Hasil Pencarian  ::  Simpan CSV :: Kembali

"Infeksi sistem saraf pusat SSP merupakan masalah yang sangat serius dalam bidang neurologi di seluruh dunia. Infeksi SSP biasanya diduga atas dasar presentasi klinis pasien, namun diagnosis berdasarkan gejala dan tanda klinis memiliki kelemahan, sehingga deteksi dan penatalaksanaan yang tidak tepat menyebabkan infeksi SSP berkembang cepat dengan morbiditas dan mortalitas yang tinggi. Pada penelitian ini, dari bahan cairan serebrospinal CSS akan dilakukan deteksi dan identifikasi bakteri dan virus guna mengetahui penyebab infeksi SSP. Penelitian ini menggunakan sisa sampel CSS dari pasien yang diperiksakan di laboratorium Departemen Patologi Klinik RSUPN CM dengan diagnosis berhubungan dengan infeksi/inflamasi. Spesimen CSS diperiksakan pewarnaan Gram langsung, biakan pada media agar, dan pendekatan molekular menggunakan primer gen 16S rRNA, lytA dan sebelas panel spesifik virus. Koloni yang tumbuh pada agar darah dilanjutkan dengan pemeriksaan pewarnaan Gram dan uji biokimia, serta MALDI-TOF-MS. Untuk bakteri, hasil kemudian dibandingkan, sedangkan untuk virus dilakukan analisis genomik.Dari 147 spesimen CSS, proporsi bakteri Streptococcus pneumoniae sebagai penyebab infeksi SSP dengan metode Gram langsung, biakan, dan qPCR adalah 0,7 dan dengan metode qPCR terget gen lytA saja adalah 2 , sedangkan proporsi virus dengan metode PCR adalah 4,1 . Berdasarkan identifikasi morfologi dan biokimia dari biakan yang tumbuh, berhasil didapatkan 1 isolat Streptococcus pneumoniae, 5 isolat Staphylococcus epidermidis, 1 isolat Staphylococcus saprophyticus, dan 1 isolat Streptococcus dysgalactiae. Berdasarkan hasil uji biokimia dan MALDI-TOF-MS, terdapat 1 isolat memiliki kesamaan jenis bakteri sampai tingkat spesies dan 8 isolat memiliki kesamaan pada tingkat genus. Streptococcus pneumoniae yang ditemukan adalah serotipe 6B, dan bersifat resistan terhadap oxacillin dan trimetoprim-sulfametoxazole. Untuk virus, terdeteksi 1 spesimen positif virus Influenza A dan 5 Herpes virus dari pemeriksaan terhadap 147 spesimen CSS. Analisis sekuens yang diperoleh menunjukkan bahwa virus Influenza tersebut adalah virus Influenza A subtipe H1N1, dan 5 Herpes virus adalah Human betaherpesvirus 5 strain HANSCTR2.Peran diagnostik 16S rRNA dalam deteksi infeksi bakteri pada CSS tidak dapat dinilai, namun penggunaan gen lytA untuk mendeteksi infeksi Streptococcus pneumoniae adalah lebih sensitif dibandingkan dengan biakan. Identifikasi bakteri menggunakan metode biakan-uji biokimia dan biakan-MALDI-TOF-MS memiliki tingkat kesesuaian yang baik sampai pada tingkat genus. Penggunaan primer spesifik virus mampu mendeteksi virus dari bahan CSS. Gambaran analisis CSS pada infeksi bakteri memiliki kesamaan dengan non-infeksi.

---

Central nervous system CNS infection is a very serious problem worldwide. The disesase is usually suspected based on patient 39;s clinical presentation, however this diagnosis has weaknesses, whereas an inaccuracy detection and management can cause high morbidity and mortality risk. This study aimed to detect and identify bacteria and virus from cerebrospinal fluid CSF, in order to determine the causes of CNS infection. This study investigated the remained CSF samples from patients examined at the laboratory of Clinical Pathology Department, Cipto Mangunkusumo hospital. The diagnosis or clinical information was related to infection or inflammation. The CSF specimens were examined by direct Gram staining, inoculated on blood agar media, and extracted for amplification using 16S rRNA, lytA and eleven viral specific primers. Colonies that grew on blood agar were stained and tested by biochemical tests, as well as MALDI-TOF-MS. For bacteria, all results were compared, and for the virus, the genomic sequence was analyzed. From 147 cerebrospinal fluid specimens, the proportion of Streptococcus pneumoniae as the etiology of CNS infection by using 3 methods direct Gram, culture, and qPCR lytA gene target was 0,7, while using qPCR lytA the proportion was 2. The proportion of virus by using PCR method was 4.1. Bacterial species isolated during culture on blood agar were Streptococcus pneumoniae 1 isolate, Staphylococcus epidermidis 5 isolates, Staphylococcus saprophyticus 1 isolate , and Streptococcus dysgalactiae 1 isolate. Based on biochemical and MALDI-TOF-MS test results, 1 isolate had the same type of bacteria to the species level and 8 isolates had similarity at the genus level. The serotypes of Streptococcus pneumoniae isolated from CSF were serotype 6B, and non-susceptible to oxacillin and trimethoprim-sulfamethoxazole. For the virus, 1 positive specimen of Influenza virus and 5 Herpes virus were detected. The sequence analysis of Influenza virus showed that the virus was Influenza A virus, subtype H1N1, and for 5 Herpes virus were Human betaherpesvirus 5 strain HANSCTR2. The use of 16S rRNA in the detection of bacterial infections in CSF could not be assessed, but the use of lytA gene in detecting Streptococcus pneumoniae showed higher senstivity compare to culture. Bacterial identification using biochemical methods and MALDI-TOF-MS had a reliable identification up to the genus level. The use of virus-specific primers was capable of detecting viruses from CSF materials. The CSF analysis on bacterial infections had similarities with non-infections."

"Latar belakang: Infeksi susunan saraf pusat (SSP) dapat berakibat fatal bagi anak. Salah satu komplikasi infeksi SSP adalah gangguan keseimbangan natrium yang dapat menyebabkan keterlambatan diagnosis, memperberat gejala infeksi SSP, dan berkaitan dengan luaran buruk. Meskipun demikian, masih sedikit penelitian yang berupaya memprediksi gangguan keseimbangan natrium pada anak dengan infeksi SSP.Tujuan: Penelitian ini bertujuan untuk mengidentifikasi dan memprediksi gangguan keseimbangan natrium pada anak dengan infeksi SSP.Metode: Penelitian ini merupakan studi prognostik dengan rancangan penelitian kohort retrospektif di RSCM menggunakan data rekam medis dari Januari 2020-Desember 2023. Subyek yang diteliti ialah anak berusia >1 bulan sampai 18 tahun yang mengalami infeksi SSP. Prediktor yang diteliti adalah penurunan kesadaran saat masuk rumah sakit, dugaan patogen penyebab, sepsis, kelainan struktural kranioserebral sebelumnya, dan kejang sebelum masuk RS.Hasil: Terdapat 76 subyek yang mengalami infeksi SSP. Median usia subyek ialah 1,61 tahun (rentang 0,09-17,14 tahun). Proporsi lelaki dan perempuan hampir sama dengan lelaki sebanyak 39 (51,3%). Jenis infeksi SSP terbanyak ialah meningitis bakterialis (22 pasien, 28,9%). Terdapat 54 episode gangguan keseimbangan natrium pada 48 subyek (63,1%). Etiologi gangguan keseimbangan natrium diketahui pada 13 pasien dengan penyebab terbanyak ialah cerebral salt wasting (CSW) pada empat subyek. Pada analisis multivariat regresi logistik hanya penurunan kesadaran saat masuk rumah sakit yang dapat memprediksi gangguan keseimbangan natrium pada subyek dengan infeksi SSP probable dan terkonfirmasi dengan RR 1,5 (IK 95% 1,033-2,176), nilai p=0,033. Gangguan keseimbangan natrium pada infeksi SSP probable dan terkonfirmasi meningkatkan risiko kematian dengan RR 7,8 (IK 95% 1,074-56,65), nilai p=0,015.Simpulan: Penurunan kesadaran saat masuk rumah sakit merupakan prediktor gangguan keseimbangan natrium pada anak dengan infeksi SSP probable dan terkonfirmasi. Gangguan keseimbangan natrium pada populasi ini dapat meningkatkan risiko kematian secara signifikan.

---

Background: Central nervous system (CNS) infection can be fatal for children. One of the complications of CNS infection is impaired sodium balance which can cause delayed diagnosis, aggravate symptoms of CNS infection, and is associated with poor outcomes. However, few studies have attempted to predict sodium balance disturbances in children with CNS infections.

Objective: This study aims to identify and predict impaired sodium balance in children with central nervous system infection.

Methods: This is a prognostic study with an retrospective cohort design at RSCM using medical record data from January 2020-December 2023. The subjects studied were children aged >1 month to 18 years who had CNS infections. The predictors studied were decreased consciousness at admission, suspected causative pathogen, sepsis, previous craniocerebral structural abnormalities, and seizures before admission.

Results: There were 76 subjects with central nervous system infection. The median age of the subjects was 1.61 years (range 0.09-17.14 years). The proportion of males and females was almost equal with males 39 (51.3%). The most common type of CNS infection was bacterial meningitis (22 subjects, 28.9%). There were 54 episodes of sodium balance disorder in 48 subjects (63.1%). The etiology of sodium balance disorders was known in 13 patients with the most common cause was cerebral salt wasting (CSW) in four subjects. In multivariate logistic regression analysis, only decreased consciousness at hospital admission predicted sodium balance disturbance in subjects with probable and confirmed CNS infection with RR 1,5 (95% CI 1,033-2,176), p value=0,033. Impaired sodium balance in probable and confirmed CNS infection increased the risk of death with RR 7,8 (95% CI 1,074-56,65), p value=0,015.

Conclusion: Decreased consciousness at hospital admission is a predictor of impaired sodium balance in children with probable and confirmed CNS infection. Impaired sodium balance in this population can significantly increase the risk of death."

"Sifilis adalah penyakit menular seksual kronik yang memiliki manifestasi klinis yang bervariasi dan menetap untuk waktu yang lama. Neurosifilis merupakan salah satu komplikasi sifilis sistemik dengan temuan di cairan serebrospinal dengan atau tanpa gejala yang jelas. Pemeriksaan yang saat ini tersedia dalam mendukung diagnosis hanya tersedia pemeriksaan analisis cairan serebrospinal dan serologi Treponema pallidum. Saat ini belum diketahui prevalensi neurosifilis di rumah sakit peneliti dan profil serologi Treponema pallidum dari bahan cairan serebrospinal. Penelitian ini merupakan penelitian potong lintang, dilakukan November 2017-Maret 2018 terhadap 50 cairan serebrospinal dan darah yang diperiksakan analisis cairan serebrospinal dengan keterangan klinis terduga infeksi intrakranial. Serum dan cairan serebrospinal diperiksakan RPR, TPHA, anti-Treponema pallidum ELISA IgG dan khusus cairan serebrospinal diperiksa pula rapid test Treponema pallidum. Uji statistik menggunakan chi quare and Fisher exact test.Dari penelitian terhadap 50 cairan serebrospinal dan serum didapatkan rapid test Treponema pallidum, RPR dan TPHA cairan serebrospinal reaktif 4(8%). Dari bahan serum didapatkan RPR reaktif 8(16%) dan TPHA reaktif 9(18%). Anti-Treponema pallidum ELISA IgG positif 4 sampel (8%). Dari 50 sampel didapatkan 7 (14%) neurosifilis, 4 confirmed neurosyphilis dan 3 probable neurosyphilis sesuai kriteria Center for Disease Control and Prevention. Profil analisis cairan serebrospinalnya tidak berwarna, jernih, tidak ada bekuan, hitung sel 12.71 ±9.20 sel/μl, dominasi mononuklear 11.57±9.47 sel/μl, Pandy positif, protein cairan 42.29±21.49 mg/dl, glukosa cairan 55±5.16 mg/dl, glukosa serum 101.04±20.10 mg/dl, dan klorida 122.14±2.48 mEq/L. Pemeriksaan RPR, TPHA, dan anti-Treponema pallidum ELISA IgG dengan bahan serum dan cairan serebrospinal memiliki hubungan bermakna. Dari penelitian ini didapatkan 14% sesuai dengan neurosifilis dari populasi penelitian dan didapatkan 85.71% dengan HIV reaktif. Pada pasien HIV disarankan RPR dan TPHA serum untuk pemeriksaan skrining sifilis.

---

Syphilis is a chronic sexually transmitted disease that has varying clinical manifestations and persist for a long time. Neurosyphilis is one of the complications of systemic syphilis with findings in cerebrospinal fluid with or without obvious symptoms. Examinations currently available for diagnostic support were cerebrospinal fluid analysis and serology of Treponema pallidum. There is currently no known prevalence of neurosyphilis in the research hospital and serologic profile of Treponema pallidum from cerebrospinal fluid. This study was a cross sectional study, conducted November 2017-March 2018 against 50 cerebrospinal fluid and blood samples that examined cerebrospinal fluid analysis with clinical information of suspected intracranial infection. Serum and cerebrospinal fluid examined by RPR, TPHA, anti-Treponema pallidum ELISA IgG and particulary rapid test Treponema pallidum for cerebrospinal fluid. Statistic tests were chi quare and Fisher exact test.From a total of 50 cerebrospinal fluid and serum, 4(8%) had reactive cerebrospinal fluid T. pallidum rapid tests, RPRs and TPHAs. From serum there were 8(16%) reactive RPRs and 9(18%) reactive TPHAs. Anti-Treponema pallidum ELISA IgG was positif 4 samples (8%). Among the 50 samples, 7 (14%) had neurosyphilis, 4 were confirmed neurosyphilis and 3 were probable neurosyphilis according to Center for Disease Control and Prevention criteria. The cerebrospinal fluid analysis profile is colorless, clear, without clot, cell count 12.71±9.20 cells/μl, mononuclear 11.57±9.47 cells/μl, positive for Pandy, cerebrospinal fluid protein 42.29±21.49 mg/dl, glucose 55±5.16 mg/dl, serum glucose 101.04±20.10 mg/dl, and chloride 122.14±2.48 mEq/L. Rapid Plasma Reagin, TPHA, and anti-Treponema pallidum ELISA IgG were associated between serum specimen and cerebrospinal fuid. Neurosyphilis was found in 14% of our patient population and 85.71% was reactive for HIV. Rapid Plasma Reagin and TPHA in sera were recommended for syphilis screening for HIV patient."

"Latar Belakang: Kanker primer tahap lanjut dapat bermetastasis ke sistem saraf pusat (SSP) yaitu otak dan spinal, maupun ke selain SSP. Perbedaan gejala klinis antara metastasis SSP dan tanpa keterlibatan SSP adalah defisit neurologis pada metastasis SSP. Kedua metastasis tersebut dapat berisiko menyebabkan indeks massa otot skeletal yang rendah akibat gejala klinis dan peningkatan metabolisme akibat kanker. Namun, belum diketahui perbedaan di antara keduanya. Tujuan penelitian ini untuk mengetahui perbedaan appendicular skeletal muscle index (ASMI) pada pasien metastasis dengan dan tanpa keterlibatan SSP. Metode: Penelitian ini adalah studi potong lintang pada subjek berusia 18-65 tahun. Karakteristik subjek berupa usia, jenis kelamin, indeks massa tubuh, status gizi berdasarkan ASPEN, lokasi tumor primer, lokasi metastasis, waktu terdiagnosis metastasis, defisit neurologis, asupan energi dan protein, Karnofsky Performance Scale, kemoterapi, terapi glukokortikoid, dan nilai ASMI. Analisis bivariat digunakan untuk menilai perbedaan nilai ASMI antara metastasis SSP dan tanpa keterlibatan SSP. Hasil: Terdapat 59 subjek dengan nilai ASMI rendah. Rerata nilai ASMI pada metastasis SSP lebih rendah (3,81±1,19 kg/m2) dibandingkan dengan metastasis tanpa keterlibatan SSP (3,97±0,93 kg/m2) dengan perbedaan tidak signifikan pada kedua kelompok (p = 0,568). Terdapat perbedaan bermakna antara ASMI rendah dengan jenis kelamin (p=0,000), asupan energi (p=0,012), disfagia (p=0,027), nyeri kepala (p=0,033), dan gangguan kognitif (p=0,032). Kesimpulan: Tidak ditemukan perbedaan bermakna antara subjek yang memiliki ASMI rendah pada metastasis SSP dan tanpa keterlibatan SSP. Perbedaan bermakna ditemukan antara ASMI dengan karakteristik subjek yaitu jenis kelamin, asupan energi, disfagia, nyeri kepala, dan gangguan kognitif.

---

Background: Advanced primary cancer can metastasize to the central nervous system (CNS), namely the brain and spinal cord, or to other than the CNS. The difference in clinical symptoms between CNS metastases and those without CNS involvement is the neurological deficit in CNS metastases. Both metastases may be at risk for low skeletal muscle mass index due to clinical symptoms and increased metabolism due to cancer. However, the differences between them are unknown. The aim of this study was to determine the difference of appendicular skeletal muscle index in metastatic patients with and without CNS involvement. Methods: This study was a cross-sectional study on subjects aged 18-65 years. Subject characteristics included age, gender, body mass index, nutritional status based on ASPEN, primary tumor location, metastasis location, time of metastasis diagnosis, neurological deficits, energy and protein intake, Karnofsky Performance Scale, chemotherapy, glucocorticoid therapy, and ASMI value. Bivariate analysis was used to assess the difference in ASMI value between CNS metastasis and without CNS involvement Results: There were 59 subjects with low ASMI values. The mean ASMI value in CNS metastasis was lower (3,81±1,19 kg/m2) compared to metastasis without CNS involvement (3,97±0,93 kg/m2) without significant difference in both groups (p=0,568). There was a significant difference between low ASMI and gender (p=0,000), energy intake (p=0,012), dysphagia (p=0,027), headache (p=0,033), and cognitive impairment (p=0,032). Conclusion: No significant difference was found between subjects who had low ASMI in CNS metastasis and without CNS involvement. Significant differences were found between ASMI and subject characteristics such as gender, energy intake, dysphagia, headache, and cognitive impairment."

"Pandemi COVID-19 membawa dampak besar pada pembelajaran anatomi. Pembelajaran anatomi yang secara konvensional dilakukan berbasis kadaver tidak dapat dilakukan atau hanya dapat dilakukan secara terbatas. Aplikasi anatomi tiga dimensi hadir sebagai media pembelajaran anatomi yang dapat memudahkan mahasiswa memahami struktur dan topografi secara akurat. Penelitian ini dilakukan untuk mengetahui hubungan antara penggunaan aplikasi anatomi 3D dengan peningkatan hasil pembelajaran anatomi (nilai pre-post test) sistem saraf pusat pada mahasiswa FKUI angkatan 2023. Desain penelitian yang digunakan adalah quasi-eksperimental. Tiga puluh satu subjek dibagi menjadi dua kelompok yaitu menggunakan aplikasi anatomi 3D (n = 14) dan tidak menggunakan aplikasi anatomi 3D (n =17). Kedua kelompok diberikan materi tambahan berupa referensi buku anatomi. Dilakukan pre-test dan post test pada kedua kelompok untuk menilai hasil pembelajaran. Analisis data dilakukan uji Spearman rank correlation menggunakan aplikasi SPSS ver. 24. Ditemukan korelasi nilai r = 0,07 dengan nilai p = 0,7 (p > 0,05) antara hasil pembelajaran dan penggunaan aplikasi anatomi 3D. Terdapat peningkatan hasil belajar yang lebih tinggi pada kelompok yang menggunakan aplikasi anatomi 3D (30,00) dibandingkan dengan yang tidak menggunakan aplikasi anatomi 3D (26,47). Terdapat hubungan yang sangat lemah dengan tendensi tidak signifikan antara penggunaan aplikasi anatomi 3D dengan peningkatan hasil pembelajaran anatomi (nilai pre-post test) sistem saraf pusat pada mahasiswa FKUI angkatan 2023. Kedua kelompok mengalami peningkatan hasil pembelajaran. Diperlukan analisis lebih lanjut pengaruh preferensi metode pembelajaran anatomi, kemampuan spasial, gaya belajar, dan kecepatan belajar mahasiswa terhadap hubungan antara penggunaan aplikasi anatomi 3D dan hasil pembelajaran anatomi.

---

The COVID-19 pandemic has had a significant impact on anatomy education. Conventional anatomy learning based on cadavers cannot be conducted or can only be done in a limited manner. Three-dimensional anatomy applications are presented as a learning tool that can facilitate students in understanding anatomical structures and topography accurately. This research was conducted to determine the relationship between the use of 3D anatomy applications and the improvement in central nervous system anatomy learning outcomes (pre-post test scores) among 2023 students of the Faculty of Medicine, Universitas Indonesia. The research design used is quasi-experimental. Thirty-one subjects were divided into two groups: one using 3D anatomy applications (n = 14) and one not using 3D anatomy applications (n = 17). Both groups were provided with additional anatomical reference materials. Pre- tests and post-tests were conducted on both groups to assess learning outcomes. Data analysis was performed using the Spearman rank correlation test with SPSS version 24. A correlation with a value of r = 0.07 and a p-value of 0.7 (p > 0.05) was found between learning outcomes and the use of 3D anatomy applications. There was a higher improvement in learning outcomes in the group that used 3D anatomy applications (30.00) compared to the group that did not use 3D anatomy applications (26.47). There is a very weak and non-significant correlation between the use of 3D anatomy applications and the improvement in central nervous system anatomy learning outcomes (pre-post test scores) among 2023 students of the Faculty of Medicine, Universitas Indonesia. Both groups experienced an improvement in learning outcomes. Further analysis is needed to understand the influence of students' preference for anatomy learning methods, student’s spatial abilities, learning styles, and learning speed on the relationship between the use of 3D anatomy applications and anatomy learning outcomes."

"Latar Belakang: Diperkirakan 20-40% pasien kanker mengalami metastasis ke sistem saraf pusat (SSP). Kondisi inflamasi sistemik pada kanker yang dimediasi sitokin berkaitan dengan penurunan massa otot. Pada kondisi inflamasi, sel hepatosit terstimulasi untuk memproduksi protein fase akut c-reative protein (CRP). Kadar CRP di sirkulasi mengalami peningkatan pada lebih dari 50% pasien keganasan. CRP diperkirakan berhubungan dengan penurunan massa otot dan menjadi prediktor dini dalam kehilangan jaringan lean. Penelitian ini dilakukan untuk mengetahui hubungan kadar CRP dengan indeks massa otot skeletal (skeletal muscle mass index, SMI) pada pasien metastasis SSP. Metode: Penelitian ini adalah studi potong lintang pada pasien kanker dengan metastasis SSP di RSCM. Karakteristik subjek berupa usia, jenis kelamin, tipe metastasis, lokasi tumor primer, defisit neurologis, status performa Karnofsky, penyakit komorbid, penyakit infeksi, terapi glukokortikoid, sedang menjalani kemoterapi, radioterapi, dan tindakan bedah, indeks massa tubuh (IMT), status gizi berdasarkan IMT dan kriteria ASPEN, asupan energi, asupan protein, kadar CRP, dan nilai SMI. Dilakukan analisis hubungan kadar CRP dengan SMI.Hasil: Terdapat 57 pasien yang mengalami metastasis SSP. Mayoritas subjek perempuan (56,1%). Median usia 47 tahun. Lokasi metastasis lebih banyak ditemukan di otak (56,1%), tipe metastasis berdasarkan lokasi susunan saraf terbanyak adalah sinkronus (86%), seluruh subjek merupakan oligometastasis, dan lokasi tumor primer mayoritas berasal dari nasofaring (17,5%), payudara (15,8%), dan paru (14%). Defisit neurologis terbanyak yaitu nyeri kanker (68,4%), nyeri kepala (56,1%), dan kelemahan anggota gerak (43,9%). Kelemahan anggota gerak mayoritas hemiparesis (22,8%). Sebagian besar status performa Karnofsky pasien terganggu sedang (45,6%), 63,2% subjek tidak memiliki penyakit komorbid, 68,4% tidak memiliki penyakit infeksi, 52,6% tidak dalam terapi glukokortikoid, 75,4% subjek tidak sedang menjalani kemoterapi, masing-masing 1,8% subjek sedang menjalani radioterapi dan tindakan bedah. Rerata IMT estimasi 21,28 kg/m2 dan mayoritas status gizi berdasarkan IMT estimasi adalah berat badan normal (43,9%). Berdasarkan kriteria ASPEN, mayoritas termasuk malnutrisi sedang (49,1%) dan berat (31,6%). Rerata asupan energi 19 kkal/kgBB dan median asupan protein 0,6 g/kgBB. Median kadar CRP 46,6 mg/L dan 96,5% subjek mengalami peningkatan kadar CRP. Rerata SMI seluruh subjek yaitu 6,17 kg/m2, rerata SMI laki-laki 7,2 kg/m2 sedangkan rerata SMI perempuan 5,4 kg/m2. Terdapat korelasi negatif lemah (r=-0,373) yang bermakna secara statistik (p=0,005) antara kadar CRP dengan SMI pasien metastasis SSP .Kesimpulan: Terdapat korelasi yang bermakna antara kadar CRP dengan SMI pada pasien metastasis SSP.

---

Background: It is estimated that 20-40% of cancer patients experience metastases to the central nervous system (CNS). Systemic inflammatory conditions in cancer mediated by cytokines are associated with a decrease in muscle mass. In inflammatory conditions, hepatocyte cells are stimulated to produce the acute-phase protein called c-reactive protein (CRP). Circulating CRP levels increase in over 50% of cancer patients. CRP is believed to be related to a decrease in muscle mass and serves as an early predictor in lean tissue loss. This study was conducted to determine the relationship between CRP levels and the skeletal muscle mass index (SMI) in patients with CNS metastases. Methods: This study is a cross-sectional study on cancer patients with CNS metastases at RSCM. Subject characteristics include age, gender, metastases type, primary tumor location, neurological deficits, Karnofsky performance status, comorbidities, infectious diseases, glucocorticoid therapy, undergoing chemotherapy, radiotherapy, and surgery, body mass index (BMI), nutritional status based on BMI and ASPEN criteria, energy intake, protein intake, CRP levels, and skeletal muscle mass index (SMI). An analysis of the relationship between CRP levels and SMI was conducted.

Results: There were 57 patients with CNS metastases. Most subjects were female (56.1%). The median age was 47 years. Metastases was more commonly found in the brain (56.1%), and the most common type of metastasis based on the nervous system location was synchronous (86%). All subjects had oligometastasis, and most primary tumor locations were in the nasopharynx (17.5%), breast (15.8%), and lungs (14%). The most common neurological deficits were cancer pain (68.4%), headaches (56.1%), and limb weakness (43.9%). Most limb weakness was hemiparesis (22.8%). Most Karnofsky performance status was moderately impaired (45.6%), 63.2% had no comorbidities, 68.4% had no infectious diseases, 52.6% were not on glucocorticoid therapy, 75.4% were not undergoing chemotherapy, and 1.8% each were undergoing radiotherapy and surgery. The estimated mean BMI was 21.28 kg/m2, with the majority having a normal weight (43.9%). According to ASPEN criteria, the majority were moderately malnourished (49.1%) and severely malnourished (31.6%). The mean energy intake was 19 kcal/kgBW, and the median protein intake was 0.6 g/kgBW. The median CRP level was 46.6 mg/L, with 96.5% of subjects experiencing an increased CRP level. The mean SMI for all subjects was 6.17 kg/m2, with male subjects having a mean SMI of 7.2 kg/m2 and female subjects having a mean SMI of 5.4 kg/m2. There was a weak negative correlation (r=- 0.373) that was statistically significant (p=0.005) between CRP levels and SMI in patients with CNS metastases.

Conclusion: CRP levels are correlated with SMI in patients with CNS metastasis. Higher CRP levels are associated with lower SMI in patients with CNS metastases."

"Latar belakang: Metastasis leptomeningeal (ML) merupakan penyebaran sel tumor ke leptomening dan ruang subarakhnoid, dengan insidens yang semakin meningkat dan prognosis yang buruk. Analisis cairan serebrospinal (CSS) merupakan pemeriksaan penting dengan sitologi sebagai standar baku emas untuk deteksi sel tumor di CSS.Metode penelitian: Studi potong lintang retrospektif multisenter untuk mengetahui gambaran analisis rutin dan sitologi CSS pada keganasan dengan kecurigaan ML yang dilakukan pungsi lumbal pada Januari 2018-Desember 2021. Dilakukan pencatatan data klinis, radiologis, jenis tumor, analisis rutin serta frekuensi pungsi lumbal, dan dianalisis hubungannya dengan sitologi CSS.Hasil: Terdapat 153 subjek dengan abnormalitas analisis rutin CSS(75,2%) berupa peningkatan jumlah sel >5/uL(47,1%) dengan median 5(1-3504)/uL; peningkatan protein CSS >45 mg/dl (52,9%) dengan median 50 (5-820)mg/dl serta penurunan glukosa CSS <50 mg(15%) dengan median 68 (3-269)mg/dl. Proporsi sitologi CSS positif sel ganas 20,3%. Proporsi flow cytometry immunophenotyping CSS positif pada keganasan hematologi dengan kecurigaan ML 25,6%. Terdapat hubungan bermakna antara peningkatan sel, jenis keganasan hematologi, dan gambaran MRI dengan sitologi CSS (p<0,001;p=0,03;p=0,03). Tidak terdapat hubungan bermakna antara manifestasi klinis dan frekuensi pungsi lumbal dengan sitologi CSS.Kesimpulan: Abnormalitas analisis rutin CSS didapatkan pada sebagian besar subjek keganasan dengan kecurigaan ML, dengan positivitas sitologi yang rendah. Gejala klinis yang bervariasi dan pengulangan pungsi lumbal tidak signifikan menaikkan kemungkinan sitologi CSS positif.

---

Background: Leptomeningeal metastases (LM) is a condition where malignant cells spread to leptomeninges and subarachnoid space, with increasing incidence and poor prognosis. Cerebrospinal fluid (CSF) analysis is an important examination with cytology as the gold standard for malignant cells detection in CSF.

Methods: A multicenter cross-sectional retrospective study to describe CSF routine analysis and cytology in suspected LM on January 2018-December 2021. Clinical manifestations, radiological data, tumor type, CSF routine analysis, and lumbal puncture frequency were recorded, and their correlation with CSF cytology was analyzed.

Results: There were 153 subjects with abnormalities on CSF routine analysis(75,2%), consist of CSF cell count >5/uL(47,1%) with median 5(1-3504)/uL, CSF protein >45 mg/dL(52,9%) with median 50(5-820) mg/dL, and CSF glucose <50 mg/dL(15%) with median 68(3-629)mg/dL. Positive CSF cytology result was 20,3%. Positive CSF flow cytometry immunophenotyping in hematological malignancy with suspected LM was 25,6%. There was significant correlation between the increase in CSF cell count, hematological malignancy, and MRI results with CSF cytology (p<0,001;p=0,03;p=0,03). There was no significant correlation between clinical manifestations and lumbal puncture frequency with CSF cytology.

Conclusion: Abnormalities of CSF routine analysis were found in majority subjects with suspected LM but CSF cytology positivity rate was considered low. The presence of varied clinical symptoms and repeated lumbal punctures didn’t increase the likelihood of positive CSF cytology."

"Tumor sistem saraf pusat (SSP) dapat menurunkan massa otot dan massa bebas lemak akibat defisit neurologis yang terjadi serta efek sistemik karena keganasan. Penurunan massa bebas lemak dan massa otot dengan inflamasi saling memengaruhi serta dikaitkan dengan prognosis yang buruk. Penelitian ini bertujuan untuk mengetahui korelasi indeks massa bebas lemak (FFMI) dengan indeks inflamasi imun sistemik (SII) pada pasien tumor SSP. Studi ini merupakan studi potong lintang pada pasien dewasa dengan diagnosis tumor SSP di RSUPN Dr. Cipto Mangunkusumo. Pengukuran FFMI menggunakan bio impedance analysis (BIA). Nilai SII didapatkan dari hasil pemeriksaan laboratorium darah perifer lengkap. Terdapat 74 pasien tumor SSP dengan mayoritas perempuan (59,5%) dan lokasi tersering adalah tumor di otak (79,7%). Proporsi jenis tumor primer maupun sekunder adalah sama (50%). Median indeks massa tubuh (IMT) yaitu 22,85 kg/m2 (11,99–37,60 kg/m2) dengan kategori IMT terbanyak adalah berat badan normal (33,8%). Rerata FFMI yaitu 16,05±3,12 kg/m2 dengan 51,4% pasien memiliki FFMI yang rendah. Median SII sebesar 1140,9 (103,6–8745,6). Tidak didapatkan korelasi antara FFMI dengan SII pada pasien tumor SSP. Pada analisis tambahan didapatkan korelasi negatif bermakna antara FFMI dengan SII pada wanita (r=- 0,351; p=0,019), sebaliknya pada pria tidak ditemukan adanya korelasi (r=-0,096; p=0,613).

---

Central nervous system (CNS) tumors can reduce muscle mass and fat-free mass due to neurological deficits and systemic effects of malignancy. Decreased fat-free mass and muscle mass with inflammation are mutually influential and associated with poor prognosis. This study aimed to determine the correlation between fat-free mass index (FFMI) and systemic immune inflammation index (SII) in patients with CNS tumors. This is a cross-sectional study of CNS tumors adult patients at Dr. Cipto Mangunkusumo National General Hospital. FFMI measurements were obtained using bioimpedance analysis (BIA). SII values obtained from complete peripheral blood laboratory examination results. There were 74 patients with CNS tumors, with the majority being female (59.5%), and the most common location was brain tumors (79.7%). The proportion of primary and secondary tumor types was equal (50%). The median body mass index (BMI) was 22.85 kg/m2 (11.99– 37.60 kg/m2), with the majority falling under the normal weight category (33.8%). The mean FFMI was 16.05±3.12 kg/m2, with 51.4% of patients having a low FFMI. The median SII was 1140.9 (103.6–8745.6). There was no correlation between FFMI and SII in patients with CNS tumors. In additional analysis, a significant negative correlation was found between FFMI and SII in women (r=-0.351; p=0.019), whereas in men, no correlation was found (r=-0.096; p=0.613)."