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"Background: treatment guidelines for ulcerative colitis (UC) not yet established. Currently, mesalazine, corticosteroids, and immunomodulators are treatment options for UC. However, they are known to have unpleaseant side effects such as nausea, vomiting, headaches, hepatitis, and male infertility. Curcumin is found in Turmeric plants (Curcuma longa L.), which possesses both anti-inflammatory and antioxidant properties. This study aimed to determine whether curcumin as adjuvant therapy can induce or maintain remission in UC

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Latar belakang: panduan tatalaksana untuk kolitis ulseratif (KU) belum tersedia. Saat ini, mesalazine, kortikosteroid, dan imunomodulator merupakan pilihan terapi untuk KU. Namun, obat-obatan tersebut memiliki efek samping yang tidak menyenangkan, misalnya mual, muntah, sakit kepala, hepatitis, dan infertilitas pria. Curcumin terdapat dalam tanaman Kunyit (Curcuma longa L.) yang memiliki aktivitas anti inflamasi dan antioksidan."

"Nekrosis avaskular adalah suatu kondisi di mana sel-sel tulang mati karena kurangnya aliran darah. Kondisi ini sering dijumpai pada pasien yang mengonsumsi kortikosteroid dosis tinggi. Sedangkan kortikosteroid dosis tinggi yang sering diberikan pada pasien Systemic Lupus Erythematosus (SLE) menunjukkan adanya hubungan antara AVN dan SLE karena regimen pengobatan itu sendiri. Hal ini memungkinkan untuk menyelidiki faktor mana pada pasien SLE yang dapat mempengaruhi perkembangan AVN. Metode: Sebanyak 22 rekam medis pasien dari RSUPN Cipto Mangunkusumo dicatat dan dianalisis. Sampel yang diambil terdiri dari pasien yang didiagnosis dengan SLE dan kemudian berkembang menjadi AVN. Setiap faktor risiko kemudian dianalisis untuk mengetahui besarnya signifikansi masing-masing faktor risiko terhadap AVN. Hasil: Dari semua faktor risiko yang dianalisis, hanya kortikosteroid dosis kumulatif (p <0,05) yang bermakna dengan terjadinya AVN. Faktor risiko lain tidak signifikan. SLEDAI dan antibodi antifosfolipid tidak dapat dianalisis karena kurangnya data. Kesimpulan: Kortikosteroid dosis tinggi akan mempengaruhi AVN sekunder pada pasien SLE sedangkan tidak ada hubungan yang pasti antara skor SLEDAI dan antibodi antifosfolipid.

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Avascular necrosis is a condition in which bone cells die due to a lack of blood flow. This condition is often seen in patients taking high doses of corticosteroids. Meanwhile, high doses of corticosteroids that are often given to patients with Systemic Lupus Erythematosus (SLE) indicate a relationship between AVN and SLE because of the treatment regimen itself. This made it possible to investigate which factors in SLE patients might influence AVN development.

Methods: A total of 22 patient medical records from RSUPN Cipto Mangunkusumo were recorded and analyzed. The sample taken consisted of patients who were diagnosed with SLE and later developed an AVN. Each risk factor was then analyzed to determine the significance of each risk factor for AVN.

Results: Of all the risk factors analyzed, only the cumulative dose of corticosteroid (p <0.05) was significant with the occurrence of AVN. Other risk factors are not significant. SLEDAI and antiphospholipid antibodies could not be analyzed due to lack of data.

Conclusion: High doses of corticosteroids will affect secondary AVN in SLE patients whereas there is no definite relationship between SLEDAI score and antiphospholipid antibodies."

"Sistem imun adalah suatu sistem yang kompleks terdiri dari sel, jaringan, organ, serta mediator yang terlibat untuk mempertahankan integritas tubuh kita terhadap serangan asing yang mengancam. Sistem imun tubuh yang tidak seimbang dan terganggu dapat dimodulasi dengan menggunakan imunomodulator. Dilakukan studi literatur mengenai obat-obatan golongan imunomodulator yang bekerja dengan cara imunorestorasi, imunostimulan, dan imunosupresan. komponen imunorestorasi adalah Immune Serum Globulin (ISG), Hyperimmune Serum Globulin (HSG), plasma, plasmapheresis, dan leukopheresis. Bahan-bahan yang dapat menjadi imunostimulator dapat bersumber dari bahan biologis dan bahan sintetik. Contoh golongan obat imunosupresan adalah kortikosteroid, antimetabolit, penghambat kalsineurin, dan agen biologis.

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The immune system is a complex system of cells, tissues, organs, and mediators involved in maintaining the integrity of our body against foreign invaders. An unbalanced and compromised immune system can be modulated by using immunomodulators. A literature study was conducted on immunomodulatory drugs that work by immunorestoration, immunostimulants, and immunosuppressants. Immunorestoration components are Immune Serum Globulin (ISG), Hyperimmune Serum Globulin (HSG), plasma, plasmapheresis, and leukopheresis. Materials that can be immunostimulators can be sourced from biological materials and synthetic materials. Examples of immunosuppressant drugs are corticosteroids, antimetabolites, calcineurin inhibitors, and biological agents."

"Background: health workers are one of the groups affected physically as well as psychologically from the pandemic. Recent studies showed many of the health workers reported experiencing anxiety, depression, and insomnia. This study aims to identify psychotherapy as a psychological health intervention, for healthcare workers during the COVID-19 pandemic. Methods: an evidence based clinical review of psychotherapy as a psychological health intervention, reported in the literature, which is developed for healthcare workers during the COVID-19 pandemic. The review was conducted following set out for Evidence-based clinical review by searching the following digital libraries: PubMed, ProQuest, Cochrane, and Google Scholar. Results: six publications were selected. The identified psychotherapy used as a mental or psychological intervention for healthcare workers during COVID-19 consists of supportive psychotherapy, psychoeducation, social support, and music therapy. Overall, it shows that psychotherapy, especially supportive psychotherapy, can reduce anxiety, depression, and insomnia. Conclusion: the physiological condition of health workers needs to get attention during the COVID-19 pandemic. Although there is no standard of therapy yet, psychotherapy could be an option as it is proven to be able to reduce anxiety, depression, and insomnia."

"Background: resistive index (RI) is highly utilised to assess the graft function using Doppler ultrasonography. The RI has been shown as the best ultrasound parameter to assess kidney allograft dysfunction. Several studies have established the role of the RI as a predictor of transplant failure. However, these studies were using RI measurement in the later stages post transplantation. The present study has conducted to identify the association between early RI measurement and early graft function represented as delayed graft function (DGF) and immediate graft function (IGF), as well as long-term graft survival. Methods: an evidence based clinical review of studies published before May 2018 was conducted from Medline, Science Direct, EMBASE and Cochrane databases. Studies on early measurement of RI whereby the primary or secondary goals of the study related to graft function and/or graft survival were included. Studies using late RI measurement and without RI value groups were excluded. The Mantzel Haenzel method was used to analyse pooled risk ratio and 95% confidence interval, while the heterogeneity of the study was calculated through I2 value. Data analysis was performed using Review Manager 5.3. Results: nine studies with a total of 1802 patients who had undergone a kidney transplant were analysed. DGF was found in 19% (193/1015) of the low RI group and in 42.8% (337/787) of the high RI group (RR 2.04 (95% CI 1.72 - 2.41), p < 0.00001, I2 = 28%). IGF was found in 39.5% (62/157) of the low RI group and in 10.5% (28/268) of the high RI group (RR 0.26 (95% CI 0.17 0.40), p < 0.00001, I2 = 0%). Long term graft survival, with follow up between 60 144 months, was found in 83% (701/845) of the low RI group and in 69.4% (395/569) of the high RI group (RR 0.82 (95% CI 0.72 0.93), p = 0.002, I2 = 63%). Conclusion: the results of this study emphasise the association between early measurement of RI and early graft function, and longterm graft survival. An elevated RI provides the chance of recognizing the patients with poor longterm prognosis, from the first moment after kidney transplant.

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Latar belakang: pemeriksaan Resistive Index (RI) sering dilakukan untuk menilai fungsi organ transplant dengan menggunakan alat Doppler ultrasonography. Hasil pemeriksaan RI merupakan parameter terbaik untuk menilai disfungsi ginjal transplant. Beberapa studi telah menunjukkan peran RI sebagai prediktor kegagalan transplantasi namun studi-studi tersebut menggunakan hasil RI yang tidak segera pasca transplantasi. Tujuan studi ini untuk mengidentifikasi hubungan antara hasil pemeriksaan RI yang dilakukan segera pasca transplantasi dengan fungsi awal ginjal transplant yang direpresentasikan oleh delayed graft function (DGF) dan immediate graft function (IGF) beserta angka kelangsungan hidup ginjal transplant dalam jangka waktu lama.

Metode:artikel yang merupakan tinjauan klinis berbasis bukti dilakukan pada penelitian yang dipublikasikan sebelum Mei 2018 menggunakan sumber dari Medline, Science Direct, EMBASE dan Cochrane. Penelitian yang mengukur hasil RI segera pasca transplantasi dimana tujuan utama atau tujuan sekundernya berkaitan dengan fungsi ginjal transplant dan/atau angka kelangsungan hidup ginjal transplant dimasukkan ke dalam studi ini. Penelitian yang mengukur hasil RI tidak segera pasca transplantasi dan tanpa kelompok tingkat RI, tidak dimasukkan ke dalam studi ini. Metode Mantzel-Haenzel digunakan untuk menganalisis pooled risk ratio dan 95% interval kepercayaan, sementara heterogenitas dianalisis melalui tingkat I2. Analisis menggunakan program Review Manager 5.3.

Hasil:analisis dilakukan pada sembilan penelitian dengan total pasien sebanyak 1802 pasca transplantasi ginjal. DGF ditemukan pada 19% (193/1015) pasien di kelompok RI rendah dan 42.8% (337/787) pasien di kelompok RI tinggi (RR 2.04 (95% IK 1.72-2.41), p < 0.00001, I2 = 28%). IGF ditemukan pada 39.5% (62/157) pasien di kelompok RI rendah dan 10.5% (28/268) pasien di kelompok RI tinggi (RR 0.26 (95% IK 0.17-0.40), p < 0.00001, I2 = 0%). Ginjal transplant yang masih berfungsi ditemukan pada 83% (701/845) pasien di grup RI rendah dan 69.4% (395/569) pasien di grup RI tinggi (RR 0.82 (95% IK 0.72-0.93), p = 0.002, I2 = 63%), dengan follow-up antara 60-144 bulan.

Kesimpulan: hasil studi ini menegaskan hubungan antara hasil pemeriksaan RI yang dilakukan segera pasca transplantasi dengan fungsi awal ginjal transplant dan kelangsungan hidup ginjal transplant dalam jangka waktu lama. Peningkatan RI memberikan peluang untuk mengenali pasien dengan prognosis jangka panjang yang buruk, bahkan disaat-saat awal pasca transplantasi ginjal"

"Latar Belakang: Kolitis ulseratif distal merupakan kolitis ulseratif yang paling sering ditemukan. Dibandingkan dengan terapi oral, terapi topikal kurang banyak digunakan pasien. Satu studi melaporkan bahwa terapi oral digunakan pada 35,6% pasien sedangkan terapi topikal hanya digunakan pada 6,7% pasien. Namun demikian, berbagai studi yang menilai terapi topikal tersebut memberikan hasil yang inkonsisten.Tujuan: Mengetahui efektivitas pemberian beberapa terapi topikal dalam tatalaksana kolitis ulseratif distal derajat ringan dan sedang.Sumber Data: Penelusuran studi dilakukan hingga September 2020 pada empat basis data: PubMed/MEDLINE, Cochrane, ProQuest, dan SCOPUS. Pencarian sekunder dilakukan dengan teknik snowballing pada referensi studi yang ditemukan, pencarian melalui ClinicalTrial.Gov, pencarian melalui Garuda, dan Global Index Medicus.Seleksi Studi: Studi randomized controlled trial (RCT). Subyek merupakan pasien kolitis ulseratif distal derajat ringan dan sedang. Studi dengan intervensi yang dilakukan berupa terapi topikal 5-ASA enema, kortikosteroid enema, asam hialuronat enema. Luaran efektivitas yang dinilai berdasarkan respon klinis, remisi klinis, profil keamanan dan efek samping terapi tersebut. Tidak dilakukan pembatasan bahasa maupun waktu.Ekstraksi Data: Ekstraksi data dilakukan oleh kedua peninjau secara independen. Hasil: Respon klinis ditunjukkan pada pemberian 5-ASA enema dibandingkan plasebo enema (RR 2.48, IK 95% 1.81-3.38, p<0.00001). NNT 3 (IK 95% 2-4). Remisi klinis ditunjukkan pada pemberian kortikosteroid enema dibandingkan plasebo enema (RR 1.98, IK 95% 1.59-2.45, p<0.00001). NNT 5 (IK 95% 4-7). Tidak terdapat perbedaan antara pemberian 5-ASA enema bila dibandingkan dengan kortikosteroid enema baik Beclomethasone diproprionate enema (RR 1.04, IK 95% 0.70-1.54, p=0.85) dan Budesonide enema (RR 1.26, IK 95% 0.91-1.73, p=0.16). Asam hialuronat enema merupakan terapi topikal baru yang cukup aman dan efektif namun membutuhkan penelitian lebih lanjut dengan kualitas penelitian yang lebih baik. Terapi topikal memiliki profil keamanan yang baik. Sebagian besar adverse event ringan dan tidak signifikan.Kesimpulan: 5-ASA enema dan kortikosteroid enema efektif dalam mencapai respon dan remisi klinis bila dibandingkan dengan plasebo. Tidak terdapat perbedaan antara 5-ASA enema bila dibandingkan dengan kortikosteroid enema

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Background: Distal ulcerative colitis is the most common ulcerative colitis. Compared with oral therapy, topical therapy is less used by patients. One study reported that oral therapy was used in 35.6% of patients whereas topical therapy was used in only 6.7% of patients. However, studies assessing this topical therapy have yielded inconsistent results. Objective: To determine the effectiveness of topical therapy in the management of mild and moderate distal ulcerative colitis. Data Source: Study searching was done through September 2020 on four databases: PubMed / MEDLINE, Cochrane, ProQuest, and SCOPUS. Secondary searching was done by snowballing method of the study references, searching through ClinicalTrial.Gov, Garuda, and the Global Index Medicus. Study Selection: A randomized controlled trial (RCT). Subjects were mild and moderate distal ulcerative colitis patients. Intervention studies included topical 5-ASA enema therapy, corticosteroid enema, and hyaluronic acid enema. The effectiveness outcome was assessed based on clinical response, clinical remission, safety profile and side effects of the therapy. There are no language or time restrictions. Data Extraction: Data extraction was done by both reviewers independently. Results: Clinical response was shown in 5-ASA enema versus placebo enema (RR 2.48, CI 95% 1.81-3.38, p <0.00001). NNT 3 (CI 95% 2-4). Clinical remission was shown in corticosteroid enema versus placebo enema (RR 1.98, CI 95% 1.59-2.45, p <0.00001). NNT 5 (CI 95% 4-7). There was no difference between 5-ASA enema administration when compared to corticosteroid enema, Beclomethasone diproprionate enema (RR 1.04, 95% CI 0.70-1.54, p = 0.85) and Budesonide enema (RR 1.26, CI 95% 0.91 -1.73, p = 0.16). Hyaluronic acid enema is a new topical therapy that is quite safe and effective in achieving clinical response and remission but requires further research with better research quality. Topical therapies have a good safety profile. Most of the adverse events were mild and insignificant. Conclusion: 5-ASA enemas and corticosteroid enemas were effective in achieving clinical response and remission when compared to placebo. There was no difference between 5-ASA enemas when compared with corticosteroid enemas"

"This is the first book manages to provide comprehensive and updated scientific evidence of the effectiveness of acupuncture and moxibustion intervention for cancer care. Laboratory and animal studies have uncovered the mechanisms of acupuncture and moxibustion for cancer therapy. Promising results of most clinical trials show the efficacy and safety of acupuncture and moxibustion in cancer management. This book consists of fifteen chapters which address a range of important aspects that will impact on the application of acupuncture and moxibustion. An overview of the safety and side effects of acupuncture and moxibustion for cancer care are also covered. In addition, the integration of acupuncture with Western medicine in cancer treatment and recent clinical trials are included as well."

"This book introduces the key ideas of evidence-based clinical social work practice and their thoughtful application. This book lays out the many strengths of the EBP model, but also offers perspectives on its limitations and challenges. Practical issues (agency supports, access to research resources, help in appraising research) are addressed and some practical solutions offered. Ethical issues in assessment/diagnosis, working with diverse families to make treatment decisions, and delivering complex treatments requiring specific skill sets are also included."