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Profile of Neuron-Specific Enolase, Lactate Dehydrogenase, Fine Needle Aspiration Biopsy, and Bone Marrow Aspiration Examination to Diagnose Neuroblastoma Patients in Hematology Oncology Division of Pediatric Department at Dr. Soetomo General Hospital Mutiani, Faradillah; Ugrasena, I Dewa Gede; Soedewo, Fery Hudowo
Indonesian Journal of Cancer Vol 12, No 4 (2018): October-December
Publisher : National Cancer Center - Dharmais Cancer Hospital

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (743.484 KB) | DOI: 10.33371/ijoc.v12i4.585

Abstract

Background: Neuroblastoma is a malignant solid tumour in children which attacks sympathetic nervous system. Despite of increment in its number of incidence, it is still rarely investigated. This research aims to improve the understanding of neuroblastoma based on the profile of patients, and further, to improve services for patients.Methods: This was a retrospective study conducted by assessing and descriptively analyzed patients medical record.Results: From 52 patients, 56% were male and 71% were between age of 1-5 years. Neuron Specific Enolase (NSE) examination showed that most patients had high levels in 29 patients (56%) while Lactate Dehydrogenase (LDH) examination showed that 23 patients (44%) had low levels. Based on Fine Needle Aspiration Biopsy (FNAB) examination, 22 patients (42%) showed formation of malignant round cell tumor. Meanwhile, through Bone Marrow Aspiration (BMA) examination, it was found that the tumors had already spread to bone marrow in 17 patients (33%).Conclusions: Based on tumor markers and pathological finding, this study revealed that the majority of neuroblastoma patients had poor prognosis.
CD4+ T-cell, CD8+ T-cell, CD4+ /CD8+ ratio, and apoptosis as a response to induction phase chemotherapy in pediatric acute lymphoblastic leukemia Tanzilia, May Fanny; Cahyadi, Andi; Hermaningsih, Yetti; Retnowati, Endang; Ugrasena, I Dewa Gede
Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (248.015 KB) | DOI: 10.14238/pi57.3.2017.138-44

Abstract

Background Acute lymphoblastic leukemia (ALL) is a neoplastic disease resulting from somatic mutation in the lymphoid progenitor cells, often occuring in children aged 2-5 years, predominantly in males. Results from the induction phase of chemtherapy are used to measure success, but the failure remission rate is still high. Increased apoptosis of cancer cells, as induced by CD4+ and CD8+T-cells, is an indicator of prognosis and response to chemotherapy.Objective To assess for correlations between CD4+, CD8+, or CD4+/CD8+ ratio to the chemotherapy induction phase response (i.e., apoptosis) in pediatric ALL patients.Methods This observational analytical cohort study was done in 25 pediatric ALL patients. Whole blood (3 mL) with EDTA anticoagulant were used to measure absolute counts of CD4+, CD8+, and CD4+/CD8+ ratio. Peripheral blood mononuclear cells (PBMC) were examined for apoptosis. The principle of CD4+, CD8+ examination was bond between antigens on the surface of the leukocyte in the blood with fluorochrome labeled antibodies in the reagents, while the principle of apoptosis examination was FITC Annexin V will bonds with phosphatidylserine that moves out of the cell when the cell undergoes apoptosis, then intercalation with propidium iodide (PI). All examination were detected by flow cytometry BD FACSCalibur.Results Subjects were 25 newly-diagnosed, pediatric ALL patients (64% males and 36% females). Most subjects were 3 years of age (20%). Numbers of CD4+ and CD8+ cells, as well as CD4+/CD8+ were significantly decreased after chemotherapy. However, apoptosis was not significantly different before and after chemotherapy (P=0.689), There were significant negative correlations between apoptosis and CD4+ (P=0.002; rs=-0.584), and CD8+ (rs=-0.556; P=0.004), before chemotherapy. In addition, CD4+-delta and apoptosis-delta also had a significant positive correlation (rs=0.478; P=0.016). However, no correlation was found between the CD4+/CD8+ ratio and apoptosis, before or after chemotherapy.Conclusion There are significantly lower mean CD4+, CD8+, and CD4+/CD8+ ratio after chemotherapy than before. Also, there are significant correlations between CD4+-delta and apoptosis-delta, as well as between apoptosis and CD4+, CD8+, and CD4+/CD8+, before chemotherapy. CD4+, CD8+, and CD4+/CD8+ can be used to predict apoptosis before chemotherapy. In addition, CD4+-delta can be used to predict apoptosis-delta as a response to induction phase chemotherapy in pediatric ALL.
Family Factors that Affect Family Empowerment in Caring Children with Leukemia Arief, Yuni Sufyanti; nursalam, Nursalam; Ugrasena, I Dewa Gede; Devy, Shrimarti Rukmini; Saudah, Noer
Health Notions Vol 2 No 4 (2018): April 2018
Publisher : Humanistic Network for Science and Technology (Address: Cemara street 25, Ds/Kec Sukorejo, Ponorogo, East Java, Indonesia 63453)

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Abstract

Introduction: Leukemia is one of the conditions of chronic disease in children. Families of children with chronic health conditions often feel helpless in meeting their childs health care needs. Powerlessness experienced by the family will affect the ability of families in providing care to their children. Many factors can affect the empowerment of families in providing care to their families. Method: This study aims to analyze family factors that affect family empowerment in treating children with leukemia leukemia. The research design used is explanation survey. The population in this study were families with children suffering from leukemia in Pediatric Ward RSUD Dr. Soetomo Surabaya. Result: The results showed that there was the influence of family factor to family empowerment in caring children with leukemia equal to t: 3.801. Discussion and Conclusions: Family factors need to be taken into account in family-centered empowerment, so families can improve their ability to care for leukemia children. Increased family-based health involves the strength and ability of families in coping mechanisms, the role of nurses, to encourage families to provide support in health care. More research is needed on family-centered empowerment models in the ability to care for children with leukemia. Factors that affect family empowerment in caring for child leukemia, can be considered nurse in giving nursing intervention especially child nurse in empowering parent at the time care of child leukemia. Keywords: Leukemia, Children, Family, Factor, Empowerment
Antibiotic Resistance Control Program in Pediatric Hematology and Oncology Patients at Dr. Soetomo Hospital in 2006–2007 Andarsini, Mia Ratwita; Ugrasena, I Dewa Gede; Permono, Bambang
Indonesian Journal of Tropical and Infectious Disease Vol 1, No 2 (2010)
Publisher : Institute of Topical Disease

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (306.357 KB) | DOI: 10.20473/ijtid.v1i2.2173

Abstract

Antibiotic resistance has been increasing since the first years of the clinical usage. It caused by inappropriate usage and uncontrol of antibiotic drugs. Therfore an Antibiotic Resistance Control Program (ARCP) is needed to overcome the problem. The purpose of this study is to know microorganism pattern and evaluate antibiotic use. Phase 1 (before ARCP), retrospective study by medical record of pediatric hematology-oncology patients with suspision of infection and admitted at dr Soetomo Hospital from June–August 2006 was carried out. Phase 2 (during ARCP), a prospective observational study was done from November 2006 to January 2007. We were evaluated the isolated microorganism, quantity of antibiotic were determined by Defined Daily Doses (DDD)/100 patients-days, quality of antibiotics usage were assessed with Glyssen classification, and the cost calculation of antibiotic therapy. Twenty seven patients were enrolled in phase 1 and 28 patients in phase 2. Coagulase-negative Staphylococci and Acinetobacter Sp as isolated microorganism was reported. Phase 1, the most sensitive antibiotic was Cefoperazone-Sulbactam and the most resistant was Penicillin G. Phase 2, Meropenem was the most sensitive antibiotic and Cotrimoxazole was the most resistant antibiotic. The use of antibiotics were decreased 6 vs 12 and DDD/100 patients-days were 14.52 vs 45.04. There were improving of Glyssen classification. The cost calculation of antibiotics therapy were decreased. ARCP can improve antibiotic use in pediatric hematology-oncology patients.
The Development of Model Family-Centered Empowerment on Caring for Children with Leukemia Arief, Yuni Sufyanti; Nursalam, Nursalam; Ugrasena, I Dewa Gede; Devy, Shrimarti Rukmini; Savage, Eileen
Jurnal Ners Vol 13, No 1 (2018): April 2018
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (156.051 KB) | DOI: 10.20473/jn.v13i1.7774

Abstract

Introduction: Children with leukemia desperately need serious attention, commitment and it is a hard struggle for family members. Powerlessness experienced by the family will affect the ability of the families to provide care for their children. Many factors can affect the empowerment of families in providing care to their families.Methods: The purpose of this study was to develop a family-centered empowerment model related to the family's ability to care for their child suffering from leukemia. The research design used was an explanation survey. The sample consisted of 140 families with children suffering from leukemia in the pediatric ward of Dr. Soetomo Hospital.Results: The family-centered empowerment model was formed from the family factor, patient factor and nurse factor. The greatest effect was on the nurse factor, with the T statistic value = 6.590.Conclusion: Family factors and nurse factors need to be taken into account in family-centered empowerment. The patient factor has little influence on family empowerment in relation to caring for children. More research is needed on family-centered empowerment models in relation to their ability to care for children with leukemia. For example, a nurse providing a nursing intervention, especially a pediatric nurse, in relation to empowering a parent at the time of caring for their child with leukemia.
Family Factors that Affect Family Empowerment in Caring Children with Leukemia Arief, Yuni Sufyanti; Nursalam, Nursalam; Ugrasena, I Dewa Gede; Devy, Shrimarti Rukmini; Saudah, Noer
Health Notions Vol 2, No 4 (2018): April
Publisher : Humanistic Network for Science and Technology

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

Abstract

Introduction: Leukemia is one of the conditions of chronic disease in children. Families of children with chronic health conditions often feel helpless in meeting their child's health care needs. Powerlessness experienced by the family will affect the ability of families in providing care to their children. Many factors can affect the empowerment of families in providing care to their families. Method: This study aims to analyze family factors that affect family empowerment in treating children with leukemia leukemia. The research design used is explanation survey. The population in this study were families with children suffering from leukemia in Pediatric Ward RSUD Dr. Soetomo Surabaya. Result: The results showed that there was the influence of family factor to family empowerment in caring children with leukemia equal to t: 3.801. Discussion and Conclusions: Family factors need to be taken into account in family-centered empowerment, so families can improve their ability to care for leukemia children. Increased family-based health involves the strength and ability of families in coping mechanisms, the role of nurses, to encourage families to provide support in health care. More research is needed on family-centered empowerment models in the ability to care for children with leukemia. Factors that affect family empowerment in caring for child leukemia, can be considered nurse in giving nursing intervention especially child nurse in empowering parent at the time care of child leukemia.Keywords: Leukemia, Children, Family, Factor, Empowerment
The discrepancy between manual and computerized leukocyte and thrombocyte counts Permono, Bambang; Asih, Retno; Ugrasena, I Dewa Gede
Paediatrica Indonesiana Vol 43 No 3 (2003): May 2003
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (260.091 KB) | DOI: 10.14238/pi43.3.2003.95-8

Abstract

Background Discrepancy between results of leukocyte and throm-bocyte count by computerized and manual examination may existObjective To determine the discrepancy between computerizedand manual leukocyte and thrombocyte count.Methods The design was a randomized sampling cross sectionalstudy. The blood sample was examined with computerized CellDyn 1400 instrument for the leukocyte and thrombocyte count. Formanual examination, blood smear was performed to measurethrombocyte while leukocyte was measured in Improved Neubauerhemocytometer. The results of computerized examination wereused as gold standard. Sensitivity, specificity, predictive values ofmanual count were calculated. The agreement of Kappa and McNemar test were determinedResults Blood specimens drawn from 100 patients with differentkinds of diagnoses were examined using computerized and manualmethods. In computerized group, 66% had normal leukocyte and55% had normal thrombocyte count. In the manual group, 78% ofsubjects had normal leukocyte and 82% had normal thrombocytecount. From leukocyte examination, the sensitivity of manual countwas 87.9%, specificity was 41.2%, and positive predictive valuewas 74.36 with the agreement of Kappa of 0.32 and Mc Nemarvalue of 0.036. From thrombocyte examination, the sensitivity was96.4%, specificity was 35.6%, and positive predictive value was64.6 with the agreement of Kappa of 0.41 and Mc Nemar value of0.41.Conclusion The result of manual thrombocyte count was in ac-cordance with computerized with the agreement of Kappa of 0.41.On the other hand, there was a discrepancy between manual infavor of computerized leukocyte count with the agreement of Kappaof 0.32
Epidemiological Study of Clinical and Laboratory Profiles of Patients with Acute Lymphoblastic Leukemia at Dr. Soetomo Hospital Surabaya Putri, Kezia Warokka; Ugrasena, I Dewa Gede; Hernaningsih, Yetti
Biomolecular and Health Science Journal Vol 2, No 1 (2019): Biomolecular and Health Science Journal
Publisher : Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (269.215 KB) | DOI: 10.20473/bhsj.v2i1.13247

Abstract

Introduction: Considering the high number of acute lymphoblastic leukemia (ALL) and it being the type of cancer with the highest fatality rate among the children, this study seeks to determine the epidemiological description of the clinical and laboratory profiles of patients with ALL.Methods: This research used a descriptive study by using medical data record of patients with ALL. The research variables were gender, age, leukemia history of the patient’s family, nutritional status, symptoms and signs, laboratory examination, ALL subtypes, risk factors, and result outcomes. All data presented descriptively.Results: From a total of 50 patients, 54 % of them were male aged 1,5 – 10 years old. 84% of the patients’ family had no medical record related to leukemia. 42% of the patient malnutrition. Pale (78%), fever (64%), pain (32%), hepatomegaly (38%), lymphadenopathy (28%), splenomegaly (26%), patients with anemia (82%), leukocytosis (38%), thrombocytopenia (54%). The highest types were ALL–LI (68%), SR-ALL (54%), and remission outcome reached 82%.Conclusion: Insidence higher in male, aged 1,5 – 10 years old, malnourished at the start of the diagnosis. Most of the patients’ family had no medical history of leukemia. Symptoms and medical signs mostly appeared were pale, fever, and bone/joint pain. The physical examination showed hepatomegaly, lymphadenopathy, and splenomegaly and laboratory first test showed the patients had anemia, leukocytosis, and thrombocytopenia.
COMPARISON OF PERIPHERAL BLOOD ACTIVATED NK CELL PERCENTAGE BEFORE AND AFTER INDUCTION PHASE CHEMOTHERAPY IN PEDIATRIC ACUTE LYMPHOBLASTIC LEUKEMIA (Perbandingan Persentase Sel NK Teraktivasi Darah Tepi Sebelum dan Sesudah Kemoterapi Tahap Induksi di Pasien Leukemia Limfoblastik Akut Anak) TJ, Syntia; Retnowati, Endang; Hernaningsih, Yetti; Ugrasena, I Dewa Gede; Ma?at, Soeprapto
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 23, No 3 (2017)
Publisher : PERHIMPUNAN DOKTER SPESIALIS PATOLOGI KLINIK INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v23i3.1208

Abstract

Leukemia Limfoblastik Akut (LLA) adalah keganasan sel progenitor limfoid yang berasal dari sumsum tulang dan ditandai proliferasileukosit. Kejadian LLA masih tinggi, sehingga perlu diteliti peran sel NK dalam melawan leukemia. Tujuan penelitian adalah untukmengetahui perbedaan persentase sel NK teraktivasi sebelum dan sesudah pengobatan induksi dan hubungan persentase sel NK teraktivasisebelum pengobatan induksi dengan keluaran kemoterapi pasien LLA anak. Penelitian analitik observasional dengan rancang banguncohort prospektif. Subjek penelitian 27 pasien di Ruang Rawat Inap Hemato-Onkologi Anak RSUD Dr. Soetomo Surabaya, antara bulanMaret?Juli 2016. Metode memeriksa flowcytometry menggunakan alat BD FACS CaliburTM reagen Fast Immune CD56FITC/CD69PE/CD45 Per CP No.katalog.5055879. Analisis statistik dengan uji Wilcoxon Signed Rank dan regresi logistik. Terdapat perbedaan bermaknarerata persentase sel NK teraktivasi sebelum pengobatan induksi 0,57% (SB 0,53%) dan sesudahnya 2,01% (SB 1,86%) p=0,000.Menunjukkan peningkatan bermakna sel NK teraktivasi sesudah pengobatan induksi. Kenasaban sel NK teraktivasi sebelum pengobataninduksi dengan keluaran kemoterapi berkurangnya gejala penyakit (remisi) dan meninggal R=0.723 berarti kenasabannya kuat.Peningkatan persentase sel NK teraktivasi sesudah pengobatan induksi disebabkan kerja kemoterapi meningkatkan hasil MICA/B dankerja activating receptors sel NK (NKG2D) yang bersifat sitotoksik yang kuat. Persentase sel NK teraktivasi sebelum pengobatan induksiyang rendah disebabkan mekanisme menghilangnya tumor di LLA. Terdapat perbedaan bermakna persentase sel NK teraktivasi sebelumdan sesudah pengobatan induksi. Hasilnya dapat menjadi peramal keberhasilan pemberian kemoterapi LLA anak. Persentase sel NKteraktivasi sebelum kemoterapi tahap induksi yang tinggi berpengaruh kuat terhadap keluaran kemoterapi berkurangnya gejala penyakitdan sebaliknya bila rendah berpengaruh terhadap kemungkinan yang bersangkutan meninggal. Diperlukan hasil jangka panjang sampaiselesai dalam pengelolaan pemberian pengobatan terkait.
RISK FACTORS OF MORTALITY IN CHILDREN WITH WILMS’ TUMOR AT SOETOMO HOSPITAL SURABAYA Shanty, Maria Christina; Yuniarchan, Sherly; Andarsini, Mia Ratwita; Ugrasena, I Dewa Gede; Permono, Bambang; Prasetyo, Risky Vitria
Indonesian Journal of Urology Vol 26 No 2 (2019)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (7762.046 KB) | DOI: 10.32421/juri.v26i2.469

Abstract

Objective: Wilms? tumor is the most common childhood renal tumor for about 6% of pediatric malignant disease. The 5-year survival rate in United States increased from approximately from 70% (1970-1973) to 92% (1989-1996). This study was aim to analyze the risk factors of mortality in children with Wilms? tumor. Material & Methods: A cross-sectional study was conducted in children with Wilms? tumor at Soetomo Hospital during 2006-2011. The data of demographic, clinical profile, complete blood count, blood urea nitrogen, glomerular filtration rate, histological type, disease stage, metastases and relapse were analyzed as risk factors of mortality using logistic regression. Results: There were 37 Wilms? tumor children and 5 children were excluded because of incomplete data. The mean age was 3.0 (SD 2.6) years, and male-to-female ratio was 2.5 : 1. There were 5/32 children in stage I, 7/32 children in stage II, 8/32 children in stage III, 11/32 children in stage IV, and 1/32 children in stage V. There were 15/32 children underwent operation. Complete remission occurred in 12/32 children and 1/32 children relapsed. There were 20/32 children died, associated with anemia (P=0.033, OR=6.111, 95% CI=1.056-35.352) and advanced stage (P=0.021, OR=8.000, 95% CI=1.575-40.632). The risk of mortality increased 3.284 folds with every increased stage (P=0.007, 95% CI=1.338-7.775). Conclusion: Disease stage is the significant risk factor of mortality in children with Wilms? tumor.