PERBEDAAN INDEKS TROMBOSIT ANTARA PASIEN KANKER KOLOREKTAL NONMETASTASIS DAN METASTASIS DI RSMH PALEMBANG

Kanker kolorektal masih menjadi permasalahan kesehatan di dunia. Hal ini karena progresivitas kanker berkaitan dengan prognosis dan angka kematian. Salah satu faktor yang berhubungan dengan progresivitas dan metastasis pada kanker kolorektal adalah indeks trombosit. Penelitian ini bertujuan untuk mengetahui perbedaan indeks trombosit antara pasien kanker kolorektal nonmetastasis dan metastasis. Penelitian ini adalah penelitian analitik komparatif dengan pendekatan case-control. Subyek penelitian adalah pasien kanker kolorektal di Poliklinik Hematologi dan Onkologi Medik Penyakit Dalam dan di bangsal rawat inap Penyakit Dalam RSMH Palembang mulai Januari – Juli 2020. Sampel berupa darah yang diambil dari vena mediana cubiti. Indeks trombosit (jumlah trombosit, MPV dan PDW) diperiksa menggunakan automated hematology analyzer di Laboratorium Patologi Klinik RSMH Palembang. Data dianalisis menggunakan uji T tidak berpasangan. Hasil penelitian menunjukkan kadar trombosit (484,1±185,1/µL) lebih tinggi pada kelompok kanker kolorektal dengan metastasis dibandingkan kelompok nonmetastasis (361,9±97,9/µL) dengan nilai p=0,000. Kadar MPV (8,9±0,7 fl) dan PDW (9,1±1,4%) lebih rendah pada kelompok kanker kolorektal dengan metastasis dibandingkan kelompok nonmetastasis (masing-masing 9,5±0,8 fl dan 10,6±2,2%) dengan nilai p=0,000.  Pada penelitian ini, ada perbedaan indeks trombosit antara pasien kanker kolorektal dengan metastasis dan kanker kolorektal nonmetastasis

Profile of Coagulation Marker and The Influence Factors in Central Nervous System Tumor

Brain tumors have the highest percentage of thrombosis compared to other types of malignancies. Hypercoagulation is a risk for thromboembolic events in patients with malignancy. Hypercoagulation conditions are frequentlyfound in patients with malignancy arising from the aptitudeof tumor cells to activate the coagulation system. This condition can be detected through coagulation markers in the blood. This marker isPT, APTT, INR, Fibrinogen and D-Dimer.This research is a descriptive analytic study using secondary data from medical records of patients with central nervous system (CNS) tumors. The inclusion criteria were CNS tumor patients> 18 years old and had been diagnosed with CNS tumor. Coagulation markers are recorded based on the results of the initial laboratory examination upon entering the hospital, consisting of D-Dimer, PT, APTT, Fibrinogen, INR.There were 124 researchsubjects, consisting of 60 men and 64 women. Most research subjects are in the age range of 40-49 years (54.8%). Hypercoagulation conditions were found in 92.74% of study subjects. The most common accompanying conditionwas hypertension (22.6%). There were no significant differences in the hypercoagulable conditions in groups with and without accompanying conditions.Hypercoagulation was found in most research subjects. There are no factors that influence the hypercoagulation condition in this study

THE COMPARISON OF EFFECTIVENESS AND SAFETY BETWEEN WARFARIN AND RIVAROXABAN IN HYPERCOAGULATED CENTRAL NERVOUS SYSTEM TUMORS

Abstract:                                                                                                                                           Background: Central nervous system (CNS) tumors originate from the brain and spinal cord, and have complications, such as hypercoagulation. The administration of anticoagulants (warfarin and rivaroxaban) has been able to reduce hypercoagulation-related morbidity and mortality, however, the effectiveness and safety of their use has not been well studied. This study aims to compare the effectiveness and safety of anticoagulant drugs between warfarin and rivaroxaban in hypercoagulated CNS tumors. Methods: This was a randomized clinical trial study, double-blinded, conducted on CNS tumor patients from September-November 2020 at Mohammad Hoesin Hospital. The patients were given warfarin and rivaroxaban for 3 weeks. Coagulation status was measured before and after. Data were analyzed using SPSS ver.24. Results: The mean age of 20 patients was 42.70+8.14 years and majority were female (80%), with tumor characteristics were primary (80%), single (85%), and located in the brain (95%). In the warfarin group (n=10), there were significant improvements in PT (p 0.008), INR (p 0.013), Fibrinogen (p 0.041), and D-Dimer (p 0.008) value, also the rivaroxaban group (n=10) in PT (p 0.013), APTT (p 0.012), INR (p 0.028), Fibrinogen (p 0.047), D-Dimer (p 0.032), and Anti Fxa (p 0.028). However, there was no significant difference between groups, except when comparing the Anti Fxa delta (p 0.041). There was 1 person with major bleeding using warfarin, and 1 person (excluded) with GIT bleeding using rivaroxaban. Conclusion: There was a significant improvement of coagulation value in both groups, also side effects were seen as well. Keyword: CNS Tumor, Hypercoagulation, Warfarin, Rivaroxaba

Profile of Coagulation Marker and The Influence Factors in Central Nervous System Tumor

Brain tumors have the highest percentage of thrombosis compared to other types of malignancies. Hypercoagulation is a risk for thromboembolic events in patients with malignancy. Hypercoagulation conditions are frequently found in patients with malignancy arising from the aptitude of tumor cells to activate the coagulation system. This condition can be detected through coagulation markers in the blood. This marker is PT, APTT, INR, Fibrinogen and D-Dimer. This research is a descriptive analytic study using secondary data from medical records of patients with central nervous system (CNS) tumors. The inclusion criteria were CNS tumor patients > 18 years old and had been diagnosed with CNS tumor. Coagulation markers are recorded based on the results of the initial laboratory examination upon entering the hospital, consisting of D-Dimer, PT, APTT, Fibrinogen, INR. There were 124 research subjects, consisting of 60 men and 64 women. Most research subjects are in the age range of 40-49 years (54.8%). Hypercoagulation conditions were found in 92.74% of study subjects. The most common accompanying condition was hypertension (22.6%). There were no significant differences in the hypercoagulable conditions in groups with and without accompanying conditions. Hypercoagulation was found in most research subjects. There are no factors that influence the hypercoagulation condition in this study

EFEKTIVITAS SUPLEMENTASI VITAMIN D TERHADAP SKOR BECK DEPRESSION INVENTORY PADA PASIEN ACQUIRED IMMUNODEFICIENCY SYNDROME DI POLIKLINIK VCT RSUP DR MOHAMMAD HOESIN PALEMBANG

Depresi merupakan gangguan psikosomatik tersering pada pasien terinfeksi HIV dan mengganggu kualitas hidup penderita secara bermakna. Hipovitaminosis D sering terjadi pada pasien AIDS dan kadar vitamin D berkorelasi negatif dengan tingkat depresi. Namun, sampai saat ini belum ada penelitian mengenai efektivitas suplementasi vitamin D terhadap tingkat depresi penderita AIDS. Penelitian ini dilakukan untuk menganalisis pengaruh penambahan vitamin D terhadap perubahan tingkat depresi penderita AIDS. Penelitian uji klinis acak tersamar ganda melibatkan penderita AIDS dengan skor BDI ? 10 di Poliklinik VCT RSMH Palembang sejak April 2019 sampai dengan Februari 2020 menggunakan nonprobability consecutive sampling. Sampel dirandomisasi untuk mendapat vitamin D (calitriol 0,5 mcg per hari) atau plasebo selama 8 minggu. Uji T berpasangan digunakan untuk menilai perubahan tingkat depresi. Dari 37 subjek, terdapat 26 orang laki-laki dan 11 orang perempuan dengan skor BDI awal kelompok perlakuan 19,95±9,88 dan kelompok plasebo 20,44±8,86. Setelah 8 minggu penelitian, didapatkan skor BDI kelompok perlakuan 6,63±6,16 dan kelompok plasebo 11,94±7,14. Uji T berpasangan menunjukkan perbedaan bermaka pada tingkat depresi antara kelompok perlakuan dan plasebo (p=0,000). Suplementasi vitamin D secara bermakna memperbaiki skor BDI pada penderita AIDS

Cancer Progression : Focus on Platelet

Platelets are an important component in the process of hemostasis and coagulation. It’snow known that high platelets count closely related to poor prognosis of patients withcancer, due to their role in the hematogenous spread of cancer cells. Platelet can beactivated by cancer cells into tumor educated platelet and then cause thrombosis throughtumor induced platelet aggregation. Platelet also protect cancer cells in the blood circulationfrom natural killer cells and help the transition of cancer cells from epithelial tomesenchymal and vice versa, resulting in the process of metastasis. In the next stage ofmetastasis, platelets trigger extravasation of cancer cells from primary cancer and helpadhesion of cancer cells to distant organs

The Role of Vascular Endothelial Growth Factorin Thrombocytosis in Colorectal Cancer Patients: The Role of VEGF in Thrombocytosis

Backgorund: Colorectal cancer was included in a group of cancer with various complications. One complication that was often a cause of morbidity and mortality was thrombocytosis. In colorectal cancer, the incidence of thrombocytosis associated with the formation of blood vessels around the tumor or angiogenesis. Factors that played an important role in angiogenesis was vascular endothelial growth factor (VEGF). Methods: This study was an observational analytic research in colorectal cancer patients to determine the correlation levels of platelets and serum VEGF levels. A total of 33 patients with colorectal cancer at the Palembang Mohammad Hoesin Hospital be research subjects to examine the levels of platelets and levels of VEGF. The level of serum VEGF was performed using ELISA technique from SIGMA®. Results: The average level of the patient's platelets was281,090.9±105,860.8/mm3.  In this study, two patients (6.06%) have thrombocytosis.The average serum levels of VEGF research subjects were 221.2 ± 152.8 pg/mL.Correlation test of levels of serum VEGF and platelets levels showed the value of p=0.040 (p> 0.05) and r = 0468. Conclusions: Thus, it can be concluded that in this research serum VEGF levels are almost always causes an increase in platelet levels in patients with colorectal cancer

The Effect of Vitamin D Supplementation on the Increase in CD4 count of HIV/AIDS Patients Receiving Antiretroviral Therapy

Introduction. Vitamin D plays a role in health overall, but hypovitaminosis D stilloccurs throughout the world. HIV/AIDS patients are prone to suffer fromhypovitaminosis D because of the infection itself and the side effects of antiretroviraltherapy. Various effort have been tried to improve the immune status of HIV/AIDSpatients, one of them is by adding vitamin D. Vitamin D acts as an antiinflammatoryso that it can prevent apoptosis of CD4 T cells and increase CD4 cell count.Methods. This is a randomized control trial add on a study that aims to determinethe effect of vitamin D to increase in CD4 counts of HIV / AIDS patients who havereceived antiretroviral drugs. Subjects were HIV / AIDS patients who had receivedantiretroviral drugs. A total of 20 subjects were divided randomly into two groups;one group received vitamin D (calcitriol 0.5 mcg per day) for eight weeks, and theother group that received a placebo. Each group was measured of CD4 cell countbefore and after treatment. Results. There was a significant increase in the CD4 cellcount of the vitamin D group (p = 0.046), but not in the CD4 cell count of bothgroups (p = 0.985). The comparison of mean CD4 cell counts between groups beforetreatment was not significantly different (p = 0.057), but after treatment, it becamesignificantly different (p = 0.040). Conclusion. Vitamin D has been successful inincreasing CD4 cell count in the vitamin D group, and it is recommended to giveHIV / AIDS patients to increase CD4 cell count