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Ayu Diandra Sari
Terapi medik gizi dan perbaikan kadar vitamin d terhadap status gizi dan kualitas hidup pasien autoimun = Medical nutrition therapy and improvement of vitamin d serum on nutritional status and quality of life of autoimmune disease patient
"Defisiensi vitamin D sering terjadi pada penyakit autoimun, termasuk pemfigus vulgaris (PV) dan systemic lupus erythematosus (SLE). Sementara itu, terapi nutrisi dan suplementasi vitamin D masih belum rutin dilakukan dalam tata laksana PV dan SLE. Serial kasus ini melaporkan terapi nutrisi dan suplementasi vitamin D pada empat kasus penyakit autoimun yang mengalami kekambuhan. Serial kasus terdiri atas dua pasien laki-laki PV dan dua pasien perempuan SLE dengan defisiensi vitamin D yang putus obat akibat pandemi corona virus disease 2019 (COVID-19). Keempat pasien mengalami malnutrisi berat secara klinis, karena penurunan asupan makanan dan berat badan dengan berbagai komplikasi obat imunosupresan jangka panjang, yaitu meningkatnya risiko infeksi, sepsis, sarkopenia, deposisi lemak, diabetes mellitus diinduksi steroid, dislipidemia, hipertensi, dan depresi. Asupan energi secara bertahap ditingkatkan secara enteral melalui nasogatric tube (NGT) dan/atau rute oral untuk memenuhi kebutuhan energi dan protein total. Kebutuhan energi total menggunakan Formula Harris-Benedict dengan faktor stres yang disesuaikan dengan profil klinis dan metabolik masing-masing pasien. Kebutuhan protein ditetapkan 1,5–2,0 g/kg BB/hari untuk pasien PV dan 0,8–1,2 g/kg BB/hari untuk pasien SLE dengan keterlibatan ginjal. Lemak dan karbohidrat (KH) disesuaikan dengan komposisi seimbang, yaitu 45–60% KH, 25 g serat, dan <5% added sugar serta 25–30% lemak dengan <7% asam lemak jenuh, ~20% asam lemak tak jenuh tunggal, dan ~ 10% asam lemak tak jenuh jamak. Dua pasien PV mengalami insufisiensi (16,4 ng/mL dan 22,1 ng/mL) dan dua pasien SLE mengalami defisiensi (6,6 ng/mL dan 9,1 ng/mL). Keempat pasien mendapatkan kolekalsiferol 6000 IU/hari selama 8 minggu berturut-turut. Setelah 1 bulan suplementasi vitamin D dan terapi nutrisi adekuat, serum vitamin D serta status nutrisi dan skor Karnofsky meningkat. Kualitas hidup yang dinilai dengan Dermatology Life Quality Index (DLQI) untuk pasien PV dan Lupus quality of life (LupusQoL) untuk pasien SLE juga meningkat. Serial kasus ini menyimpulkan bahwa tata laksana komprehensif yang menyertakan terapi nutrisi adekuat dan evaluasi serum vitamin D dapat meningkatkan kondisi klinis dan metabolik, status gizi, kapasitas fungsional, dan kualitas hidup pasien autoimun kambuh.
Vitamin D deficiency is common in autoimmune disease, including pemphigus vulgaris (PV) and systemic lupus erythematosus (SLE). Meanwhile, nutrition therapy and vitamin D supplementation are still not routines in comprehensive management of PV and SLE. In this case series, we report nutrition therapy and vitamin D supplementation of four cases of relapse autoimmune disease. This series consist of two males of PV and two females of SLE with vitamin D deficiency that dropped out of treatment due to corona virus disease 2019 (COVID-19) pandemic. Patients became clinically severe malnutrition because of reduced food intake and body weight with various long-term immunosuppressant drug complications, ie increased risk of infections, sepsis, sarcopenia, fat deposition, steroid induced diabetes mellitus, dyslipidemia, hypertension, and depression. Energy intake was gradually increased enterally via nasogatric tube (NGT) and/or oral route to meet total energy and protein requirement. Total energy requirement was calculated by Harris-Benedict Formula with stress factor adjusted by clinical and metabolic profile of each patient. Protein requirement set by 1.5–2.0 g/kg BW/day for PV and 0,8–1,2 g/kg BW/day for SLE with renal involvement. Fat and carbohydrate (CHO) were tailored by balance composition, ie 45–60% CHO, 25 g fiber, and <5% added sugar and 25–30% fat with <7% saturated fatty acid, ~20% monounsaturated fatty acid, and ~10% polyunsaturated fatty acid. Two PV patients were insufficiency (16,4 ng/mL and 22,1 ng/mL) and two SLE patients were deficiency (6,6 ng/mL and 9,1 ng/mL). Cholecalciferol 6000 IU/day was prescribed for 8 weeks. After 1 month vitamin D supplementation and an adequate nutrition therapy, serum vitamin D was increased as well as nutritional state and Karnofsky’s score. Dermatology Life Quality Index (DLQI) for PV and LupusQoL for SLE were also enhanced. Finally, comprehensive management along with an adequate nutrition therapy and vitamin D evaluation improved clinical and metabolic condition, nutritional status, functional capacity, and quality of life of relapse autoimmune patient."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Nugrahayu Widyawardani
Peran Terapi Medik Gizi terhadap Status Nutrisi Kapasitas Fungsional, dan Kualitas Hidup Pasien Tuberkulosis Paru dengan Penyulit = Role of Medical Nutrition Therapy on Nutrition Status, Functional Capacity, and Quality of Life of Patient with Lung Tuberculosis with Complication.
"Latar Belakang:
Tuberkulosis Paru (TB Paru) merupakan penyakit infeksi yang bersifat kronis dengan tingkat morbiditas dan mortalitas yang tinggi. Perubahan metabolisme akibat infeksi Mycobacterium Tuberkulosa(M.TB) dan aktivasi sistem neurohormal turut berperan terhadap terjadinya malnutrisi, yang dapat memberikan efek negatif terhadap prognosis pasien dengan TB Paru. Penderita TB Paru mengalami penurunan kapasitas fungsional dan kualitas hidup. Terapi Medik Gizi sejak awal diagnosis ditegakkan, akan mendukung proses pemulihan pasien TB.
Kasus :
Dalam serial kasus ini, dipaparkan empat kasus pasien TB Paru dengan berbagai faktor risiko, diantaranya adalah penyakit TB Paru, TB Miliar, PPOK et causa TB Paru, Meningitis TB. Pada awal pemeriksaan didapatkan adanya defisiensi asupan makronutrien dan mikronutrien, hipoalbuminemia, CRP yang meningkat, hemoglobin (Hb) yang turun, penurunan kapasitas fungsional dan kualitas hidup. Terapi medik gizi diberikan secara individual, sesuai dengan kondisi klinis, hasil pemeriksaan laboratorium, dan analisis asupan makan terakhir.
Hasil:
Tiga dari empat pasien mengalami peningkatan asupan, perbaikan kondisi klinis, dan kapasitas fungsional serta kualitas hidup pasien. Status nutrisi pasien tidak mengalami perburukan selama perawatan,
Kesimpulan:
Terapi Medik gizi yang adekuat pada pasien TB dapat mempertahankan status nutrisi pasien dan mendukung perbaikan kondisi klinis, kapasitas fungsional, serta kualitas hidup pasien.
Background:
Pulmonary tuberculosis (pulmonary TB) is a chronic infectious disease with high morbidity and mortality. Changes in metabolism due to infection with Mycobacterium Tuberculosis and activation of the neurohormal system contribute to the occurrence of malnutrition, which can have a negative effect on the prognosis of patients with pulmonary TB. Patients with pulmonary TB have decreased functional capacity and quality of life.Early medical nutrition therapywill support the recovery process of pulmonary TB patients.
Case :
In this case series, four cases of pulmonary TB patients were presented with various risk factors, including pulmonary TB disease, miliar TB, COPD et causa lung TB, and TB meningitis. Deficiency of macro and micronutrient intake, hypoalbuminemia, increased CRP, decreased hemoglobin (Hb), decreased functional capacity and quality of life were found at the beginning of examination. Nutrition medical therapy is given individually, according to clinical conditions, results of laboratory examinations, and analysis of recent food intake.
Result :
Three out of four patients experience increased intake, improvement of clinical conditions, functional capacity and quality of life. The nutritional status of patients did not experience worsening during treatment.
Conclusion:
Adequate nutritional medical therapy in TB patients can maintain patient nutritional status and support improvement of clinical conditions, functional capacity, and quality of life."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
T59146
UI - Tesis Membership  Universitas Indonesia Library
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Fenny
Terapi medik gizi pada pasien luka bakar berat: peran pemberian vitamin D = Medical nutritional therapy in severe burns patients: role of vitamin D supplementation
"Latar Belakang: Pada luka bakar terjadi peningkatan respon inflamasi. Peningkatan c-reactive protein (CRP) pada luka bakar merupakan penanda inflamasi sistemik. Kadar vitamin D yang rendah banyak ditemukan pada pasien luka bakar dan berhubungan dengan luaran klinis yang buruk. Vitamin D memiliki efek memodulasi imun dan antiinflamasi. Metode: Serial kasus ini terdiri dari 4 pasien luka bakar berat karena ledakan gas dan api yang dirawat di ULB pada periode Januari hingga Mei 2022. Terapi medik gizi yang diberikan berupa nutrisi enteral dini, kemudian ditingkatkan secara bertahap sesuai toleransi dan klinis pasien, hingga kebutuhan energi total (berdasarkan formula Xie), target protein 1,5-2 g/kg BB/hari, lemak 25-30%, dan karbohidrat 55-60%. Keempat pasien serial kasus diberikan suplementasi vitamin D dan dilakukan pemeriksaan kadar vitamin D sebelum dan sesudah suplementasi, serta pemeriksaan kadar CRP. Hasil: Keempat pasien serial kasus selama perawatan telah mencapai kebutuhan makronutrien sesuai target, meskipun terdapat fluktuasi asupan karena adanya perburukan kondisi klinis atau tindakan operasi/perawatan luka. Keempat pasien serial kasus memiliki kadar vitamin D yang rendah, namun mengalami peningkatan dengan suplementasi. Kadar CRP juga diperoleh meningkat dan mengalami penurunan dengan meningkatnya kadar vitamin D, yang menyebabkan hambatan produksi sitokin proinflamasi dan jalur NF-kB, selain adanya terapi pembedahan dan antibiotik. Keempat pasien serial kasus diperbolehkan rawat jalan pada akhir perawatan. Kesimpulan: Pada serial kasus ini, semua pasien luka bakar dengan kadar vitamin D yang rendah memiliki kondisi inflamasi yang tinggi ditandai dengan peningkatan CRP. Pemberian suplementasi vitamin D menyebabkan peningkatan kadar vitamin D dan turut berperan dalam penurunan CRP, selain adanya terapi pembedahan dan antibiotik
Background: Burns induce an increased inflammatory response. Elevated c-reactive protein (CRP) is a marker of systemic inflammation in burns. Low vitamin D levels are common in burn patients and are associated with poor clinical outcomes. Vitamin D has immune-modulating and anti-inflammatory effects. Method: The case series was held in the burn unit Dr. Cipto Mangunkusumo Hospital from January to May 2022, involving 4 severe burn patients due to gas explosions and fire. Nutritional medical therapy was given in the form of early enteral nutrition, then gradually increased according to patient tolerance and clinical, up to total energy requirements (based on Xie's formula), the target protein is 1.5-2 g/kg BW/day, 25-30% fat and 55-60% carbohydrates. Vitamin D supplementation was given and vitamin D levels were measured before and after supplementation, CRP levels were also measured. Result: All case series patients during treatment had achieved the target macronutrient requirements, despite fluctuations of intake due to clinical deterioration or surgical procedure or wound care. All patients had low vitamin D levels but increased with supplementation. CRP levels also increased and decreased with increasing vitamin D levels, leading to inhibition of inflammatory cytokines production and the NF-kB pathway, besides surgical and antibiotics therapy. All patients were allowed outpatient treatment at the end of treatment. Conclusion: This case series exhibited low level of vitamin D in burn patients accompanied with elevated CRP level indicating high inflammatory condition. Vitamin D supplementation causes an increase in vitamin D levels and may contribute to decreasing CRP levels, in addition to surgical and antibiotic therapy."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
TA-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Dimas Erlangga Luftimas
Peran terapi medik gizi pada status gizi dan kapasitas fungsional pasien meningitis tuberkulosis = The role of medical nutrition therapy on nutritional status and functional capacity improvement of tuberculous meningitis patient
"Meningitis tuberkulosis (MeTB) merupakan manifestasi klinis berat dari infeksi TB yang menyerang sistem saraf pusat (SSP) dan menyebabkan pasien mengalami penurunan asupan nutrisi karena menurunnya kemampuan makan dan selera makan. Asam amino rantai cabang (AARC) diketahui memiliki efek meningkatkan selera makan dan protektif terhadap massa otot. Pemenuhan kebutuhan AARC berpotensi memperbaiki kapasitas fungsional pasien sehingga menurunkan morbiditas dan mortalitas pasien MeTB. Empat pasien MeTB dipantau selama perawatan di Rumah Sakit Cipto Mangunkusumo (RSCM). Pencatatan asupan makanan pasien dilakukan dengan metode FFQ semi kuatitatif dan 24h dietary recall. Selama masa perawatan diberikan terapi medik gizi sesuai kondisi klinis pasien, dilakukan pemantauan harian termasuk penilaian kapasitas fungsional pasien hingga pasien selesai perawatan. Semua pasien menunjukkan tanda malnutrisi berdasarkan kriteria klinis menurut American Society of Parenteral and Enteral Nutrition (ASPEN). Belum ada rekomendasi terapi medik gizi khusus MeTB yang dapat digunakan, namun pada pasien dengan masalah infeksi disertai masalah neurologis rekomendasi tatalaksana TB paru dan stroke dapat menjadi acuan untuk tatalaksana pasien. Pemberian asupan kalori 35-40 kkal pada pasien dengan protein minimal 1,5 g/kgBB berpotensi meningkatkan kapasitas fungsional pasien dan mencegah perburukan penyakit. Tiga pasien mendapatkan asupan AARC diatas rekomendasi dan didapatkan peningkatan kapasitas fungsional dengan menggunakan indeks Barthel. Terapi medik gizi dengan pemberian protein dan AARC yang lebih tinggi dari rekomendasi IOM pada pasien MeTB dapat meningkatkan kapasitas fungsional pasien.
Tuberculous Meningitis (TBM) has been the most severe manifestation of Tuberculosis infection attacking central nervous system (CNS) and causes the risk of malnutrition in patients due to decrease the ability of eating and loss appetite. Branched chain amino acid (BCAA) has been known having effects in appetite and protection of muscle mass. Fulfilling BCAA requirement is potential to improve patient functional capacity, furthermore lowering the morbidity and mortality of TBM patient. Four TBM patients has been observed during hospitality in Cipto Mangunkusumo Hospital (RSCM). Patient’s dietary intake was collected using semiquantitative FFQ and 24h dietary recall. During hospitality, medical nutrition therapy was administered based on patient clinical condition, daily observation including patient functional capacity was done until patient was discharged. All patients showed malnutrition signs based on clinical criteria according to American Society of Parenteral and Enteral Nutrition (ASPEN). Recommendation of nutrition therapy on TBM patient still not exist, however in patient with infection and neurological problem, guideline of nutrition therapy in TB infection and stroke can be used. Intake of 35-40 kcal/kgBW calories and 1,5 g/kgBW of protein can be potential to increase patient functional capacity and prevent further morbidity. Three patient can fulfill their BCAA beyond the requirement and there were increase in patient functional capacity using Barthel Index. Medical nutrition therapy using protein and BCAA administration above the IOM recomendation in TBM patient can improve functional capacity."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Audrey Haryanto
Korelasi antara kadar vitamin D serum dengan kadar hsCRP pada usia lanjut = Correlation between serum vitamin D level and hsCRP in elderly
"Prevalensi penyakit kardiovaskuler (PKV) meningkat seiring dengan proses penuaan. Aterosklerosis yang menyebabkan terjadinya inflamasi dan diikuti peningkatan kadar C-reactive protein (CRP). Vitamin D merupakan vitamin yang memiliki efek antiinflamasi dan dapat menurunkan kadar hsCRP. Penelitian ini merupakan penelitian dengan desain potong lintang yang bertujuan untuk mengetahui korelasi antara kadar vitamin D dengan kadar hsCRP pada usia lanjut (usila). Penelitian dilakukan di Pusat Santunan Keluarga (Pusaka) 12 di Tomang dan Pusaka 39 di Senen pada pertengahan bulan Desember 2012 sampai bulan Januari 2013. Pengambilan subyek dilakukan dengan cara cluster random sampling, dan didapatkan 71 orang subyek yang memenuhi kriteria penelitian. Data dikumpulkan melalui wawancara meliputi data usia, asupan vitamin D dengan metode Food Frequency Questionnaire (FFQ) semikuantitatif serta total skor pajanan sinar matahari mingguan. Pengukuran antropometri untuk menilai status gizi dan pemeriksaan laboratorium yang meliputi kadar vitamin D dan hsCRP. Didapatkan median usia 69 (60-85) tahun dan 80,3% subyek adalah perempuan. Malnutrisi terdapat pada 71,8 % subyek. Asupan vitamin D menunjukkan 98,6% subyek memiliki asupan vitamin D kurang dari Angka Kecukupan Gizi (AKG) Indonesia. Sebanyak 97,2% subyek memiliki skor pajanan sinar matahari rendah. Nilai rerata kadar vitamin D 38,02±12,94 nmol/L dan 78% subyek tergolong defisiensi vitamin D. Nilai median kadar hsCRP 1,5 (0,1-49,6) mg/L, dan 67,6% subyek tergolong risiko PKV sedang dan tinggi. Didapatkan korelasi positif tidak bermakna antara kadar vitamin D serum dengan kadar hsCRP pada usila (r=0,168, p=0,162).
The prevalence of cardiovascular disease (CVD) increases in the elderly. Atherosclerosis is a major cause of CVD which stimulate inflammation and followed by increase production of C-reactive protein (CRP). Vitamin D is a vitamin which has anti-inflammatory effects and may reduce level of hsCRP. The aim of this cross sectional study was to find the correlation between serum vitamin D level and hsCRP in elderly. Data collection was conducted during December 2012 to January 2013 on 2 selected Pusaka, Pusaka 12 (Tomang) and Pusaka 39 (Senen). Subjects were obtained using cluster random sampling method. A total of 71 elderly subjects had met the study criteria. Data were collected through interviews including age, vitamin D intake and weekly score of sunlight exposure. Anthropometry measurements to assess the nutritional status and laboratory examination i.e blood levels of vitamin D and hsCRP. Majority of the subjects were female (80,3%), median age was 69 (60-85) years. Malnutrition was occured in 71.8% of the subjects. Intake of vitamin D showed 98.6% of the subjects were less than recommended dietary allowances (RDA). Majority of the subjects had low score of sunlight exposure (97,2%). Mean of vitamin D levels 38,02±12,94 nmol/L, while 78% the of subjects were categorized as vitamin D deficiency. Median of hsCRP levels 1,5 (0,1-49,6) mg/L, while 67,6% subjects were at moderate and high risk of CVD. No significant correlation was found between serum vitamin D levels and hsCRP levels (r=0,168, p=0,162)."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
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Isa Rosalia Ruslim
Korelasi antara asupan vitamin D dan skor paparan sinar matahari dengan kadar kalsidiol serum pada ibu hamil trimester 1 di Jakarta = Correlation between vitamin d intake and sun exposure score with serum calcidiol on first trimester pregnant women in Jakarta
"Hipovitaminosis D selama masa kehamilan dapat menimbulkan komplikasi selama kehamilan dan pada janin. Selain itu data mengenai status vitamin D pada ibu hamil terutama trimester 1 di Indonesia masih terbatas. Oleh karena itu penelitian ini dilakukan untuk mengetahui kadar kalsidiol serum pada ibu hamil trimester 1 dan korelasinya dengan asupan vitamin D dan skor paparan sinar matahari.
Penelitian ini menggunakan metode studi potong lintang pada ibu hamil sehat usia 20-35 tahun dengan usia kehamilan <12 minggu. Hasil penelitian menunjukkan rerata usia subyek 27,36+3,91 tahun dengan median usia kehamilan 9 minggu. Sebagian besar subyek berpendidikan tinggi (68,1%), status bekerja (70,2%) dengan pendapatan >UMP (59,6%) dan rerata IMT 23,74+3,83 kg/m2. Asupan lemak, protein, dan kalsium subyek
Median skor paparan sinar matahari adalah 14 (0-42) dengan median lama paparan 17,41 (0-85,71) menit. Terdapat perbedaan bermakna antara kadar kalsidiol serum dengan kelompok lama paparan sinar matahari 5-30 menit dan >30 menit (p=0,033). Rerata kadar kalsidiol serum 39,26+10,25 nmol/mL (insufisiensi) dengan 100% subyek memiliki kadar kalsidiol serum < 80 nmol/L yang menggambarkan keadaan hipovitaminosis D.
Tidak terdapat korelasi antara kadar kalsidiol serum dengan skor paparan sinar matahari (r=0,087; p=0,562), dan asupan vitamin D (r=-0,049; p=0,745). Kesimpulan yang didapatkan dari penelitian adalah seluruh ibu hamil trimester 1 di Jakarta mengalami hipovitaminosis D sehingga perlu segera diatasi melalui konseling dan edukasi gizi.
Vitamin D deficiency could be related to several complications to pregnancy`s outcomes, both for mother and fetus. Besides, there is limited data regarding to vitamin D status among pregnant women in Indonesia especially during the first trimester. Therefore this study was performed to determine serum calcidiol on the first trimester of pregnancy and its correlation to vitamin D intake and sun exposure score.
The methode in this study was cross-sectional study among healthy pregnant women aged 20-35 years old on their first trimester of pregnancy. Average age of the subjects was 27.36±3.91 years old with median gestational age of 9 weeks. Most of the subjects was well educated (68.1%), working (70.2%) with monthly income equal and more than the province minimum salary (59.6%), and with BMI average of 23.74±3.83 kg/m2. Mostly the subjects had fat, protein, and calcium intake below its RDA with the average intake of 44.49±22.22 g/day; 45.07±19.35 g/day; 661.93±405.91 mg/day, respectively. Vitamin D intake was mostly below its RDA with a median of 2.9 mcg/day and ranged from 0.3 to 15.6 mcg/day.
The median score of sun exposure score was 14 that ranged from zerro to 42, with a median for its duration of 17.41 minutes that ranged from zerro to 85.71 minutes. In this study, there was significant differences between serum calcidiol and sun exposure duration in 5-30 minutes and more than 30 minutes groups (p=0,033). As the main finding, it reveals that the average of serum calcidiol was 39.26±10.25 nmoL/mL or classified as insufficient where all of the subjects (100%) had serum calcidiol less than 80 nmol/L (hypovitaminosis D).
However, there were no significant correlations between serum calcidiol with sun exposure score and vitamin D intake (r=0.087 and p=0.562; r=-0,049 and p=0.745, respectively). In conclusion, all of the pregnant women in Jakarta, especially in their first trimester had low vitamin D status. Therefore, intervention is needed, i.e. through prenatal counselling and nutrition education regarding to natural sources of vitamin D."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
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Yusi Deviana Nawawi
Korelasi antara kadar vitamin D serum dengan performa fisik pada usia lanjut di panti wreda = Correlation between vitamin D serum levels with physical performance among elderly individuals in nursing homes
"Usia lanjut berisiko tinggi mengalami defisiensi vitamin D, sedangkan vitamin D memiliki efek protektif terhadap massa otot. Penurunan massa otot dan fungsinya disebut dengan sarkopenia. Prevalensi sarkopenia sangat tinggi pada usia lanjut yang tinggal di panti wreda, kondisi ini disebabkan gaya hidup sedentari pada penghuni panti wreda. Deteksi dini sarkopenia dapat dilakukan dengan mengukur fungsi otot, salah satunya adalah mengukur performa fisik dengan tes short physical performance battery (SPPB). Penelitian potong lintang ini bertujuan untuk melihat korelasi antara kadar vitamin D serum dengan performa fisik pada usia lanjut di lima panti wreda yang terdaftar di Kota Tangerang Selatan. Pengambilan subjek dilakukan dengan cara proportional random sampling, didapatkan 100 usila yang memenuhi kriteria penelitian. Pemeriksaan kadar vitamin D menggunakan kadar kalsidiol serum dengan metode chemiluminescence immunoassay (CLIA). Pemeriksaan massa otot menggunakan bioelectric impedance analysis Tanita SC-330. Analisis korelasi menggunakan uji nonparametrik. Didapatkan nilai tengah usia subjek adalah 74,89 tahun dan 72% subjek adalah perempuan. Terdapat  85% subjek memiliki asupan vitamin D yang kurang dan  94% subjek memiliki skor pajanan sinar matahari yang rendah, serta seluruh subjek masih memiliki massa otot yang normal. Nilai tengah kadar vitamin D serum  adalah 15,50(4-32) ng/mL, dengan 72% subjek mengalami defisiensi vitamin D. Nilai tengah performa fisik adalah 9(3-12) dan sebanyak 47% subjek mengalami performa fisik yang buruk. Hasil penelitian ini menunjukkan bahwa tidak terdapat korelasi antara kadar vitamin D serum dengan performa fisik pada usia lanjut di panti wreda (r=0,130; p=0,196).
Elderly individuals have a risk of vitamin D deficiency, whereas vitamin D has a protective effect on muscle mass. Decrease in muscle mass and function is called sarcopenia. The prevalence of sarcopenia is very high in the elderly who live in nursing homes, this condition is due to the sedentary lifestyle. Early detection of sarcopenia can be done by measuring physical performance with short physical performance battery (SPPB) test. This cross-sectional study aimed to explore the correlation between vitamin D serum levels with physical performance among elderly individuals in five nursing homes registered in South Tangerang. A hundred subjects who fulfilled study criteria gathered using proportional random sampling method. Examination of vitamin D levels using calcidiol serum with the chemiluminescence immunoassay (CLIA) method. Muscle mass was measured using bioelectric impedance analysis Tanita type SC-330. Nonparametric correlation was used for correlation analysis. Median age of subjects was 74.89 years old and 72% were female. Eighty-five percent of subjects had low vitamin D intake, 94% of subjects had low sun exposure score, and all subjects had normal muscle mass. Mean level of vitamin D serum was 15.50 (4-32) ng/mL, with 72% of subjects had vitamin D deficiency. Mean score of physical performance was 9(3-12) and 47% of subjects had low physical performance. This study showed that there was no correlation found between vitamin D serum levels with physical performance among elderly individuals in nursing homes (r=0.130; p=0.196)."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
T58914
UI - Tesis Membership  Universitas Indonesia Library
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Silalahi, Eva Roria
Jumlah Dendritic Cells (DC) 10 dan Sel T Regulatorik CD4+ CD25+FoxP3 Desidua pada Preeklamsia dan Keterkaitannya dengan Kadar Seng, Vitamin A, dan Vitamin D dalam Patomekanisme Penolakan Imun = Number of Decidual Dendritic Cells (DC) 10 and Regulatoric T cell CD4+CD25+FoxP3 in Preeclampsia and Their Correlations with Decidual Levels of Zinc, Vitamin A, and Vitamin D in the Pathomechanism of Immune Rejection
"Preeklamsia dibagi menjadi preeklamsia awitan dini (PEAD) jika terjadi pada usia kehamilan < 34 minggu dan preeklamsia awitan lanjut (PEAL) pada kehamilan > 34 minggu. Intoleransi imun diduga menyebabkan penolakan imun terhadap fetus di plasenta. Dendritic cell 10 (DC-10) dan sel T regulator CD4+CD25+FoxP3 (Treg) di desidua berperan penting dalam menciptakan lingkungan yang tolerogenik selama kehamilan. Namun, peran spesifik dalam patomekanisme PEAD dan PEAL serta faktor-faktor nutrisi yang berperan dalam regulasi DC-10 dan Treg, yaitu seng, vitamin A, dan vitamin D belum diteliti secara jelas. Penelitian ini bertujuan untuk memahami patomekanisme penolakan imun pada preeklamsia melalui jumlah DC-10 dan sel Treg desidua serta hubungannya dengan vitamin A, vitamin D, dan seng.
Desain penelitian ini adalah studi potong lintang komparatif antara kehamilan dengan PEAD, PEAL, dan NT antara Oktober 2019 dan Desember 2021. Subjek penelitian direkrut dari RSUP Fatmawati (Jakarta), RSUPN Cipto Mangunkusumo (Jakarta), dan RSUD Karawang (Jawa Barat). Kriteria penerimaan adalah semua ibu hamil 20–40 minggu yang menjalani persalinan dengan seksio sesaria dan setuju untuk dilibatkan dalam penelitian. Kriteria penolakan meliputi pasien dengan penyulit obstetrik, plasenta previa, memiliki riwayat penyakit kronik, hipertensi sebelum kehamilan 20 minggu, terdiagnosis COVID-19, demam dan leukosit >15.000 /mL pada saat pemeriksaan dan kematian janin dalam rahim. Spesimen desidua diperoleh dengan kuretase tajam setelah seksio sesaria. Jumlah DC-10 dan sel Treg dihitung dengan flow cytometry. Konsentrasi faktor nutrisi diperiksa dengan metode ICP-MS dan LC-MS. Perbandingan median dianalisis dengan uji Kruskal-Wallis, sedangkan koefisien korelasi diperoleh dengan uji korelasi Spearman. Subjek penelitian adalah 14 ibu hamil untuk setiap kelompok (total 42 kasus). Jumlah DC-10 lebih rendah secara bermakna pada PEAD dibandingkan NT (p < 0,001) dan lebih rendah secara bermakna pada PEAL dibandingkan NT (p = 0,015). Sebaliknya, sel Treg FoxP3+CD25+ lebih tinggi secara bermakna pada PEAD dibandingkan NT (p = 0,015). Tidak terdapat korelasi antara faktor nutrisi dan jumlah faktor tolerogenik pada kelompok preeklamsia (PE). Namun, terdapat korelasi sedang antara konsentrasi seng desidua dan DC-10 di kelompok NT (r = 0,656; p = 0,011) dan korelasi kuat antara konsentrasi retinol desidua dan DC-10 juga di kelompok NT (r = 0,746; p = 0,002). Korelasi sedang didapatkan antara konsentrasi vitamin D dan jumlah sel Treg FoxP3+CD25+ di kelompok NT (r = 0,590; p = 0,026). Disimpulkan bahwa jumlah DC-10 pada PEAD lebih rendah dibandingkan dengan kehamilan NT, sedangkan jumlah sel Treg pada PEAD secara bermakna lebih tinggi dibandingkan dengan kehamilan NT. Konsentrasi faktor nutrisi desidua tidak berkorelasi dengan jumlah DC-10 atau Treg desidua pada preeklamsia (PEAD dan PEAL). Namun, pada kelompok NT terdapat korelasi positif antara seng dan DC-10, retinol dan DC-10, serta vitamin D dan jumlah sel Treg desidua.
Preeclampsia is categorized as early-onset preeclampsia (EOPE) at < 34 week of gestation and late-onset preeclampsia (LOPE) at > 34 week of gestation. Immune intolerance is thought to be the underlying cause of immune rejection to the fetus in the placenta. Decidual dendritic cell-10 (DC-10) and T regulator cell CD4+CD25+FoxP3 (Treg) play important role to create a tolerogenic environment during pregnancy. However, the specific role in the pathomechanism of EOPE or LOPE and nutritional factors that play role in the regulation of DC-10 and Treg, i.e. zinc, vitamin A, and vitamin D have not been widely studied. This study was aimed to know the pathomechanism of immune rejection in preeclampsia through the number of decidual DC-10 and Treg cell and their correlations with vitamin A, vitamin D, and zinc.
The study design was cross-sectional comparative among EOPE, LOPE, and NT pregnancies between October 2019 and December 2021. Study subjects were recruited from Fatmawati General Hospital (Jakarta), Cipto Mangukusumo National General Hospital (Jakarta), and Karawang Regional Public Hospital (West Java). Inclusion criteria were all pregnant women between 20–40 weeks of gestation who underwent cesarean delivery and gave their written consent to be included in the study. Exclusion critera were patients with obstetric complications, placenta previa, history of chronic disease, hypertension before 20 weeks of gestation, was diagnosed with COVID-19, fever and leukocyte count of >15.000 /mL at the time of examination and presence of intrauterine fetal death. Decidual specimens were obtained by curettage after the cesarian section. The number of DC-10 and Treg cells were counted using flow cytometry. Concentrations of nutritional factors were assayed using ICP-MS and LC-MS method. Median comparison among groups was analyzed using Kruskal-Wallis test, while correlation coefficient was obtained by using the Spearman correlation test. Study subjects were 14 pregnant women for each group (42 cases in total). The DC-10 was significantly lower in EOPE compared to NT (p < 0.001) and significantly lower in LOPE compared to NT (p = 0.015). On the other hand, Treg FoxP3+CD25+ cells were significantly higher in EOPE compare to NT (p = 0.015). No correlation between nutritional factors and the number of tolerogenic factors in the preeclampsia group. However, there was a moderate correlation between decidual zinc concentration and DC-10 in the NT group (r = 0.656; p = 0.011) and a strong correlation between decidual retinol concentration and DC-10 also in NT group (r = 0.746; p= 0.002). A moderate correlation was found between vitamin D concentration and Treg FoxP3+CD25+ cells in the NT group (r = 0.590; p = 0.026). To conclude, the number of DC-10 in EOPE is lower than NT pregnancy, whereas the number of Treg cells in EOPE is higher than NT pregnancy. Concentrations of dedicual nutritional factors do not correlate with the number of decidual DC-10 or Treg cells in preeclampsia (EOPE and LOPE). However, in NT group, there is positive correlation between decidual zinc and DC-10, retinol and DC-10, and vitamin D and Treg cells."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Disertasi Membership  Universitas Indonesia Library
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Noor Diah Erlinawati
Peran terapi medik gizi pada perbaikan severitas stroke dan kapasitas fungsional pasien geriatri dengan Stroke Iskemik = The role of medical nutrition therapy on severity and functional capacity improvement in Geriatric Patient with Ischemic Stroke
"Stroke iskemik pada pasien geriatri meningkatkan risiko malnutrisi yang dipengaruhi oleh
beberapa faktor yaitu disfagia, tipe stroke, masalah gastrointestinal, disabilitas fisik,
penyakit komorbid dan psikologis. Tujuan utama intervensi nutrisi adalah membantu
pemulihan fungsi neurokognitif dan mencegah defisit energi dan protein. Pasien pada
serial kasus ini adalah pasien geriatri berusia di atas 65 tahun dengan diagnosis stroke
iskemik yang dirawat di RSCM pada bulan Agustus-September 2019. Terapi medik gizi
diberikan pada keempat pasien sesuai dengan kondisi klinis masing-masing pasien
melalui jalur enteral. Satu pasien dapat makan melalui jalur oral di akhir perawatan.
Suplementasi mikronutrien yang diberikan adalah vitamin B6, vitamin B12, vitamin C,
asam folat dan seng. Hasil yang didapatkan selama perawatan sebanyak tiga pasien
mencapai kebutuhan energi total (KET)dan satu pasien mencapai kebutuhan 83% KET.
Asupan protein mencapai target 1,2 g/kg BB atau lebih pada tiga orang pasien.
Suplementasi mikronutrien mencapai nilai AKG bagi usia di atas 65 tahun. Mikronutrien
belum mencapai AKG yaitu vitamin E, vitamin D, kalium, magnesium. Nutrien spesifik
omega-3 dan kolin yang diperoleh dari asupan makan pada sebagian pasien belum
memenuhi AKG. Lama perawatan pasien di rumah sakit 10 hingga 33 hari. Nilai severitas
stroke dengan NIHSS dan kapasitas fungsional dengan FIM di akhir perawatan
menunjukkan perbaikan. Keempat pasien pulang ke rumah dengan keadaan klinis
perbaikan. Kesimpulan yang didapatkan yaitu terapi medik gizi yang adekuat berperan
memperbaiki derajat keparahan dan kapasitas fungsional pasien geriatri dengan stroke
iskemik.
The geriatric patient with ischemic stroke increased risk of malnutrition, which because
various causes including dysphagia, type of stroke, gastrointestinal problems, physical
disability, comorbid disease and psychological problem. The main purpose of nutrition
intervention is to help restore neurocognitive function and prevent energy/protein deficits.
Patients in this case series were geriatric patients aged over 65 years with a diagnosis of
ischemic stroke who were treated at the Cipto Mangunkusumo General Hospital in
August-September 2019. Medical nutrition therapy was given to all four patients,
according to the clinical condition of each patient through the enteral route. One patient
could eat by oral route at the end of treatment. Patients have given oral micronutrient
supplementation consisting of vitamin B6, Vitamin B12, vitamin C, folic acid and zinc.
The results obtained as many as three patients achieved total energy requirements and one
patient reached 83% energy requirements. Protein intake reached the target of 1,2 g/kg
body weight just in three patients. Supplementation micronutrients oral reached RDA
values for people over 65 years. Micronutrients that have not yet reached the RDA were
vitamin E, vitamin D, potassium, magnesium. Omega-3 and choline obtained from food
intake in some patients do not meet the RDA. The length of stay in the hospital was around
10-33 days. The value of stroke severity with NIHSS and functional capacity with FIM
at the end of treatment showed improvement. All four patients returned home with
improvement. The conclusion obtained is that adequate nutritional medical therapy plays
a role in improving the severity and functional capacity of geriatric patients with ischemic
stroke."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library
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Sri Utami Ningsih
Gambaran kadar vitamin D pada penggunaan obat anti epilepsi generasi pertama tunggal di Poli Neurologi Rumah Sakit Cipto Mangunkusumo = Profile of vitamin d in using first generation of anti epileptic drugs as monotherapy at Cipto Mangunkusumo Hospital Outpatient Clinic
"Kadar vitamin D dapat menurun pada penggunaan OAE lebih dari 6 bulan karena mengaktivasi pregnane x receptor (PXR) yang selanjutnya akan meningkatkan regulasi 24-hydroxylase. Hal ini dapat memicu perubahan vitamin D menjadi metabolit inaktif. Karbamazepin (CBZ), fenitoin (PHT), fenobarbital (PHB) dan asam valproat (VPA) merupakan jenis OAE generasi pertama yang banyak digunakan di RSCM. Tujuan penelitian ini adalah mengetahui gambaran kadar vitamin D dan faktor-faktor yang mempengaruhi penggunaan OAE generasi tunggal
Metode. Desain penelitian berupa studi potong lintang dengan pengambilan sampel secara konsekutif. Subyek penelitian adalah orang dengan epilepsi yang mengkonsumsi CBZ, PHT, PHB dan VPA minimal 6 bulan dan memenuhi kriteria inklusi dan eksklusi. Pada subyek dilakukan wawancara, pengisian kuesioner, pemeriksaan fisik, recall makanan dan pengambilan darah vena untuk pemeriksaan kadar vitamin D.
Hasil. Dari 59 subyek diperoleh subyek lelaki : perempuan (1,4:1). Sebagian besar subyek menggunakan karbamazepin (45,8%) dengan durasi penggunaan OAE berkisar 6 bulan – 35 tahun. Lebih banyak subyek yang mendapatkan paparan sinar matahari yang cukup lebih banyak dibandingkan yang kurang. Prevalensi kadar vitamin D rendah, yaitu, 30,5%. Median vitamin D yaitu, 36,9 ng/ml.
Kesimpulan. Kadar vitamin D pada penggunaan OAE generasi pertama tunggal lebih dari 6 bulan adalah normal. Kadar vitamin D tidak dipengaruhi oleh jenis OAE, durasi penggunaan OAE dan asupan vitamin D. Namun kadar vitamin D pada orang dengan epilpesi dipengaruhi oleh jumlah paparan sinar matahari.
Level of vitamin D can be decreased by first generation anti epileptic anti epileptic drugs (AEDs) due to pregnane x receptor (PXR) activated and increase of 24-hydroxylase regulation. Carbamazepine (CBZ), phenytoin (PHT), phenobarbital (PHB) or valproic acid (VPA) are first generation AEDs that are common used at Cipto Mangunkusumo Hospital. Therefore, the aim of this study is knowing vitamin D level in patients that have been treated by those AEDs more than 6 months.
Method. This was a cross-sectional study with consecutive sampling. Subjects were people with epilepsy taking CBZ, PHT, PHB, or VPA for at least 6 months and fulfilled both inclusion and exclusion criteria. All subjects were interviewed, food recalled and underwent physical examination and measurements of vitamin D level.
Result. Among 59 subjects, male:female ratio is 1.4:1. Most subjects using carbamazepine (45.8%) with duration of OAE therapy is 6 months - 35 years. Prevalence of hipovitaminosis D is 30.5%. Median of vitamin D is 36.1 ng / ml.
Conclusion. Vitamin D level is normal among people with epilepsy (PWE) and not influenced by AEDs type, duration of medication and food intake. However, vitamin D level is influenced by sun exposure in PWE."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
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UI - Tesis Membership  Universitas Indonesia Library
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