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Abstrak :
ABSTRAK Latar belakang: Mengetahui faktor-faktor yang berhubungan dengan mortalitas pada pasien ikterus obstruktif dengan etiologi maligna merupakan hal penting untuk membantu membuat perencanaan optimal dalam melakukan pendekatan terapi yang tepat untuk masing-masing etiologi dan faktor terkait guna membantu meningkatkan kesintasan dan kualitas hidup pasien. Tujuan: Mendapatkan kesintasan dan faktor-faktor yang berhubungan dengan mortalitas pada pasien ikterus obstruktif dengan etiologi maligna di RSCM. Metode: Penelitian kohort retrospektif dan prospektif dilakukan dengan data sekunder pasien ikterus obstruktif yang dirawat di ruang perawatan RSCM antara Januari 2010 ? Desember 2013. Faktor-faktor yang dinilai meliputi umur, jenis kelamin, sepsis, hipoalbumin, tingkat bilirubin serum, tingkat CA 19-9 serum, drainase bilier, keganasan non ca ampula Vater, dan komorbid dengan hasil keluaran berupa mortalitas pasien. Kesintasan kumulatif terjadinya mortalitas dalam 3 bulan setelah diagnosis dinyatakan dengan kurva Kaplan Meier. Analisis bivariat dan multivariat dilakukan dengan Cox Proportional Hazards Regression Model untuk mendapatkan Hazard Ratio (HR) dari setiap faktor prognosis. Skor prognosis dari setiap faktor bermakna ditentukan berdasarkan model akhir regresi. Hasil: Sebanyak 181 dari 402 pasien ikterus obstruktif dengan etiologi maligna memenuhi kriteria penelitian dengan proporsi laki-laki sebesar 58,6 % dengan pasien berumur ≥ 50 tahun sebesar 57,5 %. Sepsis (HR 2.462 ; IK 95% 1.552 ? 3.906), drainase bilier tidak berhasil/tidak ada (HR 1.604 ; IK 95% 0.988 ? 2.603), serta skor indeks komorbid Charlson ≥ 4 (HR 2.476 ; IK 95% 1.562 ? 3.923) merupakan faktor prognosis yang bermakna terhadap mortalitas pasien. Median kesintasan pasien dengan faktor prognosis bermakna 14 hari; IK 95% 9.66 ? 18.34 sedangkan median kesintasan keseluruhan 26 hari; IK 95% 20.82 ? 31.19 (p < 0.01). Ambang skor prognostik terbaik didapatkan pada skor ≥ 2 dengan sensitifitas 68% dan spesifisitas 75%. AUC pada kurva ROC 0.769. Kesimpulan: Kesintasan pasien dengan faktor prognosis sepsis, drainase bilier tidak berhasil/tidak ada, dan skor indeks komorbid Charlson ≥ 4 lebih pendek dibandingkan kesintasan keseluruhan pasien. Skor prognostik ≥ 2 termasuk dalam risiko tinggi kematian dan kemampuan prediksi mortalitas dari faktor prognosis bermakna sebesar 76.9%.

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ABSTRACT Background: Understanding any related factors affecting mortality in patients with malignant obstructive jaundice will better guide to an approriate and optimal planning in making theurapetic approach for each etiological and relating factors thus improving survival and patients? quality of life. Aim: To obtain survival rate and mortality-related factors of malignant obsructive jaundice patients in Cipto Mangunkusumo Hospital. Methods: Retrospective-prospective cohort study was conducted with medical records of obstructive jaundice inpatient from January 2010 to December 2013 were reviewed. Suggested mortality-related factors include age, gender, sepsis, hypoalbumin, serum bilirubin level, serum CA 19-9 level, billiary drainage, non-ampulla Vateri carcinoma, and comorbid were analyzed. Three-month cumulative overall survival was calculated by Kaplan-Meier curve. Bivariat and multivariat analysis was done with Cox Proportional Hazards Regression Model to obtain Hazard Ration (HR) of each prognostic factor. Prognosis score from each mortality-related factor was calculated based on the last regression model. Results: 181 from 402 patients were enrolled in this study with male proportion was 58.6% and patients aged 50 years or above was 57.5%. Sepsis (HR 2.462 ; CI 95% 1.552 ? 3.906), unsuccessful / no prior billiary drainage (HR 1.604 ; CI 95% 0.988 ? 2.603), and Charlson comorbid score ≥ 4 (HR 2.476 ; CI 95% 1.562 ? 3.923) were mortality-related factors with significant difference. Patients with significant prognostic factors had median survival 14 days; 95% CI: 9.66 ? 18.34 compared with overall median survival 26 days; 95% CI: 20.82 ? 31.19 (p < 0.01). Score ≥ 2 identified as the highest prognostic score threshold with sensitivity 68%, specificity 75%, and AUC on ROC curve 0.769. Conclusion: Patients with significant prognostic factors which were sepsis, unsuccessful / no prior billiary drainage, and Charlson comorbid score ≥ 4 had shorter survival than overall survival. Prognostic threshold ≥ 2 quite good to classify malignant obstructive jaundice inpatient into high risk mortality population. Mortality of patients with those significant prognostic factors can be predicted in 76,9%.

Abstrak :
Hiperbilirubinelnia merupakan fenomena klinis yang sering ditemukan pada bayi baru lahir. Tujuan penelitian untuk mengidentifikasi pengaruh perubahan posisi tidur selama fototerapi terhadap rata-rata kadar bilirubin total. Desain penelitian adalah quasi experimental pre-post test with control group. Sampel yang digunakan yaitu bayi baru lahir dengan hiperbilirubinemia, terdiri atas 20 bayi kelompok intervensi dan 20 bayi kelompok kontrol. Analisis perbedaan kadar bilirubin total menggunakan independent t test. Hasil penelitian menunjukkan tidak ada perbedaan yang bermakna pada kadar bilirubin total kelompok kontrol dan kelompok intervensi, namun penurunan kadar biliiubin pada kelompok intervensi lebih cepat dari pada kelompok kontrol. Penelitian ini merekomendasikan perubahan posisi tidur dapat mempercepat penurunan kadar bilirubin total.

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Abstract
Hyperbilirubinemia is a clinical phenomenon that mostly appears to the newborn baby. The purpose of the research is to identify the effect of changing sleeping position during the phototherapy on the rate of total concentrate of bilirubin. The research design was quasi experimental pre-post test with control group. The sampel, was new born babies with hyperbilirubinemia; which were classified into 20 babies in intervention group and 20 babies in controlled group. The analysis of different total bilirubin rate used independent t test showed that there was no any significant differences on the total of bilirubin rate in controlled group and intervention group. However, the total bilirubin rate reduction on the intervention group was faster than control group. This research reccomended that sleeping position changes can decrease the total bilirubin rate fastly.

Abstrak :
ABSTRAK
Neonatal jaundice sering terjadi pada minggu pertama awal kehidupan bayi setelah lahir. Deteksi dini neonatal jaundice dapat mencegah terjadinya kernikterus sebagai komplikasi tingginya kadar bilirubin pada neonatus. Visual assessment merupakan salah satu pemeriksaan untuk menilai neonatal jaundice yang diperkenalkan oleh Kramer. Tujuan penelitian ini adalah mengetahui nilai sensitivitas, spesifitas dan akurasi visual assessment atau pemeriksaan Kramer pada neonatal jaundice. Penelitian ini menggunakan desain cross sectional pada 102 bayi dengan teknik pengambilan sampel consecutive sampling. Analisis data dilakukan dengan tabel uji diagnostik 2x2. Hasil penelitian ini menunjukkan bahwa visual assessment pada neonatal jaundice nilai sensitivitas 76,92 , spesifisitas 89,47 , dan nilai akurasi 86,27 . Penelitian ini dapat menjadi informasi untuk pengembangan pemeriksaan noninvasif lainnya dalam menilai neonatal jaundice untuk menurunkan angka mobiditas neonatus. Kata Kunci: akurasi, neonatal jaundice, sensitivitas, spesitifitas, visual assessment

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ABSTRACT
Neonatal jaundice often occurs in the first week after birth. Early detection of neonatal jaundice can prevent kernicterus as a complication of high levels of bilirubin in neonates. Visual assessment is one of the examinations to assess the neonatal jaundice introduced by Kramer. The purpose of this study was to determine the sensitivity, specificity and accuracy of visual assessment or Kramer examination in neonatal jaundice. This study used cross sectional design to examine 102 babies as the sample which was selected by convenience sampling method. 2x2 table diagnostic test was employed in this study to analyze the data. The results of this study showed that visual assessment in neonatal jaundice had sensitivity valued 76.92 , specificity valued 89.47 , and accuracy valued 86.27 . This research can be acknowledged for the development of other non invasive examinations in assessing neonatal jaundice for decreasing the number of neonatal morbidity. Keywords accuracy, neonatal jaundice, sensitivity, specificity, visual assessment

Abstrak :
ABSTRAK
Hiperbilirubinemia tidak terkonjugasi merupakan kondisi dimana kadar total serum bilirubin (TSB) lebih dari sama dengan 5 mg per dL dan biasanya terjadi pada 60% bayi sehat lahir cukup bulan dan 80% bayi lahir kurang bulan. Kadar TSB yang meningkat hingga 20-25 mg per dL dapat menyebabkan gangguan neurologis (kernikterus) karena fraksi bebas bilirubin tidak terkonjugasi dapat melewati sawar darah otak. Peningkatan kadar bilirubin tidak terkonjugasi dapat disebabkan oleh peningkatan sirkulasi enterohepatik. Mikrobiota pencernaan memiliki peran penting dalam menurunkan sirkulasi enterohepatik dengan mereduksi bilirubin tidak terkonjugasi menjadi urobilinogen yang selanjutnya akan dimetabolisme tubuh. Profil mikrobiota pencernaan neonatus memiliki asosiasi dengan risiko perkembangan hiperbilirubinemia. Informasi mengenai profil mikrobiota pencernaan neonatus dengan hiperbilirubinemia tidak terkonjugasi pada populasi di Indonesia masih langka. Tujuan dari penelitian ini adalah untuk mendapatkan gambaran awal profil mikrobiota pencernaan dari mekonium neonatus dengan hiperbilirubinemia tidak terkonjugasi di Rumah Sakit Cipto Mangunkusumo (RSCM). Penelitian observasional dengan pendekatan cross sectional dilakukan dengan memilih sebanyak masing-masing 3 sampel neonatus dengan total serum bilirubin ³ 5 mg/dL dan < 5 mg/dL serta dilahirkan pada periode Februari-Maret 2019. Mekonium neonatus dikultur secara mikrobiologi pada medium selektif dan nonselektif kemudian dilakukan identifikasi media selektif, morfologi koloni, mikroskopik, dan molekuler dengan Polymerase Chain Reaction-16s rRNA Sanger Sequencing (PCR-sequencing). Data klinis neonatus diperoleh dengan pencatatan rekam medik di RSCM. Profil mikrobiota terkulturkan dari mekonium neonatus dengan hiperbilirubinemia tidak terkonjugasi di Rumah Sakit Cipto Mangunkusumo terdiri dari filum Firmicutes yang didominasi oleh genus Staphylococcus (50%) diikuti oleh Bacillus (37,5%) dan Enterococcus (12,5%) sedangkan neonatus normal terdiri dari filum Firmicutes yang didominasi oleh genus Staphylococcus (58,34%) diikuti oleh Bacillus (25%), Streptococcus (8,33%), dan Enterococcus (8,33%). Profil mikrobiota mekonium neonatus dengan hiperbilirubinemia tidak terkonjugasi dan normal didominasi oleh genus Staphylococcus (anaerob fakultatif) yang berpotensi sebagai patogen. Profil mikrobiota mekonium neonatus dengan hiperbilirubinemia tidak terkonjugasi (TSB ³ 5 mg/dL) memiliki keberagaman lebih rendah dibandingkan neonatus normal (TSB < 5 mg/dL) khususnya neonatus dengan metode persalinan caesar.

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ABSTRACT
Unconjugated hyperbilirubinemia is a condition where total serum bilirubin (TSB) levels are greater than or equal to 5 mg per dL and usually affects up to 60% healthy term neonates and 80% preterm neonates. Increased TSB levels up to 20-25 mg per dL can cause neurological disorders (kernicterus) because the free fraction of unconjugated bilirubin can cross the blood-brain barrier. Increased unconjugated bilirubin concentration is due to increased enterohepatic circulation. Gut microbiota has an important role in reducing the enterohepatic circulation by transforming unconjugated bilirubin to urobilinogen which will be metabolized by the body. The neonates gut microbiota profile is associated with the risk of hyperbilirubinemia. Information regarding gut microbiota profile of neonates with unconjugated hyperbilirubinemia in Indonesian population is scarce. The purpose of this study was to get a preliminary description of gut microbiota profile from neonates meconium with unconjugated hyperbilirubinemia at Cipto Mangunkusumo Hospital (RSCM). Observational study with the cross-sectional design was conducted by selecting 3 samples each from neonates with TSB ³ 5 mg/dL and < 5 mg/dL and born in February-March 2019. Neonates meconium was cultured microbiologically on selective and nonselective media and identified based on selective media, morphology, microscopy, and molecular by Polymerase Chain Reaction-16s rRNA Sanger Sequencing (PCR-sequencing). Clinical data of neonates were obtained from the medical record at RSCM. Cultured microbiota profiles from neonates meconium with unconjugated hyperbilirubinemia consisted of Firmicutes which was dominated by Staphylococcus (50%) followed by Bacillus (37,5%) and Enterococcus (12,5%) whereas normal neonates meconium consisted of Firmicutes which was dominated by Staphylococcus (58,34%) followed by Bacillus (25%), Streptococcus (8,33%), and Enterococcus (8,33%). Microbiota profiles from neonates meconium with and without unconjugated hyperbilirubinemia were dominated by Staphylococcus (facultative anaerobe) with pathogenic potential. The meconium microbiota profile of neonates with unconjugated hyperbilirubinemia (TSB ³ 5 mg/dL) had lower diversity than normal neonates (TSB < 5 mg/dL), especially cesarean-born infants.

Abstrak :
Salah satu penyebab hiperbilirubinemia tidak terkonjugasi pada neonatus adalah polimorfisme Gly71Arg gen UGT1A1 yang dapat menurunkan aktivitas enzim UDP Glukoronosil Transferase UGT , sehingga angka kejadiannya cukup tinggi pada neonatus hiperbilirubinemia di daerah Asia Timur. Penelitian ini bertujuan untuk mengetahui profil polimorfisme Gly71Arg di Indonesia pada populasi ras heterogen yang termasuk bagian Asia tenggara dengan menggunakan sampel pasien neonatus yang dirawat di Rumah Sakit Cipto Mangunkusumo sebanyak 42 sampel yang lahir pada periode Januari ndash; April 2017. Data sampel neonatus berupa total serum bilirubin diperoleh dari rekam medik serta penelusuran ras orang tua pasien neonatus melalui wawancara. Analisis dilakukan menggunakan metode Polymerase Chain Reaction ndash; Restriction Fragment Length Polymorphism PCR-RFLP dengan enzim AvaII sebagai enzim restriksi. Dari 42 sampel yang dianalisis, 95,24 memiliki genotip G/G wild type dan 4,76 memiliki genotip G/A heterozigot. Tidak ditemukan satu pun sampel yang memiliki polimorfisme Gly71Arg genotip A/A homozigot. Terdapat pengaruh perbedaan intraetnik pada kelompok etnik tertentu terhadap polimorfisme Gly71Arg yaitu pada ras Betawi yang mendominasi kejadian heterozigot. Polimorfisme Gly71Arg secara keseluruhan mungkin tidak memengaruhi angka kejadian hiperbilirubinemia tidak terkonjugasi pada populasi di Indonesia tetapi mungkin dipengaruhi oleh mutasi pada ekson 1 di situs lain atau mutasi pada promotor.

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One of the risk factor of unconjugated hyperbilirubinemia in neonates is Gly71Arg polymorphism of UGT1A1 gene that can lead to reduced UDP Glucuronosyl Transferase UGT enzyme activity, so it has high incidence among neonates in East Asian population. The aim of this study, was to identify Gly71Arg polymorphism profile in Indonesia in the heterogeneous race population which is part of Southeast Asia, and 42 sample of neonates who were born in January ndash April 2017 that treated in Rumah Sakit Cipto Mangunkusumo were used. Neonatal sample data which is total serum bilirubin were obtained from medical records and tracing naonates parents race through interview. The analysis used was Polymerase Chain Reaction ndash Restriction Fragment Length Polymorphism PCR RFLP method with AvaII enzyme as restriction enzyme. From 42 samples that were analysed, 95,24 were found as G G genotype wild type, while 4,76 were G A genotype heterozygous. None of the sample has Gly71Arg polymorphism A A genotype homozygous. There is an influence of intra ethnic differences in certain ethnic groups against Gly71Arg polymorphisms, which is in the Betawi race that dominates heterozygous events. Overall, Gly71Arg polymorphism may not affect incidence of unconjugated hyperbilirubinemia in Indonesia population, yet may be affected by mutation in other site of exon 1 or mutation in promoter.

Abstrak :
Polimorfisme pada gen uridin difosfo UDP -glukuronosiltransferase UGT 1A1 menjadi salah satu faktor risiko terjadinya hiperbilirubinemia tidak terkonjugasi pada neonatus. Polimorfisme gen UGT1A1 dapat menurunkan aktivitas enzim UDPGT dalam konjugasi bilirubin sehingga meningkatkan jumlah bilirubin tidak terkonjugasi dan menyebabkan hiperbilirubinemia tidak terkonjugasi. Kejadian polimorfisme gen UGT1A1, terutama c-3279T>G beragam pada kelompok ras yang berbeda. Tujuan dari penelitian ini adalah untuk mengetahui profil polimorfisme c-3279T>G pada neonatus di Rumah Sakit Cipto Mangunkusumo RSCM dengan ras yang heterogen dan berat badan lahir yang berbeda. Sebanyak 42 sampel dengan total serum bilirubin ge; 5mg/dL dan lahir pada periode Januari ndash; April 2017 dianalisis menggunakan metode Polymerase Chain Reaction ndash; Restriction Fragment Length Polymorphism PCR-RFLP menggunakan enzim DraI untuk mengetahui profil polimorfisme c-3279T>G. Data rekam medik pasien neonatus diperoleh dari RSCM dan penelusuran ras dilakukan dengan wawancara orang tua pasien melalui telepon. Dari 42 sampel yang dianalisis, 95,2 memiliki polimorfisme homozigot dan 4,8 memiliki polimorfisme heterozigot. Polimorfisme c-3279T>G pada sampel tidak dipengaruhi oleh ras tertentu atau keberagaman ras di Indonesia.

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Uridine diphospho UDP glucuronocyltransferase UGT 1A1 gene polymorphisms are a risk factor of unconjugated hyperbilirubinemia in neonates. UGT1A1 gene polymorphisms can decrease the activity of UDPGT enzyme in conjugating bilirubin thus increase the number of unconjugated bilirubin and lead to unconjugated hyperbilirubinemia. UGT1A1 gene polymorphism, especially c 3279T G, diverse in different racial group. The purpose of this study is to discover the polymorphism profile of c 3279T G in neonates with unconjugated hyperbilirubinemia at Rumah Sakit Cipto Mangunkusumo RSCM with heterogenous race and different birth weight. Forty two samples born in January ndash April 2017 and have total serum bilirubin ge 5mg dL were being analyzed by Polymerase Chain Reaction ndash Restriction Fragment Length Polymorphism PCR RFLP method using DraI enzyme to find out the c 3279T G polymorphism profile. The medical records information of neonates were obtained from RSCM. Researcher interviewed the neonates rsquo parent by phone to obtain their race information. From 42 samples that have been analyzed, 95,2 have homozygote polymorphism and 4,8 have heterozygote polymorphism. C 3279T G polymorphism is not affected by certain race or diversity of races in Indonesia.

Abstrak :
Background: Tire methods of ERCP have been used for diagnostic and therapeutic purposes to pass bile fluid and extract stones from the bite duct in patients with obstructive extrahepatic jaundice. Method: A retrospective study was performed on patients with obstructive extrahepatic jaundice patients who underwent ERCP dttring a two-years time period from January 1999 to December 2000. ERCP was performed with a premedication of I0 mg midazolam, followed by a chollangiography contrast containing 1 mg/dl of Garamicin and 25 mg of Pethidine if sphincterotomy was performed. Results: From 126 patients with obstructive extrahepatic jaundice treated with ERCR the male to female ratio was 1.86:1. The majority of the (group) of patients were between 51-60 years of age (33.3 % ). The youngest patient (group) was 24 years and the oldest 97 years. The diagnostic study found the following cases: normal 3 cases (28%), bile duct stone 46 cases (43.4%) carcinoma of ampula voter 20 cases (18.9%), CBD tumor 7 crises (6.6%), carcinoma of head of pancreas 2 cases (1.9%), diverticle 4 cases (38%), duodenal tumor I case (0.9%), carcinoma of ampula vater and bite duct stone 1 case (0.9%), SOD 5 cases (4.7%), CBD stricture 1 case (0.9%) and failure I6 cases (15.1%). The patients received the following treatment: sphyncterotomy 36 cases (51 .4%), stent application 11 cases (15.7%), sphincterotomy with stent 18 cases (25.7%) and basket method 5 cases ( 7. 1%).

Abstrak :
Chalangiocarcinoma is the second most common primary liver malignancy with global increase of incidence and mortality. The mean age at presentation is 50 years. Patients with cholangiocarcinoma usually will have symptoms of obstructive jaundice followed with supporting laboratory and imaging findings. The predominant clinical feature of extrahepatic cholangiocarcinoma is biliary obstruction resulting in Jaundice; while intrahepatic cholangiocarcinoma causes symptoms of intrahepatic mass including abdominal pain in right upper quadrant and other tumor-related symptoms such as cachexia and malaise. The diagnosis and staging of cholangiocarcinoma require multidisciplinary approaches including laboratory, radiological, endoscopic approaches and analysis on pathology. This case report describes a patient with a cholangiocarcinoma based on result of endoscopic retrograde cholangiopancreatography (ERCP) imaging. In addition to a diagnosis tool, ERCP can also be a therapeutic modality for placing stent to reduce symptoms of cholestasis. There were supporting laboratory findings such as increased bilirubin level, alkaline phosphates (ALP) and gamma glutamyltransferase (GGT) levels as well as increased level of tumor markers such as carcinoembryonic antigen (CEA), carbohydrate antigen (CA 19-9 and cytological examination.