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All Journal Keluwih: Jurnal Kesehatan dan Kedokteran The Indonesian Journal of Community and Occupational Medicine Neurona Acta Neurologica Indonesia
Wiratman, Winnugroho
Unknown Affiliation
Agriculture, Biological Sciences & Forestry Health Professions Medicine & Pharmacology Neuroscience Nursing Public Health

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Association between CYP2C9 and CYP2C19 Polymorphism, Metabolism, and Neurotoxicity after Administration of Phenytoin: A Systematic Review Mardhiani, Rizka; Harahap, Yahdiana; Wiratman, Winnugroho
Keluwih: Jurnal Kesehatan dan Kedokteran Vol. 5 No. 1 (2023): Keluwih: Jurnal Kesehatan dan Kedokteran (December)
Publisher : Direktorat Penerbitan dan Publikasi Ilmiah, Universitas Surabaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24123/kesdok.V5i1.6010

Abstract

Abstract—Phenytoin is an antiepileptic drug (AED) metabolized by cytochrome P450 enzymes, especially by CYP2C9 (90%) and CYP2C19 (10%), where both enzymes are polymorphic so that they can undergo polymorphism and it can change the metabolic rate of the drug. Phenytoin is one of the drugs whose risk of side effects may increase due to its narrow therapeutic window of 10-20 µg/mL if the metabolism is slow. The main literature was taken from publications through the library databases in 2017 – 2021. Studies and reviews describing the metabolism, CYP2C9 and CYP2C19 polymorphisms, and neurotoxicity of phenytoin were included, and unrelated research were excluded. There were 18 of 853 articles describing CYP2C9 and CYP2C19 polymorphisms, metabolism, and neurotoxicity events associated with phenytoin used. The authors conclude that based on the results from various literature, there is an association between CYP2C9 and CYP2C19 polymorphism, metabolism, and neurotoxicity after Phenytoin administration with CYP2C9*2 and CYP2C9*3 types of polymorphisms for CYP2C9 and CYP2C19*2 and CYP2C19*3 types for CYP2C19*3 enzymes which can slow down the phenytoin metabolism and increase its concentration in serum so that the risk of causing neurotoxicity. Keywords: CYP2C9, CYP2C19,metabolism, neurotoxicity, phenytoin Abstrak—Fenitoin merupakan obat antibangkitan yang dimetabolisme oleh enzim sitokrom P450 terutama oleh CYP2C9 (90%) dan CYP2C19 (10%), dimana kedua enzim tersebut bersifat polimorfik sehingga dapat mengalami polimorfisme dan dapat mempengaruhi laju metabolisme obat. fenitoin merupakan salah satu obat yang risiko efek sampingnya dapat meningkat jika metabolismenya lambat karena jendela terapeutiknya yang sempit, yaitu 10-20 µg/mL. Literatur utama diambil dari publikasi melalui database perpustakaan tahun 2017 – 2021. Penelitian dan ulasan yang menggambarkan metabolisme, polimorfisme CYP2C9 dan CYP2C19, dan neurotoksisitas fenitoin, dan penelitian yang tidak terkait dikeluarkan. Terdapat 18 dari 853 artikel yang menjelaskan polimorfisme CYP2C9 dan CYP2C19, metabolisme, dan kejadian neurotoksisitas terkait dengan fenitoin yang digunakan. Peneliti menyimpulkan bahwa berdasarkan hasil dari berbagai literatur, terdapat hubungan antara polimorfisme, metabolisme, dan neurotoksisitas CYP2C9 dan CYP2C19 setelah pemberian fenitin dengan jenis polimorfisme CYP2C9*2 dan CYP2C9*3 untuk CYP2C9 dan CYP2C19*2 dan CYP2C19*3 jenis enzim CYP2C19*3 yang dapat memperlambat metabolisme fenitoin dan meningkatkan konsentrasinya dalam serum sehingga berisiko menyebabkan neurotoksisitas. Kata kunci: CYP2C9, CYP2C19, fenitoin, metabolisme, neurotoksisitas
FENOMENA OTOT POSITIF PADA KELAINAN NEUROMUSKULAR Angelita, Michelle Cancera; Indrawati, Luh Ari; Hakim, Manfaluthy; Octaviana, Fitri; Budikayanti, Astri; Safri, Ahmad Yanuar; Wiratman, Winnugroho; Fadli, Nurul; Harsono, Adrian Ridski
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 40 No 2 (2024): Vol 40 No 2 (2024): Volume 40, No 2 - Maret 2024
Publisher : PERDOSNI

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Abstract

Positive muscle phenomena arise due to various forms of spontaneous muscle hyperactivity originating from motor neurons or the muscle itself. The presence of this phenomenon can constringe the possible diagnosis to be more specific, so if presence it is necessary to be identified in patients with potential neuromuscular disease. However, the presence of positive muscle phenomena is often overlooked. This gap in our knowledge regarding definitions, clinical findings, electrodiagnostic findings, and pathophysiological mechanisms hampers effective diagnosis and treatment. In this article, we review the clinical characteristics approach to diagnosis of various positive muscle phenomena originating from the lower motor neuron (LMN) and muscle, including tetany, cramps, fasciculations, myokymia, neuromyotonia, rippling muscle, percussion induced rapid contractions (PIRCs), myoedema, and contractures. Keywords: fasciculation, muscle phenomena, hyperactivity, myotonia, rippling muscle
The Effectiveness of Plasmapheresis Compared to Intravenous Immunoglobulin in Guillain-Barre Syndrome Patients Mustika, Alyssa Putri; Hakim, Manfaluthy; Sari, Waode Satriana; Octaviana, Fitri; Budikayanti, Astri; Safri, Ahmad Yanuar; Wiratman, Winnugroho; Indrawati, Luh Ari; Fadli, Nurul; Harsono, Adrian Ridski; Savitri, Irma
Acta Neurologica Indonesia Vol. 2 No. 02 (2024): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v2i02.24

Abstract

Introduction : Guillain-Barré syndrome (GBS) is the second most common cause of acute and subacute general paralysis. The management is symptom-adjusting, but plasmapheresis (plasma exchange/PE) and intravenous immunoglobulin immunotherapy (IVIG) can be administered to accelerate the return of neurological function. This study aim to determine PE's effectiveness compared to IVIG in GBS patients and the side effects or complications that may arise. Method : The literature study is carried out on four databases. Selection is carried out using inclusion and exclusion criteria. The articles were screened and extracted independently by two investigators. Results : The literature study obtained three systematic review studies. In the first study, shows the outcomes in the form of improved Hughes Score (OR 1.9; 95% CI 1.11-3.28) and mortality (OR 0.8; 95% CI 0.31-2.29) against IVIG. The second study, outcomes shown in the form of improved disability scores (WMD -0.02, p: 0.83), and secondary outcomes such as mortality or relapse (p >0.05, respectively). The third study showed that IVIG had higher efficacy (OR 1.6, p: 0.067, 95% CI 0.972-2.587), shorter duration of hospitalization, 38 days, compared to 49-day PE therapy (SMD -3.389, 95% CI -11.601-4.824; p: 0.419), however, had higher side effect (OR 0.8, p: 0.430, 95% CI 0.389-1.495). Conclusion : PE efficacy is generally lower than IVIG, as indicated by disability scores/motor ability scores in various studies, as well as the duration of hospitalization. The safety of therapy is assessed by the side effects that appear and appear-more-often in IVIG therapy rather than PE.
Carpal Tunnel Syndrome and Associated Factors Among Workers in Blacksmithing Industry in Java, Indonesia Maha Putra, I Gede; Isbayuputra, Marsen; Wiratman, Winnugroho; Hidayat, Rakhmad; Soemarko, Dewi Sumaryani
The Indonesian Journal of Community and Occupational Medicine Vol. 5 No. 2 (2025): ijcom
Publisher : ILUNI MKK FKUI and PRODI MKK FKUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53773/ijcom.v5i2.173.66-72

Abstract

Introduction: Carpal Tunnel Syndrome (CTS) is one of the most common work-related musculoskeletal disorders, particularly in the informal sector such as traditional blacksmithing industries. Objective. This study aims to determine the prevalence and associated factors of CTS among blacksmith workers in Mekarmaju Village, Bandung Regency. Methods: Using a cross-sectional design, data were collected from 100 male workers through questionnaires, work observations, and physical examinations (Phalen and Tinel tests). Result:The results showed a CTS prevalence of 68%, with the majority of cases being bilateral. Bivariate analysis revealed several factors associated with CTS, including body mass index, age, dominant hand, and type of work. However, multivariate analysis identified only work duration (>3 years) as a significantly associated factor (aOR = 0.03; 95% CI: 0.01–0.92; p = 0.045), indicating that newer workers are more vulnerable to CTS. Conclusion: These findings highlight the importance of early ergonomic interventions and health screening at the beginning of employment to prevent CTS in the informal labor sector.
Co-Authors Andhika Rachman Angelita, Michelle Cancera Aninditha, Tiara Budikayanti, Astri Dewi Sumaryani Soemarko Fadli, Nurul Fitri Octaviana Hakim, Manfaluthy Harsono, Adrian Ridski Indrawati, Luh Ari Isbayuputra, Marsen Maha Putra, I Gede Mardhiani, Rizka Mustika, Alyssa Putri Pratiwi, Astri Dewina Rakhmad Hidayat Ranakusuma, Teguh A. S Rini Andriani Safri, Ahmad Yanuar Sari, Riska Nanda Sari, Waode Satriana Savitri, Irma Sofyan, Henry Riyanto Yahdiana Harahap Yesnuar Safri, Ahmad