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"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."

"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. "

"Nasopharyngeal carcinoma (NPC) is a unoque ephithelial malignancy that occurs at a high frequency in certain regions of Southeast Asia. Previous study revealed the association between Epstein Barr Virus (EBV) and to a lesser extent, Human papiloma Virus (HPV) with NPC...."

"ABSTRAKTenofovir disoproksil fumarat (tenofovir) dan telbivudin merupakan dua analog nukleos(t)ida yang tersedia untuk terapi pasien hepatitis B. Tenofovir telah diketahui sebagai agen nefrotoksik pada pasien HIV, namun masih menjadi kontroversi pada pasien hepatitis B kronik. Di lain sisi, telbivudin memiliki efek proteksi terhadap fungsi ginjal dan bahkan meningkatkan estimasi laju filtrasi glomerulus (eLFG). Penelitian ini bertujuan untuk mengetahui profil keamanan terhadap fungsi ginjal dari tenofovir dan telbivudin pada pasien hepatitis B kronik di Indonesia. Metode. Penelitian ini menggunakan desain studi kohort retrospektif pada pasien hepatitis B kronik yang mendapat terapi tenofovir atau telbivudin dalam rentang waktu Januari 2013 - Desember 2016. Pasien yang mempunyai eLFG awal <60 mL/ menit/1,73 m2 sebelum mulai terapi, mengalami perubahan regimen, lost to follow up, atau meninggal dalam 1 tahun tidak diikutsertakan dalam penelitian ini. Data kreatinin serum yang dinilai adalah data pada minggu ke 24 dan 48 setelah pemberian tenofovir atau telbivudin. Hasil. Sebanyak 68 pasien dalam terapi tenofovir dan 62 pasien dalam terapi telbivudin dimasukkan penelitian ini. Kadar kreatinin serum meningkat pada kelompok tenofovir dari 0,88 (simpang baku [SB] 0,17) mg/dL pada awal studi menjadi 0,93 (SB 0,22) mg/dL setelah 24 minggu (p = 0,02) dan cenderung plateau setelah penggunaan selama 48 minggu. Namun, pada kelompok telbivudin, kadar kreatinin serum menurun dari 0,85 (SB 0,21) mg/dL pada awal menjadi 0,80 (SB 0,18) mg/ dL pada minggu ke 48 (p = 0,003).Simpulan. Tenofovir berhubungan dengan peningkatan kadar kreatinin serum dan penurunan eLFG pada pasien hepatitis B kronik dengan eLFG >60 mL/menit/1,73 m2."

"Pendahuluan: Neutrofil merupakan sel inflamasi yang diyakini berperan pada patogenesis Penyakit Paru Obstruktif Kronik (PPOK). Telah terdapat bukti korelasi antara hambatan aliran udara pada pasien PPOK dengan kadar neutrofil sputum. Penelitian beberapa tahun terakhir membuktikan nilai rasio neutrofillimfosit (RNL) dan protein C-reaktif (CRP) dari darah perifer berpotensi menjadi petanda inflamasi sistemik, tidak terkecuali PPOK. Beberapa penelitian membuktikan nilai RNL dan CRP lebih tinggi pada pasien dengan PPOK dibanding orang normal. Begitu pula saat kondisi eksaserbasi, nilai RNL dan CRP lebih tinggi daripada kondisi stabil. Selain itu terdapat bukti korelasi antara hasil spirometri dengan nilai RNL dan CRP. Hasil beberapa penelitian yang telah dilakukan sejauh ini menunjukkan bahwa nilai RNL dan CRP dapat menjadi suatu penilaian yang layak diperhatikan dalam PPOK. Tujuan: Memperoleh data mengenai nilai RNL dan CRP pada pasien PPOK eksaserbasi dan stabil di Rumah Sakit Umum Pusat Persahabatan. Metode: Analisis observasional kohort prospektif di RS Persahabatan, Jakarta Indonesia sebanyak 31 sampel dari Juli 2018 hingga Desember 2018. Kami mengikutsertakan 31 pasien PPOK eksaserbasi untuk dilakukan pemeriksaan spirometri dan pemeriksaan darah dan membandingkan hasil pemeriksaan pasien yang sama pada kondisi stabil.Hasil: Petanda inflamasi yang diperiksa pada penelitian ini RNL dan CRP keduanya menunjukkan penurunan kadar pada kondisi stabil, bertutut-turut dari 7,95 ± 6,8 menjadi 4,6 ± 5,5 dan 43,4 ± 71 menjadi 12,2 ± 18,5 dengan nilai p < 0,01. Didapatkan pula korelasi negatif yang bermakna antara RNL dan nilai VEP1/KVP pada kondisi eksaserbasi. Nilai CRP menunjukkan korelasi negatif hanya dengan VEP1 pada saat eksaserbasi. Di samping itu, terdapat pula subjek penelitian dengan nilai CRP yang sangat tinggi pada saat eksaserbasi, meninggal dunia dalam kurun waktu dua bulan setelah eksaserbasi. Kesimpulan: Nilai RNL dan CRP pada subjek dengan PPOK lebih tinggi pada kondisi eksaserbasi dan mungkin dapat menggambarkan status eksaserbasi pada pasien PPOK.

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Introductions: Although COPD has been believed to be characterized by respiratory disease, currently limited study conducted to evaluate inflammation markers and exacerbation rate in COPD by noninvasive method. We observed the COPD severity, future exacerbation by using peripheral blood test. We did a prospective cohort study to observe the alteration of Neutrophyl-Lymphocyte Ratio (NLR) and C-reactive protein (CRP) in COPD patients to find any possible correlation with COPD exacerbation status.

Aims: To study the value of NLR and CRP of COPD patients during exacerbation and stable in Persahabatan Hospital, Jakarta.

Methods: Starting from July to December 2019, a prospective cohort study was performed with blood and pulmonary function test in 31 COPD patients in two different conditions: during exacerbation and stable. The mean of both inflammation markers was compared and correlated them with pulmonary function test.

Results: Both inflammation markers NLR and CRP value decreased during stable condition (from 7,95 ± 6,8 to 4,6 ± 5,5 and 43,4 ± 71 to 12,2 ± 18,5) with p < 0,01 respectively. In addition, we also found a significant inverse correlation between NLR and FEV1/FVC during exacerbation but not during the stable condition, and CRP showed inverse correlation only with FEV1 during exacerbation. Another interesting finding was subject with very high CRP whose value remained above nomal limit during stable, died within 2 month after exacerbation.

Conclusions: NLR and CRP in COPD patients increased during exacerbation and may reflect lung function and exacerbation status in COPD patient."

"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."

"Latar Belakang : Coronavirus disease 2019 (COVID-19) menjadi pandemi pada Maret 2020. Luaran penyakit ini sangat bervariasi, hingga mengakibatkan kematian. Mortalitas COVID-19 dipengaruhi oleh banyak faktor. Pemeriksaan radiografi merupakan salah satu pemeriksaan penunjang yang dapat dilakukan pada COVID-19 untuk skrining, diagnosis, menentukan derajat keparahan penyakit dan memantau respons pengobatan. Foto toraks merupakan modalitas yang banyak tersedia di berbagai fasilitas layanan kesehatan, murah, mudah, dan dapat dilakukan di tempat tidur pasien. Skor Brixia merupakan salah satu sistem penilaian derajat keparahan foto toraks yang mudah dan cepat. Metode : Desain penelitian ini adalah kohort retrospektif menggunakan data rekam medik awat inap RSUP Persahabatan yang dipilih secara acak sistematis. Subjek penelitian adalah pasien COVID-19 yang dirawat pada Maret hingga Agustus 2020. Subjek penelitian dipilih sesuai kriteria inklusi dan eksklusi. Hasil : Pada penelitian ini didapatkan total 313 subjek dengan pasien yang memiliki luaran meninggal sebanyak 65 subjek dan yang hidup sebanyak 248 subjek. Nilai tengah skor Brixia 8 dengan nilai paling rendah 0 dan paling tinggi 18. Jenis kelamin terbanyak adalah laki-laki sebanyak 185 subjek (59,1%). Sebanyak 79 subjek (25,2%) merupakan pasien berusia lanjut (> 60 tahun). Status gizi subjek terdiri atas gizi cukup (53,7%), gizi lebih (42,5%), dan gizi kurang (3,8%). Pasien yang memiliki komorbid sebanyak 143 subjek (45,7%) dengan jenis komorbid terbanyak adalah hipertensi dan diabetes melitus. Pada titik potong 7,5, skor Brixia memiliki nilai sensitivitas 61,5% dan spesifisitas 50%. Terdapat hubungan bermakna skor Brixia dengan status gizi (p < 0,001) dan ada tidaknya komorbid (p 0,002). Tidak terdapat hubungan bermakna antara usia (p 0,420), jumlah komorbid (p 0,223) dan mortalitas (p 0,121) dengan skor Brixia. Skor Brixia 16-18 memiliki risiko mortalitas 3,29 kali lebih besar daripada skor Brixia 0-6.

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Background : Coronavirus disease 2019 (COVID-19) became a pandemic in March 2020. The outcome of this disease varies widely, including death. There are many risk fators for mortality in COVID-19. Imaging is one of the supporting examinations that can be performed on COVID-19 for screening, diagnosis, determining the severity of the disease and monitoring response to treatment. Chest X-ray is a modality that is widely available in various health care facilities, is cheap, easy, and can be done bedside patient. The Brixia score is an easy and fast chest radiograph severity rating system.

Methods : The design of this study was a retrospective cohort using medical records of inpatients at Persahabatan General Hospital which were selected systematically random sampling. The research subjects were COVID-19 patients who hospitalized from March to August 2020. The study subjects were selected according to the inclusion and exclusion criteria.

Results : In this study, a total of 313 subjects were obtained with 65 died and 249 survived. The median of Brixia score was 8 with the lowest score 0 and the highest score 18. The male population was 185 subjects (59.1%). Total of 79 subjects (25.2%) were elderly patients (> 60 years). The subjects are grouped into three categories nutritional status based on body mass index. There were normal (53.7%), overweight (42.5%), and malnutrition (3.8%). Patients who had comorbidities were 143 subjects (45.7%). The most frequent comorbidities were hypertension and diabetes mellitus. At the cut point of 7.5, the Brixia score has a sensitivity value 61.5% and a specificity 50%. There is a significant relationship between the Brixia score and nutritional status (p < 0.001) and the presence or absence of comorbidities (p 0.002). There was no significant relationship between age (p 0.420), number of comorbidities (p 0.223) and mortality (p 0.121) with the Brixia score. Brixia score of 16-18 has a mortality risk 3.29 times higher than Brixia score of 0-6."

"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."