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Analysis of IFN-gamma and IL-10 Levels as Markers of Inflammation and Response Therapy of Anti-Tuberculosis in MDR Lung TB Patients Setyawati, Herni; Soedarsono, Soedarsono; Yulistiani, Yulistiani; Fatmawati, Umi
Folia Medica Indonesiana Vol. 55, No. 4
Publisher : Folia Medica Indonesiana

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Abstract

Multidrug-Resistant Tuberculosis (MDR TB) is caused by an organism that is resistant to at least isoniazid and rifampisin, the two most potent TB drug. Immune response to against Mycobacterum tuberculosis infection is related to the function of immunity. The function of interferon-γ (pro-inflammatory) is to activate macrophages, to stimulate antimicrobial molecules (to reactive oxygen species and nitric oxide), and to inhibits interleukin-10. Interleukin-10 function is to triggers humoral immunity, to inhibit IFN- γ. This study aimed to analyze level changes and the correlation with clinical data, also months of MDR TB patients who received standard OAT therapy. This was an observational study using cross sectional design. There were 29 patients who received standard MDR TB OAT therapy from 1-24 months, who met the inclusion criteria. Then, the patients were divided based on duration of the therapy, which are the initial/intensive and advanced phase. The initial phase divided into 2: first one is for 1-4 months therapy's time (5 patients) and the second one is for more than 4-8 months (6 patients). Then, the advanced group divided into two groups again, which are third group with more than 8-16 months (13 patients) and fouth group with more than 16-24 months (5 patients). Then, measured serum concentration IFN-γ, IL-10 at the start of the study and 4 weeks later with the ELISA method. This research during the period July-December (6 months). IFN-γ post concentrations were decreased by 39.14 ± 139.12 pg/mL (p > 0.05). The concentration of IL-10 was decreased by 33.93 ± 109.20pg/mL (p>0.05). Based on the TB score bandim method during pre and posts results were 1 patient experienced severity change from severity class 1 to 2, 1 patient from severity class 2 to 1, 1 patient remained in severity 2 and 26 patient remained in severity 1. The results showed that serum IFN-γ and IL-10 levels in initial/intensive and advanced phase patients who received MDR TB regiment after four weeks did not changed,
Effectivity of Erythropoietin-Alpha between Fixed- and Adjusted-Dose in Chronic Kidney Disease Patients With Anemia on Hemodialysis Purwiningtyas, Mida; Yulistiani, Yulistiani; Suprapti, Budi; Santi, Bayu Dharma
Folia Medica Indonesiana Vol. 55, No. 4
Publisher : Folia Medica Indonesiana

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Every year, there are 500.000 new cases and more than 250.000 deaths caused by cervical cancerworldwide. Cervical cancer patients faced physical and psychological problems several times that it activate stress mechanism such as hypothalamus-pituitary-adrenal (HPA) axis. These recurrent activations caused HPA axis disruption and adverse clinical effects. Several symptoms of endocrine stress response are the change of circadian cortisol rhythm. Cortisol is known as a stress hormone that involves an organism's response to stress and anxiety that influence the quality of life. This research aims to analyze the differences among serum cortisol level, anxiety, and quality of life in cervical cancer patients before and after psychocurative intervention in obstetrics and gynecology wards and polyclinic in RSUD Dr. Moewardi Surakarta. This research is an experimental double-blind randomized controlled clinical trial pre-test post-test group design study. The subjects were advance stage (IIB-IV)cervical cancer patients. The subjects were randomly chosen into fifteen subjects that given standard therapy and psychocurative, while the other fifteen subjects as a control only got standard therapy. Data were obtained from measurement of serum cortisol level, anxiety questionnaire DASS 42 and WHO quality of life questionnaire. Data were analyzed using SPSS 21 using difference test. The difference mean test result of cortisol serum level, anxiety, quality of life from the controlled group and uncontrolled group showed a significant difference (p < 0.05). In conclusion, psychocurative is significant to reduce cortisol level, anxiety, and improve the quality of life in advanced stage cervical cancer patients.
Analysis of induction phase glucocorticoid use on adrenal suppression in pediatric patients with acute lymphoblastic leukemia Simbolon, Octaviana; Yulistiani, Yulistiani; Ugrasena, I DG; Qibtiyah, Mariyatul
Folia Medica Indonesiana Vol. 52, No. 1
Publisher : Folia Medica Indonesiana

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Abstract

Glucocorticoids play an important role in the treatment of acute lymphoblastic leukemia (ALL). However, supraphysiological doses may cause suppression of the adrenal. Adrenal suppression resulting in reduced cortisol response may cause an inadequate host defence against infections, which remains a cause of morbidity and mortality in children with ALL. The occurrence of adrenal suppression before and after glucocorticoid therapy for childhood ALL is unclear. The aim of this study is to analysis the effect of glucocorticoid on cortisol levels during induction phase chemotherapy in children with acute lymphoblastic leukemia. A cross-sectional, observational prospective study was conducted to determine the effect of glucocorticoid on cortisol levels in children with acute lymphoblastic leukemia. Patients who met inclusion criteria were given dexamethasone or prednisone therapy for 49 days according to the 2013 Indonesian Chemotherapy ALL Protocol. Cortisol levels were measured on days 0, 14, 28, 42 and 56 of induction phase chemotherapy. There were 24 children, among 31 children recruited, who suffered from acute lymphoblastic leukemia. Before treatment, the means of cortisol levels were 228.95 ng/ml in standard risk group (prednisone) and 199.67 ng/ml in high risk group (dexamethasone). In standard risk group, the adrenal suppression occurs at about day 56. There was a significant decrement of cortisol levels in high risk group in days 14, 28, 42 against days 0 of induction phase (p=0.001). Both groups displayed different peak cortisol levels after 6 week of induction phase (p=0.028). Dexamethasone resulted in lower cortisol levels than prednisone during induction phase chemotherapy in children with acute lymphoblastic leukemia.
Analysis of nacl-mannitol hydration on renal function of head and neck cancer patients receiving high-dose cisplatin chemotherapy combination Desiani, Ekanita; Suharjono, Suharjono; Yulistiani, Yulistiani; Susilo, Dwi Hari
Folia Medica Indonesiana Vol. 53, No. 1
Publisher : Folia Medica Indonesiana

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Abstract

Cisplatin is one of platinum cytostatic drug for the medication of solid cancers, one of which is head and neck cancer. Adverse event that resulted during drug treatment was acute or chronic nephrotoxicity. Cisplatin concentration in proximal tubular epithelial cells is about 5 times the serum concentration. Platinum exposure on renal tubular cells bonding covalent complex which stimulate production of inflammatory factors that lead to apoptosis and necrosis cell. Cisplatin nephrotoxicity can be prevented by aggressive hydration or alternate method of administration. The aim of this study was to analyze the effectiveness of NaCl-Mannitol hydration on renal function of head and neck cancer patients receiving cisplatin 100 mg/m2 chemotherapy combination with 5FU or paclitaxel. This was a cohort, prospective, and observational study to analyze renal function of head and neck cancer patients receiving cisplatin 100 mg/m2 chemotherapy combination with 5FU or paclitaxel. Inclusion criteria were BUN 7-18 mg/dl and serum creatinine < 2 mg/dl of any cycle. All patients received infuse NaCl-Mannitol hydration with term that provided in Surgeon Departement of Dr. Soetomo General Hospital. Data obtained were BUN, SCr, and eClCr Cockroft-Gault, each was measured pre- and post-hydration. In cisplatin and 5FU chemotherapy combination value BUN pre-hydration (11,99 + 4,62) mg/dl, value BUN post-hydration (12,14 + 4,74) mg/dl and value serum creatinine pre-hydration (0,97 + 0,34) mg/dl, value serum creatinine post-hydration (1,02 + 0,37) mg/dl. Meanwhile to the combination of cisplatin and paclitaxel chemotherapy, value BUN pre-hydration (10,19 + 2,58) mg/dl, value of BUN post-hydration (10,43 + 2,31) mg/dl and value of serum creatinine post- hydration (0,98 + 0,26) mg/dl. In conclusion, NaCl-Mannitol hydration administration is adequate which is shown by BUN and serum creatinine in pre- and post-hydration data within normal limits.
C-reactive protein (crp) as a supporting marker of antibiotic effectiveness on central nervous system (cns) infections Olevianingrum, Melawati; Yulistiani, Yulistiani; Saharso, Darto; Zairina, Nun
Folia Medica Indonesiana Vol. 51, No. 3
Publisher : Folia Medica Indonesiana

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Abstract

Infection of the central nervous system in pediatric patients have a high mortality as well as acute and chronic neurological sequelae. Signs of the disease are unclear, so cerebrospinal fluid (CSF) test is used as a gold standard for diagnosis, but the investigation has faced many obtacles. Empiric antibiotic therapy is the key factor in reducing morbidity and mortality. Microbiological culture result is obtained within 5-7 days. The effectiveness of empirical antibiotic use is questionable. Therefore, other investigations are conducted to determine the effectiveness of antibiotics by using one marker, the CRP. This study was to analyze CRP level in supporting antibiotic therapy effectiveness in pediatric patients with central nervous system (CNS) infections. A prospective cohort study was conducted to determine the relationship of CRP with other parameters, including clinical, microbiological and laboratory, in pediatric patients with central nervous system infections. Patients meeting blood samples criteria were taken before (H0), the third day (H3) and the fifth day (H5) after antibiotics administration. This study involved 10 patients with central nervous system infections (meningoencephalitis, encephalitis and encephalitis with cerebral edema). Six patients were male, with ages less than a year. Antibiotic treatment effectiveness was associated with improved condition of the patients' CRP level. It was 3.558 ±3.196 before (H0), 3.878±2.813 on the third day (H3) and 3.891±2.204 on the fifth day (H5) after antibiotic administration. Leukocyte levels were 13.680±1.660 before (H0), 17.832±7.213 on the third day (H5), and 10.546±3.671 on the fifth day (H5) after antibiotic administration. Pearson's correlation test analysis performed on CRP and WBC parameters showed H0 p=0.981, CRP and WBC H3 p=0.621, while CRP and WBC H5 obtained significance p=0.644. There was no significant correlation observed between CRP and WBC parameters before and after antibiotic administration. In conclusion, there was no correlation of CRP levels with clinical, laboratory and micobiological parameters in patients with central nervous system infections.
Analysis of Prophylactic Antibiotics Usage in Caesarean Section Delivery Muzayyanah, Binti; Yulistiani, Yulistiani; Hasmono, Didik; Wisudani, Nuraida
Folia Medica Indonesiana Vol. 54, No. 3
Publisher : Folia Medica Indonesiana

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Abstract

Caesarean section is the delivery through a surgical incision in the abdomen and uterus with various risks, such as Surgical Site Infection (SSI) which either occurs rapidly (24-48 hours postoperatively) or delayed. To reduce the risk of various post-cesarean section infections, prophylactic antibiotics are given. The administration of prophylactic antibiotics with recommended regimens, such as in developed countries as in the United States and Europe, with first generation of cephalosporins has not been applied in Dr. Iskak Hospital, Tulungagung. This hospital still used other types of antibiotics, such as cefotaxime or ceftriaxone. In addition, for several reasons, prophylactic antibiotics were continued with other antibiotics to reduce the risk of delayed infection. This study was designed to analyze the effectiveness of prophylactic antibiotics as recommended in cesarean section. This was a prospective observational study with consecutive sampling type, examined 41 mothers with cesarean section at the Department of Obstretics and Gynecology, Dr. Iskak Hospital, Tulungagung, Indonesia. This study was conducted from May to July, 2017. The results of the study showed that the effectiveness of prophylactic antibiotic use was 98% based on the clinical parameters and maternal laboratory outcome, which showed that SIRS was in normal category. Whereas, there was one mother (2%) who had SSI on day 10 postoperatively.
Effectiveness and safety differences of isoxsuprine and nifedipine as tocolytics in the risk of preterm labor Oktavia, Nur; Yulistiani, Yulistiani; Markus, Unedo H; Mamo, Hendriette Irene
Folia Medica Indonesiana Vol. 53, No. 4
Publisher : Folia Medica Indonesiana

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Abstract

Premature labor is a cause of high rates of perinatal morbidity and mortality. The use of tocolytics is one of the efforts to handle the risk of preterm labor. Tocolytics which are widely used in Indonesia is isoxsuprine and nifedipine. The purpose of this study was to identify the difference of effectiveness and safety of isoxsuprine as tocolytics in the risk of preterm labor. This was an observational study in the form of a case study that was done in detail and depth to the patients who were diagnosed as imminent preterm labor. In conclusion, there were differences in the effectiveness and safety of isoxsuprine and nifedipine as tocolytics in the risk of preterm labor.
Effects of methyldopa on vegf levels as proangiogenic factor in severe pre-eclampsia at haji hospital, surabaya Juwita, Dina Ratna; Yulistiani, Yulistiani; M, Eddy Zarkaty
Folia Medica Indonesiana Vol. 53, No. 4
Publisher : Folia Medica Indonesiana

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Methyldopa is the main antihypertensive drug widely used in pregnant women with hypertensive disorder. It lowers blood pressure in pre-eclampsia by affecting a2-adrenoreceptors in central nervous system. However, it also decreases the production of proangio-genic factors that involved in the pathophysiology of hypertension in pre-eclampsia. Vascular Endothelial Growth Factor (VEGF) is one of proangiogenic and mitogenic factor that important for vasodilatation. VEGF is produced by the placenta and affected after treatment with methyldopa. The aim of this study was to analyze the effects of methyldopa on VEGF maternal circulating level as a proangiogenic factor in severe pre-eclampsia patients who were hospitalized at Obstetrics and Gynecology Department, Haji Hospital, Surabaya. This study was performed by cohort prospective observational method on August to October 2016.The data was assessed at before and 48 hours after methyldopa therapy. The study was approved by the ethical committee of Haji Hospital, Surabaya. There were 19 patients with severe pre-eclampsia who met inclusive criteria. The results showed that levels of VEGF before and 48 hours after 250 mg methyldopa therapy were 1178.37(281.97-3567.28) pg/mL and 1055.17 (129.79-4272.66) pg/mL, respectively. VEGF levels in severe pre-eclampsia patients were 1194.29 (175.68-3432.01) pg/mL at before treatment and 510.66 (214.34-1236.16) pg/mL after treatment with methyldopa 500 mg therapy. In conclusion, methyldopa could decrease VEGF level on severe pre-eclampsia patients, with a decrease of 10% at the dose of 250 mg and 57% at the dose of 500 mg.
Phosphatidylglycerol study as fetal lung maturation parameter after dexamethasone administration for women at risk of preterm birth Rahmadani, Rizal Umar; Sulistyono, Agus; Yulistiani, Yulistiani; Yahya, Muhammad
Folia Medica Indonesiana Vol. 52, No. 4
Publisher : Folia Medica Indonesiana

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Abstract

Phosphatidylglycerol is an important indicator of fetal lung maturation, which plays a role in stabilizing surfactant lipoprotein complex. Corticosteroid antenatal can stimulate the synthesis of pulmonary surfactant in infants with preterm birth. The objective of this study is to examine the phosphatidylglycerol levels as fetal lung maturation parameter after dexamethasone administration in women with preterm birth compared to L/S ratio parameter. This study was prospective longitudinal (cohort). The samples were pregnant women with preterm birth risk at 28-34 weeks gestation getting the therapy of antenatal dexamethasone 6 mg IM every 12 hours given 4 times in 48 hours. The samples were 17 patients. Determination of L/S ratio and PG levels was performed by ELISA. The study was conducted from May - November 2015 and reviewed to obtain ethics eligibility permit by the research ethic committees of Dr. Soetomo General Hospital. The results show that the mean value of L/S ratio is 2.28 with a range of 1.35 to 9.06 and the mean of PG level is 1.17 with a range from 0 to 3.79. L/S ratio and PG show no significant relationship between the two of them. Increased levels of PG on the gestational age of 28-32 weeks have not demonstrated clinically significant changes yet. The highest PG level occurs in the gestational age of 32-34 weeks.
Children with Standard Risk Acute Lymphoblastic Leukemia in Induction And Consolidation Phase Amarullah, Adinugraha; Hasmono, Didik; Ugrasena, IGD; Yulistiani, Yulistiani
Folia Medica Indonesiana Vol. 54, No. 1
Publisher : Folia Medica Indonesiana

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Abstract

Prednisone has an important role in the therapy of patient with standard risk ALL. Patients with standard risk ALL receiving high dose prednisone as therapy and supraphysiology dose of prednisone are expected to cause suppression in HPA-axis (Hypothalamic Pituitary Adrenal axis). This suppression could reduce immune system in children with ALL and increase infection risk because reduction of cortisol level. In Indonesia, we did not find study about the incident of adrenal suppression after high dose prednisone therapy, especially in induction to consolidation phase ALL patient. The aim of this study was to analyze adrenal suppression after high dose prednisone therapy on children with standard risk acute lymphoblastic leukemia in induction and consolidation phase. This study has received a certificate of Ethical Clearance No. 588/Panke.KKE/X/2016, a longitudinal observational, prospective, non-randomized trial involving children with ALL who received prednisone for 49 days during the induction phase. We collected and compared laboratory result of cortisol level in children with ALL and received prednisone therapy during induction to consolidation phase. Sample was taken at week 0,4,5,6,7,8,10,12 in the course of ALL chemotheraphy Indonesian protocol year 2013. Serum was examined using methods CLIA ADVIA Centaur® XP. Between June 2016 – January 2017, 13 patients (8 males, 5 females) were included in this study. Decrease of cortisol level after prednisone therapy occured in week-10 as much as 53% compared with week-0 (p=0.027). Cortisol level increased 64% of week-12 compared with week-10 (p=0.003). In conclusion, high dose prednisone is not significant to causing adrenal suppression in induction phase of ALL patients, and the reducing cortisol level is reversible.