Susanna Hilda Hutajulu
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JAK2 mutation and treatment of JAK2 inhibitors in Philadelphia chromosome-negative myeloproliferative neoplasms Hutajulu, Susanna Hilda; Kurnianda, Johan
Acta Interna The Journal of Internal Medicine Vol 3, No 2 (2013): Acta Interna The Journal of Internal Medicine
Publisher : Acta Interna The Journal of Internal Medicine

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Abstract

ABSTRACTThe Philadelphia chromosome-negative (Ph-negative) myeloproliferative neoplasms (MPNs) polycythaemia vera (PV), essential thombocythaemia (ET) and primary myelofi brosis (PMF) are clonal disorders of multipotent haematopoietic progenitors. The genetic cause of these disorders was not fully defi ned until a somatic activating mutation in the JAK2 non-receptor tyrosine kinase, JAK2V617F, was identifi ed in most patients with PV and a considerable proportion of patients with ET and PMF. The discovery of JAK2 mutation has changed the molecular reclassification of MPNs and served as a genomic target for therapeutic implication. A number of JAK2 inhibitors have been developed and tested for MPNs. Several JAK2 inhibitors have reached the phases of clinical trial and included patients with intermediate-risk or high-risk MF. This population of MF is the best candidate for trials because currently it has no effective therapy besides patients’ poor survival. Considering all clinical data on Ph negative MPNs, JAK2 inhibitors have shown a clinical benefi t and reduced symptoms in the vast majority of MF cases. The most developed among JAK2 inhibitors is Ruxolitinib, which has demonstrated clinical improvement with well tolerated toxicities. However, JAK2 inhibitor was equally active in patients with and without JAK2 mutation. Other JAK2 inhibitors are less developed, but showed a similar clinical benefi t. Furthermore, its effect on the natural course of MPNs in treating patients needs to be investigated.Keywords: myeloproliferative neoplasms – JAK2 mutation – JAK2 inhibitors.
Ketahanan hidup 5 tahun pada pasien kanker payudara Sinaga, Evi Susanti; Ahmad, Riris Andono; Hutajulu, Susanna Hilda
Berita Kedokteran Masyarakat (BKM) Vol 33, No 2 (2017)
Publisher : Fakultas Kedokteran Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/bkm.10543

Abstract

Latar belakang: Berdasarkan data Globocan tahun 2012, insidensi kanker yang tertinggi di Indonesia adalah kanker payudara. Kejadian kanker payudara di Indonesia menduduki peringkat tertinggi diderita oleh perempuan. Masih banyak kematian yang disebabkan oleh kanker payudara. Ketahanan hidup pasien tergantung beberapa faktor yang sangat penting untuk diidentifikasi.Metode: penelitian ini mengunakan rancangan kohort rertrospektif. Sampel pada penelitian ini adalah pasien kanker payudara yang pertama kali terdiagnosa kanker payudara dari 01 Januari 2009 sampai dengan 31 Desember 2009 di RS Sardjito, Yogyakarta. Analisis data menggunakan metode Kapplan Meier dan faktor yang berhubungan dianalisis dengan cox regression.Hasil: Ketahanan hidup 5 tahun pasien kanker payudara adalah 51,07%. Pada analisis bivariat, ada hubungan antara variabel umur diagnosis, pendidikan, stadium klinik , ukuran tumor dan lokasi tumor terhadap ketahanan hidup 5 tahun pasien kanker payudara. Pada analisis multivariat, umur diagnosis memiliki hubungan yang paling kuat (HR=3,73;95%CI=1,0-13,6) terhadap ketahanan hidup (pvalue=0,046).Kesimpulan: Ketahanan hidup pasien kanker payudara pada wanita berusia kurang dari 50 tahun lebih rendah. Wanita muda dengan kanker payudara cenderung memiliki kanker payudara yang lebih agresif pertumbuhannya dan risiko kekambuhan yang besar. Maka diperlukan upaya deteksi dini kanker payudara untuk meningkatkan ketahanan hidup pasien kanker payudara. 
JAK2 mutation and treatment of JAK2 inhibitors in Philadelphia chromosome-negative myeloproliferative neoplasms Hutajulu, Susanna Hilda; Kurnianda, Johan
Acta Interna The Journal of Internal Medicine Vol 3, No 2 (2013): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (8753.06 KB) | DOI: 10.22146/acta interna.5003

Abstract

ABSTRACTThe Philadelphia chromosome-negative (Ph-negative) myeloproliferative neoplasms (MPNs) polycythaemia vera (PV), essential thombocythaemia (ET) and primary myelofi brosis (PMF) are clonal disorders of multipotent haematopoietic progenitors. The genetic cause of these disorders was not fully defi ned until a somatic activating mutation in the JAK2 non-receptor tyrosine kinase, JAK2V617F, was identifi ed in most patients with PV and a considerable proportion of patients with ET and PMF. The discovery of JAK2 mutation has changed the molecular reclassification of MPNs and served as a genomic target for therapeutic implication. A number of JAK2 inhibitors have been developed and tested for MPNs. Several JAK2 inhibitors have reached the phases of clinical trial and included patients with intermediate-risk or high-risk MF. This population of MF is the best candidate for trials because currently it has no effective therapy besides patients’ poor survival. Considering all clinical data on Ph negative MPNs, JAK2 inhibitors have shown a clinical benefi t and reduced symptoms in the vast majority of MF cases. The most developed among JAK2 inhibitors is Ruxolitinib, which has demonstrated clinical improvement with well tolerated toxicities. However, JAK2 inhibitor was equally active in patients with and without JAK2 mutation. Other JAK2 inhibitors are less developed, but showed a similar clinical benefi t. Furthermore, its effect on the natural course of MPNs in treating patients needs to be investigated.Keywords: myeloproliferative neoplasms – JAK2 mutation – JAK2 inhibitors.
Cisplatin Desensitization in a Patient with Nasopharyngeal Carcinoma Experiencing Urticarial Allergic to Cisplatin Nugraha, Doddy Rizqi; Mulya, Deshinta Putri; Hutajulu, Susanna Hilda
Acta Interna The Journal of Internal Medicine Vol 9, No 1 (2019): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (137.833 KB) | DOI: 10.22146/actainterna.51362

Abstract

Background. Allergic reactions to cisplatin are not uncommon situations with an incidence of 5-20%. In general, allergic reactions to cisplatin is a type 1 hypersensitivity with manifestations of itching, redness, papules, urticaria, chest pain, and anaphylactic symptoms. Desensitization methods are needed for patients who have no alternative medication.Case Report. A 59-year-old woman with nasopharyngeal carcinoma experienced urticaria because of cisplatin in her first cycle of chemotherapy. In the second cycle, chemotherapy desensitization program was applied using a 12-step Castell protocol. We measured vital signs and symptoms every 15 minutes. Administration of cisplatin was completed in 2 hours and the patient tolerated the whole program very well.Discussion. Risk factors of hypersensitivity to cisplatin include age <70 years, previous allergy history, history of carboplatin use with dose >650 mg, mutation of BRACA1/2 gene, and administration of combined regimens with taxane groups or liposomal inhibitor. Desensitization uses 3 solutions with 12 steps. Solution is 100 times the dilution of the target dose. Solution 2 is 10 times the dilution of the target dose and solution 3 uses the appropriate target dose. Each solution is administered for 15 minutes using an infusion pump. Strict monitoring of vital signs and patient symptoms are done every 15 minutes during the program.Conclusion. Doctors should be aware of allergies to cisplatin. Currently, the allergic reaction to cisplatin can be overcome using the desensitization method when no alternative drug is not available.
FAKTOR – FAKTOR YANG MEMPENGARUHI TINDAKAN KRIOTERAPI PADA INDIVIDU IVA POSITIF DI KABUPATEN TEMANGGUNG TAHUN 2018 Napitupulu, Dahlan; Hutajulu, Susanna Hilda
Berita Kedokteran Masyarakat (BKM) Vol 34, No 11 (2018)
Publisher : Fakultas Kedokteran Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/bkm.36262

Abstract

Latar Belakang: Penyakit kanker adalah penyakit yang timbul akibat pertumbuhan tidak normal sel jaringan tubuh yang berubah menjadi sel kanker. Berdasarkan WHO, Setiap tahun 12 juta orang di dunia menderita kanker dan 7,6 juta meninggal dunia. Diperkirakan pada 2030 mencapai 26 juta orang dan 17 juta meninggal. Indonesia, tahun 2013 prevalensi tertinggi sebesar 0,8‰. Rumah sakit kanker Dharmais tahun 2010, kanker serviks 296 kasus, tahun 2011, kanker serviks 300 kasus, tahun 2012 kanker serviks 343 kasus, tahun 2013, kanker serviks 356 kasus, tahun 2014 kanker serviks 383 kasus. Kabupaten Temanggung sejak akhir tahun 2015 sampai Mei tahun 2017, pemeriksaan leher rahim sebanyak 5.323 orang terdiri dari IVA positif sebanyak 2.013 orang dan yang dilakukan krioterapi sebanyak 238 orang. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang mempengaruhi tindakan krioterapi pada individu IVA positif di Kabupaten Temanggung tahun 2017.Metode: Jenis penelitian ini adalah analitik observasional dengan desain cross sectional. Sampel diambil secara simpel random sampling. Terdiri dari 356 sampel. Analisis dilakukan dengan univariat, bivariat dan multivariatHasil: Penelitian ini dilaksanakan di wilayah Kabupaten Temanggung terhadap individu IVA positif. Jumlah responden dalam penelitian ini sebanyak 356 orang responden umur ≥ 35 tahun sebanyak 198 (55,62%. Pendidikan sekolah dasar dengan tindakan krioterapi di peroleh p value 0,000; PR = 1,83 (CI 95% = 1,131-2,414). Pengetahuan dengan tindakan krioterapi di peroleh p value 0,003; PR = 0,78 (CI 95% = 0,660-0,913). Pekerjaan bertani dengan tindakan krioterapi diperoleh p value 0,005; PR = 1,34 (CI 95% = 1,120-1,567). Keterjangkauan jarak dengan tindakan krioterapi di peroleh p value 0,016; PR = 1,26 (CI 95% = 1,029-1,538). Dukungan suami tidak memberikan ijin untuk melakukan krioterapi di peroleh p value 0,018; PR = 1.48 (CI 95% = 1,219-1,799). Dukungan suami tidak mau mengantar ke puskesmas untuk melakukan krioterapi di peroleh p value 0,026; PR = 1,21 (CI 95%  = 1,031-1,428).Kesimpulan: Pendidikan ada pengaruh, pengetahuan kurang ada pengaruh risikonya 0,78 kali lebih besar dibandingkan dengan pengetahuan baik, pekerjaan, keterjangkauan jarak, dukungan suami tidak memberikan ijin ada pengaruh risikonya 1,45 kali lebih besar dibandingkan dengan dukungan suami memberikan ijin melakukan tindakan krioterapi pada individu IVA positif di Kabupaten Temanggung.