HUBUNGAN ANTARA DERAJAT NYERI DENGAN TINGKAT KUALITAS HIDUP PASIEN KANKER PARU YANG MENJALANI KEMOTERAPI

Background. Lung cancer is the most common case of malignancy and the leading cause of death from malignancy throughout the world, more so in Indonesia, which most of population are smokers. In general, lung cancer is found at an advance stage, specifically stage IIIB and IV, so that the main goals of therapy are to increase life expectancy and quality of life. Chemotherapy is one of the options of palliative therapy. Chemotherapy cause many side effects including pain. In addition, pain can also occur due to the cancer itself. Objective. To prove the correlation between pain intensity and quality of life in lung cancer patients undergoing chemotherapy. Methods. Cross-sectional analysis was conducted on 13 lung cancer patients from the Chemotherapy Department, Kariadi Hospital, Semarang from April to June 2015. Sosiodemographic characteristics and clinical data including diagnosis, cancer stage, performance status, and chemotherapy cycle were obtained from the medical records, followed by a questionnaire-based interview afterwards. Statistical analysis using Perason and Spearman were performed. Results. The mean of pain intensity of the patients was 6,5 ± 2,22 and mean of quality of life score was 799,6 ± 81,05. The results showed that there was no significant correlation between pain intensity and quality of life in lung cancer patients undergoing chemotherapy (p=0,8). Pain intensity had a significant correlation (r=-0,854) with global quality of life (p<0,001) and dyspneu (r=0,537) with p=0,04. Conclusion. There was no correlation between pain intensity and quality of life in lung cancer patients undergoing chemotherapy. Key word: lung cancer, chemotherapy, pain intensity, quality of lif

Distribusi Geografis dan Tingkat Keparahan Pasien Karsinoma Hepatoseluler Etiologi Virus Hepatitis B di RS.Dr Kariadi

Background: Hepatocellular carcinoma is ranked fifth in all malignancy worldwide. HCC is 10-20% of all liver disease in Indonesia. There is no geographic distribution data of HCC patients with Hepatitis B virus as etiology in Central Java. Objective: Analyzing geographic distribution and the correlation between patient’s place of origin with severity index of HCC with Hepatitis B virus as etiology in RSUP Dr Kariadi Semarang, Methods: Retrospective study using RSUP Dr Kariadi HCC patient’s medical record within 2013-2015. Analyzed variables were geographic distribution of the patients (urban/rural), clinical characteristic: age, sex, severity: child-pugh score, BCLC staging, and AFP level. The data was processed with SPSS program, with significant value p<0,05. Results: There were 103 HCC patients with most place of origin included Demak(22,3%), Semarang (17,5%), Grobogan (14,6%). Male : female ratio 4,4 : 1, Group age mean 47±12,8, Child-Pugh A, 14 (13,6%) , Child-Pugh B, 54 (52,4%), Child-Pugh C 35 (34,0%) , 7 (6,8%) BCLC A (early stage), BCLC B (intermediate stage)41 (39,8%) . BCLC C (advanced stage) 21 (20,4%) . 34(33%) BCLC D (terminal stage). AFP 70% > 400. There was no significant correlation between geographic distribution with clinical characteristic and severity. Conclusion: There was no significant correlation between geographic distribution with clinical characteristic and HCC’s severity (age, sex, BCLC staging, Child-Pugh level, and AFP level). Key words: hepatocellular carcinoma, geographic distribution, severity inde

PENGARUH PEMBERIAN EKSTRAK BROKOLI (Brassica Oleracea L.Var Italica) TERHADAP HISTOPATOLOGI AORTA TIKUS WISTAR HIPERLIPIDEMIA

Latar Belakang: Aterosklerosis terjadi akibat adanya kondisi hiperlipidemia dan paparan radikal bebas. Brokoli merupakan bahan kaya antioksidan yang dapat berperan sebagai agen anti-aterosklerosis. Tujuan: Penelitian ini bertujuan untuk melihat pengaruh pemberian ekstrak brokoli (Brassica oleracea L.Var italica) terhadap histopatologi aorta tikus wistar hiperlipidemia. Metode: Penelitian ini menggunakan rancangan post test only controlled group design terhadap 30 tikus yang dipilih secara random dan dibagi kepada 5 kelompok. Kelompok K1 diberi pakan minum standar selama 17 hari. Kelompok K2 diberi diet tinggi lemak berupa minyak babi 2ml/ ekor/ hari selama 10 hari dilanjutkan pakan minum standar selama 7 hari. Kelompok P1 diberi diet tinggi lemak selama 10 hari kemudian dilanjutkan pemberian ekstrak brokoli 250mg/ kgBB/ hari selama 7 hari. Kelompok P2 diberi diet tinggi lemak selama 10 hari kemudian dilanjutkan pemberian ekstrak brokoli 750mg/ kgBB/ hari selama 7 hari. Setelah itu dilakukan pengamatan histopatologi aorta yang difokuskan pada derajat sel busa, peradangan dan perdarahan. Hasil: Ekstrak brokoli 250mg/kgBB dapat menurunkan derajat sel busa hingga derajat sedang, derajat peradangan hingga derajat ringan, dan derajat perdarahan hingga derajat sedang. Ekstrak brokoli 500mg/kgBB dan 750mg/kgBB dapat menurunkan derajat sel busa hingga derajat ringan, derajat peradangan hingga setara dengan kontrol normal K1, dan derajat perdarahan hingga setara dengan kontrol normal K1. Ekstrak brokoli dapat menurunkan derajat sel busa, peradangan, dan perdarahan secara bermakna (p<0,05) dibanding kelompok kontrol hiperlipidemia. Kesimpulan: Pemberian ekstrak brokoli dapat menurunkan derajat sel busa, peradangan, dan perdarahan pada pembuluh darah aorta tikus wistar yang diinduksi diet tinggi lemak. Kata Kunci: Aterosklerosis, hiperlipidemia, radikal bebas, ekstrak brokoli, histopatologi aort

Crosstalk between hypoxia and inflammation in non-Hodgkin lymphoma

Tumor hypoxia is a well-known biological circumstance that has an impact on cancer growth and metastasis. This phenomenon is associated to poor patient outcomes, particularly in patients with non-Hodgkin Lymphoma. As the tumor mass grows, aggressive lymphoid malignancies necessitate a constant increase in perfusion which activate the hypoxia-inducible factor HIF-1α. HIF-1α is an important regulator that is widely discussed in various studies and pathological states which influence the expression of several genes through transcriptional regulation including metabolism/respiration, cell cycle, apoptosis, proliferation, angiogenesis, and others that may favor tumor growth. Tumor hypoxia also induces the expression of other important regulators such as microRNA-210 (miR-210) and Nuclear Factor Kappa B (NF-κB) which propagate the tumorigenesis process. This article reviewed the molecular mechanisms of how HIF-1α correlates with NF-κB and other factors in non-Hodgkin Lymphoma patients

IDENTIA Registry: Incidence of Deep Vein Thrombosis in Medically Ill Subjects at High Risk in Indonesia: A Prospective Study

Background: medically ill hospitalized patients are at risk of deep vein thrombosis (DVT) and consequentially have high chances of mortality. In Indonesia, there is disparity in healthcare facility and data on incidence of DVT in this multi-ethnic, geographically unique country with large population are limited. Hence, we determined the incidence of DVT and evaluated mean Wells score among medically ill hospitalized persons at increased risk. Methods: in this multicenter, prospective, observational registry in Indonesia, subjects (age >40 years) with acute medical illness (like cancer, acute infection, or severe respiratory disease) confined to bed for >3 days were enrolled between January 2016 and November 2017. Data for medical history, Wells score, and DVT diagnosis with compression ultrasonography (CUS) were recorded. DVT incidence was analyzed in eligible and evaluable groups. Data were analyzed by descriptive method. Results: out of 360 subjects enrolled, 334 were included in the eligible group for analyses. CUS could not be performed in 26 subjects. Thus, 308 subjects who completed the study were included in the evaluable group. Javanese were predominant in the eligible group and obesity was the most common medical history at presentation. Overall, incidence of DVT in eligible and evaluable patients was 37.1% and 40.3%, respectively. Mean (SD) Wells score and bedridden days were 3 (1.20) and 9 (6.89), respectively. Conclusion: this study indicated that the incidence of DVT is high in medically ill patients in Indonesia and will provide new insights and awareness about DVT in Indonesia

Dengue Hemorrhagic Fever In Indonesia: The Role Of Cytokines In Plasma Leakage, Coagulation And Fibrinolysis

Demam berdarah Dengue (DBD) merupakan penyakit endemic yang pada tahun 1994 telah menyebar ke seluruh propinsi di Indonesia. Berdasarkan laporan WHO 1991-1995, Indonesia menduduki peringkat pertama dalam besarnya jumlah kematioan kasus DBD. Manifestasi klinik infeksi virus dengue bervariasi mulai tanpa gejala, ringan (DF, DHFI, DHFII) dan berat (DHFIII dan DHFIV). Penelitian I tentang diagnosa banding penderita infeksi virus dengue dewasa di Indoensia. Diteliti 118 penderita dewasa penderita dewasa yang memenuhi criteria WHO untuk dengue. Dengan pemeriksaan serologi IgM/LgG ELISA, ternyata hanya 58 penderita dapat dikonfirmasi adanya infeksi baru firus dengue. Untuk menentukan penyebab infeksi pada 60 penderita yang tersisa, dilakukan pemeriksaan serologi tambahan. Pada 20 penderita dapat ditujukkan infeksi baru terhadap: hantavirus (5), chikungunya virus (2), influenza A virus (2), rubella virus (3), Rickettsia typhi (5), Rickettsia tsutsugamushi (2) dan leptospira (2). Gambaran klinik dan laboratorik dari 20 penderita ini mirip dengan 58 penderita dengan dengue. Temuan tentang infeksi virus hanta sebagai penyebab demam berdarah pada manusia merupakan lapoaran yang pertama di Indonesia, sebelumnya pernah dilaporkan adanya infeksi virus hanta pada tikus. Penelitian II tentang gambaran klinik dan resiko kematian pada 50 penderita DSS anak. Dalam penelitian ini kami mencari temuan klinik dan laboratorik yang berasosiasi dngan kematian. Hasil penelitian menunjukkan bahwa efusi pleura bilateral, suatu penanda kebocoran plasma, serta kadar thrombin-antithrombin compleses (TATc), penanda pengaktifan system pembekuan darah, mempunyai asosiasi yang yang bermakna dengan kematian. Penelitian III, IV dan V tentang peran sitokin pada patogenesis DBD. Diduga, sitokin merupakan mediator penting untuk terjadinya kebooran plasma dan pendarahan, keduanya merupakan perubahan patologik khas pada DBD. Dalam penelitian ini kami menemukan bahwa sitokin mempunyai asosiasi yang bermakna dengan (i) penanda kebocoran plasma, (ii) penanda pengaktifan system pembekuan darah, (iii) penanda pengaktifan system fibrinolisis dan (iv) kematia

Serum Complement 3 (C3) and Complement 4 (C4) Level in Febrile Neutropenia Patients at Dr. Kariadi Hospital, Semarang and Dr. Moewardi Hospital, Surakarta

Aim: to identify the serum complement 3 (C3) and complement 4 (C4) level in febrile neutropenia and nonfebrile neutropenia patients. Methods: this is a cross-sectional prospective study. Samples were collected from patients with febrile neutropenia as sample group and patients with neutropenia but without fever as control. Both groups were tested for serum complement 3 and complement 4 level, and the data were analyzed using student T- test. Results: from 37 neutropenia patients, 23 were classied as febrile neutropenia group and 14 in non-febrile neutropenia as control group. Total mean neutrophil count was 653.22/ ml serum in sample group and 594.36/ ml serum in control group (p = 0.575). Mean C3 level was 95.74 ug/dl in sample group and 130.00 ug/dl in control group, showing signicant difference with p= 0.031. The mean serum C4 level was 34.13 ug/ml in sample group and 34.00 ug /dl in control group, the difference is not signicant with p = 0.98. When sample C3 and C4 data were combined, the total level was 125.61 ug/ml, which was signicantly lower than the total C3 and C4 in control group 184.07 ug/dl. (p = 0,04) Conclusion: in febrile neutropenia there is signicant decrease of serum C3 level compared to non-febrile neutropenia. Serum C4 level in febrile neutropenia group is lower than the non-febrile neutropenia group, but the difference is not signicant

Addition of Beetroot Extract to Neoadjuvant Adriamycin Cyclophosphamide Regimen Increased Tumor Cell Apoptosis in Mammary Adenocarcinoma Rats

Apoptosis is one of the anticancer targets. Currently, the concomitant use of phytotherapy products and chemotherapy regimens is common in breast cancer patients. The purpose of this study was to examine the apoptotic effect of adding beetroot extract to the neoadjuvant Adriamycin Cyclophosphamide (AC) regimen by observing the expression levels of p53 and caspase 3 in tumor tissue from mammary adenocarcinoma rats. Twenty-four rats that succeeded in growing tumor nodules were randomly divided into 4 treatment groups: without treatment, AC only treatment, AC plus beetroot extract at dose of 25 and 100 mg/kg BW, respectively. AC was given 4 cycles in doses of 5 and 50 mg/kg body weight intraperitoneally every week. Tumor tissue was dissected at 4th week for examination of p53 and caspase 3 expression levels using the qRT-PCR method. The addition of beetroot extract at doses of 25 and 100 mg/kg BW in the neoadjuvant AC regimen showed significantly higher levels of p53 and caspase 3 expression than those with AC treatment alone. These results proved that beetroot extract has a synergistic effect with neoadjuvant AC regimen by increasing tumor cells apoptosis.Keywords: Beetroot extract, Adriamycin, Cyclophosphamide, apoptosis, p53

Risk Factors for Mortality in Dengue Shock Syndrome (DSS)

Background: Dengue shock syndrome (DSS) is the most severe form of dengue hemorrhagic fever (DHF) and has a high mortality. There are two major pathological changes in DHF determining the severity of disease, plasma leakage and bleeding. Cytokines released during the immune response to dengue virus have been thought to be mediators of the process. Methods: The study involved 50 children with DSS, of whom 13 (26%) died. We investigated which clinical signs and laboratory findings are related to mortality. Results: We found that gastrointestinal bleeding and bilateral pleural effusion were significantly more frequent in non-survivors than in survivors (p<0.02 and p=0.0006, respectively). Also, mean admission levels of thrombin-antithrombin complexes (TATc) and plasminogen activator inhibitor type 1 (PAI-1), activation markers of coagulation and fibrinolysis, respectively, were significantly higher in non-survivors (p=0.004 and p=0.0006, respectively). In regression analysis, bilateral pleural effusion and admission levels of TATc were significantly associated with mortality (p=0.007 and p=0.048, respectively). Conclusions: Our data provide evidence for a relationship of mortality with pleural effusion, a marker of plasma leakage, and coagulation activation, both characteristic pathological changes in dengue shock syndrome