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The effect of ACTH4-10Pro8Gly9Pro10 and HMG-CoA reductase inhibitor in moderate head injury: clinical outcome and serum Bcl-2 concentration Indharty, Suzy
Medical Journal of Indonesia Vol 22, No 4 (2013): November
Publisher : Faculty of Medicine Universitas Indonesia

Background: An important component of brain tissue damage is apoptotic neuronal death. Bcl-2 is an anti-apoptotic protein, which inhibits the intrinsic pathway of apoptosis. ACTH4-10Pro8Gly9Pro10 and HMG-CoA reductase inhibitor are known for their neuroprotective effects. This study aimed to compare the effect of standard therapy, ACTH4-10Pro8Gly9Pro10, and HMG-CoA reductase inhibitor (simvastatin 40 mg/day) on serum Bcl-2 levels, clinical outcome, and reduction of hospital stay.Methods: Sixty subjects with moderate head injury without any indication for surgery were taken consecutively and separated into three groups: standard treatment only (control group), standard treatment combined with ACTH4-10Pro8Gly9Pro10, and standard treatment combined with inhibitor of HMG-CoA reductase. Blood samples were taken on day-1 and day-5 from each subject for measurement of Bcl-2 concentration. Barthel Index and MMSE were measured at discharge and hospital length of stay was noted. Difference in mean was analyzed with one way ANOVA and correlation between Bcl-2 and clinical outcome was measured with Pearson correlation test.Results: Bcl-2 serum levels on day-1 and day-5 were tespectively as follows: in control group were 1.39 ± 0.75 and 1.48 ± 0.77 ng/mL; in ACTH4-10Pro8Gly9Pro10 group 1.39 ± 0.70 and 3.70 ± 1.01 ng/mL which was significantly higher compared to other groups and associated with the shortest length of stay. In simvastatin group, 1.53 ± 0.55 and 2.17 ± 0.56 ng/mL. We found the length of stay in the ACTH4-10Pro8Gly9Pro10 group to be significantly shorter (p < 0.001). The correlation of clinical outcome (Barthel index and MMSE) with serum Bcl-2 levels was not significant.Conclusion: ACTH4-10Pro8Gly9Pro10 significantly increased serum Bcl-2 concentration in head injury and associated with shorter length of stay. An increase of serum Bcl-2 concentration was also found in simvastatin group, but it was not significant. (Med J Indones. 2013;22:221-6. doi: 10.13181/mji.v22i4.604)Keywords: ACTH4-10Pro8Gly9Pro10, Bcl-2, traumatic brain injury

REVIEW OF NASA FIBROMYXOMA: Aggressive Behaviour? (Case Report) Indharty, Rr. Suzy
BALI MEDICAL JOURNAL Vol 4 No 3 (2015)
Publisher : BALI MEDICAL JOURNAL

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Background: Myxomas are rare benign tumors arising from mesenchymal tissues throughout the body. These tumors are usually seen in the atrium of the heart and the jawbone. Involvement of the skull base with intracranial extension is extremely rare, and only a few cases of primary intracranial myxomas have been described in the literature. This article presents a rare case of primary myxoma of the nasal bone. Methods: The patient underwent a skull base surgery with a pre-diagnosis of possible fibromyxomas. The tumor pathology revealed a diagnosis of myxoma with bone and meningeal involvement. Despite the debulking surgery, the tumor showed a local recurrence in five month. A second debulking surgery in piece meal was required. In the article, the etiology, histological and radiological findings as well as treatment options of this rare entity were briefly discussed under the highlights of the relevant literature. Such a localization and intracranial extension of myxomas is extremely unusual in clinical practice; the diagnosis therefore requires a high degree of suspicion and detailed histopathological examination. The differential diagnosis frequently includes chondrosarcomas, chordoma, metastatic tumors of the skull, hemangiopericytoma, meningioma and other neoplasms of the dura and skull base in this location.

INCREASE OF SERUM BCL-2 CONCENTRATION IN SEVERE HEAD INJURY: The Role of ACTH4-10Pro8Gly9Pro10 and HMG Co-A Reductase Inhibitor Suzy-Indharty, Rr
BALI MEDICAL JOURNAL Volume 2 Number 1, January-April 2013
Publisher : BALI MEDICAL JOURNAL

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Objective: ACTH4-10Pro8Gly9Pro10 and HMG Co-A reductase inhibitor had a well-known neuroprotective effects. One important process happened in head injury is apoptotic neuronal death. Bcl-2 is one of anti-apoptotic protein inhibits the intrinsic pathway of apoptosis. This study aimed to compare the effect of standard therapy, ACTH4-10Pro8Gly9Pro10, and HMG Co-A reductase inhibitor on serum Bcl-2 levels and the potential effect to a better outcome and reduction of hospital stay. Method: Subjects of severe head injury without any indication for surgery were taken consecutively (n=60) and separated into three groups of; standard treatment only (control group), standard treatment combined with ACTH4-10Pro8Gly9Pro10, and standard treatment combined withInhibitor HMG CoA Reductase. Blood samples were taken on day-1 and day-5 from each subject for measurement of Bcl-2 concentration. Barthel index and MMSE were measured at discharge and hospital length of stay was noted. Results: Bcl-2 serum levels in control group was 1.49±1.01 ng/mL on day one and 1.64±0.61 ng/mL on day five; and 1.72±1.40 ng/mL on day one and 4.02±1.19 ng/mL on day five after treatment with ACTH4-10Pro8Gly9Pro10. In the HMG Co-A reductase inhibitor group, Bcl-2 serum level was 1.55±0.98ng/mL on day one and 2.00±0.90ng/mL on day five. The correlation of outcome (Barthel Index and MMSE) with serum Bcl-2 levels was not significant. We found the length of stay in the ACTH4-10Pro8Gly9Pro10 group was significantly shorter (p<0.05; CI 95%). Conclusion: ACTH4-10Pro8Gly9Pro10 significantly increased serum Bcl-2 concentration in head injury. Although we didn’t find any correlation between serum Bcl-2and outcome (Barthel Index and MMSE), therapy with ACTH4-10Pro8Gly9Pro10 resulted in a significantly shorter hospital length of stay.

Langerhans Cell Histiocytosis: A Case Report Suzy-Indharty, Rr.
BALI MEDICAL JOURNAL Volume 1, Number 2, May-August 2012
Publisher : BALI MEDICAL JOURNAL

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Objective: Langerhans Cell Histiocytosis (LCH) is a rare proliferative disorder of a distinct cell type that is similar to Langerhans cell. Prevalence is estimated at 1:200.000/year in children. Clinical presentations are variable, ranging from a single location in the bone to severe multivisceral involvement leading to dysfunction of vital organs. Therefore, objective of this study was to explore LCH based on clinical findings, skull x-ray, head CT-Scan, cytology, histopathology. and Immunohistochemistry. Method: We report a case of Langerhans Cell Histiocytosis of a 3-year-old boy. Fine needle aspiration biopsy was performed from a nodule in parietal area on the scalp; dry fixation was made and stained with Giemsa. Immunohistochemistry examination was performed with CD1a and S100. Histopathology examination was done post-operatively and cytology examination were consistent with LCH, composing Langerhans cells with complex, clefted, grooved, irregular or convoluted nuclei with fine chromatins and one or more small nucleoli and moderate to abundant quantities of eosinophilic cytoplasm, mixed with multinucleated eosinophils. Results: The finding of pentalaminar Birbeck granules by electron microscope is diagnostic of LCH, but this examination cannot be performed in our institution, so diagnosis was supported by immunohistochemistry with CD1a and S 100. Conclusions: Based on clinical findings, skull x ray, Head CT-Scan, cytology, histopathology and Immunohistochemistry, this case was concluded as a Langerhans Cell Histiocytosis.

Analysis of Glial Fibrillary Acidic Protein (GFAP) Serum Levels on Spontaneous Intracerebral Hemorrhage Non-Lesion Patients Indharty, Suzy; Japardi, Iskandar; Fadhli, Muhammad
BALI MEDICAL JOURNAL Vol 5 No 1 (2016)
Publisher : BALI MEDICAL JOURNAL

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Background: Stroke is one of the root causes of brain disorders at the height of the productive age and ranks second cause of death after heart disease in most countries in the world. Fairly large-scale study conducted by ASNA (ASEAN Neurological Association) in 28 Hospitals in Indonesia. This study was conducted in patients with acute stroke who were treated in hospital (hospital-based study) and conducted a survey of factors - risk factors, treatment duration and mortality and morbidity. Method: This is a cross sectional study, with intracerebral hemorrhage Head CT scan examination then examined serum levels of plasma GFAP her at the time of patient entry from RSUP. H. Adam Malik Medan from March 2014 -May 2014. Results: In this research, we found the frequency of male patients as many (62.5%), while as many women (37.5%). Predominant age range in patients encountered in this study were 46-51 years old and are the dominant ethnic Batak tribe (43.8%). Conclusion: There were no significant differences between groups in serum GFAP levels with bleeding volume ? 30 cc compared to those with bleeding volume

Hubungan antara reseptor progesteron dengan Ki-67 labeling index pada meningioma Steven Tandean; Rr Suzy Indharty; Iskandar Japardi; Sufida dr
Majalah Kedokteran Nusantara The Journal Of Medical School Vol 46, No 1 (2013): The Journal of Medical School
Publisher : Fakultas Kedokteran USU

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Introduction : Meningiomas are benign tumor and the most prevalent intracranial tumors which recur locally. Their morphologic grading do not always correlate with patient outcome and some of them associated with a less favorable clinical outcome. The incidence in women is approximately twice than in men. Progesterone receptors may play role in the proliferation and grading of meningiomas. Aims of this study isto evaluate the correlation of progesterone receptor status with proliferation marker ki67 in various grades of meningioma.Methods : A retrospective research of 30 paraffin-embedded sections of meningiomas was collected that was done histological typing and grading with hematoxylin and eosin. Immunodetection of Progesterone receptors was conducted with peroxidaseantiperoxidase complex and Ki-67 was achieved by streptavidin-biotin peroxidase complex. Progesterone receptors status considered positive if >50% of nuclei were stained with medium intensity or >10 of tumor cell’s nuclei were strongly stained. The Ki-67 is defined into three groups as no proliferation, low proliferation (<14%), and high proliferation (> 14%). Results : Progesterone receptors were positive in 13/27 (48.1%) of grade I tumors, 1/2 (50%) of grade II tumors, and 0/1 (0%) of grade III tumor. In grade I tumor, negative progesterone receptors with negative Ki-67 was 6/14 (42.9%) and low Ki-67 was 8/16 (57.1%). While, positive progesterone receptors with negative Ki-67 was 7/13 (53.8%), low Ki-67 was 4/13 (30.8%), and high Ki-67 was 2/13 (15.4%). In grade II tumor, negative progesterone receptors with negative Ki-67 and positive progesterone receptors with low Ki-67 expression. In grade III tumor, negative progesterone receptors with negative Ki-67 expression. Conclusion : There was a not significant relationship between Ki-67 and progesterone receptors status, but high Ki-67 expression was only found in positive progesterone receptors. Progesterone receptors may play role in proliferation of meningioma. Keywords : meningioma; progesterone; receptor; Ki-67 antige

Hubungan raeseptor estrogen dengan Ki-67 labeling index pada meninagioma intrakranial Abdurrahman Mouza; Iskandar Japardi; Suzy Indharty
Majalah Kedokteran Nusantara The Journal Of Medical School Vol 50, No 2 (2017): The Journal of Medical School
Publisher : Fakultas Kedokteran USU

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Introduction : Meningioma occurs more in women than men with ratio 2 : 1. Mitosis of meningioma is stimulatedbyfewgrowth factorsand one of itis estrogen. Expression of estrogen receptor on meningioma showsthat clinical meningioma has characteristic more aggressive. Proliferation Index can be measured by antibody of Mind Bomb (MIB-1) binding Ki-67 antigen. Ki-67 is showed on the cells which proliferating through cells cycle.Relation between estrogen receptor and cell proliferation is interesting because it has controversy.Method : This Study used Cross Sectional method for analising relation between estrogen receptor and Ki-67 in patients have been diagnosed meningioma. This study has been done at general hospital H. Adam Malik Medan and laboratorium of patologi anatomi at Murni Teguh hospital.This study did in Oktober-November 2013.Result : In this study is almost meningioma grade I stained Ki-67 not have mitosis with amount 13 sample (43.3%) or positive mitosis is 14 sample (45%). While immunohistochemistry staining of estrogen receptor on meningioma grade I has 25 negative sample (83.3%) and 14 positive sample (51.8%). All of grade I and II are negative.Relation of these staining was used Chi-Square with limit value p<0.05. This result is p=0.677 that shows no significance relation between estrogen receptor and labeling Index Ki-67.Conclusion : These histopatology have many frequents type that is 16 cases of meningothelial meningioma (53.3%), fibroblastic meningioma, and 4 cases transitional meningioma (13.3%). The result is no relation between estrogen receptor and Ki-67 with p=0.667 (p>0.05).Other results are no relation Ki-67 with age p=0.204 (p>0.05) and sex p=0.121 (p>0.05). Keywords : estrogen receptor, Ki-67, meningioma

Pengaruh kadar protein dan jumlah sel CSF terhadap angka kejadian malfungsi VP shunt di RS. H. Adam Malik Medan Indra Saputra; Rr. Suzy Indharty; A. Gofar Sastrodiningrat
Majalah Kedokteran Nusantara The Journal Of Medical School Vol 47, No 2 (2014): The Journal of Medical School
Publisher : Fakultas Kedokteran USU

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Background : Hydrocephalus is a disorder formation or absorption of fluid flow cerebrospinal. Number of cases of hydrocephalus in the world is quite high at around 0.5 -4 per 1000 live births while in Indonesia as much as 2-3 per 1000 live births. Ventriculoperitoneal shunt (VP shunt) is the main option in the treatment of hydrocephalus. One of the complications that occur in the installation of VP shunt was VP shunt malfunctions that happen as much as 25-40% especially in the first year after installation of VP shunt.Methods : The study was conducted on 169 hydrocephalus patients who performed the installation VP shunt in Haji Adam Malik Hospital Medan since January 2010 to December 2012. The data were analyzed using chi square and p values <0.05 were considered as significant.Results : In the 169 patients who performed the installation of VP shunt, 47 patients (27.8%) of them had VP shunt malfunction. Among the 47 patients who had malfunctions of VP shunt, 16 patients (40%) had shown increased of total cerebrospinal fluid protein and it had been statistically significant association between the incidence of VP shunt malfunction with cerebrospinal fluid protein levels (p = 0.049). While the examination of the number of cells in the cerebrospinal fluid of 47 patients who had VP shunt malfunctions, 14 patients (36%) had shown the increasing of number of cells in the cerebrospinal fluid and this indicates that the relationship of the incidence of VP shunt malfunction with the number of cells in the cerebrospinal fluid was not statistically significant (p =0.199).Conclusion : There is a significant correlation between cerebrospinal fluid protein levels with the incidence of VP shunt malfunction. While the number of cells in the cerebrospinal fluid showed no significant correlation with the incidence of VP shunt malfunctions.Keywords : Malfunction; VP shunt; protein; cel count; cerebrospinal fluid; Hydrocephalus

Evan’s Index Values and Its Relationship with Individual Characteristics (Age and Gender) in Head CT-Scan Examination at Haji Adam Malik Hospital Medan 2021-2022 Zamzami, Muhammad Avicienna; Daulay, Elvita Rahmi; Indharty, Suzy
Journal of Society Medicine Vol. 2 No. 7 (2023): July
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v2i7.69

Introduction: Enlargement of the ventricles caused by disturbances in the production, flow, and absorption of cerebrospinal fluid is known as hydrocephalus.Radiological examinations such as computed tomography (CT) play an important role in establishing the diagnosis of hydrocephalus. Assessment of ventricular enlargement in most cases is done subjectively and based on radiological experience. Objectively, ventricular size can be assessed by linear ratios on CT. Evan's index (EI) is the simplest and most reliable method for assessing ventricular size. Age and sex have an influence on the size of the ventricles. The aim of this study was to determine the average Evan's Index and its relationship with individual characteristics (age and sex) in patients who underwent head CT scans at H. Adam Malik General Hospital, Medan. Method: This study used a case series design to determine the relationship between individual characteristics (age and gender) with the Evan's Index value and to obtain an average normal Evan's Index value in patients who underwent head CT scans at the Haji Adam Malik General Hospital in Medan. Results: : The highest sample age was in the 19-30 year age group, namely 39 people (35%). In this study, there were more female subjects, namely 51% compared to males (49%). Mean + standard deviation and median (min-max) in Evan’s Index data were 0,26 + 0,03 and 0,25 (0,2-0,36). There was a significant correlation between age and the Evan's Index (p <0.001) with a moderate degree of correlation (0.442). There was no significant relationship between gender and Evan's Index (p=0,121; ηp2=0,022). There was no significant difference between education levels and the average Evan's Index (p=0.434). Conclusion: There is a relationship between the increase in the age group of the participants and the increase in the EI value which is linear and correlative. There was no difference in EI values between gender and level of formal education regardless of the age group of the individuals analyzed.

Effect of face masks on dyspnea perception, cardiopulmonary parameters, and facial temperature in healthy adults Ramoti, Natanael; Siahaan, Andre MP.; Indharty, Suzy; Adella, Cut A.
Narra J Vol. 4 No. 1 (2024): April 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i1.574

Respiratory droplets, naturally produced during expiration, can transmit pathogens from infected individuals. Wearing a face mask is crucial to prevent such transmission, yet the perception of dyspnea and uncomfortable breathing remains a common concern, particularly during epidemics. The aim of this study was to investigate the impact of face mask use on the perception of dyspnea, cardiopulmonary parameters, and facial temperature during physical activity. A randomized crossover study was conducted on healthy adults at a physiology laboratory located in the Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia, in November 2022. Participants underwent five stages of physical exercise tests based on the Bruce Protocol under three conditions: without any face mask (control), wearing a surgical mask, and an N95 mask, forming the study's main groups. Dyspnea perception (measured by the Modified Borg Dyspnea Scale), cardiopulmonary parameters (heart rate, oxygen saturation, respiratory rate, blood pressure, and mean arterial pressure) and facial temperature were measured before the exercise test (pre-workout), at the end of stage 1, 2, 3, 4, 5, and after the whole exercise test (post-workout). A two-way repeated measures ANOVA was conducted, considering two factors: the type of mask (control, surgical mask, N95 mask) and the various stages of the exercise test. A total of 36 healthy adults were included in the study. We found that dyspnea perception was much worse in the N95 mask group, particularly during vigorous exercise. There was no significant difference between groups in cardiopulmonary parameters. However, participants wearing N95 had a greater supralabial temperature than those wearing surgical masks or no mask at all. It is recommended to undertake a more in-depth evaluation of cardiopulmonary physiological measures.

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