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Penggunaan terkini oksimetazolin pada praktik klinik sehari-hari dan rekomendasi Kelompok Studi Rinologi Indonesia Wardani, Retno Sulistyo; Zakiah, Azmi Mir’ah; Magdi, Yoan Levia; Irfandy, Dolly; Kusuma Dewi, Anna Mailasari; Sutikno, Budi; Hendradewi, Sarwastuti; Ratunanda, Sinta Sari; Munir, Delfitri; Dolly Irfandy
Oto Rhino Laryngologica Indonesiana Vol 46, No 2 (2016): Volume 46, No. 2 July - December 2016
Publisher : PERHATI-KL

Latar belakang: Oksimetazolin adalah bahan aktif dekongestan topikal yang digunakan untuk rinitis alergi maupun inflamasi mukosa hidung lainnya. Cara pemakaian oksimetazolin yang baik dan benar akan memengaruhi keberhasilan pengobatan. Efek samping rinitis medikamentosa merupakan komplikasi yang sering terjadi dan sebaiknya dapat dicegah. Tujuan: Penulisan tinjauan pustaka ini untuk memberikan pemahaman terkini tentang berbagai indikasi oksimetazolin pada praktik klinik Telinga Hidung Tenggorok sehari-hari, cara pemakaian yang tepat, efek samping dan komplikasi yang terjadi berdasarkan studi kepustakaan yang dipublikasikan di PubMed, Google Scholar, dan Scopus dalam 10 tahun terakhir (2007–2016) oleh tim adhoc anggota Kelompok Studi (KODI) Rinologi Indonesia. Tinjauan pustaka: Oksimetazolin memiliki indikasi yang diperluas jika digunakan bersama dengan bahan aktif lain. Oksimetazolin semprot hidung 0,05% yang digunakan bersama dengan steroid intranasal dilaporkan memberikan manfaat pada penatalaksanaan rinitis alergi, rinitis kronis, dan polip hidung. Oksimetazolin digunakan juga dalam bedah sinus endoskopik untuk mendapatkan visualisasi lapang operasi yang baik karena efek hemostatik vasokonstriktor intranasal. Keuntungan yang dilaporkan juga diiringi dengan kemungkinan efek samping dan komplikasi yang sudah dikenal sampai yang membahayakan hingga kematian akibat koarktasio aorta, infark miokard elevasi non-ST, dan krisis hipertensi. Kesimpulan: Rekomendasi yang dibuat oleh KODI Rinologi berdasarkan analisis secara sistematik dengan telaah kritis, diharapkan dapat meningkatkan pengetahuan dan pemahaman tentang penggunaan oksimetazolin yang bermanfaat dan dapat mencegah efek samping yang berbahaya.Kata kunci: Oksimetazolin, dekongestan intranasal, indikasi, efek samping, komplikasiABSTRACT Background: Oxymetazoline is an active ingredient of topical decongestant in treating allergic rhinitis and other nasal mucosal inflammation. A good and proper usage of oxymetazoline will influence a beneficial outcome. Rhinitis medicamentosa is a common complication that should be avoided. Purpose: Content of the literature review is the indications of oxymetazoline usage in daily ENT clinical practice; the proper usage, side effects and complications are appraised from Pubmed, Scopus and Google Scholar publications within the last 10 years (2011 – 2015). The work was performed by adhoc team consisted of member of Rhinology Study Group Indonesia. Literature Review: Oxymetazoline broader indications obtained when applied together with other active ingredients. Oxymetazoline 0.05% nasal spray with topical intranasal steroid was reported as having efficacy in management of allergic rhinitis, chronic rhinitis and nasal polyps. Oxymetazoline is used as topical vasoconstrictor during endoscopic sinus surgery to get clear endoscopic visualization due to its hemostatic effect. Combination of oxymetazoline with topical intranasal steroid, was reported to be beneficial in the management of allergic rhinitis, chronic rhinitis and nasal polyps. Oxymetazoline is also used as topical vasoconstrictor during endoscopic sinus surgery to get clear endoscopic visualization due to its hemostatic effect. The good result of oxymetazoline was reported along with its side effects, which could be fatal, such as coarctation of the aorta, non-ST elevation myocardial infarction, and critical hypertension. Conclusion: Recommendation from Rhinology Study Group Indonesia based on systematic analysis with critical appraisal that has been made, may widen the knowledge and understanding of oxymetazoline usage and indications, and also avoiding the dangerous side effects and complications.Keywords: Oxymetazoline, topical intranasal decongestant, indication, side effect, complication

Korelasi ekspresi Cyclooxygenase-2 (COX-2) dan TNF-α sebagai mediator cancer-related inflammation pada karsinoma nasofaring Nurdiansah, Firman; Pardede, Sujahn Anto; Farhat, Farhat; Munir, Delfitri; Asnir, Rizalina Arwinati; Hasibuan, Mangain; Eyanoer, Putri Chairani
Oto Rhino Laryngologica Indonesiana Vol 43, No 2 (2013): Volume 43, No. 2 July - December 2013
Publisher : PERHATI-KL

Latar belakang: Karsinoma nasofaring (KNF) adalah suatu karsinoma sel skuamosa yang berasal dari sel epitel nasofaring. Cyclooxygenase (COX) merupakan enzim pada jalur biosintetik dari prostaglandin, tromboksan dan prostasiklin dari asam arakhidonat. Ekspresi seluler COX-2 meningkat di atas normal pada stadium awal karsinogenesis dan selama perkembangan serta pertumbuhan invasif tumor. TNF-α diperlukan untuk proliferasi dan fungsi yang normal dari NK cells, sel T, sel B, makrofag dan sel dendrit. Akan tetapi bukti yang terbarumenunjukkan bahwa TNF-α merupakan suatu mediator utama pada cancer-related inflammation dan juga berperan sebagai tumour-promoting factor.Tujuan: Untuk mengetahui ekspresi COX-2 dan TNF-α sebagai mediator cancer-related inflammation pada KNF. Metode: Penelitian ini bersifat deskriptif secara cross sectional design dengan 30 sampel dilakukan di RSUP. H. Adam Malik Medan. Ekspresi COX-2 dan TNF-α pada KNF diperiksa dengan immunohistokimia. Hasil: Dengan menggunakan Fisher’s exact test tidak ditemukan hubungan yang signifikan antara ukuran tumor primer, ukuran kelenjar getah bening serta stadium klinis dengan ekspresi COX-2 (p > 0,05). Ditemukan hubungan yang signifikan antara ukuran tumor primer dan ekspresi TNF-α (p < 0,05). Tidak ditemukan adanya hubungan antara ukuran kelenjar getah bening dan stadium klinis dengan ekspresi TNF-α (p >0,05). Dengan uji Spearman’s rho didapatkan bahwa COX-2 berkorelasi signifikan dengan TNF-α pada KNF (p <0,05). Kesimpulan: Terdapat korelasi signifikan ekspresi COX-2 dan TNF-α pada KNF.Kata kunci: Karsinoma nasofaring, cyclooxygenase-2, TNF-α.

Hubungan rinitis alergi dan disfungsi tuba Eustachius dengan menggunakan timpanometri Rambe, Andrina Yunita Murni; -, Fadhlia; Munir, Delfitri; Haryuna, Tengku Siti Hajar; Eyanoer, Putri Chairani
Oto Rhino Laryngologica Indonesiana Vol 43, No 1 (2013): Volume 43, No. 1 January - June 2013
Publisher : PERHATI-KL

Latar belakang: Rinitis alergi merupakan masalah kesehatan global dengan prevalensi yang terusmeningkat serta dapat berdampak pada penurunan kualitas hidup penderitanya. Ko-morbiditas rinitis alergi salahsatunya adalah otitis media yang sangat erat hubungannya dengan gangguan fungsi tuba Eustachius yangberkaitan dengan tekanan telinga tengah. Tujuan: Mengetahui hubungan rinitis alergi dengan disfungsi tubaEustachius dengan menggunakan timpanometri. Metode: Satu studi kasus-kontrol. Disfungsi tuba ditentukandengan pemeriksaan timpanometri (MEP negatif/<-25 daPa) dan hasil tes fungsi tuba (ETF) yang tidak baik.Analisis hasil dengan uji Chi-square dan regresi logistik. Hasil: Penelitian ini melibatkan 60 sampel. Tipetimpanogram terbanyak pada kedua kelompok yaitu tipe A, dimana kelompok RA tipe A sebesar 73,3% (rerataMEP -40,8 daPa), tipe As 10%, tipe Ad dan tipe B masing-masing 3,3%, tipe C 10%. Kelompok kontrol tipe Asejumlah 93,3% dan tipe As 6,7%. Pada kelompok kasus 83,3% hasil tes fungsi tuba abnormal dan 16,7%normal, sedangkan kelompok kontrol yaitu 93,3% normal dan 6,7% abnormal. Uji chi-square menunjukkanperbedaan yang signifikan antara klasifikasi RA dan disfungsi tuba Eustachius (p=0,006) dan perbedaan yangsignifikan antara jenis alergen dan disfungsi tuba Eustachius (p=0,041). Hasil uji multivariat terdapat bahwa tiperinitis alergi berpengaruh tiga kali lebih besar terhadap disfungsi tuba Eustachius (OR 2,9; 95% IK: 1,52-241,90dan nilai p=0,022) sedangkan jenis alergen dua kali lebih berpengaruh terhadap disfungsi tuba dengan OR 2,2;95% IK: 0,01-7,31 dan nilai p=0,295. Kesimpulan: Rinitis alergi memiliki kemungkinan 3 kali lebih seringmengalami disfungsi tuba Eustachius dari pada kelompok kontrol OR:2,5 (95% CI 2,36-2,99) P=0,000.Kata kunci: rinitis alergi, disfungsi tuba Eustachius, rerata tekanan telinga.ABSTRACTBackground: Allergic rhinitis is a global health problem with increasing prevalence and can have impacton the quality of life of sufferers. One of co-morbidity of allergic rhinitis is otitis media which is closely relatedto Eustachian tube dysfunction, associated with middle ear pressure. Purpose: To determine the relationshipbetween allergic rhinitis and Eustachian tube dysfunction, using tympanometry. Methods: A case-control study.Tubal dysfunction was determined with tympanometry (MEP negative / <-25 Dapa) and tubal function test resultwas not good (≤15 daPa). Chi-square test and logistic regression analysis used for data analysis. Results: Therewere 60 samples. The most common tympanogram type in both groups were type A, which AR group was 73.3%(mean -40.8 daPa MEP), type As 10%, type ad and type B respectively 3.3%, type C 10.0% and control groupstype A 93.3%, type As 6.7%. In AR group, 83.3% showed abnormal tubal function and 16.7% was normal. As incontrol group, 93.3% was normal and 6.7% was abnormal. Chi-square test showed a significant differencebetween AR classification and Eustachian tube dysfunction (p = 0.006), and also between type of allergens andEustachian tube dysfunction (p= 0.0041). Multivariate test revealed AR classification contributed to Eustachiantube dysfunction OR:2.9 (95% CI 1.52-241.90) p=0.022, not between type of allergens and Eustachian tubedysfunction OR:2.2 (95% CI 0.01-7.31) p=0.295. Conclusion: Allergic rhinitis contributes three times higher toEustachian tube dysfunction than the control group. OR: 2.5 (95% CI 2.36-2.99) p= 0.000.Keywords: allergic rhinitis, Eustachian tube dysfunction, Mean Ear Pressure.

Biofilm bakteri pada penderita rinosinusitis kronis: laporan seri kasus berbasis bukti Silvia, S; Munir, Delfitri; Rambe, Andrina Yunita Murni; Simanjuntak, Amran; Chrestella, Jessy; Ashar, Taufik
Oto Rhino Laryngologica Indonesiana Vol 47, No 2 (2017): Volume 47, No. 2 July - December 2017
Publisher : PERHATI-KL

Latar belakang: Rinosinusitis kronis merupakan penyakit yang sering dijumpai pada bagian telinga hidung tenggorok kepala dan leher. Melalui berbagai macam teknik pencitraan, biofilm dijumpai pada mukosa sinonasal dari pasien rinosinusitis kronis. Beberapa peneliti mengemukakan bahwa biofilm adalah penyebab yang umum dari infeksi persisten kronis. Peranan biofilm pada penderita rinosinusitis kronis dapat membantu menjelaskan manifestasi klinis pada penyakit tersebut. Ketersediaan pewarnaan hematoksilin-eosin yang luas dalam laboratorium patologi klinik membuatnya menjadi metode yang sangat praktis untuk mendeteksi biofilm dalam praktik klinis. Tujuan: Mempresentasikan ekspresi biofilm bakteri pada penderita rinosinusitis kronis yang menjalani tindakan bedah sinus endoskopi fungsional. Kasus: Sebanyak 33 pasien rinosinusitis kronis menjalani tindakan bedah sinus endoskopi fungsional di beberapa rumah sakit di Sumatera Utara selama bulan Januari-Desember 2016. Prevalensi biofilm didapati pada 22 pasien (66,7%) penderita rinosinusitis kronis. Pada penderita rinosinusitis kronis dengan biofilm positif dijumpai jenis kelamin pria lebih banyak, umur lebih tua, lama gejala lebih singkat, keberadaan polip lebih sering, dan keluhan hidung tersumbat lebih sering. Metode: Pencarian literatur melalui Pubmed dengan kata kunci: chronic rhinosinusitis and biofilm. Setelah melalui proses skrining didapati 2 literatur yang dianalisis. Hasil: Penatalaksanaan rinosinusitis kronis dengan medikamentosa, meliputi pemberian antibiotik, dekongestan, kortikosteroid dan mukolitik disertai terapi tambahan irigasi hidung, serta pembedahan. Bila dijumpai biofilm, maka regimen pemberian antibiotik memakai protocol Marshall. Kesimpulan: Prevalensi biofilm pada penderita rinosinusitis kronis cukup tinggi, pemeriksaan biofilm dapat dipertimbangkan pada pasien rinosinusitis kronis yang menjalani tindakan bedah sinus endoskopi fungsional. Kata kunci: Biofilm, rinosinusitis kronis, hematoksilin-eosin, bedah sinus endoskopi fungsional ABSTRACT Background: Chronic rhinosinusitis is a disease that often found in otorhinolaryngology. Its pathogenesis is not fully understood. Using variety techniques, biofilms have been found in the mucosa of chronic rhinosinusitis patients. Some researchers have suggested that biofilm is a common cause of chronic persistent infection. The role of biofilms in patients with chronic rhinosinusitis can help explain the clinical manifestations of the disease. The extensive availability of hematoxylin-eosin staining in clinical pathology laboratories makes it a very practical method for detecting biofilms in clinical practice. Purpose: To present bacterial biofilm expression in chronic rhinosinusitis patients who had underwent functional endoscopic sinus surgery. Cases:About 33 chronic rhinosinusitis patients who had underwent functional endoscopic sinus surgery in several hospitals in North Sumatera during January-December 2016.Biofilms were found in 22 (66.7%) patients with chronic rhinosinusitis. Chronic rhinosinusitis patients with positive biofilms found mostly male, older in age, shorter duration of symptoms, more frequent polyps, and more frequent nasal congestion complaints. Method: Literature study was conducted through Pubmed with keywords chronic rhinosinusitis and biofilm. After screening process, we obtained two articles that were analyzed based on the critical appraisal. Result: Management of chronic rhinosinusitiswas medical treatment with antibiotic, decongestant, corticosteroid and mucolytic, accompanied by additional nasal irrigation therapy, and surgery. If biofilm was found, antibiotic regimen given using Marshal protocol. Conclusion: The prevalence of biofilms in patients with chronic rhinosinusitis was quite high. Biofilm examination should be considered in patients with chronic rhinosinusitis who undergo functional endoscopic sinus surgery. Keywords: Biofilm, chronic rhinosinusitis, hematoxylin-eosin, fungsional endoscopic sinus surgery

The Difference of Olfactory Functions in The Workers of The Gas Station by Using Sniffin’ Stickstest in Medan City Sagala, Irwan Pernandi; Munir, Delfitri; Rambe, Andriana Yunita Murni; Ashar, Taufik
Sumatera Medical Journal Vol. 1 No. 1 (2018): Sumatera Medical Journal (SUMEJ)
Publisher : Talenta Publisher

Introduction: Chronic exposure of volatile substances can cause the impaired olfactory function. Objectives: In order to identify the difference of olfactory function in the workers of the Gas Station in Medan city. Methods: Analytical research with cross- sectional approach. The research subjects were 80 persons consisting of 40 gas station operators and 40 non-operators who fulfilled the inclusion and exclusion criteria. The applied statistical analysis was Mann Whitney, Fisher's Exact, Chi Square, T independent, Spearman with 95% confidence level. Results: Proportion of the impaired olfactory function in the gas station operator group by 77.5% and non-operator group by 0%. Significant correlation was obtained between age, duration of work with the impaired olfactory function (p = 0,047, p = 0,001). The gas station operators will suffer the impaired olfactory function if they work for  3.89 years. Conclusions: There were differences of olfactory functions in the gas station workers by using Sniffin 'Sticks Test in Medan city.

Olfactory Functions Difference on Gas Station Workers Using Sniffin’ Sticks Test sagala, irwan pernandi; Munir, Delfitri; Rambe, Andrina Y.M
Sumatera Medical Journal Vol. 3 No. 2 (2020): Sumatera Medical Journal (SUMEJ)
Publisher : Talenta Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/sumej.v3i2.1224

ABSTRACT Background: Chronic exposure of volatile substances can cause the impaired olfactory function. Objective: To identify the difference of olfactory function at Gas Station workers in Medan city. Method: Cross-sectional analitic study. A total of 80 persons consisting of 40 gas station operators and 40 non-operators who fulfilled the inclusion criteria. The applied statistical analysis was Mann Whitney, Fisher's Exact, Chi Square, T independent, Spearman with 95% confidence level. Result: Proportion of the impaired olfactory function in the gas station operator group by 77.5% and non-operator group by 0%. Significant correlation was obtained between age, duration of work with the impaired olfactory function (p = 0,047, p = 0,001). The gas station operators will suffer the impaired olfactory function if they works for ≥ 3.89 years. Conclusion: There were differences of olfactory functions on the gas station workers by using Sniffin 'Sticks Test.

Factors Affecting Presbycusis on Audiogram Overview at H. Adam Malik General Hospital Medan Manullang, Frenky Sorimuda; Adnan, Adlin; Munir, Delfitri
Journal of Epidemiology and Public Health Vol 6, No 1 (2021)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (31.695 KB)

Background: Presbycusis incidence is thought to have a relationship with hereditary factors, metabolism, atherosclerosis, noise and lifestyle. The presbycusis classification consists of Sensory (outer hair-cell), neural (ganglion-cell), metabolic (strial atrophy), and conductive cochlea (stiffness of the basilar membrane). Factors that influence presbycusis include age, gender, genetics, hypertension, gout, diabetes mellitus, hypercholesterolemia, noise exposure, and smoking. This study aims to determine the factors that influence presbycusis on the audiogram image at H. Adam Malik Hospital Medan.Subjects and Method: This study was an analytical study with a cross sectional design in elderly patients at the polyclinic. The study was conducted in November to December 2019. The dependent variable was the incidence of presbycusis. The independent variables were uric acid levels, blood sugar levels, smoking habits, hypercholesterolemia, and hypertension. Data were analyzed by using chi square test.Results: The prevalence of presbycusis in the 45-59 years age group was 39 people (54.2%) and the 60-74 years age group was 33 people (45.8%). In this study, it shows that male respondents are more than female respondents, where the number of men is 58 people (80.6%) and women are 14 people (19.4%). Based on presbycusis type, there were 33 (45.9%) people (normal), 18 (25%) people (strrial type), 7 (7.9%) people (neural type), 7 (7.9%) people (sensory type), 7 (7.9%) people (cochlear type). High sugar content (OR= 3.33; 95% CI= 1.81 to 6.13; p <0.001), uric acid levels (OR= 2.36; 95% CI= 1.19 to 4.70; p= 0.005), total cholesterol levels (OR= 3.33; 95% CI= 1.81 to 6.13; p <0.001), and smoking (OR= 1.90; 95% CI = 1.21 to 2.97; p= 0.016) increased the risk of presbycusis.Conclusion: High sugar levels, uric acid levels, total cholesterol levels, and smoking habits increase the risk of presbycusis.Keywords: presbycusis, audiogram imageCorrespondence: Frenky Sorimuda Manullang. Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia. Email: manulangdrfrenky@gmail.com. Mobile: +62-8126394830.Journal of Epidemiology and Public Health (2021), 06(01): 12-20https://doi.org/10.26911/jepublichealth.2021.06.01.02

Serum 25-Hydroxyvitamin D Levels as a Predictive Factor for Allergic Rhinitis Restimulia, Lia; Munir, Delfitri
Sumatera Medical Journal Vol. 4 No. 3 (2021): Sumatera Medical Journal (SUMEJ)
Publisher : Talenta Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/sumej.v4i3.7626

Introduction: Allergy and 25-Hydroxyvitamin D deficiency were mentioned to be correlated. Still, there was limited number of studies in determining serum 25-Hydroxyvitamin D levels as a predictive factor, particularly in allergic rhinitis (AR). This study has never been implemented in Indonesia which the main objective was to explore this topic. Methods: Consecutive sampling was used in recruiting the fifteen subjects. Serum 25-Hydroxyvitamin D levels were quantified using electrochemiluminescence immunoassay (ECLIA) method while the total nasal symptom scores were acquired by enumerate all nasal symptoms. Data of serum vitamin D levels and TNSS were analysed statistically.Results: Based on our previous study, the predictive value was illustrated from linier regresion = 10,230 – 0,281 (vitamin D), with negative moderate correlation (r = -0,613). This result can be comparable for someone with vitamin D level of 5.66 ng/mL that could predicted as 8.64 nasal score. Conclusion: 25-Hydroxyvitamin D could be a predictive factor for allergic rhinitis with negative moderate correlation. Hence, in the future research needs to be implemented.

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