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Abstrak :
Preeklamsia merupakan kondisi spesifik pada kehamilan yang menjadi penyebab utama morbiditas dan mortalitas maternal-perinatal. Plasentasi abnormal menyebabkan hipoksia plasenta dan gangguan regulasi responss imun sehingga mengakibatkan perubahan mikroskopik struktur plasenta berupa penurunan syncytial bridge. Penelitian ini bertujuan mengetahui toleransi imun dan nekrosis pada preeklamsia berdasarkan gambaran syncytial bridge, jumlah sel Treg, konsentrasi LDH serta profil vitamin 1,25(OH)2D3, dan seng. Penelitian potong lintang ini dilakukan pada bulan Februari–Agustus 2019 di RS Budi Kemuliaan dan RSUD Koja, Jakarta. Subjek penelitian adalah ibu hamil normotensi dan preeklamsia yang memenuhi kriteria penerimaan dan tidak memenuhi kriteria penolakan. Subjek dibagi tiga kelompok yaitu: normotensi/NT (n = 20), preeklamsia tanpa komplikasi/PE (n = 21), dan preeklamsia dengan komplikasi/PEK (n = 20). Semua subjek dilakukan pengukuran. jumlah syncytial bridge plasenta (HE), jumlah sel Treg (flowcytometric dan IHK), konsentrasi LDH (enzymatic colorimetric dan ELISA), vitamin 1,25(OH)2D3 (LC-MS/MS) dan seng (ICP-MS) darah maternal dan plasenta. Data diolah menggunakan SPSS versi 2 dan dianalisis dengan uji test-tidak berpasangan dan Mann-Whitney. Jumlah syncytial bridge pada kelompok PE (10,52/LPB) dan PEK (6,33/LPB) lebih rendah bermakna dibanding NT (14,71/LPB). Syncytial bridge PEK lebih rendah bermakna dibanding PE. Jumlah Treg plasenta kelompok PE (2,89/LPB) dan PEK (2,94/LPB) lebih rendah bermakna dibanding NT (4,11/LPB). Konsentrasi LDH maternal pada PEK (418U/L) lebih tinggi dibanding NT (167,5 U/L), dan PEK lebih tinggi dibanding PE (204 U/L) secara bermakna. Kkonsentrasi 1,25(OH)2D3 maternal kelompok PE (55 pg/mL) dan PEK (41,3 pg/mL) lebih rendah dibanding NT (63,5 pg/mL). Konsentrasi 1,25(OH)2D3 maternal PEK lebih rendah bermakna dibanding PE. Tidak ada perbedaan bermakna konsentrasi seng maternal dan plasenta pada ketiga kelompok. Sel Treg plasenta kelompok syncytial bridge sangat rendah (SSR) 2,86/LPB dan syncytial bridge rendah (SR) 3,09/LPB lebih rendah secara bermakna dibanding syncytial bridge normal (SN) 3,87/LPB. Konsentrasi LDH maternal SSR (318 U/L) lebih tinggi bermakna dibanding SR (213 U/L) dan SN (168 U/L). Konsentrasi vitamin 1,25(OH)2D3 maternal pada SSR (39 pg/mL) lebih rendah dibandingkan SR (53,85 pg/mL) dan SN (58,10 pg/mL). Peningkatan konsentrasi LDH maternal, penurunan konsentrasi 1,25(OH)2D3 maternal dan sel Treg plasenta merupakan faktor risiko berkurangnya jumlah syncytial bridge. Disimpulkan berkurangnya jumlah syncytial bridge menggambarkan beratnya proses nekrosis yang berhubungan dengan penurunan toleransi imun dan konsentrasi 1,25(OH)2D3 maternal. ......Preeclampsia is a specific condition in pregnancy as the main cause of maternal-perinatal morbidity and mortality. Abnormal placentation causes placental hypoxia and disturbances in the regulation of the immune response, thereby resulting in the microscopic structure of the placenta in the form of syncytial bridges. The present study aimed to determine the immune tolerance and necrosis in preeclampsia, on the basis of the syncytial bridge characteristic, Treg cell count, LDH concentration and vitamin 1,25(OH)2D3, and zinc profiles. This cross-sectional study was carried out from February to August 2019 at RS Budi Kemuliaan and RSUD Koja, Jakarta. The subjects were pregnant women who met the inclusion criteria and did not meet the exclusion criteria. The subjects were divided into three groups, namely the normotensive (NT) group (n = 20), the uncomplicated preeclampsia (PE) group (n = 21), and the complicated preeclampsia (PEC) group (n = 20). All subjects underwent the following examinations: placental syncytial bridge count (HE), Treg cell count (flowcytometric and IHC), LDH (enzymatic colorimetric and ELISA), 1,25(OH)2D3 (LC-MS/MS) and zinc (ICP-MS) concentration in maternal blood and placenta. The data were processed using SPSS version 20 and analyzed by means of the unpaired t and Mann-Whitney tests. The syncytial bridge count in groups PE (10.52/HPF) and PEC (6.33/HPF) was significantly lower compared with NT (14.71/HPF). PEC syncytial bridge count was significantly lower than PE. Placental Treg count in groups PE (2.89/HPF) and PEC (2.94/HPF) were significantly lower than that of the NT (4.11/HPF). Maternal LDH concentration in PEC (418U/L) was significantly higher than in NT (167.5 U/L), and PE (204 U/L). Maternal 1,25(OH)2D3 concentration in groups PE (55 pg/mL) and PEC (41.3 pg/mL) was lower compared with NT (63.5 pg/mL). Maternal 1,25(OH)2D3 concentration in group PEC was significantly lower than in PE. There were no significant differences in maternal blood and placental zinc concentration in the three groups. Placental Treg cell counts in the very low syncytial bridge count (VLSB) group (2.86/HPF) and the low syncytial bridge count (LSB) (3.09/HPF) were significantly lower than in the normal syncytial bridge count (NSB) (3.87/HPF). Maternal blood LDH in group VLSB (318 U/L) was higher than those in LSB (213 U/L) and NSB (168 U/L). Maternal 1,25(OH)2D3 concentration in group VLSB (39 pg/mL) was lower compared with LSB (53.85 pg/mL) and NSB (58.10 pg/mL). Increased maternal LDH concentration, decreased maternal 1,25(OH)2D3 concentration and placental Treg cell count were risk factors for decreased syncytial bridge count. It was concluded that the decrease in syncytial bridge count depicts the severity of the necrotic process that is associated with decreased immune tolerance and maternal 1,25(OH)2D3 concentration.

Abstrak :
Latar Belakang Pandemi COVID-19 telah membawa dampak signifikan di seluruh dunia, termasuk sistem pendidikan di Indonesia yang mengadopsi sistem pembelajaran jarak jauh (PJJ). Mahasiswa kedokteran tingkat preklinik, kelompok yang rentan mengalami masalah kesehatan mental, juga terdampak. Meskipun terdapat perubahan akibat pandemi COVID-19, institusi pendidikan perlahan mulai kembali ke pembelajaran tatap muka. Hal ini menciptakan kemungkinan alterasi kualitas tidur mahasiswa kedokteran tingkat preklinik pada dua fase tersebut. Dengan demikian, kualitas tidur mahasiswa kedokteran tingkat preklinik di fase puncak dan pascapuncak pandemi COVID-19 perlu diselidiki. Metode Desain penelitian yang digunakan adalah potong lintang. Kuesioner PSQI yang sudah diterjemahkan dan divalidasi disebarkan pada dua periode, yaitu bulan Juli—Oktober 2021 untuk data puncak dan April 2022—Maret 2023 untuk data pascapuncak. Sebanyak 246 mahasiswa kedokteran diikutsertakan dalam penelitian ini yang kemudian akan diuji menggunakan Mann-Whitney untuk mengetahui perbedaan kualitas tidur saat puncak dengan pascapuncak pandemi. Faktor yang dianalisis antara lain jenis kelamin, usia, dan tingkat preklinik. Hasil Uji Mann-Whitney menunjukkan tidak terdapat perbedaan kualitas tidur yang signifikan antara fase puncak dengan pascapuncak pandemi (p > 0,05). Dalam aspek komponen PSQI, ada perbedaan yang signifikan antara durasi tidur dan gangguan tidur saat puncak dengan pascapuncak (p < 0,05). Rata-rata durasi tidur adalah 6—7 jam. Kesimpulan Tidak terdapat perbedaan kualitas tidur yang signifikan antara saat puncak dengan pascapuncak pandemi pada mahasiswa kedokteran tingkat preklinik. ......Introduction The COVID-19 pandemic has had a significant impact worldwide, including on the educational system in Indonesia, which adopted remote learning (PJJ). Pre-clinical medical students, a group vulnerable to mental health issues, were also affected. Despite the changes brought about by the COVID-19 pandemic, educational institutions are gradually returning to in-person learning. This presents the risk of alterations in the quality of sleep of pre-clinical medical students during these two phases. Therefore, the sleep quality of pre-clinical medical students during the peak and post-peak phases of the COVID-19 pandemic needs to be examined. Method The research design used was cross-sectional. The PSQI questionnaire, which had been translated and validated, was administered during two periods: July to October 2021 for peak data and April 2022 to March 2023 for post-peak data. A total of 246 medical students participated in this study and were tested using the Mann-Whitney test to determine differences in sleep quality during the peak and post-peak phases of the pandemic. Factors analysed included gender, age, and pre-clinical level. Results Mann-Whitney test revealed no significant difference in sleep quality between the peak and post-peak phases of the pandemic (p > 0,05). In terms of PSQI componentes, there were significant differences in sleep duration and sleep disturbances between the peak and post-peak phases (p < 0,05). The average sleep duration was 6—7 hours. Conclusion There was no significant difference in sleep quality between the peak and post-peak phases of the pandemic among pre-clinical medical students.