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Mycophenolate mofetil versus cyclophosphamide for therapy of lupus nephritis: an evidence-based case report from systematic reviews and meta-analyses Pramono, Laurentius A.; Karim, Birry; Rajabto, Wulyo; Siregar, Parlindungan; Sukmana, Nanang; Setyohadi, Bambang
Medical Journal of Indonesia Vol 21, No 1 (2012): February
Publisher : Faculty of Medicine Universitas Indonesia

Background: The aim of this case study is to compare the effectiveness between cyclophosphamide and mycophenolate mofetil to achieve remission of lupus nephritis in an evidence-based case report from meta-analyses.Methods: Method in this case study is evidence-based case report using meta-analyses. Clinical question used in this paper is; which immunosuppressant gives better result in achieving remission in lupus nephritis patient: cyclophosphamide or mycophenolate mofetil? To answer this question, we search the evidence from PubMed with the keywords: âlupus nephritis AND mycophenolate mofetil AND cyclophosphamideâ with inclusion criteria of meta-analysis, written in English, and focused comparing cyclophosphamide and mycophenolate mofetil.Results: From the searching method, we found 11 articles which is relevant. One has been excluded since it written in Hebrew, 4 articles excluded since are not focus answering the clinical question. At the end, 6 studies were included to the critical appraisal step.Conclusion: Based on the evidences, mycophenolate mofetil is non-inferior to cyclophosphamide in achieving remission in lupus nephritis patients, but with the better safety profile. Patient in our case study get mycophenolate mofetil and shows better clinical condition towards remission as she are evaluated in the outpatient clinic. (Med J Indones 2012;21:44-51)Keywords: Cyclophosphamide, evidence-based case report, lupus nephritis, meta-analysis, mycophenolate mofetil, remission, systematic review

The Pathogenic Triad of Chronic Cough: Postnasal Drip Syndrome, Asthma, and Gastroesophageal Reflux Disease Rajabto, Wulyo; Syam, Ari Fahrial; Sundaru, Heru
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 8, ISSUE 1, April 2007
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Chronic cough, lasting for 3 weeks or more, is one of the most common symptoms for which adult patients seek medical attention. The pathogenic triad of chronic cough is Postnasal Drip Syndrome (PNDS), Asthma, and Gastroesophageal Reflux Diseases (GERD) are the vast majority etiology of chronic cough in non-smoker adult with normal chest X-ray. The clinical investigations that should be performed are spirometry pre-post bronchodilator and bronchoprovocation testing for asthma; plain sinus radiograph and or computed tomographic imaging of the sinus for PNDS due to sinusitis; gastro-intestinal investigation 24 hours oesophageal pH monitoring and upper gastrointestinal endoscopy for GERD. Keywords: chronic cough, postnasal drip syndrome, asthma, gastroesophageal reflux disease

Colonic Tuberculosis: a high Index of Suspicion Rajabto, Wulyo; SM, M Usman; Chen, Khie; Syam, Ari F; Abdullah, Murdani; A, Djumhana; Rumende, C Martin
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 6, ISSUE 2, August 2005
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Tuberculosis remains to be one of the most common problems in developing countries such as Indonesia. It can involve many organs including gastrointestinal tract. Colonic tuberculosis is an ancient disease and has long been recognized. However, it is sometimes difficult to make early diagnosis due to nonspecific sign and symptoms. In endemic areas, correct diagnoses were made only 50% of the time. Without a high index of suspicion of the disease, it has been rarely diagnosed correctly. We reported a case of colonic tuberculosis in 18 years old female patient with lung tuberculosis.Endoscopic examination showed ulcerative mucosa, ‘halo lesion’, and pseudopolyp while PPD skin test, sputum smear and histopathological examination of endoscopic biopsy revealed negative for tuberculosis infection. The presence of lung tuberculosis had made high index of suspicion of colonic tuberculosis. Standard regimen of antituberculosis therapy was given and the patient showed good clinical response. Keywords: high index suspicion, colonic tuberculosis

A Case of Primary Ileocecal Lymphoma Rajabto, Wulyo; Atmakusuma, Djumhana; S, Ivan Onggo; Makmun, Dadang
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 17, No 3 (2016): VOLUME 17, NUMBER 3, December 2016
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Primary lymphoma in gastrointestinal tract is not very common. Ileocecal region is the commonest site for primary lymphoma and diffuse large B cell lymphoma (DLBCL) is the most prevalent subtype. The clinical presentation in this condition is pain in right lower quadrant region and this can very confusing since many diseases can also cause this problem like infection and inflammatory disease. In this paper, we report a case of primary lymphoma subtype DLBCL in ileocecal region that come to emergency department with ileus obstruction. Abdominal computerized tomography (CT) scan and colonoscopy revealed tumour in ileocecal region ascendens colon. Hemicolectomy was performed and the specimen was sent to pathology which revealed non-Hodgkin lymphoma with subtype DLBCL CD20 (+). The patient had undergone of Rituximab, Cyclophosphamide, Doxorubicine, Vincristin, and Prednison (RCHOP) chemotherapy regimen and had complete remission.

After Imatinib Treatment Failure in Chronic Phase CML: What Can We Do? Wijayanto, Nicholas; Rajabto, Wulyo
Cermin Dunia Kedokteran Vol 45, No 10 (2018): Muskuloskeletal
Publisher : PT. Kalbe Farma Tbk.

Chronic myeloid leukemia(CML) is characterized by reciprocal translocation between chromosome 9 and 22. This translocation will activate the tyrosin kinase, leads to underlying pathogenesis of CML. Imatinib is the first line of Tyrosine Kinase Inhibitor (TKI) to treat chronic phase of CML, but resistance has been a significant problem. NCCN has announced recommendation to treat imatinib resistance, including high-dose imatinib, the use of nilotinib or dasatinib.Leukemia mielositik kronik(LMK) terjadi karena translokasi resiprokal antara kromosom 9 dan 22. Translokasi ini akan mengaktifkan enzim tyrosin kinase yang mencetuskan LMK. Imatinib adalah terapi lini pertama dari golongan Tyrosin Kinase Inhibitor (TKI) untuk LMK fase kronik. Namun, resistensi terhadap imatinib menjadi masalah yang cukup signifikan. NCCN telah mengeluarkan rekomendasi untuk menangani resistensi imatinib, yaitu pemberian imatinib dosis tinggi, nilotinib atau dasatinib.

Ekspresi Topoisomerase II Î± pada Diffuse Large B Cell Lympho-ma dan Hubungannya dengan Respon Terapi Indri Windarti; Endang SR Hardjolukito; Maria Francisca Ham; Tubagus Djumhana Atmakusuma; Wulyo Rajabto
Majalah Patologi Indonesia Vol 22 No 3 (2013): MPI
Publisher : Perhimpunan Dokter Spesialis Patologi Indonesia (IAPI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (515.276 KB)

ABSTRAK Latar belakang Kemoterapi pilihan untuk Diffuse Large B Cell Lymphoma (DLBCL) adalah regimen yang mengandung doksorubisin. Doksorubisin merupakan obat kemoterapi golongan antrasiklin yang bekerja sebagai anti Topoisomerase II (Top2). Penelitian sebelumnya terhadap galur sel tumor menunjukkan bahwa ekspresi Topoisomerase II Î± (Top2A) yang tinggi berhubungan dengan sensitifitas terhadap antrasiklin yang tinggi pula. Tujuan penelitian ini adalah untuk mengetahui ekspresi protein Top2A pada DLBCL dan hubungannya dengan respon terapi. Metode Studi potong lintang dilakukan terhadap 38 kasus DLBCL dengan pulasan CD20 positif, yang telah mendapat kemoterapi minimal 4 siklus. Imunohistokimia dilakukan pulasan terhadap protein Top2A dengan menggunakan H-score. Hasil Ekspresi Top2A ditemukan pada 37 dari 38 kasus (97%) dengan kisaran H-score 101,5-215,0 dan median 124,1. H-score nilai Top2A dikatakan tinggi jika H-score lebih dari 124,1. Analisis statistik menunjukkan bahwa ekspresi Top2A pada DLBCL tidak berhubungan bermakna dengan respon terapi (p=0,670). Kesimpulan Ekspresi Top2A dan respon terapi tidak memiliki hubungan bermakna. Ekpresi Top2A pada DLBCL tidak dapat dijadikan prediktor respon terapi. Kata kunci: DLBCL, Doksorubisin, ekspresi Top2A, respon terapi. ABSTRACT Background Standard of chemotherapy for Diffuse Large B Cell Lymphoma (DLBCL) is a regimen containing doxorubicin. Doxorubicin is a component of anthracycline based chemotherapy that work as anti Topoisomerase II (Top2). Previous study on tumor cell lines showed that high expression of Topoisomerase II Î± (Top2A) was related to higher sensitivity to anthracycline as well. The aim of this study is to know the expression of Top2A and its relation to treatment response. Methods A cross-sectional study on 38 which DLBCL cases CD20 positive that have been treated with at least 4 cycles of chemotherapy. The immunohistochemical staining was performed on Top2A protein assesed using H-score. Results Expression of Top2A protein were found in 37 of 38 (97%) cases (H-score range: 101.5-215.0 and median 124.1). Value Top2A was defined as high if H-score more was higher than 124.1. Statistical analysis showed that Top2A expression in DLBCL was not significantly related to treatment response (p=0.670). Conclusion There was no significant relation between Top2A expression and treatment response. Top2A expression in DLBCL cannot be used as a predictor of treatment response. Key words: DLBCL, Doxorubicin, Top2A expression, treatment response.

After Imatinib Treatment Failure in Chronic Phase CML: What Can We Do? Nicholas Wijayanto; Wulyo Rajabto
Cermin Dunia Kedokteran Vol 45, No 10 (2018): Muskuloskeletal
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v45i10.589

Chronic myeloid leukemia(CML) is characterized by reciprocal translocation between chromosome 9 and 22. This translocation will activate the tyrosin kinase, leads to underlying pathogenesis of CML. Imatinib is the first line of Tyrosine Kinase Inhibitor (TKI) to treat chronic phase of CML, but resistance has been a significant problem. NCCN has announced recommendation to treat imatinib resistance, including high-dose imatinib, the use of nilotinib or dasatinib.Leukemia mielositik kronik(LMK) terjadi karena translokasi resiprokal antara kromosom 9 dan 22. Translokasi ini akan mengaktifkan enzim tyrosin kinase yang mencetuskan LMK. Imatinib adalah terapi lini pertama dari golongan Tyrosin Kinase Inhibitor (TKI) untuk LMK fase kronik. Namun, resistensi terhadap imatinib menjadi masalah yang cukup signifikan. NCCN telah mengeluarkan rekomendasi untuk menangani resistensi imatinib, yaitu pemberian imatinib dosis tinggi, nilotinib atau dasatinib.

Iron Deficiency Anemia as The Only Manifestation of Colon Cancer in Male Patient: A Case Report Wulyo Rajabto; Pandu Tridana Sakti; Andi Putra Kevinsyah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 21, No 3 (2020): VOLUME 21, NUMBER 3, December 2020
Publisher : The Indonesian Society for Digestive Endoscopy

Iron deficiency anemia can be the first manifestation of colon cancer. However, iron deficiency anemia is also common in other benign conditions, which may cause a longer delay for referral decisions to get a definitive diagnosis. This is a case of 40-year-old male patient who had only iron deficiency anemia as a manifestation of colon cancer. Colonoscopy revealed intraluminal mass in transverse colon. After resection of the tumor, histopathology showed well-differentiated mucinous adenocarcinoma, invasion of sub-serous, and one node positive (pT3pN1pM0). After resection, we administered XELOX as adjuvant chemotherapy every 3 weeks for 8 cycles.

A Case of Primary Ileocecal Lymphoma Wulyo Rajabto; Djumhana Atmakusuma; Ivan Onggo S; Dadang Makmun
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 17, No 3 (2016): VOLUME 17, NUMBER 3, December 2016
Publisher : The Indonesian Society for Digestive Endoscopy

Primary lymphoma in gastrointestinal tract is not very common. Ileocecal region is the commonest site for primary lymphoma and diffuse large B cell lymphoma (DLBCL) is the most prevalent subtype. The clinical presentation in this condition is pain in right lower quadrant region and this can very confusing since many diseases can also cause this problem like infection and inflammatory disease. In this paper, we report a case of primary lymphoma subtype DLBCL in ileocecal region that come to emergency department with ileus obstruction. Abdominal computerized tomography (CT) scan and colonoscopy revealed tumour in ileocecal region ascendens colon. Hemicolectomy was performed and the specimen was sent to pathology which revealed non-Hodgkin lymphoma with subtype DLBCL CD20 (+). The patient had undergone of Rituximab, Cyclophosphamide, Doxorubicine, Vincristin, and Prednison (RCHOP) chemotherapy regimen and had complete remission.

The Pathogenic Triad of Chronic Cough: Postnasal Drip Syndrome, Asthma, and Gastroesophageal Reflux Disease Wulyo Rajabto; Ari Fahrial Syam; Heru Sundaru
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 8, ISSUE 1, April 2007
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/81200720-23

Chronic cough, lasting for 3 weeks or more, is one of the most common symptoms for which adult patients seek medical attention. The pathogenic triad of chronic cough is Postnasal Drip Syndrome (PNDS), Asthma, and Gastroesophageal Reflux Diseases (GERD) are the vast majority etiology of chronic cough in non-smoker adult with normal chest X-ray. The clinical investigations that should be performed are spirometry pre-post bronchodilator and bronchoprovocation testing for asthma; plain sinus radiograph and or computed tomographic imaging of the sinus for PNDS due to sinusitis; gastro-intestinal investigation 24 hours oesophageal pH monitoring and upper gastrointestinal endoscopy for GERD. Keywords: chronic cough, postnasal drip syndrome, asthma, gastroesophageal reflux disease

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