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All Journal Medical Journal of Indonesia The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia

Nanang Sukmana

Faculty of Medicine University of Indonesia, Ciptomangunkusumo Hospital, Jakarta

Author-ID : 390464

Health Professions Medicine & Pharmacology

Published : 6 Documents Claim Missing Document

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Articles

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 Role of Specific Cellular Immune System in Chronic Hepatitis C Husna, Ihsanil; Akbar, Nurul; Gani, Rino Alvani; Budihusodo, Unggul; Sukmana, Nanang
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 5, ISSUE 1, April 2004
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Hepatitis C virus is a RNA virus with very high speed replication. The clinical course of chronic hepatitis C is frequently asymptomatic like other hepatitis viruses. Infection of hepatitis virus will activate the immune system specifically as well as non-specifically. Mechanism of the immune system regulation is controlled by tissues consisting of antibodies cells and cytokines. In the process, all of the immune systems integrate and coordinate with the main agent-lymphocytes. Lymphocytes recognize antigens through the specific-surface antigen receptors. Following exposure to viral chronic hepatitis virus, viremia takes place within 1-2 weeks. In immuno-competent hosts, viremia will be preceded with the increase in transaminase enzyme and delayed seroconversion of antibodies will occur. Unlike other immunologic processes, these established antibodies are not protective in nature but serve only as the sign that someone has been infected by hepatitis C. In most cases of hepatitis C virus infection, this virus cannot be eradicated in the acute phase. Approximately 80-90% of acute infection progresses to be chronic infection and in 50% of the cases, there is an increase in transaminase enzyme that reveals that there is still liver cell damage. The degree of liver tissue damage in hepatitis depends on the number of virus infecting and the activity of cytotoxic T cells. Keywords: hepatitis C virus, humoral immune response,cellular immune response

Risk Factors for Recurrent Upper Gastrointestinal Tract Bleeding after Esophageal Varices Ligation on Patients with Liver Cirrhosis Hidayat, Syarif; Djojoningrat, Dharmika; Akbar, Nurul; Sukmana, Nanang; Prasetyo, Sabarinah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 5, ISSUE 3, December 2004
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Upper gastrointestinal tract (GIT) bleeding on liver cirrhosis patients will increase morbidity and mortality. Recurrent bleeding’s risk rise after the first episode of variceal bleeding. The mortality risk also rises on each bleeding. Purpose: This study was done in order to identify the risk factors for the first episode of recurrent bleeding of upper GIT on liver cirrhosis patient. Evaluation of risk factors was based on preliminary data prior to ligation. Method: Evaluation of the upper GIT bleeding was done using anamnesis on the patients or their relatives by letter, home visits or telephone. The data on recurrent bleeding was obtained from medical records. They were evaluated on the 3rd month then 1st year after ligation. This study was a cross sectional study with retrospective data and a consecutive sampling method. Result: Bivariate analysis revealed the 3rd month’s risk factors for first episode of upper GIT bleeding were ascites, total bilirubin level of > 2 mg/dL, hepatoma, Child-Pugh C classification of the liver function and red color sign on esophageal varices. The risk factors for the first episode of upper GIT bleeding on first year were age £ 60 years old, hepatoma, and red color sign (RCS) on esophageal varices. The differences between risk factors on upper GIT bleeding on the 3rd month and 1st year were likely due to intervention, collateral para-esophageal varices, medication that irritated GIT, physical activities, and differences on variceal obliteration rate related to variceal ligation. Conclusion: Risk factors for recurrent upper GIT bleeding that could be minimized were ascites, total bilirubin level, Child-Pugh classification and RCS. It was expected with parascentesis, diuretics, hepatoprotector medications and drugs that lowers portal hypertension (such as propranolol and isosorbid mononitrate), might improve those risk factors thus decreasing the risk for recurrent upper GIT bleeding. Keywords: Upper gastrointestinal tract, esophageal varices, liver cirrhotic

Risk Factors for Spontaneous Bacterial Peritonitis in Patients with Liver Cirrhosis and Ascites Razy, Fachrul; Sukmana, Nanang; Djojoningrat, Dharmika; Noer, Sjaifoellah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 3, NUMBER 1, April 2002
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Spontaneous bacterial peritonitis (SBP) is one of serious complication of liver cirrhosis. Most of the patient with SBP have severe reduced liver function that clasified as Child Plugh class C. There are other risk factors for SBP such as poor nutritional status, GI bleeding, intravascular catheter insertion, ascites fluid protein concentration of less than 1 g/L, large volume paracentesis, urinary tract infection and respiratory tract infection. The management of SBP is mainly the administration of proper antibiotics. The antibiotic of choice for the emperial treatment is cefotaxim. Keywords: sbp,liver cirrhosis, risk factor, ascites

Bone Mass Density in HIV/AIDS Patients Mulansari, Nadia Ayu; Sukmana, Nanang; Setyohadi, Bambang; Setiati, Siti
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 4
Publisher : UI Scholars Hub

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Antiphospholipid Antibody Profile in HIV/AIDS Patients Pandjaitan, Inolyn; Sukmana, Nanang; Effendy, Shufrie
Jurnal Penyakit Dalam Indonesia Vol. 4, No. 4
Publisher : UI Scholars Hub

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Introduction. Through the process of molecular mimicry, human immunodeficiency virus (HIV) infection can increase the concentration of antiphospholipid antibody (APA) which has possible association with thrombosis. The molecular mimicry in this HIV/AIDS patients is influenced by several factors, such as immunocompromised condition, the use of antitretroviral (ARV) therapy, hepatitis B and C coinfection, use of other drugs, and history of intravenous drug user (IDU). We conducted this study to determine the profile and prevalence of antiphospholipid antibody in patients with HIV/ AIDS in Dr. Cipto Mangunkusumo General Hospital. Further, we explored the relationship between APA in HIV/AIDS patients with the factors mentioned before. Methods. This cross sectional study was done on HIV/AIDS outpatient at AIDS Working Group Clinic at Dr. Cipto Mangunkusumo General Hospital. We assessed the patients by history taking and measured their level of antibody anticardiolipin (ACA) dan Anti β2 glycoprotein I (anti-β2 GP1). Subjects were selected using simple random sampling. Descriptive data regarding the characteristics of the subjects and the proportions of APA were presented in numbers and percentages. The bivariate analysis between APA with the history of injecting drug use, the absolute CD4 lymphocyte count, antiretroviral therapy, and chronic hepatitis coinfection was performed using Chi-Square test and Fisher test. Results. APA examination results showed 27 (29,3%) patients were positive for ACA IgM, 77 (83,7%) patients were positive for ACA IgG, 61 (66,3%) patients were positive for anti β2 GP1 IgM, and 7 (7,6%) pateints were positive for anti β2 GP1 IgG. There is significant association between APA and the history of intravenous drug user (IDU) and ARV therapy. No association was observed between CD4 lymphocyte count and hepatitis coinfection with prevalence of APA in patients with HIV/AIDS patient. Conclusion. Proportion of anticardiolipin antibody IgG is higher than IgM (83,7% vs 29,3%), while the proportion of anti-β2 GP1 IgM is higher than IgG (66,3% vs 7,6%).

Co-Authors Bambang Setyohadi Birry Karim Dharmika Djojoningrat Fachrul Razy Ihsanil Husna Inolyn Pandjaitan, Inolyn Laurentius A. Pramono Nadia Ayu Mulansari, Nadia Ayu Nurul Akbar Parlindungan Siregar Rino Alvani Gani Sabarinah Prasetyo Shufrie Effendy Siti Setiati Sjaifoellah Noer Syarif Hidayat Unggul Budihusodo Wulyo Rajabto

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