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All Journal Journal of Tropical Life Science : International Journal of Theoretical, Experimental, and Applied Life Sciences Jurnal Anestesiologi Indonesia Althea Medical Journal Mutiara Medika: Jurnal Kedokteran dan Kesehatan Jurnal Respirasi (JR) Respiratory Science
Erna Kusumawardhani
Department Of Pulmonology And Respiratory Medicine, Faculty Of Medicine, Lambung Mangkurat Univesity, Ulin General Hospital, Banjarmasin
Agriculture, Biological Sciences & Forestry Environmental Science Health Professions Medicine & Pharmacology Public Health

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Potensi Pemberian Tocilizumab pada Pasien COVID-19 Di ICU RSUD Ulin Banjarmasin Rohmantuah Trada Purba; Mahendratama Purnama Adhi; Erna Kusumawardhani; Rapto Hardian; Andri Lumban Tobing
JAI (Jurnal Anestesiologi Indonesia) Vol 12, No 3 (2020): 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.v12i3.32905

Abstract

Latar Belakang: Corona Virus Disease 2019 (COVID-19) adalah penyakit pandemi yang menjadi masalah global yang melanda seluruh dunia. Manifestasi klinis dan tingkat keparahan penyakit COVID-19 sangat bervariasi. Pada pasien COVID-19 derajat kritis yang memerlukan perawatan di intensive care unit (ICU) telah ditemukan adanya proses badai sitokin yang meningkatkan mortalitas dan morbiditas. Interleukin-6 (IL-6) berperan dalam terjadinya badai sitokin.Kasus: Berikut kami laporkan serial kasus 5 pasien COVID-19 terkonfirmasi positif derajat sedang-kritis yang diberikan tocilizumab (TCZ) sebagai suatu IL-6 inhibitor yang memiliki potensi terapi menurunkan mortalitas dan morbiditas pasien COVID-19 derajat berat-kritis.Pembahasan: Dari 5 pasien yang diberikan TCZ, didapatkan hasil 3 pasien bisa pulang dan 2 pasien meninggal. Terdapat potensi pemberian IL-6 inhibitor karena dari patofisiologi penyakit COVID-19 yang berkaitan dengan IL-6 dan badai sitokin. IL-6 inhibitor dapat menurunkan mortalitas dan morbiditas dengan mencegah terjadinya badai sitokin. Hal ini diukur menggunakan evaluasi onset penyakit, kadar biomarker inflamasi dan gangguan koagulasi yang sering diteliti pada pasien COVID-19 seperti c-reactive protein (CRP), lactate dehydrogenase (LDH), D-Dimer dan ferritin.Kesimpulan: Pemberian TCZ memiliki potensi efek terapeutik jika diberikan pada onset penyakit <10 hari. Perlu dilakukan penelitian lebih lanjut untuk menilai efek terapeutik dan timing pemberian yang tepat.
Tatalaksana Komplikasi Tromboemboli pada Pasien Terkonfirmasi Corona Virus Disease-19 Alfian Aditia; Mahendratama Purnama Adhi; Bagus Fajar Rohman; Oky Susianto; Erna Kusumawardhani
JAI (Jurnal Anestesiologi Indonesia) Vol 12, No 3 (2020): 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.v12i3.32906

Abstract

Latar Belakang: Corona Virus Disease-19 (COVID-19) merupakan penyakit pandemi yang dapat menyebabkan komplikasi tromboemboli sebagai akibat terjadinya koagulopati dengan insidensi sekitar 16.5-21%.  Salah satu patofisiologi koagulopati pada pasien COVID-19 disebabkan oleh proses inflamasi. Peningkatan faktor inflamasi, faktor koagulasi, dan skoring klinis digunakan sebagai prediksi terjadinya komplikasi tromboemboli. Pemberian antikoagulan memiliki peran untuk mencegah terjadinya komplikasi tersebut.Kasus: Pasien laki-laki, 43 tahun, positif COVID-19 dengan skor PADUA = 4, peningkatan D-dimer dan mendapatkan terapi profilaksis antikoagulan. Dalam perawatan hari ke-14, sesak napas memberat, takikardi dan hipoksemia dialami pasien. Didapatkan gambaran Humpton’s hump pada foto toraks dan gambaran elektrokardiography (EKG) pola S1Q3T3 dan corrected QT interval (QTc) 552 mms. Penatalaksanaan pasien dengan ventilasi mekanik dan terapi unfractionated heparin (UFH) dosis terapeutik. Saat pasien bebas dari sedasi, ditemukan kelemahan tubuh bagian kiri.Diskusi: Gejala klinis emboli paru umumnya berupa dispnea/takipnea, takikardi, sianosis, hemoptisis, hipoksemia dengan onset akut. Berdasarkan keparahannya, dibagi menjadi masif, sub-masif, risiko rendah. Gambaran Humpton’s hump pada foto toraks dapat menjadi dugaan terjadi emboli paru. Pemeriksaan computed tomography pulmonary angiogram (CTPA) merupakan standar diagnosisnya, namun EKG dapat digunakan sebagai modalitas kecurigaan emboli dengan gambaran takikardi/takiaritmia, pola S1Q3T3 dan pemanjangan interval QTc. Pemberian antikoagulan sebagai tromboprofilaksis tetap tidak dapat mencegah terjadinya komplikasi tromboemboli seperti terjadinya stroke iskemik, tetapi emboli paru merupakan komplikasi tromboemboli yang paling sering terjadi.Kesimpulan: Evaluasi klinis, EKG secara rutin dan kadar D-dimer dapat menjadi pertimbangan dalam pemberian tromboprofilaksis dan dapat menjadi strategi penapisan awal risiko komplikasi tromboemboli. Pada pasien COVID-19 derajat kritis perlu dipertimbangkan pemberian antikoagulan yang lebih agresif dan menggunakan dosis terapeutik.
Clinical Characteristics of Hospitalized Individuals Dying with COVID-19 in Ulin Regional Hospital Banjarmasin Haryati Haryati; Mohamad Isa; Ali Assagaf; Ira Nurrasyidah; Erna Kusumawardhani
Jurnal Respirasi Vol. 7 No. 1 (2021): January 2021
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (327.938 KB) | DOI: 10.20473/jr.v7-I.1.2021.1-7

Abstract

Background: Corona Virus Disease (COVID-19) has become a global pandemic and has spread to more than 200 countries including Indonesia. South Kalimantan is one of the provinces in Indonesia that has a high COVID-19 mortality rate (case fatality rate 4.1%). Information about characteristic of mortality patients with SARS-CoV-2 infection in Indonesia was limited. The objective of this study to describe clinical characteristics of COVID-19-confirmed deaths at Ulin Regional Hospital Banjarmasin, as a referral hospital in South KalimantanMethods: Medical records of 108 hospitalized patients dying with COVID-19 between March until August 2020 were collected. The recorded information included gender, age, onset and severity of disease, comorbidities, symptoms, signs, and laboratory findingsResults: The 108 confirmed cases of COVID-19 deaths were mostly male (73.1%) aged <65 years old (85.2%). About 84% of the cases had at least one comorbidity or more, like hypertension (44.4%), obesity (38%), and diabetes mellitus (32.4%). Common early symptoms were fever (91.7%) and shortness of breath (89.8%). Laboratory findings included lympocytopenia and eosinophilopenia (80.6% and 72.2%), increased neutrophil lymphocyte ratio (NLR; 86.1%), decreased absolute lymphocyte count (ALC; 72.2%), and hyponatremia (55.6%). Elevated C-reactive protein (CRP; 92.6%), lactate dehydrogenase (LDH; 91.7%), serum glutamic oxaloacetic transaminases (SGOT; 82.4%), and creatinine levels (57.4%). The majority of non survivors were severe-critical stage with severe acute respiratory distress syndrome (ARDS).Conclusion: In this depictive study, patients with comorbidities and severe-critical stage are at risk of death. Laboratory abnormalities were common in non survivors. Shortness of breath may indicate poor prognosis of COVID-19.
Chemotherapy in Lung Cancer With Hepatic and Renal Impairment Aida Hastuti; Erna Kusumawardhani; Haryati Haryati
Respiratory Science Vol. 2 No. 2 (2022): Respiratory Science
Publisher : Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/respirsci.v2i2.42

Abstract

Chemotherapy is one of the therapeutic modalities for lung cancer. Chemotherapy with anticancer drugs has a narrow therapeutic index and pharmacokinetic variability between individuals. The administration of anticancer drugs should consider many factors that may affect the pharmacokinetics of the drug, such as hepatic and renal function. In lung cancer patients who have hepatic and renal impairment, an adjusted dose of anticancer drug is needed to achieve levels of drug exposure similar to patients who have normal organ function and avoid toxicity. Renal function is calculated by the glomerular filtration rate or creatinine clearance. Assessment of hepatic function can be taken from Child Pugh's score or from bilirubin and aminotransferase enzyme data in patients. In addition, hepatitis screening is also required. The results of the assessment will determine the adjustment dose recommendation for anticancer drugs.
Nutritional Status of Hospitalized Tuberculosis Patients in South Kalimantan: A Cross-Sectional Study Mohamad Isa; Ira Nurrasyidah; Elok Hikmatun Nikmah; Desi Rahmawaty; Ali Assagaf; Haryati Haryati; Erna Kusumawardhani
Mutiara Medika: Jurnal Kedokteran dan Kesehatan Vol 22, No 2 (2022): July
Publisher : Universitas Muhammadiyah Yogyakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18196/mmjkk.v22i2.15021

Abstract

The burden of tuberculosis (TB) infection is significant in Indonesia. There is likely a substantial link between TB and malnutrition. Anemia, which is linked to TB patient outcomes and length of hospital stay, is another issue that might aggravate the disease. This study aims to identify how common undernutrition and anemia are among tuberculosis patients at the Ulin Regional Hospital in Banjarmasin. A cross-sectional observational study was conducted using medical record data from 31 hospitalized tuberculosis patients from September to December 2021. Data of weight, height, body mass index (BMI), Hemoglobin (Hb) and blood albumin level at admission were analyzed. The result showed that tuberculosis cases were mostly found in males (61.3%) aged 20-60 years (83.9%). There were 42% of patients with undernutrition (BMI 18.5), 93.5% with anemia, and 71% with hypoalbuminemia. Rifampicin resistance was found in 38.7% of all patients, with 58.3% malnutrition, 100% anemia, and 50% hypoalbuminemia. Thus, there was a possible link between tuberculosis and undernutrition condition. Screening, early diagnosis, and treatment for undernutrition, anemia, and hypoalbuminemia should be encouraged in patients with tuberculosis, whether they are susceptible or resistant to rifampicin, to lower the burden of the disease.
Clinical and Laboratory Features of COVID-19 in Ulin Referral Hospital of South Kalimantan: Predictors of Clinical Outcome Haryati Haryati; Mohamad Isa; Ali Assagaf; Ira Nurrasyidah; Erna Kusumawardhani; Eko Suhartono; Fidya Rahmadhany Arganita
Journal of Tropical Life Science Vol. 11 No. 3 (2021)
Publisher : Journal of Tropical Life Science

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jtls.11.03.06

Abstract

Corona Virus Disease (COVID-19) is becoming a global pandemic. Indonesia, especially South Kalimantan had recorded increasing cases with a high fatality rate of 3.7%. Information about factors related to outcomes based on clinical and laboratory features in Indonesia is still limited. Identification of the risk is crucial to determine optimal management and reducing mortality. This retrospective study enrolled 455 adults COVID-19 patients, and data were extracted from medical records of Ulin General Hospital Banjarmasin. The latter is COVID-19 referral hospital in South Kalimantan between March-November 2020. Demographic data, comorbidities, and laboratory were all collected. Data were compared between survivors and non-survivors. Fisher’s exact test and chi-square were used to compare categorical variables. The Mann_Whitney U test was used to compare continuous variables. Analysis was continued by multivariate logistic regression then receiver operating characteristic (ROC) curve to determine cut-off value. The multivariate analysis showed that number of comorbidities [odds ratio (OR) 1,339 (95% confidence interval (CI): 1,064-1,685, P = 0,013) was a significant risk factor to the outcome. In laboratory, lactate dehydrogenase (LDH) [OR: 1.001, 95% CI: 1,000-1.002, P = 0.001], Ferritin (OR 1.000, CI: 1,000-1.001, P = 0.013), APTT (OR: 1.045, CI: 1.010-1.082, P = 0.012), and D-dimer (OR: 1.188, CI: 1.064 - 1.327, P = 0.002) were significant predictor factors but only LDH, ferritin, and D- dimer were obtained good AUC 0.731, 0.715, and 0.705, respectively. The cut of the value of LDH was 656.5 U/L, ferritin was 672.18 ng/ml, and D-dimer was 2.28 mg/L. Sensitivity and specificity were 66.7% and 68,0% for LDH, 83,2% and 56,3% for ferritin, and 62,8 and 70,8% for D-dimer. From this research, we revealed that the number of comorbidities was a risk factor for death. Elevated LDH, ferritin, and D-dimer could be good predictive factors for poor outcomes, thereby considering the accelerating management of COVID-19 patients.
Clinical Characteristic of Different SARS-CoV-2 Variants in South Kalimantan, Indonesia: A Case Study Haryati Haryati; Desi Rahmawaty; Mohamad Isa; Ali Assagaf; Ira Nurrasyidah; Erna Kusumawardhani
Althea Medical Journal Vol 10, No 1 (2023)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v10n1.2810

Abstract

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has undergone various mutations of Corona Virus Disease 2019 (COVID-19). The World Health Organization (WHO) has designated B.1.617.2 (Delta) and B.1.1.529 (Omicron) as variants of concern (VOC). Since clinical features and epidemiological characteristics of patients infected with SARS-CoV-2 variants remain largely unknown, especially in Indonesia, this study aimed to identify the clinical characteristics of COVID-19 patients from South Kalimantan, Indonesia.Methods: Data from medical records of COVID-19 patients at Ulin General Hospital Banjarmasin from June 2021 to February 2022 were randomly extracted, containing demographic data, comorbidities, and laboratory data, as well as the type of virus. Results: In total, 32 patients were included, 9 were infected with delta, 14 with probable omicrons, and 9 with non-VOC. Patients in the probable Omicron group were significantly older than other groups (median age 64 years old, range 54–73 years; p=0.049), had hypertension as the dominant comorbidity (85.7%; p=0.039), the onset appeared slightly earlier (median 3 days; range 2-3 days, p=0.062), with no anosmia symptom (p=0.006). Critical illness predominated and mostly survived in all variants but was not statistically significant (p=0.590 and 0.726, respectively). The three variants showed similarities in laboratory findings; hence, statistical analysis suggested that the leucocytes differed significantly (p=0.020).Conclusions: Patients with the likely Omicron variant are much older, have hypertension as their main comorbidity, do not have any symptoms of anosmia, and have higher leukocyte counts compared to other variants.
Co-Authors Aida Hastuti Alfian Aditia Ali Assagaf Andri Lumban Tobing Bagus Fajar Rohman Desi Rahmawaty Desi Rahmawaty Eko Suhartono Elok Hikmatun Nikmah Fidya Rahmadhany Arganita Haryati Haryati Ira Nurrasyidah Mahendratama Purnama Adhi Mahendratama Purnama Adhi Mohamad Isa Oky Susianto Rapto Hardian Rohmantuah Trada Purba