Terapi Cairan dan Elektrolit pada Keadaan Gawat Darurat Penyakit Kulit

Latar Belakang: Kulit berfungi untuk melindungi tubuh dari kehilangan cairan dan elektrolit berlebihan. Pada penyakit nekrolisis epidermal toksik, sindrom Stevens-Johnson, Staphylococcal scalded skin syndrome, dan pemfigus vulgaris terjadi kegawatdaruratan disebabkan oleh terbentuknya bula yang luas, sehingga cairan hilang berlebihan melalui kulit. Tujuan: Terapi cairan dan elektrolit intravena bertujuan mengganti kekurangan air, elektrolit, dan zat makanan yang diperlukan tubuh. Telaah Kepustakaan: Pemberian cairan dan elektrolit harus berdasarkan penyebab, kemudian menentukan jenis, jumlah, serta kecepatan pemberian. Penatalaksanaan meliputi evaluasi status hemodinamik, memeriksa kadar elektrolit, analisis gas darah, memasang tekanan vena sentral, dan kateter urine untuk menghitung kehilangan cairan sehingga dapat diberikan cairan dan elektrolit yang tepat. Terapi suportif pada kegawatdaruratan penyakit kulit sama dengan pasien luka bakar, yaitu menggunakan ‘rule of nine’ untuk bula >10% total area permukaan tubuh.Cairan yang dianjurkan adalah NaCl 0,9%, Ringer laktat, dan dextrosa 5%.Simpulan: Prognosis terapi cairan dan elektrolit pada keadaan gawat darurat penyakit kulit tergantung terapi yang adekuat, kelengkapan unit luka bakar, pemberian cairan yang tepat, dan nutrisi tambahan

Clinical Profile of Adverse Cutaneous Drug Reactions in Patients with Human Immunodeficiency Virus

Background: Adverse cutaneous drug reactions (ACDRs) are common problems in patients during the treatment of various diseases. The clinical feature varies from mild manifestation such as morbilliform, urticaria, and contact dermatitis, to severe manifestation such as Stevens - Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Patients infected with the human immunodeficiency virus (HIV) have an increased risk of developing ACDRs due to immune system disruption. This study aimed to describe the clinical features of ACDRs in HIV patients and the drugs that cause ACDRs.Method: This study was a retrospective study using secondary data from medical records of HIV patients with ACDRs who visited Teratai Clinic of Dr. Hasan Sadikin General Hospital Bandung from 2014 to 2018. Total sampling was applied and results were presented in percentage.Results: There were 94 HIV patients with ACDRs out of 557 HIV patients. Adverse cutaneous drug reactions are commonly found in males aged 20-39 years old. The clinical features found were morbilliform (85.6%), SJS (8.9%), urticaria (4.4%), and erythroderma (1.1%). The most common drugs causing ACDRs were Cotrimoxazole (30%), Efavirenz (28.9%), and Nevirapine (16.7%).Conclusion: The prevalence of ACDRs in HIV patients in this study is 16.9%. The most common clinical features are morbilli form and SJS with Cotrimoxazole, Efavirenz, and Nevirapine causing most of the ACDRs

Serum Level of IL-6, Reactive Oxygen Species and Cortisol in Patients with Recurrent Aphthous Stomatitis related Imbalance Nutrition Intake and Atopy

One of the most common oral ulcerations is recurrent aphthous stomatitis (RAS), affecting approximately 20% of the general population worldwide. The etiology of RAS is still unclear but it is considered to be multifactorial, including imbalanced nutrition intake and allergic conditions such as atopy. The purpose of this study was to investigate the differences and correlation between the serum level of IL-6, reactive oxygen species (ROS), and cortisol in RAS patients. Our study was cross-sectional and used a consecutive sampling method. There were significant differences of IL-6 and ROS levels in all groups (p = 0.000, p = 0.049 respectively) and a significant correlation between cortisol and ROS in the RAS group without atopy (r = -0.985, p = 0.015). Serum IL-6 and ROS measurement may be used for detecting RAS caused by malnutrition or atopy but not cortisol for patients without psychological stress detected. This is consistent with the results of a very strong correlation with a negative value between cortisol and ROS in RAS without atopy

Quality of Life in Children with Atopic Dermatitis

Background: Atopic dermatitis (AD) is the most common chronic skin disease in children which caused significant morbidity and impaired quality of life (QoL). The main goal of AD therapy is to prevent flare -ups, prolong remission and increase QoL. Therefore, the study aimed to discover QoL in children with AD.Methods: The study was conducted at Pasundan Public Health Centre, Al Islam General Hospital and Kimia Farma Private Dermatology Clinic, from September to November 2015. This descriptive study used consecutive sampling with 24 outpatients who were admitted to the health facility and diagnosed as AD. A questionnaire on Infant Dermatitis Quality of Life for infants aged 0–4 years, and Children Dermatology Life Quality Index for children aged 5–16 years was used in this study to measure QoL.Results: Out of 24 patients, 9 patients aged 0–4 years had mean score of 4.44±4.36, and 15 patients aged 5–16 years had mean score of 5.80±3.95. Mean SCORAD Objective in patients aged 0–4 and 5–16 was 15.61±7.75 and 17.44±11.Conclusions: The QoL in children with AD vary among patients. Most of the patients have mild-moderate impairment in QoL.

Is leukotriene B4 one of the keloid marker? a fibroblast keloid study

Keloid pathogenesis occurs due to the duration of prolonged inflammatory phase and increased production of various growth factors such as TGF-β1 which may cause increasing fibroblast proliferation and collagen synthesis. Existence of one of the chemical mediators released during inflammation, leukotriene B4 (LTB4), in keloid pathogenesis specifically in the phases of inflammation and proliferation, is still unclear. The purpose of the study is to analyze the levels of LTB4 in keloid. Methods: Fibroblast culture that was done by explanting keloid and normal skin of a keloid patient. Measurement of LTB4 on keloid and normal fibroblast was done by Elisa method. This experiment was run in triplicate. Statistical test was conducted by t test for the unpaired data and Anova test. The experiment was done at cell culture laboratory of Medical Faculty of Padjadjaran University Bandung. Levels of LTB4 in keloid fibroblast was higher than that of normal skin fibroblast (mean 23143.27 vs 18191.85 pg/ml; p<0.05). Conclusion, increased LTB4 levels in keloid fibroblast showed the existence of LTB4 role in the prolonged inflammatory process in keloid pathogenesis

Relationship between Knowledge, Attitude and Practice of Student’s Personal Hygiene with Scabies Incidence in Pesantren Darul Fatwa, Jatinangor, West Java, Indonesia

Background: Scabies is a parasitic infection caused by Sarcoptesscabiei Hominis varian and Acarina order. Sarcoptes scabiei infects both male and female in any age groups, ethnics, and socio-economic levels. Transmission of scabies can pass through by a direct contact from skin-to-skin or indirect contact through sharing bed, clothes, and towels. Pesantren as an educational institution supplies facilities that are shared thus making students susceptible to scabies infection. This study was conducted to discoverrelationshipbetween knowledge, attitude, and practice of student’s personal hygiene with scabies incidence.Methods: An analytic observational study was conducted from October to November 2015 in Pesantren Darul Fatwa, Jatinangor. Study was conducted with cross-sectional design and total sampling for the sample size. Total of 37 students whoparticipated in this study were 22 malesand 15 females. This study was begun with a stand alone-questionnaire, fill out on knowledge, attitude, and practice of personal hygiene that was supervised by researcher, and physical examination for scabies diagnosis that was performed by doctors.Results: Based on history taking and physical examination, 15 out of 37 students were diagnosed with scabies positive. All of them were males, dominated by 13 year old students, 1st and 2nd Junior High School students. Statistical analysis with chi-square test showed that there were no relationship between knowledge, attitude and practice of student’s personal hygiene with  scabies incidence.Conclusions: There is no relationship between knowledge, attitude and practice of student’s personal hygiene with  scabies incidence in Pesantre

KULTUR PRIMER FIBROBLAS: PENELITIAN PENDAHULUAN

AbstrakKultur sel fibroblas banyak digunakan untuk penelitian proses penyembuhan luka dan penuaankulit. Metode ini digunakan untuk melihat perkembangan sel, proliferasi kinetik seluler, sertabiosintesis komponen matriks ekstraseluler. Penelitian pendahuluan ini dilakukan untuk optimasiteknik laboratorium serta berbagai kendala yang didapatkan saat kultur fibroblas. Kultur primerfibroblas dibagi menjadi 2 jenis sampel yaitu sampel yang berasal dari embrio mencit usia 7,5–9,5 hari, dan kulit pasien keloid. Sampel dari embrio mencit dilakukan kultur primer denganmetode dissociated fibroblast. Sampel jaringan keloid dan kulit normal dikultur dengan metodeskin explant. Fibroblas yang berasal dari kultur primer embrio mencit tumbuh baik sehinggadapat dilakukan subkultur dan disimpan di dalam nitrogen cair suhu -198°C. Fibroblas yangberasal dari sampel keloid pertama tumbuh sesuai pola pertumbuhan fibroblas, namun padasampel kedua terdapat kontaminasi Paecilomyces sp. yang merupakan salah satu jenis jamurkontaminan. Sel fibroblas mudah untuk dikultur karena memiliki kemampuan tumbuh danmelekat yang tinggi serta regenerasi cepat, namun penelitian lebih lanjut untuk optimasi teknikkultur dan pencegahan kontaminasi masih dibutuhkan sehingga sel dapat tumbuh baik.AbstractFibroblast cell culture method has been used for wound healing and skin aging studies. Thismethod was used for cell development imaging study, celullar kinetic proliferation andextracelullar matrix component biosynthesis. This preeliminary study was done for laboratoricaltechnic optimation as well as problems appeared in fibroblast culture. Fibroblasts primary culturewas divided into 2 type of samples, from 7.5-9.5-day-mice embryo and keloid-patient skin.Primary culture with dissociated fibroblast method was done for mice embryo sample. Keloidtissue sample and normal skin were cultured with skin explant method. Fibroblasts that weretaken from mice embryo primary culture grew well therefore subculture can be done and kept in -198°C liquid nitrogen storage. Fibroblasts that were taken from first keloid sample grewaccording to fibroblast growth pattern, but, there was contamination with Paecilomyces sp. whichwas one of the contaminating fungi. Fibroblast cells are easy to be cultured as they have growthability and high adhesion capability as well as rapid regeneration, but, further study for culturedtechnical optimation and contamination prevention are still neededthereforethe cells can growwell.</p

Keberhasilan Terapi Kombinasi Menggunakan Metotreksat Injeksi dan Siklosporin pada Psoriasis Pustulosa Generalisata

Psoriasis pustulosa generalisata (PPG) adalah bentuk khusus dari psoriasis yang bersifat akut dan berat. Etiologi yang belum diketahui secara pasti menyebabkan pengobatan PPG masih menjadi suatu tantangan. Terapi kombinasi dapat diberikan pada PPG yang berat maupun yang tidak memberikan respons terhadap terapi sistemik tunggal, selain itu terapi kombinasi juga dapat meningkatkan efektivitas dari obat tunggal. Dilaporkan satu kasus PPG pada seorang wanita yang diterapi dengan menggunakan kombinasi metotreksat (MTX)  injeksi dan siklosporin. Dari anamnesis dan pemeriksaan fisis didapatkan pustula berkelompok pada dasar makula eritem yang bergabung membentuk lake of pus, disertai gejala sistemik demam dan leukositosis. Keluhan tersebut sudah berulang sejak 13 tahun yang lalu. Pasien diberikan terapi kombinasi injeksi MTX dan siklosporin. Pustula pada pasien menghilang setelah tujuh hari pemberian obat. Terapi kombinasi dengan MTX injeksi dan siklosporin ini baru pertama kali dilakukan 19 Mei–26 Mei 2017 di Departemen Ilmu Kesehatan Kulit dan Kelamin Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung dan memberikan hasil yang baik. [MKB. 2017;49(3):208–12]Kata kunci: Metotreksat, metotreksat injeksi, psoriasis pustulosa generalisata, siklosporin Succesful Treatment of Generalized Pustular Psoriasis with a Combination of Methotrexate Injection and CyclosporineGeneralized pustular psoriasis (GPP) is a special form of acute and severe psoriasis. The definite etiology of GPP remains a challenge. Combination therapy may be given to severe GPP or GPP that does not respond to a single systemic therapy sincecombination therapy may also improve the effectiveness of a monotherapy drug. A GPP case was reported in a woman treated with a combination of methotrexate (MTX) and cyclosporine. From anamnesis and physical examination it was revealed that there were clustered  pustules on the base of erythematous macules that form a lake of pus accompanied by systemic symptoms of fever and leukocytosis. This was a recurrent complaint since 13 years ago. Patients were given combination therapy of MTX injection and cyclosporine. Pustules disappeared after seven days of drug administration. This case was the first combination therapy with MTX injection and cyclosporine used during the period of 19 May to 26 May 2017 at the Department of Dermatology and Venereology Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung, resulting in good results. [MKB. 2017;49(3):208–12]Key words: Cyclosporine, generalized pustular psoriasis, methotrexate, methotrexate injectio

Butyrate Properties in Immune-Related Diseases:Friend or Foe?

Butyrate is a short-chain fatty acid (SCFA) created within the intestinal lumen by bacterial fermentation of largely undigested dietary carbohydrates. Its beneficial effects on cellular energy metabolism and intestinal homeostasis have garnered significant attention among SCFAs. Butyrate also has systemic effects and is known to regulate the immune system. Most of the butyrate and other SCFAs are produced in the human colon, through the fermentation of dietary fiber or resistant starch. However, the modern diet often lacks sufficient intake of fermentable dietary fiber, which can lead to low butyrate levels in the colon. To increase butyrate levels, it is helpful to incorporate fiber sources into meals and drinks that rely on slow bacterial fermentation. Butyrate is well known for its anti-inflammatory properties and has a range of immune system-related properties. As an agonist for GPR41, GPR43, or GPR109A, butyrate may have anti-inflammatory effects through these receptors’ signaling pathways. Butyrate also serves as an epigenetic regulator, responding to environmental or pharmacological changes by inhibiting HDAC, up-regulating miR-7a-5p, and promoting histone butyrylation and autophagy processes. This review discusses the importance of butyrate in regulating immunological homeostasis and the inflammatory response. It also addresses experimental models and human studies investigating the therapeutic potential of butyrate supplementation in immune-related conditions linked to butyrate depletion. Specifically, it covers the role of butyrate in some immune-related diseases such as systemic lupus erythematosus, atopic dermatitis, psoriasis, human immunodeficiency virus, cancer, and several other special conditions.</p