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C-REACTIVE PROTEIN (CRP) AS A SUPPORTING MARKER OF ANTIBIOTIC EFFECTIVENESS ON CENTRAL NERVOUS SYSTEM (CNS) INFECTIONS Melawati Olevianingrum; Yulistiani Yulistiani; Darto Saharso; Nun Zairina
Folia Medica Indonesiana Vol. 51 No. 3 (2015): July - September 2015
Publisher : Universitas Airlangga

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.

EFFECTIVITY AND RENAL SAFETY OF CYCLOSPORINE AND METHYLPREDNISOLONE COMBINATION THERAPY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) Desantika Wuryana; Bagus PP Suryana; Yulistiani Yulistiani
Folia Medica Indonesiana Vol. 51 No. 3 (2015): July - September 2015
Publisher : Universitas Airlangga

Cyclosporine and methylprednisolone combination are second line therapy for moderate to severe systemic lupus erythemathosus. Some study suggest that the combination were effective to decrease of systemic lupus erythematosus disease activity. But record from the study, cyclosporine cause nephrotoxicity side effect. Therefore, this study should be considered to monitore therapy effect on disease activity and renal side effect. The aim of this study is to analyze the effect of cyclosporine and methylprednisolone combination therapy on disease activity in systemic lupus erythematosus (SLE) assessed by MEX-SLEDAI and renal side effect assessed by creatinine, ureum and proteinuria. A cohort, observational prospective study was conducted to determine the effect of cyclosporine and methylprednisolone combination therapy on disease activity of SLE and renal side effect of this combination. Patients who met criteria were given cyclosporine and methylprednisolone combination that normally renal function tests. MEX-SLEDAI score, creatinine, ureum and proteinuria were measured for fourth times (one time in one mounth), before study, 1st mounth, 2nd mounth, and 3rd mounth. The study comprised 9 patients SLE were given cyclosporine and methylprednisolone combination that normally renal function tests. All patients were female and had productive age. At 3rd mounth, there was increase patients who had MEX-SLEDAI score <2 (55,6%) and one patient (11,1%) had increase of creatinine, ureum and proteinuria. In conclusion, cyclosporine and methylprednisolone combination therapy showed the effectiveness and safety in 88,9% patients and renal dysfunction in 11,1% patients.

ANALYSIS OF INDUCTION PHASE GLUCOCORTICOID USE ON ADRENAL SUPPRESSION IN PEDIATRIC PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA Octaviana Simbolon; Yulistiani Yulistiani; I DG Ugrasena; Mariyatul Qibtiyah
Folia Medica Indonesiana Vol. 52 No. 1 (2016): JANUARY - MARCH 2016
Publisher : Faculty of Medicine, Universitas Airlangga

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.

PHOSPHATIDYLGLYCEROL STUDY AS FETAL LUNG MATURATION PARAMETER AFTER DEXAMETHASONE ADMINISTRATION FOR WOMEN AT RISK OF PRETERM BIRTH Rizal Umar Rahmadani; Agus Sulistyono; Yulistiani Yulistiani; Muhammad Yahya
Folia Medica Indonesiana Vol. 52 No. 4 (2016): OCTOBER - DECEMBER 2016
Publisher : Faculty of Medicine, Universitas Airlangga

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.

ANALYSIS OF DL--TOCOPHEROL AS ANTIOXIDANT ON MALONDIALDEHYDE LEVEL IN PEDIATRIC PATIENTS WITH -THALASSEMIA MAJOR Levana Rismayanti; Yulistiani Yulistiani; Mia Ratwita Andarsini; Mariyatul Qibtiyah
Folia Medica Indonesiana Vol. 53 No. 1 (2017): JANUARY - MARCH 2017
Publisher : Faculty of Medicine, Universitas Airlangga

Thalassemia is a hereditary form of anemia that affects the synthesis of hemoglobin. The management of therapy in patients with b-thalassemia major which patients should receive continuous blood transfusions and increased iron absorption from the digestive tract causes excess iron in the body. This will lead to an increase of free iron level that triggers Radical Oxygen Species (ROS). Increased level of ROS can initiate lipid peroxidation which used as an indicator of oxidative stress in cells and tissues and produce reactive carbonyl, mainly malondialdehyde (MDA). Thus, MDA measurement is widely used as an indicator of lipid peroxidation. On the other hand, the risk of oxidative damage can be reduced by antioxidant, one of them is Vitamin E that is a fat-soluble vitamin with high potential antioxidant. The objective of this study was to analyze the effect of the dl-a-tocopherol (Vitamin E) administration on decrease of MDA serum level on pediatric patients with b-thalassemia major. This was a longitudinal observational study design for one group without comparison was conducted to examine the use of vitamin E to decreased MDA serum level on children patients with b-thalassemia major. The inclusion criteria were patients who rely on blood transfusions, patients who received only one type of iron chelating agents during the study period, the clinical condition is stable, agrees, and has completed the informed consent. In the course of the study of 21 patients there were variations in patient compliance in taking vitamin E tablet dosage 200 IU once-daily for one month: only 11 out of 21 patients consumed 30 tablets of vitamin E 200 IU (total dose of 6000 IU) in the 1-month study, and only data from those 11 samples will be analysed further. MDA serum level was measured pre- and post-administration of vitamin E and patient’s characteristics of subjects was obtained for additional information. Pre-administration of vitamin E, serum level of MDA was 1239.4 ± 502.55 ng/mL with a range of 216.95 to 2297.3 ng/mL, whereas in the group post administration of vitamin E, MDA serum level was 786.49 ± 704.88 ng/mL with a range of 6.5380 to 1958.6 ng/mL. In conclusion, there was no significant difference in MDA serum level in the group pre- and post- administration of vitamin E (p = 0.15).

ANALYSIS OF NACL-MANNITOL HYDRATION ON RENAL FUNCTION OF HEAD AND NECK CANCER PATIENTS RECEIVING HIGH-DOSE CISPLATIN CHEMOTHERAPY COMBINATION Ekanita Desiani; Suharjono Suharjono; Yulistiani Yulistiani; Dwi Hari Susilo
Folia Medica Indonesiana Vol. 53 No. 1 (2017): JANUARY - MARCH 2017
Publisher : Faculty of Medicine, Universitas Airlangga

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.

METHOTREXATE USE IS SAFE IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA Febriansyah Nur Utomo; Yulistiani Yulistiani; Nun Zairina; Bambang Permono
Folia Medica Indonesiana Vol. 53 No. 2 (2017): JUNE 2017
Publisher : Faculty of Medicine, Universitas Airlangga

Monitoring level of methotrexate is not only aimed at monitoring effectiveness, but also safety aspects of the administration of high-dose methotrexate because the use of high-dose methotrexate is one of the problems associated with toxicity in various organs. In the use of high-dose methotrexate, measurement of methotrexate is important to identify patients with a high risk of toxicity, particularly nephrotoxicity as well as for dosing guidelines for leucovorin therapy. The aim of this study was to analyze the safety of high-dose methotrexate on kidney function during chemotherapy consolidation phase in children with acute lymphoblastic leukemia. This was a longitudinal, observational prospective study conducted to determine the safety profile of high-dose methotrexate on kidney function during chemotherapy consolidation phase in children with acute lymphoblastic leukemia. Patients who met the inclusion criteria were given high-dose methotrexate according to the 2013 Indonesian ALL Chemotherapy Protocol. Measurement of methotrexate level and kidney function was done 3 times on each cycle of chemotherapy consolidation phase. Measurements were made on the 0, 24 and 48 hours after the first drop of high-dose methotrexate. This study had been reviewed by Ethics Committee of Dr. Soetomo Hospital Surabaya. There were 12 patients who met inclusion criteria and 6 patients among them had finished their chemotherapy consolidation phase completely. There was no significant change in kidney function after the administration of high-dose methotrexate compared to baseline (p>0.05) and there was no significant correlation between serum level of methotrexate versus creatinine clearance. In conclusion, methotrexate was safe to use in children with acute lymphoblastic leukemia.

EFFECTIVENESS AND SAFETY DIFFERENCES OF ISOXSUPRINE AND NIFEDIPINE AS TOCOLYTICS IN THE RISK OF PRETERM LABOR Nur Oktavia; Yulistiani Yulistiani; Unedo H Markus; Hendriette Irene Mamo
Folia Medica Indonesiana Vol. 53 No. 4 (2017): December 2017
Publisher : Faculty of Medicine, Universitas Airlangga

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 Dina Ratna Juwita; Yulistiani Yulistiani; Eddy Zarkaty M
Folia Medica Indonesiana Vol. 53 No. 4 (2017): December 2017
Publisher : Faculty of Medicine, Universitas Airlangga

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.

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