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All Journal Medical Journal of Indonesia Jurnal Penyakit Dalam Indonesia
Alvina Widhani, Alvina
Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia - RSUPN Dr. Cipto Mangunkusumo, Jakarta
Medicine & Pharmacology

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Association between immune system parameter and clinical characteristics among patients with solid cancer Cahyanur, Rahmat; Widhani, Alvina; Pantoro, Nico Iswanto; Madadika, Annisa Tsana
Medical Journal of Indonesia Vol. 33 No. 2 (2024): June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.247272

Abstract

BACKGROUND Lymphopenia has been reported to be a major predictor of chemotherapy-related toxicity. This study aimed to investigate the correlation between neutrophils, lymphocytes, CD4, and CD8 in solid cancer patients and cancer clinical characteristics. METHODS This was a cross-sectional study of patients who will undergo chemotherapy at the Hematology and Medical Oncology Clinic, Cipto Mangunkusumo Hospital, from June to September 2023. Clinical characteristics, CD4 and CD8 levels, and neutrophil and lymphocyte counts were assessed at the first visit. A comparative test was carried out on the patients’ average CD4, CD8, neutrophil, and lymphocyte counts. RESULTS Types of cancer were associated with CD4 levels. Patients with head and neck cancer had lower CD4 levels (411.3 [119.3–1,427.5] cells/mm³) compared with colorectal (514.7 [129.2–861.3] cells/mm³), breast and gynecological (567.5 [180.1–939 cells/mm³), and other cancers (681.4 [175.1–2,056.9] cells/mm³), with p = 0.009. Patients aged ≥40 years had higher CD8 levels than those aged <40 years (376.4 [142.8–1,293.1] cells/mm³ versus 565.3 [185.9–1,944] cells/mm³, p = 0.01). Additionally, lymphocyte count was associated with cancer type, with the lowest number in head and neck cancer (1,380 [280–2,660] μl, p = 0.044). CONCLUSIONS CD4 levels and lymphocyte counts were associated with the cancer type, whereas CD8 levels were influenced by age.
Campak dan Vaksinasi Campak pada Orang Dewasa Sinto, Robert; Koesnoe, Sukamto; Nelwan, Erni Juwita; Widhani, Alvina; Shakinah, Sharifah; Pasaribu, Adeline; Duindrahajeng, Bernadine Gracia; Suwarto, Suhendro; Nainggolan, Leonard; Chen, Lie Khie; Susilo, Adityo; Maria, Suzy; Hasibuan, Anshari Saifuddin; Wicaksana, Bramantya
Jurnal Penyakit Dalam Indonesia Vol. 13, No. 1
Publisher : UI Scholars Hub

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Measles is a highly contagious viral infection that remains a significant global health problem despite the availability of an effective vaccine. Measles re-emergence is driven by gaps in immunization coverage, waning post-vaccination immunity, and increased population mobility. In adults, measles infection is associated with greater disease severity compared to children. This literature review was conducted by reviewing recent scientific publications addressing the epidemiology, pathogenesis, clinical manifestations, diagnosis, management, complications, and prevention of measles, with a focus on the adult population.  Measles is caused by an RNA virus of the Paramyxoviridae family and is transmitted through respiratory droplets and aerosols. Typical clinical features include fever, cough, coryza, conjunctivitis, and a maculopapular rash with a centrifugal and cephalocaudal distribution. Diagnosis is based on clinical findings and confirmed by laboratory tests such as RT-PCR and measles-specific IgM serology. Measles infection causes significant immunosuppression, including immune amnesia, which increases susceptibility to secondary infections. Management is primarily supportive and vitamin A supplementation has been shown to reduce mortality in certain populations. In adults, complications tend to be more severe, particularly pneumonia as the leading cause of morbidity and mortality, as well as neurological complications such as encephalitis and subacute sclerosing panencephalitis (SSPE). Measles vaccination with the MMR vaccine remains the main prevention strategy. However, its implementation faces challenges, including gaps in immunization coverage, vaccine hesitancy, and limited adult immunization record system. Measles in adults remains a significant health concern with a high risk of severe complication. Strengthening immunization program, improving public education, and developing integrated surveillance system are essential to reduce disease incidence and burden.
Hubungan Penggantian Imunosupresan Tidak Terencana dengan Aktivitas Penyakit Lupus Eritematosus Sistemik: Studi Kohort Retrospektif di RSUPN Dr. Cipto Mangunkusumo, Jakarta Amanda, Rosvitha; Koesnoe, Sukamto; Widhani, Alvina; Rinaldi, Ikhwan; Susilo, Adityo; Kurniawan, Juferdy; Putranto, Rudi; Karim, Birry
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Abstract

Introduction. Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease with diverse clinical manifestations. Treatment stabilization is crucial for optimal disease control, but the consistency of immunosuppressive therapy may be affected by non-ideal conditions, including drug unavailability or adverse effects. This study aimed to assess the association between unplanned immunosuppressant switching and increased disease activity in SLE patients. Methods. A retrospective cohort study of SLE patients meeting the inclusion criteria, whose disease activity was evaluated using the MEX-SLEDAI score during immunosuppressant substitution. Participants were grouped into an exposed group undergoing unplanned immunosuppressant switching due to drug unavailability and a comparison group continuing maintenance therapy without switching. Disease activity was assessed using the MEX-SLEDAI score during follow-up. Results. A total of 213 SLE patients were included; 45 patients (21.1%) experienced increased disease activity. Unplanned immunosuppressant substitution was significantly associated with increased disease activity (RR 2.06; 95% CI 1.18–3.60; p=0.011), and remained significant after adjustment for confounders (aRR 1.82; 95% CI 1.05–3.15; p=0.034). Subgroup analysis showed most flares occurred within the first three months after substitution, and mycophenolate-containing replacement regimens were associated with a lower risk of increased disease activity (p=0.025). Conclusions. Unplanned immunosuppressant substitution is associated with increased disease activity in SLE patients. Close monitoring following switching is essential to maintain disease stability.
Co-Authors Adeputri Tanesha Idayu Adeputri Tanesha Idayu, Adeputri Tanesha Adityo Susilo, Adityo Aida Lydia Amanda, Rosvitha Andhika Rachman Andru, Gestana Angga Pramudita Anggoro, RM Suryo Annisa, Firda Arif Mansjoer Aulia Rizka, Aulia Birry Karim Bramantya Wicaksana C. Martin Rumende, C. Martin Ceva W. Pitoyo Cleopas Martin Rumende Cynthia Olivia Maurine Jasirwan Desi Salwani, Desi Dono Antono Duindrahajeng, Bernadine Gracia E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Edwin Wijaya Edwin Wijaya, Edwin Erni J Nelwan, Erni J Erni Juwita Nelwan, Erni Juwita Evy Yunihastuti Findy Prasetyawaty, Findy Firda Annisa Gurmeet Singh Hamdan, Muhammad Afriadi Hasibuan, Anshari Saifuddin Hasudungan, Wicensius Parulian Herikurniawan Herikurniawan Herikurniawan, Herikurniawan Ika Prasetya Wijaya Ikhwan Rinaldi Jasirwan, Chyntia OM Josephine, Jennifer Juferdy Kurniawan Khie Chen Laras Budiyani Laras Budiyani, Laras Leonard Nainggolan Madadika, Annisa Tsana Maksum, Maradewi Maradewi Maksum Mira Yulianti Mira Yulianti, Mira Mondrowinduro, Prionggo Muhammad Yamin Nababan, Saut Horas Noto Dwimartutie Nur Imami, Ghefira Pantoro, Nico Iswanto Pasaribu, Adeline Praptini, Mirna Nurasri Rahmat Cahyanur Rino A Gani Rino A Gani Robert Sinto Robert Sinto Rudi Putranto Satrio, Trian Shakinah, Sharifah Siti Setiati Siti Setiati Suhendro Suwarto, Suhendro Sukamto Koesnoe Suzy Maria Teguh Harjono Karjadi, Teguh Harjono Wicaksana, Bramantya Widayat Djoko Santoso Widayat Djoko Santoso, Widayat Djoko