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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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Korelasi Proteinuria Metode Rasio Albumin-Kreatinin Urin dengan Metode Kromatografi pada Preeklamsi Syuhada, -; Noormartany, -; Alamsyah, Muhammad; Dewi, Nina Susanna
Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Preeklamsi masih merupakan salah satu penyebab utama kematian ibu melahirkan. Pada preeklamsi terjadi kerusakan endotel vaskular ginjal yang menyebabkan proteinuria. Pemeriksaan proteinuria penting dalam diagnosis preeklamsi. Metode rasio albumin-kreatinin urin (uACR) adalah metode pemeriksaan proteinuria yang memiliki korelasi yang baik dengan kadar protein urin 24 jam sebagai baku emas. Metode lain adalah metode kromatografi (carik celup) yang masih secara luas digunakan di berbagai fasilitas kesehatan namun dari berbagai penelitian metode ini memiliki variasi nilai sensitivitas dan spesifisitas yang luas. Tujuan penelitian untuk mengetahui apakah terdapat korelasi yang baik antara hasil pemeriksaan proteinuria metode carik celup dan metode uACR pada penderita preeklamsi. Penelitian dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung. Subjek penelitian adalah wanita hamil penderita preeklamsi yang sesuai dengan kriteria inklusi dan tidak masuk ke dalam kriteria eksklusi. Analisis statistik dilakukan dengan uji korelasi rank Spearman. Subjek penelitian sebanyak 52 orang. Kelompok usia terbanyak adalah 20–34 tahun. Dari uji statistik yang dilakukan, didapatkan korelasi yang baik antara hasil pemeriksaan proteinuria dari kedua metode tersebut (r=0,51; p<0,05). Simpulan, terdapat korelasi yang baik antara hasil pemeriksaan proteinuria metode carik celup dan metode uACR pada penderita preeklamsi, sehingga metode carik celup dapat tetap dipakai. [MKB. 2012;44(4):218–23].Correlation between Urinary Albumin Creatinin Ratio Test and Chromatographic Method in PreeclampsiaPreeclampsia is still one of the major causes of maternal mortality. In preeclamptic renal vascular endothelial damage occurs that leads to proteinuria. Examination of proteinuria is essential in preeclampsia diagnosis. Urinary albumin-creatinine ratio (uACR) is one of proteinuria test methods with good correlation with 24-hour urinary protein as the gold standard. Another method is chromatographic method (dipstick urinalysis) which is still widely used in various health facilities but from various studies it has wide variation of sensitivity and specificity values. The purpose of this study was to determine whether there is a good correlation between the results of the proteinuria examination by dipstick method and uACR method in patients with preeclampsia. The study was conducted at Dr. Hasan Sadikin Hospital Bandung. Subjects were woman with preeclampsia in accordance with inclusion and exclusion criteria. Statistical analysis was performed using Spearman rank correlation test. There were 52 subjects. Thelargest age group was 20–34 years. From the statistical test performed, agood correlation between the results of proteinuria examination from both methods was found. In conclusion, there is a good correlation between the results of dipstick urinalysis method and the method of urinary albumin-creatinine ratio in patients with preeclampsia. Therefore, dipstick urinalysis examination can still be utilized. [MKB. 2012;44(4):218–23]. DOI: http://dx.doi.org/10.15395/mkb.v44n4.139
Hubungan Lama Obstruksi Usus, Warna dan Kejernihan Cairan Peritoneum dengan Kontaminasi Bakteri pada Hernia Inkarserata Sidabutar, Unedo M. H.; Sulthana, Bambang A.; Lukman, Kiki
Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Hernia inkarserata merupakan salah satu kasus abdomen akut yang diakibatkan obstruksi usus karena jepitan cincin. Penelitian eksperimental pada hewan coba membuktikan bahwa terjadi kerusakan barier mukosa setelah 4 jam obstruksi total usus dan kerusakan total setelah 12 jam, sehingga terjadi translokasi bakteri ke luar lumen usus. Untuk menentukan kontaminasi bakteri dalam kantung hernia akibat translokasi kuman, dilakukan pemeriksaan kultur dalam cairan peritoneum. Tujuan penelitian untuk mengetahui hubungan lama gejala obstruksi, warna, dan kejernihan cairan peritoneum dengan kontaminasi bakteri sebagai akibat translokasi kuman pad penderita hernia inkarserata. Waktu penelitian bulan Oktober 2009–Juli 2010 di Instalasi Gawat Darurat Bedah Rumah Sakit Dr. Hasan Sadikin Bandung. Dilakukan penelitian potong lintang yang menganalisis hubungan lama obstruksi usus, warna dan kejernihan cairan peritoneum dengan positivitas kultur bakteri. Penelitian dilakukan pada 40 penderita, 36 laki-laki dan 4 perempuan. Lama inkarserasi rata-rata adalah 7 jam. Terdapat 11 kasus dengan kultur positif, dengan jenis bakteri terbanyak Staphylococcus (27%). Analisis statistik dengan metode chi-kuadrat dan analisis regresi logistik berganda menunjukkan hubungan lama obstruksi dan perubahan warna cairan peritoneum dengan kontaminasi bakterial (p=0,015; p=0,001) dengan rasio prevalens lama obstruksi >7 jam sebesar 3,63, namun tidak terdapat hubungan dengan kejernihan cairan peritoneum (p=0,078). Penelitian ini tidak dapat menentukan cut-off time karena tidak mengikuti perjalanan penyakit, namun belum dapat dibuktikan translokasi bakteri karena kultur yang didapat adalah kuman komensal kulit. Simpulan, terdapat hubungan lama obstruksi usus dan perubahan warna cairan peritoneum dengan kontaminasi bakteri pada hernia inkarserata, tetapi tidak terdapat hubungan dengankejernihan cairan peritoneum dan kultur bakteri positif dengan kuman kontaminan kulit tidak dapat membuktikan translokasi kuman pada penderita hernia inkarserata. [MKB. 2012;44(4):199–204].Kata kunci: Hernia inkarserata, kontaminasi bakteri, lama obstruksi usus, warna dan kejernihan cairan peritoneumRelationship Bowel Obstructions Color and Clarity of Peritoneal Fluid with Bacterial Culture in Incarcerated HerniaIncarcerated hernia is an acute abdominal case caused by bowel obstruction due to incarceration of hernia ring. An experimental study on animals proved that there was mucosal barrier damage after 4 hours of total bowel obstruction and total damage after 12 hours causing bacterial translocation. In order to determine contamination due to bacterial translocation in the hernia sac, culture was taken from the peritoneal fluid. A cross-sectional study in Dr. Hasan Sadikin Hospital Bandung was done during October 2009 to July 2010 to analyze the relationship between duration of obstruction, color and clarity of peritoneal fluid, and bacterial culture. There were 40 patients, 36 males and 4 females involved in this study. Mean incarceration time was 7 hours. There were 11 positive culture cases, mostly Staphylococcus species (27%). Statistical analysis with chi-square and multiple logistic regression test showed that there was correlation between duration of obstruction and color and clarity of peritoneal fluid with bacterial contamination (p=0.015, p=0.001) with prevalence ratio of >7 hours length obstruction was 3.63, but not with clarity (p=0.078). In this study we could not obtain exact cut-off time of bowel obstruction’s period with bacterial translocation because it did not follow the pathologic event. In conclusions, there is correlation between duration of obstruction, color and clarity of peritoneal fluid with bacterial contamination, but bacterial translocation can not be proven because only commensal bacteria of the skin was obtained from the culture. [MKB. 2012;44(4):199–204].Key words: Bacterial contamination, color and clarity of peritoneal fluid, duration of obstruction, incarcerated hernia DOI: http://dx.doi.org/10.15395/mkb.v44n4.175
Hubungan antara QT Variability Index dan Laju Filtrasi Glomerulus pada Penyakit Ginjal Kronik Predialisis Sugiantoro, -; Purnomowati, Augustine; Martakusumah, Abdul Hadi; Achmad, Chaerul
Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Penderita penyakit ginjal kronik (PGK) mempunyai risiko yang tinggi untuk mengalami aritmia ventrikel dan kematian mendadak (sudden cardiac death/SCD). Angka kejadian SCD pada penderita PGK meningkat seiring dengan menurunnya laju filtrasi glomerulus (glomerular filtration rate/GFR). Mekanisme patofisiologi yang mendasari SCD pada umumnya aritmia ventrikel yang berhubungan dengan ketidakstabilan repolarisasi miokardium. QT variability index (QTVI), suatu indeks yang menggambarkan ketidakstabilan repolarisasi miokardium, merupakan prediktor yang kuat untuk terjadi aritmia fatal dan SCD. Penelitian ini merupakan studi observasi potong lintang untuk menilai hubungan antara QTVI dan GFR pada penderita PGK predialisis dengan GFR <60 mL/menit. Penelitian ini dilakukan pada penderita PGK yang berobat ke Poliklinik Ginjal Hipertensi Rumah Sakit Dr. Hasan Sadikin Bandung periode Oktober–Desember 2011. Penelitian ini melibatkan 51 subjek. Pemeriksaan elektrokardiografi (EKG) istirahat dilakukan pada semua subjek dan selanjutnya dilakukan penghitungan QTVI. Hampir semua subjek menderita hipertensi atau mendapat antihipertensi (94%). Gambaran EKG dengan hipertrofi ventrikel kiri didapatkan pada 37% subjek dan QTVI rata-rata subjek sebesar 0,16 (SD 0,24). Hubungan antara QTVI dan GFR dianalisis menggunakan Spearman’s rank correlation. QT variability index mempunyai hubungan yang bermakna baik dengan GFR (r=-0,816; p<0,001) maupun dengan estimated glomerular filtration rate (eGFR) (r=-0,460; p<0,001). Simpulan, terdapat hubungan sangat kuat antara QTVI dan GFR pada penderita PGK predialisis, makin rendah GFR makin panjang nilai QTVI. [MKB. 2012;44(4):193–98].Kata kunci: Kematian jantung mendadak, laju filtrasi glomerulus, penyakit ginjal kronik, QT variability indexCorrelation between QT Variability Index and Glomerular Filtration Rate in Predialysis Chronic Kidney DiseaseAbstractChronic kidney disease (CKD) patients are at increased risk for ventricular arrhythmia and sudden cardiac death (SCD). The rate of SCD in CKD patients increased as glomerular filtration rate decreased. Sudden cardiac death is generally mediated by ventricular arrhythmias associated with instability of myocardial repolarization. QT variability index (QTVI) as an index of myocardial repolarization instability is a strong predictor for fatal ventricular arrhythmias and SCD. The aim of this study was to evaluate correlation between QTVI and GFR(< 60 >mL/minute) in predialysis CKD patients. This study was done in Kidney and Hypertension Clinic of Dr. Hasan Sadikin Hospital Bandung, from October to December 2011. A total of 51 subjects were included in this study and had their resting electrocardiography (ECG) recorded and QTVI calculated, 94% had hypertension or received anti hypertension, while only 37% fulfilled the ECG criteria for left ventricular hypertrophy. We determined the correlation between QTVI and GFR using Spearman’s rank, with mean QTVI 0.16 (SD 0.24), we had strong and significant correlation between QTVI and GFR (r=-0.816, p <0.001) and moderate correlation between QTVI and estimated glomerular filtration rate (r=-0.460, p<0.001). In conclusions, there is a strong correlation between QTVI and GFR in predialysis CKD patients, the lower GFR the higher QTVI value. [MKB. 2012;44(4):193–98].Key words: Chronic kidney disease, glomerular filtration rate, QT variability index, sudden cardiac death DOI: http://dx.doi.org/10.15395/mkb.v44n4.214
Pengaruh Alfa Tokoferol pada Efek Ototoksik Sisplatin Santosa, Yanuar Iman; Samiadi, Dindy; Aroeman, Nur Akbar; Fianza, Pandji Irani
Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Kemoterapi sisplatin memiliki efek samping ototoksik, diperantarai radikal bebas, mengakibatkan kematian sel rambut luar koklea, menyebabkan gangguan dengar. Alfa tokoferol memiliki efek otoprotektif terhadap sisplatin pada hewan coba. Diperlukan penelitian lebih lanjut pada manusia. Tujuan penelitian mengukur fungsi pendengaran untuk mengetahui pengaruh pemberian alfa tokoferol per oral pada pencegahan efek ototoksik sisplatin. Dilakukan penelitian uji klinis acak di Rumah Sakit Dr. Hasan Sadikin Bandung (RSHS) periode Desember 2011–Februari 2012 pada dua kelompok. Kelompok perlakuan menjalani pengobatan standar kemoterapi sisplatin dengan tambahan alfa tokoferol per oral dengan dosis 400 International Unit (IU) per hari sejak 1 hari sebelum kemoterapi selama 30 hari. Kelompok kontrol menjalani pengobatan standar kemoterapi sisplatin. Pemeriksaan fungsi pendengaran dilakukan dengan timpanometri, audiometri, dan distortion product otoacoustic emission (DPOAE) sebelum dan setelah kemoterapi siklus pertama dan kedua. Didapatkan hasil kejadian ototoksik setelah siklus pertama lebih rendah secara bermakna pada kelompok 1 (33,3%) dibandingkan dengan kelompok 2 (66,7%) (p=0,046; IK=95%). Demikian juga dengan kejadian ototoksik setelah siklus kedua lebih rendah secara bermakna pada kelompok 1 (50%) dibandingkan dengan kelompok 2 (88,9%) (p=0,027; IK=95%). Simpulan, terapi alfa tokoferol 400 IU per oral dapat mencegah efek ototoksik sisplatin. [MKB. 2012;44(4):205–12].Kata kunci: Alfa tokoferol, ototoksik, sisplatinEffects of Alpha Tocopherol Againts Cisplatin–Induced OtotoxicityOtotoxicity is a known side effect of cisplatin chemotherapy due to formation of free radicals causing death to cochlear outer hair cells, resulting in hearing loss. Alpha tocopherol has otoprotective effects towards cisplatin in animal studies. Further human studies are needed. The objective of this study was to measure hearing function to know the otoprotective effects of alpha tocopherol against cisplatin. A randomized control trial was performed at Dr. Hasan Sadikin Hospital Bandung in December 2011–February 2012 in 2 groups. The treatment group received standard cisplatin chemotherapy treatment and alpha tocopherol 400 International Unit (IU)/day since day 1 before a 30-day-treatment. the control group received standard cisplatin chemotherapy treatment. Hearing evaluation was done using tympanometry, audiometry and distortion product otoacoustic emission (DPOAE) before and after the first and second cycles of chemotherapy. Results showed that ototoxic incidence after the first cycle of chemotherapy was significantly lower in group 1 (33.3%) than group 2 (66.7%) (p=0.046, CI=95%). Ototoxic incidence after the second cycle of chemotherapy was significantly lower in group 1 (50%) than group 2 (88.9%) (p=0.027, CI=95%). In conclusion, oral alpha tocopherol 400 IU can prevent cisplatin-induced ototoxicity. [MKB. 2012;44(4):205–12]Key words: Alpha tocopherol, cisplatin, ototoxicity DOI: http://dx.doi.org/10.15395/mkb.v44n4.176
Efektivitas Pemberian Antibiotik Disertai Lansoprazol pada Refluks Laringofaring dengan Infeksi Helicobacter pylori Nurrokhmawati, Yanti; Madiadipoera, Teti; Anggraeni, Ratna; Sarbini, Tonny Basriyadi
Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Refluks laringofaring adalah aliran balik isi lambung ke daerah laringofaring dan dapat dipengaruhi oleh infeksi Helicobacter pylori. Regimen terapi untuk infeksi H. pylori terdiri atas proton pump inhibitor (PPI) dan dua jenis antibiotik yaitu amoksisilin dan klaritromisin. Peran PPI pada regimen ini masih diteliti. Dilakukan penelitian mengenai perbandingan efektivitas terapi antibiotik disertai PPI (lansoprazol) terhadap perbaikan gejala klinis dan kualitas hidup penderita refluks laringofaring dengan infeksi H. pylori. Penelitian ini dilakukan di Departemen THT-KL RS Dr. Hasan Sadikin Bandung periode September 2009-Desember 2010 merupakan randomized clinical trial dengan pengamatan open label.Data dianalisis dengan menggunakan uji t dan uji Mann Whitney. Penelitian ini melibatkan 26 subjek penelitian yang dibagi menjadi dua kelompok. Kelompok pertama diberikan regimen terapi H. pylori, berupa klaritromisin dan amoksisilin dengan lansoprazol dan kelompok kedua diberikan klaritromisin dan amoksisilin tanpa lansoprazol. Dilakukan pemeriksaan skor gejala refluks (SGR), skor temuan refluks (STR), dan penilaian kualitas hidup dengan kuesioner reflux qual short-form (RQS). Evaluasi dilakukan setelah 2 minggu. Didapatkan perbedaan bermakna (p=0,034) skor SGR pascaterapi pada kelompok perlakuan antibiotik kombinasi dengan lansoprazol. Tidak didapatkan perbedaan bermakna (p=0,169) pada perbaikan STR pascaterapi. Perbaikan skor RQS lebih baik pada kelompok perlakuan pertama dibandingkan dengan kelompok kedua (p=0,018). Disimpulkan bahwa pemberian campuran antibiotik kombinasi dan lansoprazol lebih efektif terhadap perbaikan gejala klinis dan kualitas hidup dibandingkan dengan tanpa lansoprazol. [MKB. 2012;44(4):224–32].Kata kunci: Helicobacter pylori, kualitas hidup, lansoprazol, refluks laringofaringThe Effectiveness of Antibiotics with Lansoprazole in the Treatment of Laryngopharyngeal Reflux with Helicobacter pylori InfectionAbstractLaryngopharyngeal Reflux (LPR) is a reflux of gastric content to the laryngopharyngeal and influenced by Helicobacter pylori infection. The treatment of H. pylori infection consists of proton pump inhibitor and two kinds of antibiotics, i.e. amoxicillin and clarithromycin. The role of PPI is currently being studied. The objectives of the research were to compare the effectiveness of antibiotics regimen with and without lansoprazole in reducing the level of the severity and quality of life improvement in LPR patients with H. pylori infection. Twenty six subjects were divided into two groups; the first group received antibiotics with lansoprazole and the second group received antibiotics without lansoprazole. The research subjects were assessed using reflux symptom index (RSI) questionnaire and reflux finding score (RFS) while the assessment on the quality of life was performed using reflux qual short-form (RQS) questionnaire. These data were obtained at baseline and after 2 weeks of treatment. The method was randomized clinical trial with open label observation and the analysis was conducted using t and Mann Whitney tests. There was a significant improvement in the RSI post treatment in the first group (p=0.034). The difference in RFS was not significantly different statistically between both groups (p=0.169). The RQS was significantly better statistically in the first group (p=0.018). It is concluded that treatment regimen with claritromicin, amoxycillin and lansoprazole is more effective in the treatment of LPR associated with H. pylori infection compared to without lansoprazole. [MKB. 2012;44(4):224–32].Key words: Helicobacter pylori, laryngopharyngeal reflux, lansoprazole, quality of life DOI: http://dx.doi.org/10.15395/mkb.v44n4.215
Hubungan Kadar Seng Plasma dengan Derajat Penyakit Pneumonia Winarni, Paramita Diah; Rachmadi, Dedi; Sekarwana, Nanan
Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Pneumonia merupakan masalah kesehatan utama anak di dunia dan sebagai penyebab terbanyak morbiditas dan mortalitas anak di negara berkembang. Anak dengan defisiensi mikronutrien termasuk seng berisiko tinggi terjadi pneumonia, karena gangguan sistem imun. Penelitian ini bertujuan mengetahui hubungan kadar seng plasma dengan pneumonia, pneumonia berat, dan sangat berat pada anak usia 2–59 bulan. Penelitian observasi analitik dengan rancangan potong lintang dilakukan bulan Agustus sampai November 2009 di Departemen Ilmu Kesehatan Anak RS Dr. Hasan Sadikin Bandung, RS Ujung Berung, dan RS Cibabat. Subjek harus memenuhi kriteria diagnosis klinis pneumonia menurut World Health Organization (WHO) Indonesia dan berusia 2–59 bulan. Pengambilan sampel darah untuk pemeriksaan kadar seng plasma dilakukan saat penderita datang. Analisis data menggunakan uji eksak Fisher dan untuk melihat hubungan kadar seng plasma dengan derajat pneumonia menggunakan uji Mann-Whitney. Dari total 42 subjek yang memenuhi kriteria inklusi, didapatkan 1 (2%) anak pneumonia, 32 (76%) pneumonia berat, dan 9 (22%) pneumonia sangat berat. Terdapat perbedaan bermakna (p=0,032) kadar seng plasma antara kelompok pneumonia berat dan sangat berat dengan median 96,685 μg/dL (57,32–195,66 μg/dL) untuk penumoia berat dan 80,240 μg/dL (63,01–111,84 μg/dL) untuk pneumonia sangat berat. Penelitian ini menunjukkan bahwa bahwa kadar seng plasma memiliki hubungan dengan pneumonia berat dan sangat berat pada anak usia 2–59 bulan. [MKB. 2012;44(4):213–17].Kata kunci: Pneumonia, seng plasma, sistem imun Association Plasma Zinc Level with Severity of PneumoniaPneumonia is a major health problem affecting children all over the world and remains a major cause of childhood morbidity and mortality in developing countries. Children with micronutrients deficiency including zinc, which might cause immune system disorder, have higher risk to have pneumonia. The aim of this study was to investigate the association between plasma zinc level and pneumonia, severe, and very severe pneumonia in children aged 2–59 months. This observational analytic with cross-sectional study was performed at the Pediatric Department of Dr. Hasan Sadikin General Hospital, Ujung Berung Hospital and Cibabat Hospital, in August to November 2009. Subjects of this study were 2–59-month-old children who meet the WHO Indonesian classification for pneumonia. Blood samples for plasma zinc examination were collected on admission. Data were analysed using exact Fisherand Mann-Whitney test for the association between plasma zinc level and severity of pneumonia. A total of 42 subjects were enrolled, 1 (2%) child were classified as having pneumonia, 32 (76%) children with severe, and 9 (22%) with very severe pneumonia. There were significant differences (p=0.032) in plasma zinc levels between severe and very severe pneumonia with a median of 96.685 μg/dL (57.32–195.66 μg/dL) for severe pneumonia and 80.240 μg/dL (63.0–111.84 μg/dL) for very severe pneumonia. This study shows an association between plasma zinc levels and severe and very severe pneumonia in children aged 2–59 months. [MKB. 2012;44(4):213–17].Key words: Pneumonia, plasma zinc, immune system DOI: http://dx.doi.org/10.15395/mkb.v44n4.177
Hubungan Faktor Risiko, Status Instabilitas Mikrosatelit, dan Ekspresi P53 dengan Karsinogenesis Adenokarsinoma Kolorektal pada Orang Indonesia Lukman, Kiki; Yuniasari, Laely; Hernowo, Bethy S.
Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Berbeda dengan berbagai negara lain, karakteristik molekuler adenokarsinoma kolorektal (AKK) pada orang Indonesia di dalam kelompok usia ≤40 tahun memiliki kesamaan dengan kelompok usia >40 tahun, dan keduanya berada pada jalur karsinogenesis sporadik. Untuk mengetahui hubungan karakteristik molekuler dengan berbagai faktor risiko AKK, dilakukan penelitian potong lintang yang mempelajari hubungan berbagai faktor risiko, status instabilitas mikrosatelit (IM), dan ekspresi P53 (instabilitas kromosom=IK) pada 39 penderita AKK yang memenuhi kriteria inklusi di Rumah Sakit Dr. Hasan Sadikin Bandung dalam periode Maret 2009−Maret 2010. Diperoleh masing-masing 21 dan 18 penderita AKK laki-laki dan perempuan, serta 17 dan 22 penderita berusia >40 dan ≤40 tahun. Dilakukan pemeriksaan imunohistokimia ekspresi gen MLH1, MSH2, dan p53 untuk menentukan status IM dan IK. Hasilnya adalah penderita AKK ≤40 tahun menunjukkan 4 IM tinggi, 1 IM rendah, dan 17 IM negatif, serta 10 status P53 positif dan 12 P53 negatif. Penderita AKK >40 tahun menunjukkan 4 IM rendah, dan 13 IM negatif, yang disertai oleh 11 status P53 positif dan 6 status P53 negatif. Pada kedua kelompok tersebut tidak didapatkan perbedaan yang bermakna (p>0,05) dalam pola hubungan berbagai faktor risiko AKK dengan karakteristik molekulernya. Pola diet tinggi lemak dan protein, rendah serat, overweight, merokok, dan aktivitas fisik rendah ditemukan sebagai faktor risiko yang berperan pada kedua kelompok tersebut. Simpulan, mayoritas penderita AKK pada orang Indonesia memiliki klasifikasi molekuler berupa status IK tinggi dan status IM rendah, serta berhubungan dengan faktor risiko diet tinggi lemak dan protein, rendah serat, overweight, merokok, dan aktivitas fisik rendah. [MKB. 2012;44(4):245–52]Kata kunci: Ekspresi P53, faktor risiko, instabilitas mikro-satelit, karsinogenesis adenokarsinoma kolorektalThe Association of Risk Factors, Microsatellite Instability, and P53 Expression in the Carcinogenesis of Colorectal Adenocarcinoma among IndonesianDifferent from developed countries, molecular characteristic of colorectal adenocarcinoma (CRC) among Indonesians in the age group of ≤40 years old is mostly similar compared to the CRC of the age group of >40 years old, and both are sporadic cancers. To know the association of molecular characteristic with the risk factors of CRC, a cross sectional study was conducted to analyze the association of risk factors, microsatellite instability (MSI) and P53 expression (chromosomal Instability=CIN) status in 39 consecutive CRC patients who were eligible for this study at Dr Hasan Sadikin Hospital, from March 2009 until March 2010. They consisted of 21 male and 18 female patients. Of them, there were 17 and 22 patients with>40 and≤40 years of age, respectively. The immuno-histochemistry examinations for the expression of mutated MLH1, MSH2 and p53 genes were conducted to determine the CIN and MSI status. The results showed that the CRC ≤40 years of age had 4 MSI high, 1 MSI low, and 17 MSI negative, associated with 10 P53 positives and 12 p53 negatives. By contrast, in the CRC >40 years of age the MSI was low and negative in 4 and 13 cases, respectively. They were associated with 11 and 6 of p53 positive and negative status, respectively. Between the two groups, there were no significant differences with regards to the association pattern between the risk factors and their molecular characteristics (p>0.05). Conclusions, majority of CRC patients among Indonesian show a molecular classification of high CIN and low MSI, and is associated with risk factors of high fat and protein, low fiber dietary intake, overweight, smoking, and low physical activitis. [MKB. 2012;44(4):245–52]Key words: Carcinogenesis of colorectal carcinoma, expression of P53, microstallite instability, risk factors DOI: http://dx.doi.org/10.15395/mkb.v44n4.216
KADAR PROTEIN S-100 SERUM PENDERITA FRAKTUR OROMAKSILOFASIAL YANG DISERTAI CEDERA KEPALA RINGAN Miguna, Hayana; Arifin, Muhammad Zafrullah
Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Penderita fraktur oromaksilofasial sering disertai dengan cedera kepala karena letak dan strukturnya yang berdekatan. Penilaian kemungkinan untuk lesi intrakranial setelah cedera kepala ringan merupakan tantangan utama dalam mendiagnosisnya. Salah satu metode yang dapat digunakan yaitu dengan menggunakan biomarker (petanda biokimia) protein S-100 serum yang merupakan protein neuron-spesifik. Tujuan penelitian adalah untuk menilai peningkatan kadar protein S-100 serum dan melihat perbedaannya berdasarkan lokasi fraktur oromaksilofasial pada cedera kepala ringan. Penelitian ini menggunakan metode studi kasus kontrol yang dilakukan di RS Dr. Hasan Sadikin Bandung pada bulan November 2010?Januari 2011. Sampel berjumlah 76 orang yang terdiri atas 38 penderita dewasa fraktur oromaksilofasial disertai dengan cedera kepala ringan dan 38 orang dewasa sehat sebagai kontrol. Hasil penelitian menunjukkan bahwa pada penderita fraktur oromaksilofasial dengan cedera kepala ringan diperoleh kadar protein S-100 serum rata-rata meningkat sebanyak dua kali lipat, yang secara statistik signifikan dengan t hitung=2,26 atau nilai p=0,0135. Bila kelompok penderita yang satu dibandingkan dengan kelompok penderita lainnya, maka didapatkan hasil yang tidak signifikan secara statistik atau dapat dikatakan mempunyai kadar protein S-100 serum yang sama. Simpulan, pada penderita dewasa fraktur oromaksilofasial disertai cedera kepala ringan terdapat peningkatan kadar protein S-100 serum dan tidak terdapat perbedaan kadar protein S-100 serum berdasarkan lokasi fraktur oromaksilofasial. [MKB. 2012;44(4):233?39].Kata kunci: Cedera kepala ringan, fraktur oromaksilofasial, protein S-100 serumSerum Levels of S-100 Protein in Oromaxillofacial Fracture Patients with Mild Head InjuryOromaxillofacial fracture is often accompanied by head injury due to its adjacent location and structure. Risk estimation for clinically relevant intracranial lesions after minor head injury remains a major diagnostic challenge. One possible method to evaluate the possibility of intracranial lesion is by using biomarkers (biochemical marker) protein S-100. Protein S-100 is a neuron-specific protein. The aim of present study was to assess the elevated levels of S-100 protein serum and to investigate whether there was any difference in the S-100 protein serum concentrations depending on the location of the oromaxillofacial fractures in mild head injury. This study was performed using analytic observational method with case control research design conducted at Dr. Hasan Sadikin General Hospital Bandung between November 2010 and January 2011. There were 76 samples, comprised of 38 adult patients with oromaxillofacial and mild head injury and 38 healthy adults as a control group. The result showed that there was an increase level of S-100 protein serum concentrations in patients having oral and maxillofacial fractures with mild head injury. The concentration increased on average twice as much, which was statistically significant at t test=2.26 with p-value=0.0135. If one group of patients was compared with other patient groups, however, the results were not statistically significant, or it can be stated to have the same level of S-100 protein serum concentrations. In conclusion, oral and maxillofacial fractures in adult patients with mild head injury have elevated levels of S-100 protein serum concentrations and there is no difference in S-100 protein serum concentrations based on the location of oromaxillofacial fractures in mild head injury. [MKB. 2012;44(4):233?39].Key words: Mild head injury, oromaxillofacial fracture, S-100 protein serum DOI: http://dx.doi.org/10.15395/mkb.v44n4.178
Diet-Induced Changes in Serum Ganglioside Spectrum Patterns in 6-Month-Old Infants Gurnida, Dida A.; Idjradinata, Ponpon; Muchtadi, Deddy; Sekarwana, Nanan; Fong, Bertram; McJarrow, Paul; Rowan, Angela; Norris, Carmen
Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Human milk contains higher levels of gangliosides when compared to infant formula. Gangliosides play a role in neuronal growth, migration, maturation, sinaptogenesis, and myelination. Seven of the identified gangliosides (GM1, GM2, GM3, GD3, GD1a, GD1b, and GT1b) are dominant gangliosides with different specific functions. Thus, the aim of the study was to understand the effects of ganglioside-enhanced diet and to compare the spectrum patterns of those seven classes of serum gangliosides in infants consuming standard infant formula (IF group), ganglioside-fortified infant formula (GA group) and exclusive breastfeeding (BF group). This study used liquid chromatography–mass spectrometry (LC-MS) method. This was a prospective study involving 30 infants in IF group, 29 in GA group and 32 in BF group. Subject recruitment was performed using consecutive admission  approach from March 2008 to February 2009 in Bandung. Statistical analyses using Wilcoxon test showed that there was a significant change in the spectrum patterns of GD3, GM1, GM2 and GT1b in IF group; of GD1a, GM1 and GM2 in GA group and of GD1a, GD1b, GM1 and GM3 in BF group. It is concluded that ganglioside-enriched diet extends spectrum patterns of gangliosides especially in seven of them, i.e. GM1, GM2, GM3, GD3, GD1a, GD1b, and GT1b, in 6-month old infants. [MKB. 2012;44(4):240–44]..Key words: Gangliosides, human milk, infants, infant formula, LC-MSPerubahan Pola Spektrum Gangliosida Serum yang Diinduksi Makanan pada Bayi Usia 6 BulanAir susu ibu (ASI) mengandung gangliosida yang kadarnya lebih tinggi dibandingkan dengan susu formula. Gangliosida berperan dalam pertumbuhan, migrasi, maturasi saraf, sinaptogenesis, dan mielinisasi. Tidak kurang dari 100 tipe gangliosida telah ditemukan, tujuh di antaranya (GM1, GM2, GM3, GD3, GD1a, GD1b, dan GT1b) merupakan kelas utama dengan fungsi yang berbeda. Penelitian ini bertujuan untuk mengetahui efek penambahan diet gangliosida serta membandingkan pola spektrum tujuh kelas gangliosida serum tersebut pada bayi yang mengonsumsi susu formula standar (kelompok infant formula/IF), susu formula difortifikasi gangliosida (kelompok GA), dan ASI eksklusif (kelompok breastfeeding/BF). Penelitian ini menggunakan metode liquid chromatography-mass spectrometry (LC-MS) untuk menghitung kadar ketujuh kelas gangliosida tersebut. Penelitian ini adalah penelitian prospektif yang melibatkan 30 bayi kelompok IF, 29 bayi kelompok GA, dan 32 bayi kelompok BF. Perekrutan subjek penelitian dilakukan dengan cara consecutive admission dari bulan Maret 2008 sampai bulan Februari 2009 di Bandung. Analisis statistik tes Wilcoxon menunjukkan perubahan bermakna pada pola spektrum GD3, GM1, GM2 dan GT1b pada kelompok IF; GD1a, GM1, dan GM2 pada kelompok GA; GD1a, GD1b, GM1, dan GM3 pada kelompok BF. Kesimpulan, penambahan diet gangliosida akan meningkatkan 7 spektrum gangliosida yaitu GM1, GM2, GM3, GD3, GD1a, GD1b, dan GT1b pada anak usia 6 bulan. [MKB.2012;44(4):240–44].Kata kunci: ASI, bayi, gangliosida, LC-MS, susu formula DOI: http://dx.doi.org/10.15395/mkb.v44n4.217

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