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All Journal Medical Journal of Indonesia The Indonesian Biomedical Journal Acta Biochimica Indonesiana The New Ropanasuri Journal of Surgery

Yefta Moenadjat

Department Of Surgery, Faculty Of Medicine, Universitas Indonesia, Jakarta

Author-ID : 321155

Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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The safety and efficacy of feracrylum as compared to silver sulfadiazine in the management of deep partial thickness burn: A clinical study report Moenadjat, Yefta; Setiabudy, Rianto; Astrawinata, Dalima A.W.; Gumay, Saukani
Medical Journal of Indonesia Vol 17, No 4 (2008): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Instead of haemostatic effect, feracrylum provides antibacterial activity; wound improvement has been clinically proven. Feracrylum is a water soluble mixture of incomplete ferrous salt of polyacrylic acid containing 0.05 to 0.5% of iron in physiologic solution (0.85% solution of sodium chloride). A clinical study on safety and efficacy of feracrylum compared to silver sulfadiazine (SSD) was conducted in burn management, since with the widely use of SSD, the sulfadiazineâs disadvantages lead to wound healing impairment. In this open, randomized, controlled study, feracrylum and SSD were topically applied, each on different side of the burnt areas in parts of body for a treatment period of eleven days. Of eight enrolled patients, seven patients completed the study; one patient withdrew due to acute burn complication. On day 7th and 11th, the re-epithelialization in group receiving feracrylum increased as the raw surface area reduced. Mean percentages of epithelialization on both evaluation days in Feracrylum group were 70.53Â±24.298 and 81.71Â±28.922, respectively, which were higher than SSD group (66.15Â±25.080 and 64.64Â±74.684 respectively). Feracrylum was found to be safe and well tolerated. This study showed a clinical difference although it was not significant statistically. (Med J Indones 2008; 17: 259-71)Keywords: Feracrylum, silver sulfadiazine, wound management

Overexpression of p53 in extra large (more than 10 cm) hepatocellular carcinoma Lalisang, Toar J.M.; Moenadjat, Yefta; Siregar, Nurjati C.; Stephanie, Marini
Medical Journal of Indonesia Vol 27, No 2 (2018): June
Publisher : Faculty of Medicine Universitas Indonesia

Background: Extra large hepatocellular carcinoma (HCC) of >10 cm managed in our center shows a specific characteristic in tropical regions. This type of HCC exhibits distinct p53 expression. This study aimed to determine the association between p53 expression and tumor size and behavior. Method: Subjects with HCC who underwent surgical resection in our hospital during 2012–2015 were enrolled in thisstudy. Subject’s characteristics, tumor size, histopathology findings, and tumor behavior were variables observed. Animmunohistochemical study on p53 expression was conducted to determine its association with those variables.Results: This study involved 38 subjects with tumor size ranging from 3 cm to 25 cm in diameter and 20 subjects (52.8%) with tumor size ranging from 10 cm to 25 cm in diameter. Only 13 samples were evaluated for p53 expression. Five subjects with >10 cm (extra large) tumor showed highly/overexpressed p53 (intensity>50%), two subjects with strong p53 expression (intensity>5%–50%), and two subjects with weak expression. Three subjects with <10 cm (large) tumor showed strong expression of p53 (5%–9%) and a subject with 3 cm tumor showed weak p53 expression (<5%). Highly expressed p53 was found in patients with microvascular invasion, inflammatory response, mitosis, and necrosis.Conclusion: Overexpression of p53 was associated with extra large and poorly differentiated HCC.

The application of human umbilical cord blood mononuclear cells in the management of deep partial thickness burn Moenadjat, Yefta; Merlina, Maurin; Surjadi, Camy F.; Sardjono, Caroline T.; Kusnadi, Yuyus; Sandra, Ferry
Medical Journal of Indonesia Vol 22, No 2 (2013): May
Publisher : Faculty of Medicine Universitas Indonesia

Background: Wound healing in burn is a complex process and early complete wound closure still enfaces many problems. Application of stem cells is found to be the future method of wound healing. Among the available sources of allogenic stem cells, umbilical cord blood is quite easy to be obtained, has less ethical issue, and contain multipotent stem cells, which are characterized by low immunogenicity. The study aims to evaluate the potential of human umbilical cord blood mononuclear cells (hUCBMNCs) treatment in the management of deep partial thickness burns. Methods: Twenty patients with deep partial thickness burns were treated with topical application of 2 x 107 hUCBMNCs and silver sulfadiazine (SSD) cream on the comparable wound size in the other sites. The treatments were applied for six times in every two consecutive days. Wound surface area was measured with Visitrak® on day 0, 7, and 11. Pain intensity was evaluated using Wong Baker’s faces scale on each wound dressing change. Histology examination was performed in some samples of collected skin biopsy of the newly re-epithelialized area of hUCBMNCs and SSD-treated wound at the end of treatment. HLA typing is used to evaluate the issue of safety. Wilcoxon signed rank test was used to compare the rate of wound healing. Results: Sixteen patients of hUCBMNCs-treated showed a significant wound closure in faster than SSD-treated; measured on day 7 (p = 0.041) and day 11 (p = 0.021). Number of patients with reduced pain intensity, from approximately scale 3 to 1/0 on day 7 and 11, were higher in hUCBMNCs-treated compared to SSD-treated wound. In spite of the HLA-mismatch, no allergic reaction, rejection, and infection found on hUCBMNCs-treated wound suggested the safety of this therapy. Histology examination found the formation of dermal-epidermal junction and rete ridges equal to the normal skin on hUCBMNCs-treated wounds. Conclusion: hUCBMNCs are effective and safe to promote re-epithelialization in deep partial thickness burns. (Med J Indones. 2013;22:92-9)Keywords: Deep partial thickness burn, mononuclear cells, re-epithelialization, umbilical cord blood

Adipose derived stem cell conditioned medium effect on proliferation phase of wound healing in Sprague Dawley rat Tarcisia, Twidy; Damayanti, Lia; Antarianto, Radiana D.; Moenadjat, Yefta; Pawitan, Jeanne A.
Medical Journal of Indonesia Vol 26, No 4 (2017): December
Publisher : Faculty of Medicine Universitas Indonesia

Background: Disintegration of skin tissue can lead to disability and death. Recent studies on wound therapy applied stem cells and adipose derived stem cell conditioned medium (ADSC-CM) to improve wound healing. However, the role of ADSC-CM in wound healing mechanism in terms of angiogenesis, quantity of collagen, and epithelialization is not fully understood. Therefore, this study aimed to analyze the levels of growth factors (VEGF and EGF) in ADSC-CM and histological features of angiogenesis, epithelialization, and collagen density after skin incision in Sprague Dawley rats.Methods: Thirty rats were injured at the back (full thickness wound) and treated topically with ADSC-CM, culture medium, basal medium, and without treatment. Mice were sacrificed on days 3, 7, 14, 21 and 28. After sacrificed, tissue samples were examined microscopically to assess angiogenesis, epithelialization, and collagen density. Concentrations of VEGF and EGF in ADSC-CM were measured by ELISA.Results: Clinically, wound that was treated with ADSC-CM showed improvement in wound healing process. ADSC-CM treated wound showed the highest epithelialization ratio and the fastest wound closure.Conclusion: There were no statistical significant differences between groups that were treated with ADSC-CM and not. However, topical ADSC-CM treated wound revealed a better clinical improvement in epithelialization.

Effect of reperfusion injury from distant ischemia to small intestine Moenadjat, Yefta; Ramdhani, Aris; Jeo, Wifanto Saditya; Suharto, Wuryantoro; Werdhani, Retno Asti
Medical Journal of Indonesia Vol 28, No 1 (2019): March
Publisher : Faculty of Medicine Universitas Indonesia

BACKGROUND The ileum is the most vulnerable part of the small intestine that plays an important role as the motor of multisystem organ failure. Villous damage is demonstrated after ligation of supply artery in mice; however, there is no study on the ileum after distant ischemic organs. Thus, this study was aimed to find out ileal villous changes following reperfusion injury, the protective effects of ischemic hypothermia and ischemic preconditioning.METHODS An experimental study conducted enrolled 21 subjects of Oryctolagus cuniculus. Ischemia is induced by ligation of the femoral artery for 4 hours. Eight hours after ligation was released, ileum and duodenal specimens were taken through laparotomy. H&E stained specimens were examined for histomorphological changes. Villi change scores, tissue level of hypoxia-inducible factor-1α (HIF-1α), malondialdehyde (MDA), and occludin were statistically analyzed in four treatment groups, namely ischemia, ischemic hypothermia, ischemic preconditioning, and control.RESULTS Intestinal villi changes were found following ischemic-induced arterial ligation. Ileal villi changes showed differences with the duodenum and controls as indicated by the villi damage scores, increased tissue HIF-1α and MDA, and decreased occludin levels. Ileal villi changes in the ischemic and ischemic hypothermia groups showed significant changes with controls; whereas the ischemic preconditioning group showed no significant differences.CONCLUSIONS Ischemia at a distance leads to both histomorphological and biochemical damage of the ileal villi and disrupts the integrity of the intestinal mucosal barrier. In addition, the study showed a protective effect of ischemic preconditioning.

Compliance of Patients with Locally Advanced Colorectal Cancer to Chemotherapy Using FOLFOX compared to XELOX Regimen Kusnadi, Dana S.; Putranto, Agi S.; Saunar, Rofi Y.; Kekalih, Aria; Moenadjat, Yefta
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Adjuvant chemotherapy become the treatment of choice in advance colorectal cancer to prevent recurrence. Studies showed that FOLFOX and XELOX regimen has been proven to increase overall survival rate and disease free survival. This study is aimed to compare XELOX response to FOLFOX regimen in our center, which is characterized by advanced stage neoplasm in the first presentation with low compliance. It also aimed to find out affecting factors of such response. Method. We run a retrospective study enrolled of 133 subjects with colorectal carcinoma of stage III and high–risk stage II who received adjuvant chemotherapy and treated in dr. Cipto Mangunkusumo– and Fatmawati General Hospital. Consecutive sampling was instituted, CEA level and one year mortality rate was recorded as variables of the efficacy, which was then associated with subjects’ compliance. Statistical analysis was done using Chi square or Fisher test, and a multivariate logistic regression. Significance was found as the difference met <0.05 with confidence interval of 95%. Results. We found there is no significant difference between the two regimens with efficacy (p = 0.61). There is significant correlation between the regimen (p = 0.001 and 0.000); with compliance is found much higher in FOLFOX (86% compared to 45%). We also found statistically significant of influencing factors the efficacy, i.e. Karnofsky score >90 (OR = 5.8; p = 0.004), body mass index both of normal and more (OR = 4.7; p = 0.006), and with histopathologic grading of moderate differentiated (OR = 6.3; p = 0.003). Conclusion. FOLFOX and XELOX regimen has been shown to have a same efficacy in response in our center. However, compliance showed a strong correlation to efficacy and FOLFOX regimen showed much higher rather than XELOX. Karnofsky score and body mass index should be subjects of consideration to increase the response of such adjuvant chemotherapy.

Qualitative Study on Endothelial Cell–to–cell–junction Disassembly in Severe Burn Injury Moenadjat, Yefta; Siregar, Nurjati C.; Wanandi, Septelia I.; Sadikin, Mohamad
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Endothelial gap in severe burn injury remain a mystery. Capillary leaks possess its own characteristics, which is found in burned– and non–burned area. The gaps remain up to 10 post burned days or more. This is somehow representing the feature of systemic capillary leaks syndrome at the first date. VE–cadherin of adherens endothelial junction molecules known to be temporarily disassembled following thermal exposure, but there’s a question about reversibility. Question is also addressed to occludin of the tight junction molecules. We run a study to investigate these junction molecules. Method. We run an investigation to find out both molecules qualitatively descriptive on 30 burn patients enrolled, consist of 20 severe– and 10 of non–severe burn. Samples of moderate size vein taken from burned– and non–burned area were subjected to study of histomorphology and immunohistochemistry. Light microscopic study and polymerase chain reaction test were carried out to compare the features and its expression. Analysis is carried out to find the difference, specificity and sensitivity. Results. Samples took within the first 8 hours following ER presentation showed severely deteriorated endothelial lining and both ofVE–cadherin and occludin dissociation. This endothelial junction disassembly was found in both of burned– and non–burned area; both of severe– and non– severe burn as well. In burned area, mRNA expression of VE–cadherin found to be increased, as occludin decreased. In severe burned group, mRNA expression of VE–cadherin as well as occludin found to be increased. VE–cadherin synthesis was found to be earlier than occludin. Conclusion. Dissociation of both of endothelial cell–to–cell molecules junction show no differences between the two groups, and between burned– and non–burned areas.

Problem based management in delayed presented burned in dr. Cipto Mangunkusumo General Hospital, Jakarta Moenadjat, Yefta; Mulya, Dina
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Burn injured victims managed in Burn Unit of dr. Cipto Mangunkusumo General Hospital, Jakarta (RSCM) is dominated by delayed presentation and categorized as the difficult cases. Though had been rescued before being referred to our unit, these cases were characterized by massive edema and minimal to nil responsiveness to standard burn fluid resuscitation and were followed by high mortality. Method. A retrospective study run on those resuscitated in period of 1998–2010 using different protocols aimed to find out the most suitable formula to treat these subjects. Pediatric–, chemical– and electrical burns was excluded. Hydration status, hemodynamic– and perfusion indices, complication(s), mortality as well as survival days were variables of interest subjected to statistical analysis. Significance met if p <0.05. Results. Out of 1768 subjects managed, 659 were enrolled in the study. Mortality in those treated in first period was 44.9% with survival 10.10 pbd ± 7.39, in the second period was 54.6% with survival 8.55 pbd ± 6.39, in the third period was 43.4% with survival 11.34 pbd ± 7.34, and the last period was 13.4% with survival 18.78 ± 6.32 pbd. Conclusion. In these characteristics, perfusion targeted resuscitation showed to be superior than volume oriented. Even though mortality remains the problem, survival days markedly increased.

Need for the Development of Indonesian Clinical Practice Guideline Moenadjat, Yefta
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Effect of Preconditioning and Hypothermia in Ischemia–Reperfusion Injury to the Endothelial Cells of Blood Vessels in Oryctolagus cuniculus Ismet, Mohamad F.; Moenadjat, Yefta; Kekalih, Aria
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Ischemia/reperfusion injury (I/RI) remain a problem in post–hypoxia period, leading to remote organ injury. Studies showed that ischemic preconditioning (IPC) and hypothermia (HI) let destructive effect of ischemia to be minimized. The aim of study was to find out the impacts of interventions such as IPC and HI on morphology and function of the endothelial distal to ligation (ischemia) and contralateral vessel (I/RI). Method. An experimental study carried out by ligation the right common femoral artery of Oryctolagus cuniculus to induce ischemia. Endothelial cells distal to ligation and contralateral side was subjected to investigation. The effect of IPC and HI were investigated and compared to those in I/RI. Results. Morphological study showed significant difference scores between endothelial damage in ipsilateral vessels in interventional subjects with control, and intervention with I/RI group (p 0.05). Conclusion. Ischemia may lead to remote endothelial dysfunction; IPC and HI showed the efficacy to minimize the impact of reperfusion.

Co-Authors Abdul Halim Sadikin Agus Firmansyah Ahmad Aulia Jusuf Anis Karuniawati Aria Kekalih Benjamin Ngatio, Benjamin Camy F. Surjadi Caroline T. Sardjono Dalima A.W. Astrawinata Ferry Sandra Handaya, Adeodatus Y. Hasibuan, Muhamad Irfan A Indah S. Widyahening Iskandar Rahardjo Budianto Ismet, Mohamad F. Iswanto, J. Jeanne A. Pawitan Jeo, Wifanto S. Jeo, Wifanto Saditya Kusnadi, Dana S. Lalisang, Toar JM. Lia Damayanti Marini Stephanie Maulanisa, Sinta C. Maurin Merlina Mazni, Yarman Mohamad Sadikin Mulya, Dina Mulya, Dina D. Nasution, Safruddin Novi Sylvia Hardiany Nurjati C. Siregar Pratama, Dennis W. Putranto, Agi S Putranto, Agi S. Radiana D. Antarianto Ramdhani, Aris Retno Asti Werdhani Rianto Setiabudy Robby, Rizky DK. Saukani Gumay Saunar, Rofi Y. Saunar, Rofy S. Sekarsari, Damayanti Septelia I. Wanandi Suharto, Wuryantoro Syafina, Adinda B Toar J.M. Lalisang Tony Loho Twidy Tarcisia, Twidy Usman, Nurhayat Vanto, Yoni Vivian Soetikno Yuyus Kusnadi

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