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All Journal Acta Interna : The Journal of Internal Medicine Journal of the Medical Sciences (Berkala Ilmu Kedokteran) JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Jurnal Gizi Klinik Indonesia Budapest International Research and Critics Institute-Journal (BIRCI-Journal): Humanities and Social Sciences Journal of Innovation in Management, Accounting and Business The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Pendidikan Indonesia (Japendi) Jurnal Penyakit Dalam Indonesia Journal of Mandalika Literature

Neneng Ratnasari

Division Of Gastroenterology And Hepatology, Department Of Internal Medicine, Faculty Of Medicine, Gadjah Mada University-Sardjito General Hospital, Yogyakarta

Author-ID : 2968414

Religion Arts Humanities Biochemistry, Genetics & Molecular Biology Economics, Econometrics & Finance Education Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences

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Correlation between leptin level with lipid profile and free fatty acid in liver cirrhosis patients Siti Maryani; Neneng Ratnasari; Siti Nurdjanah
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 46, No 03 (2014)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Malnutrition is a common condition in liver cirrhotic patients. Leptin regulates body weightphysiologically by suppressing appetite and increasing energy expenditure. Leptin is higher in femalethan male. Studies have shown correlation between leptin with metabolic factors like body massindex (BMI) and lipid profile in cirrhotic patients. This study was conducted to investigate thecorrelation between serum leptin levels with lipid profile and free fatty acid in male patients with livercirrhosis. This was a cross sectional study that conducted at Gastroentero-Hepatology Clinic andInternal Ward at Dr. Sardjito General Hospital, Yogyakarta. The inclusion criteria were patients withliver cirrhosis > 18 years old, male, with Child-Pugh classification B and C, and provided informedconsent. The exclusion criteria were liver cirrhotic patients with comorbidity chronic kidney disease,chronic heart failure, diabetic, cancer, infection/septic, pregnancy, breast feeding, and steroid use.Data collecting was performed by anamnesis, physical examination, abdominal ultrasonographyexamination, and blood chemistry test. Pearson test was used to evaluate the correlation betweenthe serum leptin level with the lipid profile and free fatty acid. The results showed that no significantnegative correlation was observed between the serum leptin level with the total cholesterol (r= -0.052; p=0.766), high-density lipoprotein/HDL (r= -0.078; p=0.658) and triglyceride (r= -0.170; p=0.328) in male patients with liver cirrhosis. Furthermore, no significant positive correlationwas observed between the serum leptin levels with the low-density lipoprotein/LDL (r= -0.013; p=0.942) and free fatty acid/FFA (r= 0.007; p=0.968). In conclusion, there was no correlationbetween serum leptin levels with lipid profile and FFA in male patients with liver cirrhosis.

Expression of circulating miR-200c and vascular endothelial growth factor-A (VEGF-A) mRNA as potential biomarker in human hepatocellular carcinoma Nanda Qoriansas; Dede Renovaldi; Juwita Raditya; Puji Lestari; Nur Signa Gumilas; . Suharno; Didik Setyo Heriyanto; Neneng Ratnasari; Sofia Mubarika H
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 50, No 4 (2018)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Hepatocellular carcinoma (HCC) is a common liver disease that causes significant publichealth problems throughout the world, including in Indonesia. The HCC is the six mostcommon cancers and second cancer-related deaths among men in the world. Recentlyit was reported that the microRNA is an important player in hepatocarcinogenesis. Theexpression of MiRNA-200c is often regulated in primary HCC and HCC cell lines. Vascularendothelial growth factor-A (VEGF-A) is a regulator of angiogenesis that has been reportedas miR-200c target gene. This study was conducted to measure expression levels in miR-200c and mRNAVEGF-A and their potential role as biomarkers at HCC. A total of 36HCC patients and 36 healthy subjects were included in this study. The relative expressionof miRNA-200c and mRNA VEGF-A was quantified using reverse transcription real timequantitative PCR (qRT PCR). Relative expression was calculated using . Unpaired t-testwas used to compare the expression levels of circulating miRNA-200c and mRNA VEGF-Ain HCC patients and healthy subjects. Pearson test was used to determine correlationbetween circulating miR-200c expression and mRNA VEGF-A expression levels. Theexpression levels of circulating miR-200c in HCC patients were lower compared to healthysubjects although it was not significant (p = 0.258). Conversely, the expression levelsof circulating mRNA VEGF-A in HCC patients were significantly higher compared tohealthy subjects (p = 0.001). The relative expression levels of circulating miR-200c werenegatively correlated with mRNA VEGF-A in HCC patients. In conclusion, the expressionlevels of mRNA VEGF-A in HCC patients are significantly deregulated in compared tothat in healthy subjects. Negative correlation between circulating miRN-200c and mRNAVEGF-A expression levels are reported in HCC patients.

ANALISIS PENGGUNAAN OBAT PADA KOMPLIKASI SIROSIS HATI Yeni Farida; Tri Murti Andayani; Neneng Ratnasari
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 4, No 2
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.270

Penatalaksanaan terapi sirosis hati bervariasi sesuai dengan komplikasi yang menyertai. Penelitian ini bertujuan untuk mengetahui gambaran penggunaan obat pada komplikasi sirosis hati dan membandingkan kesesuaiannya dengan standar pelayanan medik rumah sakit dan guideline Asia Pasific Ascociation Study for Liver (APASL). Penelitian ini merupakan penelitian observasional analitik dengan pengambilan data secara retrospektif. Subyek penelitian diperoleh dengan teknik purposive sampling dengan kriteria inklusi pasien dewasa dan rawat inap pada periode 2013. Data diperoleh dari rekam medik kemudian dianalisis dengan cara membandingkan kesesuaian pemberian obat dengan standar pelayanan medik rumah sakit dan guideline APASL. Subyek penelitian berjumlah 70 pasien dengan komplikasi utama hipertensi portal (varises esofagus) sebanyak 46 kasus, perdarahan 24 kasus, ascites 36 kasus, infeksi 28 kasus dan ensefalopati hepatik 24 kasus. Terapi utama hipertensi portal dengan propranolol, perdarahan dengan vitamin K, ascites dengan spironolakton dengan atau tanpa kombinasi furosemid, infeksi dengan sefalosporin generasi 3 dan quinolone, ensefalopati hepatik dengan laktulosa dengan atau tanpa neomisin, BCAA dan LOLA. Hasil penelitian menunjukan bahwa penanganan komplikasi sirosis hati di RSUP Dr. Sardjito belum semuanya sesuai dengan standar pelayanan medik rumah sakit dan guideline APASL. Pada kondisi pasien yang tidak mengalami perbaikan dengan terapi standar dilakukan modifikasi terapi seperti pada kasus perdarahan dengan menambahkan proton pump inhibitor (omeprazole, lansoprazol atau pantoprazol) dan asam traneksamat. Kata kunci: pengobatan sirosis hati, komplikasi sirosis hati, standar pelayanan medik rumah sakit,

Evaluation of Spironolactone in Combination with Furosemide in Cirrhotic Patients with Permagna (Large) Ascites Tuty Mulyani; Fita Rahmawati; Neneng Ratnasari
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 7, No 2
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.30285

Ascites happens in 50% of patients with liver cirrhosis, Some of them experienced permagna ascites (large ascites). Based on the European Association for the Study of the Liver (EASL) guidelines in 2010, therapy of permagna ascites (large ascites) is paracentesis followed by restriction of sodium intake and diuretics. The use of diuretics can cause side effects such as hyperkalemia and hypokalemia. The aims of this study is to determine the effectiveness and safety of the combination of spironolactone and furosemide in patients with liver cirrhosis with permagna ascites.This study was an analytical observational study with retrospective cohort design. This study was done through a search of cirrhotic patients with permagna ascites’ medical record during January 2010-December 2014. This study was conducted at RSUP Dr. Sardjito. A total of 19 subjects categorized in the tense group and 39 subjects were in non-tense group. The effectiveness of diuretics seen by decreasing 1 cm/day of the patient's abdominal girth daily and the achievement of minimum of fluid balance -500 ml/day. Effectiveness data was analyzed by using independent t-test statistic. Side effects data was analyzed descriptively. There are no significantly different in reduction of abdominal girth and achieving fluid balance between cirrhotic patients with tense and non-tense ascites (p> 0.05); Adverse events of diuretics occurs in 5 patients, consist of hypokalemia 2 patients (3.45%), hyperkalemia 2 patients (3.45%) and hyponatraemia 1 patient (1.72%).

Asupan natrium dan kalium berhubungan dengan frekuensi kekambuhan sindrom dispepsia fungsional Hervina Dwijayanti; Neneng Ratnasari; Susetyowati Susetyowati
Jurnal Gizi Klinik Indonesia Vol 5, No 1 (2008): Juli
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.17514

Background: A high-salt diet is known to cause gastritis, has been associated with a high risk of atrophic gastritis, and is considered a gastric tumor promoter. Excessive NaCl intake enhances Helicobacter pylori colonization in mice and in humans and that chronic salt intake may exacerbate gastritis by increasing Helicobacter pylori colonization. Furthermore, elevated salt intake may potentiate Helicobacter pylori-associated carcinogenesis by inducing proliferation, pit cell hyperplasia, and glandular atrophy.Objective: The aim of this research was to describe the correlation between sodium and potassium intake and relapse frequent functional dyspepsia syndrome in Sardjito Hospital Yogyakarta.Method: This was an observational research with cross sectional design. The subjects of this research were 32 course care patients in Sardjito Hospital Yogyakarta on November 2006–Januari 2007 who met the inclusion criteria. Those were who diagnosed as functional dyspepsia, with or without Helicobacter pylori infection, and above eighteen years old. Data were collected by interviewing and gathered from medical record, then analyzed using Rank-Spearman test.Results: The average of the relapse frequent of dyspepsia syndrome in Sardjito Hospital was 14.38 ±2.93, with the minimum score was 4 and the maximum score was 32. The result showed that sodium intake gave a positive relation and significant for relapse frequent of dyspepsia syndrome (p<0.05). The potassium intake gave a negative relation and significant for relapse frequent of dyspepsia syndrome (p<0.05).Conclusion : There was a positive and significant correlation between sodium intake and relapse frequent of dyspepsia syndrome, but there was a negative and significant correlation between potassium intake and relapse frequent of dyspepsia syndrome.

Correlation between the Severity of Liver Cirrhosis (Chil-Pugh Score) and QTc Interval Prolongation Rachmad Aji Saksana; Putut Bayupurnama; Fahmi Indrarti; Neneng Ratnasari; Sutanto Maduseno; Catharina Triwikatmani; Siti Nurdjanah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 3, Desember 2012
Publisher : The Indonesian Society for Digestive Endoscopy

ABSTRACT Background:Liver cirrhosis causes changes in cardiovascular system. Electrographic (ECG) abnormality commonly found in cirrhosis patients is QT interval prolongation. It is part of cirrhotic cardiomyopathy. QTc interval prolongation is correlated to the incidence of life-threatening arrhythmias. The objective of this study was to recognize the correlation between the severity of liver cirrhosis and QTc interval prolongation in patients with liver cirrhosis at Sardjito General Hospital, Jogjakarta.Method: The design of this study was cross-sectional. The subjects were hospitalized patients with liver cirrhosis at the Department of Internal Medicine, Sardjito Hospital, Jogjakarta between January 2011 and March 2012. ECG was performed in all patients and QTc interval was measured. The severity of liver cirrhosis was determined by Child-Pugh score. Spearman correlation analysis was used to determine the correlation between variables of QTc interval prolongation and Child-Pugh score.Results: A total of 73 patients were enrolled, including 51 (69.9%) male and 22 (31.1%) female patients with mean age of 54.05 ± 12.55 years (range 20-80). Liver cirrhosis was caused by hepatitis B virus in 36 (49.3%) patients, hepatitis C virus in 20 (27.4%) patients and other causes in 19 (26%) patients. The Child-Pugh score for liver cirrhosis was found as follows: child A in 10 (13.6%) patients, child B in 27 (36.9%) patients and child C in 36 (49.3%) patients. The correlation between the severity of liver cirrhosis and QTc interval prolongation was weak (r = 0.255; p = 0.029).Conclusion:Severity of liver cirrhosis has a weak positive correlation with QTc interval prolongation. Keywords: liver cirrhosis, QTc interval, Child-Pugh score

Tuberculosis Peritonitis Patient with Septic Shock caused by Extended–Spectrum Beta Lactamases Producing Pseudomonas Aeruginosa Suharjo B Cahyono; Neneng Ratnasari; Putut Bayupurnama; Catharina Triwikatmani; Siti Nurdjanah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 3 (2014): VOLUME 15, NUMBER 3, December 2014
Publisher : The Indonesian Society for Digestive Endoscopy

According to World Health Organization (WHO), tuberculosis (TB) is a worldwide pandemic. Up to 5% of patients with TB may have abdominal disease and 25-60% may have peritoneal involvement. Diagnosis of TB peritonitis is still challenging, and symptoms are usually insidious. The sensitivity of acid fast bacilli (AFB) is very low, ranging from 0-6%. Conventional mycobacterial culture takes up to 8 weeks to achieve results. Laparoscopic or laparotomy biopsy is uncomfortable for patient. The consequence of these problems is missing and delays in diagnosing TB peritonitis. In the end, it can results in significant morbidity and mortality. This case described a 20 year old female patient with TB peritonitis that suffered from septic shock caused by extended-spectrum beta lactamases (ESBL) producing Pseudomonas aeruginosa. In this case, TB peritonitis was diagnosed based on clinical features, high levels of adenosine deaminase (ADA) and a positive rapid DNA test with Xpert MTB/RIF. Keywords: tuberculosis peritonitis, extended-spectrum beta lactamases producing bacilli, adenosine deaminase, XpertMTB/RIF assay

The Clinical Significance of CYP450 in Gastrointestinal Tract Neneng Ratnasari
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 8, ISSUE 3, December 2007
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/83200780-83

Cytochromes P450 (CYP450) is a super-family of multigenes bound to heme and also a catalysator enzyme. Cytochrome P450s (1, 2, and 3) are the most important enzymes for biotransformation of drugs administered through gastrointestinal tract. The gastrointestinal tract is the first part of immune system against all of oral xenobiotics. Drug interaction may be predicted but it is hardly prevented. Thus, it frequently becomes clinical problem. CYP450 polymorphism may influence effective drug metabolism, which consequently will affect drug response and good therapeutic effect. Poor metabolizers need only a small dose of drug to bring on drug response but extensive or ultra-rapid metabolizers will need a large dose of drug. The unexpressed CYP2E1, one of the CYP families, may influence cancer incidence. However, it is still controversial. Keywords: CYP450, xenobiotics, biotransformation of drugs, gastrointestinal tract

Serum Zinc Level and Urinary Zinc Excretion in Liver Cirrhotic Patient Catharina Triwikatmani; Putut Bayupurnama; Sutanto Maduseno; Neneng Ratnasari; Fahmi Indrarti; Siti Nurdjanah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, ISSUE 1, April 2009
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/10120092-6

Background: Zinc deficiency is commonly found in liver cirrhotic patient, and it is usually caused by excessive urinary excretion that is exaggerated by diuretic agents. The objective of this study is to know the differences of zinc serum concentration according to the Child-Turcotte-Pugh (CTP) score and clinical factors that influence zinc serum level and 24-hour urinary zinc excretion. Method: The design of this study was cross-sectional. In adult patients with liver cirrhosis, blood samples were collected after patients had fasted for at least 8 hours. Zinc levels were measured by the flame atomic absorption spectrophotometry method. Correlation test was performed among numeric variables, as well as Mann-Whitney U test to measure mean differences of zinc serum concentration and of 24-hours urinary zinc excretion according to clinical factors. The level of significance was p 0.05. Results: During the period of May 1st - September 30th 2007, there were 36 eligible patients. The mean value of zinc serum levels was 63.70 ± 24.85 µg/dL. There were 24 (66.67%) patients with hypozincemia. The mean value of 24-hour-urinary zinc excretion was 787.52 ± 570.20 µg. There were 19 (52.8%) patients with urinary zinc excretion 550 µg/24 hour. The results of mean difference test of zinc serum concentration between CTP score B and C showed no statistical significance (p = 0.052). Urinary zinc excretion correlated to urine volume (r = 0.638, p = 0.000), and it was higher in hospitalized patients compared to outpatients. It also was higher in men compared to women. There were no statistically significant differences in zinc serum level, zinc urinary level, and urinary zinc excretion on the administration of diuretic agents. Conclusion: There were no significant differences of fasting zinc serum concentration in cirrhotic patients between the CTP scores B and C. In liver cirrhotic patients, urinary zinc excretion positively correlates to urine volume. Keywords: liver cirrhosis, serum zinc level, urinary zinc excretion

Hepatitis A Virus Infection in Guillain-Barré Syndrome Neneng Ratnasari; Siti Nurdjanah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 3, NUMBER 2, August 2002
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/32200258-62

Prodromal factors of Guillain-Barré syndrome (GBS) are often associated with previous viral infection (60%). The ailment supported by the acquired immunomediated disorder concept. Viral hepatitis is very rarely found in GBS, preceded by cytomegalovirus (15-18%), Campylobacter jejuni (28%), and Epstein-Barr virus (5%). There is no specific etiology of GBS because those viruses usually appear sporadically (subclinically). All hepatitis virus infection can cause neurological complications, including GBS. We report two cases of hepatitis A virus infection (HAV) in GBS patients in Dr. Sardjito General Hospital during 5 years of observation (1996-2000) from 92 GBS patients. The diagnosis of HAV was based on more than 2 times increment of transaminase enzyme, positive IgM anti HAV, negative HbsAg, and negative IgM anti HCV. The diagnosis of GBS was based on clinical symptoms of acute generalized paralysis, cerebrospinal fluid examination, and electromyelography. In both cases, sub-clinical and sporadic symptoms appeared several days before paralysis, which makes it more likely that the prodromal period of GBS occurred at the same time of HAV incubation period.

Co-Authors . Suharno Agus Siswanto Arif Nur Widodo Arif Rohman Hakim Aulia, Nisma Catharina Triwikatmani Deshinta Putri Mulya Didik Setyo Heriyanto Dite Ari Prapti Dwijayanti, Hervina Eko Budiono Endro tanoyo Fahmi Indrarti Farida, Yeni Firman Wahyudi Fita Rahmawati Fita Rahmawati Fujawati, Eli Hakim, Suharno Hasanah Mumpuni Hemi Senorita Hervina Dwijayanti I Dewa Putu Pramantara Jamhari Jamhari Juwita Raditya Lina Tjandra Marcellus, Marcellus Moch. Abdul Nasir Muhammad Arif Muhammad Eko Cahyanto Mulyani, Tuty Nanda Qoriansas Nugraha, Adityansyah Irendra Nur Signa Gumilas Nurdjanah S Nurdjanah S, Nurdjanah Probowati, Wiwiek Puji Lestari Putut Bayupurnama Putut Bayupurnama Putut Bayupurnama Putut Bayupurnama Putut Bayupurnama Putut Bayupurnama Putut Bayupurnama RA Aditya Adhi Puruhita Rachmad Aji Saksana Renovaldi, Dede Retnaningrum, Yuliana Rahmah Retno Ambarukminingsih Riska Humardewayani Adie SATRIYAS ILYAS Siti Maryani SITI MARYANI Siti Nurdjanah Siti Nurdjanah Siti Nurdjanah Siti Nurdjanah Siti Nurdjanah Siti Nurdjanah Siti Nurdjanah Sofia Mubarika Haryana Suhara, Ade Suhara Suharjo B Cahyono Suharjo B Cahyono Suharjo B Cahyono Suharjo Broto Cahyono Suharno Hakim Suryo Taroeno Susetyowati Susnita, Tia Aprilia Sutanto Maduseno Sutanto Maduseno Sutanto Maduseno Tri Murti Andayani Tuty Mulyani Wiwiek Probowati Yeni Farida Zagoto, Agnes Dina Irene Dorithy

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