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Abstrak :
Nekrosis hati akibat karbon tetraklorida (CC1&) diperkeras oleh berbagai macam obat/zat kimia yang dimetabolisme di hati dan berperan sebagai 'inducer' sitokrom P-450 seperti misalnya fenobarbital dan DDT. Steroid depo-medroksiprogesteron asetat (DMPA) yang banyak dipakai sebagai obat pencegah kehamilan juga dimetabolisme di dalam hati, Penelitian ini untuk melihat pengaruh DMPA terhadap luas nekrosis hati akibat CC14. Digunakan 60 mencit betina C3H, tidak sedang bunting, umur 10-12 minggu yang sebagian diberi CC14, sebagian lagi diberi DMPA 10 atau 100x3 mg/kg BB 7 atau 14 hari sebelum pemberian CC14, dan sebagian lagi untuk kelola. Dua puluh empat jam setelah pemberian CC14 mencit dimatikan, dibuat sediaan mikroskopik hati dari lobus kiri dengan pulasan hematoksilin-eosin. Luas nekrosis sentral hati diukur dalam persentase pada setiap sediaau mikroskopik. Hasil dan Kesimpulan: Didapatkan nekrosis sentrolobulus hati pada seluruh mencit kelompok CCIA dan kelompok DMPA + CC1h. Dibandingkan dengan kelompok yang mendapat CC1 , terlihat sedikit kenaikan luas nekrosis sentrolobulus pada kelompok mencit yang mendapat DMPA + CC1 (terutama pada kelompok yang mendapat DMPA 100x3 mgfkg BB, 7 hari sebelum pemberian CCIA. Namun demikian tidak terdapat perbedaan bermakna antara kelompok-kelompok tersebut (tes Kruskal-Wallis dan Mann Whitney, u 52). Hal ini mungkin disebabkan karena rendahnya haik kadar medroksiprogesterqn asetat (MPA) di dalam darah maupun 'metabolism rate' MPA di dalam mikrosom sel hati, sehingga tidak cukup kuat berperan sebagai 'inducer' sitokrom P-450 yang akan menimbulkan perbedaan bermakna luas nekrosis sentrolobulus hati. Tentunya hal ini perlu penegasan dengan memeriksa sitokrom P-450 di dalam sel hati di bawah pengaruh DMPA. ......Necrosis of the liver due to carbon tetrachloride (CCI4) are increased by various drugs / chemicals which are metabolized in the liver and acted as cytochrome P-450 inducer such as phenobarbital and DDT. Steroid depo-medroxyprogesterone acetate (DMPA) which is used as a birth control drug, is also metabolized in the liver. The objective of this study is to know the influence of DMPA on the width of centrolobular necrosis in the liver caused by CCl. Sixty non-pregnant female C3H mice, 10-12 weeks old, were divided into groups given CCl4, DMPA 10 or 100x3 mg/kg body weight 7 or 15 days prior to CCl& treatment and solvent as control group. Mice were killed 24 hours after CC1& administration and specimens were taken for microscopic slides from the left lobe of the liver and stained by haematoxylin-eosin. The width of the centrolobular necrosis was measured in percentage for each microscopic slide. Findings and Conclusions: Centrolobular necrosis was found in all mice in the CClh and DMPA + CCl4 groups. Compared with the CCl4 group, there was a slight increase in the width of centrolobular necrosis in the DMPA + CCIA groups (especially those groups receiving DMPA 100x3 mg/kg, 7 days prior to CCl4 administration). But neither group of mice showed any significant difference in the ratio of the width of centrolobular necrosis (Kruskal-Wallis and Mann-Whitney test, a 52). This might be caused by the low level of medroxyprogesteron acetate (MPA) in the blood and by a very slow metabolism rate of MPA by the liver microsome, so it is not strong enough to act as Cytochrome P-650 inducer to give significant difference in the width of the centrolobular necrosis. Further confirmation is necessary to determine the amount of cytochrome P-A50 in the liver under the influence of DMPA.

Abstrak :
Nama : Fazria NasriatiProgram studi : Ilmu Penyakit DalamJudul : Korelasi Antara Kadar Tumor Necrosis Factor-?, Kadar Free Fatty Acid, dan Kadar Vascular Cellular Adhesion Molecule-1 Pada Pasien Artritis Reumatoid Latar Belakang: Mortalitas Artritis Reumatoid cukup tinggi, dimana sebagian besar disebabkan oleh komplikasi kardiovaskular yang disebabkan oleh proses disfungsi endotel. Salah satu mediator inflamasi penting yang berperan terhadap kerusakan sendi pasien AR yaitu TNF-?, juga terbukti berperan dalam proses disfungsi endotel serta berperan meningkatkan lipolisis intraselular sehingga meningkatkan kadar FFA yang bersirkulasi.Tujuan: Mengetahui korelasi antara kadar TNF-? dengan kadar VCAM-1, korelasi kadar TNF-? dengan kadar FFA, serta korelasi kadar FFA dengan kadar VCAM-1.Metode: Penelitian desain cross sectional dan retrospektif terhadap pasien AR dewasa yang berobat di Poliklinik Reumatologi Rumah Sakit Cipto Mangunkusumo RSCM , tanpa gangguan metabolik, infeksi akut, gangguan kardiovaskular, maupun penyakit autoimun lain. Pengumpulan data cross sectional dilakukan pada rentang bulan Oktober hingga November 2017, sedangkan sampel retrospektif telah dikumpulkan sejak Agustus 2016. Kadar TNF-?, VCAM-1, dan FFA dinilai melalui pemeriksaan darah serum dengan metode ELISA. Analisis korelasi dilakukan dengan analisis Pearson bila sebaran data normal dan dengan analisis Spearman bila sebaran data tidak normal.Hasil Penelitian: Sebanyak 35 orang subjek diikutsertakan dalam penelitian ini. Sebagian besar 97,1 merupakan perempuan dengan rerata usia 45,29 tahun, median lama sakit 48 bulan, dan sebagian besar memiliki derajat aktifitas penyakit sedang 65,7 . Tidak didapatkan adanya korelasi antara kadar TNF-? dengan kadar VCAM-1 p = 0,677; r = 0,073 . Korelasi antara kadar FFA dengan kadar VCAM-1 memperlihatkan adanya korelasi yang bermakna dengan arah korelasi negatif dan kekuatan korelasi lemah p = 0,036; r = - 0,355 . Korelasi antara kadar TNF-? dan kadar FFA memiliki arah negatif dan kekuatan korelasi yang lemah dengan hubungan yang tidak bermakna p = 0,227; r = - 0,21 .Kesimpulan: 1 Belum terdapat korelasi antara kadar TNF-? dengan kadar VCAM-1 pada pasien AR; 2 Belum terdapat korelasi antara kadar TNF-? dengan kadar FFA pada pasien AR; 3 Terdapat korelasi negatif antara kadar FFA dengan kadar VCAM-1 pada pasien AR. Kata Kunci : Tumor Necrosis Factor-?, Free Fatty Acids, Vascular Cell Adhesion Molecule-1, Artritis Reumatoid. ......Name Fazria NasriatiStudy Program Internal MedicineTitle Correlation Between Tumor Necrosis Factor levels, Free Fatty Acid Levels, and soluble Vascular Cell Adhesion Molecule 1 Levels in Rheumatoid Arthritis Patients. Backgrounds The mortality of Rheumatoid arthritis RA is quite high, which is largely due to cardiovascular complications caused by endothelial dysfunction. One of the important inflammatory mediators that contribute to AR joints arthritis of TNF , also proven to play a role in endothelial dysfunction and play a role in increasing intracellular lipolysis, thus increasing circulating FFA levels.Objectives To determine the correlation between TNF levels with VCAM 1 levels, correlation of TNF levels with FFA levels, and correlation of FFA levelswith VCAM 1 levels.Methods Cross sectional and retrospective design studies of adult AR patients treated at Cipto Mangunkusumo Hospital RSCM , without metabolic disturbances, acute infection, cardiovascular disorders, or other autoimmune diseases. The cross sectional data was collected from October to November 2017, while retrospective samples were collected since August 2016. TNF , VCAM 1, and FFA levels were assessed by serum blood test by ELISA method. Correlation analysis is done by Pearson analysis when the data distribution is normal and with Spearman analysis when the data distribution is not normal.Results A total of 35 subjects were enrolled in the study. Most 97.1 were women with an average age of 45.29 years, median duration of 48 months, and most had moderate disease status 65.7 . No correlation was found between TNF levels and VCAM 1 levels p 0.677 r 0.073 . The correlation between FFA and VCAM 1 levels showed significant correlation with negative correlation and weak correlation p 0.036 r 0.355 . The correlations between TNF levels and FFA levels had negative direction and weak correlation strength with non significant associations p 0.227 r 0.21 .Conclusions 1 There was no correlation between TNF levels and VCAM 1 levels in AR patients 2 There was no correlation between TNF levels and FFA levels in AR patients 3 There was a negative correlation between FFA levels and VCAM 1 levels in AR patients.Keywords Tumor Necrosis Factor , Free Fatty Acids, Vascular Cell Adhesion Molecule 1, Rheumatoid Arthritis.

Abstrak :
Latar belakang: Aritmia ventrikular idiopatik, baik kompleks ventrikel prematur (KVP) maupun takikardia ventrikel (TV), dapat menyebabkan terjadinya penurunan fungsi sistolik ventrikel kiri (VKi) yang akan menimbulkan kardiomiopati dan meningkatkan mortalitas. Banyak faktor yang berkontribusi menyebabkan terjadinya kardiomiopati akibat KVP (KA-KVP) meskipun mekanisme terjadinya belum sepenuhnya dipahami. Variasi sirkadian KVP dilaporkan berhubungan dengan terjadinya penurunan fraksi ejeksi VKi. Deteksi dini adanya disfungsi sistolik intrinsik Vki dapat dilakukan melalui pemeriksaan speckle tracking ekokardiografi dengan mengukur nilai global longitudinal strain (GLS). Sampai saat ini belum diketahui apakah variasi sirkadian KVP berhubungan dengan penurunan fungsi sistolik intrinsik ventrikel kiri. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara variasi sirkadian aritmia ventrikular idiopatik dengan fungsi sistolik intrinsik ventrikel kiri melalui speckle tracking ekokardiografi. Metode: Penelitian ini adalah studi potong lintang dengan total subjek 67 pasien (17 laki-laki [25,4%]; usia rata-rata 46.5 + 9.8 tahun; fraksi ejeksi ventrikel kiri 63,2% + 7,5%) dengan KVP yang berasal dari jalur keluar ventrikel dari pemeriksaan elektrokardiogram 12 sadapan. Semua pasien menjalani pemeriksaan Holter monitoring 24 jam dan speckle tracking ekokardiografi. Dilakukan perhitungan variasi sirkadian beban KVP dan nilai global longitudinal global (GLS) kemudian dilakukan analisis statistik untuk menilai hubungan kedua variabel tersebut. Hasil: Sebanyak 31 pasien (46.3%) mengalami gangguan fungsi sistolik Vki (GLS lebih buruk dari -18%). Pasien dengan gangguan fungsi sistolik VKi memiliki GLS yang kurang negatif (-15.1% + 1.8% vs -21.3% + 2.0%; p=<0,001), beban KVP yang lebih tinggi (22.2% + 11.1% vs 13.9% + 8.3; p=0,001), variasi sirkadian beban KVP yang rendah (koefisien variasi beban KVP per 6 jam 26.8% + 15.6 vs 52.0 % + 28.2%; p=<0,001), dan episode TV non-sustained yang lebih sering (10 pasien [76.9%] vs 3 pasien [23.1%]; p=0,019). Sebanyak 70.6% pasien dengan jenis kelamin laki-laki mengalami gangguan disfungsi sistolik VKi (p=0,002). Pada analisis multivariat didapatkan beberapa prediktor terhadap gangguan fungsi sistolik Vki antara lain variasi sirkadian beban KVP yang rendah dengan [(koefisien variasi beban KVP per 6 jam < 35%), odds ratio (OR)=3.89 interal kepercayaan (IK)95%=1.09-13.80 p=0.036], episode TV non-sustained (OR=14.4, IK 95%=2.36-88.55, p=0.008), beban KVP > 9% (OR=6.81, IK 95%=1.35-34. Kesimpulan: Variasi sirkadian aritmia ventrikular idiopatik yang rendah berhubungan dengan penurunan fungsi sistolik intrinsik ventrikel kiri melalui speckle tracking ekokardiografi. Variasi sirkadian beban KVP per 6 jam < 35% memiliki risiko 3.89 kali lebih tinggi untuk terjadinya disfungsi sistolik ventrikel kiri ......Background: Idiopathic ventricular arrhythmias (AVI) including premature ventricular complex (PVC) or ventricular tachycardia (VT) can cause left ventricular (LV) dysfunction which may lead to cardiomiopathy. The mechanisms of this cardiomyopathy remain elusive, many factors are believed to contribute. PVC burden is influenced by circadian rhythmicity and lack of PVC circadian variability was proposed as one mechanism of LV dysfunction. Since early detection of LV systolic dysfunction can be done by speckle tracking echocardiography examination, further studies are needed to assess intrinsic left ventricular systolic function and its correlation with PVC circadian variation in patients with idiopathic ventricular arrhythmias. Objective: This study aimed to investigate the correlation between circadian variation of IVA and left ventricular intrinsic systolic function assessed by speckle tracking echocardiography. Methods: The subjects of this cross sectional study were 67 consecutive patients (17 men [25.4%]; mean age 46.5 + 9.8 years; left ventricular ejection fraction 63.2% + 7.5%) with PVC originated from ventricular outflow tract based on 12 lead electrocardiogram. All patients underwent 24-hour Holter monitoring and speckle tracking echocardiography examinations. The circadian variation of PVC burden and global longitudinal strain (GLS) were determined and statistical analysis was conducted to evaluate their correlation. Results: A total 31 patients (46.3%) had impaired LV systolic function by GLS ( worse than -18%). Patients with impaired LV systolic function had a less negative GLS (-15.1% + 1.8% vs -21.3% + 2.0%; p=<0.001), a higher PVC burden ((22.2% + 11.1% vs 13.9% + 8.3; p=0,001), less variation in circadian PVC distribution (coefficient of variation 6 hourly 26.8% + 15.6 vs 52.0 % + 28.2%; p=<0.001), and more frequent episode of non-sustained VT (10 patients [76.9%] vs 3 patients [23.1%]; p=0.019). Total 70.6% patient with male gender experienced impaired LV systolic function (p=0.002). Independent predictors for impaired systolic LV function were less variation in circadian PVC distribution [(coeficient of variation < 35%), odds ratio (OR)=3.89, 95% confidence interval (CI)= 1.09-13.80, p=0.036)], episode of non-sustained VT (OR=14.4, 95%CI=2.36-88.55, p=0.008), PVC burden > 9% (OR=6.81, CI 95%=1.35-34.41, p=0.020), and male gender (OR=14.4, CI 95%=2.02-101.1, p=0.004). Conclusion: Lack of circadian variation of IVA is associated with impaired LV systolic function by GLS. Coefficient of variation PVC burden < 35% has 3.89 times higher risk for development of left ventricular systolic dysfunction.

Abstrak :
ABSTRAK
Latar Belakang: Pengaruh metastasis sebagai penyebab peningkatan procalcitonin (PCT) pada pasien tumor padat nonsepsis masih belum jelas. Studi-studi sebelumnya memberikan hasil yang tidak konklusif. Nilai titik potong PCT untuk diagnosis sepsis pada tumor padat metastasis juga belum diketahui. Tujuan: Mengetahui peran PCT dalam diagnosis sepsis pada pasien tumor padat dengan metastasis. Metode: Studi potong lintang terhadap pasien tumor padat yang berobat di RSCM September-Desember 2015. Pada pasien ditentukan ada tidaknya sepsis menggunakan kriteria sepsis ACCP/SCCM 2001, dilakukan pemeriksaan darah perifer, serta PCT. Dilakukan analisis untuk mengetahui perbedaan kadar PCT pasien tumor padat metastasis dan tanpa metastasis yang tidak sepsis. Selain itu, dilakukan pula pencarian nilai titik potong PCT untuk diagnosis sepsis pada pasien tumor padat metastasis dengan menggunakan ROC. Hasil dan Pembahasan: Didapatkan 112 pasien tumor padat, pria sebanyak 51%, dengan rerata usia 47,9 ±12,47 tahun. Sebanyak 71 (63,4%) pasien sudah didapatkan metastasis, 36 (32,1%) diantaranya sepsis, dan 6 (5,3%) mengalami SIRS. Dari 41 (36,6%) pasien tanpa metastasis, 9 (8%) mengalami sepsis, dan 5 (4,4%) SIRS. Terdapat perbedaan bermakna kadar PCT pada pasien tumor padat metastasis dibandingkan tanpa metastasis pada kondisi nonsepsis [0,25 ng/mL (0,07-1,76) vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Pasien tumor padat metastasis yang mengalami sepsis memiliki kadar PCT lebih tinggi dibandingkan nonsepsis [3,5 ng/mL (0,66-189,4) vs. 0,25 ng/mL (0,07-1,76); p<0,001]. Dari kurva ROC kadar PCT pada tumor padat metastasis, didapatkan AUC [0,956, IK 0,916-0,996] untuk mendiagnosis sepsis. Nilai titik potong PCT untuk diagnosis sepsis pada pasien tumor padat metastasis adalah 1,14 ng/mL dengan sensitivitas 86% dan spesifisitas 88%. Kesimpulan: Pada kondisi nonsepsis, kadar PCT pasien tumor padat metastasis lebih tinggi dibandingkan pasien tanpa metastasis. Nilai titik potong PCT untuk diagnosis sepsis pada tumor padat metastasis adalah 1,14 ng/mL. ABSTRACT
Background: The effect of metastasis as a cause of increased procalcitonin (PCT) in patients with solid tumors without sepsis remains unclear. Previous studies did not provide conclusive results. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors is also unknown. Objective: To determine the role of PCT in the diagnosis of sepsis toward metastatic solid tumors patients. Methods: A cross sectional study was conducted in solid tumor patients who were admitted to Cipto Mangunkusumo, Jakarta between September 2015 and December 2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS in patients. Procalcitonin level, as well as routine blood examination, was performed to determine the differences of PCT level among solid tumor patients with and without metastasis. Cut off point of PCT for diagnosing sepsis in patients with metastatic solid tumors was determined using ROC curve. Results and Discussion: There were 112 patients with solid tumors, 51% male, with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis, while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41 (36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. In the absence of sepsis, the PCT level was significantly higher in patients with metastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76) vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsis had PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs. 0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsis in metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCT for sepsis in patients with metastatic solid tumors was 1.14 ng / mL with a sensitivity of 86% and specificity of 88%. Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solid tumors is higher than patients without metastasis. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT) in patients with solid tumors without sepsis remains unclear. Previous studies did not provide conclusive results. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors is also unknown. Objective: To determine the role of PCT in the diagnosis of sepsis toward metastatic solid tumors patients. Methods: A cross sectional study was conducted in solid tumor patients who were admitted to Cipto Mangunkusumo, Jakarta between September 2015 and December 2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS in patients. Procalcitonin level, as well as routine blood examination, was performed to determine the differences of PCT level among solid tumor patients with and without metastasis. Cut off point of PCT for diagnosing sepsis in patients with metastatic solid tumors was determined using ROC curve. Results and Discussion: There were 112 patients with solid tumors, 51% male, with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis, while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41 (36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. In the absence of sepsis, the PCT level was significantly higher in patients with metastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76) vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsis had PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs. 0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsis in metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCT for sepsis in patients with metastatic solid tumors was 1.14 ng / mL with a sensitivity of 86% and specificity of 88%. Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solid tumors is higher than patients without metastasis. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT) in patients with solid tumors without sepsis remains unclear. Previous studies did not provide conclusive results. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors is also unknown. Objective: To determine the role of PCT in the diagnosis of sepsis toward metastatic solid tumors patients. Methods: A cross sectional study was conducted in solid tumor patients who were admitted to Cipto Mangunkusumo, Jakarta between September 2015 and December 2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS in patients. Procalcitonin level, as well as routine blood examination, was performed to determine the differences of PCT level among solid tumor patients with and without metastasis. Cut off point of PCT for diagnosing sepsis in patients with metastatic solid tumors was determined using ROC curve. Results and Discussion: There were 112 patients with solid tumors, 51% male, with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis, while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41 (36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. In the absence of sepsis, the PCT level was significantly higher in patients with metastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76) vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsis had PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs. 0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsis in metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCT for sepsis in patients with metastatic solid tumors was 1.14 ng / mL with a sensitivity of 86% and specificity of 88%. Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solid tumors is higher than patients without metastasis. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT) in patients with solid tumors without sepsis remains unclear. Previous studies did not provide conclusive results. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors is also unknown. Objective: To determine the role of PCT in the diagnosis of sepsis toward metastatic solid tumors patients. Methods: A cross sectional study was conducted in solid tumor patients who were admitted to Cipto Mangunkusumo, Jakarta between September 2015 and December 2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS in patients. Procalcitonin level, as well as routine blood examination, was performed to determine the differences of PCT level among solid tumor patients with and without metastasis. Cut off point of PCT for diagnosing sepsis in patients with metastatic solid tumors was determined using ROC curve. Results and Discussion: There were 112 patients with solid tumors, 51% male, with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis, while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41 (36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. In the absence of sepsis, the PCT level was significantly higher in patients with metastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76) vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsis had PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs. 0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsis in metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCT for sepsis in patients with metastatic solid tumors was 1.14 ng / mL with a sensitivity of 86% and specificity of 88%. Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solid tumors is higher than patients without metastasis. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT) in patients with solid tumors without sepsis remains unclear. Previous studies did not provide conclusive results. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors is also unknown. Objective: To determine the role of PCT in the diagnosis of sepsis toward metastatic solid tumors patients. Methods: A cross sectional study was conducted in solid tumor patients who were admitted to Cipto Mangunkusumo, Jakarta between September 2015 and December 2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS in patients. Procalcitonin level, as well as routine blood examination, was performed to determine the differences of PCT level among solid tumor patients with and without metastasis. Cut off point of PCT for diagnosing sepsis in patients with metastatic solid tumors was determined using ROC curve. Results and Discussion: There were 112 patients with solid tumors, 51% male, with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis, while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41 (36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. In the absence of sepsis, the PCT level was significantly higher in patients with metastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76) vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsis had PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs. 0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsis in metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCT for sepsis in patients with metastatic solid tumors was 1.14 ng / mL with a sensitivity of 86% and specificity of 88%. Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solid tumors is higher than patients without metastasis. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors was 1,14 ng / mL.

Abstrak :
Peningkatan konsentrasi kristal monosodium urea pada sendi dan jaringan menunjukkan adanya keradangan Gout artritis (GA). Angka insiden dan prevalensi GA tersebar di negara berkembang sebesar 2?15%. Di Indonesia, prevalensi GA sekitar 29% dan sering terjadi pada suku Minahasa, Toraja dan Batak. Penelitian ini bertujuan untuk menganalisis aplikasi minyak atsiri kunyit sebagai anti-radang pada penderita GA dengan diet tinggi purin serta mengukur mediator seluler tumor necrosis factor-α (TNF-α). Desain penelitian adalah randomized pretest-posttest control group design dengan pemberian secara single blind. Tes GCMS dilakukan untuk mengetahui komponen aktif minyak atsiri. Sampel penelitian ini adalah pasien baru GA di RS Haji Surabaya. Selama tujuh hari, kelompok perlakuan diberi minyak atsiri kunyit dengan dosis 25 mg/kg BB, sedangkan kelompok kontrol diberi indometasin dengan dosis 150 mg/kg BB. Sampel darah diambil sebelum dan sesudah perlakuan. Minyak atsiri kunyit mempunyai empat fraksi komponen aktif. Terdapat penurunan kadar urea darah pada kelompok perlakuan (p = 0,001) dan kelompok kontrol (p = 0,007). Terdapat penurunan konsentrasi pelepasan TNF-α, tetapi penurunan ini tidak berbeda secara signifikan pada kelompok kontrol dan perlakuan.

Increased concentrations of crystal monosodium urea at joint and soft tissue represent induced of inflammation at gout arthritis (GA). Incidence and prevalence GA disseminate wide in developed countries in Asian range from 2-15% and In Indonesia, GA prevalence was 29% and mostly found in Minahasa, Toraja, and Batak ethnics. This research was aimed to analyse application of curcuma domestica volatile oil as anti inflammation agent on gout arthritis patient who has high purin diet and to assess specific cellular mediator Tumor Necrosis Factor-α (TNF-α). The design of the study was randomized pretest-posttest control group design with single blind treatment. The GCMS test was performed to identify active component in volatile oil. The sample was the new gout arthritis patient in Haji Public Hospital Surabaya. For a week, treatment group was assigned with volatile oil with dose 25 mg/kg body weight and the control group was given indometasin 150 mg/kg body weight. Blood samples were taken before and after treatment. Volatile oil of curcuma domestica (Curcuma domestica, val) has four fraction of active component. There was decreasing in blood urea level in treatment group (p = 0.001) and control group (p = 0.007). Both in control and treatment group, there was also decreasing in TNF-α, however it was not statistically significant.

Abstrak :
ABSTRACT
Medication-Related Osteonecrosis of the Jaw (MRONJ) therapy remains an unresolved problem. The proposed conservative and surgical treatment regimens are associated to contradictory success rates. Surgical approach with Er:YAG laser is associated to significant better results compared to medical treatment and traditional surgical approaches. Objective: To describe a new surgical approach that couples the advantages of the Er:YAG laser and the usefulness of the AF in highlighting surgical margins. One of the difficulties encountered during surgical removal of a MRONJ is the precise individuation of necrotic bone margins. Case Report: A case of Stage III mandibular osteonecrosis treated with a new surgical approach is presented. The aim is to describe an auto-fluorescence (AF) guided surgical approach performed with Er:YAG laser and Nd:YAG Low Level Laser Therapy (LLLT). After one month of follow-up, the complete mucosal healing was evident and symptoms was unobserved. Such a technique allowed a highly accurate and minimally invasive approach through the selective ablation of the non-/hypofluorescent areas. Conclusion: Taking into account the advantages of laser therapy and the possible effectiveness of the AF in highlighting surgical margins, this approach would probably achieve excellent outcomes.

Abstrak :
Latar Belakang: Ikterus obstruktif merupakan salah satu komplikasi tersering keganasan sistem bilier. Keadaan ini akan memicu pelepasan sitokin proinflamasi. Terdapat kontroversi mengenai pengaruh drainase bilier terhadap perubahan kadar sitokin proinflamasi pada penderita kanker pankreatobilier. Tujuan: Untuk mengetahui kadar Tumor Necrosis Faktor alfa (TNF-alfa) dan Interleukin 6 (IL6) sebelum dan sesudah Endoscopic Retrograde Cholangio Pancreatography (ERCP) atau Percutaneus Transhepatic Biliary Drainage (PTBD) pada penderita ikterus obstruksi etiologi kanker pankreatobilier. Metode: Desain penelitian adalah one group before after study. Pemilihan sampel secara consecutive sampling. Sampel darah diambil sebelum dan lima hari sesudah ERCP atau PTBD. Pengukuran kadar TNF-alfa dan IL-6 dengan cara Enzyme Linked Immunosorbed Assay (ELISA). Hasil: Terdapat 40 orang responden yang diikutsertakan dalam penelitian ini, 22 laki laki dan 18 perempuan dengan usia rata rata 55,3 tahun. Berdasarkan imaging dan endoskopi, ditegakkan diagnosis kolangiokarsinoma sebanyak 22 orang, tumor ampula Vateri 10 orang, dan tumor pankreas 8 orang. Kadar rata-rata TNF- alfa sebelum tindakan 4,81 (2,91) pg/ml dan sesudah tindakan 8,05 (6,7) pg/ml, terdapat peningkatan yang bermakna setelah tindakan drainase bilier (p:0,02). Kadar rata-rata IL-6 sebelum tindakan 7,79 (1,57) pg/ml dan sesudah tindakan 7,75 (1,76) pg/ml, tidak terdapat perbedaan yang bermakna setelah tindakan drainase bilier (p:0.52). Kadar rata-rata bilirubin sebelum tindakan 15,5 mg% dan sesudah tindakan 11,3 mg%. Simpulan: Terjadi peningkatan kadar rata-rata TNF-alfa secara bermakna setelah drainase. Tidak ada penurunan yang bermakna kadar rata-rata IL-6.

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Background: Obstructive jaundice represents the most common complication of biliary tract malignancy. Obstructive jaundice causes releases of proinflammatory cytokine. There has been controversy about effect of biliary drainage on the change in proinflammatory cytokine level in pancreatobiliary cancer patients. Objective: The present study was designed to determine levels of Tumor Necrosis Factor Alpha (TNF-Alpha) and Interleukin 6 (IL-6) in preprocedure of either Endoscopic Retrograde Cholangio Pancreatography (ERCP) or Percutaneus Transhepatic Biliary Drainage (PTBD) and postprocedure of them in obstructive jaundice patient caused by pancreatobiliary cancer. Methods : The study method is before- and- after case study design with consecutive sampling. Blood was collected five days prior to either Endoscopic Retrograde Cholangio Pancreatography (ERCP) procedure or Percutaneus Transhepatic Biliary Drainage (PTBD) procedure and five days after either of them. Enzyme Linked Immunosorbed Assay (ELISA) was used to determine TNF-Alpha and IL-6. Results: Forty subjects were included in this study which consisted of 22 men and 18 women. The mean age was 55.3 years old. According to the results of imaging and endoscopy procedure, twenty two (22) people were diagnosed cholangi carcinoma, ten (10) people were diagnosed ampulla varteri and eigth (8) people were diagnosed pancreatic tumor. In preprocedure, the mean of TNF-Alpha concentration was 4.81 (2.91) pg/mL, the mean of IL-6 concentration was 7.79 (1.57) pg/mL and the mean of bilirubin concentration was 15.5 mg%. In postprocedure, the mean of TNF-Alpha concentration was 8.05 (6.7) pg/mL, there was significant increase in TNF-Alpha concentration (p:0.02). However, the mean of IL-6 concentration was 7.75 (1.76) pg/mL, there was not any significant chance in IL-6 concentration (p:0.52). The mean of bilirubin concentration was 11.3 mg%. Conclusions: On one hand, there was significant increase in mean concentration value of TNF-Alpha after biliary drainage procedure. On the other hand there was not any significant decrease in mean concentration value of IL-6 after biliary drainage procedure.

Abstrak :
Latar Belakang : Terjadinya peningkatan biomarker inflamasi akibat penyelaman dekompresi merupakan salah satu faktor yang dapat menyebabkan terjadinya penyakit dekompresi, hal ini telah dibuktikan dengan terjadinya peningkatan ekspresi TNF? akibat penyelaman dekompresi tunggal. Pencegahan peningkatan biomarker inflamasi dapat dilakukan dengan memberikan perlakuan sebelum penyelaman dekompresi, sesuai dengan preconditioning theory, yang salah satunya adalah pemberian latihan fisik sebelum penyelaman yang dapat mengurangi ukuran dan jumlah gas bubble akibat penyelaman. Pengaruh latihan fisik sebelum penyelaman terhadap kadar biomarker inflamasi TNF? sesudah penyelaman belum pernah diteliti. Penelitian ini bertujuan untuk membuktikan bahwa latihan fisik sebelum penyelaman dekompresi dapat mencegah terjadinya peningkatan kadar biomarker inflamasi TNF?. Metode : Penelitian ini menggunakan desain studi eksperimental murni dengan seluruh subjek penelitian adalah penyelam laki-laki terlatih, terbagi secara random kedalam dua kelompok, yaitu perlakuan dan kontrol, di mana kelompok perlakuan mendapatkan latihan fisik submaksimal dengan intensitas 70 frekuensi jantung maksimal menggunakan cycle ergometer dengan 60 kayuhan permenit, 24 jam sebelum penyelaman dekompresi 280 kPa bottom time 80 menit, pada kelompok kontrol tidak diberikan latihan fisik submaksimal. Ekspresi biomarker diperiksa sebanyak tiga kali, awal penelitian, sebelum penyelaman dan sesudah penyelaman. Hasil : Pada kelompok perlakuan tidak terjadi peningkatan, bahkan terjadi penurunan eskpresi TNF? yang tidak bermakna, dari 7.06 1.85 pg/ml menjadi 6,75 1,81 pg/ml, sedangkan kelompok kontrol mengalami peningkatan ekspresi TNF? yang bermakna, dari 8,22 1,45-13,11 pg/ml menjadi 8,39 1,73-12,18 pg/ml, dan terdapat perbedaan selisih rerata yang signifikan antara kelompok yang mendapatkan latihan fisik sebelum penyelaman dan kelompok yang tidak mendapatkan latihan fisik sebelum penyelaman dengan perbedaan rerata -024 -2.74 - 1.67 pg/ml dan 0.45 -0.94 ndash; 0.95 pg/ml. Kesimpulan dan Saran : Latihan fisik submaksimal akut dapat mencegah terjadinya peningkatan kadar TNF? akibat penyelaman dekompresi tunggal. ...... Background : The increase of Inflammatory biomarkers due to decompression dive is one of the factors that could cause decompression sickness, which has been proven by the increased expression of TNF due to a single decompression dive. According to the preconditioning theory, physical exercise before the dive, can reduce the size and the amount of gas bubble caused by the dive, but no research has been done on the influence of physical exercise before diving to the expression of inflammatory biomarkers like TNF. This study aims to prove that physical exercise before diving can prevent increase of the inflammatory biomarker TNF. Methods : This study used an experimental study design with trained male divers as a subjects, who are divided randomly into two groups, treatment and control. The treatment group got submaximal physical exercise with 70 maximal cardia rate intensity, using cycle ergometer 24 hours before decompression diving 280 kPa bottom time 80 minute, whereas the control group did not get physical exercise. Biomarker expression was checked three times, at beginning of the study, before the dive and after the dive. Results : In the treatment group there was no increase in TNF expression, and even showed an insignificant decrease, from 7.06 1.85 pg ml to 6.75 1.81 pg ml, whereas the control group showed a significant increased TNF concentration, from 8.22 1.45 to 13.11 pg ml to 8.39 1.73 to 12.18 pg ml, and significant difference was found between the mean difference of treatment and control groups from 0.24 2.74 ndash 1.67 pg ml and 0.45 0.94 ndash 0.95 pg ml. Conclusions and Recommendations : It can be concluded that acute submaximal physical exercise prevent an increase in the expression of TNF after single dive decompression.

Abstrak :
Fase awal pergerakan gigi ortodontik diawali dengan respon inflamasi akut. Proses ini menimbulkan respon dari sel paradental dan sel pertahanan tubuh dengan mensintesis dan melepaskan berbagai biomolekul seperti sitokin. Tumor necrosis factor-a TNF-? merupakan sitokin pro-inflamasi penting yang meregulasi respon awal inflamasi pada pergerakan gigi ortodontik. Tujuan dari penelitian ini adalah untuk menganalisis ekspresi TNF-? dengan membandingkan konsentrasinya pada gingival crevicular fluid GCF antara sistem self-ligating SL dan preadjusted edgewise appliance PEA pada tahap awal perawatan. Metode: Delapan belas pasien usia 15-35 tahun yang berpartisipasi dalam penelitian ini dibagi menjadi dua kelompok eksperimental PEA dan SL dan satu kelompok kontrol tanpa perawatan ortodontik. Pasien dipilih berdasarkan kriteria inklusi: indeks iregularitas Little sebesar 4-9 mm pada anterior maksila dengan indikasi perawatan non-ekstrakasi serta tanpa karies aktif, penyakit periodontal, dan penyakit sistemik terkait kerusakan tulang. Cairan krevikular gingiva subjek diambil pada lima titik di anterior maksila sebelum perawatan dan pada: 1, 24, dan 168 jam setelah aplikasi gaya ortodontik. Konsentrasi TNF-? pada sampel GCF diperiksa menggunakan metode enzyme-linked immunoabsorbent assay ELISA. Hasil: Konsentrasi TNF-? meningkat pada 1 jam dan 24 jam setelah aplikasi gaya ortodontik pada kedua sistem baik pada kelompok SL dan PEA. Konsentrasi TNF-? menurun signifikan pada 168 jam setelah aplikasi gaya ortodontik pada kelompok PEA. Sementara itu, pada kelompok SL konsentrasi TNF-? pada 168 jam tetap meningkat walaupun secara statistik tidak signifikan. Kesimpulan: Konsentrasi TNF-? meningkat pada 1 jam dan 24 jam setelah aplikasi gaya ortodontik pada kelompok PEA dan SL. Pada kelopok PEA, konsentrasi TNF-? menurun signifikaan pada 168 jam, sedangkan pada kelompok SL konsentrasi TNF-? tetap meningkat. Perbedaan konsentrasi TNF-? antara kelompok PEA dan SL mungkin disebabkan oleh perbedaan braket, kawat, dan sistem ligasi yang digunakan antara kedua sistem tersebut. ...... The early phase of orthodontic tooth movement begins with acute inflammation response. This processes engender a response on the part of paradental cells and migrating inflammatory cells from periodontal ligament capillaries via the synthesis and release of various biomolecules such as cytokines. Tumor necrosis factor a TNF is an important pro inflammatory cytokine that regulates the early phase of inflammation reaction during orthodontic tooth movement. The aim of the present study was to analyze TNF expression by comparing its concentrations in the gingival crevicular fluid GCF between self ligating SL and preadjusted edgewise appliance PEA systems during the early levelling stage of orthodontic treatment. Methods: Eighteen patients aged 15 35 years who participated in this study were divided into two experimental groups PEA and SL and control group without orthodontic treatment. Patients were selected according to the inclusion criteria Little irregularity index on maxillary anterior teeth ranging from 4 9 mm non extraction orthodontic treatment for the experimental group no active dental caries, periodontitis, and medical history of bone disorder. The GCF was taken at five sites in the maxilla anterior teeth from each subject just before bracket bonding and at 1, 24, and 168 hours after orthodontic force application. TNF levels in GCF were determined by enzyme linked immunoabsorbent assay ELISA. Results: The concentration of TNF was significantly higher in the experimental groups than in the control group at 24 hours after force application. TNF levels were significantly decreased at 168 hours after force application in the PEA group. Meanwhile, in the SL group, the level of TNF at 168 hours was still increased, although there was no statistically significant difference. Conclusion: TNF concentration was increased at 1 hour and 24 hours after orthodontic force application in both the PEA and SL groups. In the PEA group, TNF concentration was significantly decreased at 168 hours, meanwhile in the SL group, this value remained increased at this time point. The differences in TNF concentration between the PEA and SL groups may be caused by their different types of brackets, wires, and ligation methods.