Ralph Girson Gunarsa
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Total Lymphocyte Count as a Nutritional Parameter in Hospitalized Patients Ralph Girson Gunarsa; Marcellus Simadibrata; Ari Fahrial Syam; Ina Susianti Timan; Siti Setiati; Abdul Aziz Rani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 2, August 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (535.438 KB) | DOI: 10.24871/122201189-94

Abstract

Background: Nowadays, there are still many malnourished patients during hospitalization, which comprises around 45-50% patients. Malnutrition is related to increased mortality and morbidity rate; therefore, nutritional state should be assessed in hospitalized patients. Total lymphocyte count (TLC) is related to decreased body function in malnutrition and it is a means of nutritional assessment. Until now, there is no data showing association between malnutrition and TLC in hospitalized patients in Indonesia. The objective of this study was to identify the association between malnutrition and TLC 1,200 cell/mm3 in hospitalized patients. Method: This study was a cross-sectional study. Subjects were new patients hospitalized at internal medicine ward of Cipto Mangunkusumo Hospital. Patients were collected by consecutive sampling. We conducted the study between April and May 2008. Fifty four patients were assessed for malnutrition by the subjective global assessment (SGA) and they also had undergone complete blood count. TLC was numbered with routine complete blood count test. Patients were classified into malnutrition according to SGA. TLC was classified with cut-off point of 1,200 cell/mm3. Statistical analysis included Chi-square test, which was used to compare proportion. Results: There were 52% malnourished patients, 33% patients with TLC 1,200 cell/mm3, 57% patients with malnutrition and TLC 1,200 cell/mm3. This study showed that there was an association between malnutrition and TLC 1,200 cell/mm3 (p = 0.001). Moreover, there was also significant association between severe malnutrition (SGA C) with TLC 900 cell/mm3 (p = 0.02). Conclusion: There is an association between malnutrition and TLC 1,200 cell/mm3.   Keywords: malnutrition, total lymphocyte count, body mass index, subjective global assessment
Nutrition Management on Acute Pancreatitis Ralph Girson Gunarsa; Rino Alvani Gani; Ari Fahrial Syam
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 8, ISSUE 1, April 2007
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/81200716-19

Abstract

Pancreatitis is an inflammatory process in pancreas. Clinical manifestation of acute pancreatitis can be mild to severe. Mortality rate is high in severe acute pancreatitis. Etiology of acute pancreatitis generally remains obscured. Supportive management is important in acute pancreatitis. Nutrition is important part in acute pancreatitis. Patient should not be given enteral nutrition temporarily and meanwhile parenteral nutrition must provide sufficient amount of calories and nutritional requirements. Immune nutrition should also be considered. In mild acute pancreatitis, oral realimentation can be started in 3rd-7th day. In severe acute pancreatitis with prolonged fasting, gradual enteral nutrition via nasoenteral tube is recommended Keywords: nutrition, acute pancreatitis, enteral nutrition
Outcome Result of Acute Myeloid Leukemia Undergoing Treatment in Semi-Isolation Chemotherapy Ward Irawan, Cosphiadi; Steven, Ricci; Gunarsa, Ralph Girson; Tenggara, Jeffry Bela
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 3
Publisher : UI Scholars Hub

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Abstract

Introduction. Standard positive pressure isolation room is not yet widely available in Indonesia. In several private hospitals, current best practice is admitting patients to semi-isolation room with additional protective measures. Despite the limitation, this practice is considered safe and might benefit Acute Myeloid Leukemia (AML) patients. This study aimed to analyze the leukemic profile and survival in AML patients admitted to semi-isolation room. Methods. A retrospective cohort study was conducted using secondary data from medical record of AML patients diagnosed in Mochtar Riady Comprehensive Cancer Center between 2018 – 2020. Patients were divided into semi-isolation room group and not admitted to semi-isolation room group. Semi-isolation room patients who received standard chemotherapy regimen were further analyzed according to complication, outcome, and survival.Results. We included 45 AML patients, 53.3% were females, 42.2% in the 40-59 years age group, and 28.9% were AML-M2. Fifteen patients received standard chemotherapy regimen including D3A7, FLAG, ATRA-Daunorubicin-Cytarabine in semi-isolation room, 60% of them had complete remission after treatment completion. Patients who not admitted to semi-isolation room received conservative treatments including hydroxyurea, mercaptopurine, cytarabine cytoreduction, and decitabine. Among patients in semi-isolation room, 41.2% had sepsis and 29.4 % had septic shock, with most of the sources coming from bloodstream infection (80%), Acinetobacter baumannii remained the most prevalent microorganism. Treatment outcomes showed median Progression Free Survival (PFS) of 11 months, 1-year survival was 47%, and 2-year survival was 27%.Conclusions. In countries with limited standard isolation room, treatment of AML patients in semi-isolation room with infection control protocol could be considered in order to give the standard induction chemotherapy regimen. Although there was an infection risk, strict isolation policy produced good response (60% complete remission).