Hasil Pencarian  ::  Simpan CSV :: Kembali

"Pasien dengan disfagia rentan mengalami komplikasi seperti pneumonia aspirasi hingga kematian. Oleh karena itu diperlukan alat skrining untuk mendiagnosis disfagia secara cepat. GUSS merupakan alat skrining dengan validitas dan reliabilitas yang baik dalam menilai disfagia, namun belum dilakukan uji diagnostik di Indonesia. Subjek penelitian terdiri dari pasien disfagia neurogenik yang kemudian menjalani pemeriksaan GUSS-INA dengan modifikasi bahan uji, dilanjutkan dengan pemeriksaan baku emas FEES. Selanjutnya, dilakukan uji diagnostik untuk melihat sensitivitas dan spesifisitas GUSS-INA sebagai metode skrining disfagia. Rerata pasien disfagia neurogenik di RSCM berusia 56 tahun dengan jumlah proporsi laki – laki lebih besar dengan penyebab tersering adalah stroke, dengan komorbid hipertensi (56.5%), dengan komplikasi pneumonia 21.7%. Sebagian besar mengalami disfagia kronik, seluruh pasien mengalami keluhan subjektif disfagia dengan 3 gejala tersering adalah batuk, tersedak, dan sulit menelan terutama konsistensi padat. Lebih dari separuh pasien membutuhkan selang makan. Rerata status gizi pasien menunjukan indeks masa tubuh 24.92, dengan rerata penurunan BB 2 kg. Berdasarkan pemeriksaan pencitraan pasien stroke, lokasi tersering berada supratentorial, dengan derajat stroke sedang. Rerata nilai GUSS 14 (disfagia sedang) pada seluruh subjek, 28.3% mengalami aspirasi. Hasil Uji diagnostik GUSS-INA sebagai alat skrining deteksi disfagia memiliki nilai Sensitivitas 84%, Spesifisitas 78%, NDP 94%, NDN 54% dan AUC 0.86. Modalitas GUSS-INA dapat dijadikan alat skrining disfagia yang cukup baik.

---

Patient with dysphagia has the tendency to undergo serious complications such as aspiration pneumonia that can cause increased mortality. Screening tool to effectively diagnose dysphagia in patient with difficulty swallowing is needed. GUSS is a screening tool with good validity and reliability; however, no diagnostic test has been done in Indonesia. This study samples consisted of neurogenic dysphagia patients which underwent GUSS-INA with test material modification assessment followed by FEES as gold standard examination. Diagnostic test was then done to analyze sensitivity and specificity of GUSS-INA as dysphagia screening tool. The average age of neurologenic dysphagia patients in Cipto Mangunkusumo Hospital was 56 years with higher male proportion, most common etiology was stroke, with most common morbidity being hypertension (56,5%). History of pneumonia was found in 21.7% patients.Majority of patients have chronic dysphagia, all patients had subjective dysphagia complaint with three most common symptoms being cough, choking, and difficulty swallowing especially of solid texture. More than half of the patients needed feeding tube. The average of BMI was 24.93, with average weight loss of 2 kg. Based on radiology results on post-stroke cases, the most common lesion was supratentorial, with moderate stroke score. Average GUSS score is 14 (moderate dysphagia) from all subjects and in 18.3% patients aspiration in found. Diagnostic test result of GUSS-INA as screening tool for neurogenic dysphagia had 84% sensitivity, 78% specificity, 94% PPV, 54% NPV, and AUC of 0.86. GUSS-INA could be used as a screening tool for dysphagia."

"Inflammasi neurogenik berperan pada penyebaran infeksi oral. Teori infeksi fokal rongga mulut telah diusulkan sejak awal 1900an, infeksi gigi menyebabkan berbagai penyakit sistemik. Namun, teori ini mulai ditinggalkan setelah banyak gigi telah dicabut tanpa memberikan hasil yang memuaskan. Penelitian terbaru membuktikan bahwa infeksi rongga mulut dapat menyebar secara sistemik. Walaupun demikian, penemuan terdahulu tidak dapat membuktikan bagaimana terapi periodontal “assisted drainage” (ADT), dapat mengurangi gejala migren dan asma dalam hitungan menit. Penelitian terkait interaksi keradangan imunogenik dan neurogenik yaitu mediator proinflamasi calcitonin gene-related peptide (CGRP), TNF-α dan vasoactive intestinal peptide (VIP) masih jarang dilakukan. Tujuan: Melakukan verifikasi penyebaran keradangan neurogenik mulut ke organ yang jauh setelah melakukan ADT melalui ekspresi CGRP, VIP dan TNF-α. Metode: 24 tikus wistar jantan disuntik intragingival dengan lipopolisakarida Porphyromonas gingivalis (PgLPS1435/1450). Setelah empat hari, 12 tikus diberikan ADT, kemudian semua sampel dikorbankan 40 menit setelah ADT. Ekpresi CGRP, VIP dan TNF-α dianalisis dengan imunohistokimia. Analisis statistik menggunakan ANOVA dilakukan untuk menganalisis perbedaan nilai ekspresi CGRP, VIP, dan TNF-α tiap kelompok uji. Hasil: Injeksi PgLPS meningkatkan CGRP, VIP an TNF-α walau tidak selalu bermakna pada kelompok kontrol. Ekspresi CGRP dan TNF-α menurun, tetapi ekspresi VIP meningkat pada kelompok ADT. Simpulan: Peradangan neurogenik terlibat dalam penyebaran keradangan rongga mulut ke seluruh tubuh yang dimungkinkan karena ADT mengurangi peradangan organ lain melalui stimulasi VIP.

---

Focal infection theory proposed in early 1900’s stated that dental infection caused systemic disorders. Nevertheless, the theory was abandoned since large number of teeth were extracted with no satisfying result. Recent reports revealed that oral infections were able to spread systemically. However, there is no rationalization available toexplain how assisted drainage therapy (ADT), a periodontal therapy that could relief migraine and asthma within minutes. Oral neurogenic and immunogenic inflammation interaction involving pro-inflammatory markers such as calcitonin gene-related peptide (CGRP), TNF-α; and antiinflammatory vasoactive intestinal peptide (VIP) was still under investigation. Objective: To verify the spread of oral inflammation to distant organ after performing ADT by analysing CGRP, VIP and TNF-α expressions. Methods: Two different concentration of Porphyromonasgingivalis lipopolysaccharide (PgLPS1435/1450) was injected intragingivally into two groups of 12 Wistar rats. After four days, 12 rats were given ADT and all samples were subsequently sacrificed 40 mins after ADT. Immunohistochemistry analysis using CGRP, VIP and TNF-α on the nasal and bronchus tissue was performed. ANOVA was used for statistical analyisis of the difference between CGRP, VIP and TNF-α expression between experimental groups. Results: PgLPS injections slightly increased CGRP, VIP and TNF-α expressions in the control group. Rats undergone ADT had lower CGRP and TNF-α but higher VIP expressions. Conclusion: Neurogenic inflammation involved in systemic spread of oral infection. ADT was able to downregulate inflammation in distant organ posibly by stimulating VIP."