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    Evaluasi Pasien Praoperasi Transplantasi Hati Anak di RSUPN dr. Cipto Mangunkusumo

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     Terapi definitif pasien gagal hati tahap akhir adalah transplantasi hati. Kondisi praoperasi transplantasi hatimembutuhkan penanganan multidisiplin untuk mencegah mortalitas dan optimalisasi kondisi pasien. Penelitian inibertujuan untuk mengetahui derajat keparahan penyakit hati, morbiditas, dan mortalitas pasien anak dengan gagalhati yang akan dilakukan operasi transplantasi hati di RSCM. Penelitian deskriptif retrospektif ini dilakukan padapasien sirosis hati anak yang berobat ke RSCM pada tahun Januari 2011 hingga Desember 2017. Sumber databerasal dari rekam medik pasien dan wawancara keluarga pasien melalui telepon. Variabel yang dinilai adalah datademografi, status nutrisi, indikasi transplantasi hati, skor Pediatric End-stage Liver Disease (PELD), skor Laennec,dan luaran pasien sebelum operasi. Diperoleh 108 subjek dengan usia termuda 1 bulan, usia tertua 14 tahun, dannilai tengah 9 bulan. Usia terbanyak berusia 7-12 bulan sebanyak 46 pasien (46,2%). Dari 57 pasien (52,8%) yangmemiliki data status gizi, didapatkan 29 pasien (50,9%) merupakan gizi buruk, 9 pasien (15,8%) gizi kurang, dan 19pasien (33,3%) gizi baik. Atresia bilier merupakan diagnosis terbanyak meliputi 83 pasien (76,9%). Data skor PELDdari 82 pasien (75,9%), nilai tengahnya 17 dengan nilai terendah 1 dan tertinggi 40. Data skor Laennec dari 71 pasien(65,7%) didapatkan derajat kerusakan terbanyak adalah Laennec 4, yaitu 61 pasien (85,9%). Sebanyak 36 pasienanak dengan gagal hati (33,3%) masuk ke dalam daftar tunggu transplantasi hati. Sebagian besar pasien datangdengan kondisi gizi buruk, skor PELD, skor Laennec yang tinggi, dan mortalitas sebelum transplantasi hati 42,6%. Kata kunci: evaluasi praoperasi, gagal hati anak, transplantasi hati.   Evaluation of Preoperative Pediatric Liver Transplantationin dr. Cipto Mangunkusumo Hospital Abstract The definitive treatment for end stage liver disease is liver transplantation. Preoperative conditions for livertransplantation require multidiciplinary management to prevent mortality and optimize the patient’s condition. Thepurpose of this study is to explore the severity of liver disease, morbidity, and mortality of pediatric patients with liverfailure that will undergo liver transplantation at RSCM. This descriptive retrospective study observed pediatric patientswith hepatic cirrhosis who were admitted in RSCM on January 2017 - December 2017. Data sources were collected frompatient’s medical record and direct interview with patient’s relatives. Demographic status, nutritional status, diagnosticindicated liver transplantation, PELD score, Laennec score, and patient outcome were evaluated. Subjects were 108patients, age ranging between 1 to 168 months old, with the median age of 9 months. From 57 patients (52.8%) whosenutritional status was evaluated, 29 patients (50.9%) had severe malnutrition, 9 patients (15.8%) had mild malnutrition,and 19 patients (33.3%) had good nutrition. The most commonly encountered cause of liver disease is biliary atresia,which comprised 83 patients (76.9%). From 71 patients (65.7%), the lowest PELD score is 1, whereas the highestscore is 40, with the median score 17. As for Laennac score, from 71 patients (65.7%), Laennec 4 is obtained from 61patients (85.9%). The outcome revealed 36 pediatric patients with liver disease (33.3%) enlisted as candidates for livertransplantation. Most patients presented with pre-existing severe malnutrition, high PELD and Laennec scores, and themortality rate before transplantation is 42.6%. Keywords: evaluation preoperative, liver failure in children, liver transplantation.&nbsp

    Personal Values of Being a Long-term Peer Health Educator Cadre for Elderly and Reproductive-age Women Communities: a Qualitative Study

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    Maintaining health cadres in a long term program is important as well as challenging. A collaboration ofuniversity, financial support institution (BTPN) and international NGO (Grand Aides) has developed five yearscommunity empowerment, named Daya Program to promote community health education. The program trainednew workforce of customer volunteers to perform peer health education for elderly and reproductive age womencommunities in nine cities across Indonesia in 2012-2017. This study aimed to evaluate personal value of layelderly and reproductive age women for being a long-term peer health educator cadre in Indonesiaand exploredhealth cadres’ perceived benefit, motivation and challenge. To this end, semi-structured focus group discussionwith twenty cadres and interview with nine area supervisors were conducted. Thematic analysis was employed toanalyse the data collected. Daya Program benefited not only to the community but also to cadres and their family.Beside promoting financial benefits, health cadres and their family perceived social incentives for their status of beingpeer health counsellor in the community such as pride and respects from their neighbourhood. Cadres’ skill inperforming some health screening like blood pressure check and self-breast examination were highly appreciatedby the communities. Cadres feel trusted and meaningful because client openly discuss sensitive health issues likebreast lump among them. Such incentives had been external drivers for the cadres to actively involve in the longtermprogram. Cadres emphasized perceived respect from the community as important reason, beside financialbenefit, that maintain their contribution in long-term. Therefore, these lessons might be important for communityhealth program drafter in designing long-term peer health development program. Keywords: personal value, health cadres, community empowerment program.   Persepsi Manfaat dan Motivasi Kader Penyuluh Kesehatan bagi KomunitasLansia dan Perempuan Usia Produktif:Sebuah Studi KualitatifAbstrakMenjaga motivasi kader kesehatan dalam pelaksanaan program pemberdayaan masyarakat jangkapanjang merupakan hal penting namun penuh tantangan. Kolaborasi universitas (Universitas Indonesia), bank(BTPN) dan lembaga internasional (Grand Aides) telah merintis program pemberdayaan masyarakat selamalima tahun bernama Program Daya yang berfokus kepada promosi kesehatan melalui edukasi kesehatankepada masyarakat. Program ini melatih sukarelawan nasabah bank untuk melakukan edukasi kesehatan bagikomunitas lansia dan wanita usia reproduksi di sembilan kota di Indonesia di periode 2012-2017. Studi inibertujuan untuk mengevaluasi persepsi manfaat dan motivasi pribadi kader perempuan lanjut usia dan usiaproduktif yang telah menjadi kader pendidik dalam program ini selama 5 tahun. Studi ini menggali persepsiakan manfaat yang didapat, motivasi, dan tantangan yang mereka hadapi. Oleh karena itu, dilakukan diskusikelompok terarah semi-terstruktur kepada dua puluh kader dan wawancara dengan sembilan supervisorpelaksana di masing-masing. Analisis tematik digunakan untuk menganalisis topik-topik yang dikumpulkan.Selain mendapatkan manfaat finansial, kader kesehatan merasakan manfaat sosial karena meningkatkan statussosial dan apresiasi dari masyarakat sekitar lingkungan mereka tinggal dan hal itu menjadi kebanggaan bagimereka, Keahlian kader dalam melakukan pemeriksaan kesehatan seperti pemeriksaan tekanan darah danpemeriksaan payudara sendiri sangat dihargai oleh masyarakat. Kader merasa dipercaya karena klien secaraterbuka mendiskusikan masalah kesehatan sensitif yang mereka alami seperti benjolan payudara. Hal tersebutlahyang terutama menjadi pendorong eksternal bagi kader untuk terlibat aktif dalam program jangka panjang selainmanfaat finansial. Oleh karena itu, pembelajaran ini penting bagi penyusun program pemberdayaan masyarakatdalam merancang program jangka panjang khususnya dalam hal edukasi kesehatan. Kata kunci: manfaat dan motivasi, kader kesehatan, program pemberdayaan masyarakat

    The Impact of Globalization on Medical Students’ Identity Formation

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    Globalization on medical education and health care allows medical students, medical trainees and medical doctors to study and work in different countries with various cultural contexts. Despite understanding that this is inevitable nowadays, it introduces certain challenges in medical education especially in preparing medical students and medical trainees who are prepared to socialize and interact with different culture. The process will be facilitated by solid professional identity formation as part of professional development of medical students and trainees who are becoming future medical doctors. This literature review aims to explore personal and professional identity formation and how medical education may support medical students to be culturally aware and competent in facing changing and dynamic world.&nbsp

    Efek Pemberian Tepung Kedelai terhadap Gambaran Histopatologi Ginjal Tikus Wistar yang Diinduksi Diazinon

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    Kacang kedelai (Glycine max L. Merr) memiliki kemampuan untuk mencegah terjadinya kerusakanginjal akibat keracunan diazinon karena mengandung tannin, proanthocyanidin, dan isoflavonoid. Tujuanpenelitian ini untuk membuktikan efek pemberian tepung kedelai sebagai nefroprotektor terhadap tikus yangdiinduksi diazinon. Penelitian dilakukan di Laboratorium Fisiologi dan Farmakologi Fakultas KedokteranUniversitas Jember, pada bulan Oktober-Desember 2017. Sebanyak 25 tikus wistar jantan usia 12-15 minggudiacak dan dibagi menjadi 5 kelompok, kelompok kontrol normal (K1) yang diberikan normal salin selama28 hari, kelompok kontrol negatif (K2) yang diberikan normal salin 28 hari dan diazinon selama 5 hari.Kelompok perlakuan yang diberikan larutan tepung kedelai dengan dosis masing-masing (K3) 1 g/10mL,(K4) 1,5 g/10mL, dan (K5) 2 g/10mL selama 28 hari, dilanjutkan diazinon 40 mg/kgBB selama 5 hari. Tikusdisakrifasi menggunakan eter kemudian diambil organ ginjal dan dibuat preparat histopatologi yang diwarnaiHematoksilin-Eosin. Pengamatan berat ringan kerusakan ginjal dinilai berdasarkan skoring yang dikonversimenjadi data interval menggunakan method of successive interval (MSI). Kelompok K1 memiliki rata-rataskor histopatologi terendah yaitu 2,427±0,191, sedangkan rata-rata skor histopatologi tertinggi di kelompokK2 4,272±0,221. Kelompok perlakuan dengan rata-rata skor histopatologi terendah berada pada kelompokK5 yaitu 2,875±0,211. Terdapat perbedaan signifikan terhadap rata-rata skor histopatologi ginjal tikusantarkelompok (Tukey HSD, p<0,05). Penelitian ini menunjukkan bahwa pemberian tepung kedelai dapatmemberikan efek proteksi terhadap toksisitas diazinon yang dikonfirmasi melalui pemeriksaan histopatologi. Kata kunci: tepung kedelai, diazinon, tikus wistar, kerusakan ginjal.   The Effect of Soybean Flour Administration to Renal Histopathology of Diazinon-Induced Wistar Rats Abstract Soybean (Glycine max L. Merr) has the ability to prevent renal injury due to diazinon intoxicationwhich contains tannin, proanthocyanidin, and isoflavonoid. This study was intended to prove the effect ofsoybean flour administration as nephroprotective agent on diazinon induced rats. This study was conductedat Physiology and Pharmacology Laboratory, Faculty of Medicine Universitas Jember on October-December2017. A total of 25 male wistar rats, aged 12 – 15 months were randomized and divided into 5 groups, normalcontrol group (C1) which was given normal saline solution for 28 days, negative control group (C2) which wasgiven diazinon for 5 days and normal saline solution for 28 days. The treated group was given soybean floursolution with 3 different dosages, 1g/10 ml (C3), 1.5 g/10 ml (C4), and 2g/10 ml (C5) for 28 days, continuedwith diazinon administration of 40 mg/kg for 5 days. Rats euthanasia were done using ether, followed bykidney extraction and its histopathology preparation stained by Hematoxylin Eosin. The observation ofrenal injury severity was assessed by a scoring converted into interval data by using method of successiveinternal (MSI). C1 group had the lowest mean histopathology score 2.427±0.191 whereas the highest meanhistopathology score was on group C2 4.272±0.221. The treated group with the lowest mean histopathologyscore was on group C5 2.875±0.211. There was a significant difference of mean kidney histopathologicalscores between groups (Turkey HSD, p<0.05). This study shows that administration of soybean flour can havea nephroprotective effect from diazinon toxicity which is confirmed by histopathologic examination. Keywords: soybean flour, diazinon, wistar rats, renal injury

    Pengaruh Latihan Fisik Intensitas Sedang terhadap Jumlah Reseptor Insulin di Jaringan Lemak Tikus Jantan Obesitas

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    Obesitas adalah kondisi abnormal yaitu akumulasi lemak berlebih yang mengakibatkan inflamasi kronikdan menyebabkan resistensi insulin. Latihan fisik dapat memperbaiki resistensi insulin. Tujuan penelitianini adalah untuk mengetahui peningkatan jumlah reseptor insulin dengan latihan fisik intensitas sedang.Penelitian menggunakan desain eksperimental murni dengan rancangan post-test only control group design.Penelitian ini dilaksanakan di Laboratorium Biomedik Terpadu, Fakultas Kedokteran Univesitas Udayanapada periode bulan Januari – Juni 2018. Subjek penelitian adalah 36 ekor tikus putih (Rattus norvegicus)jantan, sehat, umur 4-5 bulan, obesitas (IMT >0,68) yang dibagi menjadi dua kelompok masing-masing 18ekor tikus, yaitu kelompok kontrol tikus jantan obesitas tanpa perlakuan (P0) dan kelompok perlakuan tikusjantan obesitas yang diberi latihan fisik intensitas sedang dengan metode renang selama 20 menit/hari, 5 hari/minggu selama 2 minggu (P1). Pemeriksaan jumlah reseptor insulin alfa menggunakan pewarnaan immunehistokimia(IHC) terhadap antibody poliklonal. Metode interpretasi jumlah reseptor insulin alfa yang tepat padahasil pewarnaan IHC menggunakan program “region of interest” pada software NIS Image Viewer versi 3.1®.Hasil penelitian menunjukkan rerata jumlah reseptor insulin sesudah 2 minggu pada kelompok P0 adalah12,28±4,89% dan pada kelompok P1 adalah 17,51±7,57% (p<0,05). Disimpulkan latihan fisik intensitassedang dapat meningkatkan jumlah reseptor insulin pada jaringan lemak tikus jantan dengan obesitas. Kata kunci: latihan fisik, obesitas, reseptor insulin, jaringan lemak.   The Influence of Moderate Intensity Exercise to The Level of InsulinReceptors on Adipose Tissue of Obese Male Rats Abstract Obesity is an abnormal condition of excessive lipid accumulation which may cause chronic inflammationand insulin resistance. Physical exercise is able to reduce insulin resistance. This study was aimed to observe theincrease of total insulin receptors after moderate intensity exercise. This was an experimental study with post-testonly control group design. This study was conducted at Biomedical Laboratory, Faculty of Medicine UniversitasUdayana on January – June 2018. Subjects were 36 obese (BMI>0.68) healthy white male rats (Rattus novergicus)aged 4 – 5 months which were divided into two groups consisting of 18 rats on each group with (P1) or without(P0) intervention (moderate intensity exercise 20 minutes/day, 5 times a week for 2 weeks). The calculation oftotal insulin receptor alpha was done using immunohistochemistry staining (IHC) against polyclonal antibody. Theproper interpretation of total insulin receptors alpha on IHC was conducted using “region of interest” program byNIS Image Viewer version 3.1® software. This study showed the mean total insulin receptor after 2 weeks on groupP0 was 12.28±4.89% and on group P1 was 17.51±7.57% (p<0.05). It can be concluded that moderate intensityexercise can increase total insulin receptors on adipose tissue of obese male rats. Keywords: exercise, obesity, insulin receptors, adipose tissue

    Effect of Hypobaric Hypoxia Induction on Cognitive Function and Glutamate Receptor in Sprague-Dawley Rats

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    Induction of sublethal hypoxia provides neuroprotective effect pathological processes such as myocardial infarc and stroke. This study aimed to know the effect of intermittent hypobaric hypoxia (IHH) induction on cognitive function and glutamate receptor in the rat brain. The study was conducted at dr. Saryanto Institute for Aviation and Aerospace Health (LAKESPRA) from 2015-2016. 25 sprague dawley rats, divided into 4 IHH treatment groups and 1 control group. Group 1 was induced with 1x IHH exposure, group 2 was induced with 2x IHH exposure, group 3 was induced with 3x IHH exposure and group 4 was induced with 4x IHH exposure (days 1, 8, 15 and 22). After induction, cognitive function tests are performed with Y Maze and immunohistochemistry is performed to evaluate the glutamate receptor N-methyl-D-aspartic acid (NMDA). There were no significant differences between the four treatment groups compared with the control group (p>0.05) on cognitif function, but significant difference in NMDA receptor. In conclution, HHI induction was not cause change cognitive fuction but increased the response of neuroplasticity of sprague-dawley rats brain tissue which assessed from increasing NMDA receptor.&nbsp

    Uji Kepekaan Bakteri Asam Laktat Kandidat Probiotik terhadap Antibiotik Kanamisin, Oleandomisin, dan Polimiksin B

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    Bakteri probiotik utama adalah strain yang berasal dari genera Lactobacillus dan Bifidobacterium.Bakteri asam laktat (BAL) sensitif terhadap antibiotik beta laktam, kecuali penisilin. Beberapa BAL sepertiLactobacillus dan Lactococcus resisten terhadap tetrasiklin dan eritromisin. Tujuan penelitian ini adalahmengetahui kepekaan bakteri asam laktat kandidat probiotik terhadap antibiotik kanamisin, oleandomisin,dan polimiksin B. Penelitian dilakukan di Bagian Mikrobiologi Klinik, Balai Besar Laboratorium Kesehatan(BBLK) Sulawesi Selatan, pada bulan Mei-September 2017. Isolat bakteri berasal dari hasil isolasi pisangkemudian dilakukan uji sensitivitas dan resistensi bakteri terhadap antibiotik kanamisin, oleandomisin, danpolimiksin menggunakan VITEK 2 Compact biomereux clinical diagnostics (USA). Hasil uji resistensi daritujuh sampel isolat bakteri asam laktat (BAL) kandidat probiotik menunjukkan tingkat sensitivitas paling tinggiterhadap antibiotik kanamisin dan oleandomisin terdapat pada tiga isolat yaitu 1C,1E, dan 5D; hanya satubakteri yang sensitif pada polimiksin B yaitu isolat 5D. Isolat bakteri asam laktat dari hasil isolasi pisang dapatdiuji lebih lanjut sebagai kandidat probiotik. Kata kunci: sensitivitas, resistensi, kanamisin, oleandomisin, polimiksin B.   Sensitivity and Resistance of Antibiotic Kanamycin, Oleandomycin andPolymyxin B on Lactid Acid Bacteria as Probiotic Candidate Abstract Probiotics are living microorganisms which, in sufficient quantities, could affect their hosts to be healthier.The main probiotic bacteria are strains originating from the genera Lactobacillus and Bifidobacterium. Thepurpose of this study was to determine the sensitivity of candidate probiotic lactic acid bacteria to kanamycin,oleandomicin, and polymixin B. Bacterial isolates originated from banana and the sensitivity and resistanceof these bacteria were then tested to kanamycin, oleandimycin, and polymyxin B antibiotics using VITEK 2Compact biomereux clinical diagnostics (USA). The resistance test results from seven samples of lactic acidbacteria isolates of probiotic candidates showed the highest level of sensitivity to kanamycin and oleandomisinantibiotics found in three isolates namely 1C, 1E, and 5D; only one bacterium that was sensitive to polymyxinB is the 5D isolate. Isolates of lactic acid bacteria can be further tested as probiotic candidates. Keywords: sensitivity, resistance, kanamycin, oleandomycin, polymyxin B.&nbsp

    Peran Ekstrak Sargassum duplicatum terhadap Penurunan Edema Sendi Pergelangan Kaki Tikus dengan Artritis Ajuvan yang Terpajan Stresor Dingin

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    Stresor dingin meningkatkan proses peradangan karena peningkatan produksi reactive oxygen species (ROS). Sargassum duplicatum mengandung antioksidan seperti polifenol (flavonoid dan florotanin) dan fukosantin. Tujuan penelitian ini mengetahui peran ekstrak S.duplicatum (ESD) dalam mengurangi edema dan menghambat ekpresi MMP-3 di sendi pergelangan kaki tikus dengan artritis ajuvan (AA) yang terpajan stresor dingin. Penelitian dilakukan pada bulan Januari - Februari tahun 2017 di Laboratorium Biokimia unit hewan coba Fakultas Matematika dan Ilmu Pengetahuan Alam Universitas Brawijaya, Malang. Digunakan 30 tikus AA jantan usia 10-12 minggu yang dibagi menjadi tiga kelompok, yaitu kelompok yang tidak mendapat perlakuan, kelompok yang dipajankan stresor dingin, dan kelompok yang diberi ekstrak ESD 400 mg/kg BB/hari per oral selama 21 hari serta dipajankan stresor dingin. Tebal sendi pergelangan kaki tikus diukur dengan kaliper dan ekspresi MMP-3 dengan metode imunohistokimia. Hasil uji anova menunjukkan kelompok tikus yang mendapatkan stresor dingin mengalami ketebalan sendi yang berbeda bermakna dengan kelompok tikus tanpa perlakuan (p=0,042) dan pemberian S. duplicatum menurunkan edema kaki tikus (p=0,001) secara bermakna jika dibandingkan kelompok yang hanya mendapat stresor dingin. S. duplicatum menurunkan secara bermakna jumlah sel yang mengekspresi MMP-3 di sendi pergelangan kaki tikus yang mendapatkan stresor dingin (p=0,001). Stresor dingin dapat menimbulkan edema di pergelangan kaki tikus model AA dan pemberian ekstrak S. duplicatum menurunkan edema secara bermakna serta menghambat ekspresi MMP-3 pada tikus model AA Kata kunci: Sargassum duplicatum, artritis ajuvan, MMP-3, stresor dingin.   The Role of Sargassum duplicatum Extract to Inhibit Ankle Joint Edema in Adjuvant Arthritic Rat Exposed to Cold Stress   Abstract Cold stress increase inflammatory process caused by increasing reactive oxygen species (ROS) production. S. duplicatum contains antioxidants, e.g. polyphenols (flavonoids and phlorotannin). The aim of this research was to show the role of S. duplicatum extract (ESD) to decrease ankle joint edema and inhibit MMP-3 expression in adjuvant arthritic rats (AA) exposed to cold stress. This research was conducted on January - April 2017 in Experimental Animal Unit, Biochemistry Laboratory, Faculty of Mathematics and Science, Brawijaya University, Malang. Thirty male AA rats were used and divided into three groups, i.e group without treatment, group exposed to cold stress, and group that was given ESD 400 mg/kgbw/day per oral for 21 days and exposed to cold stress. The thick of rat’s ankle joint was measured by caliper and MMP-3 expression was measured by immunohistochemistry. The results of anova test showed that there was significant different the thick of rat’s ankle joint between group of rats received cold stress and group of rats without treatment (p=0,042), and giving S. duplicatum reduced rat’s ankle edema significantly (0,001) compared to group of rats that only exposed to cold stress. S. duplicatum reduced significantly the sum of cells that expressed MMP-3 in rat’s ankle joint exposed to cold stress (p=0,001). Cold stress caused rat’s ankle joint edema in rat AA model and S. duplicatum administration reduced edema and inhibited MMP-3 expression significantly in rat AA model. Keywords: Sargassum duplicatum, adjuvant arthritis, MMP-3, cold stress

    Food IgE-Sensitization in Respiratory Allergic Patients in Jakarta

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    Food allergy and respiratory allergy may co-exist in atopic person. Although both conditions can worsen allergic symptoms, food allergen sensitization has not gain much attention in clinical studies. The aim of this study is to evaluate food IgE sensitization in respiratory allergic patients. This was a cross-sectional study in patients with a history of respiratory allergy in Jakarta, on September to December 2016. Adult asthmatic patients aged 19-60 years were invited to undergo serum specific IgE testing at the Allergy and Immunology Clinic, Cipto Mangunkusumo Hospital, Jakarta. Patients were included if they showed at least one positive skin prick test with environmental allergens. Quantitative determination of specific IgE in serum was carried out by multiple allergosorbent test. Serum specific IgE levels of more than 0.35 kU/L or Class 1 was considered positive. A total of 100 subjects were eligible for analysis; 76% were women. Patients mean age was 38.8+12.1 (range 19-59) years old; 62% of the patients have both asthma and allergic rhinitis. There are 46% patients with at least one positive food-IgE sensitization. The most common sensitization was to shrimp (17%), followed by fruit-mix (14%), goat milk (13%), crab (13%), potato (13%), soybean (11%), and strawberry (11%). Significant difference of IgE sensitization was found between house dust mites and crab or shrimp and between cockroach and crab or shrimp. In conclusion food-IgE sensitization in respiratory allergic patients is common. The most common allergens were shrimp, fruit-mix, goat milk, crab, and potato.&nbsp

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