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The Accuracy of Wells Clinical Model for Predicting Pretest Probability in Deep Vein Thrombosis (DVT) at Dr. Sardjito Hospital Wulansih, Dwi; Kurnianda, Johan; Widayati, Kartika
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
Publisher : Acta Interna The Journal of Internal Medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (171.005 KB)

ABSTRACTBackground: The diagnosis of deep vein thrombosis (DVT) is an important issue in the medical fieldÂ because a large number of cases are undiagnosed. The accurate diagnosis of the DVT is essential toÂ prevent complications of acute pulmonary embolism and long-term complications. The complication suchÂ as pulmonary hypertension and post phlebitis syndrome. It also to avoid improper anticoagulant therapyÂ associated with a high risk of bleeding. There are several models of clinical suspicion of DVT includeÂ Hamiltonâs score and Wellsâ score. The Wells clinical model for predicting pretest probability for DVT hasÂ been widely used and tested its validity in several countries in Europe. The accuracy of a Wells clinical modelÂ of pretest probability for DVT has not been done for the races of Asia especially in Indonesia.Objective: This study aimed to test the accuracy and precision (sensitivity, specificity and predictive value)Â of Wells clinical model for predicting pretest probability for diagnose DVT for patients in the Dr. SardjitoÂ Hospital.Methods: This study was a diagnostic study with cross-sectional design. The subjects were patients withÂ DVT symptoms who visited Tulip clinic, outpatient and inpatient in the department of Dr. Sardjito GeneralÂ Hospital during January 2011-May 2012. In this study, a total of 100 patients were participated the WellsÂ clinical model of pretest probability for DVT examination, Doppler ultrasound and D-dimer examination.Â The negative results on the fi rst ultrasound examination will be examined again 1 week later.Results: DVT was confi rmed in 56 patients (56%) from 100 patients. The baseline characteristics showedÂ the number of women more than men and the mean age was 52.98 Â±1.335 years. The 57% of subjectsÂ were women and the median age was â¥60 years. The most frequent risk factors of DVT were cancer 49Â patients (49%), bed ridden 42 patients (42%) and elderly 33 patients (33%). The accuracy of the Wells clinicalÂ model of pretest probability for DVT was 81%, precision was 77.6%, sensitivity was 92.8%, specifi city wasÂ 65.9%, and negative predictive value was 87.9%.Conclusion: The Wells clinical model for predicting pretest probability in DVT has a high accuracy, moderateÂ precision, high sensitivity and poor specifi city to diagnose DVT at Dr. Sardjito Hospital.Keywords: deep vein thrombosis/DVT, the Wells clinical model of pretest probability for DVT, accuracyÂ test, precision

ACUTE PULMONARY EMBOLISMS Hariadi, Kartika Widayati Taroeno
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Acta Interna The Journal of Internal Medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar

ABSTRACTAcute pulmonary embolisms is a major cause of complications and death associated in surgery, medical illnesses, injury, and also may occurs afterÂ a long-distance air travel. It is often originating from deep-vein thrombosis and has a wide spectrum of clinical manifestation ranging from asymptomatic, incidentally discovered emboli, to massive embolism causing immediate death. Incidence of pulmonary embolism ranges from 23-69 cases per 100,000 populations. Case fatality rates vary widely depending on the severity of the cases; at an average case fatality rate within 2 week of diagnosis of approximately 11%. It may have chronic sequele as post thrombotic syndrome and chronic thromboembolism pulmonary hypertension.Â Â Â Â Â Â Â Â Â Â Â Acute pulmonary embolism is often difficult to diagnose. The predisposing factors for pulmonary embolisms consist of hereditary factors, acquired factors, and probable factors. Patients with symptoms of dyspnea, chest apnea, tachypnea or tachycardia arise suspiciousness of pulmonary embolisms therefore should be screened their probability for developing the disease. Low risk patients will then be evaluated for d-dimer test. Treatment should be initiated promptly in high risk patients, followed by imaging procedure evaluation. Chest radiographs, CT scan arteriography, VQ scan are performed to either include or exclude diagnosis of pulmonary embolisms.Â Â Â Â Â Â Â Â Â Â Â Treatments consist of thrombolysis for acute and unstable massive pulmonary embolisms, and anticoagulation with heparin for stable acute pulmonary embolism. A meta-analysis of several major trials showed that low molecular weight heparin is at least as effective as unfractionated heparin in preventing the recurrence of venous thromboembolism events and at least as safe with respect to the rate of major bleeding.Â Â Â Â Â Â Â Â Â Â Â This review will further describe in detail the pathomechanisms, diagnosis, and management of acute pulmonary embolisms.Â

Secondary acute myeloblastic leukemia after adjuvant chemotherapy and radiotherapy in breast cancer: A case report Hardianti, Mardiah Suci; Kurnianda, Johan; Taroeno-Hariadi, Kartika Widayati
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 46, No 03 (2014)
Publisher : Universitas Gadjah Mada

A rising number of long-term survivors and potential long-term outcome related to the treatment isone of the most important issue due to the advances of management in cancer. The development ofsecondary malignancy has been reported in a number of cohorts. We present a case of breast cancerpatient developing acute myeloid leukemia (AML)- M5 within a relatively short interval of two and ahalf years from her primary treatment with adjuvant chemotherapy with 4 cycles of doxorubicin andcyclophosphamide, followed by 4 cycles of three weekly paclitaxel (AC-T) and radiotherapy. Whatcould be attributed to the occurrence of secondary leukemia in this patient will be discussed.

Efikasi Afatinib dan Gefitinib pada Pasien Non-small Cell Lung Cancer EGFR Mutasi Positif: Tinjauan Sistematis Seftika Sari; Tri M. Andayani; Dwi Endarti; Kartika Widayati
Indonesian Journal of Clinical Pharmacy Vol 8, No 4 (2019)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2019.8.4.289

Tyrosine kinase inhibitors (TKIs) telah direkomendasikan oleh National Comprehensive Cancer Network (NCCN) sebagai terapi lini pertama pada pasien non-small cell lung cancer (NSCLC) dengan mutasi EGFR, yaitu gefitinib (generasi pertama) dan afatinib (generasi kedua). Beberapa penelitian telah dilakukan terkait efikasi golongan TKIs ini, namun masih sedikit yang melakukan tinjauan sistematis (systematic review) secara khusus pada afatinib dan gefitinib. Systematic review ini bertujuan untuk memberikan gambaran secara komprehensif terkait efikasi afatinib dan gefitinib sebagai terapi lini pertama. Database yang digunakan untuk mengidentifikasi studi yang relevan yaitu Science Direct, PubMed dan Google Scholar. Penelitian ini terbatas pada penelitian randomized control trial, penggunaan afatinib dan gefitinib sebagai terapi lini pertama, penggunaan afatinib dan gefitinib secara monoterapi serta artikel yang menggunakan bahasa Inggris. Penelusuran berbasis data elektronik menghasilkan 2089 artikel; 48 artikel yang sudah sesuai dengan judul dan abstrak, namun hanya 8 artikel yang sesuai dengan inklusi yang ingin ditinjau. Secara umum efikasi afatinib dan gefitinib lebih unggul dibandingkan kemoterapi berbasis platinum, dapat dilihat dari progression free survival dari kedua obat ini yang lebih lama dibandingkan kemoterapi berbasis platinum. Walaupun nilai overall survival-nya tidak begitu lebih baik, afatinib dapat memperlambat perkembangan tumor lebih baik dibandingkan gefitinib. Efek samping yang sering terjadi pada afatinib dan gefitinib yaitu ruam dan diare, sedangkan neutropenia, mual, anemia sering terjadi pada penggunaan kemoterapi berbasis platinum. Afatinib dan gefitinib memberikan efikasi yang lebih baik dibandingkan kemoterapi berbasis platinum, namun afatinib memiliki efikasi yang lebih unggul dibandingkan gefitinib dalam pengobatan lini pertama pada pasien NSCLC dengan mutasi EGFR.Kata kunci: Afatinib, efikasi, gefitinib, non-small cell lung cancer Afatinib and Gefitinib Efficacy on Non-small Cell Lung Cancer EGFR Mutation Patients: A Systematic Review AbstractTyrosine kinase inhibitors (TKIs) have been recommended by the National Comprehensive Cancer Networks (NCCN) as first-line therapy in non-small cell lung cancer (NSCLC) with EGFR mutation, namely gefitinib (first generation) and afatinib (second generation). Several studies have been conducted related to the efficacy of these TKIs, but few have conducted systematic reviews specifically afatinib and gefitinib. This systematic review aimed to provide a comprehensive overview of the efficacy of gefitinib and afatinib as first-line therapy. To identify the relevant studies, it used several databases such as Science Direct, PubMed, and Google Scholar. The review was limited to the randomized control trial study, the use of afatinib and gefitinib as first-line therapy, the use of afatinib and gefitinib as monotherapy, and articles written in the English language. An electronic data-based search identified 2089 articles; 48 articles matched the title and abstract, yet only 8 articles met the inclusion to be reviewed. In general, the efficacy of afatinib and gefitinib is more effective than platinum-based chemotherapy as showed that the progression-free survival of these medications is longer than platinum-based chemotherapy. Although the overall survival value is not better than platinum-based chemotherapy, afatinib inhibits the tumor growth better compared to gefitinib. Common side-effects in afatinib and gefitinib include rashes and diarrhea, while neutropenia, nausea, and anemia commonly occur in platinum-based chemotherapy. Afatinib and gefitinib offer better efficacy compared to platinum-based chemotherapy. Specifically, the afatinib has greater efficacy compared to gefitinib in first-line therapy for patient with NSCLC EGFR mutation.Keyword: Afatinib, efficacy, gefitinib, non-small cell lung cancer

ACUTE PULMONARY EMBOLISMS Kartika Widayati Taroeno Hariadi
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTAcute pulmonary embolisms is a major cause of complications and death associated in surgery, medical illnesses, injury, and also may occurs after a long-distance air travel. It is often originating from deep-vein thrombosis and has a wide spectrum of clinical manifestation ranging from asymptomatic, incidentally discovered emboli, to massive embolism causing immediate death. Incidence of pulmonary embolism ranges from 23-69 cases per 100,000 populations. Case fatality rates vary widely depending on the severity of the cases; at an average case fatality rate within 2 week of diagnosis of approximately 11%. It may have chronic sequele as post thrombotic syndrome and chronic thromboembolism pulmonary hypertension. Acute pulmonary embolism is often difficult to diagnose. The predisposing factors for pulmonary embolisms consist of hereditary factors, acquired factors, and probable factors. Patients with symptoms of dyspnea, chest apnea, tachypnea or tachycardia arise suspiciousness of pulmonary embolisms therefore should be screened their probability for developing the disease. Low risk patients will then be evaluated for d-dimer test. Treatment should be initiated promptly in high risk patients, followed by imaging procedure evaluation. Chest radiographs, CT scan arteriography, VQ scan are performed to either include or exclude diagnosis of pulmonary embolisms. Treatments consist of thrombolysis for acute and unstable massive pulmonary embolisms, and anticoagulation with heparin for stable acute pulmonary embolism. A meta-analysis of several major trials showed that low molecular weight heparin is at least as effective as unfractionated heparin in preventing the recurrence of venous thromboembolism events and at least as safe with respect to the rate of major bleeding. This review will further describe in detail the pathomechanisms, diagnosis, and management of acute pulmonary embolisms.

The Accuracy of Wells Clinical Model for Predicting Pretest Probability in Deep Vein Thrombosis (DVT) at Dr. Sardjito Hospital Dwi Wulansih; Johan Kurnianda; Kartika Widayati
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: The diagnosis of deep vein thrombosis (DVT) is an important issue in the medical field because a large number of cases are undiagnosed. The accurate diagnosis of the DVT is essential to prevent complications of acute pulmonary embolism and long-term complications. The complication such as pulmonary hypertension and post phlebitis syndrome. It also to avoid improper anticoagulant therapy associated with a high risk of bleeding. There are several models of clinical suspicion of DVT include Hamilton’s score and Wells’ score. The Wells clinical model for predicting pretest probability for DVT has been widely used and tested its validity in several countries in Europe. The accuracy of a Wells clinical model of pretest probability for DVT has not been done for the races of Asia especially in Indonesia.Objective: This study aimed to test the accuracy and precision (sensitivity, specificity and predictive value) of Wells clinical model for predicting pretest probability for diagnose DVT for patients in the Dr. Sardjito Hospital.Methods: This study was a diagnostic study with cross-sectional design. The subjects were patients with DVT symptoms who visited Tulip clinic, outpatient and inpatient in the department of Dr. Sardjito General Hospital during January 2011-May 2012. In this study, a total of 100 patients were participated the Wells clinical model of pretest probability for DVT examination, Doppler ultrasound and D-dimer examination. The negative results on the fi rst ultrasound examination will be examined again 1 week later.Results: DVT was confi rmed in 56 patients (56%) from 100 patients. The baseline characteristics showed the number of women more than men and the mean age was 52.98 ±1.335 years. The 57% of subjects were women and the median age was ≥60 years. The most frequent risk factors of DVT were cancer 49 patients (49%), bed ridden 42 patients (42%) and elderly 33 patients (33%). The accuracy of the Wells clinical model of pretest probability for DVT was 81%, precision was 77.6%, sensitivity was 92.8%, specifi city was 65.9%, and negative predictive value was 87.9%.Conclusion: The Wells clinical model for predicting pretest probability in DVT has a high accuracy, moderate precision, high sensitivity and poor specifi city to diagnose DVT at Dr. Sardjito Hospital.Keywords: deep vein thrombosis/DVT, the Wells clinical model of pretest probability for DVT, accuracy test, precision

Validation of the Palliative Prognostic Score (PaP score) in Patients with Metastatic Cancers in Dr. Sardjito General Hospital Yogyakarta Prafita Cahya Dewanti; Johan Kurnianda; Kartika Widayati
Acta Interna The Journal of Internal Medicine Vol 9, No 1 (2019): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Background. The mortality burden of cancer continues to increase in developing countries, most likely because of a late-stage at diagnosis. Identify the terminal stage is important in patients with advanced cancer because no longer aggressive therapy in patients with terminal cancer. Palliative prognostic score (PaP score)is a scoring system to predict the probability of survival within 30 days in patients with advanced cancer. PaP score divided into the heterogeneous patient sample into three iso-prognostic groups related to the chance of 30-days survival. Group A, score: 0 to 5.5 (the probability of survival within 30 days > 70%); Group B, score: 6-11 (the probability of survival in 30 days 30-70%) and group C, the score: 11.5 to 17.5 (the probability of survival in 30 days <30%).Aims. The aim of this study was to validate and to evaluate the prognostic accuracy of the palliative prognostic (PaP score) to predict 30-days survival in patients with metastatic cancers in Dr. Sardjito General Hospital Yogyakarta.Methods. The design of this prognostic study was cohort, including patients with metastatic cancers who were visited in Tulip Hematology and Medical Oncology Clinic, inpatient and outpatient care in Dr. Sardjito General hospital during May 2015 until May 2016. The PaP score calculated in 159 consecutive patients with metastatic cancers. The positive predictive value of the PaP score was evaluated and survival analysis was performed to compare the survival of the three prognostic groups.Results. PaP score tested on 159 subjects with overall median survival was 90 days, 76 subjects categorized into group A, 22 subjects into group B and 61 patients into group C. The 30-day survival probability was 98.7% for group A (median survival could not be assessed), 63.6 % probability of 30-day survival for the group B with median survival was 35 days and for group C with 3.3% probability of 30-day and median survival was 6 days. These survival differences were highly significant (log-rank test of trends, X =203.97; P<0.0001).The positive predictive value of the PaP score in predicting 30-day mortality was 96.7% with an accuracy of PaP the score was 93.1%.Conclusion. PaP score was a valid test tool in determining prognosis in patients with metastatic cancers with high accuracy and precision in predicting 30-days survival.Keywords: PaP score, validation, survival, prognostic, metastatic cancers.

Secondary acute myeloblastic leukemia after adjuvant chemotherapy and radiotherapy in breast cancer: A case report Mardiah Suci Hardianti; Johan Kurnianda; Kartika Widayati Taroeno-Hariadi
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 46, No 03 (2014)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

A rising number of long-term survivors and potential long-term outcome related to the treatment isone of the most important issue due to the advances of management in cancer. The development ofsecondary malignancy has been reported in a number of cohorts. We present a case of breast cancerpatient developing acute myeloid leukemia (AML)- M5 within a relatively short interval of two and ahalf years from her primary treatment with adjuvant chemotherapy with 4 cycles of doxorubicin andcyclophosphamide, followed by 4 cycles of three weekly paclitaxel (AC-T) and radiotherapy. Whatcould be attributed to the occurrence of secondary leukemia in this patient will be discussed.

Diffuse Large B-Cell Lymphoma Complicated by Small Bowel Obstruction after Radiotherapy: a Case Study Diah Ari Safitri; Kartika Widayati Taroeno-Hariadi; Johan Kurnianda; Ibnu Purwanto
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 48, No 3 (2016)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

ABSTRACTAlthough the spleen is frequently involved in disseminated non-Hodgkin’s lymphoma (NHL), splenic presentation as the initial or only site of disease is uncommon. Treatment modalities include surgery, chemotherapy, and radiation therapy. The priority of cancer follow up is to perform surveillance for recurrent cancer and evaluation of treatment response. Side effects of treatment are frequently missed or overlooked. A 66-year-old woman was presented to our hospital with a month history of spleen enlargement. On physical examination the spleen was palpated at Schuffner 2. Abdominal MSCT scan was suggestive of lymphoma. Surgery revealed adhesion and obstruction of the stomach. Biopsy and gastrojejunostomy shunting were done, but splenectomy was difficult. The pathology anatomy findings confirmed the diagnosis of diffuse non Hodgkin’s lymphoma large B-cell type. Immunohistochemistry showed positive CD3 and CD20. She underwent 6 cycles of rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone (RCHOP) chemotherapy. CT evaluation done 7 months later revealed that the hilus lienalis lymph nodes and spleen has decrease in size. However, a lumbosacral x-ray done due to back pain revealed metastasis on her 1st and 2nd lumbal spine. After a single fraction of radiotherapy, nausea, vomiting and abdominal distension occurred. A 3 position abdominal x-ray revealed signs of small bowel obstruction. After surgery she has received 9 cycles of zoledronic acid and remained in good condition and ambulatory. Splenic presentation as the initial or only site of non-Hodgkin’s lymphoma (NHL) is uncommon. Acute small bowel obstruction and fistula due to palliative radiation therapy for bone metastasis needs prompt and appropriate treatment.

EVALUASI TERAPI ADJUVAN DAN KEJADIAN RELAPS PADA PASIEN PREMENOPAUSAL EARLY BREAST CANCER DI RSUP DR. SARDJITO YOGYAKARTA Fef Rukminingsih; Tri Murti Andayani; Fita Rahmawati; Kartika Widayati
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 7, No 1
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.364

Terapi adjuvan pada pasien early breast cancer (EBC) bertujuan untuk meningkatkan disease free survival, menurunkan risiko relaps dan menurunkan angka kematian. Tetapi pada kenyataannya masih sering dijumpai, pasien EBC yang telah mendapat terapi adjuvan mengalami relaps. Kejadian relaps sering dihubungkan dengan meningkatnya risiko kematian tanpa memperhatikan jenis pengobatan. Tujuan penelitian ini adalah mengetahui angka kejadian relaps pada pasien premenopausal EBC yang telah mendapatkan terapi adjuvan di RSUP dr. Sardjito Yogyakarta. Penelitian ini merupakan penelitian deskriptif observasional dengan desain cross sectional study menggunakan data retrospektif yang diperoleh dari data rekam medik pasien premenopausal EBC di Poliklinik Kanker Terpadu “Tulip” RSUP dr. Sardjito Yogyakarta yang telah mengalami tindakan pembedahan pada tahun 2010-2013, bersifat hormon responsif dan HER-2 negatif, mendapatkan terapi adjuvan, perempuan dengan umur 18-60 tahun dan riwayat pemeriksaan sampai bulan Desember 2016. Pasien akan di eksklusi bila mempunyai penyakit penyerta. Dari 30 pasien diketahui sebanyak 46,67% berumur 41-50 tahun, sebanyak 63,33% menunjukkan ekspresi ER-PR positif, sebanyak 93,34% merupakan invasive ductal carcinoma (IDC). Semua pasien mendapatkan terapi adjuvan kemoterapi menggunakan regimen kombinasi dan semua pasien mendapatkan terapi endokrin berupa tamoksifen. Relaps terjadi pada 11 pasien (36,67%) dan kejadian relaps paling banyak adalah metastasis tulang yaitu pada 8 pasien (26,67%).

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