3

Expression of mRNA IL-17F and sIL-17F in atopic asthma patients Prof.Dr.R.D Kandou
Manado
Eko E Surachmanto, Mochammad Hatta, Andi Asadul Islam, Syarifuddin Wahid
Department of Internal Medicine Faculty of Medicine, Sam Ratulangi University Manado, Indonesia
Molecular Biology and Immunology Laboratory, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Department of Neurosurgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Department of Pathology Anatomy, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
*Corresponding author: hattaram@yahoo.com

Abstract

Background

Asthma is a chronic inflammatory disorder of airway that involves many cells and elements.
Chronic inflammation caused by increase Airway hyperesponsive-ness that cause recurrent
episodic symptoms of breathlessness, wheezing, chest tightness and coughing, especially at night
or early morning. Interleukin 17F is a cytokine that plays an important role in the
pathophysiology of asthma attacks. Some studies show a variety of IL-17F roles in the
pathogenesis of airway inflammation due to an allergic reaction.

Results

The study was conducted at the Prof. Dr. R. D. Kandou Manado Hospital, Indonesia. Samples
were taken continuously until the number of meant samples was achieved. Blood samples were
collected from 40 atopic asthmatic patients. From statistical analysis based on the hypothesis,
there was positive correlation between mRNA levels of IL-17F and IL-17F in atopic asthmatic
patient (p = 0.000 and r = 0.988).

Conclusions

According these data suggest that levels of mRNA IL-17F and IL17F might be useful parameters
for the diagnosis of atopic asthma patient.
Keywords: mRNA IL-17F, Soluble IL-17F, Asthma, ELISA, Real-time PCR
14

Profile of IgE total in Chronic Kidney Disease Patients

Susilo A., Surachmanto E.*, Soekarno J.*, Datau E.A.*, Sugeng C.**
Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia*Division of Allergy-Immunology,
Department of Internal MedicineFaculty of Medicine, Sam Ratulangi University, Manado, Indonesia**Division of Nephrology and Hypertension
Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia

ABSTRACT
Background: Uremic pruritus (UP) is one of the disturbing symptom for patients with Chronic
Kidney Disease (CKD). A significant increase of IgE levels in hemodialysis patients was foundin
uremic pruritus patients.
Objective: This study is aimed to assess the profile of IgE total in CKD patient
Metode: This is an observational descriptive study with cross-sectional design at Nephrologyand
Hypertension outpatient department and admitted patient at RSUP Prof.Dr.R.D.KandouManado.
Subjects were 30 sample for each CKD stage 1, 2, 3, 4, 5 and we measure the IgEtotal value.
Results: Total subject of this study was 150 subject with 77 (51,13%) subject were male and73
(48,6%) subject were female. History of allergy was found in 24 (16%) subject. The meanvalue
of IgE total for CKD 1 subjects were 222,6 IU/mL, CKD 2 subjects were 338,38 IU/mL,CKD 3
subjects were 449,8 IU/mL, CKD 4 subjects were 959,4 IU/mL and CKD 5 subjectswere 1213,9
IU/mL.An increase of IgE total > 100 IU/mL for CKD 1 were 4 subject (13,3%), CKD 2 were
8subject (26,6%) CKD 3 were 19 subject (63,3%), CKD 4 were 26 subject (86%), CKD 5
were30 subject (100%).
Conclusion:Significant increase profile of IgE total with an increase stage of Chronic
KidneyDisease patient
Keyword: IgE total; Chronic Kidney Disease (CKD)
15

Association between asthma control and Interleukin – 17F expression levels in adult patients
with atopic asthma
Surachmanto EE, Hatta M, Islam AA, Wahid S.
Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia*Division of Allergy-Immunology,
Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia

Abstract
OBJECTIVES:
To investigate the correlation between Interleukin 17 (IL-17F) and the level of asthma control.

METHODS:
This is a cross-sectional study of 40 subjects who were diagnosed with atopic asthma. All
participants were recruited from the Allergy and Immunology Clinic, Prof. R.D. Kandou General
Hospital, Manado, Indonesia, between April 2015 and April 2016. Total serum IL-17F measured
by using Enzyme-Linked Immunosorbent Assay methods; and mRNA IL-17F was obtained by
using real-time reverse transcriptase polymerase chain reaction. Level of asthma control was
quantified by using asthma control test (ACT) scoring system. The correlation between IL-17F,
mRNA, and level of asthma control was analyzed by using Pearson's correlation coefficient (r).

RESULTS:
There is a strong positive correlation between IL-17F serum level and Nathan's ACT-score
(r=0.969) which is statistically significant (p less than 0.001). Analysis of the correlation
between mRNA IL-17F serum level and Nathan's ACT-score revealed a strong positive
correlation (r=0.963), which is statistically significant (p less than 0.001).

CONCLUSION:
These findings suggest that IL-17F plays an important role in asthma control. However, the role
played by IL-17F in asthma pathogenesis are still questions to be answered.
16

Expression of Mrna IL-17F and SIL – 17F in atopic asthma patients

Surachmanto EE, Hatta M, Islam AA, Wahid S.
Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia*Division of Allergy-Immunology,
Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
Abstract
Background
Asthma is a chronic inflammatory disorder of airway that involves many cells and elements.
Chronic inflammation caused by increase Airway hyperresponsiveness that cause recurrent
episodic symptoms of breathlessness, wheezing, chest tightness and coughing, especially at night
or early morning. Interleukin 17F is a cytokine that plays an important role in the
pathophysiology of asthma attacks. Some studies show a variety of IL-17F roles in the
pathogenesis of airway inflammation due to an allergic reaction.
Results
The study was conducted at the Prof. Dr. R. D. Kandou Manado Hospital, Indonesia. Samples
were taken continuously until the number of meant samples was achieved. Blood samples were
collected from 40 atopic asthmatic patients. From statistical analysis based on the hypothesis,
there was positive correlation between mRNA levels of IL-17F and IL-17F in atopic asthmatic
patient (p = 0.000 and r = 0.988).
Conclusions
According these data suggest that levels of mRNA IL-17F and IL17F might be useful parameters
for the diagnosis of atopic asthma patient.
Keywords: mRNA IL-17F, Soluble IL-17F, Asthma, ELISA, Real-time PCR
18

Hubungan Antara Tumor Necrosis Factor – α dan Rasio Kolesterol Total / HDL dengan Derajat
Kerusakan Hati pada Pasien Hepatitis B Kronik
Patasik YZ, Waleleng BJ, Wantania F
Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia*Division of Gastroenterohepatic,
Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia

Latar Belakang: Kondisi perlemakan hati terjadi dikarenakan adanya penambahan asam lemak
bebas dihati.Hal ini akan menimbulkan peningkatan oksidasi dan esterifikasi lemak.Ketika
kondisi stres oksidatif di hati melebihi kemampuan perlawanan antioksidan, maka aktivasi sel
stelata dan sitokin proinflamasi akan berlanjut dengan inflamasi progresif. TNF-ɑ merupakan
salah satu sitokin pro-inflamasi yang mengalami peningkatan signifikan pada kondisi Hepatitis B
kronik.

Tujuan: Mengetahui perbedaan kadar TNF-α antara pasien Hepatitis B kronik dan kelompok
kontrol

Metode: Studi potong lintang terhadap 30 pasien Hepatitis B kronik secara konsekutif. Penilaian
Hepatitis B kronik menggunakan pemeriksaan penunjang. Analisis univariat, bivariat (uji Chi-
square dan fisherexact) dengan SPSS versi22.

Hasil: Pada grup Hepatitis B kronik memiliki nilai median TNF-α3,18 pg/ml dan pada grup
kontrol dengan nilai median1,72 pg/ml.Terdapat perbedaan yang signifikan nilai TNF-α antara
grup Hepatitis B kronik dengan grup kontrol (p=0,0001).

Kesimpulan: Terdapat perbedaan yang signifikan kadar TNF-α antara grup Hepatitis B kronik
dengan kontrol. Dimana kadar TNF-α serum lebih tinggi pada grup Hepatitis B kronik
dibandingkan dengan grup kontrol

Kata kunci: Hepatitis B kronik, Inflamasi, TNF-ɑ

19

The Relationship Between Total IgE and Neutrophils Count with Degrees of Asthma Control in
Adult Atopic Patients
Surachmanto EE, Hatta M, Islam AA, Wahid S.
Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia*Division of Allergy-Immunology,
Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia

Abstract Introduction: Asthma is a chronic reversible inflammation which is caused by bronchial

hypereactivity
due to exposure to allergen and hyperproduction of certain specific IgE. Neutrophil in respiratory
tract and high level of IgE in the blood serum is known to play in complex mechanism in asthma
development. The role of total IgE serum and neutrophil serum in asthma development is still not well
known.
Aim: This study aim is to assess the correlation between level of total IgE and neutrophil serum with
degree of asthma control.
Methods: This is a cross sectional study with 35 adult subjects with atophy asthma (age 22-61), all of
participant reside in Manado and its surrounding area. Degree of asthma control is categorized as
intermittent, mild persistent, moderate persistent and severe persistent based on criteria by GINA.
Patient with malignancy, sepsis, lung tuberculosis, diabetes mellitus, pregnant, and late stage chronic
kidney disease are excluded from this study.
Result: In this study there is no significant correlation between total IgE serum level and degree of
asthma control (p>0.05.) also there is no significant correlation between each total IgE level and each
degree of asthma control. There is significant positive correlation between neutrophil count and degree
of asthma control (r = 0.309; p<0.05). The higher neutrophil count is higher in mild persistent asthma
in comparison with intermittent asthma is found to be significant (p<0.05).
Conclusion: The neutrophil count in serum is related to degree of asthma control. Especially neutrophil
count in
mild persistent is higher than intermittent asthma. There is no correlation between total IgE level with
degree of
asthma control in adult subject with atopic asthma.
Keywords: atopic asthma, total Ig E, neutrophil count, degree of asthma control
20
Hubungan antara Peningkatan Imunoglobulin E Total dengan Anti Salmonella Tubex pada Pasien
Curiga Demam Tifoid

Abstrak: Demam tifoid adalah suatu penyakit infeksi akut sistemik yang disebabkan oleh bakteri
Salmonella typhi yang dapat di temukan di seluruh dunia. Menurut data World Health
Organization (WHO) tahun 2003, diperkirakan terdapat sekitar 17 juta kasus demam tifoid di
seluruh dunia dengan insidensi 600.000 kasus kematian tiap tahun. Di Indonesia sendiri demam
tifoid merupakan satu dari lima besar temuan diagnosis. Penegakan diagnosis demam tifoid
dilakukan secara klinis dan melalui pemeriksaan laboratorium. Pemeriksaan laboratorium dapat
berupa pemeriksaan darah tepi, uji serologis, dan kultur atau biakan. Pemeriksaan
Immunoglobulin M (IgM) anti Salmonella (tes TUBEX® ) merupakan salah satu dari uji
serologis baru yang lebih cepat dan akurat dalam mendiagnosis demam tifoid, namun dibutuhkan
penanda lainnya yang dapat mendukung hasil pemeriksaan seperti Immunoglobulin E (IgE).
Pemeriksaan ini merupakan tes aglutinasi kompetitif semi kuantitatif yang sederhana, cepat dan
akurat dalam diagnosis infeksi akut demam tifoid dengan tujuan mendeteksi adanya antibodi
peningkatan IgE pada pasien terduga demam tifoid.

Kata Kunci: Demam tifoid, pemeriksaan IgE, anti Salmonella, Tubex

29
Surveillance of Helicobacter pylori Antibiotic Susceptibility in Indonesia: Different Resistance
Types among Regions and with Novel Genetic Mutations
1,2,3,4
Miftahussurur M , Syam AF5, Nusi IA3, Makmun D5, Waskito LA1,4, Zein LH6, Akil F7, Uwan WB8, Simanjuntak D9, Wibawa
ID10, Waleleng JB11, Saudale AM12, Yusuf F13, Mustika S14, Adi P4, Maimunah U3, Maulahela H5, Rezkitha YA4, Subsomwong
P1, Nasronudin4, Rahardjo D4, Suzuki R1, Akada J1, Yamaoka Y1,2.

Abstract
Information regarding Helicobacter pylori antibiotic resistance in Indonesia was
previously inadequate. We assessed antibiotic susceptibility for H. pylori in Indonesia, and
determined the association between virulence genes or genetic mutations and antibiotic
resistance. We recruited 849 dyspeptic patients who underwent endoscopy in 11 cities in
Indonesia. E-test was used to determine the minimum inhibitory concentration of five antibiotics.
PCR-based sequencing assessed mutations in 23S rRNA, rdxA, gyrA, gyrB, and virulence genes.
Next generation sequencing was used to obtain full-length sequences of 23S rRNA, infB, and
rpl22. We cultured 77 strains and identified 9.1% with clarithromycin resistance. Low
prevalence was also found for amoxicillin and tetracycline resistance (5.2% and 2.6%,
respectively). In contrast, high resistance rates to metronidazole (46.7%) and levofloxacin
(31.2%) were demonstrated. Strains isolated from Sumatera Island had significantly higher
metronidazole resistance than those from other locations. Metronidazole resistant strains had
highly distributed rdxA amino acid substitutions and the 23S rRNA A2143G mutation was
associated with clarithromycin resistance (42.9%). However, one strain with the highest MIC
value had a novel mutation in rpl22 without an A2143G mutation. Mutation at Asn-87 and/or
Asp-91 of gyrA was associated with levofloxacin-resistance and was related to gyrB mutations.
In conclusions, although this is a pilot study for a larger survey, our current data show that
Indonesian strains had the high prevalence of metronidazole and levofloxacin resistance with low
prevalence of clarithromycin, amoxicillin, and tetracycline resistance. Nevertheless,
clarithromycin- or metronidazole-based triple therapy should be administered with caution in
some regions of Indonesia.
34
Hubungan Infeksi Helicobater Pylori Dengan Derajat Lesi Mukosa Saluran Cerna Bagian Atas
Pada Subjek Pengguna Asam Asetil Salisilat Dosis Rendah

Many of etiologies that still less understanding to explain the pathogenesis can influence
mucosal surface of stomach and make hyperemic lesion in the stomach that influent dyspepsia
level. The objective of this study was to determine the relationship between hyperemic lesion in
the stomach and dyspepsia level. This study was conducted in Dr. M. Djamil Padang hospital
from Juli until Oktober 2014. From 35 subjects were taken by inclusion and exclusion criteria
and using consecutive sampling non probability. The subjects were interviewed using dyspepsia
score to determine the dyspepsia level. The endoscopy will remain the initial investigation of
choice for seeing the mucosal surface of gaster. The result showed from 33 samples that had
hyperemic lesion 57.6% had moderate-severe dyspepsia level and there is no significant
correlation of hyperemic lesion finding in the gaster with dyspepsia level but from 19 samples
that had wide hyperemic lesion 73.7% had moderate-severe dyspepsia level and it showed it had
significant correlation between both variables and the significant score is 0.031 (p<0.05).
Keywords: functional dyspepsia, hyperemic lesion in the stomach, dyspepsia score
46

Profil Pasien Penyakit Tiroid di Poliklinik Endokrin Metabolik Bagian / SMF Ilmu Penyakit
Dalam RSUP Prof.Dr.R.D Kandou Manado Periode Januari 2017 - Desember 2018
Crosby H, Pontoh V, Merung MA

Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia

Abstract: Thyroid disorders are the second most common endocrine disorders in the world after
diabetes. The most common thyroid disorders are goitre, Graves' disease, Hashimoto's
thyroiditis, and thyroid neoplasm. This study was aimed to determine the pattern of thyroid
disorder at Prof. Dr. R. D. Kandou Hospital Manado from January 2017 to December 2018. This
was a descriptive retrospective study. Data were obtained from Medical Rrecord Installation and
Departement of Pathology at Prof. Dr. RD Kandou Hospital Manado periods January 2017 to
December 2018. The results showed that of total 244 cases of thyroid disorders the highest
percentage was in the period January - December 2015 ias many as 132 cases (54.1%) consisted
of 196 (80.3%) females and 48 (19.7%) males. Most patients were in the age group 51-60 years
(24.2%) amd lived in mountainous area (66.7%). The most common pathological results were
benign colloid goitre (71.9%) and papillary carcinoma (62.7%). Since the incidence of thyroid
disorders continues to rise each year at Prof. Dr. R. D. Kandou Hospital Manado, prevention and
education to patients with thyroid disorders are needed to minimalize the complications of
thyroid disorders.
Keywords: thyroid disorder
53

Skrining Diabetes Gestasional di Puskesmas

Aim: Gestational Diabetes Mellitus (GDM) can threaten because it can cause some
complications in antenatal, intranatal, and postnatal. GDM can threaten the baby's condition even
cause death. Antenatal care to pregnant women in Indonesia only focused on hypertension and
anemia. Early detection (screening) for the diagnosis of gestational diabetes in pregnant women
has not done thoroughly. The aimed of this study was to determine the prevalence of GDM and
risk factors that influence (age, family history of diabetes and BMI) in Puskesmas
Methods: This study is a quantitative research with cross sectional approach. The sampling
method used a non-probability sampling with purposive sampling technique were 18 respondents
to the inclusion criteria, namely pregnant women with gestational age of 24-28 weeks during the
study period and are willing to become respondents. Furthermore, the data were analyzed using
univariate analysis using computer applications to statistics and bivariate analysis using Pearson
correlation test.
Results: The prevalence of gestational diabetes incidence in Puskesmas 2016 as much as 5.6%.
There is significant correlation between age and the incidence of gestational diabetes mellitus (p
value ≤0,05 ie, 0.02), there was a significant association between a family history of diabetes in
the incidence of gestational diabetes mellitus (p value ≤0,05 ie 0,002), there is no relationship
significant between BMI with the incidence of gestational diabetes mellitus (p value> 0.05 ie
0.387).
Conclusion: The screening of GDM in pregnant women early on can be one way to improve
maternal health, especially in pregnancy and prevent complications that can occur in their babies.

Keywords: GDM, screening, age, family history of diabetes, BMI

54
Association of Hypertension with Depression and Anxiety in Primary Hypertensive Subjects

BACKGROUND:

Psychosocial stress can be the cause or the consequence of hypertension.

OBJECTIVE:

To study the association between hypertension and anxiety or depression in adults

SUBJECTS AND METHODS:

Patients with diagnosed hypertension (n=197) were recruited to complete the Hospital Anxiety and
Depression Scale (HADS) questionnaire. The control group comprised 182 normotensive subjects
recruited using random sampling

RESULTS:

The score in the anxiety subscale (HADS-A) of the HADS correlated with age (r= −0.23, P<0.001) and
sex (r=0.11, P=0.042), and was found to be higher in women. The score in the depression subscale
(HADS-D) correlated with age (r=0.17, P=0.003) and hypertension (r=0.12, P=0.039), but not with sex
(r=0.02, P=0.68). When the control subjects were matched for sex and age with the subjects with
hypertension, the mean HADS-A score was 5.51±0.41 in 113 hypertensive subjects and 4.38±0.39 in 113
normotensive subjects (P=0.047). The mean HADS-D score was 5.56±0.39 in the hypertensive and
4.76±0.32 in the normotensive subjects (P=0.11). Multiple regression analysis using data from both
groups indicated that the HADS-A score was related to the HADS-D score (β=0.49, P<0.001), age (β=
−0.25, P<0.001) and sex (β=0.12, P=0.01) (R2=0.28), whereas the HADS-D score was related to the
HADS-A score (β=0.48, P<0.001), age (β=0.30, P<0.001), positive smoking status (β=0.13, P=0.004) and
lack of exercise habit (β=0.12, P=0.008) (R2=0.31). Hypertension was related to waist circumference,
history of parental hypertension and age (R2=0.38, P<0.001).

CONCLUSIONS:

Hypertension was associated with anxiety but not depression; however, age, history of parental
hypertension and central obesity appeared to have a stronger association with hypertension in adults

Keywords: Anxiety, Blood pressure, Depression, Hypertension, Questionnaire

55
Leptin is not associated with maternal fat mass on the third trimester of pregnancy
Langi YA, Hatta M, Bakri S, As’ad S, Tahir M

Department of Internal Medicine Faculty of Medicine, Sam Ratulangi University Manado, Indonesia
Molecular Biology and Immunology Laboratory, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Obstetric and Gynecologic, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Leptin was initial known as adipocyte product link to the obese gene. Pregnancy is a physiologic
leptin resistance state. The placenta is reported to synthesize and release leptin too. This study is
to observe the association between maternal serum leptin with maternal body fat mass on the
third trimester of pregnancy. Leptin was measured by ELISA from the serum of maternal on
median pregnancy age 30 weeks. Maternal body fat mass was measured by bioelectrical
impedance analyzing (BIA) methods.-295 The mean of maternal fat mass is, M= 20,1 kg, SD=
5,2, minimum 10,6 kg and maximum 35,3 kg. Leptin, M= 46,9 µgr/L, SD= 32,6, minimum 5,8
µgr/L and maximum 146,7 µgr/L. Univariate analysis showed, in third trimester of pregnancy,
maternal serum leptin could not predict the maternal fat mass appropriately, SS 14,007, MS 4,67,
F (3, 66) = 0,17, p 0,92, partial η 2 0,01. This current study shows, leptin level is higher during
the third trimester of pregnancy and not associate with maternal fat mass. In the third trimester of
pregnancy, maternal serum leptin could not precisely predict the maternal fat mass.
65
Hubungan Kadar Serum Albumin dengan Ketebalan Tunika Intima Media Arteri Karotis pada
Pasien Penyakit Ginjal Kronik yang Menjalani Hemodialsis Rutin.
Puguh K. Sandjojo, Palar S, Wantania F
Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia

Latar belakang :. Meningkatnya angka kejadian kardiovaskular masih menjadi penyebab utama mortalitas
pada subjek Penyakit Ginjal Kronik (PGK)-dialisis yang disebabkan oleh penurunan sintesis albumin yang
merupakan marker inflamasi. Ketebalan tunika intima media arteri karotis (KTIMAK) merupakan indikator
suatu proses aterosklerosis karotid yang juga merupakan penyakit inflamasi kronis. Tujuan penelitian ini
untuk meneliti hubungan kadar serum albumin dengan KTIMAK pada subjek PGK yang menjalani
hemodialisis rutin.
Metode : Penelitian ini menggunakan rancangan studi potong lintang. Sebanyak 38 pasien yang memenuhi
kriteria, dilakukan anamnesis, pemeriksaan fisik dan pemeriksaan laboratorium untuk menghitung kadar
serum albumin, kemudian dilakukan pemeriksaan Ekokardiografi Doppler pada arteri karotis untuk
mengukur KTIMAK. Analisis statistik menggunakan uji korelasi Pearson.
Hasil : Terdapat hubungan tidak bermakna antara kadar serum albumin dan KTIMAK pada subjek PGK yang
menjalani dialisis rutin minimal 2 tahun (p = 0,062).
Diskusi : Terdapat hubungan tidak bermakna antara kadar serum albumin dan KTIMAK pada subjek PGK
yang menjalani dialisis rutin minimal 2 tahun. Hasil ini disebabkan bahwa pada penelitian ini sampel
mendapat asupan nutrisi yang cukup. George Kaysen dkk melaporkan bahwa asupan protein adekuat pada
subjek PGK yang menjalani hemodialisis sangat penting untuk dalam mengatasi proses inflamasi pada PGK.
Penelitian lain oleh Janeen Leon dkkmelaporkan bahwa pemberian nutrisi adekuat pada subjek PGK yang
menjalani HD dapat meningkatkan dan menjaga kadar serum albumin. Penelitian lain oleh Kamyar Kalantar-
Zadeh dkk mendapat kesimpulan bahwa memberikan makanan atau suplemen nutrisi oral kepada subjek
PGK sangat dianjurkan untuk menjaga dan meningkatkan kadar serum albumin.
62
Malaria. Tatalaksana Klinis dan Terapi. Edisi III.

Malaria merupakan salah satu masalah kesehatan masyarakat yang dapat menyebabkan kematian
terutama pada kelompok risiko tinggi yaitu bayi, anak balita, ibu hamil, selain itu malaria secara
langsung menyebabkan anemia dan dapat menurunkan produktivitas kerja. Penyakit ini juga masih
endemis di sebagian besar wilayah Indonesia. Dalam rangka pengendalian penyakit malaria banyak hal
yang sudah maupun sedang dilakukan baik dalam skala global maupun nasional. Malaria merupakan
salah satu indikator dari target Pembangunan Milenium (MDGs), dimana ditargetkan untuk
menghentikan penyebaran dan mengurangi kejadian insiden malaria pada tahun 2015 yang dilihat dari
indikator menurunnya angka kesakitan dan angka kematian akibat malaria. Global Malaria Programme
(GMP) menyatakan bahwa malaria merupakan penyakit yang harus terus menerus dilakukan
pengamatan, monitoring dan evaluasi, serta diperlukan formulasi kebijakan dan strategi yang tepat. Di
dalam GMP ditargetkan 80% penduduk terlindungi dan penderita mendapat pengobatan Arthemisinin
based Combination Therapy (ACT). Dan melalui Roll Back Malaria Partnership ditekankan kembali
dukungan tersebut. Karena pentingnya penanggulangan Malaria, maka beberapa partner internasional
salah satunya Global Fund, memberikan bantuan untuk pengendalian malaria. Dalam pengendalian
malaria, yang ditargetkan penurunan angka kesakitannya dari 2 menjadi 1 per 1.000 penduduk. Program
eliminasi malaria di Indonesia tertuang dalam keputusan Menteri Kesehatan RI No 293/MENKES/SK/
IV/2009. Pelaksanaan pengendalian malaria menuju eliminasi dilakukan secara bertahap dari satu pulau
atau beberapa pulau sampai seluruh pulau tercakup guna terwujudnya masyarakat yang hidup sehat
yang terbebas dari penularan malaria sampai tahun 2030. Status Indonesia masih tahap pertama yaitu
pada eliminasi malaria di DKI, Bali dan Barelang Binkar pada tahun 2010. Untuk melihat sejauh mana
perkembangan pengendalian penyakit malaria pada tulisan ini akan dibahas situasi epidemiologi dan
upaya/program pengendalian malaria di Indonesia yang dilihat dari hasil survei dan laporan program
malaria
74

Cancer Anorexia Cachexia Syndrome In Patients With Carcinoma at Prof. DR. R. D. Kandou
Hospital Manado
Muliawati Y1, Haroen H, Rotty LW.
Department of Internal Medicine Faculty of Medicine, Sam Ratulangi University Manado, Indonesia

Abstract : Cancer anorexia-cachexia syndrome (CACS) is a devastating and debilitating

aspect at any stage of malignancy. It presents primarily as anorexia, weight loss and muscle
wasting secondary to inadequate oral intake and metabolic changes. This syndrome is highly
prevalent among cancer patients, has a large impact on morbidity and mortality, and impinges on
patient quality of life. The pathogenic mechanisms of CACS are multifactorial. It is suggested to
be the result of tumor-host interactions and cytokines have a siginificant role. Diagnosis of
cancer cachexia is complex and multifaceted and requires meticulous clinical examination of the
patient. The challenge for clinicians is to know how best to manage the symptoms of weight loss
and anorexia for optimal patient outcome. This article outlines the diagnosis of cancer cachexia,
reviews its impact on patient quality of life and survival, and updates the reader on potential
therapies that may suppress it.
102

Risk Factors related to methicillin-resistant Staphylococcus aureus infection among inpatients at

Prof. dr. R. D. Kandou general hospital Manado.
H T Utomo1, A Nugroho1 and P N Harijanto1
Department of Internal Medicine Faculty of Medicine, Sam Ratulangi University Manado, Indonesia

Abstract : Methicillin-resistant Staphylococcus aureus (MRSA) presents nosocomial infection

problemsin hospitals. Identification of risk factors related to MRSA infection is a concern among
healthcare provider. A retrospective case-control study was conducted to identify MRSA
infection proportion among isolates, also to identify risk factors amonginpatients at Prof. dr.R. D.
Kandou General Hospital, Manado. Data were from themedical record, from patient's culture
isolateswith positive Staphylococcus aureus infection from January-December 2015. Case
subject isolated cultures of MRSA and control subject isolated cultures of non-MRSA. Bivariate
analysis were performed in 10 independent variables (age, length of stay, prior use of antibiotics
before cultures, history of HIV infection, prior use of corticosteroid, history of malignancy,
history of chronic disease, prior use of medical tools (catheter, ventilator, etc), history of invasive
medical procedure, history of hospitalization before). All variables with a p-value<0.05 were into
multivariate analysis with forwarding stepwise logistic regression. Mean subjects age were 48.13
± 2.05 years old and length of stay were 8.65 ± 0.25 days, and only prior antibiotic use-variable
were considered statistically significant (p = 0.017; OR 1.889; 95%CI 1.595 – 2.238).
106

Correlation between HbA1C with Lipid Profile on Patients Diabetes Melitus Type 2 in RSUP
Prof. dr. R. D. Kandou Manado
Glorya Stevani Cicilia Loei, Karel Pandelaki, Veny Mandang
Department of Internal Medicine Faculty of Medicine, Sam Ratulangi University Manado, Indonesia

Abstract: Diabetes mellitus now really been treading worldwide era, and became the world's
health problems. The main findings the study of diabetes by the Diabetes Control and
Complications Trial (DCCT) has showed the importance of HbA1c. The study showed that
reduce unemployment HbA1c can delay or prevent chronic complications.
Purpose of this research is to know is there any relationship between HbA1c levels with the
levels of lipid profile in type 2 DM patients.
Method used in this study is a retrospective observational analytic by approach cross sectional
using secondary data. The total sample of 36 patients seeking treatment at the Polyclinic
Endocrine and Metabolic RSUP Prof. Dr. R. D. Kandou in Manado the period November 2012 -
November 2013.
Results of the analysis using Chi Square test shows that there are positive correlation between
HbA1c levels with the levels of total cholesterol, LDL, HDL and Triglyceride levels but
statistically not significant. Seeing the results, patients with type 2 diabetes have to do with good
glycemic control. In order for the complications that occur can be prevented.
Keywords: Type 2 Diabetes Mellitus, HbA1c, Lipid Profile
118
Association Between CD8 T-Cell Subsets and CD4/CD8 Ratio with HS-CRP Level in HIV
Infected Patients on Antiretroviral Therapy
S Isabela, A Nugroho and P N Harijanto
Department of Internal Medicine Faculty of Medicine, Sam Ratulangi University Manado, Indonesia

Due to improved access and adherence to antiretroviral therapy (ART), most HIV-infected
persons worldwide are predicted to live longer. Nowadays the cause of death for most HIV-
infected persons has changed to serious non-AIDS events (SNAEs) which is due to low-grade
viremia. HIV patients with ART who had undergone CD4 cell count above 500/uL and there is
an increase in hs-CRP despite an undetectable viral load. Some conditions CD8 cells count do
not decrease with CD4 cells repairs. We researched in Prof Kandou General Hospital with a total
sample of 35 HIV patients who had received ART with the level of CD4>350/uL. CD8 levels,
CD4/CD8 ratio, and hs-CRP were assessed. This research is analytic descriptive with cross-
sectional study design and analysis uses Spearman correlation. The mean CD8 during the study
was 1291.8 (IQR 319-2610cells/uL), the mean ratio of CD4:CD8 was 0.57 (IQR 0.16-1.24) and
median hs-CRP is 2.18 (IQR 0.3-6.6mg/dL). There was a significant positive correlation between
CD8 and increased hs-CRP (r=0.369, p<0.05). There was a negative correlation between
CD4/CD8 ratio and hs-CRP (r=-0.370, p<0.05).
122

Seorang Pasien dengan Infeksi Dengue dengan Manifestasi Expanded Dengue Syndrome
J. Niky, A. Nugroho

Divisi Tropik Infeksi, Bagian Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Sam Ratulangi Manado

Latar Belakang
 Infeksi Dengue → virus Dengue genus Flavivirus → transmisi oleh nyamuk Aedes Aegypti.
 Epidemiologi → hampir seluruh negara tropis dan subtropis.
 Manifestasi klinis yang tidak biasanya dari Dengue Fever (DF) → keterlibatan gangguan
organ yang berat → hati, ginjal, otak dan jantung & berkaitan dengan infeksi Dengue
Haemoraghic Fever (DHF) & tidak memiliki insidensi kejadian kebocoran plasma.
 Expanded Dengue Syndrome (EDS) → istilah yang ditambahkan oleh WHO sebagai
klasifikasi penyakit dengan manifestasi tersebut.

Kasus
 Tn.MR,25 tahun MRS 3 februari 2018 pukul 13.30 WITA → keluhan demam.
 Dari anamnesis → demam 1 hari, mual, muntah, nyeri kepala & kepala pusing.
 Dari Pemeriksaan Fisik → TTV dalam batas normal.
 Dari Pemeriksaan Penunjang →Hb 15,9 gr/dl, Ht 45 vol%,leuko 5.600/uL,trombo 12.000/uL,ureum
74 mg/dL,kreatinin 1,8 mg/dL,SGOT 79 u/L,SGPT 106 u/L,NS1 negatif,malaria (-), IgG anti
dengue (+), IgM anti dengue (-).
 Pasien didiagnosis dengan Demam Dengue & komplikasi Expanded Dengue Syndrome.
 Pasien dirawat di RS selama 9 hari & sempat menjalani perawatan di ICU karena sesak nafas dan
penurunan kesadaran.
 Pasien rawat jalan & kontrol ke poliklinik untuk evaluasi jantung karena kecurigaan cardiomyopaty
viral
 Manifestasi klinis organ yang terkena → encephalopaty, suspek miokarditis, edema paru &
ARDS, gagal ginjal akut, hepatitis.
 Penatalaksaaan → terapi cairan,terapi oksigen, penggunaan ventilator untuk gagal nafas & terapi
nutrisi.

Kesimpulan
Dilaporkan kasus seorang laki-laki 25 tahun dengan infeksi Demam Dengue dengan komplikasi
Expanded Dengue Syndrome. Diagnosis ditegakkan berdasarkan anamnesis, pemeriksaan fisik dan
pemeriksaan penunjang. Pasien diberikan terapi suportif. Prognosis pasien dubia.