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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research
Yolanda Wulandari Erwen
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

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Vitamin D Supplementation is Associated with Attenuated Ocular Surface Oxidative Stress in Mild Thyroid Eye Disease: A Preliminary Interventional Study Mardijas Efendi; Hendriati; Pattih Primasakti; Yolanda Wulandari Erwen; Rani Apriani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1451

Abstract

Background: Thyroid eye disease (TED) is an autoimmune orbitopathy where inflammation drives significant oxidative stress, contributing to patient morbidity. Malondialdehyde (MDA), a lipid peroxidation product, is a key biomarker of this oxidative damage. While vitamin D has known systemic immunomodulatory effects, its capacity to mitigate local oxidative stress on the ocular surface in TED is poorly understood. This study aimed to investigate the association between oral vitamin D supplementation and tear film MDA levels in patients with mild TED. Methods: A prospective, single-center, quasi-experimental pre-post study without a control group was conducted on 15 patients diagnosed with mild, active TED (Clinical Activity Score ≤3). Participants received 1000 IU of oral cholecalciferol (Vitamin D3) daily for 21 consecutive days. The primary outcome was the change in tear film MDA concentration, measured by ELISA. Secondary outcomes included serum 25-hydroxyvitamin D [25(OH)D] levels and clinical ocular surface parameters (Ocular Surface Disease Index [OSDI], Tear Break-Up Time [TBUT], Schirmer's I test). Results: A statistically significant reduction in mean tear film MDA levels was observed, decreasing from a baseline of 8.69 ± 4.15 ng/L to 5.70 ± 1.56 ng/L post-intervention (p<0.001). This was accompanied by a significant increase in mean serum 25(OH)D levels from 18.2 ± 5.9 ng/mL to 29.8 ± 6.4 ng/mL (p<0.001). Significant improvements were also noted in OSDI scores (p=0.002) and TBUT (p=0.005). The reduction in tear film MDA showed a significant negative correlation with the increase in serum 25(OH)D (r = -0.68, p=0.005). Conclusion: In this preliminary, uncontrolled study, short-term oral vitamin D supplementation was associated with a significant attenuation of ocular surface oxidative stress in patients with mild TED. These findings provide initial biochemical evidence for the potential localized benefits of vitamin D and support the need for larger, placebo-controlled randomized trials to validate its role as a safe adjunctive therapy for managing the ocular surface component of this disease.
Vitamin D Supplementation is Associated with Attenuated Ocular Surface Oxidative Stress in Mild Thyroid Eye Disease: A Preliminary Interventional Study Mardijas Efendi; Hendriati; Pattih Primasakti; Yolanda Wulandari Erwen; Rani Apriani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1451

Abstract

Background: Thyroid eye disease (TED) is an autoimmune orbitopathy where inflammation drives significant oxidative stress, contributing to patient morbidity. Malondialdehyde (MDA), a lipid peroxidation product, is a key biomarker of this oxidative damage. While vitamin D has known systemic immunomodulatory effects, its capacity to mitigate local oxidative stress on the ocular surface in TED is poorly understood. This study aimed to investigate the association between oral vitamin D supplementation and tear film MDA levels in patients with mild TED. Methods: A prospective, single-center, quasi-experimental pre-post study without a control group was conducted on 15 patients diagnosed with mild, active TED (Clinical Activity Score ≤3). Participants received 1000 IU of oral cholecalciferol (Vitamin D3) daily for 21 consecutive days. The primary outcome was the change in tear film MDA concentration, measured by ELISA. Secondary outcomes included serum 25-hydroxyvitamin D [25(OH)D] levels and clinical ocular surface parameters (Ocular Surface Disease Index [OSDI], Tear Break-Up Time [TBUT], Schirmer's I test). Results: A statistically significant reduction in mean tear film MDA levels was observed, decreasing from a baseline of 8.69 ± 4.15 ng/L to 5.70 ± 1.56 ng/L post-intervention (p<0.001). This was accompanied by a significant increase in mean serum 25(OH)D levels from 18.2 ± 5.9 ng/mL to 29.8 ± 6.4 ng/mL (p<0.001). Significant improvements were also noted in OSDI scores (p=0.002) and TBUT (p=0.005). The reduction in tear film MDA showed a significant negative correlation with the increase in serum 25(OH)D (r = -0.68, p=0.005). Conclusion: In this preliminary, uncontrolled study, short-term oral vitamin D supplementation was associated with a significant attenuation of ocular surface oxidative stress in patients with mild TED. These findings provide initial biochemical evidence for the potential localized benefits of vitamin D and support the need for larger, placebo-controlled randomized trials to validate its role as a safe adjunctive therapy for managing the ocular surface component of this disease.
Balancing Efficacy and Tolerability: A Prospective Cohort Study of Oral and Intravenous Methylprednisolone for Active Graves' Ophthalmopathy in an Indonesian Tertiary Care Center Mardijas Efendi; Hendriati; Pattih Primasakti; Yolanda Wulandari Erwen
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1466

Abstract

Background: In managing active, moderate-to-severe Graves' Ophthalmopathy (GO), a notable gap often exists between treatment efficacy in controlled trials and effectiveness in real-world practice. High-dose corticosteroids are standard, but the choice between intravenous (IV) and oral routes involves a complex trade-off between efficacy, tolerability, and practicality, particularly in diverse populations. Methods: This single-center, pragmatic, prospective cohort study was conducted at a tertiary hospital in Indonesia from March 2023 to March 2024. Thirty-six GO patients were treated with either IV pulse or daily oral methylprednisolone based on a shared clinical decision-making process. The primary outcome was the change in proptosis. To address the non-randomized design and control for selection bias, a propensity score-adjusted Analysis of Covariance (ANCOVA) was used to compare treatment effectiveness. Results: Baseline analysis revealed that patients selected for IV therapy had significantly more severe proptosis. Both unadjusted and adjusted analyses showed that each regimen resulted in a significant reduction in proptosis from baseline (p < 0.01). In the primary, propensity score-adjusted analysis, no statistically significant difference was detected in the degree of proptosis reduction between the IV and oral groups. However, the tolerability profiles were profoundly different; patients in the oral group experienced a significantly higher incidence of adverse events, including dyspepsia (66.7%) and Cushingoid features (55.6%), compared to a single case of transient hypokalemia in the IV group. Conclusion: In this real-world setting, after statistically controlling for baseline severity, both IV and oral methylprednisolone demonstrated comparable effectiveness in reducing proptosis. However, the intravenous route was associated with a vastly superior safety profile. These findings underscore the critical importance of tolerability in clinical decision-making and support the continued recommendation of IV pulse therapy as the first-line treatment.
Balancing Efficacy and Tolerability: A Prospective Cohort Study of Oral and Intravenous Methylprednisolone for Active Graves' Ophthalmopathy in an Indonesian Tertiary Care Center Mardijas Efendi; Hendriati; Pattih Primasakti; Yolanda Wulandari Erwen
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1466

Abstract

Background: In managing active, moderate-to-severe Graves' Ophthalmopathy (GO), a notable gap often exists between treatment efficacy in controlled trials and effectiveness in real-world practice. High-dose corticosteroids are standard, but the choice between intravenous (IV) and oral routes involves a complex trade-off between efficacy, tolerability, and practicality, particularly in diverse populations. Methods: This single-center, pragmatic, prospective cohort study was conducted at a tertiary hospital in Indonesia from March 2023 to March 2024. Thirty-six GO patients were treated with either IV pulse or daily oral methylprednisolone based on a shared clinical decision-making process. The primary outcome was the change in proptosis. To address the non-randomized design and control for selection bias, a propensity score-adjusted Analysis of Covariance (ANCOVA) was used to compare treatment effectiveness. Results: Baseline analysis revealed that patients selected for IV therapy had significantly more severe proptosis. Both unadjusted and adjusted analyses showed that each regimen resulted in a significant reduction in proptosis from baseline (p < 0.01). In the primary, propensity score-adjusted analysis, no statistically significant difference was detected in the degree of proptosis reduction between the IV and oral groups. However, the tolerability profiles were profoundly different; patients in the oral group experienced a significantly higher incidence of adverse events, including dyspepsia (66.7%) and Cushingoid features (55.6%), compared to a single case of transient hypokalemia in the IV group. Conclusion: In this real-world setting, after statistically controlling for baseline severity, both IV and oral methylprednisolone demonstrated comparable effectiveness in reducing proptosis. However, the intravenous route was associated with a vastly superior safety profile. These findings underscore the critical importance of tolerability in clinical decision-making and support the continued recommendation of IV pulse therapy as the first-line treatment.
Co-Authors Hendriati MARDIJAS EFENDI Pattih Primasakti Rani Apriani