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Preliminary Report: Clinical Characteristic, Hematologic Response and Gene Mutation of Patients with Chronic Phase Chronic Myeloid Leukemia (CML) to Imatinib at Cipto Mangunkusumo National Hospital (RSUPN CM) Reksodiputro, Arif Harryanto; Tadjoedin, Hilman; Rinaldi, Ikhwan
Indonesian Journal of Cancer Vol 5, No 4 (2011): Oct - Dec 2011
Publisher : "Dharmais" Cancer Center Hospital

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (187.199 KB)

Leukemia Granulositik Kronik (LGK) disebabkan oleh gen BCR-Abl domainÂ tyrosin kinase, produk dari kromosom Philadelphia. Imatinib mesylate merupakan inhibitor selektif terhadap kinase tersebut. Di Indonesia, data mengenai karakteristik pasien LGK fase kronik, respons hematologi terhadap imatinib, dan mutasi gen masih jarang ditemukan. Metode dan desain: studi potong lintang ini menggunakan data rekam medik pasien yang didiagnosis sebagai LGK fase kronik dengan BCR-ABL positif yang berobat ke Poliklinik Teratai Departemen Ilmu Penyakit Dalam Rumah Sakit Cipto Mangunkusumo selama Januari â Desember 2009.Hasil: dalam periode 1 tahun studi, peneliti mengikutsertakan 20 pasien LGK fase kronik yang memiliki BCR-ABL positif dengan median umur 36 tahun (13-62 tahun). Pasien laki-laki lebih banyak dibandingkan dengan perempuan (12 vs 7) dengan rasio 1,7: 1. Sebanyak tujuh pasien (36,8%) berasal dari suku Jawa. Dilaporkan juga karakteristik pasien adalah 15 orang berada pada fase kronik (78,9%); 3 pasien berada pada fase akselerasi (15,8%) sementara 1 pasien mengalami krisis blast (5,3%); 12 pasien (63,2%) ditemui adanya splenomegali; dan 5 dari 11 pasien dilaporkan memiliki skor Sokal yang rendah. Berdasarkan hasil laboratorium didapati nilai median hemoglobin 9,9 g/dL (5-14 g/dL); leukosit 73.000/uL (4.100-332.000/uL) dan nilai median trombosit 481.000/uL (263.000/uL-1.116.000/uL); nilai median kadar basofil di darah perifer 1% (1-10%) dengan nilai median sel blast di perifer adalah 1% (0-22%). Selama studi, respons hematologik komplet dalam 3 bulan dicapai oleh 10 dari 19 pasien (52,6%), termasuk di antaranya 1 pasien yang mengalami fase akselerasi dan 1 pasien yang lain mengalami krisis blast. Sebanyak 18 pasien (94,7%) telah diobati dengan hydrea sebelum mendapat terapi Imatinib, sementara 1 pasien (5,3%) tidak pernah mendapatkan pengobatan apapun sebelumnya.Kesimpulan: didapati nilai median usia pasien LGK fase kronik adalah 36 tahun, sebagian besar adalah laki-laki. Sebanyak enam puluh tiga persen pasien memiliki splenomegali. Dilaporkan juga nilai median leukosit adalah 73.000/uL (4.100-332.000/uL) dengan nilai median sel blast di darah perifer sebanyak 1% (0-22%). Respons hematologik komplet dalam 3 bulan dicapai oleh 52,6% pasien.Kata kunci: LGK fase kronik, imatinib, respons hematologik, mutasi.

Tuberculous Peritonitis Presenting Acute Recurrent Pancreatitis Karim, Birry; Is, Afifah; Rinaldi, Ikhwan; Syam, Ari Fahrial; Abdullah, Murdani; Pitoyo, Ceva Wicaksono
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, NUMBER 3, December 2009
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Tuberculosis (TB), one of the oldest diseases known to affect humans, is a major cause of death worldwide. TB is still a major problem in Indonesia. This disease, which is caused by bacteria of the Mycobacterium tuberculosis, usually affects the lungs, although other organs are involved in up to one- third of cases. Approximately 95% cases of TB and 98% death because of TB occur in developing country. Gastrointestinal tuberculosis is uncommon, making up 3.5% of extrapulmonary cases in the United States. This kind of TB may involve gastrointestinal tract, peritoneal, lymph nodes, or solid intraabdominal organs (viscera). A 17 years old male admitted to hospital with TB peritonitis presenting unusual clinical manifestation. At the first admission patients was diagnosed with acute pancreatitis based on elevation of amylase and lipase level up to 285 and 2,046 U/L and after finishing further examination, patients suffered from tuberculous peritonitis which based on literature manifested some gastrointestinal disorders. Diagnostic confirmation was accomplished by conducting serum-ascites albumin gradient (SAAG) of < 1.1 g/dL, peritoneal thickening and the presence of ascites with fine mobile septations on ultrasound, positive polymerase chain reaction (PCR) TB from ascitic fluid. Patients received conventional antitubercular therapy for 12 months of rifampicin, isoniazid, pyrazinamide, and ethambutol. The addition of corticosteroids for the first two or three months of treatment may reduce the incidence of late complications arising from adhesive disease, such as small bowel obstruction. Keywords: mycobacterium tuberculosis, tuberculous peritonitis, PCR, serum-ascites albumin gradient

Cardiac Tamponade Due to Liver Amebiasis Rupture Karim, Birry; Is, Afifah; Rinaldi, Ikhwan; Antono, Dono; Rumende, Cleopas Martin; Sulaiman, Andri Sanityoso
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 3, December 2010
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Amebiasis is common cases in Asia, Africa, and South Africa. Liver amebiasis has become a serious problem worldwide especially in health and social aspect. The protozoa named Entamoeba histolytica was easily found in area with poor sanitation, low socioeconomic status, and poor nutrition status. The incidence of amebiasis in several hospitals in Indonesia is 5-15% per year. Epidemiological observation showed the comparison of incidence among male and female population and it was approximately 3 : 1 until 22 : 1 with male predominance. The potential age suffered from amebiasis is around 20 - 50 years old. The route of infection spread to oral-fecal and oral-anal-fecal. The most common complication is abscess rupture (5-15.6%). Rupture may be located in pleural cavity, pericardial cavity, lung, bowel, intraperitoneal, and skin. Rupture of liver amebias spread to pleural and pericardial cavity is a rare case and frequently under reported. This case report illustrates a 40-year-old male with cardiac tamponade due to rupture of liver amebiasis. Patient’s was admitted with chief complaint of shortness of breath, positive Beck’s triad, hepatomegaly, pleural effusion, liver abscess on sonography and swinging of heart on echocardiography. This patient was treated with metronidazole as a drug of choice, and pericardiocentesis for the cardiac tamponade.Keywords: cardiac tamponade, Entamoeba histolytica, oral-anal-fecal, metronidazole, pericardiocentesis

Correlation between Zinc Intake and Zinc Serum Levels with C-reactive Protein Level in Head and Neck Cancer Patients Muningtya Philiyanisa Alam; Diana Sunardi; Ikhwan Rinaldi
World Nutrition Journal Vol. 2 No. 2 (2019)
Publisher : Indonesian Nutrition Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25220/WNJ.V02.i2.0003

The inflammatory process of head and neck cancer leads to an increase the proinflammatory cytokines and the synthesis of c-reactive protein (CRP), which then causes metabolic alteration and anorexia in the patients. Zinc is one of nutrient that has an important role in suppressing inflammation, but it is reported that about 65% of head and neck cancer patients have zinc deficiency. The aim of this cross sectional study is to determine the correlation between zinc intake and serum zinc levels with CRP level as an effort in reducing inflammation process in head and neck cancer patients. Subjects were collected by consecutive sampling in the Oncology Polyclinic Rumah Sakit Kanker Dharmais, from 49 subjects 67,3% were men, most subjects were in the age range between 46–65 years. The highest frequency (65,3%) is nasopharyngeal cancer and 69,4% are already in stage IV. All subjects (100%) in this study have a zinc intake below the recommended dietary allowance (RDA) in Indonesia. The mean serum zinc level of the subjects was 9.83±2.62 μmol/L. Most subjects have elevated CRP levels. There was a weak negative correlation between zinc concentration and CRP levels of subjects (r =-0.292, p =0.042), but there was no correlation between zinc intake and CRP levels of subjects (r =-0.25).

Correlation between Interleukin-6 and E-Selectin as a Marker of Endothelial Dysfunction in Rheumatoid Arthritis Patient without Traditional Cardiovascular Risk Factor Jerry Eddya Putra Boer; Rudy Hidayat; Ika Prasetya Wijaya; Ikhwan Rinaldi
Indonesian Journal of Rheumatology Vol. 10 No. 2 (2018): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Rheumatoid arthritis (RA) is an autoimmune disease which has recently been recognized to manifest as not only intraarticular but also extraarticular symptoms. Cardiovascular events, presented either subclinically or clinically, were discovered more in AR patients. Atherogenic inflammatory mediator in AR including interleukin-6 (IL-6) was thought to be one of nontraditional cardiovascular risk factor contributing to increase the endothelial dysfunction biomarker such as E-Selectin. This study was purposed to determine the correlation between inflammatory mediator and endothelial dysfunction event, especially between IL-6 and E-Selectin, in RA patient without traditional cardiovascular risk factor. A cross-sectional study was performed to 40 RA patients of Rheumatology Clinic of Cipto Mangunkusumo National General Hospital, Indonesia from September to November 2017. Measurement of the level of IL-6 and E-Selectin were performed using enzyme-linked immunosorbent assay (ELISA). Bivariate correlation analysis was performed to determine the correlation between those two biomarkers. The mean age of this study subjects was 44.9 (13.1) years and median of disease duration was 36 months. This study showed weak correlation between IL-6 and E-Selectin level, but not statistically significant.232, p=0.149). There is weak correlation between IL-6 and sE-Selectin in rheumatoid arthritis patient without traditional risk factor cardiovascular Keywords: traditional risk factor cardiovascular, E-Selectin, interleukin-6, pro inflammatory mediator, rheumatoid arthritis

Preliminary Report: Clinical Characteristic, Hematologic Response and Gene Mutation of Patients with Chronic Phase Chronic Myeloid Leukemia (CML) to Imatinib at Cipto Mangunkusumo National Hospital (RSUPN CM) Arif Harryanto Reksodiputro; Hilman Tadjoedin; Ikhwan Rinaldi
Indonesian Journal of Cancer Vol 5, No 4 (2011): Oct - Dec 2011
Publisher : National Cancer Center - Dharmais Cancer Hospital

Leukemia Granulositik Kronik (LGK) disebabkan oleh gen BCR-Abl domaintyrosin kinase, produk dari kromosom Philadelphia. Imatinib mesylate merupakan inhibitor selektif terhadap kinase tersebut. Di Indonesia, data mengenai karakteristik pasien LGK fase kronik, respons hematologi terhadap imatinib, dan mutasi gen masih jarang ditemukan. Metode dan desain: studi potong lintang ini menggunakan data rekam medik pasien yang didiagnosis sebagai LGK fase kronik dengan BCR-ABL positif yang berobat ke Poliklinik Teratai Departemen Ilmu Penyakit Dalam Rumah Sakit Cipto Mangunkusumo selama Januari Desember 2009.Hasil: dalam periode 1 tahun studi, peneliti mengikutsertakan 20 pasien LGK fase kronik yang memiliki BCR-ABL positif dengan median umur 36 tahun (13-62 tahun). Pasien laki-laki lebih banyak dibandingkan dengan perempuan (12 vs 7) dengan rasio 1,7: 1. Sebanyak tujuh pasien (36,8%) berasal dari suku Jawa. Dilaporkan juga karakteristik pasien adalah 15 orang berada pada fase kronik (78,9%); 3 pasien berada pada fase akselerasi (15,8%) sementara 1 pasien mengalami krisis blast (5,3%); 12 pasien (63,2%) ditemui adanya splenomegali; dan 5 dari 11 pasien dilaporkan memiliki skor Sokal yang rendah. Berdasarkan hasil laboratorium didapati nilai median hemoglobin 9,9 g/dL (5-14 g/dL); leukosit 73.000/uL (4.100-332.000/uL) dan nilai median trombosit 481.000/uL (263.000/uL-1.116.000/uL); nilai median kadar basofil di darah perifer 1% (1-10%) dengan nilai median sel blast di perifer adalah 1% (0-22%). Selama studi, respons hematologik komplet dalam 3 bulan dicapai oleh 10 dari 19 pasien (52,6%), termasuk di antaranya 1 pasien yang mengalami fase akselerasi dan 1 pasien yang lain mengalami krisis blast. Sebanyak 18 pasien (94,7%) telah diobati dengan hydrea sebelum mendapat terapi Imatinib, sementara 1 pasien (5,3%) tidak pernah mendapatkan pengobatan apapun sebelumnya.Kesimpulan: didapati nilai median usia pasien LGK fase kronik adalah 36 tahun, sebagian besar adalah laki-laki. Sebanyak enam puluh tiga persen pasien memiliki splenomegali. Dilaporkan juga nilai median leukosit adalah 73.000/uL (4.100-332.000/uL) dengan nilai median sel blast di darah perifer sebanyak 1% (0-22%). Respons hematologik komplet dalam 3 bulan dicapai oleh 52,6% pasien.Kata kunci: LGK fase kronik, imatinib, respons hematologik, mutasi.

Cardiac Tamponade Due to Liver Amebiasis Rupture Birry Karim; Afifah Is; Ikhwan Rinaldi; Dono Antono; Cleopas Martin Rumende; Andri Sanityoso Sulaiman
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 3, December 2010
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/1132010150-155

Amebiasis is common cases in Asia, Africa, and South Africa. Liver amebiasis has become a serious problem worldwide especially in health and social aspect. The protozoa named Entamoeba histolytica was easily found in area with poor sanitation, low socioeconomic status, and poor nutrition status. The incidence of amebiasis in several hospitals in Indonesia is 5-15% per year. Epidemiological observation showed the comparison of incidence among male and female population and it was approximately 3 : 1 until 22 : 1 with male predominance. The potential age suffered from amebiasis is around 20 - 50 years old. The route of infection spread to oral-fecal and oral-anal-fecal. The most common complication is abscess rupture (5-15.6%). Rupture may be located in pleural cavity, pericardial cavity, lung, bowel, intraperitoneal, and skin. Rupture of liver amebias spread to pleural and pericardial cavity is a rare case and frequently under reported. This case report illustrates a 40-year-old male with cardiac tamponade due to rupture of liver amebiasis. Patient’s was admitted with chief complaint of shortness of breath, positive Beck’s triad, hepatomegaly, pleural effusion, liver abscess on sonography and swinging of heart on echocardiography. This patient was treated with metronidazole as a drug of choice, and pericardiocentesis for the cardiac tamponade.Keywords: cardiac tamponade, Entamoeba histolytica, oral-anal-fecal, metronidazole, pericardiocentesis

Tuberculous Peritonitis Presenting Acute Recurrent Pancreatitis Birry Karim; Afifah Is; Ikhwan Rinaldi; Ari Fahrial Syam; Murdani Abdullah; Ceva Wicaksono Pitoyo
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, NUMBER 3, December 2009
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/1032009125-130

Tuberculosis (TB), one of the oldest diseases known to affect humans, is a major cause of death worldwide. TB is still a major problem in Indonesia. This disease, which is caused by bacteria of the Mycobacterium tuberculosis, usually affects the lungs, although other organs are involved in up to one- third of cases. Approximately 95% cases of TB and 98% death because of TB occur in developing country. Gastrointestinal tuberculosis is uncommon, making up 3.5% of extrapulmonary cases in the United States. This kind of TB may involve gastrointestinal tract, peritoneal, lymph nodes, or solid intraabdominal organs (viscera). A 17 years old male admitted to hospital with TB peritonitis presenting unusual clinical manifestation. At the first admission patients was diagnosed with acute pancreatitis based on elevation of amylase and lipase level up to 285 and 2,046 U/L and after finishing further examination, patients suffered from tuberculous peritonitis which based on literature manifested some gastrointestinal disorders. Diagnostic confirmation was accomplished by conducting serum-ascites albumin gradient (SAAG) of 1.1 g/dL, peritoneal thickening and the presence of ascites with fine mobile septations on ultrasound, positive polymerase chain reaction (PCR) TB from ascitic fluid. Patients received conventional antitubercular therapy for 12 months of rifampicin, isoniazid, pyrazinamide, and ethambutol. The addition of corticosteroids for the first two or three months of treatment may reduce the incidence of late complications arising from adhesive disease, such as small bowel obstruction. Keywords: mycobacterium tuberculosis, tuberculous peritonitis, PCR, serum-ascites albumin gradient

Prognosic Factors Related to The Complete Hematologic Response (CHR) in 3 Months in Leukemia Granulositic Patients Administered with Imatinib Mesylate Rinaldi, Ikhwan; Reksodiputro, Arry H.
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 3
Publisher : UI Scholars Hub

Show Abstract | Download Original | Original Source | Check in Google Scholar

Introduction. The complete hematologic response is an integral part to achieve the complete cytogenetic response target and the major molecular response of imatinib mesylate therapy, although it does not determine the prognosis. The complete hematologic response in Indonesia is lower than in the world (74% vs. 95%). Sixty percent of chronic myeloid leukemia patients in Indonesia were administered hydroxyurea before imatinib mesylate. Chronic myeloid leukaemia (CML) patients in Indonesia are younger than in other countries. This study aimed to determine what prognostic factors which affect the complete hematological response of chronic phase CML patients who received imatinib mesylate in Indonesia. Methods. The study was done by retrospective cohort design using the medical records data of chronic myeloid leukemia patients who were treated at Teratai Clinic and hematology clinic RSCM and received imatinib mesylate therapy from January 2004-December 2011. Results. Most of the study subjects were male (61.5%), aged 26-40 years (47.4%), duration of diagnosis <12 months>(69.2%), duration of hydroxyurea therapy <6 months>(64.1%), hemoglobin concentration <12 g>/dl (69.2%), leukocyte count ≥50,000 (48.7%), platelet count 0 – <450,000 (42.3%), spleen size ≥10 cm (55.1%), low Sokal score (42.3%), and achieve a complete hematologic response within 3 months (57.7%). Duration of hydroxyurea therapy <6 months is prognostic factor higher CHR achievement. Conclusions. Clinical and laboratory characteristics CML patients in Indonesia are different than CML patients in the world. Duration of diagnosis until imatinib mesylate administration <12 months, duration of hydroxyurea administration <6 months, and hemoglobin concentration ≤12 g/dl were associated with the achievement of complete hematological response of chronic CML patients in Indonesia. Duration of hydroxyurea administration <6 months was identified as independent factor of achievement of complete hematological response of chronic CML patients in Indonesia.

Correlation between Rheumatoid Factor and Vascular Cell Adhesion Molecule-1 Levels in Rheumatoid Arthritis Patients Without Metabolic Syndrome Yogaswara, Reza; Hidayat, Rudy; Muhadi, Muhadi; Rinaldi, Ikhwan
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 2
Publisher : UI Scholars Hub

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