The Characteristics of Breast Cancer Patients in Dharmais Hospital National Cancer Center Jakarta Based on Occupational and Environmental Status

Hubungan jenis pekerjaan (okupasi) dengan kanker payudara bervariasi di tiap negara. Tujuan dari studi ini adalah untuk mengetahui faktor risiko kanker payudara di Indonesia berupa faktor pekerjaan dan lingkungan. Studi deskriptif ini mengambil 103 sampel pasien kanker payudara di RS Dharmais. Hasilnya adalah karakteristik mayoritas pasien kanker payudara adalah berumur 51-60 tahun (35%), memiliki riwayat keluarga (61,2%); melahirkan 3 hingga 4 kali (42,7%); dan konsumsi tinggi lemak(76,7%). Faktor pajanan yang berhubungan dengan kanker payudara adalah rokok (76%); estrogen (43%); bahan industry (41%); dan radiasi (21%). Faktor okupasi tidak berperan penting, tetapi factor lingkungan memiliki peran yang tinggi dalam terjadinya kanker payudara di Indonesia

Effects of Retinoic Acid and Valproic Acid on differentiation of Embryonic Neural Stem Cells

Neural stem cells (NSC) have a myriad of potential uses, such as the treatment for spinal cord injury. Both retinoic acid (RA) and valproic acid (VPA) have been proven to be involved in neurogenesis in mice model; VPA as an HDAC inhibitor to induce neuronal differentiation and RA which enhances histone H3 acetylation to induce astrocyte differentiation of NSC.  The objective of this research is to find the most suitable substance and/or combination of substances to be used in neuronal differentiation of ESC-derived NSCs. NS cells were derived first from mouse ES cells. DMEM Ham’s F-12 along with Vitamin B27, PSF, EGF, and BFGF was used. For experiment cells were moved to a four-well dish with N2 medium and FGF; control, RA, RA+FBS, RA+VPA. Immunocytostaining was done with antibodies for Tuj1, GFAP, and nestin, and then observed under fluorescent microscope. Cell count was done to determine differentiation of cells in each dish. In treatment of the VPA and RA, there is indication that neurogenesis enhanced compared to cells that was only treated with RA and the control dish. The enhancement is mostly shown in the Tuj1 immunofluorescence where it is more abundant. However the number of astrocyte differentiation was also increased in the combination of RA and VPA treatment. This indicates that there is no specific fate preference from the treatment. It does however indicate that during the incubation period there was an increase in cell proliferation and differentiation of NSCs when treated with a combination of VPA and RA

Post Conference Report: Indonesia International (bio)Medical Students’ Congress (INAMSC) 2013

The 1st Indonesia International (bio)Medical Students’ Congress, a part of Faculty of Medicine Universitas Indonesia’s “LigaMedika”, was held in Jakarta and Depok from May 1st-4th 2013. A total of 183 students from 5 different countries participated in the event. The theme for this year was “Cancer: Pursuing the Cure of the Century”

Hiperbilirubinemia pada neonatus >35 minggu di Indonesia; pemeriksaan dan tatalaksana terkini

Pada bayi baru lahir terjadi kenaikan fisiologis kadar bilirubin dan 60% bayi >35 minggu akan terlihat ikterik. Namun, 3%-5% dari kejadian ikterik tersebut tidaklah fisiologis dan berisiko untuk terjadinya kerusakan neurologis bahkan kematian. Sebagai pencegahan hiperbilirubinemia berat yang dapat menyebabkan kerusakan neurologis, pemeriksaan bilirubin telah menjadi rekomendasi universal bayi baru lahir yang terlihat kuning. Semakin tinggi perhatian klinisi untuk pencegahan kernikterus, semakin rendah insidensinya. Indonesia menghadapi masalah overtreatment di perkotaan, dan undertreatment di daerah terpencil. Masalah overtreatment ini dapat menyebabkan kecemasan ibu, waktu menyusui anak ke ibu berkurang, serta tidak memungkiri peningkatan biaya yang harus ditanggung. American Academy of Pediatrics (AAP) telah menyusun algoritma dan kurva untuk menyesuaikan tata laksana bayi baru lahir dengan hiperbilirubinemia. Kurva ini mengarahkan klinisi untuk melakukan pengukuran kadar bilirubin dengan cara yang memungkinkan untuk masing-masing fasilitas kesehatan. Pada kenyataannya, masih ada fasilitas kesehatan yang belum memiliki sarana yang memadai untuk pemeriksaan kadar bilirubin maupun terapi sinar. Saat ini ditemukan beberapa penemuan baru, seperti Bilistick, sebagai alat pemeriksaan bilirubin yang kurang invasif dan penggunaan filter atau film untuk menangani hiperbilirubinemia ringan dengan sinar matahari. Penemuan baru inilah yang diharapkan dapat membantu negara berkembang, seperti Indonesia dan lainnya, dalam tata laksana hiperbilirubinemia pada bayi baru lahir

Optimasi Perolehan DNA Mikrobioma yang Diekstraksi dari Mekonium dan Feses Neonatus Prematur untuk diaplikasikan pada Next-Gen Sequencing 16S rRNA

The composition of the intestinal microbiome of neonates can be identified from meconium and feces by Next-Generation Sequencing (NGS) technology. However, the yield of microbiome DNA of meconium and feces has its own challenges due to the consistency and the high content of PCR inhibitors in these samples. This study aims to optimize the yield of microbiome DNA from meconium sample and feces of pre-term neonates. The DNA yield was obtained by applying certain optimized parameters, i.e., considering the replication and condition of the sample, using a particular kit for DNA extraction, and modifying the DNA elution of the column purification. The genomic DNA obtained was quantified and confirmed using Polymerase Chain Reaction. Results showed that the best DNA yield was achieved by replicating the number of samples twice in the pre-extraction stage, working on fresh meconium and feces samples instead, and suspended the sample in ddH2O prior to extraction process as observed on agarose gel visualization with UV trans-illuminator, as well as in quantitative measurement by a nano spectrophotometer. The best extraction process was using MP Biomedical FastDNA Spin Kit for Soil, in addition to the use of an elution buffer in a smaller volume, resulting in a higher concentration and purity of DNA. In conclusion, we were able to obtain an optimized yet reliable DNA yields, especially from meconium, which fulfilled the quality and quantity requirement for further sequencing process of microbiome.Komposisi mikrobioma usus pada neonatus prematur dapat diidentifikasi dari mekonium dan feses dengan teknologi Next-Generation Sequencing (NGS). Akan tetapi, perolehan DNA mikrobioma sampel mekonium dan feses memiliki tantangan karena konsistensi serta kandungan inhibitor PCR yang tinggi pada sampel tersebut. Tujuan dari penelitian ini adalah untuk mengoptimasi perolehan DNA mikrobioma dari mekonium dan feses neonatus. Proses perolehan DNA dilakukan dengan menerapkan optimasi parameter yaitu pertimbangan tahap pra-ekstraksi yaitu replikasi dan kondisi sampel, penggunaan pilihan kit ekstraksi, dan tahap elusi DNA hasil ekstraksi. DNA genomik yang diperoleh dikuantifikasi serta dikonfirmasi menggunakan Polymerase Chain Reaction. Hasil optimasi terbaik berdasarkan pengamatan visual kualitas DNA dengan agaros gel dan transiluminator UV, maupun secara kuantitas yang diukur dengan spektrofotometer nano adalah dengan replikasi jumlah sampel sebanyak 2 kali lipat, menggunakan sampel mekonium dan feses yang segar, dan terlebih dahulu disuspensikan menggunakan ddH2O untuk tahap-tahap pra-ekstraksi. Kit terbaik untuk ekstraksi DNA adalah MP Biomedical Fast DNA Spin Kit for Soil, serta penggunaan dapar elusi dengan volume yang lebih sedikit untuk menghasilkan konsentrasi serta kemurnian DNA yang lebih tinggi. Dapat disimpulkan bahwa perolehan DNA yang andal terutama dari sampel meconium berhasil teroptimasi untuk memenuhi kualitas dan kuantitas DNA untuk tahap selanjutnya dengan teknologi sekuensing mikrobioma

The Characteristic of Tuberculosis Patients in Jakarta 2011 Based on Nutritional Status, History of Immunodeficiencies, History of Tuberculosis, and Source of Infection at Home

Our study’s aim is to determine the Tuberculosis (TB) infection source in Jakarta to decrease its prevalence. This cross sectional study lasted 4 months involving 109 TB patients. Subjectsshould be diagnosed as primary lung TB patients. Questionnaire was used as this study’s tool,comprising questions as follows: patient’s identity and 4 main questions relating to Body MassIndex (BMI), TB history, history of immunodeficiencies, and TB infection source existence athome. From 109 TB patients, only 35 persons (32.1%) have BMI problem. Only 2 persons(1.8%) have all factors supposedly linked to TB prevalence. Other patients showed varied resultson combination of 2 factors (e.g. BMI and immune disease), ranging from 1.8% to 11.9%.Wealso found that 15 persons (13.8%) have normal BMI, no history of TB, no immune disease, andno infection source at home. Bad nutritional status is the TB patients’ main characteristic inJakarta 2011

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Optimalisasi Pertumbuhan Bayi Prematur dan Pasca Prematur di Indonesia; Mengacu pada Pedoman Nutrisi Bayi Prematur di RSCM

Bayi prematur memiliki risiko lebih tinggi untuk terjadinya gagal tumbuh dan gagal kembang dibandingkan bayi aterm. Intervensi yang diperlukan penting terutama selama 1000 hari pertama kelahiran. Risiko penyakit metabolik, obesitas, penyakit kardiovaskuler, gangguan tumbuh kembang, merupakan beberapa dari dampak negatif bila pemberian nutrisi yang ridak optimal di 1000 hari pertama. Indonesia merupakan salah satu negara dengan masalah stunting. Stunting bisa dicegah dengan pemberian nutrisi yang adekuat serta pemantauan rutin yang baik dengan grafik khusus bayi prematur. Selama perawatan, dokter anak harus sudah bisa memberikan nutrisi enteral dan parenteral yang agresif untuk mencegah extra-uterine growth restriction (EUGR). Sedangkan setelah pulang, pilihan susu yang tepat sangat penting untuk mencegah gagal tumbuh dan stunting. Di Indonesia tersedia berbagai jenis susu formula dan human milk fortifier untuk membantu bayi yang masih mendapatkan ASI dan berusia di bawah usia koreksi 40 minggu. Bila ASI dan human milk fortifier tidak sesuai, maka pemberian susu formula dapat dipilih dari susu formula standar (20kkal/30ml), formula prematur (24kkal/30 ml), dan formula 22kkal/30ml. Ketiga produk ini masih digunakan secara bergantian di Indonesia. Penentuan produk susu formula berhubungan dengan kondisi klinis dan kebutuhan kalori, serta perlu dipantaunya target kenaikan berat badan yang tampak dari kurva pertumbuhan yang tepat sesuai usia, jenis kelamin, dan usia gestasional. Data dari RSCM menunjukkan bahwa pada bayi dengan ASI eksklusif yang mengalami gagal tumbuh, pemberian susu 22kkal/30ml menyebabkan peningkatan persentil dan mencegah penurunan lebih lanjut. Saat ini, Rumah Sakit Cipto Mangunkusumo telah menyusun panduan untuk memudahkan dokter anak menentukan pemberian nutrisi dari hari pertama kelahiran di rumah sakit, selama perawatan, dan setelah pulang dari keperawatan.</jats:p

Metagenomic profiles of the early life microbiome of Indonesian inpatient neonates and their influence on clinical characteristics

AbstractDetermining the initial normal neonatal gut microbiome is challenging. The debate regarding the sterile fetal environment is still ongoing. Therefore, studying and comparing normal and dysbiotic microbiomes requires the elucidation of both the fetal and infant microbiomes. Factors influencing the normal microbiome also include regional and genetic factors specific to different countries. Determining the normal microbiome population in our center and their association with the clinical conditions of infants is helpful as a tool for both the prevention and treatment of related diseases during neonatal care. Here, we employed metagenomic sequencing to characterize meconium and the subsequent early-life gut microbiome of preterm neonates in Jakarta, Indonesia. Microbiome diversity and complexity was higher in the meconium and on day 4 than on day 7. At the genus level, the most abundant genus overall was unidentified Enterobacteriaceae, with meconium samples dominated by Ureaplasma, day 4 fecal samples dominated by Staphylococcus, and day 7 samples dominated by Clostridiales, while at the phylum level the most abundant was Proteobacteria and Firmicutes. Perinatal factors of PROM and mother’s diet influenced the meconium microbiome, while day 4 and day 7 microbiome was associated with bacteremia and early administration of antibiotics. One of our sample sets was derived from triplets, and they had varying diversity despite being triplets. These data are valuable for understanding the formation of a healthy microbiome specific to neonates and devising a strategy to improve both the gut health and related clinical outcomes of the neonate.</jats:p