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"ABSTRACTSkleroderma (sklerosis sistemik) merupakan penyakit autoimun dengan ciri fibrosis kulit dan organ viseral. Skleroderma menurunkan kualitas hidup penderitanya dan menyebabkan kematian, yang dapat diakibatkan oleh penyakit paru interstisial (ILD) sebagai manifestasi fibrotik pada skleroderma. Pemantauan ILD pada skleroderma memerlukan penilaian penanda inflamasi, termasuk di antaranya adalah laju endap darah (LED) dan kadar protein c-reaktif (CRP) darah, serta penilaian fungsi paru dengan menilai kapasitas vital paksa (KVP). Penelitian ini dilakukan untuk mengetahui korelasi antara LED dan CRP dengan KVP pada pasien skleroderma di Rumah Sakit Cipto Mangunkusumo Jakarta. Penelitian potong lintang dilakukan dengan mengumpulkan data dari rekam medis pasien tahun 2013-2015. Hasil penelitian menunjukkan tidak adanya korelasi yang signifikan antara LED dengan KVP (r=0,209; p=0,287) dan CRP dengan KVP (r=0,261; p=0,241).

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ABSTRACTScleroderma (systemic sclerosis) is an autoimmune disease characterized by the fibrosis of skin and visceral organs. Scleroderma affects the quality of life and cause mortality, which may be caused by interstitial lung disease (ILD) as the fibrotic manifestation of scleroderma. Monitoring of ILD in scleroderma requires the evaluation of markers of inflammation, including erythrocyte sedimentation rate (ESR) and CRP level, and also evaluation of lung function by measuring forced vital capacity (FVC). The objective of this study is to determine the correlation of ESR and CRP to FVC in scleroderma patients of Cipto Mangunkusumo Hospital Jakarta. A cross-sectional study was done by gathering data from medical records of patients from year 2013-2015. The study showed that there is no significant correlation between ESR and FVC (r=0,209; p=0,287 and between CRP and FVC (r=0,261; p=0,241)."

"Latar belakang - Skleroderma merupakan kelainan jaringan ikat yang ditandai dengan keterlibatan multisistem organ, bersifat kronik dan progresif, dan memiliki tingkat mortalitas serta disabilitas yang tinggi. Hipertensi pulmonal merupakan salah satu penyebab utama kematian pada pasien skleroderma. Tujuan - Penelitian ini bertujuan untuk mencari hubungan antara laju endap darah dan kadar protein reaktif C dengan kejadian hipertensi pulmonal pada pasien skleroderma. Metode - Desain studi pada penelitian ini adalah potong lintang dengan menggunakan data sekunder dari 115 pasien skleroderma di RSUPN Cipto Mangunkusumo Jakarta. Hasil - Dari 115 pasien, hanya 46 subjek yang memenuhi syarat. Hipertensi pulmonal terdeteksi pada 4 pasien berdasarkan hasil ekokardiografi. Tidak ada perbedaan rerata laju endap darah yang bermakna antara kelompok yang mengalami hipertensi pulmonal dengan yang tidak (p = 0,154; perbedaan rerata = 22,58; IK95%:  -8,80 – 53,97). Rerata kadar protein reaktif C juga tidak berbeda bermakna antara kelompok hipertensi pulmonal dengan yang tidak (p = 0,748; perbedaan rerata 0,80; IK95%: 0,19 – 3,29). Simpulan - Dari penelitian ini, tidak ada hubungan antara laju endap darah dan kadar Protein reaktif C terhadap kejadian hipertensi pulmonal pada pasien skleroderma. Walaupun demikian, laju endap darah dan kadar protein reaktif C cenderung lebih tinggi pada kelompok yang tidak mengalami hipertensi pulmonal.

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Background - Scleroderma is connective tissue disease characterized by multisystem organ involvement, chronic and progressive course, and high mortality and disability rate.

Objectives - This study aimed to determine the association between erythrocyte sedimentation rate and C-reactive protein level to the occurrence of pulmonary hypertension in scleroderma patients.

Methods - This study design was cross-sectional. One-hundred-and-fifteen medical records of scleroderma patient in Cipto Mangunkusumo National Hospital were reviewed.

Results - From 115 patients, only 46 subject eligible in this study. Pulmonary hypertension was detected in 4 patients by echocardiography. There was no significant erythrocyte sedimentation rate mean  difference between the group with pulmonary hypertension and those without (p = 0,154; mean difference = 22,58; CI95%:  -8,80 – 53,97). Mean C-reactive protein level was not significantly different between those with pulmonary hypertension and those without (p = 0,748; mean difference = 0,80; CI95%: 0,19 – 3,29).

Conclusions - From this study, there was no significant association between erythrocyte sedimentation rate and C-reactive protein level to the occurrence of pulmonary hypertension in scleroderma patients. Nevertheless, erythrocyte sedimentation rate and C-reactive protein tend to be higher in those without pulmonary hypertension."

"Skleroderma adalah penyakit autoimun yang melibatkan jaringan ikat. Salah satu gejala klinis skleroderma adalah Fenomena Raynaud dengan perubahan 3 warna pada kulit. Pemeriksaan marker seperti C-reactive protein (CRP) dan laju endap darah (LED) digunakan untuk memeriksa tingkat inflamasi terkait Fenomena Raynaud. Tujuan penelitian adalah menelusuri hubungan kemaknaan antara CRP maupun LED dengan Fenomena Raynaud pada pasien skleroderma. Desain penelitian adalah desain potong lintang dan non-probability sampling. Jumlah sampel adalah 73 (30 memiliki Fenomena Raynaud, 43 tidak memiliki Fenomena Raynaud). Analisis data menggunakan uji chi square (diganti menjadi uji Fisher) untuk mengetahui apakah data yang diperoleh bermakna secara statistik dan klinis. Data bermakna secara statistik jika nilai p < α. Data bermakna secara klinis jika nilai besar efek penelitian > besar efek minimal. Hasil penelitian memperoleh, pasien skleroderma terbanyak adalah 26, 38, dan 47 tahun (masing-masing 6,8%), rentang usia 20-73 tahun, mayoritas wanita (87,7%). Hasil yang diperoleh, tidak terdapat hubungan yang bermakna secara statistik maupun klinis antara CRP dengan Fenomena Raynaud, maupun antara LED wanita dengan Fenomena Raynaud. Hubungan antara LED pria dengan Fenomena Raynaud diperoleh tidak bermakna secara statistik, namun dianggap bermakna secara klinis.

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Scleroderma is an autoimmune disease that involves connective tissue. One of the clinical symptoms is Raynaud's Phenomenon with 3 colors change on the skin. Marker inflammations, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can be used for investigating inflammation level in establishing Raynaud's Phenomenon.

The aim was to investigate whether there was a significant relationship between CRP and ESR level with Raynaud's Phenomenon on scleroderma patients. This research use cross sectional design and non-probability sampling. Total sample used was 73 (30 with Raynaud's Phenomenon, 43 did not have). The test used was chi square (then change into Fisher Test) to determine whether the data obtained were statistically and clinically significant. Data is considered statistically significant if the value of p < α. Data is considered clinically significant if value of research effect size > minimal effect size.

The results showed that most of scleroderma patients were 26, 38, and 47 years old (6,8% respectively) with range 20-73 years old, the majority was women (87,7%). The results obtained were no statistically or clinically significant relationship between CRP and Raynaud's Phenomenon, nor between female's ESR and Raynaud's Phenomenon. The relationship between male's ESR and Raynaud's Phenomenon was not statistically significant, but was considered clinically significant. "

"This essential resource presents the most up-to-date information on scleroderma. A clear and concise synthesis of current concepts in pathogenesis and modern approaches to management, this book is comprised of the authoritative work of international experts. With an integrated multidisciplinary approach to comprehensive care, this book is easily accessible for health care professionals in many fields. It is a valuable resource for rheumatologists, pulmonologists, cardiologists, gastroenterologists, nephrologists and all those involved in the care of scleroderma patients."

"ABSTRAK Latar belakang Bayi baru lahir BBL sangat rentan terhadap infeksi dari dalam kandungan maupun di lingkungan luar kandungan Infeksi berat yang terjadi di 3 hari pertama kehidupan Early Onset Sepsis pada BBL dapat ditegakkan melalui penampakan klinis maupun beberapa marka infeksi seperti C reak tif protein CRP Sampel darah yang diperlukan utuk pemeriksaan CRP cukup banyak dan cukup menyulitkan untuk BBL Saliva mengandung komponen yang mirip dengan darah dalam hal mendeteksi CRP Tujuan Mengetahui apakah CRP saliva dapat digunakan seakurat darah neonatus mendeteksi infeksi dini neonatus Metode Penelitian dilakukan selama periode Oktober 2015 ndash Desember 2015 pada bayi baru lahir risiko infeksi yang memenuhi kriteria Data dianalisis dengan perangkat elektronik statistik dengan tingkat kemaknaan p0 05 terdapat hubungan yang bermakna antara CRP saliva terhadap CRP darah Nilai p 0 05 dengan r positif atau searah yang menunjukkan semakin tinggi kadar CRP saliva semakin tinggi juga kadar CRP darah Kekuatan hubungan sangat kuat 0 8 ABSTRACT Backgound Newborns babies are very susseptible to infection from intra and extrauterine environment Severe infection within the first 3 day of life is classified as early onset sepsis EOS in the newborn baby based on clinical manifestation and same serological markers such as C reactive protein CRP Blood samples procedure to CRP examination are more volume liquid and requires highly trainned personnel for newborn Objective To know wether salivatory CRP can be used acurated as CRP from blood sample for detection early infection in neonate and to evaluated sample characteristic association with blood and CRP saliva Methods A prospective study was conducted in newborn baby at Ulin Hospital Banjarmasin period 15 october 2015 to December 15 2015 The participates are newborn babies with risk infection who enrolled inclusion criteria Statistical analyses used the software statistic electronic significant is p 0 05 Saliva CRP and blood samples were detected in each group as 8 babies with concentration ge 10mg L There was a statisticaly significant correlation between salivary CRP level to blood CRP level r 0 806 p"

"Latar belakang: Artritis Reumatoid (AR) merupakan penyakit yang menyerang persendian dan merupakan penyakit autoimun. Pada tahun 2020, estimasi penderita AR di Indonesia mencapai 1,3 juta jiwa, dengan menghitung estimasi dari prevalensi AR di dunia yang mencapai 0,5% hingga 1%. Penelitian dari Majorczyk, et al (2022) menunjukkan adanya pengaruh dari Laju Endap Darah (LED) terhadap keberhasilan terapi metotreksat pada pasien AR. Penelitian ini bertujuan untuk mengetahui apakah terdapat hubungan antara LED terhadap keberhasilan terapi Metotreksat pada pasien AR di Rumah Sakit Cipto Mangunkusumo (RSCM).Metode: Penelitian ini menggunakan desain kohort retrospektif. Penelitian ini menggunakan data dari rekam medis pasien di RSCM. Data pasien yang digunakan dalam penelitian ini merupakan data yang ter-input sejak tahun 2020 hingga 2022. Data yang telah didapat dianalisis menggunakan JASP versi 0.18.3.0. Dilakukan uji normalitas dengan Shapiro-Wilk, dan kemudian dilakukan uji Mann-Whitney untuk mengetahui hubungan dari LED terhadap keberhasilan terapi Metotreksat pada pasien AR.Hasil: Hasil uji normalitas menunjukkan bahwa data LED dengan keberhasilan terapi Metotreksat tidak terdistribusi normal (p > 0,05). Uji Mann-Whitney menunjukkan tidak ada perbedaan yang signifikan antara kelompok berhasil terapi dengan tidak berhasil terapi (p > 0,05).Kesimpulan: Tidak terdapat hubungan yang signifikan antara LED dengan keberhasilan terapi metotreksat pada pasien AR di RSCM.

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Introduction: Rheumatoid Arthritis (RA) is a disease that attacks the joints and is an autoimmune disease. In 2020, the estimate for RA sufferers in Indonesia reached 1.3 million people, counted from the estimate global prevalence of 0.5% to 1% of global population. Research from Majorczyk, et al (2022) shows that Erythrocyte Sedimentation Rate (ESR) influences the success of methotrexate therapy in RA patients. This study aims to determine whether if there is influence between ESR and the success of Methotrexate therapy in AR patients at Cipto Mangunkusumo Hospital (RSCM).

Method: This study used a retrospective cohort design. This research uses data from patient medical records at RSCM. Patient data used in this research was data inputted from 2020 to 2022. The data obtained was analyzed using JASP version 0.18.3.0. The Shapiro-Wilk normality test was carried out, and then the Mann-Whitney test was carried out to determine the connection between ESR and the success of Methotrexate therapy in AR patients.

Result: The results of the normality test showed that the ESR data with successful Methotrexate therapy were not normally distributed (p > 0.05). The Mann-Whitney test showed there was no significant difference between the successful therapy and unsuccessful therapy groups (p > 0.05).

Conclusion: There was no significant connection between ESR and the success of methotrexate therapy in AR patients at RSCM."

"scleroderma is an autoimmune disease characterized by organ fibrosis, resistant to standard treatment. It is suspected the addition of Physalis angulata Linn. (Ciplukan) extract as adjuvant therapy can improve the scleroderma skin fibrosis. The aim at this study is to evaluate the effect of ciplukan extract as adjuvant on scleroderma skin fibrosis in standard therapy, based on modified Rodnan skin scale (MRSS), inflammatory biomarkers, immunology and serum fibrosis. Methods: double-blind, randomized clinical trial was performed in scleroderma patients with stable disease at Cipto Mangunkusumo hospital and Hasan Sadikin hospital during November 2015−March 2017 who met the selection criteria and continued to receive standard therapy. The subjects were randomly allocated into two groups: the study group received the ciplukan extract 3 x 250 mg / day for 12 weeks and the placebo group. Examination of MRSS, ESR, P1NP, BAFF and sCD40L was performed every 4 weeks until the end of the study. Results: fifty-nine subjects completed the study. They consisted of 29 subjects of the treatment group and 30 of the placebo group, with an average age of 41 (SD 9) years, the proportion of women: male = 9 : 1. There was a significant improvement of skin fibrosis in the study group with a highly significant decrease in MRSS (35.9% VS 6.3%, p <0.001) and a relative decrease in P1NP levels (17.8% VS 0.7%, p = 0.002). No decrease in ESR, BAFF and sCD40L levels in both groups. There was a weak but significant positive correlation between MRSS with P1NP levels (r = 0.236, p = 0.036). Conclusion: Ciplukan extract with dose 3 x 250 mg for 12 weeks as adjuvant on scleroderma standard therapy alleviates skin fibrosis significantly based on MRSS and P1NP levels."

"Latar Belakang : Inflamasi kronik berhubungan dengan tumor dan menyebabkan prognosis yang buruk pada pasien kanker. Salah satu penanda inflamasi yang meningkat pada tumor adalah C-Reactive Protein (CRP). Kadar CRP meningkat pada lebih dari 50% pasien keganasan. Peningkatan CRP berhubungan kuat dengan keparahan penyakit pada beberapa kanker. Salah satu zat gizi dalam inflamasi adalah asam lemak omega-3. Asam lemak omega-3 dapat meningkatkan pembentukan specialized pro-resolving mediators (SPM) yang berfungsi meningkatkan mediator antiinflamasi, melindungi blood brain barrier, menurunkan sitokin proinflamasi, menurunkan apoptosis neuron. Penelitian ini bertujuan untuk menilai hubungan asupan asam lemak omega-3 dengan CRP pada pasien tumor sistem saraf pusat.Metode : Studi potong lintang ini dilakukan pada subjek berusia 18-65 tahun di RSUPN Cipto Mangunkusumo pada bulan November hingga Desember 2023. Pengukuran CRP menggunakan metode immunoturbidimetric assay. Pengambilan asupan asam lemak omega-3 menggunakan Food Frequency Questionnaires semikuantitatif. Analisis bivariat digunakan untuk menilai hubungan antara variabel bebas dan terikat.Hasil : Dari total 63 subjek penelitian, sebanyak 35 subjek (55,6%) pada kelompok asupan asam lemak omega-3 < 2 g/hari dan 28 subjek (44,4%) pada kelompok asupan asam lemak omega-3 ≥ 2 g/hari. Nilai median CRP 8,3 (0,6 – 71,5) mg/L. Tidak terdapat hubungan yang bermakna (p = 0,714) antara asupan asam lemak omega-3 dengan CRP pada pasien tumor sistem saraf pusat.Kesimpulan : Tidak terdapat hubungan bermakna antara asupan asam lemak omega-3 dengan CRP pada pasien tumor sistem saraf pusat.

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Background: Chronic inflammation is associated with tumors and causes poor prognosis in tumor patients. One of the inflammatory markers that increase in tumors is C-Reactive Protein (CRP). CRP levels are elevated in more than 50% of patients with malignancies. Elevated CRP is associated with disease severity in some cancers. One of the nutrients in inflammation is omega-3 fatty acids. Omega-3 fatty acids can increase the formation of specialized pro-resolving mediators (SPM) which function to increase anti-inflammatory mediators, protect the blood brain barrier, reduce pro-inflammatory cytokines, reduce neuron apoptosis. This study aims to assess the relationship between omega-3 fatty acid intake and CRP in patients with central nervous system tumors.

Methods: This cross-sectional study was conducted on subjects aged 18-65 years at Cipto Mangunkusumo Hospital from November to December 2023. CRP measurement using immunoturbidimetric assay method. Omega-3 fatty acid intake was collected using semiquantitative Food Frequency Questionnaire. Bivariate analysis was used to assess the relationship between independent and dependent variables.

Results: From the total 63 research subjects, 35 subjects (55,6%) in the omega-3 fatty acid intake group < 2 g/day and 28 subjects (44,4%) in the omega-3 fatty acid intake group ≥ 2 g/day. The median CRP value was 8.3 (0.6 - 71.5) mg/L. There was no significant relationship (p = 0,714) between omega-3 fatty acid intake and CRP in patients with central nervous system tumors.

Conclusion: There is no significant relationship between omega-3 fatty acid intake and CRP in patients with central nervous system tumors."

"klerosis sistemik atau skleroderma adalah suatu penyakit jaringan ikat yang dimediasi imun yang ditandai dengan fibrosis kulit dan organ dalam serta vaskulopati. Penyebab kematian utama pada sklerosis sistemik adalah penyakit paru interstisial. Pengobatan penyakit paru interstisial pada sklerosis sistemik saat ini belum memuaskan. Herba ciplukan (Physalis angulata) merupakan salah satu terapi alternatif yang potensial dan terbukti dapat memperbaiki fibrosis kulit pada pasien sklerosis sistemik namun data pada manifestasi paru belum ada. Penelitian ini bertujuan untuk menilai efek herba ciplukan dalam mencegah dan memperbaiki inflamasi dan fibrosis paru pada model tikus sklerosis sistemik dan mencari dosis optimal ciplukan untuk memperbaiki fibrosis. Penelitian ini terbagai dalam 2 tahap yaitu tahap kuratif fibrosis (tahap 1) dan tahap preventif inflamasi dan fibrosis (tahap 2). Pada tahap 1, 33 tikus (Rattus norvegicus) galur Sprague-Dawley 10−12 minggu dibagi dalam 6 kelompok yaitu kelompok yang mendapat bleomisin dan ciplukan (dosis 50,100,150, dan 200 mg/kg), bleomisin dan salin, dan kontrol negatif. Bleomisin diberikan subkutan per hari selama 14 hari dan ciplukan atau salin diberikan mulai hari ke-21 selama 30 hari lalu hewan diterminasi. Fibrosis dinilai dengan derajat fibrosis dan luas fibrosis pada histopatologi, kadar hidroksiprolin, TGF-β dan MMP13 jaringan paru. Pada tahap 2, 36 ekor tikus dibagi dalam 6 kelompok yaitu 2 kelompok yang mendapat bleomisin dan ciplukan (50 dan 100 mg/kgBB) dan 2 kelompok bleomisin dan salin. Tiga kelompok diterminasi di H14 dan 3 kelompok di H51. Pada tahap 2, bleomisin dan ciplukan diberikan bersamaan selama 14 hari pertama. Luaran yang dinilai di H14 adalah kadar IL-6 paru, jumlah leukosit dari BAL dan skor inflamasi paru secara histopatologi. Luaran yang dinilai di H52 adalah derajat fibrosis dan luas fibrosis, kadar hidroksiprolin, TGF-β dan MMP13 paru. Kadar IL-6, TGF-β dan MMP 13 dinilai dengan ELISA dari jaringan paru, Hidroksiprolin dinilai dari jaringan paru dengan metode kolorimetri. Pada tahap 1 terdapat perbedaan luas fibrosis yang secara statistik bermakna antara kelompok yang mendapat ciplukan dosis 100, 150, dan 200 mg/kgBB dibandingkan kelompok bleomisin. Tidak terdapat perbedaan skor fibrosis antara kelompok yang mendapat ciplukan 50, 100, dan 150 mg/kgBB dengan kontrol negatif. Tidak terdapat perbedaan hidroksiprolin antara kelompok yang mendapat ciplukan dengan kontrol negatif. Tidak terdapat perbedaan kadar TGF-β dan MMP13 yang secara statistik bermakna antar kelompok. Pada tahap 2 penelitian tidak didapatkan perbedaan kadar IL-6, jumlah leukosit cairan BAL dan skor inflamasi yang bermakna antar kelompok dan tidak terdapat perbedaan skor fibrosis, luas fibrosis, kadar hidroksiprolin, TGF-β dan MMP13 antar kelompok. Sebagai simpulan ekstrak ciplukan memiliki efek kuratif untuk menurunkan luas fibrosis paru dengan dosis optimal 100 mg/kgBB. Ciplukan tidak memiliki efek preventif terhadap inflamasi dan fibrosis.

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Systemic sclerosis or scleroderma is an immune mediated connective tissue disease which is manifested by fibrosis on skin and internal organ and vasculopathy. Interstitial lung disease (ILD) is the main cause of death of systemic sclerosis however the treatment of ILD in systemic sclerosis is still unsatisfactory. Ciplukan (Physalis angulata) herb is a potential alternative treatment for systemic sclerosis and has been proven to improve skin sclerosis in systemic sclerosis patients however the study on its effect on lung has been lacking. The aim of this study is to evaluate the effect of ciplukan herb for treating and preventing inflammation and fibrosis in systemic sclerosis animal model and to find out its optimal dose in improving lung fibrosis. This study was done in 2 stages. For the first stage (treatment of fibrosis), 33 Sprague-Dawley rats aged 10−12 weeks were divided into 6 groups (4 groups were given bleomycin and ciplukan extract dose 50,100,150, and 200 mg/kgBW, respectively, bleomycin and saline and negative control). Bleomycin was given subcutaneously daily for 14 days and ciplukan or saline were given from day 21 until the next 30 days and then the animals were sacrificed. At the end of observation, degree of fibrosis and width of fibrosis from lung histopathology, hydroxyproline, TGF-β, and MMP13 levels were analyzed. For the second stage (prevention), 36 rats were divided into 6 groups (bleomycin and ciplukan dose 50 and 100 mg/kgBW, and bleomycin only). Three groups were sacrificed after 14 days of observation for evaluation of IL-6 level in lung tissue, leucocyte count on BAL fluid and inflammation score. Three groups were sacrificed after 51 days observation and were analyzed for degree of fibrosis and width of fibrosis from lung histopathology, hydroxyproline, TGF-β, and MMP13 levels. For the second stage, bleomycin and ciplukan were given simultaneously for 14 days. IL-6, TGF-β, and MMP13 levels were measured using ELISA methods while hydroxyproline was analyzed using colorimetric method. From the stage 1, there was a significant reduction in width of lung fibrosis on groups receiving bleomycin and ciplukan dose 100, 150, and 200 mg/kgBW compared with bleomycin group. There was no difference of fibrosis score among groups who received ciplukan 50,100, and 150 mg/kgBW compared to the negative control. There was no difference of hydroxyproline among groups who received ciplukan compared with negative control. There was no difference of TGF-β, and MMP13 levels among groups. From the stage 2, there were no difference of IL-6 levels, BAL leukocyte count and inflammation score among groups after 14 days and no difference of fibrosis score, extension of fibrosis, hydroxyproline, TGF-β and MMP13 levels among groups after 51 days observation. As a conclusion, ciplukan herb has a role as a treatment of fibrosis to reduce extent of lung fibrosis with optimal dose of 100 kg/BW but shows no effect on prevention of lung inflammation and lung fibrosis."

"klerosis sistemik atau skleroderma adalah suatu penyakit jaringan ikat yang dimediasi imun yang ditandai dengan fibrosis kulit dan organ dalam serta vaskulopati. Penyebab kematian utama pada sklerosis sistemik adalah penyakit paru interstisial. Pengobatan penyakit paru interstisial pada sklerosis sistemik saat ini belum memuaskan. Herba ciplukan (Physalis angulata) merupakan salah satu terapi alternatif yang potensial dan terbukti dapat memperbaiki fibrosis kulit pada pasien sklerosis sistemik namun data pada manifestasi paru belum ada. Penelitian ini bertujuan untuk menilai efek herba ciplukan dalam mencegah dan memperbaiki inflamasi dan fibrosis paru pada model tikus sklerosis sistemik dan mencari dosis optimal ciplukan untuk memperbaiki fibrosis. Penelitian ini terbagai dalam 2 tahap yaitu tahap kuratif fibrosis (tahap 1) dan tahap preventif inflamasi dan fibrosis (tahap 2). Pada tahap 1, 33 tikus (Rattus norvegicus) galur Sprague-Dawley 10−12 minggu dibagi dalam 6 kelompok yaitu kelompok yang mendapat bleomisin dan ciplukan (dosis 50,100,150, dan 200 mg/kg), bleomisin dan salin, dan kontrol negatif. Bleomisin diberikan subkutan per hari selama 14 hari dan ciplukan atau salin diberikan mulai hari ke-21 selama 30 hari lalu hewan diterminasi. Fibrosis dinilai dengan derajat fibrosis dan luas fibrosis pada histopatologi, kadar hidroksiprolin, TGF-β dan MMP13 jaringan paru. Pada tahap 2, 36 ekor tikus dibagi dalam 6 kelompok yaitu 2 kelompok yang mendapat bleomisin dan ciplukan (50 dan 100 mg/kgBB) dan 2 kelompok bleomisin dan salin. Tiga kelompok diterminasi di H14 dan 3 kelompok di H51. Pada tahap 2, bleomisin dan ciplukan diberikan bersamaan selama 14 hari pertama. Luaran yang dinilai di H14 adalah kadar IL-6 paru, jumlah leukosit dari BAL dan skor inflamasi paru secara histopatologi. Luaran yang dinilai di H52 adalah derajat fibrosis dan luas fibrosis, kadar hidroksiprolin, TGF-β dan MMP13 paru. Kadar IL-6, TGF-β dan MMP 13 dinilai dengan ELISA dari jaringan paru, Hidroksiprolin dinilai dari jaringan paru dengan metode kolorimetri. Pada tahap 1 terdapat perbedaan luas fibrosis yang secara statistik bermakna antara kelompok yang mendapat ciplukan dosis 100, 150, dan 200 mg/kgBB dibandingkan kelompok bleomisin. Tidak terdapat perbedaan skor fibrosis antara kelompok yang mendapat ciplukan 50, 100, dan 150 mg/kgBB dengan kontrol negatif. Tidak terdapat perbedaan hidroksiprolin antara kelompok yang mendapat ciplukan dengan kontrol negatif. Tidak terdapat perbedaan kadar TGF-β dan MMP13 yang secara statistik bermakna antar kelompok. Pada tahap 2 penelitian tidak didapatkan perbedaan kadar IL-6, jumlah leukosit cairan BAL dan skor inflamasi yang bermakna antar kelompok dan tidak terdapat perbedaan skor fibrosis, luas fibrosis, kadar hidroksiprolin, TGF-β dan MMP13 antar kelompok. Sebagai simpulan ekstrak ciplukan memiliki efek kuratif untuk menurunkan luas fibrosis paru dengan dosis optimal 100 mg/kgBB. Ciplukan tidak memiliki efek preventif terhadap inflamasi dan fibrosis.

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Systemic sclerosis or scleroderma is an immune mediated connective tissue disease which is manifested by fibrosis on skin and internal organ and vasculopathy. Interstitial lung disease (ILD) is the main cause of death of systemic sclerosis however the treatment of ILD in systemic sclerosis is still unsatisfactory. Ciplukan (Physalis angulata) herb is a potential alternative treatment for systemic sclerosis and has been proven to improve skin sclerosis in systemic sclerosis patients however the study on its effect on lung has been lacking. The aim of this study is to evaluate the effect of ciplukan herb for treating and preventing inflammation and fibrosis in systemic sclerosis animal model and to find out its optimal dose in improving lung fibrosis. This study was done in 2 stages. For the first stage (treatment of fibrosis), 33 Sprague-Dawley rats aged 10−12 weeks were divided into 6 groups (4 groups were given bleomycin and ciplukan extract dose 50,100,150, and 200 mg/kgBW, respectively, bleomycin and saline and negative control). Bleomycin was given subcutaneously daily for 14 days and ciplukan or saline were given from day 21 until the next 30 days and then the animals were sacrificed. At the end of observation, degree of fibrosis and width of fibrosis from lung histopathology, hydroxyproline, TGF-β, and MMP13 levels were analyzed. For the second stage (prevention), 36 rats were divided into 6 groups (bleomycin and ciplukan dose 50 and 100 mg/kgBW, and bleomycin only). Three groups were sacrificed after 14 days of observation for evaluation of IL-6 level in lung tissue, leucocyte count on BAL fluid and inflammation score. Three groups were sacrificed after 51 days observation and were analyzed for degree of fibrosis and width of fibrosis from lung histopathology, hydroxyproline, TGF-β, and MMP13 levels. For the second stage, bleomycin and ciplukan were given simultaneously for 14 days. IL-6, TGF-β, and MMP13 levels were measured using ELISA methods while hydroxyproline was analyzed using colorimetric method. From the stage 1, there was a significant reduction in width of lung fibrosis on groups receiving bleomycin and ciplukan dose 100, 150, and 200 mg/kgBW compared with bleomycin group. There was no difference of fibrosis score among groups who received ciplukan 50,100, and 150 mg/kgBW compared to the negative control. There was no difference of hydroxyproline among groups who received ciplukan compared with negative control. There was no difference of TGF-β, and MMP13 levels among groups. From the stage 2, there were no difference of IL-6 levels, BAL leukocyte count and inflammation score among groups after 14 days and no difference of fibrosis score, extension of fibrosis, hydroxyproline, TGF-β and MMP13 levels among groups after 51 days observation. As a conclusion, ciplukan herb has a role as a treatment of fibrosis to reduce extent of lung fibrosis with optimal dose of 100 kg/BW but shows no effect on prevention of lung inflammation and lung fibrosis."