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Synergistic Cytotoxicity of 5-Fluorouracil and Epigallocatechin-3-Gallate on Colorectal Cancer Stem Cell Ibrahim, Sugeng; Riwanto, Ignatius; Suharti, Catharina; Putra, Agung; Budijitno, Selamat
Indonesian Journal of Cancer Vol 18, No 2 (2024): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i2.1211

Abstract

Background: Colorectal cancer stem cells (CR-CSCs) derived from the HCT-116 cell line established human colon carcinoma cell line, validated with CD44+/CD133+. The study investigates the synergistic effects of combining epigallocatechin gallate (EGCG) with 5-fluorouracil (5-FU) on CR-CSCs through comprehensive cytotoxicity assessments, aiming to enhance therapeutic outcomes. EGCG is a polyphenol with anti-cancer activity in green tea. Previous studies have reported that the anti-cancer activity of EGCG involves inhibition of proliferation and induction of apoptosis thereby reducing recurrence by as much as 51.6% in patients with colorectal adenoma after polypectomy. The significance lies in optimizing treatment strategies by understanding the potential synergies between conventional chemotherapeutic agents and natural compounds. Given 5-FU's status as a cornerstone in CR-CSCs chemotherapy and EGCG's emergence as a promising natural compound, the study delves into their individual and combined cytotoxicity profiles. Methods: The single and combination assay aimed to determine the cytotoxicity of EGCG and 5-FU, including establishing the half inhibitory concentration (IC50) and combination index (CI) values. CR-CSCs colonies were disassociated, counted, and cultured in 96-well plates. Test solutions of varying concentrations were applied, and subsequent steps involved incubation, media removal, washing, MTT reagent addition, and absorbance measurement. Results: The single cytotoxicity tests established individual IC50 values, revealing 141.26 µM for 5-FU and 464.56 µM for EGCG. Subsequent combination cytotoxicity tests demonstrated a synergistic effect at specific doses, indicated by CI values below 1. Conclusions: These findings highlight the potential for increased cytotoxicity against CR-CSCs when treated with the combination of 5-FU and EGCG.
Antioxidant and Anti-inflammatory effect of Graptophyllum pictum (L.) Griff extract Study on SOD and COX-2 serum of experimental hemorrhoids Azhar, Abu; Riwanto, Ignatius; Nugroho, Eriawan Agung; Susilaningsih, Neni; Prajoko, Yan Wisnu; Budiono, Parish; Prasetyo, Sigit Adi
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 2 (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (274.539 KB) | DOI: 10.36408/mhjcm.v7i2.515

Abstract

Background The 1st, 2nd and small 3rd degree hemorrhoids are non-operatively treated by using anti-inflammatory and plebotonic medicines, high fiber diet and changing lifestyle. Graptophyllum pictum (L.) Griff (GP) is potential to be a hemorrhoid medicine (anti-inflammatory and plebotonic medicine) since its anti-inflammatory effect may be related to antioxidant property. ObjectiveTo elaborate the anti-inflammatory and anti-oxidant effect of GP on experimental hemorrhoid in male Wistar rats. MethodsA Randomized Controlled Trial Post-test only design in hemorrhoid-like rats using croton oil induced into the anus for 30 seconds each day for 3 consecutive days. 14 Wistar rats were randomly allocated into 2 groups. Group 1 got normal saline solution, while group 2 treated with GPE 100mg/Kg bw for 5 consecutive days. On the 9th experimental day, the blood was drawn for Elisa examination of COX-2 and SOD levels. As COX-2 and SOD normally distributed, pool t-test and product moment correlation was used for statistical analysis. Results All of Wistar rats were still alive. COX-2 levels (ng/ml) in the GPE group was 266.28±158.47, was significantly lower compared to control (595.21±68.92) (p=0.000). Serum SOD levels (ng/ml) in the GPE was 77.00±11.0, and was significantly higher than the control 28.00±4.00 (p=0.02). Correlation between COX-2 and SOD serum level was significantly strong negative correlation (p=0,000 and r=-0.842) Conclusions GPE at a dose of 100 mg/kg bw has antioxidant and anti-inflammatory effects on artificial hemorrhoids through decreased COX-2 levels, and elevated SOD levels. There is a strong negative correlation between SOD and COX-2 serum level. KeywordsGraptophyllum pictum, hemorrhoids, Croton oil, COX-2, SOD.
Pengaruh Pemberian Fenitoin Oral dan Vitamin C Oral terhadap Jumlah Kolagen dan Diameter pada Fistula Enterokutan Tikus Wistar: Effect Phenytoin and Vitamin C Therapy to Collagen Deposition and Diameter of Enterocutaneous Fistula in Wistar Rat Pambudi Utomo, Gede; Riwanto, Ignatius; Nugroho, Trilaksana
Medica Hospitalia : Journal of Clinical Medicine Vol. 9 No. 3 (2022): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v9i3.766

Abstract

Latar Belakang : Enterocutaneous fistula (ECF) adalah salah satu tantangan bagi banyak ahli bedah di dunia. Meskipun terdapat perkembangan dalam perawatan medis dan tekhnik operasi, namun morbiditas dan mortalitas terkait ECF masih tinggi. Keberhasilan dalam tatalaksana ECF memerlukan perawatan yang komprehensif dan sumber daya yang mahal, dimana tidak terjangkau oleh sebagian masyarakat Indonesia. Fenitoin dan Vitamin C adalah obat yang murah dan telah menunjukan manfaat baik dalam penyembuhan luka. Tujuan : Penelitian ini bertujuan untuk mengetahui apakah pemberian fenitoin dan vitamin C akan meningkatkan kolagenisasi dan menurunkan diameter ECF pada tikus wistar. Kemudian untuk mengevaluasi apakah pemberian kombinasi fenitoin dan vitamin C memberikan hasil yang lebih baik dibandingkan pemberian tunggal fenitoin atau fitamin C Metode : Peneliti membuat caecostoma sebagai model ECF pada 24 ekor tikus. Tikus kemudian dibagi menjadi empat kelompok perlakuan dengan : perawatan NaCl,  Kombinasi fenitoin-vitamin C, Fenitoin saja dan Vitamin C saja. Pengamatan hasil dilakukan pada hari ke-7 dengan mengamati deposisi kolagen dan mengukur diameter ECF. Hasil : Penelitian ini menunjukan perbedaan kolagenisasi dan penurunan diameter ECF bermakna secara statistik (p<0.05) pada tiap kelompok perlakuan jika dibandingkan kelompok kontrol (5,521 + 2,552 %; 9,395 ± 0,582 mm). Penelitian ini juga mengungkapkan bahwa pemberian kombinasi fenitoin dengan vitamin C (28,110 ± 6,535 %; 5,742 ± 0,394 mm) memberikan hasil yang lebih baik (p<0.05) dibanding pemberian tunggal fenitoin (15,448 ± 5,184 %; 8,101 ± 0,822 mm) atau vitamin C (19,118 ± 4,190 %; 6,883 ± 0,744 mm). Kesimpulan : Kami menyimpulkan baik fenitoin maupun vitamin C memiliki efek baik dalam penyembuhan ECF. Pemberian kombinasi Fenitoin dan vitamin C terbukti lebih bermanfaat dibandingkan pemberian tunggal. Kata Kunci :  Enterocutaneous fistula, Fenitoin, Vitamin C, kolagen, Diameter fistula
Assessing the Inter-observer Agreement of Electrocardiography Interpretation in the Elderly Surgical Patients: A Cross-Sectional Study Mupangati, Yudo Murti; Setyawan, Henry; Soejono, Czeresna Heriawan; Gasem, Muhammad Hussein; Riwanto, Ignatius
Medica Hospitalia : Journal of Clinical Medicine Vol. 10 No. 3 (2023): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v10i3.969

Abstract

Background: Electrocardiography (ECG) is an essential objective diagnosis tool, specifically for the elderly who are about to undergo surgery. From the examination results, it is possible to determine the presence of a heart condition that could impair the surgical outcome. Furthermore, the examination is slightly influenced by the subjectivity of observers. Purpose: To evaluate the inter-observer agreement on the reader of a 12-lead ECG on elderly patients subjected to elective surgery. Method: A consequential ECG examination was conducted on elderly patients who underwent elective surgery at Dr. Kariadi Hospital  Semarang between July and November 2021. Two junior internist observers were independently involved in reading the ECG results in different places. The inter-observer reliability analysis used kappa statistics to determine consistency between observers. Result: Analysis was carried out on 193 patients aged  60-87 years old, with a prevalence of abnormal ECG was 33.7%. Kappa Conformity Value was 0.864 (95 % CI: 0.790-0.938,  p<0.001). Conclusion: The value of agreement between junior internists in ECG interpretation among elderly surgical patients is good (kappa value  >0.8). Even though the observers are junior internist, the result of the interpretation with a high kappa is considered to have reliable validity.
The Comparison between Preoperative Maltodextrine and Sugar Water Administration on Random Blood Glucose Levels in Enhanced Recovery After Cesarean Surgery (ERACS) Patients Wicaksono, Satrio Adi; Pudjonarko, Dwi; Riwanto, Ignatius
JAI (Jurnal Anestesiologi Indonesia) Vol 16, No 3 (2024): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.65043

Abstract

Background: Oral carbohydrate administration reduces post-operative insulin resistance and improves post-operative recovery. Sugar water and maltodextrin are oral carbohydrates that can be given to enhanced recovery after caesarean surgery (ERACS) patients.Objective: To compare the effect between pre-operative maltodextrin treatment and sugar water treatment on random blood glucose (RBG) levels in enhanced recovery after caesarean section (ERACS) patients.Methods: A randomized control study with pre-test and post-test design was used on 48 patients who underwent ERACS surgery at Dr. Kariadi hospital Semarang Indonesia and met the inclusion and exclusion criteria. Study subjects were divided into two groups: a pre-operative maltodextrin treatment group (n=24) and a pre-operative sugar water control group (n=24). RBG levels were checked with point-of-care testing (POCT) at soon before surgery and at 2 hours after surgery. Mann-Whitney test was used to analyse the difference of RBG levels between group with Maltodextrin and group with sugar water. Wilcoxon test was used to analyse the difference of RBG levels before surgery (pre-operative RBG) and 2 hours after surgery (post-operative RBG). The p value of <0.05 was considered as statistically significant.Result: There were significant lower RBG levels in group with pre-operative maltodextrin treatment compared to group with pre-operative sugar water at soon before surgery (pre-operative) (83.5 ± 9.73 vs 96.2 ± 12.99 mg/dL, p=0.003) and at 2 hours post-operative (101.7 ± 15.81 vs 118.9 ± 28.38, p=0.035) in ERACS patients.Conclusion: If confirmed by further studies, pre-operative maltodextrin administration might provide better outcome in reducing post-operative catabolic status by reducing post-operative insulin resistance and improving RBG levels before and after ERACS compared to sugar water control.
Predictors for 30-day mortality in hepatocellular carcinoma patients undergoing liver resection Prabowo, Erik; Susilaningsih, Neni; Suharti, Catharina; Purnomo, Hery D.; Riwanto, Ignatius; Fuadi, Ahmad F.; Ar, Ardiyana; Bulandari, Beatrice LA.; Tjandra, Kevin C.; Respati, Danendra RK.; Rampengan, Derren DCH.
Narra J Vol. 4 No. 3 (2024): December 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i3.1001

Abstract

Hepatocellular carcinoma (HCC) ranks among the most prevalent and fatal liver cancers globally. Liver surgery, particularly resection, offers the potential for cure but poses challenges, especially in Indonesia, where patients often present in advanced stages. This study aimed to determine the intraoperative and perioperative factors associated with 30-day mortality of HCC patients undergoing liver resection at a tertiary referral hospital. The study included HCC patients undergoing liver resection at Karadi General Hospital, Semarang, Indonesia, between January 2018 and September 2023. Demographic data, intraoperative, perioperative, and postoperative factors were collected, with the primary outcome being 30-day mortality. Factors influencing 30-day survival were assessed using a log-rank test and the survival analysis employed Kaplan-Meier curves. Among 58 HCC patients who had liver resection, 62.1% were males, with a mean age was 57.27±9.56 years old. Preoperative comorbidities, notably hepatitis B, affected 34.4% of patients. Child-Pugh Score categorized 91.4% as class A. The study found a 30-day mortality rate of 10.3% with no subsequent increase in incidence. The failure-to-rescue rate (FTR) of this study was found to be 46%. Factors associated with 30-day mortality were Child-Pugh classification (p<0.001), intraoperative bleeding (p=0.001), creatinine levels (p=0.005), Clavien-Dindo classification (p<0.001), and posthepatectomy liver failure (PHLF) (p<0.001). This study suggests that pre-operative (Child-Pugh classification), intraoperative (blood loss volume) and postoperative factors (Creatinine level, Clavien-Dindo classification, and PHLF) could predict the mortality rate of HCC patients undergoing liver resection.
Successful High-Risk Pulseless-Balloon Aortic Valvuloplasty Procedure in Uncorrected Pulmonary Atresia with Severe Congenital Aortic Stenosis and Low Left Ventricular Function Sofia, Sefri Noventi; Bahrudin, Bahrudin; Riwanto, Ignatius; Susanto, Hardhono; Soetadji, Anindita; Baskoro, Adhi Gunawan; Prawara, Ananta Sidhi; Satyagraha, Muhammad Thifan; Kurniawati, Yovie; Prakoso, Radityo
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 3 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.72347

Abstract

Background: Pulmonary atresia with ventricular septal defect (PA-VSD) and severe bicuspid aortic stenosis is an uncommon condition that presents significant surgical challenges. The dual obstruction leads to chronic pressure overload, resulting in ventricular hypertrophy and decreased systolic function. A low left ventricular ejection fraction (LVEF) increases the risk of mortality during surgical interventions. Percutaneous balloon aortic valvuloplasty (PBAV) poses additional risks due to the intentional induction of pulselessness during balloon inflation. This case report aims to detail the perioperative management strategies employed during PBAV in a patient with PA-VSD, severe aortic stenosis, and low LVEF.Case: We present a 19-year-old female patient weighing 45 kg with shortness of breath and fatigue. Her oxygen saturation was measured at 90% across all extremities. Electrocardiogram (ECG) findings indicated sinus rhythm with biventricular hypertrophy and incomplete left bundle branch block (LBBB). Chest X-ray revealed cardiomegaly and pulmonary artery dilation, while echocardiography confirmed PA-VSD, severe aortic stenosis with a mean pressure gradient (mPG) of 55 mmHg, and an LVEF of 41.3%. A percutaneous pulseless-BAV was performed using a Tyshak balloon via an antegrade transvenous femoral approach under fluoroscopy and transesophageal echocardiography guidance.Discussion: Anesthesia management focused on gradual medication titration, minimizing patient movement during the procedure, and ensuring comfort due to transesophageal echocardiogram (TEE) probe insertion. A temporary pacemaker was placed in the right ventricular apex for pacing at 220 beats per minute until cardiac arrest occurred post-balloon inflation, and defibrillation successfully restored spontaneous circulation.Conclusion: This case illustrates that PBAV in uncorrected PA-VSD with severe aortic stenosis and low LVEF is feasible despite its inherent risks when conducted by a skilled team utilizing careful judgment throughout the procedure.
Association between cholesterol and blood pressure examination in Sampangan, Semarang City: a preliminary study Christyana, To Lidwina Prillya Indra; Riwanto, Ignatius; Sebong, Perigrinus H; Sutanto, Eviana Budiartanti; Ernestia, Henrita; Tjitradinata, Cynthia; Kristanti, Alberta Widya
BKM Public Health and Community Medicine Vol 39 No 12 (2023)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/bkm.v39i12.9841

Abstract

Purpose: This study aims to determine the baseline prevalence and association between blood pressure and cholesterol examination. Method: This preliminary study used a cross-sectional design to analyze the secondary blood pressure and cholesterol levels data in the Sampangan sub-district, Semarang City. The total sampling technique covered those enrolled in the metabolic syndrome screening from January to April 2023. The logistic regression test was used in data analysis. Results: 58 respondents took blood pressure checks, while only 40 had cholesterol checks. The probability of males getting changes in cholesterol levels was higher than that of females (OR = 8.69; p-value = 0.01). However, neither (female nor male) had a significant relationship, and there was no difference in the chances of changes in blood pressure (OR = 1.43; p = 0.72). Respondents above 60 years had a significant association with changes in blood pressure compared to those under 60 years (OR = 0.09; p = 0.007). Conclusion: This study revealed males of a certain age experience higher changes in cholesterol levels compared to females. People over 60 years old tend to have higher blood pressure compared to those under 60 years old. These findings propose an outreach strategy for health screening for patients with limited mobility, transportation access, and finances for routine checkups at public or government healthcare facilities.
Soursop Leaf Extract Reduces AST, ALT, Bilirubin Levels, and Liver Damage Scores in Sorafenib-treated Wistar Rats with Hepatocellular Carcinoma Susilaningsih, Neni; Prajoko, Yan Wisnu; Budijitno, Selamat; Prabowo, Erik; Istiadi, Hermawan; Muniroh, Muflihatul; Riwanto, Ignatius
The Indonesian Biomedical Journal Vol 18, No 1 (2026)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v18i1.3883

Abstract

BACKGROUND: Sorafenib, the standard therapeutic agent for advanced hepatocellular carcinoma (HCC), may induce hepatic dysfunction, thereby necessitating adjunctive therapy to mitigate this adverse effect. While preliminary research has suggested that Soursop (Annona muricata) leaves exhibit anti-tumor and hepatoprotective properties, their efficacy in mitigating liver damage associated with sorafenib treatment remains unexplored. This study was conducted to assess the liver-protective effects of soursop leaf extract in Wistar rats receiving sorafenib for HCC treatment.METHODS: Ethanol extract of soursop leaves was prepared using the maceration method. Twenty-nine Wistar rats were divided into five groups: healthy control (HC) group, HCC groups receiving no treatment, sorafenib only, sorafenib + 50 mg/kgBW/day soursop extract, and sorafenib + 100 mg/kgBW/day soursop extract. All groups, except the HC group, were given Diethyl Nitrosamine (DEN) to cause HCC. Following a two-week treatment period, serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were assessed using colorimetric methods, while total bilirubin was assessed using diazo with sulphanilic acid method. From histopathological specimen, relative liver weight was measured and liver damage score was assessed using Hematoxylin and Eosin.RESULTS: Administration of sorafenib resulted in a reduction of AST, ALT, total bilirubin, relative liver weight, and liver damage scores. Furthermore, the combined administration of sorafenib with soursop leaf extract at dosages of 50 and 100 mg/kgBW/day led to a dose-dependent amelioration of these indicators. The most pronounced improvement was observed with the highest dose of soursop extract, which significantly reduced AST, ALT, total bilirubin, relative liver weight, and liver damage scores compared to the sorafenib-only group.CONCLUSION: Soursop leaf extract at 100 mg/kgBW/day effectively reduced AST, ALT, bilirubin levels, and liver damage score in sorafenib-treated Wistar rats with HCC, indicating its hepatoprotective effects. These findings suggest that soursop leaf extract may be a promising adjuvant therapy for mitigating sorafenib-induced hepatotoxicity in HCC treatment.KEYWORDS: Annona muricata, hepatocellular carcinoma, sorafenib, AST, ALT, bilirubin, hepatoprotective
Modified BI-RADS model for stratifying borderline breast lesions based on BI-RADS: a cross-sectional study Kuntjoro, Lydia Purna; Riwanto, Ignatius; Sukmaningtyas, Hermina; Prajoko, Yan Wisnu; Suhartono; Choridah, Lina; Mahati, Endang; Tjandra, Kevin Christian; Pravitha, Clarissa Aulia
Medical Journal of Indonesia Vol. 35 No. 1 (2026): March
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.258117

Abstract

BACKGROUND Breast imaging reporting and data system (BI-RADS) is a globally recognized method for categorizing breast lesions. However, it is dependent on subjective interpretation, which can result in variability between radiologists. Currently, no scoring system exists to assist in categorizing borderline findings as either benign or malignant. This study aimed to introduce a scoring system that classifies borderline breast lesion findings without altering the standard BI-RADS interpretation and minimizes inter-reader variability. METHODS This single-center retrospective cross-sectional study included 215 women who underwent breast ultrasound (US) and histopathology between January 2021 and December 2022, excluding those with non-neoplastic breast lesions. The index test was US BI-RADS features, and the reference standard was histopathology. Prevalence ratios (PRs) and probability scores were used to assess the risk contribution of individual US features. The diagnostic performance of the BI-RADS interpretation strategy and predictive scoring model was compared with that of the standard BI-RADS classification using SPSS software version 26. RESULTS Margin, orientation, and age had the highest PRs of malignancy, with odds ratios and 95% confidence intervals of 39.86 (13.19–120.47), 17.47 (2.42–125.72), and 9.74 (3.51–27.04), respectively. These three characteristics increased the probability of malignancy by 99.53%. A comparison of diagnostic tests between the modified BI-RADS interpretation strategy and the standard BI-RADS classification revealed improvements in specificity (94.0% versus 84.7%), positive predictive value (85.0% versus 70.5%), accuracy (89.3% versus 84.7%), and area under the curve (0.931 versus 0.873). CONCLUSIONS According to the interpretation strategy, margin, orientation, and age, this US scoring model appear to be promising tools for classifying borderline malignant masses.