Iriana Maharani, Iriana
Otolaryngology Head&Neck Surgery Department of Medical Faculty Brawijaya University / Dr. Saiful Anwar Regional Public Hospital

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AIRBORNE FUNGI IN CHRONIC RHINOSINUSITIS PATIENTS MAXILLARY SINUS LAVAGE AT DR. SAIFUL ANWAR HOSPITAL MALANG Maharani, Iriana; Suheryanto, Rus; Retnoningsih, Endang
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
Publisher : BALI MEDICAL JOURNAL

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Abstract

Background: Chronic rhinosinusitis has a significant impact on the quality of life and health of adult population. Role of airborne fungi remains a controversy and have become the source of discussion for decades. Objective to know the prevalence of airborne fungi in the chronic rhinosinusitis with or without polyps patients and to know the possible effect of airborne fungi on chronic rhinosinusitis inflammation. Methods: This is a cross sectional research in the Saiful Anwar Public Hospital Malang, there were 29 patients involved. We examine fungi culture, H&E staining and DNA fungi by using PCR from sinus lavage sample. From the blood serum we examine allergen specific IgE, IgG3, IL-13 and IL-5. Results: Fungi culture there were 31,03 % of sample growth but only matches the PCR result in 3 samples (10,34 %). From PCR examinations we found all sample were positive with 2-5 species fungi, Alternaria alternata was found positive in 24,13% samples. There was an increment of IgE allergen specific and IL-5, a decrement of IL-13 and IgG3 in all of our samples regardless presence of nasal polyps and species of fungi found in PCR. Conclusions: PCR is a more reliable method compare to fungal culture. The presence of fungi in all of our samples could indicate fungi contribution to the disease pathophysiology. The increased level of Il-5 was not followed by IL-13; it may happen through PRR pathway.
Korelasi IgE terhadap rasio neutrofil/eosinofil jaringan dan darah penderita rinosinusitis kronik Aspergillus fumigatus Duhitatrissari, Fifin Pradina; Retnoningsih, Endang; Maharani, Iriana
Oto Rhino Laryngologica Indonesiana Vol 48, No 1 (2018): Volume 48, No. 1 January - June 2018
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (353.752 KB) | DOI: 10.32637/orli.v48i1.255

Abstract

Latar Belakang: Prevalensi rinosinusitis kronik (RSK) jamur saat ini cenderung meningkat. Jamurberperan sebagai mikroorganisme dan merupakan salah satu penyebab RSK. Pemeriksaan immunoglobulinE (IgE) Aspergillus fumigatus (Af) digunakan untuk menegakkan diagnosis rinosinusitis jamur tanpa harusmelalui tindakan invasif. Perubahan rasio neutrofil/eosinofil (RNE) digunakan untuk memahami responinflamasinya. Tujuan: Mengetahui korelasi antara kadar IgE Af terhadap perubahan RNE mukosa dandarah pada penderita RSK jamur. Metode: Penelitian cross sectional, melibatkan 13 subjek penelitiandengan pengambilan darah dan mukosa sinus maksila untuk diidentifikasi Af dengan Polymerase ChainReaction (PCR), dilanjutkan ELISA untuk mengukur kadar IgE Af serta flowcytometry untuk mengukurkadar neutrofil dan eosinofil mukosa sinus maksila dan darah. Hasil: Rerata IgE Af mukosa 1,112±0,883kU/mL, darah 1,041±0,876 kU/mL (N<0,35 kU/L). Dengan uji T berpasangan didapatkan kesesuaian antarakadar IgE Af darah dan mukosa (p=0,852). Rerata eosinofil mukosa 3,9±1,92% (N:0,3-0,7%) dan darah4,88±2,02% (N:3-9%). Rerata neutrofil mukosa 4,28±2,04 (N:1,1-1,7%) dan darah 49,41±13,98% (N:55,8-59,6%). Rerata RNE mukosa 1,77±2,28 (N:2,8). Rerata RNE darah 12,12 ± 6,25 (N:9,6). Didapatkan93,3% mukosa subjek penelitian mengalami inflamasi eosinofilik, 53,3% mengalami inflamasi eosinofilikpada darah. Dengan uji T berpasangan terdapat ketidaksesuaian RNE mukosa dengan darah (p:0,000).Tes korelasi Pearson antara IgE Af dengan RNE mukosa, tidak terdapat korelasi bermakna (p:0,523) danantara IgE Af dengan RNE darah, tidak terdapat korelasi bermakna (p:0,607). Kesimpulan: Terdapatkesesuaian antara kadar IgE Af mukosa dan darah, tetapi tidak terdapat kesesuaian antara RNE mukosadan darah. Tidak terdapat korelasi antara peningkatan kadar IgE Af dengan RNE pada mukosa dan darah.  ABSTRACTBackground: The prevalence of chronic fungal rhinosinusitis (CFR) nowadays tends to increase.Fungi act as microorganisms and is one of the causes of chronic rhinosinusitis. The examination ofimmunoglobulin E (IgE) Aspergillus fumigatus (Af) is applied to establish the diagnosis of CFR withouthaving to do invasive actions. Neutrophil/eosinophil ratio (NER) changes are used to understand theinflammatory response. Purpose: To determine the correlation between IgE Af levels on changes ofmucosal and blood NER in CFR patients. Method: A cross-sectional study, involving 13 subjects bytaking sample of the blood and maxillary sinus mucosa to identify Af with Polymerase Chain Reaction(PCR), followed by ELISA to measure the levels of IgE Af, and flowcytometry to measure the levels ofneutrophils and eosinophils of the blood and mucosa of maxillary sinuses. Results: The mean IgE ofmucosa: 1.112±0.883kU/mL, and of blood: 1.041± 0.876kU/mL (N<0.35kU/L). With paired T-test,there was a match between blood and mucosal IgE level (p=0.852). The mean eosinophil of mucosa:3.9±1.92%,(N:0.3-0.7%) and of blood 4.88±2.02% (N:3-9%). The mean neutrophil of mucosa:4.28±2.04%(N:1.1-1.7%) and of blood 49.41± 13.98%(N:55.8-59.6%). The mean NER of mucosa:1.77±2.28(N:2.8), and of blood: 12.12±6.25(N:9.6). It was revealed that 93.3% of mucosal subjects hadeosinophilic inflammation, 53.3% had eosinophilic inflammation in blood. With paired T-test there wasa mucosal NER mismatch with blood (p:0.000). The Pearson correlation-test between IgE Af and NERmucosa had no significant correlation (p:0.523), and between IgE Af with NER of blood there was no significant correlation (p:0.607). Conclusion: There was a correspondence between IgE Af of mucosaand blood levels, but there was no match between the mucosal and blood NERs. There was no correlationbetween elevated levels of IgE Af and NER in the mucosa and blood.
Hubungan respons terapi dengan kualitas hidup penderita karsinoma nasofaring WHO tipe III setelah terapi Deviana, Deviana; Rahaju, Pudji; Maharani, Iriana
Oto Rhino Laryngologica Indonesiana Vol 46, No 2 (2016): Volume 46, No. 2 July - December 2016
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (387.61 KB) | DOI: 10.32637/orli.v46i2.161

Abstract

Latar belakang: Hasil terapi penderita kanker umumnya dinilai dari angka kelangsungan hidup dan angka kontrol penyakit secara lokal/regional. Penilaian ini dilakukan oleh dokter dan tidak menunjukkan bagaimana kepuasan penderita terhadap hasil terapi. Di Indonesia, karsinoma nasofaring (KNF) menempati peringkat keempat keganasan tertinggi, dengan tipe terbanyak adalah KNF WHO tipe III. Penilaian kualitas hidup penting dilakukan karena penyakit dan terapi KNF dapat mempengaruhi beberapa fungsi penting kehidupan (makan, komunikasi, dan hubungan sosial). Belum pernah dilaporkan penelitian mengenai kualitas hidup penderita KNF setelah terapi di Indonesia. Tujuan: Mengetahui hubungan antara respons terapi dengan kualitas hidup penderita KNF WHO tipe III setelah radioterapi atau kemoradioterapi. Metode: Penelitian observasional analitik dengan pendekatan cross-sectional. Dinilai respons terapi dan kualitas hidup 8 subyek dari kelompok radioterapi, dan 8 subyek dari kelompok kemoradioterapi, dengan waktu evaluasi minimal 3 bulan setelah terapi. Penilaian respons terapi berdasarkan hasil pemeriksaan terakhir: biopsi nasofaring, foto Rontgen toraks, ultrasonografi abdomen,biopsi aspirasi jarum halus kelenjar getah bening leher (jika ada indikasi), dan foto Rontgen torakolumbal (jika ada indikasi). Penilaian kualitas hidup menggunakan kuesioner EORTC QLQ-C30 dan EORTC QLQ-H&N35. Hasil: Tidak didapati perbedaan respons terapi antara kelompok radioterapi dan kemoradioterapi. Seluruh subyek memiliki respons terapi positif (tidak didapati tumor menetap, kambuh secara lokal dan regional, dan metastasis jauh). Penderita dengan respons terapi positif memiliki kualitas hidup tinggi. Uji perbedaan kualitas hidup menunjukkan perbedaan bermakna hanya dalam hal fungsi emosi (p=0,031). Kesimpulan: Penderita KNF WHO tipe III dengan respons terapi positif memiliki kualitas hidup tinggi. Tidak didapati perbedaan respons terapi antara kelompok radioterapi dengan kemoradioterapi. Penderita yang mendapatkan kemoradioterapi memiliki kualitas hidup lebih tinggi dalam hal fungsi emosi.Kata kunci: Karsinoma nasofaring, radioterapi, kemoradioterapi, respons terapi, kualitas hidupABSTRACT Introduction: The endpoint of medical care for cancer patients usually focused on the survival rate and locoregional control rate. These endpoints were assessed by doctor and not the patient’s satisfaction rate to treatment outcome. In Indonesia, nasopharyngeal carcinoma (NPC) is the fourth most common cancer, especially NPC type III WHO. Assessment of quality of life is important because both the disease and the therapy of NPC could affect several important functions in life (eating, communication, and social relationships). There was no study reported about quality of life of NPC patients after therapy in Indonesia. Purpose: To assess the relationship between treatment response and quality of life of NPC WHO type III patients after radiotherapy or chemoradiotherapy. Method: Analytic observational study with cross-sectional design assessed treatment response and quality of life in 8 subjects of radiotherapy group and 8 subjects of chemoradiotherapy group with minimal evaluation time 3 months after therapy. Treatment response was assessed by the latest examination result of nasopharyngeal biopsy, thorax plain photo, abdomen ultrasonography, fine needle aspiration biopsy of neck mass (if indicated), and thoracolumbal plain photo (if indicated). Quality of life was assessed by EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaire. Result: There was no treatment response difference between radiotherapy and chemoradiotherapy group. All subjects had positive treatment response (no cancer remained, no locoregional recurrence, and no distant metastasis). Subjects with positive treatment response had high quality of life. Statistical analysis on the quality of life only showed a marked difference in emotional function (p=0.031). Conclusion: NPC WHO type III patients with positive treatment response had high quality of life. There was no treatment response difference between radiotherapy and chemoradiotherapy subjects. Patients treated with chemoradiotherapy had a better quality of life in emotional function.Keywords: Nasopharyngeal carcinoma, radiotherapy, chemoradiotherapy, treatment response, quality of life
Peran β-glucan dalam diagnosis rinosinusitis kronik jamur Wicaksana, Dhaniel Abdi; Suheryanto, Rus; Maharani, Iriana
Oto Rhino Laryngologica Indonesiana Vol 48, No 1 (2018): Volume 48, No. 1 January - June 2018
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (366.964 KB) | DOI: 10.32637/orli.v48i1.254

Abstract

Latar Belakang: Rinosinusitis kronik jamur merupakan permasalahan kesehatan terutama dinegara berkembang karena prevalensinya yang semakin meningkat, sulitnya penanganan medis, sertaberdampak besar terhadap penurunan kualitas hidup. Saat ini tengah dikembangkan teknologi untukmembantu penegakan diagnosis tanpa tindakan invasif, yaitu dengan memanfaatkan β-glucan sebagaikomponen terbesar penyusun dinding sel beberapa spesies jamur. Tujuan: Mengetahui hubungan antarakadar β-glucan jaringan sinus dan serum darah untuk diagnosis rinosinusitis kronik jamur. Metode:Penelitian cross sectional ini melibatkan 20 subjek penelitian. Dilakukan pengambilan sampel darah, danpembedahan sinus maksila untuk mengambil jaringan mukosa, yang kemudian dilanjutkan pemeriksaanpolymerase chain reaction (PCR) untuk identifikasi jamur pada mukosa sinus. Bila didapatkan spesiesjamur yang memiliki β-glucan, dilakukan pemeriksaan enzyme-linked immunosorbent assay (ELISA) untukpengukuran kadar β-glucan. Hasil: Aspergillus flavus merupakan jamur yang paling banyak ditemukan.Seluruh subjek melampaui batasan positif β-glucan (≥80 pg/mL) dari spesimen mukosa, dan hanya 1subjek memberikan hasil intermediate (60-79 pg/mL) dari darah. Uji t berpasangan mendapatkan kadarβ-glucan darah tidak berbeda bermakna dengan mukosa sinus (p=0,886), sehingga pemeriksaan β-glucanpada darah dapat menggambarkan kadar β-glucan pada sinus paranasal. Kesimpulan: β-glucan dapatdimanfaatkan untuk membantu memperoleh diagnosis rinosinusitis kronik jamur, sehingga diharapkandiagnosis dapat ditegakkan dengan cepat dan tepat tanpa memerlukan tindakan invasif, namun hasil inimembutuhkan penelitian lebih lanjut, khususnya terkait uji diagnostik.  ABSTRACTBackground: Chronic fungal rhinosinusitis is a major health problem particularly in developingcountries due to its increasing prevalence, difficult medical treatment, and also could make a large impacton the quality of life. The current technology to establish diagnosis without invasive procedure is byutilizing β-glucan, the largest component of fungal cell wall in some fungal species. Purpose: To discoverthe correlation of β-glucan level in paranasal sinus tissue and blood serum as a potential diagnosismarker for chronic fungal rhinosinusitis. Methods: A cross sectional study involving 20 subjects. Bloodsampling and maxillary sinus surgery were performed, then fungi identification in the sinus mucosawas done by Polymerase Chain Reaction (PCR). If a fungal species with β-glucan was found, then theexamination was continued with the measurement of β-glucan by Enzyme-Linked Immuno Sorbent Assay(ELISA) technique in sinus and blood. Results: Aspergillus flavus is the most commonly found fungus. Allsubjects passed the positive β-glucan limit (≥80 pg/mL) of the mucosal sample, and only 1 subject hadintermediate results (60-79 pg/mL) from the blood. Paired t-test result showed no significant differencebetween the level of β-glucan in blood and mucosal sinus (p=0.886), so that β-glucan blood examinationcould illustrate β-glucan levels in paranasal sinuses. Conclusion: β-glucan may be used to establishthe diagnosis of fungal chronic rhinosinusitis with one hope that the diagnosis process can be obtainedquickly and accurately without invasive procedure, although it still requires more studies, particularlyrelated to diagnostic test.
HUBUNGAN ANTARA PENGETAHUAN DAN SIKAP KELUARGA DENGAN TINGKAT KECACATAN PADA PENDERITA KUSTA DI RUMAH SAKIT UMUM DAERAH DR. SAIFUL ANWAR MALANG Widasmara, DheIya; Maharani, Iriana; ApriIia, Nanin
Majalah Kesehatan FKUB Vol 6, No 1 (2019): Majalah Kesehatan
Publisher : Faculty of Medicine Universitas Brawijaya

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Abstrak Perawatan dan dukungan untuk menurunkan tingkat kecacatan pada penderita kusta memerlukan partisipasi anggota keIuarga. KeIuarga yang memiIiki pengetahuan baik dan sikap yang tepat mengenai penyakit kusta dapat menurunkan tingkat kecacatan pada penderita kusta.  Kota MaIang masih menjadi penyumbang jumIah penderita kusta di Jawa Timur dengan jumlah penderita kusta tertinggi di Indonesia. Tujuan peneIitian ini adaIah untuk mengetahui hubungan antara pengetahuan dan sikap keIuarga dengan tingkat kecacatan penderita kusta di Rumah Sakit Umum Daerah Dr. SaifuI Anwar MaIang pada buIan Mei sampai JuIi tahun 2017. Tingkat kecacatan diukur menggunakan kriteria WHO yaitu grade 0, grade 1,dan grade 2. Pengetahuan dan sikap keIuarga diukur menggunakan kuesioner yang diberikan bersamaan dengan observasi tingkat kecacatan. PeneIitian diIaksanakan di wiIayah kerja RS. Dr. Saiful Anwar dengan metode cross sectionaI. JumIah subjek peneIitian adaIah 19 orang dengan teknik totaI sampIing. AnaIisis data pada peneIitian ini menggunakan uji chi-square. HasiI peneIitian menunjukkan bahwa pengetahuan dan sikap  keIuarga memiliki hubungan yang signifikan dengan tingkat kecacatan penderita kusta di RS. Dr. Saiful Anwar MaIang (masing-masing p = 0,010, OR = 8,1 dan p = 0,017, OR = 7,3). Dapat disimpuIkan bahwa terdapat hubungan yang bermakna antara pengetahuan dan sikap keIuarga dengan tingkat kecacatan pada penderita kusta di RS. Dr. Saiful Anwar MaIang.