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All Journal e-CliniC JURNAL BIOMEDIK Damianus Journal of Medicine Narra J
Nurdjannah J. Niode
Universitas Sam Ratulangi
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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 1 
Pustulosis Eksantema Generalisata Akut Susanti, Ratna I.; Mamuaja, Enricco H.; Niode, Nurdjannah J.
Jurnal Biomedik : JBM Vol 9, No 3 (2017): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.9.3.2017.17339

Abstract

Abstract: Acute generalised exanthematous pustulosis (AGEP) is a variant of severe drug allergic eruption that usually occurs very acutely (one day after antibiotic consumption, with a mean of 11 days in other cases), associated with fever. Early lesions are edematous and erythemaous patches followed by nonfollicular pustules. Laboratory examination showed leukocytosis dominated by neutrophils, occasionally by eosinophils. We reported a female of 64 years old with AGEP in the arms, neck, chest, back, and thighs that occurred one day after consumption of a decongestant drug, that became worsened with the eruption of pustules associated with fever one day after consumption of tetracycline, paracetamol, and diphenhydramine. Dermatological status showed nonfollicular pustules on erythematous skin, either discrete or confluenced. Gram examination of the pustules revealed PMN leucocytes. Routine blood examination showed leukocytosis 20,200/mm3. Blood smear showed eosinophil 0%, basophil 0.1%, neutrophil 90.4%, lymphocyte 7.3%, and monocyte 2.2%. Moreover, IgE total was 2,930 IU/ml. The patient was treated with methylprednisolon 62.5 mg intravenous and then the dose was tappered gradually. The patient improved at days 10 followed by desquamation. Conclusion: In this case, diagnosis of AGEP was based on anamnesis, physical examination, and other supporting tests. Steroid therapy resulted in satisfying improvement.Keywords: AGEP, allergic drug eruptionAbstrak: Pustulosis eksantema generalisata akut (PEGA) adalah varian erupsi alergi obat tipe berat. Erupsi PEGA biasanya terjadi tiba-tiba (satu hari setelah mengonsumsi antibiotik, rerata 11 hari pada kasus lainnya), dan disertai demam. Lesi awal berupa bercak merah yang diikuti munculnya pustul nonfolikular pada kulit yang eritematosa dan edematosa. Pemeriksaan laboratorium menunjukkan leukositosis dengan dominasi neutrofil, kadang eosinofil. Kami melaporkan kasus PEGA pada seorang perempuan, 64 tahun di daerah lengan, leher, dada, punggung, dan paha yang timbul sejak satu hari setelah mengonsumsi obat pilek. Keluhan semakin parah dengan munculnya bintil bernanah disertai demam sehari setelah mengonsumsi tetrasiklin, parasetamol, dan difenhidramin. Status dermatologik didapatkan pustul nonfolikular di atas kulit yang eritematosa, sebagian pustul diskret dan sebagian kecil berkonflues. Pemeriksaan Gram dari cairan pustul mendapatkan leukosit PMN. Pemeriksaan darah rutin memperlihatkan: leukosit 20.200/mm3. Apusan darah tepi didapatkan: eosinofil 0%, basofil 0,1%, neutrofil 90,4%, limfosit 7,3%, monosit 2,2%. Pemeriksaan IgE total 2.930 IU/ml. Pasien diterapi metilprednisolon 62,5 mg intravena, selanjutnya dosis diturunkan secara bertahap. Perbaikan pasien tampak pada hari perawatan ke-10 diikuti terjadinya deskuamasi. Simpulan: Telah dilaporkan kasus PEGA dengan diagnosis ditegakkan berdasar anamnesis, pemeriksaan fisik, dan penunjang. Terapi steroid menunjukkan hasil yang memuaskanKata kunci: pustulosis eksantema generalisata akut, erupsi alergi obat
Psoriasis Rupioid pada Pasien Pengidap Human Immunodeficiency Virus: Laporan Kasus Mellyanawati, .; Palimbong, Florencia; Kapantouw, Grace M.; Niode, Nurdjannah J.
Jurnal Biomedik : JBM Vol 11, No 3 (2019): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.11.3.2019.26333

Abstract

Abstract: Psoriasis can occur in patients with human immunodeficiency virus (HIV), but the clinical features are very unusual and difficult to establish as a diagnosis. One of the rare types of psoriasis is rupioid psoriasis that often occurs in immunocompromised patients marked with the presence of thick crusts in cone and limpet-like shapes. Definite diagnosis is usually made by performing a histo-pathological skin biopsy, and other supporting investigations to rule out differential diagnoses. The main therapy for psoriasis in HIV patients is phototherapy and antiretroviral drugs, besides that topical therapy and immunosuppressants should be considered according to the patients’ condition. We reported a male, aged 38 years, with complaints of thick crusts on the skin almost the entire body since 2 months ago, accompanied by a slight itchy feeling. On clinical examination, erythematous plaques were found accompanied by thick crusting with cone and limpet-like shapes. Anti-HIV was reactive, CD4 <200 cells/μL, and histopathology examination of skin biopsy led to the diagnosis of psoriasis. Based on these clinical findings and investigations, diagnosis of rupioid psoriasis was established. The patient showed significant improvement after being treated with symptomatic systemic drugs and topical steroids for 3 weeks.Keywords: rupioid psoriasis, human immunodeficiensy virus, topical steroid Abstrak: Psoriasis dapat terjadi pada pasien dengan human immunodeficiency virus (HIV), namun gambaran klinisnya sangat tidak khas dan sulit untuk didiagnosis. Salah satu tipe yang jarang dari psoriasis tersebut ialah psoriasis rupioid yang sering muncul pada pasien dengan imunokompromais, dengan gambaran klinis adanya krusta tebal berbentuk kerucut dan limpet. Diagnosis pasti biasanya ditegakkan dengan melakukan biopsi kulit histopatologik, dan pemeriksaan penunjang lainnya untuk menyingkirkan diagnosis banding. Terapi utama untuk psoriasis pada pengidap HIV yaitu fototerapi dan ARV. Pemberian terapi topikal dan imunosupresan perlu dipertimbangkan sesuai dengan kondisi pasien. Kami melaporkan kasus seorang laki-laki, berusia 38 tahun, dengan keluhan timbul keropeng tebal pada kulit hampir seluruh tubuh, sejak 2 bulan lalu disertai rasa sedikit gatal. Pada pemeriksaan klinis didapatkan adanya plak eritematosa yang disertai krusta tebal dengan bentuk kerucut dan limpet. Pemeriksaan anti HIV reaktif, CD4 <200 sel/μL, dan pemeriksaan biopsi kulit histopatologik mengarah ke diagnosis psoriasis. Berdasarkan temuan klinis dan pemeriksaan penunjang tersebut, diagnosis psoriasis rupioid ditegakkan. Pasien menunjukkan perbaikan nyata setelah diterapi dengan obat sistemik simptomatik dan topikal steroid selama 3 minggu.Kata kunci: psoriasis rupioid, HIV, topikal steroid
Satu kasus nekrolisis epidermal toksik yang diduga disebabkan oleh kotrimoksasol Gunawan, Ellen; Wibawa, Anthony S.; Suling, Pieter L.; Niode, Nurdjannah J.
Jurnal Biomedik : JBM Vol 9, No 1 (2017): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.9.1.2017.15320

Abstract

Abstract: Toxic epidermal necrolysis (TEN) is an acute life-threatening muco-cutaneous reaction, characterized by extensive necrosis and detachment of the epidermis (>30% BSA). Drugs are often suspected as the main cause, one of which is trimethoprim- sulfamethoxazole (TMP-SMX). Management includes immediate termination of alleged drugs, supportive treatment such as maintenance of electrolyte balance, nutrition, analgesics, antibiotics and specific treatment of immunosuppressants with dexamethasone injection. We reported a female 36 yo who complained of dark red spots and flaky skin on the face, chest, abdomen, back, arms, and genitals associated with fever, dysphagia, and sore eyes. There was a history of cotrimoxazole consumption prior to the rashes. Skin examination revealed multiple, well defined, erythematous macula, numular to plaque-sized, multiple bullae, purpura, erosion, crusts, and epidermolysis on the face, chest, abdomen, back, and upper extremities. Patient also had vulval erosion and conjunctival hyperemia. Laboratory tests showed total protein 6.5 g/dL and albumin 3.2 g/dL. Patient was treated with intravenous RL:D 5%:NaCl 0.9% = 1:1:1 20 gtt/min, ranitidine injection 2x25 mg IV, ceftriaxone injection 1x2 gr IV, NaCl 0.9% moist dressing 3x30 minutes on erosions, polymyxin B sulphate, neomycin sulphate and dexamethasone eye drops 4x1gtt, artificial tears 6x1gtt, and tapered dexamethasone injection 4x10 mg IV. Diagnosis of TEN was established through anamnesis, physical examination, and laboratory examination. Patient showed clinical improvement within 2 weeks after the discontinuation of cotrimoxazole, and administration of supportive and specific treatment.Keywords: toxic epidermal necrolysis, cotrimoxazoleAbstrak: Nekrolisis epidermal toksik (NET) merupakan reaksi mukokutan akut yang mengancam jiwa, ditandai nekrosis dan pelepasan epidermis yang luas (>30% LPB). Obat diduga sebagai penyebab utama, salah satunya ialah golongan trimetoprim-sulfametoksazol (TMP-SMX). Penatalaksanaan meliputi penghentian segera obat yang diduga penyebab, penanganan suportif (keseimbangan elektrolit, nutrisi, analgetik, antibiotik) dan pengobatan spesifik (imunosupresan deksametason injeksi). Kami melaporkan kasus seorang perempuan 36 tahun dengan bercak merah kehitaman dan kulit terkelupas di wajah, dada, perut, punggung, kedua lengan, dan kelamin disertai demam, nyeri menelan, dan kemerahan pada mata. Riwayat konsumsi kotrimoksazol sebelum timbul ruam. Status dermatologikus: pada wajah, dada, perut, punggung, kedua lengan atas dan bawah terdapat makula eritematosa, batas tegas, multipel, ukuran numular-plakat; bula, purpura, erosi, krusta, dan epidermolisis. Terdapat erosi vulva erosi dan konjungtiva hiperemis bilateral. Pemeriksaan laboratorium: protein total 6,5 g/dL dan albumin 3,2 g/dL. Penanganan berupa IVFD RL:D 5%:NaCl 0.9% = 1:1:1 20 tetes/menit, injeksi ranitidin 2x25 mg IV, injeksi seftriakson 1x2 gr IV, kompres terbuka NaCl 0,9% 3x30 menit (luka), obat tetes mata (polimiksin B sulfat, neomisin sulfat dan deksametason) 4x1 tetes, airGunawan, Wibawa, Suling, Niode: Satu kasus nekrolisis epidermal toksis ... mata buatan 6x1 tetes dan injeksi deksametason 4x10 mg IV yang diturunkan secara bertahap sesuai perbaikan klinis. Diagnosis NET pada kasus ini ditegakkan berdasarkan anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang. Keadaan umum pasien membaik dalam 2 minggu setelah dilakukan penghentian obat yang diduga penyebab, penanganan suportif, dan pengobatan spesifik.Kata kunci: nekrolisis epidermal toksik, kotrimoksazol
LUPUS VULGARIS DENGAN LESI DISEMINATA Jayadi, Nana N.; Ernaningtyas, Niken; Niode, Nurdjannah J.; Wongkar, Marthen C. P.
JURNAL BIOMEDIK : JBM Vol 7, No 3 (2015): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.7.3.2015.9490

Abstract

Abstract: Lupus vulgaris (LV) is a chronic progressive form of paucibacillary cutaneous tuberculosis. Lesion is usually solitary in the form of nodes or erythematous plaques with an apple-jelly sign on diascopy. Disseminated LV is a rare form of cutanoeus tuberculosis with multiple lesions in several body areas. We reported a male of 40 years old with a suppurative wound on the left neck and reddish nodules on the face, neck, trunk, and limbs along with fever, night sweats, weight loss, and history of previous TB infections. There were multiple erythematous nodules and painful suppurating ulcers with enlargement of several lymph nodes. Apple-jelly sign appeared on diascopy. The FNAB showed specific granulamatous inflammation for TB with lymphocytes, epitheloid macrophages, and multinucleated giant cells. The histopathological finding showed tubercles surrounded by macrophages and lymphocytes. Anti-tuberculosis drugs category I were given for 6 months, ofloxacin, and open wound care compressed with NaCl 0.9%. In the third month of observation, there was significant improvement. Conclusion: This case was diagnosed as lupus vulgaris based on the history of lymphadenitis TB and scrofuloderma, lesions in several body area with positive diascopy test, the FNAB as well as the histopathologic result supporting the diagnosis of tuberculosis, and there was significant improvement after treatment with antiTB drugs.Keywords: lupus vulgaris, diseminata, tuberculosis, ofloksasinAbstrak: Lupus vulgaris (LV) merupakan tuberkulosis (TB) kutis pausibasiler kronis dan progresif. Lesi biasanya soliter, berupa nodus atau plak eritematosa dengan gambaran apple-jelly pada diaskopi. Lupus vulgaris diseminata merupakan bentuk TB kutis yang jarang ditemukan dengan lesi multipel pada beberapa area tubuh secara bersamaan. Kami melaporkan seorang laki-laki, 40 tahun, dengan luka bernanah pada leher kiri dan benjolan-benjolan kemerahan pada wajah, leher, badan, dan tungkai disertai demam, keringat malam, penurunan berat badan dan riwayat infeksi tuberkulosis sebelumnya. Pada pemeriksaan fisik tampak nodus eritematosa multipel disertai ulkus bernanah dan pembesaran beberapa kelenjar getah bening. Gambaran apple-jelly tampak pada diaskopi. Pemeriksaan FNAB menunjukkan gambaran radang granulomatik spesifik TB dengan adanya sel-sel radang limfosit, kelompok makrofag epiteloid, dan sel-sel datia Langhans. Pemeriksaan histopatologis memberikan gambaran tuberkel yang dikelilingi oleh makrofag dan limfosit. Terapi diberikan berupa OAT kategori I selama 6 bulan, ofloksasin, dan kompres terbuka dengan NaCL 0,9%. Pada bulan ketiga tampak perbaikan signifikan. Simpulan: Pada kasus ini, diagnosis lupus vulgaris ditegakkan berdasarkan adanya riwayat limfadenitis TB dan skrofuloderma, lesi di beberapa area tubuh sekaligus dengan pemeriksaan diaskopi positif, gambaran FNAB dan histopatologis menunjang diagnosis TB, dan pengobatan dengan OAT memberikan perbaikan bermakna.Kata kunci: lupus vulgaris, diseminata, OAT, ofloksasin
PROFIL HERPES ZOSTER DI POLIKLINIK KULIT DAN KELAMIN RSUP PROF. DR. R. D. KANDOU MANADO 2011-2013 Danardono, Dwi H.; Niode, Nurdjannah J.
Jurnal Biomedik : JBM Vol 7, No 3 (2015): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.7.3.2015.9486

Abstract

Abstract: Herpes zoster is a reactivation of varicella zoster virus (VZV) that affects the skin and mucosa. The incidence of herpes zoster increases with age. There are three main goals of treatment: overcoming the acute viral infection, relief from acute pain, and prevention of post-herpetic neuralgia. This study aimed to determine the profile of herpes zoster in the Dermatology Clinic of Prof. Dr. R. D. Kandou General Hospital for three years based on the number of new cases, gender, ages, dermatome locations, and treatment. This was a retrospective study using the medical records of the Dermatology Clinic of Prof. Dr. R. D. Kandou General Hospital during period January 2011- Desember 2013. The results showed that there were 96 (0.84%) herpes zoster patients of 11,367 new patients, consisted of 51 (53.11%) males and 45 (46.87%) females. The most frequent age group was 45-64 years with a number of 59 cases (61.46%). The most frequent dermatome location was on the left thoracic region with a number of 18 cases (18.75%). The most widely prescribed treatment was a combination of antiviral agent, analgesic drugs, roborantia, and topical medicine (powder/antibiotic cream), with a number of 43 cases (44.79%).Keywords: herpes zoster, morbidityAbstrak: Herpes zoster merupakan reaktivasi virus varicella zoster (VZV) yang menyerang kulit dan mukosa. Insiden herpes zoster meningkat seiring dengan bertambahnya usia. Terdapat tiga tujuan utama pengobatan yaitu: mengatasi infeksi virus akut, mengatasi nyeri akut, dan mencegah timbulnya neuralgia pasca-herpetik. Penelitian ini bertujuan untuk mengetahui profil herpes zoster di Poliklinik Kulit dan Kelamin RSUP Prof. Dr. R. D. Kandou Manado yang meliputi jumlah kasus baru, jenis kelamin, usia, lokasi dermatom, dan terapi. Metode penelitian ialah retrospektif dengan menggunakan catatan medis pasien baru herpes zoster yang berobat di Poliklinik Kulit dan Kelamin RSUP Prof. Dr. R. D. Kandou Manado selama periode Januari 2011 hingga Desember 2013. Hasil penelitian memperlihatkan terdapat 96 (0,84%) kasus herpes zoster dari 11.367 pasien baru yang terdiri dari 51 (53,11%) laki-laki dan 45 (46,87%) perempuan. Kelompok usia terbanyak ialah 45-64 tahun sejumlah 59 kasus (61,46%). Lokasi dermatom tersering pada regio torakalis sinistra sejumlah 18 kasus (18,75%). Terapi yang paling sering diberikan ialah kombinasi antivirus, analgetik, roboransia, dan pengobatan topikal (bedak/cream antibiotika) sejumlah 43 kasus (44,79%).Kata kunci: herpes zoster, morbiditas
Co-Authors Adji, Aryani Alson . Sambonu, Alson . Baguna, Tirsa Christina Salaki Dwi H. Danardono, Dwi H. Dwi Y.F. Isa, Dwi Y.F. Earlia, Nanda Fatimawali . Ferra O. Mawu, Ferra O. Grace M. Kapantow Gunawan, Ellen Herry E. J. Pandaleke Herry E.J. Pandaleke, Herry E.J. Herry E.J. Pandeleke, Herry E.J. Hizir Sofyan Idroes, Ghazi M. Jaya, Hendra K. Julian Jonathan, Julian Kairupan, Tara S. Kapantouw, Grace M. Kawengian, Shirley ES. Lorettha Wijaya Maharani, Ayu Mamuaja, Enricco H. Manginstar, Christian O. Marlyn G. Kapantow Marthen C. P. Wongkar, Marthen C. P. Maulana, Aga Maulydia, Nur B. Mellyanawati Mellyanawati Mikyal Bulqiah, Mikyal Muhammad Subianto Nana N. Jayadi, Nana N. Niken Ernaningtyas, Niken Nova Hellen Kapantow Noviandy, Teuku R. Palimbong, Florencia Pandjaitan, Marini C. Pieter L. Suling Preisy G. I. Tampi, Preisy G. I. Pusung, Andreas V. Putri, Devita Rinaldi Idroes Rotty, Linda WA. Siahaan, Romauli E. Silvia Nathalia Stella R. Nelwan Suhendra, Rivansyah Susanti, Ratna I. Thigita A. Pandaleke Trina E. Tallei, Trina E. Tumilaar, Jibrando Wibawa, Anthony S. Wungouw, Herlina IS. Yulianty Sanggelorang