypoxic conditions induced by microvascular changes, hypoxia inducible factor-1 alpha (HIF-1α) is secreted, stimulating the production of vascular endothelial growth factor (VEGF) which induce angiogenesis. The aim of this study was to know the correlation between plasma HIF-1α concentration with microalbuminuria pattern and diabetic retinopathy in T2DM patients. This cross-sectional study was conducted on 158 T2DM patients in Endocrinology Outpatient Departement of Dr. Hasan Sadikin Hospital during July to December 2012. Data were analyzed using t-test, Mann Whitney, and multivariate analysis of variance (MANOVA) methods. Eighty two males (51.9%) and 76 females (48.1%) participated in the study, making up 158 subjects. Eighty patients (50.6%) had normoalbuminuria and 78 patients (49.4%) had microalbuminuria. Thirty eight patients were found with diabetic retinopathy (24.1%). The median of HIF-1α plasma concentrations was 0.103 (0.041–0.735) ng/mL in the microalbuminuria group and 0.144 (0.041–0.481) ng/mL (p=0.257).in the normoalbuminuria group. The median of HIF-1α plasma concentration in the group with diabetic retinopathy was 0.041 (0.041–0.33) ng/mL, while in the group without diabetic retinopathy the median was 0.167 (0.041–0.735) ng/mL (p<0.01). In conclusion, low or normal HIF-1α plasma levels in patients without diabetic retinopathy predict the grading of diabetic retinopathy, while high levels of plasma HIF-1α suggests the likehood of retinopathy event in the future. [MKB. 2014;46(2):100–5]Key words: Diabetic retinopathy, hypoxia inducible factor-1α, microalbuminuria DOI: 10.15395/mkb.v46n2.281
Status Asetilator Gen NAT2 pada Pasien Tuberkulosis dan Tuberkulosis dengan Diabetes Melitus di Kupang, Nusa Tenggara Timur Pramono, Alvinsyah Adhityo; Penggoam, Simeon; Sahiratmadja, Edhyana; Utami, Novi Vicahyani; Achmad, Tri Hanggono; Panigoro, Ramdan
Majalah Kedokteran Bandung Vol 49, No 1 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (588.875 KB) | DOI: 10.15395/mkb.v49n1.989

Abstract

Indonesia adalah negara dengan jumlah penderita tuberkulosis (TB) terbanyak kedua  di dunia. Diabetes melitus (DM) merupakan salah satu komorbid TB. Arylamine N-acetyltransferase 2 (NAT2) adalah enzim yang berfungsi memetabolisir isoniazid (INH) yang disandi oleh gen NAT2. Gen NAT2 memiliki sejumlah polimorfisme dan dapat menentukan kemampuan seseorang untuk memetabolisir obat yang disebut status asetilator. Pada individu dengan status asetilator lambat, INH dimetabolisir dengan lambat sehingga memungkinkan terjadi intoksikasi hati. Pada TB dengan DM (TBDM) status asetilator lambat dapat membuat pengobatan TB maupun DM menjadi kurang optimal. Penelitian ini bertujuan mengeksplorasi status asetilator pasien TBDM di RSUD Prof. WZ Johannes Kupang periode Juni–November 2011. Pada penelitian potong lintang ini DNA dari darah 122 pasien TB diisolasi dan gen NAT2 kemudian diamplifikasi dan disekuensing untuk diketahui status asetilatornya. Hasil penelitian menunjukkan terdapat 5 pasien yang memiliki glukosa serum >200 mg/dL yang dikategorikan sebagai pasien TBDM. Pada pasien TBDM didapatkan seorang dengan status asetilator cepat (NAT2*4/NAT2*4), 2 orang dengan status asetilator sedang (NAT2*13A/NAT2*6J), dan 2 orang dengan status asetilator lambat (NAT2*5/NAT2*5G, NAT2*6A/ NAT2*6A, NAT2*7B/ NAT2*7B). Pada pasien TB yang dipilih secara random berdasar usia dan jenis kelamin serupa dengan TBDM didapatkan 2 orang dengan status asetilator cepat (NAT2*4/NAT2*4) dan 3 orang dengan asetilator sedang (NAT2*4/NAT2*6A, NAT2*13A/NAT2*6J). TBDM yang memiliki status asetilator lambat berpotensi memiliki masalah ganda dalam terapi, selain dapat terjadi toksisitas hati akibat terapi dengan INH, juga dapat mengakibatkan pengobatan DM menjadi tidak optimal. Perlu dilakukan peneltian lebih lanjut terkait farmakogenetik pada TBDM. [MKB. 2016;49(1):61–6]Kata kunci: Asetilator, isoniazid, NAT2, farmakogenetik, tuberkulosis NAT2 Gene Acetylator Status of Tuberculosis and Tuberculosis with Diabetes Mellitus Patients in Kupang, Nusa Tenggara TimurIndonesia is the second highest country with TB patients in the world. Diabetes mellitus (DM) is a comorbid of TB. Arylamine N-acetyltransferase 2 (NAT2), encoded by the NAT2 gene, is an enzyme that metabolizes isoniazid (INH). NAT2 gene has some polimorphysims that may play a role in INH acetylating process. Those who are slow acetylators may develop liver intoxication as a consequence of slow INH metabolism process. Slow acetylator TBDM patients may complicate both TB and DM treatment, causing them to be less optimal. The aim of this study was to explore the acetylator status of TBDM patients in Kupang, Indonesia. A cross-sectional study was conducted by obtaining DNA of 122 TB patients in Kupang in June–November 2011. NAT2 gene was amplified and sequenced to determine the acetylator status. There were 5 TB patients who had a glucose serum level of >200mg/dL and was catagorized as TBDM. Result showed that there was 1 TBDM patient who was a rapid acetylator (NAT2*4/NAT2*4), 2 patients as intermediate acetylators (NAT2*13A/NAT2*6J), and 2 patients as slow acetylators (NAT2*5/NAT2*5G, NAT2*6A/ NAT2*6A, NAT2*7B/ NAT2*7B). Meanwhile,  there were 2 TB patients who was rapid acetylators (NAT2*4/NAT2*4) and 3 patients as intermediate acetylators (NAT2*4/NAT2*6A, NAT2*13A/NAT2*6J). Slow NAT2 acetylator TBDM patients potentially face more problems during therapy. As INH may cause liver intoxication, these patients may also experience unoptimum DM treatment. Therefore, it is strongly recommended to do a study on the role of pharmacogenomics in TBDM. [MKB. 2016;49(1):61–6]Key words: Acetylator, isoniazid, NAT2, pharmacogenetics, tuberculosis
Hubungan Kadar βHCG Praevakuasi, Gambaran Histopatologi, dan Kista Lutein dengan Performa βHCG pada Penderita Mola Hidatidosa yang Berkembang Menjadi PTG dan Kembali Normal Hidayat, Yudi Mulyana; Gandamihardja, Supriadi; Krisnadi, Sofie Rifayani
Majalah Kedokteran Bandung Vol 46, No 4 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Insidensi penyakit trofoblas di Indonesia maupun negara berkembang masih cukup tinggi dibandingkan dengan negara maju. Hal yang perlu diwaspadai adalah terjadinya penyakit trofoblast gestasional (PTG) pascaevakuasi mola hidatidosa berkisar 10-20%. Beberapa variabel klinis telah diteliti sebagai variabel faktor risiko keganasan seperti kadar β-human chorionic gonadotropin (βHCG) praevakuasi, gambaran histopatologi, dan terdapat kista lutein. Tujuan penelitian ini adalah mengetahui hubungan kadar βHCG praevakuasi, gambaran histopatologi dan kista lutein dengan performa penurunan βHCG pada penderita mola. Metode penelitian yang digunakan adalah case control study pada penderita mola hidatidosa komplet di Rumah Sakit Dr. Hasan Sadikin Bandung selama periode tahun 2007-2011. Hasil penelitian menunjukkan hubungan bermakna kadar βHCG ≥100.000 mIU/mL dengan keganasan pascamola (p<0,05), terdapat hubungan bermakna gambaran histopatologi proliferasi berlebih dengan keganasan pascamola (p<0,05), dan terdapat hubungan bermakna kista lutein positif dengan keganasan pascamola (p<0,05). Simpulan penelitian ini adalah variabel kadar βHCG praevakuasi ≥100.000 mIU/mL, gambaran histopatologi proliferasi berlebih, dan kista lutein positif memiliki korelasi dengan keganasan pascaevakuasi mola. Variabel faktor risiko tersebut  dapat digunakan untuk memilahkan penderita mola hidatidosa komplet risiko tinggi atau risiko rendah untuk kejadian keganasan dan variabel faktor risiko keganasan tersebut berpengaruh pada performa penurunan kurva regresi βHCG.Kata kunci: Gambaran histopatologi, kadar βHCG, kista lutein, mola hidatidosa komplit, PTGRelationship between Pre-Evacuation βHCG Level, Histopathologycal View, Lutein Cysts and βHCG Performance in Patients with Hydatidiform Mole which Developed into Gestational Trophoblastic Disease (GTD) and Back to NormalAbstractThe incidence of trophoblastic diseases in Indonesia and developing countries is relatively high compared to the developed countries. The incidence of gestational trophoblast tumors (GTT) after the evacuation of a hydatidiform mole ranges from 10% to 20%. Several clinical variables have been studied as the risk factors for malignancy, including the pre-evacuation level of beta human chorionic gonadotropin (βHCG), histopathological appearance, and the presence of lutein cysts. The purpose of this study was to determine the relationship between βHCG decline and pre-evacuation βHCG levels, histopathological features, and the lutein cysts status in patients with moles. This study was a case control study of patients with complete hydatidiform mole in Dr. Hasan Sadikin General Hospital during the period of 2007-2011. The results revealed that there was a significant correlation between the level of βHCG ≥100,000 mIU/mL and post-molar malignancy (p<0.05). There was also a significant relationship between the histopathologic feature of excessive post-molar cell proliferation and malignancy (p<0.05) and between the presence of lutein cyst and post-molar malignancy (p<0.05). This study concludes that the pre-evacuation βHCG level ≥100.000 mIU/mL, excessive proliferation, and the presence of lutein cysts are correlated with malignancy after molar evacuation. These risk factors are useful to differentiate whether a complete hydatidiform mole will become malignant or remain benign.Key words: Beta human chorionic gonadotropin levels, histopathologic features, lutein cysts, complete hydatidiform mole, gestational trophoblast tumors DOI: 10.15395/mkb.v46n4.345
Perbandingan antara Tramadol 2 mg/kgBB dan Fentanil 2 mg/kgBB Intravena Sebagai Analgetik Intraoperatif pada Operasi Laparotomi Ginekologis; Pengaruhnya terhadap Skor PRST Kurniawan, Arief; Pratiwi, Nur Pudyastuti
Majalah Kedokteran Bandung Vol 49, No 4 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (378.38 KB) | DOI: 10.15395/mkb.v49n4.1144

Abstract

Perkembangan dan kemajuan teknologi serta ilmu pengetahuan telah mendorong pelaksanaan pelayanan kesehatan yang lebih efektif dan lebih ekonomis dibanding dengan cara yang lazim dikerjakan.  Telah dilakukan penelitian terhadap 32 pasien operasi laparotomi ginekologis yang dibagi menjadi dua kelompok. Kelompok Tramadol (n=16) diberikan tramadol 2 mg/kgBB (pengenceran akuabides sampai 10 mL) lewat jalur infus selama satu menit, sedangkan pada kelompok Fentanil (n=16) diberikan fentanil 2 µg/kgBB dengan cara yang sama. Lima menit kemudian diberikan propofol 2 mg/kgBB, atrakurium 0,5 mg/kgBB, enfluran 2 volume %, N2O:O2=2 L/menit:2 L/menit. Setelah tiga menit dilakukan laringoskopi intubasi. Pasien diventilasi kendali dengan mode ventilator IPPV.  Operasi dilaksanakan bila kedalaman anestesi tercapai berdasar atas skor PRST (P=systolic arterial pressure, R=heart rate, S=sweat, dan T=tears) 2 sampai dengan 4. Analgetik pertolongan 50 µg fentanil diberikan bila skor PRST lebih dari 4. Analgetik postoperatif 30 mg ketorolak dan antimuntah 10 mg metoklopramid diberikan saat jahit kulit. Pencatatan tekanan darah, laju nadi, saturasi O2, dan skor PRST dilakukan sebagai berikut: T0 = penderita tiba di kamar operasi, T1= preintubasi, T2= satu menit setelah intubasi, T3= satu menit setelah insisi, T4 dan seterusnya diukur tiap 15 menit sampai selesai operasi. Pasien diekstubasi setelah pernapasan adekuat. Skala sedasi dan muntah dinilai setiap 15 menit setelah ekstubasi selama dua jam. Dari hasil penelitian didapatkan skor PRST mulai T1 sampai T12 secara statistis tidak berbeda bermakna antara kelompok tramadol dan fentanil (p>0,05). Kedua kelompok mengalami peningkatan skor PRST satu menit setelah intubasi. Skor PRST dipertahankan antara 0 sampai 2. Pada kelompok tramadol dan fentanil masing-masing satu orang mendapatkan analgetik pertolongan fentanil 50 µg karena skor PRST 5. Tidak ditemukan perbedaan skala sedasi dan muntah antara dua kelompok perlakuan. Penelitian ini menunjukkan tramadol 2 mg/kgBB dibanding dengan fentanil 2 µg/kgBB sebagai analgetik intraoperatif pada operasi laparotomi ginekologis memberikan pengaruh  yang sama terhadap skor PRST.Kata kunci: Analgetik intraoperatif, fentanil, laparotomi ginekologis, skor PRST, tramadolComparison of Intravenous Tramadol 2 mg kgBW-1 and Fentanyl 2 mg.kgbw-1 As Intraoperative Analgetic for Gynecologic Laparotomy; Its Effects on PRST Score The development and improvement of technology and sciences influence the effectivity and economic of health care. This study was done on 32 patients who undergoing gynecologic laparotomy. The sample was divided into 2 groups, consisted of 16 patients each group. The tramadol group was given 2 mg.kgbw-1 tramadol (diluted to 10 mL) via infuse line over one minute whereas the fentanyl group was given 2 µg.kgbw-1 fentanyl by the same procedure as tramadol. Inductions was done five minutes later with 2 mg.kgbw-1 propofol, 0.5 mg.kgbw-1 atracurium, and maintenance anesthesia with 2 vol.% enflurane, 50% O2 and 50% N2O at flow rate 4 L/minutes. After three minutes the patient was intubated and ventilated by using control mode. Surgery had performing when depth of anesthesia achieved with PRST (P=systolic arterial pressure, R=heart rate, S=sweat, and T=tears) scored 2 to 4. Rescue analgetic with 50 mcf fentanyl if the PRST score more than 4. Analgetic postoperative 30 mg ketorolac and antiemetic 10 mg metoclopramide were given intravenously during skin closure. Blood pressure, heart rate, oxygen saturation and PRST score were recorded at T0=patient on arrival in theatre, T1=preintubation, T2=one minute after intubation, T3=one minute after incision, T4 and so on were recorded every fifteen minutes until the end of surgery. Extubation was done when patient breath adequately. Sedation scale and incidence of vomiting were evaluated every fifteen minutes for two hours after extubation. The result showed that PRST scores from T1 to T12 were statistically not significant in tramadol group and fentanyl group (p>0.05), but the PRST scores increasing significantly one minute after intubation in both groups. The PRST scores were between 0 to 2. Rescue analgetic was given to one patient in tramadol group and fentanyl group with PRST scored 5. Sedation scale  and incidence of vomiting were statistically not significant  in  both groups. This study concluded that 2 mg.kgbw-1 tramadol and 2 µg.kgBB-1 fentanyl as an intraoperative analgetic during gynecologic laparotomy have the same PRST scores.Key words: Fentanyl, gynecologic, intraoperative analgetic, laparotomy, PRST score, tramadol
Hubungan Imunoekspresi E-cadherin dan C-erbB2 dengan Derajat Keganasan Histopatologik Karsinoma Kistik Adenoid Kelenjar Liur Mariam, Marry Siti; Nasserie, Wazilah
Majalah Kedokteran Bandung Vol 44, No 2 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Karsinoma kistik adenoid (KKA) merupakan keganasan kelenjar liur terbanyak, prognosisnya sukar diprediksi dengan tingkat kekambuhan yang tinggi. Berdasarkan beberapa penelitian, prognosis KKA kelenjar liur yang berhubungan dengan tingkat ketahanan hidup sangat terkait dengan derajat keganasan histopatologik berdasarkan tipe pola pertumbuhannya. Penelitian ini dilaksanakan di Departemen Patologi Anatomi Fakultas Kedokteran Universitas Padjadjaran Bandung tahun 2009. Tujuan penelitian untuk mengetahui perubahan imunoekspresi protein adhesi E-cadherin (molekul adhesi antar sel epitel) dan proto-onkogen C-erbB2 (keluarga C-erbB/reseptor faktor pertumbuhan epidermal) pada KKA kelenjar liur dikorelasikan dengan derajat keganasan histopatologik. Desain penelitian studi potong lintang tanpa acak secara retrospektif pada 51 blok parafin penderita karsinoma kistik adenoid kelenjar liur. Sampel didiagnosis ulang, serta ditentukan derajat keganasan histopatologiknya (menurut modifikasi Szantos dan Batsakis) dilanjutkan dengan pemeriksaan imunohistokimia terhadap E-cadherin dan C-erbB2. Hasil menunjukkan korelasi sangat bermakna (p<0,01) perubahan imunoekspresi E-cadherin yang negatif (82%) dengan derajat keganasan histopatologik 1, 2, dan 3 (4%, 33%, dan 46%). Perubahan imunoekspresi C-erbB2 tidak berkorelasi dengan meningkatnya derajat keganasan (p=0,11). Terjadi perubahan peningkatan imunoekspresi dari derajat 1 (5%) ke derajat 2 (11%), namun kembali menurun pada derajat 3 (8%). Simpulan, imunoekspresi E-cadherin dapat digunakan sebagai petanda tumor untuk memprediksi prognosis keganasan KKA kelenjar liur. Perubahan imunoekspresi C-erbB2 pada KKA kelenjar liur menunjukkan perilaku biologinya dan peran utama C-erbB2 pada KKA kelenjar liur terutama pada fase inisiasi dan promosi karsinogenesis. [MKB.2012;44(2):70–6].Correlation of E-cadherin and C-erbB2 Immunoexpression with the Degree of Histopathological Malignancy on Salivary Gland Adenoid Cystic CarcinomaAdenoid cystic carcinoma (ACC) is the most common salivary gland malignancies, with high rate of local recurrence and unpredictable prognosis. Based on previous research, prognosis of ACC in salivary gland which is correlated with survival rates, is related with histopathological malignancy degree based on its growth pattern type. This study was conducted in Pathology Anatomy Department of Medical Faculty, Padjadjaran University Bandung in 2009. The aim of this study was to analyze the alteration of immunoexpression of E-cadherin (adhesion molecule of epithelial cells) and C-erbB2 proto-oncogen (the family of C-erbB/epidermal growth factor receptor) in salivary gland. Adenoid cystic carcinoma correlated with cross-sectional non-random study on 51 paraffin blocks, from patients with salivary gland ACC retrospectively. The repeated histopatologic examination was to diagnose ACC and to get data of the histopathological malignancy degree (according to Szantos and Batsakis modification), and it was continued with immunohistochemistry examination of E-cadherin and C-erbB2. The alteration of negative immunoexpression of E-cadherin (82%) had correlation significantly (p<0.001) with the histological malignancy degrees 1, 2, and 3 (4%, 33% and 46%). The C-erbB2 immunoexpression change had no correlation with the increasing histopatologic malignancy degree (p=0.11). The alteration of C-erbB2 immunoexpression, increased from first (5%) to second degree (11%) but decreased on the third degree (8%). In conclusions, the immunoexpression of E-cadherin can be used as tumor marker to predict malignancy prognosis of salivary gland ACC. The expression changes of C-erbB2 in ACC indicate its biological behavior and the main role of C-erbB2 on salivary gland ACC is in the initiation and promotion phase of carcinogenesis. [MKB. 2012;44(2):70–6]. DOI:  http://dx.doi.org/10.15395/mkb.v44n2.126

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