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"ABSTRAKBackground Aim of this research is to assess the efficacy and safety of tocilizumab in combination with methotrexate in Indonesian patients with moderate to severe active rheumatoid arthritis who have an inadequate response to non biologic DMARDs.Methods This was a interventional, prospective, single arm, multicenter, study in Indonesian male or female patients aged > 18 years old, with a diagnosis of RA for > 6 months based on ACR 1987 revised criteria with moderate to severe disease activity DAS28 score > 3.2 after > 12 weeks of non biologic DMARDs treatment. The treatment consisted of tocilizumab, 8 mg/kg, intravenous, every 4 weeks for a total of 6 infusion in combination with oral MTX 10 until 25 mg every week. Efficacy was assessed based on the percentage of patients achieving low disease activity state DAS28 < 3.2, percentage of patients achieving reduction > 1.2 point of DAS28, percentage of patients achieving remission DAS28 < 2.6, and percentage of patients with ACR20, ACR50, and ACR70 responses. Descriptive statistics will be used for presentation of results.Results 100 percent patients reached low disease activity DAS28 < 3.2 at last study visit week 24 and clinically significant improvement reduction at least 1.2 units at every visit in DAS28, both for ITT or PP patients. Remission DAS28 < 2.6 was observed in 82.1 percent ITT patients and 93.1 percent PP patients on last study visit. ACR20, ACR50, and ACR70 were achieved in 20 percent, 34 percent, and 34 percent ITT patients, and 7 percent, 24 percent, and 62 percent PP patients on week 24. There were 3 out of 39 patients 7.69 percent with adverse events and serious adverse events that resulted in discontinuation of TCZ treatment, consisting of 1 patient with SAE of sepsis ec acquired community pneumonia, 1 patient with SAE of pneumonia tuberculosis, and 1 patient with AE of candidiasis. Most common adverse events were hepatic dysfunction 30.7 percent, hypercholesterolemia 23.1 percent, followed by arthralgia 20.5 percent Twelve percent of patients needed dose modification due to elevated liver enzyme elevated ALT/SGPT level. Conclusion Tocilizumab seems to be efficacious and likely to have good safety profile in non biologic DMARD nonresponsive RA patients of PICTURE INA study. "

"Background Rheumatoid arthritis is the most prevalent from of inflammatory arthritis. One of the key components for its multidimensional outcome is the disease activity, measured by DAS28 ESR. The phsycal, emotional, and social aspect of RA contribute to the quality of life, and SF 36 questionaire can be used to measure it. This study aims to ascertain the correlation between the disease activity (DAS28 ESR) and the quality of life (SF 36) in RA pantients."

"Background systemic sclerosis (SSc) is a chronic autoimmune disease which presents immunological, endothelilal dysfunction, skin and organs fibrosis. The inflammatory process is an important pathopshsiology of systemic sclerosis. Disease activity assessment using clinical parameters of c creative protein (CRP), erytrocyte sedimentation rate (ESR) and soluble CD40 lingand."

"Background. Rheumatoid Arthritis (RA) is one of the diseases associated with the immune system which causes joint damage and effect to the quality of patients life. DAS28 CRP value describes RA disease activity. The antiCCP titer is a very specific examination which provide an overview prognosis of RA patients illness. The research on the correlation of anti CCP Titers with DAS28 CRP values has never been done in Indonesia. Therefore, this research aims to determine the correlation between anti CCP Titer and DAS28 CRP value in RA patient in Cipto Mangunkusumo hospital with DAS28 CRP value in RSCM.Method. The research design is crosssectional with the sample amounted to 34. anti CCP and DAS28 CRP were obtained through patients medical records.Result. The result of this correlationstudy is (p = 0,582) and r = 0,086.Conclusion. In conclusion, there is no correlation between antiCCP and DAS28 in Cipto Mangunkusumo hospital."

"Latar Belakang: Penyakit Parkinson merupakan suatu kondisi neurodegeneratif kronik progresif dengan gejala motorik dan nonmotorik. Gejala nonmotorik yang paling sering ditemukan pada penyakit Parkinson adalah gangguan tidur dengan prevalensi sebanyak 65-95 . Scales for Outcome in Parkinson rsquo;s Disease Sleep SCOPA-SLEEP adalah kuesioner tidur yang terdiri dari skala nighttime scale NS , daytime scale DS , dan skala penilaian kualitas tidur. Kuesioner ini digunakan untuk menapis dan menilai derajat keparahan gangguan tidur pada penyakit Parkinson yang direkomendasikan oleh Movement Disorder Society MDS. Tujuan: Mendapatkan instrumen SCOPA-SLEEP versi bahasa Indonesia yang valid dan reliabel. Metode: Tiga puluh tujuh pasien penyakit Parkinson di Poliklinik Neurologi dan Geriatri Rumah Sakit Cipto Mangunkusumo yang memenuhi kriteria inklusi diikutsertakan dalam penelitian potong lintang ini. Pasien mengisi kuesioner SCOPA-SLEEP sebanyak 2 kali dengan jarak waktu 1 minggu. Konsep yang digunakan untuk uji validitas SCOPA-SLEEP INA adalah validasi lintas budaya menurut metode World Health Organization WHO. Uji reliabilitas dinilai menggunakan nilai alpha Cronbach. Hasil: SCOPA-SLEEP INA telah melalui validasi lintas budaya menurut WHO dengan nilai koefisien korelasi Spearman berkisar antara 0,479-0,880 pada pemeriksaan pertama dan 0,359-0,899 pada retest. Nilai alpha Cronbach pada pemeriksaan pertama adalah 0,827 untuk skala NS dan 0,723 untuk skala DS. Pada retest nilai alpha Cronbach untuk skala NS adalah 0,853 dan 0,592 untuk skala DS. Kesimpulan: SCOPA-SLEEP INA valid dan reliabel untuk digunakan sebagai instrumen penapis dan penilai gangguan tidur pada penyakit Parkinson.

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Background: Parkinson's disease PD is a chronic progressive neurodegenerative disease with motor and non motor symptoms. Sleep disorders are the most common non motor symptoms in PD with prevalence of 65 95. Scales for Outcome in Parkinson's Disease Sleep SCOPA SLEEP is a sleep questionnaire which consist of nighttime scale NS, daytime scale DS, and quality of sleep scale. It is recommended by Movement Disorder Society MDS to screen and assess the severity of sleep disorders in PD.

Aim: To gain a valid and reliable Indonesian version of SCOPA SLEEP instrument.

Method: Thirty seven PD patients in the Neurology and Geriatric clinic of Cipto Mangunkusumo hospital which fulfilled the inclusion criteria were included in this cross sectional study. These patients answered the SCOPA SLEEP twice with 1 week interval. The concept of validity study test of SCOPA SLEEP INA was transcultural validation based on World Health Organization WHO method. Reliability study test was assessed by Cronbach's alpha score.

Results: SCOPA SLEEP INA had transcultural validation based on WHO method with Spearman's correlation coefficient scores ranged from 0.479 to 0.880 in first test and 0.359 0.899 in the retest. Cronbach's alpha score in first test were 0.827 for NS scale and 0.723 for DS scale, respectively. In the retest, they were 0.853 for NS scale and 0.592 for DS scale, respectively.

Conclusion: SCOPA SLEEP INA is a valid and reliable instrument to be used as instrument in screening and assessing sleep disorders in PD."

"Latar Belakang COVID-19 berdampak secara signifikan bagi dunia. Tingginya prevalensi dan insidensi, serta banyaknya kasus berderajat keparahan sedang-berat, mendorong dunia dan Indonesia untuk mencari terapi yang tepat. Salah satunya adalah anti-interleukin-6 untuk mengatasi badai sitokin yang kerap terjadi pada pasien COVID-19. Anti-interleukin-6 berupa Tocilizumab yang digunakan untuk mengatasi COVID-19 derajat sedang-berat hingga saat ini masih minim diteliti di dunia maupun di Indonesia. Maka, Peneliti berharap penelitian ini dapat berkontribusi pada perkembangan dunia medis di Indonesia. Metode Penelitian ini dilakukan dengan desain kohort retrospektif yang dilakukan di Rumah Sakit Universitas Indonesia. Penelitian ini menggunakan rekam medis pasien COVID-19 berderajat sedang-berat guna menilai hubungan antara pemberian Tocilizumab dengan tingkat mortalitas, lama rawat, dan kadar biomarker inflamasi yaitu C-reactive protein dan D-dimer. Hasil Diperoleh 52 pasien yang diberikan obat Tocilizumab dan 52 pasien kontrol. Pada kelompok pasien yang diberikan Tocilizumab, 48 pasien dirawat pada bulan Januari-Juni dan 4 pasien dirawat pada bulan Juli-Desember. Pada kelompok kontrol, 32 pasien dirawat pada bulan Januari-Juni dan 20 pasien dirawat pada bulan Juli-Desember. Ditemukan sebanyak 40,4% pasien yang memperoleh Tocilizumab hidup dan sembuh, sedangkan pada kelompok kontrol hanya 16,4% pasien yang sembuh (p=0,014). Rata-rata lama rawat pasien kelompok uji mencapai 20,9±11,5 hari, lebih lama dibandingkan kelompok kontrol yaitu 16,5±12,4 hari (p=0,007). Rata-rata penurunan kadar CRP pada kelompok uji adalah -74,65±72,59 mg/L, sedangkan pada kelompok kontrol meningkat (p=0,001). Kadar D-dimer pasien yang diberikan Tocilizumab mengalami penurunan namun tidak signifikan. Kesimpulan Tocilizumab terbukti menurunkan angka mortalitas, menurunkan kadar CRP, dan cenderung menurunkan kadar D-dimer pada pasien COVID-19 derajat sedang-berat.

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Introduction COVID-19 has a significant impact globally. The high prevalence and incidence, also the large number of moderate-severe cases, encouraged the world and Indonesia to look a better therapy. One of them is anti-interleukin-6 to overcome cytokine storm that occurs in COVID-19 patients. Today, there is minimal research that learn about anti-interleukin-6, Tocilizumab. This research hope could contribute to the development of the medical sector in Indonesia. Method This research conducted with a retrospective cohort design at Universitas Indonesia Hospital. This study used medical records of COVID-19 moderate-severe patients to assess the relation between Tocilizumab administration and mortality, length of stay, and levels of C-reactive protein and D-dimer. Result There were 52 moderate-severe COVID-19 patients receiving Tocilizumab and 52 control patients. In the test group, 48 patients treated in January-June and 4 patients treated in July-December. In the control group, 32 patients treated in January-June and 20 patients treated in July-December. It was found that 40,4% of patients who were given Tocilizumab survived, while in the control group only 16,4% of patients survived (p=0,014). The average length of stay for test group reached 20,9±11,5 days, longer than the control group, which was 16,5±12,4 days (p=0,007). The average CRP levels decrease in test group was -74.,65±72,59 mg/L, while it increased in the control group (p=0,001). The D-dimer levels of patients given Tocilizumab decreased but not significant. Conclusion Tocilizumab has been proven to reduce mortality rates, lower CRP levels, and tends to reduce D-dimer levels in moderate-severe COVID-19 patients."

"Latar Belakang: COVID-19 merupakan infeksi yang disebabkan oleh virus SARS-CoV 2. Baku emas diagnosis COVID-19 dengan pemeriksaan RT-PCR untuk mendeteksi asam nukleat virus, namun pemeriksaan ini memiliki kendala karena jumlah laboratorium yang terbatas, sehingga respon time hasil pemeriksaan memanjang. Keputusan diagnosis yang cepat dan tatalaksana segera merupakan pilar penting untuk menurunkan angka morbiditas dan mortalitas dan agar rantai penularan dapat diputus. Perlu diketahui model diagnosis lain dengan data yang praktis, sederhana dan tersedia luas untuk dijadikan suatu model determinan diagnostik yang dapat membantu klinisi mengambil keputusan lebih cepat. Tujuan: Membuat model determinan diagnosis infeksi COVID-19 berdasarkan kombinasi gejala klinis, radiologis dan laboratorium. Metode: Penelitian ini menggunakan desain potong lintang dengan metode konsekutif. Penelitian dilakukan di RSUPN Dr. Cipto Mangunkusumo, Jakarta yang dimulai bulan Maret s.d Juni 2020. Data diambil dari rekam medis berupa riwayat kontak, gejala klinis, pemeriksaan laboratorium dan foto toraks. Variabel yang diteliti akan dianalisis univariat, bivariat kemudian dilanjutkan analisis multivariat, kurva ROC dan kalibrasi Hosmer-Lemeshow. Hasil: Subjek pada penelitian sebanyak 187 pasien, dengan mayoritas subjek pada kelompok usia < 60 tahun sebesar 65,2% dan jenis kelamin laki-laki sebanyak 53,47%. Komorbid terbanyak adalah diabetes mellitus dan hipertensi. Variabel akhir yang masuk kedalam sistem skoring adalah riwayat kontak (3 poin), demam/riwayat demam (1 poin), sesak dengan frekuensi napas > 20 x/menit (2 poin), leukosit ≤ 10.000 sel /µL (2 poin) dan gambaran foto toraks tipikal (2 poin). Model skoring ini mempunyai AUC: 0,777, P: < 0,001, IK 95% (0,706-0,847) dengan nilai cut off skor ≥ 4 dari total 10 poin memiliki probabilitas 82 %, NDP: 74%, NDN: 77%. Simpulan: Model determinan diagnosis infeksi COVID-19 berdasarkan kombinasi dari riwayat kontak, demam/riwayat demam, sesak napas, kadar leukosit ≤ 10.000 sel /µL dan gambaran tipikal foto toraks cukup baik dalam membantu diagnosis COVID-19.

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Background: COVID-19 is an infection caused by SARS-CoV 2. RT-PCR test is gold standart to diagnose COVID-19 by detecting SARS-CoV 2 nucleic acid. However, this test still have a problem due to the limited laboratory centers. Respond time of the RT-PCR result will lengthen. The prompt diagnosis and immediate management are important to decrease mortality, morbidity rate and also prevent transmission. A simple and practice model diagnostic by using determinant factors is needed to guide the physician for taking a quick decision. Objective: Analyze of model determinant diagnosis of COVID-19 based on combination of clinical manifestation, chest radiography and laboratory test. Methods: This study is a cross sectional study with consecutive methods. The study was conducted at RSUPN Dr. Cipto Mangunkusumo, Jakarta from March to June 2020. Hystory of contact with COVID-19, clinical symptoms, laboratory examinations and chest radiographs data were taken from medical records. The steps of analysis were univariate, bivariate multivariate analyze, ROC curve and calibrate Hosmer-Lemeshow. Results: There were 187 patients with the majority of subjects in the age group < 60 years (65.2%) and male sex (53.47%). The most frequent comorbid were diabetes mellitus and hypertension. The selected variables in this scoring are contact history,fever/ history of fever, dyspnea with respiratory rate >20 x/minute, leucocyte ≤ 10.000 cell/µL and typical chest radiography. The area under the curve for this model is 0,777 (P : 0,000 IK 95% (0,706-0,847). The probability is 82% with cut off point ≥ 4 score. Conclusions: Determinant model for diagnosing COVID-19 based on combination of contact history, fever/history of fever, dyspnea, leucocyte ≤ 10.000 cell/µL and typical chest radiography are quite good for helping diagnosis of COVID-19."

"LATAR BELAKANG : Stroke iskemik merupakan manifestasi aterosklerosis yang prosesnya dimulai jauh sebelum terjadinya serangan stroke. Bila seseorang mempunyai faktor risiko seperti hipertensi, diabetes melitus, hiperlipidemia, dan lain-lain, proses patologis yang sedang berjalan akan dipercepat sesuai jumlah faktor risiko .Sindroma metabolik bila ditemukan tiga atau lebih komponen hipertensi, obesitas sentral, hipertrigliserida, HDL kolesterol yang rendah, dan gula darah puasa yang tinggi. Dengan mendapatkan sindroma metabolik pada anak dari penderita stroke iskemik dapat dilakukan pencegahan primer.TUJUAN : Melihat gambaran sindroma metabolik pada anak dari penderita stroke iskemik dan sebaran komponennyaMETODOLOGI : Penelitian deskriptif analitik pada 87 orang anak dari penderita stroke iskemik, berusia antara 20 - 50 tahun. Dilakukan pemeriksaan tekanan darah, lingkar pinggang, kadar trigliserida , HDL kolesterol dan gula darah puasa.HASIL : 31% anak dari penderita stroke iskemik menderita sindroma metabolic. Laki-laki lebih sering dibanding perempuan. Komponen sindroma metabolik yang sering ditemui adalah HDL kolesterol yang rendah, hipertrigliserida dan obesitas sentral. Bila yang menderita stroke iskemik ayah maka lebih sering sindroma metabolik ditemukan pada anak dengan usia lebih muda. Jika ibu yang menderita stroke iskemik, kemungkinan anak menderita sindroma metabolik lebih sering pada anak laki-Iaki dengan usia lebih tua. Etnis sunda kejadian sindroma metabolik lebih rendah dibanding etnis lainnya.KESIMPULAN : Anak dari penderita stroke iskemik merupakan populasi utama untuk terjadinya aterosklerosis yang merupakan keadaan vaskuler beresiko menjadi stroke iskemik dimasa mendatang. Sindroma metabolik dengan komponen HDL kolesterol rendah, hipertrigliserida, dan obesitas sentral ditemukan lebih sering pada anak laki-laki dari penderita stroke iskemik, dan lebih jarang pada etnis sunda.

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Background ; ischemic stroke is a manifestation of arteriosclerosis which have a long-term and gradual process before manifested. If a person has risk factors such as hypertension, diabetes mellitus and hyperlipidemia, pathologic process would be accelerated according to the number of risk factors he has. Nowadays, the term of metabolic syndrome is introduced in a person who has three or more of these components: hypertension, central obesity, hypertriglyceridemia, tow HDL cholesterol and high level of fasting blood glucose. In finding metabolic syndrome in the ischemic stroke patients' descendant, primary prevention can be done.

Objectives ;The objective of this study is knowing the pattern of metabolic syndrome and it's component in ischemic stroke patients' descendants

Methods ;We performed descriptive and analytic study in 87 subjects of 20-50 years-old by examined blood pressure, waist diameters, triglyceride level, HDL-cholesterol level and fasting blood glucose level.

Results ;We found 31% of subjects who have metabolic syndrome which was more frequent in man. Among metabolic syndrome components, low level of HDL-cholesterol is the most frequent, followed by hypertriglyceridemia, and central obesity. Metabolic syndrome is more frequent in young age if the father had ischemic stroke while in older age if the mother who had ischemic stroke in Sundanese, metabolic syndrome is less frequent.

Conclusions ;The descendants of ischemic stroke patients is main target population of arteriosclerosis which is have high risk to have ischemic stroke in the future. Metabolic syndrome with low level of HDL-cholesterol, hypertriglyceridemia, and central obesity found more frequent in men and less frequent in Sundanese."

"Latar Belakang. Disfungsi otonom merupakan salah satu gejala penyakit parkinson yang sering ditemukan clan berpengaruh terhadap morbiditas dan mortalitas penderita penyakit parkinson. Disfungsi otonom memberikan gejala klinis yang seringkali tidak disadari penderita. Tujuan penelitian adalah mengetahui gambaran disfungsi otonom penyakit Parkinson menggunakan pemeriksaan Sympathetic Skin Response.Metode. Penelitian ini merupakan studi potong lintang deskriptif dengan populasi semua penderita penyakit parkinson yang memenuhi kriteria inklusi. Dilakukan pencatatan berupa identifikasi karakteristik penderita dan riwayat perjalanan penyakit, anamnesis dan pemeriksaan fisik untuk mencari gejala klinis-penyakit parkinsnn, gejala disfungsi otonom, jenis obat anti parkinson yang dipakai dan respon pengobatan . Diagnosis disfungsi otonom ditegakkan melalui pmeriksaan Sympathetic Skin Response (SSR). Data dianalisis menggunakan tes chi-square, fisher's exact dan t test dengan memakai program STATA.Hasil. Pada penelitian ini didapatkan 34 pasien penyakit parkinson. Sebagian besar subyek berjenis kelamin pria (67,8%), dengan usia rata-rata 61.11+_10.01 tahun dan terbanyak pada kelompok usia 60-69 tahun ( 41.2%). Sebanyak 22 subyek (64.7%) mengalami gejala disfungsi otonom, dengan gejala yang tersering adalah disfagia (44%) ,diikuti gejala konstipasi (38.2%), dan hipersalivasi (35.3%). SSR abnormal dijumpai pada 23 subyek (67.6%). Rata-rata subyek dengan nilai SSR abnormal lebih tua dibandingkan dengan subyek dengan SSR normal. Rata-rata lama menderita parkinson untuk SSR abnormal adalah 6.52+_3.64 . Abnormalitas SSR dijumpai pada seluruh subyek yang menderita penyakit parkinson lima tahun atau lebih (p=0.0x4) dan pada semua subyek dalam periode non honeymoon (p=0.000). SSR cenderung abnormal dengan meningkatnya derajat keparahan penyakit berdasarkan skala Hoehn & Yahr. SSR abnormal lebih sexing ditemukan path subyek yang mengalami instabilitas postural clan subyek dengan skor bradikinesia, tremor dart rigiditas dari UPDRS yang lebih tinggi. Subyek yang mengalami gejala hipotensi postural simptomatik (p=0.023), konstipasi (p=0.402), hipersalivasi (p=0.043) dan disfagia (p=0.000) menunjukkan nilai SSR abnormal. Semua subyek yang mengalami dua (p-0.04) atau lebih gejala otonom (p=0,0001). Tiga subyek (13%) yang tidak mengalami gejala disfungsi otonon ternyata menunjukkan nilai SSR abnormal.Kesimpulan. Disfungsi otonom penyakit parkinson ditemukan pada 67.6% penderita. SSR cenderung abnormal dengan meningkatnya derajat keparahan penyakit berdasarkan skala Hoehn & Yahr maupun berdasarkan skor UPDRS untuk tremor, rigiditas, bradikinesia dan stabilitas postural. Subyek yang mengalami gejala hipotensi postural simptomatik, konstipasi, hipersalivasi dan disfagia menunjukkan nilai SSR abnormal. Nilai SSR abnormal juga ditemukan pada semua subyek yang mengalami dua atau lebih gejala otonom.

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Background. Autonomic dysfunction is one of the signs that is frequently found in PD, which influences the patient's morbidity and mortality. It also comprises some frequently neglected clinical manifestations.

Aim. The aim of this study is to review autonomic dysfunction in PD, using Sympathetic Skin Response test.

Methods. This is a descriptive cross-sectional study. Population of this study is PD patients that meet the inclusion criteria. Patient's characteristic was identified. History of illness was recorded and physical examination was done to indentify patient's signs and symptoms, autonomic dysfunctions, medications used, and the responses. Diagnosis of autonomic dysfunction was confirmed by using Sympathetic Skin Response (SSR) test. Chi-Square test, fisher's exact test, and t were used to analyze the data, using the STATA program.

Results. There were 34 PD patients identified. Most of the subjects are men (67,8%) with the mean age of 61,1+10,01 year-old and mostly within 60-90 year-old group age (41,2%). Twenty two subjects (64,7%) had autonomic dysfunction with the most presenting symptoms are dysphagia .04,8%), constipation (38,2%), and hypersalivation (35,3%). Abnormal SSR was found in 23 subjects (67,6%). Most subjects with abnormal SSR are older than subjects with normal SSR. The duration of PD in subjects with abnormal SSR is 6,52+3,64 years. Abnormal SSR was found in all subjects that have had PD for five years or more (p=0,004) and all subjects were in non-honeymoon period (p=0,000), SSR tends to be abnormal when the severity of the disease is higher, based on the Hoehn & Yahr scale. Abnormal SSR is more often found in subjects who suffer postural instability and whose IJPRDS score of bradikinesia, tremor, and rigidity is high. Subjects with symptomatic postural hypotension (p=0,023), constipation (p=0,002), hypersalivation (p=0,003) and dysphagia (p=0,000) show abnormal SSR. Every subject shows two or more autonomic symptoms (p=0,0001). Three subjects (13%) that didn't show autonomic dysfunction symptoms, however, had abnormal SSR

Conclusions. Autonomic dysfunction in PD was found in 67,6% subjects. SSR tends to be abnormal when the severity of the PD is high, based on the Hoehn & Yahr scale, UPRDS score of bradikinesia, tremor, and rigidity, and the presence of postural hypotension. Subjects with symptomatic postural hypotension, constipation, hypersalivation, and dysphagia show abnormal SSR. Abnormal SSR was also found in all subjects who had two or more autonomic symptoms."

"Inflamasi periodontal merupakan kelainan periodontal dengan prevalensi tinggi di masyarakat. Periodontitis kronis dipengaruhi oleh akumulasi plak dan kalkulus sebagai faktor local, ditambah faktor sistemis misalnya diabetes mellitus (DM) dan infeksi HIV. Sitokin terutama IL-1β sebagai mediator inflamasi utama penyakit periodontal, menstimulasi ekspresi iNOS (inducible nitric oxide synthase) dan produksi NO (nitric oxide) oleh sel β, menyebabkan disfungsi sel β. Leukotoksin dan protease yang dihasilkan patogen periodontal menyebabkan jejas kemotaktik dan fagositotik, dan menurunkan fungsi fagositosis PMN. Hiperglikemia pada penyandang DM menyebabkan peningkatan kadar kalsium sitosol (Ca2+), yang menyebabkan disfungsi PMN dan menurunkan fungsi fagositosis. Advanced glycosilation endproduct pada DM tipe 2 berikatan dengan monosit menyebabkan peningkatan sitokin proinflamasi (IL-1, TNFα) dan menyebabkan aktivasi makrofag dan osteoklas. Hiperglikemia menyebabkan aktivasi diasil gliserol (DAG)-protein kinase C (PKC), yang menyebabkan peningkatan PGE2 dan ekspresi sitokin yang mempengaruhi proses inflamasi dan destruksi. Penelitian tentang pengaruh scaling (pembersihan karang gigi sebagai tindakan non-bedah pada terapi periodontal) pada penyandang DM terhadap kadar gula darah dan respons imun selular belum pernah dilakukan di Indonesia. Penelitian ini bertujuan menganalisis pengaruh pembersihan karang gigi terhadap kadar IL-1β, fungsi fagositosis PMN dan kadar glukosa darah penyandang DM tipe 2. Subyek penelitian adalah penyandang DM tipe 2, 60 penyandang DM Terkendali dan 60 penyandang DM Tidak Terkendali di Poliklinik Metabolik-Endokrin RSUPN Ciptomangunkusumo, umur 40-60 tahun. Subyek dibagi menjadi kelompok perlakuan dan kelonpok tanpa perlakuan, untuk menilai respons imun selular dan status DM, sebelum dan 6 minggu sesudah perlakuan. Analisis statistik (t test) dengan komputer menggunakan perangkat Stata 7,0 dilakukan untuk membandingkan parameter sebelum dan sesudah scaling pada kedua kelompok. Hasil penelitian menunjukkan bahwa scaling dapat menurunkan kadar IL-1β dan meningkatkan fungsi fagositosis secara bermakna (P<0,05), menurunkan kadar glukosa puasa, glukosa 2 jam PP dan kadar HbA1c, tetapi penurunannya secara statistik tidak bermakna (P>0,05), kecuali penurunan kadar HbA1c pada DM Tidak Terkendali (P=0,00).

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AbstractPeriodontal inflammation is a periodontal disorder of high prevalence in the population. Chronic periodontitis is associated with the accumulation of plaque and calculus as local factors, and systemic factors such an diabetes mellitus (DM) and HIV infection. Cytokine, especially IL-1β as inflammatory mediator for periodontal disease, may directly stimulated iNOS (inducible nitric oxide synthase) expression and NO (nitric oxide) production by β-cells, resulting in NO-mediated β-cell damage. The leucotoxin and proteases produced by periodontal pathogens will induce chemotactic and phagocytotic defect; therefore causing decreased PMN phagocytotic function. Hyperglicemia which occurs in diabetic patients increases calcium influx to the cell, resulting in the increased cytosol?s calcium ([Ca 2+]i) level and; therefore, resulting in dysfunction of PMN and impaired PMN phagocytotic function. Advanced glycosilation endproduct in NIDDM binds to monocytes resulting in the increase of pro-inflammatory cytokines (IL-1, TNFβ) and produces activation of macrophages and osteoclasts. Hyperglicemia activates diacyl glycerol (DAG)-protein kinase C (PKC), thus increasing PGE2 and cytokine expression that induce inflammation and periodontal tissue destruction processes. Studies on the effect of scaling to remove calculus disposition on blood glucose control and cellular immune response in DM patient has never been carried out. The aim of the study was to analyze the effect of scaling as non-surgical periodontal therapy on immune response (IL-1β level and PMN phagocytotic function) and blood glucose level of type 2 diabetic patients. Subjects were diabetic patients, 60 controlled-DM (CDM) and 60 uncontrolled-DM (UCDM), in Metabolic-Endocrinology Clinic of Ciptomangunkusumo Hospital, aged 40-60 years. The subjects were divided into treatment (scaling) and control group, and cellular immune response and diabetic status, before and 6 weeks after treatment were evaluated. Statistical analysis (t test) were done using Stata 7.0 software, to compare the parameters before and after scaling in CDM and UCMD subjects. The results showed that scaling decreased IL-1β level and increased phagocytotic function significantly (P<0.05). Scaling decreased fasting and 2 hours post-prandial blood glucose levels and HbA1c level, but the decrease were not significant statistically (P>0.05), except for the decrease in HbA1c level in uncontrolled DM (P=0.00)."