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All Journal Berkala Kedokteran Indonesian Journal of Rheumatology Homeostasis: Jurnal Mahasiswa Pendidikan Dokter
I Nyoman Suarjana
Department Of Internal Medicine, University Of Lambung Mangkurat/Ulin Hospital, Banjarmasin
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Role of leptin in the pathogenesis of systemic lupus erythematosus I Nyoman Suarjana
Indonesian Journal of Rheumatology Vol. 1 No. 1 (2009): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (421.243 KB) | DOI: 10.37275/ijr.v1i1.12

Abstract

Leptin is a 16 kDa adipocyte-secreted hormone that regulates weight centrally and links nutritional status to neuroendocrine and immune functions. Several studies indicate that leptin plays an important role in immune responses. Leptin affects both innate and adaptive immunity. It can stimulate dendritic cells (DC), monocytes, macrophages, neutrophils and natural killer cells. Leptin is involved in DC maturation and survival,and can skew the cytokine balance of a T helper (Th)1 profi le. In adaptive immunity, leptin can promote naïve T cell survival and production of interferon-γ and interleukin-2, and activate Th1 cells while inhibiting Th2 cells. Leptin may play an important role in theregulation of the Th1/Th2 balance. As a survival factor, leptin has been shown to suppress B cell apoptosis. The role of leptin in the pathogenesis of systemic lupuserythematosus (SLE) is not fully determined yet. This review tries to link the role of leptin in immunity to the pathogenesis of SLE.
Correlation between serum leptin concentration and disease activity in normal body mass index premenopausal women with systemic lupus erythematosus I Nyoman Suarjana; Yoga I Kasjmir; Harry Isbagio; S Soegondo
Indonesian Journal of Rheumatology Vol. 1 No. 1 (2009): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (211.372 KB) | DOI: 10.37275/ijr.v1i1.15

Abstract

Background. Leptin is recognized as a cytokine-like hormone with pleiotropic actions in modulating immune responses. The role of leptin in pathogenesis of systemiclupus erythematosus (SLE) was not fully understood yet. Previous study did not fi nd the correlation between serum leptin concentration and disease activity in patients with SLE, but selection of the subjects wasn’t based on the classifi cation of body mass index (BMI) and menopausal status.Objective. To determine correlation between serum leptin concentration and the disease activity in normal BMI premenopausal women with SLE.Methods. Serum leptin concentration was measured by enzyme-linked immunosorbent assay and disease activity was scored using Mexican SLE disease activity index (Mex-SLEDAI). Spearman’s correlation coeffi cient test was used for evaluating the strength of association between leptin level and Mex-SLEDAI score.Results. Seventy normal BMI premenopausal women with SLE were included in this study. The median of serum leptin concentration was 13.4 (0.6 – 45.9) ng/ml.The median serum leptin concentration in patients with active disease was 12.4 (0.6 – 41.6) ng/dl, whereas in patients with inactive disease was 15.2 (3.9 – 45.9) ng/dl.No signifi cant different was found between serum leptin concentration in active and inactive disease (p = 0.14). A weak negative correlation was observed between leptinconcentration and Mex-SLEDAI score, but not statistically signifi cant (r = -0.22; p = 0.07).Conclusion. No correlation was found between serum leptin concentration and disease activity in normal BMI premenopausal women with SLE. Prednisone doses anddisease duration might interfere.
Knee arthritis in an HIV positive patient - not associated with antiretroviral therapy I Nyoman Suarjana; Yoga I Kasjmir; Bambang Setiyohadi
Indonesian Journal of Rheumatology Vol. 1 No. 1 (2009): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (165.645 KB) | DOI: 10.37275/ijr.v1i1.17

Abstract

Human immunodefi ciency virus (HIV)-associated arthritis is an oligoarthritis which predominantly affect the knees and ankles. It tends to be selflimited and to last less than six weeks. However, some patients with HIV-associated arthritis have been reported to have a disease course of more than six weeks with joint destruction. Synovial fl uid cultures are typically sterile and radiographs of the affected joints are usually normal except in those rare patients with a prolonged duration of symptoms in whom joint-space narrowing can occur.1,2 The pathophysiology of HIV specific arthritis types is not fully understood but drugs of the highly active antiretroviral therapy, in particular indinavir, are supposed to cause arthritis or rheumatological complaints.3 However,recently both human T-lymphotropic virus (HTLV) type I and HTLV-II have been suggested to induce infl ammatory or autoimmune reactions which can increase signifi cantly the incidence of arthritis.4 We report a patient with HIV infection presenting as knee arthritis which was apparently not associated with antiretroviral therapy.
Systemic Lupus Erythematosus with Severe Renal Dysfunction and Severe Hematological Manifestation Lead to Septic Shock: A Case Report I Nyoman Suarjana; Ayu Cahya Andhayani
Indonesian Journal of Rheumatology Vol. 12 No. 1 (2020): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v12i1.147

Abstract

Abstract: Background:Systemic Lupus Erythematous (SLE) is an autoimmune disease that can cause major mortality and morbidity if untreated well. Various clinical manifestations and adverse events may affect the patient condition. Case Report: We reported a case of a 31 years old female patient with systemic lupus erythematosus who presented with lupus nephritis and a hematological manifestation lead to septic condition and septic shock. This is a case where initially the patient is well controlled for 1.5 years but due to 6 months of absence treatment, the SLE flareupand she suffers an end-stage renal disease(ESRD). This patient was treated with mycophenolate acid in combination with high dose steroids, antibiotics, granulocyte-colonystimulating factor and underwent hemodialysis. Because of the ESRD and a manifestation of severe neutropenia and lymphopenia, the patient experienced urinary tract infection. She suffered from severe septic with shock condition and passed away later on. Conclusion:A SLE patient with a severe manifestation of neutropenia and lymphopenia accompanied with end-stage renal failure can cause an opportunistic infection that leads to severe septic shock condition and multi-organ failure. Keyword:Systemic lupus erythematosus, lupus nephritis, hematological manifestations, septic shock, Case Report
Characteristics of Patients with Autoimmune Rheumatic Disease in the Era of COVID-19 Pandemic in Indonesia Rudy Hidayat; Harry Isbagio; Anna Ariane; Faisal Parlindungan; Laniyati Hamijoyo; I Nyoman Suarjana; Dwi Budi Darmawati; Rakhma Yanti Hellmi; Gede Kambayana; IA Ratih Wulansari Manuaba; Awalia Awalia
Indonesian Journal of Rheumatology Vol. 12 No. 1 (2020): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v12i1.159

Abstract

Background Coronavirus Disease 2019 (COVID-19) could be fatal in high-risk patient including autoimmune rheumatic patients. Nowadays, the management of these patients becomes dilemma because the use of steroids and disease-modifying anti-rheumatic drugs could suppress the immune system however, poor control of the underlying disease increases the infection risk. Understanding the characteristics of these patients in the COVID-19 pandemic is essentials to establish management guidelines and identify patients who are more susceptible to COVID-19. This study aimed to determine the characteristics of autoimmune rheumatic patients in the era of COVID-19 pandemic in Indonesia. MethodA descriptive study using national scale survey method was conducted. The subjects were autoimmune rheumatic patients in Indonesia and recruited using consecutive sampling. The variables evaluated in this study were demographic data, history of disease, current medications taken, daily activities in the COVID-19 pandemic, and also data related to COVID-19. The surveys distributed in online form to patients with autoimmune rheumatic disease in Indonesia. ResultTotal participants in this study were 570 patients, mostly women (93.9%), aged <60 years old (97.2%), and diagnosed with systemic lupus erythematosus (62.8%). Glucocorticoid (70.2%) especially low dose glucocorticoid (52.6%) is the most medication taken by patients. A 30.5% of patients is taking hydroxychloroquine/chloroquine and 88.1% of them have good compliance. During COVID-19 pandemic, 76.5% respondents still do normal activities/work and only 53.2% use personal protective equipment. Eleven of 541 respondents had positive PCR test and confirmed to COVID-19. The risk of COVID-19 infection based on British Society of Rheumatology (BSR) scoring system showed that 57.9%, 28.6%, and 13.5% patients in high, moderate and low risk, respectively. ConclusionPatients with autoimmune rheumatic diseases might be more susceptible to COVID-19 than the general population. Interplay of aging, therapies and disease-specific factors, comorbidities and the proper use of personal protective equipment seem to contribute. Keywords :autoimmune rheumatic disease, characteristic, COVID-19, Indonesia
A Systemic Lupus Erythematosus Accompanied with Myelodysplastic Syndrome, Grave’s Disease, and Sub-Acute Subdural Hemorrhage: A Case Report I Nyoman Suarjana; Anggrada K. Utomo
Indonesian Journal of Rheumatology Vol. 14 No. 1 (2022): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v14i1.202

Abstract

Background: The systemic lupus erythematosus (SLE) is a disease of autoimmune etiology affecting multiple systems, involving most commonly females of the reproductive age group and different clinical manifestations in each individual. Case presentation: A 23-year-old female patient with systemic lupus erythematosus (SLE) presented with myelodysplastic syndrome (MDS), Grave’s disease, and sub-acute subdural hemorrhage (SDH). She had chief complaints of severe headache and gum bleeding. Three weeks earlier, the patient experienced a head injury. SLE was diagnosed on biological and immunological clinical ACR criteria and the patient never had a therapy before. Bone marrow aspiration (BMA) test was performed with MDS result. Thyroid function test was performed with the result of decreased Thyroid Stimulating Hormone (TSH) and increased FT4 with diffused enlargement of thyroid gland. Brain CT Scan resulted in sub-acute SDH with midline shift of 1.13 cm to the left. The patient underwent subdural drainage with local anesthesia and received steroid, azathioprine, thiamazole and non- selective beta-blocker. She was hospitalized for 21 days and was discharged with good condition. Conclusion: Further investigation of the patient is needed to fully understand the correlation between MDS, Subdural Hemorrhage and Grave’s Disease in associated with SLE.
PERBANDINGAN EFEKTIVITAS INJEKSI INTRAARTIKULAR ASAM HIALURONAT BERAT MOLEKUL RENDAH BERDASARKAN DURASI PEMBERIAN PADA PASIEN OSTEOARTRITIS LUTUT Een Amalia Pratiwi; I Nyoman Suarjana; Alfi Yasmina
Homeostasis Vol 2, No 3 (2019)
Publisher : Homeostasis

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (121.653 KB)

Abstract

Abstract: Intraarticular hyaluronic acid is often used in clinical practice to relieve knee pain and inflammation, which are clinical manifestations of knee osteoarthritis (OA). This study aimed to determine the difference in effectiveness of weekly intraarticular injection of low molecular weight hyaluronic acid for three times and five times. This study used cohort study design. A total of 128 who met the inclusion criteria were included in this study and classified into two groups, namely, those who received injection for three weeks and five weeks. The effectiveness of the therapy was evaluated by the WOMAC scale questionnaire before and after receiving the injection. Analysis with the unpaired T test showed no significant difference between the two groups (p=0.66). It can be concluded that there was no significant difference in effectiveness of weekly intraarticular injection with low molecular weight hyaluronic acid between three and five time injection. Keywords: hyaluronic acid, duration of administration, knee osteoarthritis Abstrak: Asam hialuronat intraartikular sering digunakan dalam praktik klinis untuk meredakan nyeri dan peradangan lutut, yang merupakan manifestasi klinis dari osteoartritis (OA) lutut. Penelitian ini bertujuan untuk mengetahui perbedaan efektivitas injeksi intraartikular asam hialuronat berat molekul rendah setiap minggu selama tiga kali dan lima kali. Penelitian ini menggunakan rancangan studi kohort. Sebanyak 128 pasien yang memenuhi kriteria inklusi diikutkan dalam penelitian ini dan dibagi menjadi dua kelompok, yaitu yang mendapat injeksi selama tiga minggu dan lima minggu. Efektivitas terapi dievaluasi dengan kuesioner skala WOMAC pada saat sebelum dan sesudah mendapat injeksi. Analisis dengan uji T tidak berpasangan menunjukkan tidak ada perbedaan bermakna antara kedua kelompok (p=0,66). Dapat disimpulkan bahwa tidak terdapat perbedaan efektivitas yang bermakna antara injeksi intraartikular asam hialuronat berat molekul rendah setiap minggu selama tiga kali dan lima kali. Kata-kata kunci: asam hialuronat, durasi pemberian, osteoartritis lutut
Relationship between C-Reactive Protein Levels, Lactate Dehydrogenase, and Neutrophil-to-Lymphocyte Ratio with Coronavirus Disease 2019 Severity Hendra Wana Nur&#039;amin; I Nyoman Suarjana; Mohammad Rudiansyah; Nanang Miftah Fajari; Djallalluddin Djallalluddin
Berkala Kedokteran Vol 19, No 1 (2023)
Publisher : Fakultas Kedokteran Universitas Lambung Mangkurat

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20527/jbk.v19i1.15718

Abstract

Abstract: Risk stratification of Coronavirus disease 2019 (COVID-19) patients is very important to determine patient care and prognosis. The reliable parameters include C-reactive protein (CRP), lactate dehydrogenase (LDH), and neutrophil-lymphocyte ratio (NLR). This study aimed to determine the relationship between CRP, LDH, and NLR levels with the severity of COVID-19 patients. An observational study with a cross-sectional approach was conducted at Ulin Hospital Banjarmasin on 91 eligible subjects. A logistic regression test was conducted to determine the relationship between variables and the severity of COVID-19. The results showed that there was no significant relationship between CRP levels and the severity of COVID-19 (prevalence odds ratio (POR) 0.85, 95% confidence interval (CI 95%) 0.34-2.09, p=0.72). There was a significant difference between the mean LDH levels in severe COVID-19 compared to non-severe COVID-19 (1006 + 601.77 vs 543.5 + 480.41, p<0.001), with POR 4.23, 95% CI 95% 1.56-11.45, p=0.005; there was also a significant difference between the mean NLR values in severe COVID-19 compared to non-severe COVID-19 (9.01 + 6.32 vs 5.38 + 5.03, p=0.002) with POR of 12.21 CI 95% 3.80-39.31, p<0.001. This study showed that LDH levels and NLR values were important predictors of COVID-19 severity.
Co-Authors Alfi Yasmina Anggrada K. Utomo Anna Ariane Awalia Awalia Ayu Cahya Andhayani Bambang Setiyohadi Djallalluddin Djallalluddin Dwi Budi Darmawati Een Amalia Pratiwi Faisal Parlindungan Gede Kambayana Harry Isbagio Harry Isbagio Hendra Wana Nur&#039;amin Laniyati Hamijoyo, Laniyati Mohammad Rudiansyah Nanang Miftah Fajari Rakhma Yanti Hellmi Rudy Hidayat S Soegondo Yoga I Kasjmir Yoga I Kasjmir