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All Journal Paediatrica Indonesiana Journal of Stem Cell Research and Tissue Engineering Narra J Acta Neurologica Indonesia
Ramli, Yetty
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Biochemistry, Genetics & Molecular Biology Engineering Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Veterinary

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The School Years Screening Test for Evaluation of Mental Status-Revised (SYSTEMS-R) as a cognitive function screening tool in children with epilepsy Urfianty, Urfianty; Pusponegoro, Hardiono Djuned; Alatas, Fatima Safira; Soebadi, Amanda; Ramli, Yetty
Paediatrica Indonesiana Vol. 64 No. 5 (2024): September 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.5.2024.377-83

Abstract

Background Children with epilepsy are at high risk of cognitive impairment that can affect quality of life. Intelligence quotient (IQ) measurement using the Wechsler Intelligence Scale for Children (WISC) is the gold standard test of cognitive function, but it is time-consuming and costly. The School Years Screening Test for Evaluation of Mental Status-Revised (SYSTEMS-R) is a potential cognitive function screening tool that can be used in children with epilepsy. Objective To assess the performance of SYSTEMS-R as a cognitive function screening tool in children aged 6-15 years with epilepsy. Methods This cross-sectional diagnostic test study was conducted in children aged 6-15 years with epilepsy. All subjects were assessed using both SYSTEMS-R and WISC 4th edition. The sensitivity, specificity, positive and negative predictive value, likelihood ratios of the positive and negative tests, and accuracy of SYSTEMS-R was calculated, with WISC as the gold standard test. Results Based on the SYSTEMS-R, the prevalence of cognitive impairment in children aged 6-15 years with epilepsy in our population was 86.4%. With WISC as the gold SYSTEMS-R had 84% sensitivity, 91% specificity, 98% positive predictive value, and 47% negative predictive value. The likelihood ratio of a positive SYSTEMS-R test was 10.11 and the likelihood ratio of a negative test was 0.17. The overall accuracy of SYSTEMS-R to detect cognitive impairment was 85%. Conclusion SYSTEMS-R has good sensitivity and specificity to assess cognitive function in children 6-15 years with epilepsy. It can be considered for widespread use in the early detection of cognitive impairment in pediatric epilepsy patients aged 6-15 years.
Therapeutic potential of hUC-MSC secretome preconditioned with IFN-γ and/or TNF-α: An in vitro study on Alzheimer’s neuronal cell models Widaja, Edhijanto; Pawitan, Jeanne A.; Ramli, Yetty
Narra J Vol. 5 No. 2 (2025): August 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i2.2281

Abstract

Alzheimer's disease is a progressive neurodegenerative disease that is characterized by toxic Amyloid-β (Aβ) plaques and neurofibrillary tangles (NFTs). Treatment options include the use of human umbilical cord mesenchymal stem cell (hUC-MSC)-based therapy. Its secretome contains healing substances such as neprilysin (CD10), which breaks down Aβ42; anti-inflammatory cytokines, which lower inflammation; and growth factors, which promote neuronal regeneration. The aim of this study was to produce hUC-MSC secretomes preconditioned with tumor necrosis factor-alpha (TNF-α) and/or interferon-gamma (IFN-γ) to enhance the secretion of these healing substances. hUC-MSCs were sub-cultured in T-25 flasks at a seeding density of 5×10³ cells/cm² in 10 mL xeno-free medium. hUC-MSCs were preconditioned with TNF-α only, IFN-γ only, and a combination of TNF-α and IFN-γ. This study used 10 ng/mL TNF-α and 20 ng/mL IFN-γ. The secretome was harvested after 48 hours of preconditioning and then filtered through a 0.22 µm filter. In vitro tests were conducted to assess the effects of the secretome on neuronal survival using the neuroblastoma SH-SY5Y cell line. These cells were differentiated with retinoic acid (RA) and then exposed to Aβ42 to mimic Alzheimer's disease neurons. Secretome therapy was applied at concentrations of 5%, 10%, and 20% to evaluate neuroprotective effects. Four types of secretome were tested: unpreconditioned, TNF-α preconditioned, IFN-γ preconditioned, and a combination of TNF-α and IFN-γ. High levels of CD10 (neprilysin) expression were observed in hUC-MSCs treated with IFN-γ and TNF-α, although they did not release sufficient soluble neprilysin (sNEP). Viability results indicated that secretomes preconditioned with IFN-γ at 10% and 20% concentrations provided the highest increase in cell viability after 72 hours post-therapy. The combination of TNF-α and IFN-γ preconditioned secretome exhibited synergistic effects, particularly at 5% and 10% doses at 24- and 72-hours post-therapy. In conclusion, preconditioned hUC-MSC secretome represents a promising therapeutic approach for Alzheimer's disease, as it enhances neuronal cell viability and promotes neuronal regeneration. However, further studies are required to optimize sNEP release and maximize therapeutic efficacy in in vivo models.
Stem Cell from Human Exfoliated Deciduous Teeth (SHED) versus Human Umbilical Cord Blood Mononuclear Cells (cbMNC) Transplantation in Neural Damage Reduction in Rat Model of Cerebral Ischemia ramli, yetty
Journal of Stem Cell Research and Tissue Engineering Vol. 2 No. 2 (2018): JOURNAL OF STEM CELL RESEARCH AND TISSUE ENGINEERING
Publisher : Stem Cell Research and Development Center, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (239.648 KB) | DOI: 10.20473/jscrte.v2i2.11896

Abstract

Ischemic stroke is one of major cause of mortality and disability in Indonesia. Stem Cells are considered as a promising therapy for ischemic stroke. In this study, we compared therapeutic potency of Stem cell from human exfoliated deciduous teeth (SHED) and Human umbilical cord blood mononuclear cell (cbMNC) using rat models of ischemic stroke. Following middle cerebral artery occlusion (MCAO), twenty male wistar rats were divided into four groups : normal rats (n=5), rats undergone permanent MCAO (n=5) as the control (stroke) group, rats undergone permanent MCAO and SHED transplantation (n=5) and rats undergone permanent MCAO and cbMNC transplantation (n=5) as the treatment group. SHED transplantation was performed at the acute phase after MCAO by intravenous injection. Histopathological evaluation of the neuron death ratio with hematoxylin and eosin staining confirmed that there was no significant differences at comparative study of neuron death ratio in rats transplanted with SHED and rats transplanted with cbMNC (p=0,81). SHED and cbMNC transplantation at acute stroke showed reduction in the neuron death ratio in the brain of rat models with ischemic stroke, and may provide an opportunity for neuroprotection and neural regeneration after ischemic stroke.
Nosocomial COVID-19 Infection in Acute Neurological Diseases at the Indonesian National Referral Hospital Mesiano, Taufik; Tunjungsari, Dyah; Budikayanti, Astri; Ramli, Yetty
Acta Neurologica Indonesia Vol. 1 No. 01 (2023): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v1i01.6

Abstract

Introduction: Neurological diseases elevate the susceptibility to respiratory tract ailments. This study aims to evaluate the incidence of nosocomial coronavirus disease 2019 (COVID-19) among non-COVID neurology inpatients and identify associated risk factors. Objective: To assess nosocomial COVID-19 infection in non-COVID neurology inpatients and identify associated risk factors. Material and Methods: A prospective cohort study was conducted during the initial wave of the COVID-19 pandemic, encompassing all non-COVID neurology inpatients at Dr. Cipto Mangunkusumo Hospital from May to September 2020. Clinical data were collected, and bivariate and multivariate analyses were employed to examine risk factors. Result and Discussion: Among 308 subjects, 31 (10.6%) experienced nosocomial COVID-19 infection. Suspect cases constituted 77.4%, probable cases 16.1%, and confirmed cases 6%. Predominant neurological diseases included cerebrovascular disease (36.7%), CNS neoplasm (18.8%), and traumatic brain injury (15.6%). Comorbid diseases increased the infection risk by 6.53 times (95% CI 1.52-28.0), particularly non-CNS malignancy (12.37, 3.7-41.00), chronic pulmonary TB (12.29, 2.7-55.89), and hypertension (3.8, 1.3-11.4). Loss of consciousness and nasogastric tube (NGT) usage elevated the risk by 2.92 (1.37-6.21) and 4.68 (1.95-11.24) times. This study reinforces existing evidence that hospitalized patients with neurological diseases are more susceptible to COVID-19, particularly due to loss of consciousness and NGT usage. The risk is amplified with comorbidities such as non-CNS malignancy, chronic pulmonary TB, and hypertension. Conclusion: Individual neurological diseases alone did not heighten the risk of COVID-19 infection. Notably, factors like loss of consciousness, NGT usage, and comorbid diseases significantly correlate with nosocomial COVID-19 infection in non-COVID neurology inpatients.
Case Series: Risk and Clinical Manifestation of Non-Convulsive Status Epilepticus After Traumatic Brain Injury Ramli, Yetty
Acta Neurologica Indonesia Vol. 2 No. 01 (2024): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v2i01.20

Abstract

Traumatic brain injury occurs due to impacts on the head or penetrating injuries that result in damage to the brain. Traumatic brain injury can lead to complications, including post-traumatic seizures. Seizures following traumatic brain injury (TBI) present a complex interplay of various risk factors and determinants that significantly impact clinical outcomes and patient management, especially in non-convulsive status epilepticus. Non-convulsive status epilepticus (NCSE) is an underrecognized complication following traumatic brain injury (TBI), with potentially severe consequences for patient outcomes. Factors contributing to NCSE development include level of consciousness, injury severity, and cortical involvement. Clinical presentation is often subtle, ranging from altered mental status to focal neurological deficits. Early recognition through EEG monitoring is crucial, guiding targeted antiepileptic therapy to mitigate neuronal injury and improve outcomes Understanding these risk factors and clinical manifestations are crucial for effective surveillance, early intervention, and tailored treatment strategies aimed at mitigating the burden of seizures and improving the long-term prognosis of individuals with TBI.
Quantitative EEG Findings in Post-Stroke Epilepsy Patients Ramli, Yetty
Acta Neurologica Indonesia Vol. 2 No. 01 (2024): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v2i01.23

Abstract

Post-stroke epilepsy presents a significant clinical challenge, often accompanied by cognitive impairments. The qEEG analysis in this case reveals notable abnormalities, including increased delta waves and decreased high-frequency activity, localized to specific brain regions. These findings not only strengthen diagnostic assessments but also provide valuable insights into the underlying pathophysiology of post-stroke epilepsy. Moreover, they serve as a basis for selecting personalized therapeutic interventions, such as neurofeedback therapy. By tailoring treatment to the captured brainwave frequencies during recording, non-invasive therapeutic options can be explored as viable alternatives for patients. Integrating qEEG findings into clinical practice enhances our understanding of post-stroke epilepsy's complex nature and guides optimal patient care and management strategies.
Co-Authors Budikayanti, Astri Dyah Tunjungsari, Dyah Fatima Safira Alatas, Fatima Safira Jeanne A. Pawitan Mesiano, Taufik Pusponegoro, Hardiono Djuned Soebadi, Amanda Urfianty, Urfianty Widaja, Edhijanto