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All Journal Tropical Medicine Journal Jurnal Kesehatan Masyarakat Indonesia Jurnal Kebijakan Kesehatan Indonesia Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Pharmaciana: Jurnal Kefarmasian Jurnal Sains dan Teknologi Farmasi Indonesian Journal of Biotechnology INDONESIAN JOURNAL OF PHARMACY Syntax Literate: Jurnal Ilmiah Indonesia Jurnal Ilmu Kefarmasian Indonesia PREPOTIF : Jurnal Kesehatan Masyarakat JKKI : Jurnal Kedokteran dan Kesehatan Indonesia Sciences of Pharmacy Jurnal Manajemen Pelayanan Kesehatan (The Indonesian Journal of Health Service Management) Borneo Journal of Pharmacy Indonesian Journal of Pharmacology and Therapy

Erna Kristin

Fakultas Kedokteran Universitas Gadjah Mada

Author-ID : 260539

Humanities Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Computer Science & IT Education Environmental Science Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Materials Science & Nanotechnology Medicine & Pharmacology Neuroscience Public Health Social Sciences Other

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Serum iron level after ingestion of repeated dose of iron shortly after and 2 hours after meal Erna Kristin, Mohammad Hakim, Sri Kadarsih Soejono, Lukman Hakim
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 41, No 04 (2009)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (179.484 KB)

Background: The prevalence of iron deficiency anemia in pregnant women is estimated to be higher than nonpregnant women. Ironsupplementation program has been proven clinicallyto improvethe hemoglobin (Hb)level of pregnant women. The absorption of iron is affected by food, therefore iron has to be given 2 hours after meal. However, in practice, iron was given shortly after meal. The physiologicalchange in pregnant women affects drug absorption, distribution, and eliminationphases. Objective: To understand serum iron level after ingestion of repeated dose of iron shortly after and 2 hours after meal for 12 weeks in trimester 2 pregnant women with iron deficiency anemia. Method: The research design was a phase IIclinical trial. Subjects were 24 trimester 2 pregnant women with iron deficiency anemia, classified into two groups, who were treated as follows: The first group was consisted of 12 women with irondeficiency anemia, treated with twice-a-day ferrous sulphate tablet @300 mg orally,given shortly after meal for 12 weeks; the second group was consisted of 12 women with iron deficiency anemia, treated with twice-a-day ferrous sulphate tablet @300 mg orally, given 2 hours after meal for 12 weeks. Bloodsamples were taken in week 2, 4, 6, 8, 10, and 12 after treatment. Serum (ferric) iron level was measured with Vitros Fe Slides method. Result: Minimum,maximum, and average steady-state ironlevels (Css min, Css max, Css average) of treatment 1 were 104.1 ::I:14.03 ug/dL, 96.44::1:13.22 ug/dL, and 112.38::1:14.03 ug/dL (mean ::I:SEM),respectively; while minimum, maximum, and average steady-state iron levels (Css min, Css max, Css average) of treatment 2 were 125.77::1:9.31 ug/dL, 118.03::1:9.21 ug/dL, and 125.77::1:9.31 ug/dL (mean::l:SEM),respectively. No statistical significant difference was found within treatment in minimumsteady-state level between week 2, 4, 6, 8, 10, 12 after treatment. There was also no significant difference in minimumsteady-state level between treatment groups in week 2, 4, 6, 8, 10, and 12. Conclusion: There were no differences in serum iron level after ingestion of repeated dose of ironshortly after and 2 hours after meal for 12 weeks intrimester 2 pregnant women with iron deficiency anemia.

Serum iron level shortly after iron supplementation shortly after and 2 hours after meal in women with iron deficiency anemia ErnaKristin, Muhammad Hakimi Sri Kadarsih Soejono,,Lukman Hakim
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 41, No 03 (2009)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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Background: Incidence of anemia in women in developing countries is still high, that is, around 43%. This incidence rate is far more hig'her that that in industrial countries, which is ranged between 10-12 %. The prevalence of iron deficiency anemia is still high, particularly in developing countries. The cause of the high prevalence of iron deficiency anemia is not known, since it involves various factors. Two of the probable etiologic factors is variability in dosage administration, and the effect of co-administered food. Studies on the pharmacokinetic 'of iron after single dose iron tablet administration in women with anemia and pharmacokinetic of iron coadministered with food in healthy women have been done, but study on repeated dose has never been conducted. Objective: To understand serum iron level after ingestion of repeated dose of iron shortly after and 2 hours after meal for 12 weeks in women with iron deficiency anemia. Method: The research design was a fase II clinical trial. Subjects were 24 women with iron deficiency anemia, classified into two groups, who were treated as follows: the first group was consisted of 12 women with iron deficiency anemia, treated with twice-a-day ferrous sulphate tablet @ 300 mg orally, given shortly after meal for 12 weeks; the second group was consisted of 12 women with iron deficiency anemia, treated with twice-a-day ferrous sulphate tablet @ 300 mg orally, given 2 hours after meal for 12 weeks. Blood samples were taken in week 2,4, 6, 8, 10, and 12 after treatment. Serum (ferric) iron level was measured with Vitros Fe Slides method. Result: Minimum, maximum, and average steady-state iron levels (Css min, Css max, Css average) of treatment 1 were 108,78:t 13.79 ug/dL, 121 .44:t 15.79 ug/dL, and 115.11 :t 13.13 ug/dL (mean:t SEM), respectively; while minimum, maximum, and average steady-state iron levels (Css min, Css max, Css average) of treatment 2 were 115.15 :t 46.27 ug/dL, 141.36:t 61.36 ug/dL, and 124.92:t 53.43 ug/dL (mean:t SEM), respectively. No statistical significant difference were found within treatment in minimum steady-state level between week 2, 4, 6, 8, 10, 12 after treatment. There was also no significant difference in minimum steady-state level between treatment group in week 2, 4, 6, 8, 10, and 12. , Conclusion: There were no differences inserum iron level after ingestion of repeated dose of iron shortly after and 2 hours after meal for 12 weeks in women with iron deficiency anemia. Key Words: iron supplementation-serum iron-iron deficiency anemia-steady-state iron level

The influence of Ferrous Sulphate @ 300 mg ingestion shortly after meal and 2 hours after meal on pharmacokinetic profiles of iron in serum sample in women with Hb 2 12 g/dL Erna Kristin Erna Kristin
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 37, No 04 (2005)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (160.738 KB)

Background: Iron absorption is determined by iron status, heme- and nonheme-iron contents and amounts of various dietary factors that influence iron absorption. Few studies have examined the influence of food to iron absorption but only limited information is available about the net effect of these factors.Objectives: Objective of this study was to know the influence of Ferrous Sulphate @ 300 mg ingestion shortly after and 2 hours after meal on pharmacokinetic profiles of iron in serum sample in 12 women with Hb >_ 12 g/dLMethods: The study was carried out in a cross over design in which each of participants underwent 2pharmacokinetic studies. One tablet of Ferrous Sulphate @ 300 mg was taken by each subject shortly after and 2 hours after standard meal at the first and second study. Series of serum samples were taken at0, 0.25, 0.5, 1, 1.5, 2, 2.5, 3, 4, 6, 8, 10, and 12 hours after iron administration. The concentrations of ferric iron in serum were measured using Vitors Fe Slides System, while pharmacokinetics parameters were calculated using a non-compartmental method.Results: Pharmacokinetic parameters obtained from the first and second study were compared using t test with the following results (meant SEM): C,,, 275.92 ± 28.97 & 284.58 ± 30.44 ug/dL, T.3.50 ± 0.29& 3.50 ± 0.38 hours, K. 0.3235 t 0.0011 & 0.3816 ± 0.0010 hours-', Ka, 0.1138 ± 1.5696 & 0.1152 ±1.3331 hours' T,201 7.80 ± 1.45 & 7.03 ± 1.02 hours and AUCo-12 2493.43 ± 397.54 & 2331.15 ± 283.64 ug/dL.hours. No difference of all pharmacokinetic parameters were detected by intervention typeConclusions: It can be concluded that after ingestion of Ferrous Sulphate @ 300 mg in women with Hb 12 ug/dL shortly after and 2 hours after meal did not show significant diferrences on pharmacokinetic profiles of iron in serum sampleKey words: iron absorption - pharmacokinetic - ferrous sulphate - absorption rate - Cmax

Risk of zidovudine-induced anemia on human immunodeficiency virus (HIV) infection patients with different CD4 cell counts Anak Agung Ayu Niti Wedayani; Eti Nurwening Sholikhah; Erna Kristin; Erwin Astha Triyono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 49, No 1 (2017)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Anemia is the most common hematologic abnormality in patients with human immunodeficiency virus (HIV) infection. This abnormality is associated with HIV infection itself, HIV-related opportunities infections or drug use. Zidovudine (AZT) is the most common cause of anemia in HIV patients. Recent study showed anemia in HIV patients is also associated with CD4 cell counts. Aim of this study was to evaluate the risk of anemia on HIV patients with different CD4 cell counts after AZT-based antiretroviral therapy (ART).This retrospective cohort study was conducted using medical record of HIV patients in Dr. Soetomo General Hospital, Surabaya. Subjects who fulfilled the inclusion and exclusion criteria were divided into two group i.e. HIV patients with CD4 cell counts 200-350 cell/mm3 and those with CD4cell counts ≥350 cell/mm3. All available demographics, clinical and laboratory data of subjects before and after AZT-based ART were then recorded and evaluated. Ninety-seven HIV patients (50 male and 47 female) were involved in this study. The result showed that the anemia incidence significantly increased after AZT-based ART (p<0.05), however no significantly different in anemia incidence, mean Hb level reduction and Hb level time reduction were observed between HIV patients with CD4 cell counts 200-350 cell/mm3 and those with CD4cell counts ≥350 cell/mm3(p>0.05). Gender, age, weight and clinical stage were not associated with anemia incidence (p>0.05). In contrast, anemia incidence is associated with Hb level before AZT therapy (p<0.05). In conclusion, the anemia incidence in HIV patients after AZT based ART is not associated with the level of CD4 cell counts, however it is associated with Hb levels before AZT therapy.

DIPEPTIDYL PEPTIDASE 4 (DPP-4) INHIBITORS FOR THE TREATMENT OF TYPE 2 DIABETES MELLITUS Erna Kristin
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 48, No 2 (2016)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

ABSTRACT Diabetes mellitus (DM) is a chronic disease which caused around 1.5 million deaths in 2012. Type 2 diabetes mellitus (T2DM) accounts for 90% of DM worldwide. The prevalence of T2DM is increasing due to obesity. Clinical guidelines recommend the use of metformin as the first-line treatment, followed by the addition of 1 or 2 oral antidiabetic drugs (OADs), such as sulphonylurea (SU), an alpha-glucosidase inhibitor, or thiazolidinediones (TZDs). Recently, newer agents such as dipeptidyl peptidase 4 (DPP-4) inhibitors have been added to those treatment algorithms. The DPP-4 inhibitor is a class of OAD that inhibits the DPP-4 enzyme. Sitagliptin, saxagliptin, vildagliptin and linagliptin are DPP-4 inhibitors available for the treatment of T2DM in Indonesia and many other countries. The DPP-4 inhibitors have similar glycemic efficacy. However, they produce a moderate improvement in glycated hemoglobin (A1C). There are limited numbers of head-to-head trials of DPP-4 inhibitors. In addition, there are no data on the long-term DPP-4 inhibitors use safety (more than two years), mortality, diabetic complications, or health-related quality of life. Although DPP-inhibitors are not used as initial treatment for a majority of patients with T2DM, DPP-4 inhibitors can be used as add-on therapy in T2DM patients who are intolerant to, have contraindications for, or uncontrolled with the use of metformin, SU, or TZDs. The exact role of DPP-4 inhibitors among several other agents to manage T2DM is not clear. There are only a small number of long-term studies on DPP-4 inhibitors assessing the glycemic decrease efficacy, important clinical outcomes (cardiovascular events, mortality), or safety. In patients with chronic renal failure considered to use DPP-4 inhibitors, linagliptin can be recommended. There are inadequate data to assess the effect of DPP-4 inhibitors on the occurrence of acute pancreatitis. Overall, DPP-4 inhibitors are well-tolerated.

The influence of acetylation status of tuberculosis patients on the isoniazid serum concentrations and sputum conversion after intensive phase therapy Dwi Indria Anggraini; Erna Kristin; iwan Dwiprahasto
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 50, No 1 (2018)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Isoniazid (INH), one of the major antituberculosis drugs, is metabolized by acetylation. Previously study proved the significant differences of serum INH concentration between subject with fast and slow acetylation status. However, the correlation of acetylation status with treatment outcome after fixed-dose combination antituberculosis therapy (FDC-ATT) was not explained. The aim of this study was to evaluate the influence of acetylation status on the treatment outcome and the serum INH concentrations in the adult tuberculosis patients underwent FDC-ATT. A cross sectional study was carried out on 31 tuberculosis patients. Acetylation status was measured by spectrophotometer and serum INH concentration was measured by high performance liquid chromatography (HPLC). Sputum conversion assay was conducted by Ziehl Nelsen method. t-Test, chi square, Mann-Whitney, and Fisherman were used to analyze the data. The proportion of the fast acetylator was 61.3%, whereas the slow acetylator was 38.7%. The proportion of success and failure sputum conversion were 83.9% and 16.1%, respectively. The mean serum INH concentration in the fast acetylator groups (1.52 ± 0.15 μg/mL) was significantly lower than that in the slow acetylator groups (3.84 ± 0.35 μg/mL). The failure conversion risk of the fast acetylator group was about two folds higher than the slow acetylator group, although it was not significantly different (RR=2.53; 95% CI=0.32-20.00; p>0.05). Moreover, the mean serum INH concentration in success (2.46 ± 0.31 μg/mL) and failure (1.89 ± 0.20 μg/mL) sputum conversion was not significantly different (p>0.05). In conclusion, the acetylation status does not influence the sputum conversion in adult tuberculosis patients after FDC-ATT although the serum INH concentration on slow acetylation status is higher than that fast acetylation status.

Increasing Serum Transaminase and The Relation with The Serum Concentration of Isoniazid and Rifampicin of Tuberculosis Patients which Given Antituberculosis Fixed Dose Combination in Yogyakarta Ratih Puspita Febrinasari; Erna Kristin; Iwan Dwiprahasto
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 47, No 4 (2015)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

ABSTRACT Tuberculosis is still a major health problem in Indonesia. Isoniazid and rifampicin are major antituberculosis drugs. These two drugs have been known to cause hepatotoxicity which is characterized by an increase of serum transaminase concentration. Previous study proved the increase of hepatotoxicity due to isoniazid and rifampicin but did not explain about the correlation with the drugs concentration. The aim of this study is to know the relation between increasing serum transaminase and the serum concentration of isoniazid and rifampicin of tuberculosis patients which given antituberculosis fixed dose combination in Yogyakarta. We carried out a cross sectional study involving 31 TB patients who received antituberculosis fixed dose combination containing isoniazid and rifampicin. Serum transaminase was measured with an automatic chemical analyzer. Isoniazid and rifampicin concentration was measured by using HPLC. We used t- test, Mann Whitney, Fisher and Spearman to analyze the data. There is no correlation between mean isoniazid concentration with high (7,07±6,24mg/ml) and normal ALT (2,42±0,26mg/ml) (p>0,05). There is no correlation between mean isoniazid concentration with high (5,03+4,14 mg/ml) and normal AST (p>0,05). There is no correlation between mean rifampicin concentration with high (10,67+3,76 mg/ml) and normal ALT (3,66+0,30 mg/ml) (p>0,05). There is no correlation between mean rifampicin concentration with high (8,52+3,06 mg/ml) and normal AST (3,64+0,32 mg/ml) (p>0,05). Mean of rifampicin concentration in this study are low (4, 12+0,46 mg/ml). So the conclusion that there are no correlation between isoniazid serum concentration with an increase of serum transaminase and no correlation between rifampicin serum concentration with an increase of serum transaminase.

The effect of the implementation of evidence-based drug formulary on antibacterial use in a private hospital at Tanjung Enim, Sumatera Selatan, Indonesia Erna Kristin; Dwi Indria Anggraini; Jarir At Thobari; Alfi Yasmina
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 49, No 1 (2017)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

The increase of drug expenditure in the hospital has facilitated the implementation of an evidence-based drug formulary. The aim of this study was to assess the change in antibacterial use after the implementation of an evidence-based drug formulary in a private hospital at Tanjung Enim, Sumatera Selatan, Indonesia. This study used a pre-posttest design. Drug use data in the period before (2010-2011) and after (2012-2013) the formulary implementation were extracted from the hospital medical records. The drug use in the hospital before and after the implementation was compared using t-test and chi-square test, with the significance level of 0.05. Average number of drugs prescribed per prescription after the implementation was similar with that before the implementation (4.4 vs 4.6; p > 0.05). However, the proportion of generic drugs prescribed increased significantly after the formulary implementation (17.0% vs 52.7%; p < 0.05). Moreover, it was still significantly increased when the analysis was conducted only for antibacterial drugs (25.9% vs 72.0%; p < 0.05). Average drug cost per prescription was 34% lower after the intervention (p < 0.05), and the average cost for antibacterial drug was also decreased (26%). The use of antibacterial drugs was significantly decreased after the intervention (12.5% vs 6.9%; p < 0.05). The most often antibacterial drugs prescribed before the interventions were beta-lactams and macrolides; while quinolones were more increasingly used after the intervention. In conclusion, the implementation of evidence-based hospital drug formulary in a private hospital at Tanjung Enim, Sumatera Selatan significantly increase generic drug use and decreased antibacterial use and average drug cost per prescription. Key words : drug formulary – prescribing pattern – generic drug – antibacterial – private hospital

Combination treatment for type 2 diabetes mellitus (T2DM) : dipeptidyl peptidase-4 inhibitors (DPP-4) and metformin Erna Kristin
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 49, No 3 (2017)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Using the concept of inhibition of dipeptidyl peptidase-4 (DPP-4) as a new treatment for type 2 diabetes mellitus (T2DM) is based on the inhibition of bioactive peptide inactivation process. Most clinical trials on DPP-4 inhibition are based on vildagliptin, sitagliptin, saxagliptin, and linagliptin. The drugs may improve glycemic control when they are given as a combination with other oral hyperglycemic agents or when they are given to patients who received metformin and still had inadequate glycemic control. Studies showed that vildagliptin was well-tolerated if it was given as add-on treatment to metformin for 24 weeks duration. In addition, vildagliptin showed significant clinical improvement proven by the associated decrease in HbA1c and fasting glucose levels. Sitagliptin in initial combination therapy with metformin decreased HbA1c level by 2.1% after 24 weeks of treatment. It was reported that DPP-4 inhibitor saxagliptin increased glycemic control when it was added to metformin. The study included 743 patients with an average HbA1c level of 8.0% when they were treated with metformin alone. After 24 weeks of treatment, saxagliptin decreased HbA1c level by 0.7%. A multicenter, randomized, placebo-controlled, double-blind, parallel-group study examined the efficacy and tolerability of linagliptin as treatment adjunctive to metformin in patients T2DM. The primary end point was changed in HbA1c from baseline to 24 weeks of treatment. The mean adjusted change from baseline in HbA1c in the linagliptin group was 0.49% compared with an increase of 0.15% in the placebo group, with 26% and 9% of participants in the linagliptin and placebo groups, respectively, achieving an HbA1c 7.0% at 24 weeks. The combination of DPP-4 inhibitors and metformin has been shown to be well-tolerated with a very low risk of hypoglycemia. Therefore, DPP-4 inhibitors and metformin combination is an efficient, safe, and well-tolerated therapy for T2DM.

PENGARUH DIABETES MELLITUS TERHADAP RESISTENSI ASPIRIN PADA PASIEN STROKE ISKEMIK DI RUMAH SAKIT BETHESDA YOGYAKARTA Hardi Astuti Witasari; Rizaldy Taslim Pinzon; Erna Kristin
Pharmaciana Vol 4, No 2 (2014): Pharmaciana
Publisher : Universitas Ahmad Dahlan

The secondary prevention of ischemic stroke can be implemented by giving aspirin.However, some cases of aspirin resistance have been found. The purpose of this study was toexamine the influence of diabetes mellitus on the risk of aspirin resistance in ischemic strokepatients at Bethesda Hospital Yogyakarta. This study was using a nested case-control studydesign. The Cases group was subjects who resistance to aspirin therapy. The control group wassubjects who response to aspirin therapy. The factors that affect the incidence of aspirinresistance were analyzed by bivariate analysis chi square test. The proportion of diabetesmellitus in resistant group was bigger than the aspirin responsive group. Its odds ratio (OR) was1.605 (95% CI, 0.641 to 4.017) (p=0.155). Conclusion: Ischemic stroke patients at BethesdaHospital Yogyakarta with diabetes mellitus were not proved to have a bigger risk of aspirinresistance than the patients without diabetes mellitus.

Co-Authors Agastya, Agastya Alfi Yasmina Alfi Yasmina Alfi Yasmina Anak Agung Ayu Niti Wedayani Anak Agung Gede Sugianthara Bustami, Mursyid Diah Ayu Putriyanti Dwi Indria Anggraini Em Sutrisna Eri Supriyanti Erwin Astha Triyono Eti Nurwening Sholikhah Firman Firman Gregorius Nesi Hanevi Djasri Hardi Astuti Witasari Hermawati, Ajitya Kurnia Indwiani Astuti iwan Dwiprahasto Iwan Dwiprahasto Iwan Dwiprahasto Jarir At Thobari Kushartanti, Bernadeta Margareta Wara Lailla Affianti Fauzi Mahady, Taufik Wahyudi Mustofa Mustofa Ngatidjan Ngatidjan Ni Made Dwi Sandhiutami Novita Carolia Novita Intan Arovah Pratiwi, Woro Rukmi Prih Sarnianto Ramadaniati, Hesty Utami Ratih Puspita Febrinasari Ratih Puspita Febrinasari Ratmasari, Dewi Rizaldy Pinzon Rizaldy Taslim Pinzon Rizaldy Taslim Pinzon S.Farm., M.Farm., Apt, Sondang Khairani Sari Mutiarani Sarnianto, Prih Sri Purwaningsih Sri Purwaningsih Sumardi - Sunarto Ang Susanto, Agnes Susanto, Agnes Trijayanti, Christiana Yanri Wijayanti Subronto Yanri Wijayanti Subronto Yolanda Dyah Kartika Yusi Anggriani

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