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Abstrak :
ABSTRAK
Prevalensi migren di Indonesia tinggi dan migren menyebabkan disabilitas ketujuh terbanyak di dunia. Diagnosis migren menggunakan kriteria IHS, tetapi angka negatif palsu tinggi 50 . Disfungsi endotel adalah dasar patofisiologi migren, melalui gangguan reaktivitas vasomotor dan inflamasi. Pemeriksaan breath holding index BHI hanya menggunakan stimulus hiperkapnia sementara indeks vaskular migren IVM menggabungkan kombinasi hiperkapnia dan hipokapnia. Akurasi IVM dan peran CGRP serta ICAM-1 dalam patogenesis nyeri kepala migren belum dipahami.Penelitian ini menilai respons vasodilatasi dan vasokonstriksi pembuluh darah intrakranial penderita migren, akurasi alat IVM dibandingkan IHS dan BHI, serta menganalisis perubahan kadar CGRP dan ICAM-1 satu bulan pengobatan.Penelitian menggunakan rancangan potong lintang dan pre-post design. Subjek nyeri kepala primer fase interiktal di Poli Neurologi RSCM yang memenuhi kriteria inklusi dan eksklusi diikutsertakan. Subjek dianamnesis berdasarkan kriteria MS-Q Indonesia, pemeriksaan Doppler transkranial untuk menilai BHI dan IVM pada kedua sisi kepala, dan diberikan obat topiramat dan/atau indometasin sesuai kriteria penelitian. Subjek kontrol 1 bulan untuk menilai respons klinis nyeri kepala. Sampel darah diambil saat awal dan akhir penelitian untuk menilai kadar CGRP dan ICAM-1.Terdapat 104 subjek terkonfirmasi migren dan 24 subjek terkonfirmasi bukan migren. Tidak ada perbedaan karakteristik sosiodemografis: baik usia, jenis kelamin, tingkat pendidikan, dan pekerjaan. Nilai MFV MCA kelompok terkonfirmasi migren lebih rendah bermakna saat menahan napas dibandingkan kelompok terkonfirmasi bukan migren pada sisi ipsilateral dan sisi kontralateral. Pada kelompok terkonfirmasi migren kemampuan vasokonstriksi lebih tinggi bermakna dibandingkan kelompok terkonfirmasi bukan migren pada sisi ipsilateral dan kontralateral.Nilai sensitivitas dan spesifisitas IVM gabungan, BHI serta IHS/MS-Q berturut-turut adalah 94,23 dan 91,67 , 59,63 dan 91,67 , 60,58 dan 95,58 . Tidak ada perbedaan bermakna antara IVM gabungan dengan IVM ipsilateral. Kadar CGRP dan ICAM-1 tidak berbeda bermakna antara kedua kelompok saat awal dan akhir. Pada kelompok terkonfirmasi migren, proporsi kadar CGRP awal tinggi berkorelasi dengan penurunan CGRP akhir. Proporsi kadar CGRP awal tinggi berhubungan bermakna dengan kepositifan IVM.Simpulan: Respons vasodilatasi pembuluh darah MCA penderita migren, lebih rendah dan vasokonstriksi lebih tinggi. IVM terbukti memiliki akurasi baik untuk mendiagnosis gangguan reaktivitas vasomotor pada migren. Kadar CGRP awal tinggi pada migren merupakan prediktor penurunan CGRP dalam 1 bulan. Kata kunci: BHI, CGRP, ICAM-1, IVM, migren, reaktivitas vasomotor

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ABSTRACT
Migraine has a high prevalence in Indonesia and is the seventh cause of disability in the world. Migraine is diagnosed using the IHS criteria, but the false negative rate is high 50 . Endothelial dysfunction is the underlying pathophysiology of migraine causing impairment of the vasomotor reactivity and inflammation. Breath holding index BHI examination only uses hypercapnia stimulus, while the migraine vascular index MVI uses a combination of hypercapnia and hypocapnia stimulus. The accuracy of MVI and the role of CGRP and ICAM 1 in the pathogenesis of migraine is not fully understood.This study is aimed to assess the vasodilatory and vasoconstriction response of intracranial blood vessels of migraine patients, to know the accuracy of MVI compared to IHS and BHI, and to analyze changes in CGRP and ICAM 1 levels after 1 month of therapy.The study used a cross sectional and pre post design approach. Subjects with primary headache interictal phase who came to the neurology out patient clinic at Cipto Mangunkusumo Hospital RSCM , that met inclusion and exclusion criteria were included in the study. Subjects underwent anamnesis based on the Indonesian version of the MS Q criteria, transcranial Doppler examination to assess BHI and MVI on both sides of the head, and was given topiramate and or indomethacin based on the study 39 s criteria. Subjects were then asked to come for a 1 month follow up to assess the clinical response of headache. Blood samples were taken before and after treatment to assess CGRP and ICAM 1 levels.There were 104 confirmed migraine and 24 confirmed non migraine subjects in the study. There were no differences in sociodemographic characteristics between the two groups based on age, gender, education level, and occupation. The MCA MFV value in the confirmed migraine group is significantly lower compare to the confirmed non migraine group on the ipsilateral and contralateral side, where as the vasoconstriction ability is significantly higher in the confirmed migraine group compare to the confirmed non migraine group on the ipsilateral and contralateral side.The sensitivity and specificity of combined MVI, BHI and IHS MS Q respectively are 94.23 and 91.67 , 59.63 and 91.67 , 60.58 and 95.58 . There was no significant difference between combined MVI with ipsilateral MVI. Levels of CGRP and ICAM 1 did not differ significantly between the two groups before treatment and after treatment. In the confirmed migraine group, a high proportion of CGRP levels before treatment was correlated with CGRP decline after treatment. In addition, a high proportion of CGRP levels before treatment was associated with MVI positivity.Conclusions The vasodilatory response is found to be lower, whereas the vasoconstriction response is higher in the MCA of migraine patients. MVI is proven to have good accuracy in diagnosing impairment of vasomotor reactivity in migraine. A high initial CGRP level in migraine patients is a predictor of a decrease in CGRP within 1 month of prophylaxis therapy.Key words BHI, CGRP, ICAM 1, migraine, MVI, vasomotor reactivity

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"ABSTRAK
" Tujuan: menilai kadar Hypoxia-inducible Factor-1? HIF-1? dan Intercellular Adhesion Molecule-1 ICAM-1 vitreus pada retinopati diabetik proliferatif yang diberikan bevacizumab intravitreal, serta hubungan keduanya terhadap ketebalan makula sentral previtrektomi.Metode: tiga puluh dua mata dirandomisasi menjadi 2 kelompok, yaitu yang mendapatkan suntikan bevacizumab intravitreal 1-2 minggu previtrektomi dan kelompok kontrol langsung dilakukan vitrektomi . Penghitungan kadar HIF-1? dan ICAM-1 dilakukan dengan metode enzyme-linked immunosorbent assay ELISA . Ketebalan makula sentral diukur saat awal, previtrektomi, serta 2, 4, dan 12 minggu pascavitrektomi dengan menggunakan Stratus OCT.Hasil: rerata kadar HIF-1? vitreus dalam ng/mg protein pada kelompok kontrol dan bevacizumab intravitreal masing-masing 0,020 0,006;0,077 dan 0,029 0,016;0,21 . Kadar ICAM-1 vitreus dalam ng/mL adalah 20,10 3,41;40,16 dan 23,33 0,63;68,5 . Rerata kadar HIF-1? dan ICAM-1 vitreus didapatkan tidak berbeda bermakna antara kedua kelompok.Simpulan: bevacizumab intravitreal 1-2 minggu previtrektomi belum dapat membuat kadar HIF-1? lebih rendah daripada kelompok kontrol. Kadar ICAM-1 kelompok bevacizumab didapatkan lebih tinggi pada kelompok kontrol. Tidak didapatkan hubungan yang bermakna antara ketebalan makula sentral previtrektomi terhadap kadar HIF-1? dan ICAM-1.Kata kunci: retinopati diabetic proliferatif, HIF-1?, ICAM-1, bevacizumab "

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" "ABSTRACT
"Purpose to assess the levels of Hypoxia inducible factor 1 HIF 1 and intercellular adhesion molecule 1 ICAM 1 in vitreous of proliferative diabetic retinopathy patients which were given intravitreal bevacizumab IVB , as well as its relation to the central macular thickness CMT measured prior to vitrectomy.Method this was post test only randomized clinical trial open label, in which thirty two eyes were randomized into two groups, one that received an IVB injection at 1 2 weeks previtrectomy and the control group. Measurement of HIF 1 and ICAM 1 was conducted using enzyme linked immunosorbent assay ELISA . The CMT were measured at the initial visit, prior to vitrectomy, and at follow up time 2, 4, and 12 weeks postoperative using Stratus OCT.Result The mean levels of HIF 1 vitreous ng mg protein in the control group and IVB respectively 0.020 0.006 0.077 and 0.029 0.016 0.21 . Vitreous levels of ICAM 1 ng mL in control group and IVB group were 20.10 3.41 40.16 and 23.33 0.63 68.5 . The mean levels of HIF 1 and ICAM 1 vitreous obtained did not differ significantly between the two groups.Conclusion Intravitreal bevacizumab 1 2 weeks prior to vitrectomy was not enough to make the levels of HIF 1 lower in IVB group. Median of ICAM 1 level in IVB group was higher than control group. There were no correlation between CMT with HIF 1 and ICAM 1 levels.

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Perubahan tunika intima media (TIM) karotis dan flow mediated dilatation (FMD) dapat digunakan sebagai pemeriksaan untuk mengetahui aterosklerosis dini. Pada ODHA TIM karotis dan FMD dapat dipengaruhi oleh inflamasi kronik akibat infeksi HIV itu sendiri, efek samping terapi ARV, dan koinfeksi virus atau bakteri lain. Oleh karena itu, penelitian ini menelaah kinetika penanda inflamasi (CRP, ICAM-1 dan sTNFR), kondroitin sulfat (KS) serta antibodi CMV, mengorelasikannya dengan perubahan TIM karotis dan FMD pada ODHA yang memulai terapi ARV serta dibandingkan dengan kontrol sehat setelah 60 bulan terapi ARV. Desain penelitian kohort prospektif dan cross-sectional. Subjek penelitian didapatkan dengan consecutive sampling dari Januari 2013 sampai Desember 2014, diamati dalam 3 kurun waktu selama 60 bulan di RSUPN Dr. Cipto Mangunkusumo. Dilakukan pemeriksaan USG pembuluh darah karotis pada semua subjek, diamati perubahan ketebalan TIM karotis, FMD, kadar CD4, indeks massa tubuh, kadar CRP, ICAM-1, sTNFR, KS, dan antibodi CMV setiap periode pengamatan. Data dianalisis menggunakan uji Mann Whitney U, Wilcoxon, Spearman’s correlation, Pearson’s correlation dan multiple linear regression. Tidak didapatkan perubahan TIM karotis setelah dilakukan terapi ARV selama 12 bulan dan 60 bulan. Tidak ada perbedaan bermakna untuk TIM karotis dan FMD antara ODHA dengan kontrol sehat. ICAM-1 memiliki korelasi dengan TIM karotis pada kunjungan awal sebelum terapi dan KS memiliki korelasi dengan TIM karotis setelah 60 bulan terapi ARV. FMD memiliki korelasi negatif dengan KS dan antibodi CMV lysate pada ODHA, sedangkan pada kontrol sehat FMD memiliki korelasi negatif dengan sTNFR dan KS, namun memiliki korelasi kuat dengan antibodi CMV gB. Inflamasi kronik pada ODHA tidak menyebabkan perubahan TIM karoti. KS dan antibodi CMV lysate dapat memengaruhi nilai FMD pada ODHA. Pada kontrol sehat, KS dan sTNFR bisa memengaruhi nilai FMD, namun antibodi CMV gB bisa berfungsi sebagai faktor pelindung. ......Carotid intima-media thickness (CIMT) and flow mediated dilatation (FMD) used to detect early atherosclerosis. In people living with hiv/aids (PLWH), CIMT and FMD could be influenced by chronic inflammation affected HIV infection, ART and co-infection. We did the research to study the kinetic of inflammation biomarkers (CRP, ICAM-1 and sTNFR), chondroitine sulfate (CS) and CMV reactive antibodies, to find correlation for CIMT and FMD starting ART and compare to healthy control (HC) after 60 months. This was a cohort prospective study and repeated cross sectional. The subjects were collected from January 2013 until December 2014, follow up to 60 months. Every visit we did USG for carotid artery and FMD at brachial artery, CD4, BMI, CRP, ICAM-1, sTNFR, CS and CMV antibodies level were also measured. Data were analyzed using Mann Whitney U, Wilcoxon, Spearman’s correlation, Pearson’s correlation and multiple linear regression. There were no differences in CIMT changes in 60 years follow up. There were no differences of CIMT and FMD between PLWH and HC. ICAM-1 had a correlation with CIMT before starting ARV therapy and CS had a correlation with CIMT after 60 months of ARV therapy. FMD had a negative correlation with CS and CMV Lysate antibody for PLWH. FMD had negative correlation to CS and sTNFR but strong correlation to CMV gB antibody in HC. Chronic inflammation in PLWH did not cause CIMT changes. CS and CMV Lysate antibody may influenced FMD in PLWH, but for HC, CS and sTNFR may influenced FMD, but CMV gB antibody could be a protective factor.