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HUBUNGAN LAMA WAKTU PASCA KEMORADIASI DENGAN DERAJAT DISFAGIA OROFARINGEAL PADA KARSINOMA NASOFARING Kusuma, Lirans Tia; Antono, Dwi; Muyassaroh, Muyassaroh
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 1 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

Abstract Background : Dysphagia can occur as a side effect in patients with nasopharyngeal carcinoma (NPC) receiving chemoradiation therapy. The reported incidence rate up to 83%. The degree of oropharyngeal dysphagia accosiated with the long time of post-chemoradiation in NPC is not yet clearly known. Objective : To analysis the degree of oropharyngeal dysphagia accosiated with the long time of post-chemoradiation in NPC. Method : Analysis observational research with cross sectional design. The subjects were patients with post-chemoradiation NPC at RSUP Dr. Kariadi Semarang who met the inclusion criteria. Determination of dysphagia status and degree of dysphagia by Gugging Swallowing Screen (GUSS). The complete details of the subjects were obtained from history and medical records. Chi-Squared is used for the statistical test. Outcome : Fifty five (100%) subjects had dysphagia, 48 (87.3%) subjects had mild degrees of dysphagia, no subjects with moderate degree of dysphagia were found, and 7 (12.7%) subjects had severe dysphagia. Long time of post-chemoradiation (p = 0.451), type of chemotherapy (p = 0.267), and therapeutic modality (p = 0.402) were not related to the degree of oropharyngeal dysphagia in NPC. Conclusion : The majority of subjects had mild degree dysphagia. Long time of post-chemoradiation, type of chemotherapy, and modality of therapy are not related to the degree of oropharyngeal dysphagia in NPC. Keywords: NPC, chemoradiation, degree of dysphagia, GUSS.

PENGARUH SUPLEMENTASI KOENZIM Q10 TERHADAP KADAR LAKTAT DEHIDROGENASE PENDERITA LIMFOMA NON-HODGKIN YANG MENJALANI KEMOTERAPI DI RSUP Dr.KARIADI SEMARANG Kusulistyo, Farryanto; Suprihati, Suprihati; Yusmawan, Willy; Antono, Dwi; Budiarti, Rery; Farokah, Farokah; Widodo, Pujo
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 2 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

LATAR BELAKANG : Peningkatan kadar LDH dikenal sebagai penanda tumor yang menggambarkan aktivitas tumor termasuk tumor sel germinal, sarkoma dan LNH. Koenzim Q10 bekerja sebagai kofaktor dalam Siklus Krebs yang berperan dalam mengatasi kondisi kekurangan ATP dalam sel melalui reaksi reduksi dan oksidasi. TUJUAN : Membuktikan pengaruh pemberian koenzim Q10 terhadap kadar LDH penderita LNH yang mendapat kemoterapi di RSUP Dr.Kariadi, Semarang. METODE : Penelitian intervensi dengan desain randomized pre and post test double blind control group design. Subyek yang ditentukan sebanyak 34 orang. Subjek penelitian adalah penderita LNH yang mendapat kemoterapi dengan pemberian terapi selama 21 hari. Kelompok penelitian dibagi menjadi 2, yaitu kelompok perlakuan (penderita LNH yang mendapat kemoterapi, dan koenzim Q10 100mg/hari) sebanyak 17 orang, serta kelompok kontrol (penderita LNH yang mendapat kemoterapi dan plasebo) sebagai sisanya. Analisis data dengan deskriptif dan uji hipotesis HASIL : Terdapat perbedaan signifikan sebelum dan setelah intervensi, dimana terjadi penurunan kadar LDH pada kelompok perlakuan sedangkan pada kelompok kontrul justru terjadi peningkatan kadar LDH. KESIMPULAN : Kadar LDH pada pasien LNH yang diberikan koenzim Q10, lebih baik dibandingkan tanpa pemberian koenzim Q10. Terdapat perbedaan bermakna secara statistik pada penelitian ini Kata Kunci : Limfoma Non-Hodgkin (LNH); Lactate Dehidrogenase (LDH); Koenzim Q10, prognosis

Etiologi Dan Patofisiologi Kasus Intractable Hiccups Pada Pasien Laki-Laki 57 Tahun Iriani, Desy; Antono, Dwi; Muyassaraoh, Muyassaroh
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 3 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

Latar belakang : Hiccup adalah hembusan napas yang mengacu dari suara yang dihasilkan kontraksi diafragma dan otot intercostal secara tidak sadar dan mendadak dilanjutkan dengan kontraksi mendadak dari glotis. Hiccup merupakan gejala yang biasa dikenal setiap orang namun tetap merupakan gejala patologis. Laporan kasus : Dilaporkan laki laki usia 57 tahun dengan cegukan sejak 1 tahun. Pemeriksaan laringoskopi fleksibel menunjukkan adanya LPR (RFS 15). Pasien didiagnosis LPR dan intractable hiccup ec susp gangguan sentral (CNS), diagnosis banding psikogenik. Pasien diberikan terapi metochlopramid dan chlorpromazine selama 5 hari. Hasil evaluasi pasien mengeluh cegukan tidak berkurang. Pasien lalu diberikan terapi omeprazole 20 mg per 12 jam. Pembahasan : Persistent dan intractable hiccup merupakan gejala yang sulit diobati, bila penyebab diketahui maka diobati sesuai penyebabnya, namun bila penyebab tidak diketahui terapi empiris dilakukan untuk menekan GERD sehingga gejala hiccup perbaikan. Apabila terapi ini gagal agen farmakologi ditujukan ke reseptor dopaminergik dan GABA-ergik. Kesimpulan : Penatalaksanaan hiccup perlu diketahui etiologi terutama gangguan LPR, GERD dan CNS hingga perlu penanganan multidisipliner dari bagian THT, interna, neurologi dan psikiatri.

Faktor Risiko Disfagia pada Pasien Diabetes Mellitus: Risk Factors of Dysphagia in Patients with Diabetes Mellitus Mudha Pratomo, Santo; Mailasari Kusuma Dewi, Anna; Iman Santosa, Yanuar; Antono, Dwi; Tedjo Minuljo, Tania; Budiarti, Rery
Medica Hospitalia : Journal of Clinical Medicine Vol. 9 No. 2 (2022): Med Hosp
Publisher : RSUP Dr. Kariadi

Latar belakang : Disfagia dapat terjadi akibat komplikasi dari diabetes mellitus terutama pada fase orofaringeal. Disfagia pada diabetes mellitus terjadi karena adanya neuropati autonom akibat hiperglikemia yang lama. Komplikasi ini mempengaruhi berbagai bagian sistem saraf dan mempunyai manifestasi klinis yang beragam, salah satunya adalah kerusakan metabolik pada struktur saraf dan mikrovaskuler dari vasa vasorum. Penelitian ini bertujuan untuk membuktikan bahwa usia, jenis kelamin, merokok, BMI dan kadar HbA1c merupakan faktor risiko disfagia pada penderita Diabetes mellitus (DM). Metode : Penelitian observasional analitik dengan desain belah lintang melibatkan subjek sebanyak 95 penderita DM dewasa di klinik Penyakit Dalam RSUP Dr. Kariadi Semarang pada bulan Desember 2021 – Februari 2022. Disfagia dinilai dari kuisioner dan pemeriksaan penelanan. Data DM dan HbA1c diambil dari rekam medik. Analisis data menggunakan Chi-Square dan regresi logistic. Hasil : Rerata usia 51,61 + 8,706 dengan usia termuda 18 tahun dan usia tertua 60 tahun. jenis kelamin laki laki : perempuan = 6 : 13. Usia (p= 0,523), jenis kelamin (p= 0,043, RP -2,76 CI 95% 0,883 – 8,686) riwayat merokok (p= 0,602), status BMI (p= 0,660), dan kadar HbA1c (p= 0,679), Simpulan : Usia, jenis kelamin riwayat merokok, status BMI dan kadar HbA1c tidak merupakan faktor risiko terjadinya disfagia pada penderita diabetes mellitus.

The Effect of 1% Povidone Iodine Mouthwash on The Incidence of Oral Mucositis and Odynophagia in Patients with Head and Neck Malignancy Handayani, Peny; Budiarti, Rery; Yusmawan, Willy; Antono, Dwi; Dewi, Anna Mailasari Kusuma; Widodo , Pujo
Medica Hospitalia : Journal of Clinical Medicine Vol. 10 No. 2 (2023): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v10i2.854

BACKGROUND: Oral mucositis is an injury of normal mucosal tissue with an acute inflammation of the oral, tongue, and pharyngeal mucosa after exposure to chemo-radiotherapy. Post chemoradiotherapy oral mucositis is commonly accompanied by painful swallowing or odynophagia. Povidone iodine 1% is an antiseptic mouthwash that widely used to prevent infections in the oral cavity. OBJECTIVE: The aim of this study was to determine the effect of 1% povidone iodine mouthwash on the incidence of oral mucositis in patients with head and neck malignancy at Dr. Kariadi General Hospital Semarang. METHOD: This study was single random blinded experimental study, with total samples of 44 patients with head and neck malignancy after chemoradiotherapy. The samples divided into treatment group of 22 samples with 1% povidone iodine mouthwash and control group of 22 samples with NaCl 0.9% recruited using single random sampling at Dr. Kariadi Semarang General Central Hospital in 2022. The effect of 1% povidone iodine mouthwash on the incidence of oral mucositis and odynophagia was analyzed using the Fischer Exact and Mann Whitney test. RESULT: In the 1% povidone iodine mouthwash group day 15th, 21 patients (95.5%) were found without mucositis and 1 patient (4.5%) with mucositis oral grade I. In the 1% povidone iodine mouthwash group, 21 people (4.5%) were found without odynophagia and 1 people (4.5%) had odynophagia. There was an association between oral mucositis and odynophagia on povidone iodine 1% group (p < 0.05). CONCLUSION: Povidone iodine 1% mouthwash can affect the incidence of oral mucositis in patients with head and neck carcinoma. Povidone iodine 1% mouthwash can reduce the incidence of oral mucositis and odynophagia compared to placebo in patients with head and neck carcinoma.

Comparison Of Clinical Response Between Combine Chemotherapy 5 Fluorourasil - Platinum Based And Ifosfamid - Taxane - Platinum Based In Recurrent Nasopharyngeal Carcinoma Sanjaya, Rio; Yusmawan, Willy; Antono, Dwi; Marliyawati, Dwi; Yunika, Kanti
Medica Hospitalia : Journal of Clinical Medicine Vol. 10 No. 3 (2023): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v10i3.926

BACKGROUND : Recurrence of Nasopharyngeal Carcinoma (NPC) is the emergence of a tumor remission after administration of chemoradiation based on symptoms and several examinations. The combination of chemotherapy in recurrent NPC still gives good results. The combine of regimens used is still varied and not much study has been done to assess the clinical response. OBJECTIVE : To compare the clinical response between administration of combination 5 Fluorouracil-Platinum based (5-FU) and Ifosfamide-taxan-platinum based (IFO) in recurrent NPC. METHOD :. This observational study used electronic medical record (ERM) data at the ENT oncology clinic at Dr. Kariadi General Hospital for the period January 2020-January 2022. The number of samples that suited to the inclusion and exclusion criteria was 44 subjects divided into two groups of 22 subjects respectively. The chi-square test was used to assess differences in alteration of clinical symptoms, tumor mass size, neck lymph node enlargement, tumours stage reduction, and the effect of confounding factors on response to therapy in both groups. RESULTS : The highest number of patients with recurrent NPC were aged ≥45 Years old and male (75%). WHO type 3 is the most common (95.5%) and ECOG status 1 (95.5%). There was no significant difference administration of the combination of 5-FU with IFO in alteration of clinical symptoms (p=0.500), shrink tumor size (p=0.347), reduction of neck lymph node size (p=0.164), and reduction tumor staging (p=0.347). There was no relationship from confounding factors to clinical response between the administration of the two groups. CONCLUSION : Administration of 5 Fluorouracil-platinum based combination chemotherapy did not provide a better clinical response in terms of clinical symptoms, changes in primary tumor size, neck lymph node size, and decreased tumor stage compared to the Ifosfamide-taxane-platinum based combination based on recurrent NPC.

The Effect of Coenzym Q10 on Doxorubicin-induced Cardiotoxicity in Non Hodgkin's Lymphoma Patients Dewi, Julita Melisa; Antono, Dwi; Nugroho, Nur Iman; Yusmawan, Willy; Dewi, Anna Mailasari Kusuma
Medica Hospitalia : Journal of Clinical Medicine Vol. 11 No. 2 (2024): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v11i2.1089

BACKGROUND : Non-Hodgkin's Lymphoma is a primary malignancy in the Lymph Nodes and lymphoid tissue originating from B lymphocytes, T lymphocytes and Natural Killer (NK) cells. Therapy for Non-Hodgkin's Lymphoma chemotherapy can be given alone or combined with radioactive therapy. Doxorubicin is a chemotherapy drug used for lymphoma with side effects, one of which is cardiotoxic effects. AIMS : To prove that coenzyme Q10 can reduce the cardiotoxic effect of doxorubicin chemotherapy in non-Hodgkin's lymphoma patients METHOD : Intervention study with a randomized pre and post test double blind control group design with 34 NHL patients undergoing chemotherapy. The treatment group received additional therapy with coenzyme Q10 300mg/day for 12 weeks while the controls received placebo. The cardiotoxic effects examined were assessed based on the results of Electrocardiography and Echocardiography. RESULT : The treatment group with coenzyme Q10 supplementation after the 4th chemotherapy showed a decrease in echocardiography results in 3 patients (18%) and in the control group 17 patients (100%). There was a significant difference in the echocardiography results of the treatment and control groups (p=0.001). There were no drug side effects in both groups CONCLUSION : Coenzyme Q10 supplementation provides an improvement in the cardiotoxic effects of doxorubicin in non-Hodgkin's lymphoma patients, on echocardiography, but not on Electrocardiography.

Laryngeal carcinoma with hemorraghic varicella : a rare case report Aditomo, Rano; Antono, Dwi
Oto Rhino Laryngologica Indonesiana Vol. 53 No. 1 (2023): VOLUME 53, NO. 1 JANUARY - JUNE 2023
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v53i1.484

Background : Hemorrhagic varicella is a complication that usually occurs in patients with immune disorders or those on immunosuppressive therapy or hematologic malignancies such as leukemia. Purpose: This case report aimed to further examine the complications of a rarely found hemorrhagic varicella in neck head malignancies / laryngeal carcioma. Case report : This is a case report of laryngeal carcinoma with hemorrhagic varicella in a 44-year-old man. Examination of dermatological status revealed hemorrhagic, polymorphic vesicles, generalized pustular psoriasis, erosion and, crusting. Tzanck test of the scrapes of the base of lesion of the vesicles is helpful in establishing the diagnosis of varicella and discovered multinucleated giant cells (MGCs) and epithelial cells with acidophilic intranuclear inclusion bodies The patient died after 3 days of treatment in the isolation room. A previous study also reported cases of hemorrhagic varicella in a 3-year-old girl with the main complaint of pus-filled red spots throughout the body. A previous history of chickenpox was denied. The physical examination showed dark red, polymorphic lession, generalized pustular psoriasis, erosion and crusting. Hemorrhagic varicella in the head and neck malignancy is a very rare form of varicella. Clinical question: In patient with immunocompromised during chemotheraphy suffer from varicella, is it necessary to have a comprehensive diagnostic examination panel, and therapy? Review methods: Evidence-based literature search with keywords “immunocompromised” AND “Hemorrhagic varicella” was performed through Cochrane, PubMed and Medline database. Result : The literature search obtained 318 articles in PubMed, 11 articles in Medline,and none in Cochrane, which were relevant with the topic. Only 1 article screened with inclusion and exclusion criteria. A research was conducted by Elizabeth et al in Philipina (2011) on Pediatric Infectious Disease and Hematology-Oncology Services. Out of 26 immunocompromised patients who developed varicella during the study period, only 22 charts were available for review. Of these patients, 13 were male and 9 were female. The highest incidence occurred from 0 to 5 years old (41%). Twenty patients had an underlying malignancy in the form of leukemia (14%) and solid organ tumors (6%) including nasopharyngeal cancer. Diagnosis based on the characteristic generalized papulovesicular rashConclusion : This requires a comprehensive diagnostic panel test for the delivery of appropriate therapy and improved outcome.

Fibrous Dysplasia in the Maxillary Bone: The Early Diagnosis of Progressive Pain with Facial Asymmetry Liemiyah, Rikha; Dewi, Anna Mailasari Kusuma; Antono, Dwi; Nugroho, Nur Iman; Muyassaroh, Muyassaroh; Kusumaningrum, Lely; Arsita, Cynthia
Indonesian Journal of Cancer Vol 19, No 1 (2025): March
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i1.1316

Introduction: Fibrous dysplasia (FD) is a genetic, non-familial skeletal disorder, where in medullary bone is replaced by fibro-osseus tissue. Ninety percent of FD instances involve the craniofacial region, which usually involves one or more bones. The ethmoid, sphenoid, frontal, maxillary, and temporal bones are the most affected, but the maxilla is most affected. Misdiagnosis and inappropriate diversity in investigations and therapies are frequently caused by the disease’s rarity and varying presentation to other specialties. This study aims to analyze the signs, symptoms, and laboratory-radiology examinations of suspected FD patients at Dr. Kariadi General Hospital Semarang so that it can increase the sensitivity of medical personnel in establishing this diagnosis based on the symptoms and signs complained of by the patient.Case Presentation: A case series study assessing three patients diagnosed with FD of the maxillae between January and December 2021 at Dr. Kariadi General Hospital, Semarang. The study found 3 patients diagnosed with FD of the maxillae consisting of 2 males and 1 female. The initial complaints reported in all patients were progressive facial pain, thick sensation in the cheek area, and asymmetrical facial shape due to abnormal protrusions. Physical examination found an increase in facial volume with a hard consistency. CT scan evaluation obtained a sclerotic image with ground glass opacity in two patients and hyperostosis in one patient. Surgery with the Weber Ferguson technique was undergone by two patients, while one patient underwent the Weber Ferguson Technique + Zoledronic Acid for 6 cycles. Both patients who underwent Weber Ferguson technique surgery experienced recurrence related to symptoms in the form of pain and increased volume in the facial area within 2–4 weeks after surgery.Conclusions: Patients with complaints of progressive pain and asymmetrical shape in the facial area and physical examination found an increase in facial volume with hard consistency should be able to increase the suspicion of medical personnel regarding the diagnosis of FD. Further radiological examination with tissue histopathology should be performed to rule out or confirm the diagnosis of FD.

A GIANT CARCINOMA EX PLEOMORPHIC ADENOMA OF THE SOFT PALATE Wijayanti, Renny Swasti; Antono, Dwi
Jurnal Kesehatan Tambusai Vol. 6 No. 3 (2025): SEPTEMBER 2025
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jkt.v6i3.49295

Karsinoma eks adenoma pleomorfik (Ca eks PA) adalah keganasan epitel yang timbul dari adenoma pleomorfik jinak primer atau rekuren pada kelenjar ludah. Penilaian histopatologi merupakan baku emas untuk menegakkan diagnosis. Tujuannya adalah untuk menentukan pengobatan yang tepat mengingat kemiripan gejala klinis Ca eks PA dan adenoma pleomorfik jinak, dengan mempertimbangkan kekhasan tumor ini. Seorang wanita berusia 55 tahun datang dengan massa berbentuk oval di area junctional palatum molle selama 8 bulan. Massa tersebut berbatas tegas dan melekat pada jaringan di sekitarnya. Massa ini menyebabkan gejala disfagia dan sering terjadi rinolalia. Pemeriksaan histopatologi pascaoperasi memastikan diagnosis Karsinoma eks adenoma pleomorfik (CA-eks-PA). Diagnosis yang akurat dan tatalaksana bedah pasien dengan Ca eks PA dapat meningkatkan angka kesintasan mereka.

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