Telly Kamelia
Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta

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Perubahan Konsentrasi Amino Terminal Pro B-Type Natriuretic Peptide (NT-proBNP) dan Fraksi Ejeksi Ventrikel Kiri pada Pasien Kemoterapi Doksorubisin Kamelia, Telly; Waspadji, Sarwono; Makmun, Lukman Hakim; Effendi, Shufrie; Ramli, Muchlis; Timan, Ina Susanti
Jurnal Penyakit Dalam Indonesia Vol 4, No 2 (2017)
Publisher : Jurnal Penyakit Dalam Indonesia

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

Abstract

Pendahuluan. Pada pasien kanker yang mendapat rejimen kemoterapi mengandung doksorubisin dapat mengalami efek samping kemoterapi pada jantung yang disebut kardiotoksisitas. Pemeriksaan NR-proBNP dapat dipakai sebagai parameter baru untuk mengidentifikasi secara dini dan memantau perkembangan efek samping kemoterapi pada jantung, selain pengukuran fraksi ejeksi ventrikel kiri. Tujuan dari penelitian ini untuk mendapatkan perubahan nilai konsentrasi NT-proBNP dan fraksi ejeksi ventrikel kiri pada pasien kanker yang diberi rejimen kemoterapi mengandung Doksorubisisn siklus I-IV.Metode. Studi pre and post test design dilakukan untuk melihat perubahan konsentrasi NT-proBNP dan fraksi ejeksi ventrikel kiri pada pasien yang mendapat kemoterapi doksorubisin sebelum dan setelah kemoterapi siklus I sampai siklus IV di Rumah Sakit dr. Ciptomangunkusumo (RSCM), Jakarta. Dilakukan pengambilan sampel darah sebelum kemoterapi dan sesudah kemoterapi siklus I-IV. Analisis statistik dilakukan dengan uji two way Anova dan uji non parametrik Friedman.Hasil. Selama periode bulan Oktober 2007-Juni 2008 terkumpul 29 pasien kemoterapi doksorubisin terdiri dari 16 pasien kemoterapi CHOP (Siklofosfamid, Doksorubisin, Vinkristin, Prednison) dan 13 pasien kemoterapi FAC (5 Fluorourasil, Doksorubsisin, Siklofosfamid). Didapatkan peningkatan nilai median konsentrasi NT-proBNP antara kemoterapi naïve dengan: pasca kemoterapi siklus I 32 pg/mL (12,5-124,6 pg/mL), pasca kemoterapi siklus II 135 pg/mL (44-275,2 pg/mL), pasca kemoterapi siklus III 275,1 pg/mL (97,8-907,2 pg/mL), dan pasca kemoterapi siklus IV 514,6 pg/mL (80,6-6458,2 pg/mL). Dengan uji Friedman, didapat nilai p<0,000. Dengan uji Anova two way, didapatkan penurunan rerata fraksi ejeksi ventrikel kiri dibandingkan fraksi ejeksi ventrikel naïve; pasca kemoterapi siklus I penurunan sebesar 5,1% (p 0,000), pasca kemoterapi siklus II 8,9% (p 0,000), pasca kemoterapi siklus III 11,2% (p 0,000), dan pasca kemoterapi siklus IV sebesar 12,5% (p 0,000).Simpulan. Didapatkan peningkatan nilai median konsentrasi NT-proBNP dan penurunan rerata fraksi ejeksi ventrikel kiri pada pasien yang mendapat rejimen kemoterapi mengandung doksorubisin. Kata Kunci: doksorubisin, fraksi ejeksi, kardiotoksisitas, kemoterapi, NT-proBNP, ventrikel kiri  The Changes of Amino Terminal Pro B-type Natriuretic Peptide (NT-proBNP) Concentration and Left Ventricular Ejection Fraction on Doxorubicin Chemotherapy PatientsIntroduction. Cancer patients who received chemotherapy regimen containing doxorubicin has been known to have serious side effect in heart, called as cardiotoxicity. The measurement of NT-proBNP proposed to be used as a new parameter to identify and evaluate cardiotoxicity in cancer patients earlier before it has been manifested, superior than measurement of left ventricle ejection fraction (LVEF). The aims of this study to examine the changes of NT-proBNP concentration and LVEF on patients with cancer who receive chemotherapy regimen containing doxorubicin.Methods. The study used pre and post test design to observe the changes of NT-proBNP concentration and LVEF on the patients who receive naïve doxorubicin chemotherapy and after chemotherapy-cycle I to cyce IV at the Ciptomangunkusumo hospital, Jakarta. Echocardiography and NT-proBNP were examined on naïve chemotherapy and after chemotherapy each cycle. Statistical analysis was performed by using two way Anova and Friedman nonparametric test. Results. During the period of October 2007 to June 2008, a total of 29 consecutive patiets receiving doxorubicin chemotherapy regimen CHOP (Cyclophosphamide, doxorubicin, Vincristine, Prednisone and FAC-5 Fluorouracil, doxorubicin, Cyclophosphamide) were collected. The increase of median NT-proBNP concentration between naïve chemotherapy and: post chemotherapy cycle I was 32 pg/mL (12,5-124,6 pg/mL), post chemotherapy cycle II was 135 pg/mL (44-275,2 pg/mL), post chemotherapy cycle III was 275,1 pg/mL (97,8-907,2 pg/mL), post chemotherapy cycle IV was 514,6 pg/mL (80,6-6458,2 pg/mL). With Friedman test, p< 0,000. With Anova two way test, it was found the difference between naïve LVEF and LVEF: post chemotherapy cycle I was 5,1% (p 0,000), post chemotherapy cycle II 8,9% (p 0,000), post chemotherapy cycle III 11,2% (p 0,000), post chemotherapy cycle IV 12,5% (p 0,000). Conclusions. Elevated NT-proBNP concentration and LVEF reduction had been observed in doxorubicin chemotherapy patients.  
Diagnostic and Therapeutic Approach in Intestinal Tuberculosis Guno, Tri Hapsoro; Putra, Barry A; Kamelia, Telly; Makmun, Dadang
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 17, No 2 (2016): VOLUME 17, NUMBER 2, August 2016
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (228.324 KB) | DOI: 10.24871/1722016134-140

Abstract

Tuberculosis was still a global health problem. Beside lung, tuberculosis also manifest in other organs, one among them  is in abdominal organs. Abdominal tuberculosis was a complex disease with unspecific sign and symptoms so that its diagnostic procedure was not rarely inconclusive. We reported a 24 years old woman with chief complain of worsening abdominal pain in all region, accompanied by nausea, vomiting, bloating, and  absent bowel movement. She also had a fresh bloody stool. She had an active pulmonary tuberculosis on initiation phase treatment. Physical examination suggest a bowel obstruction sign with distended abdomen and increase bowel sound. Colonoscopy procedure findings was a mass that obstruct bowel lumen in ileocaecal region, suggest for malignancy similar to computerized tomography (CT) scan result, but pathlogic result showed an active colitis without any sign of malignancy. Because of its contradiction, the second colonoscopy was performed and concluded as intestinal tuberculosis, matched with second pathologic examination. Although polymerase chain reaction (PCR) tuberculosis (TB) showed a negative result, a further clinical judgement concluded this as an intestinal tuberculosis case. Patient was finally treated as intestinal tuberculosis with first-line antituberculosis drugs and planned to have colonoscopy evaluation. After general condition was good and obstructive ileus sign was relieved, patient planned for outpatient care.
Diagnostic and Therapeutic Approach in Intestinal Tuberculosis Guno, Tri Hapsoro; Putra, Barry A; Kamelia, Telly; Makmun, Dadang
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 17, No 2 (2016): VOLUME 17, NUMBER 2, August 2016
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (228.324 KB) | DOI: 10.24871/1722016134-140

Abstract

Tuberculosis was still a global health problem. Beside lung, tuberculosis also manifest in other organs, one among them  is in abdominal organs. Abdominal tuberculosis was a complex disease with unspecific sign and symptoms so that its diagnostic procedure was not rarely inconclusive. We reported a 24 years old woman with chief complain of worsening abdominal pain in all region, accompanied by nausea, vomiting, bloating, and  absent bowel movement. She also had a fresh bloody stool. She had an active pulmonary tuberculosis on initiation phase treatment. Physical examination suggest a bowel obstruction sign with distended abdomen and increase bowel sound. Colonoscopy procedure findings was a mass that obstruct bowel lumen in ileocaecal region, suggest for malignancy similar to computerized tomography (CT) scan result, but pathlogic result showed an active colitis without any sign of malignancy. Because of its contradiction, the second colonoscopy was performed and concluded as intestinal tuberculosis, matched with second pathologic examination. Although polymerase chain reaction (PCR) tuberculosis (TB) showed a negative result, a further clinical judgement concluded this as an intestinal tuberculosis case. Patient was finally treated as intestinal tuberculosis with first-line antituberculosis drugs and planned to have colonoscopy evaluation. After general condition was good and obstructive ileus sign was relieved, patient planned for outpatient care.
INSPIRATORY MUSCLE TRAINER EFFECTIVENESS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE REHABILITATION PROGRAM Nusdwinuringtyas, Nury; Islamadina, Balqis; Rumende, Cleopas Martin; Kamelia, Telly
Majalah Kedokteran Bandung Vol 51, No 1 (2019)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (625.998 KB) | DOI: 10.15395/mkb.v51n1.1600

Abstract

Chronic obstructive pulmonary disease (COPD) is marked by persistent respiratory disturbance which results in altered health status as well as functional capacity. Pulmonary rehabilitation (PR) is a part of comprehensive therapy in patients suffering from respiratory disturbance. This study focused on inspiratory muscles exercise using the inspiratory muscle trainer(IMT), which is a form of a weight training exercise. This experiment was conducted at the COPD outpatient clinic of Dr. Cipto Mangunkusumo Hospital during the period of September 2017 until April 2018. Patients were recruited consecutively. The criteria for inclusion were stable COPD patient with GOLD criteria A-D and never received prior exercise for pulmonary rehabilitation. Patients underwent interview about their medical history followed by spirometry testing using Carefusion® and  inspiratory muscle strength assessment using Micro RPM Carefusion®. The St George Respiratory Questionnaire (SGRQ) was used to assess the health status and the 6-minute walking test (6MWT) was conducted to assess the functional capacity. Subject exercised using IMT (Philips Respironic®) for eight weeks. Data were analyzed using paired t-test in statistical package for social sciences (SPSS) version 21. A total of 15 subjects with and average age of 65.6±8.40 years old were recruited. Pre-Post difference in inspiratory muscle strength was 11.31 cmH2O, showing a statistically significant impact. The significant impact was also shown clinically through the results of the Minimal Clinical Important Difference (MCID) on health status and functional capacity. The health status was evaluated using SGRQ with p exceeding 4%. A combined Pulmonary Rehabilitation (PR) and inspiratory muscles exercise program is proven to improve the health status and functional capacity.Key words: COPD, inspiratory muscle trainer, pulmonary rehabilitation, SGRQ, 6MWT Keefektifan Inspiratory Muscle Trainer Pada Program Rehabilitasi  Penyakit Paru Obstruktif KronikPenyakit paru obstruktif kronik (PPOK) ditandai dengan gangguan pernapasan yang persisten yang mengganggu status kesehatan dan kapasitas fungsional. Pulmonary rehabilitation (PR) merupakan bagian dari terapi komprehensif pasien dengan ganguan respirasi. Penelitian ini memfokuskan pada latihan otot inspirasi menggunakan inspiratory muscle trainer (IMT), suatu bentuk latihan otot pernapasan dengan pemberian beban. Eksperimen ini dilakukan di Rumah Sakit Cipto Mangunkusumo selama periode September 2017 hingga April 2018. Pasien direkrut secara consecutive sampling. Kriteria inklusi adalah pasien PPOK yang stabil dengan kriteria GOLD A-D yang belum pernah menerima latihan sebelumnya untuk rehabilitasi paru. Pasien menjalani wawancara, diuji dengan spirometri Carefusion®, dan kekuatan otot inspirasi dinilai menggunakan Micro RPM Carefusion®. St George Respiratory Questionnaire (SGRQ) digunakan untuk menilai status kesehatan dan 6-minute Walking Test (6MWT) dilakukan untuk menilai kapasitas fungsional. Subyek menggunakan alat IMT (Philips Respironic®) selama 8 minggu. Data dianalisis menggunakan SPSS versi 21 dengan uji T berpasangan. Subjek penelitian berjumlah 15 orang dengan rerata usia 65,6 ± 8,40 tahun. Kekuatan otot inspirasi awal didapatkan perubahan sebesar 11,31 cmH2O, yang memberikan dampak bermakna dilihat dengan pencapaian minimal clinical important difference (MCID) pada status kesehatan dan kapasitas fungsional. PR bersama dengan program latihanotot inspirasiterbukti memberikan hasil perbaikan status kesehatan dan kapasitas fungsional.Kata kunci: COPD, inspiratory muscle trainer, pulmonary rehabilitation, SGRQ, 6MWT 
Perubahan Konsentrasi Amino Terminal Pro B-Type Natriuretic Peptide (NT-proBNP) dan Fraksi Ejeksi Ventrikel Kiri pada Pasien Kemoterapi Doksorubisin Kamelia, Telly; Waspadji, Sarwono; Makmun, Lukman Hakim; Effendi, Shufrie; Ramli, Muchlis; Timan, Ina Susanti
Jurnal Penyakit Dalam Indonesia Vol 4, No 2 (2017)
Publisher : Internal Medicine Department, Faculty of Medicine Universitas Indonesia-RSCM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1290.099 KB) | DOI: 10.7454/jpdi.v4i2.127

Abstract

Pendahuluan. Pada pasien kanker yang mendapat rejimen kemoterapi mengandung doksorubisin dapat mengalami efek samping kemoterapi pada jantung yang disebut kardiotoksisitas. Pemeriksaan NR-proBNP dapat dipakai sebagai parameter baru untuk mengidentifikasi secara dini dan memantau perkembangan efek samping kemoterapi pada jantung, selain pengukuran fraksi ejeksi ventrikel kiri. Tujuan dari penelitian ini untuk mendapatkan perubahan nilai konsentrasi NT-proBNP dan fraksi ejeksi ventrikel kiri pada pasien kanker yang diberi rejimen kemoterapi mengandung Doksorubisisn siklus I-IV.Metode. Studi pre and post test design dilakukan untuk melihat perubahan konsentrasi NT-proBNP dan fraksi ejeksi ventrikel kiri pada pasien yang mendapat kemoterapi doksorubisin sebelum dan setelah kemoterapi siklus I sampai siklus IV di Rumah Sakit dr. Ciptomangunkusumo (RSCM), Jakarta. Dilakukan pengambilan sampel darah sebelum kemoterapi dan sesudah kemoterapi siklus I-IV. Analisis statistik dilakukan dengan uji two way Anova dan uji non parametrik Friedman.Hasil. Selama periode bulan Oktober 2007-Juni 2008 terkumpul 29 pasien kemoterapi doksorubisin terdiri dari 16 pasien kemoterapi CHOP (Siklofosfamid, Doksorubisin, Vinkristin, Prednison) dan 13 pasien kemoterapi FAC (5 Fluorourasil, Doksorubsisin, Siklofosfamid). Didapatkan peningkatan nilai median konsentrasi NT-proBNP antara kemoterapi naïve dengan: pasca kemoterapi siklus I 32 pg/mL (12,5-124,6 pg/mL), pasca kemoterapi siklus II 135 pg/mL (44-275,2 pg/mL), pasca kemoterapi siklus III 275,1 pg/mL (97,8-907,2 pg/mL), dan pasca kemoterapi siklus IV 514,6 pg/mL (80,6-6458,2 pg/mL). Dengan uji Friedman, didapat nilai p<0,000. Dengan uji Anova two way, didapatkan penurunan rerata fraksi ejeksi ventrikel kiri dibandingkan fraksi ejeksi ventrikel naïve; pasca kemoterapi siklus I penurunan sebesar 5,1% (p 0,000), pasca kemoterapi siklus II 8,9% (p 0,000), pasca kemoterapi siklus III 11,2% (p 0,000), dan pasca kemoterapi siklus IV sebesar 12,5% (p 0,000).Simpulan. Didapatkan peningkatan nilai median konsentrasi NT-proBNP dan penurunan rerata fraksi ejeksi ventrikel kiri pada pasien yang mendapat rejimen kemoterapi mengandung doksorubisin. Kata Kunci: doksorubisin, fraksi ejeksi, kardiotoksisitas, kemoterapi, NT-proBNP, ventrikel kiri  The Changes of Amino Terminal Pro B-type Natriuretic Peptide (NT-proBNP) Concentration and Left Ventricular Ejection Fraction on Doxorubicin Chemotherapy PatientsIntroduction. Cancer patients who received chemotherapy regimen containing doxorubicin has been known to have serious side effect in heart, called as cardiotoxicity. The measurement of NT-proBNP proposed to be used as a new parameter to identify and evaluate cardiotoxicity in cancer patients earlier before it has been manifested, superior than measurement of left ventricle ejection fraction (LVEF). The aims of this study to examine the changes of NT-proBNP concentration and LVEF on patients with cancer who receive chemotherapy regimen containing doxorubicin.Methods. The study used pre and post test design to observe the changes of NT-proBNP concentration and LVEF on the patients who receive naïve doxorubicin chemotherapy and after chemotherapy-cycle I to cyce IV at the Ciptomangunkusumo hospital, Jakarta. Echocardiography and NT-proBNP were examined on naïve chemotherapy and after chemotherapy each cycle. Statistical analysis was performed by using two way Anova and Friedman nonparametric test. Results. During the period of October 2007 to June 2008, a total of 29 consecutive patiets receiving doxorubicin chemotherapy regimen CHOP (Cyclophosphamide, doxorubicin, Vincristine, Prednisone and FAC-5 Fluorouracil, doxorubicin, Cyclophosphamide) were collected. The increase of median NT-proBNP concentration between naïve chemotherapy and: post chemotherapy cycle I was 32 pg/mL (12,5-124,6 pg/mL), post chemotherapy cycle II was 135 pg/mL (44-275,2 pg/mL), post chemotherapy cycle III was 275,1 pg/mL (97,8-907,2 pg/mL), post chemotherapy cycle IV was 514,6 pg/mL (80,6-6458,2 pg/mL). With Friedman test, p< 0,000. With Anova two way test, it was found the difference between naïve LVEF and LVEF: post chemotherapy cycle I was 5,1% (p 0,000), post chemotherapy cycle II 8,9% (p 0,000), post chemotherapy cycle III 11,2% (p 0,000), post chemotherapy cycle IV 12,5% (p 0,000). Conclusions. Elevated NT-proBNP concentration and LVEF reduction had been observed in doxorubicin chemotherapy patients.