Pustika Amalia
Faculty of Medicine Universitas Indonesia/ Cipto Mangunkusumo Hospital, Jakarta

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The Chelating Effect of Mangifera foetida Water Extract on Serum Thalassemic Patients Purwaningsih, Ernie H.; Hanani, Endang; Amalia, Pustika; Krisnamurti, Desak Gede Budi
Journal of the Indonesian Medical Association Vol. 61 No. 8 August 2011
Publisher : Journal of the Indonesian Medical Association

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Abstract

Thalassemia is still a major problem in Indonesia because of its high morbidity and mortality rate. The well-known chelating agent, deferoxamine, which is regularly administered, is expensive and has many side effects. Mangiferin, extracted from the bark of Mangifera indica Linn. has been proven in vitro, as a chelating agent to iron. The aim of this study was to prove that the water extract of Mangifera foetida Lour. leaves has a chelating effect to serum ferritin from thalassemic patients. This study was conducted at the Department of Medicat Pharmacy FMUI, Department of Child Health FMUI, and Department of Pharmacy, FMIPA UI from October2009 to June 2010. Forty two samples of serum from 7 patients that have been diluted to 200 uM, were divided into 6 groups as follows: negative control group; the treated group of extract, 0.375; 0.75; 1.125 mg, respectively; mangiferin 100 ug; deferoxamine 100 ug. The chelating activity was measured by substraction between the absorbance values of serum containing this treatment and each treatment only, divided by serum absorbance, using spectrophotometer at 280 nm. One way Anova was used for statistical analysis. The water extract of Mangifera foetida leaves at the dose 1.125 mg showed chelating effect to ferritin serum that has no significant difference to mangiferin 100 ug (p=0.735). This result showed differently compared to in vitro study because in serum, ferritin contains apo-protein that binds iron tightly, thus another specific method should be created for detecting their binding. J Indon Med Assoc. 2011;61:321-5.Keywords: Mangifera foetida, mangiferin, thalasemia, chelating agent
Ursodeoxycholic acid in neonatal sepsis-associated cholestasis Rina, Rita Mey; Oswari, Hanifah; Amalia, Pustika
Paediatrica Indonesiana Vol 54 No 4 (2014): July 2014
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (114.829 KB) | DOI: 10.14238/pi54.4.2014.206-12

Abstract

Background Sepsis-associated cholestasis (SAC) is an intrahepatic cholestasis caused by inflammatory cytokines. Patients with this condition have poor prognoses. Antibiotics are the mainstay of therapy, however, other adjuvant therapies, such as ursodeoxycholic acid (UDCA), have not been well established.Objective To assess the effect ofUDCA for treatment ofneonatal sepsis-associated cholestasis.Methods We performed a randomized, double-blind, controlled trial in 3 7 neonates who were diagnosed with sepsis-associated cholestasis in the Neonatal Care Unit of Cipto Mangunkusumo Hospital. Subjects were divided into two groups, with 19 neonates randomly allocated to the intervention group (received UDCA at 30 tngikg/day divided into 3 doses for 7 days) and 18 neonates to the control group (received placebo) . After 7 days of treatment, we evaluated the subjects' liver function parameters and performed asurvival analysis.Results Liver function parameter improvements at day 7 were not significantly different between the UDCA group and the control group, including for mean decrease of total bilirubin (TB) levels [2.2 (SD 2.9) mg/dL vs 1.7 (SD 4.6) mg/dL; P=0.080), mean decrease of direct bilirubin (DB) levels [1.1 (SD 2.3) mg/dL vs 0.6 (SD 3.6) mg/dL; P=0.080), median indirect bilirubin (lB) levels [0.4 (range 0.1- 5.6) mg/dL vs 0.9 (range 0.1-4.1) mg/dL; P=0.358) , mean decrease of alanine aminotransferase (ALT) levels [0.5 (-80.0 -21.0) U/L vs -2.0 (ranged -167 .0 - 85.0) U/L; P= 0.730), median aspartate aminotransferase (AST) levels [ 43 .0 (range 14.0-297 .0) U/L vs 150.0 (range 24.0-840.0) U/L; P=0.081), and median gamma-glutamyl transpeptidase (GGf) levels [125.0 (48.0-481.0) U/L vs 235.0 (56.0-456.0) U/L; P=0.108)). Five neonates in control group died compared to two in the UDCA group (P=0.232). In addition, UDCA did not significantly lengthen the survival time (hazard ratio/HR 3.62; 95%CI 0.69 to 18.77) .Conclusion Ursodeoxycholic acid tends to improve total bilirubin, direct bilirubin, and AST levels in sepsis associated cholestasis .
Faktor yang Berhubungan dengan Hiperglikemia dan Luarannya pada Anak Sakit Kritis Rosary, Rosary; Chair, Imral; Amalia, Pustika; Firmansyah, Agus; Mangunatmadja, Irawan; Djer, Mulyadi M.
Sari Pediatri Vol 15, No 1 (2013)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp15.1.2013.32-8

Abstract

Latar belakang. Hiperglikemia pada sakit kritis berhubungan dengan luaran yang lebih buruk, seperti lama penggunaan ventilasi mekanik, dan obat vasoaktif lebih panjang, serta derajat disfungsi organ yang lebih berat.Tujuan. Mengetahui hubungan karakteristik subjek dengan hiperglikemia serta mengetahui perbedaan proporsi subjek yang mengalami hiperglikemia antara kelompok subjek yang memakai ventilasi mekanik, mendapat obat vasoaktif, serta dengan disfungsi organ berat, dibandingkan dengan kelompok subjek yang tidak.Metode. Studi analitik potong lintang dilakukan pada anak sakit kritis di Pediatric Intensive Care Unit (PICU) Rumah Sakit Cipto Mangunkusumo (RSCM) usia 1 bulan-18 tahun, dilakukan antara Maret-Juni 2011.Hasil. Didapatkan 87 subjek penelitian, 60 di antaranya laki-laki. Hiperglikemia ditemukan pada 25/87 (28,7%) subjek dengan median kadar glukosa darah 121 (37-443) mg/dL Hiperglikemia ditemukan lebih banyak pada laki-laki, usia >1-5 tahun, gizi kurang, dan pasca-bedah, tetapi tidak ditemukan hubungan yang bermakna. Subjek yang menggunakan ventilasi mekanik dan vasoaktif memiliki proporsi lebih besar mengalami hiperglikemia dibandingkan dengan subjek yang tidak, tetapi perbedaan ini juga tidak bermakna. Enam dari 10 subjek yang memiliki skor Pediatric Logistic Organ Dysfunction (PELOD) tinggi mengalami hiperglikemia. Proporsi ini lebih besar dibandingkan subjek dengan skor PELOD rendah, yaitu 19/77 subjek (p=0,03).Kesimpulan. Proporsi subjek yang mengalami hiperglikemia lebih besar pada anak dengan disfungsi organ berat daripada disfungsi organ ringan. Karakteristik subjek tidak berhubungan dengan hiperglikemia pada sakit kritis. Tidak terbukti adanya perbedaan proporsi subjek yang mengalami hiperglikemia pada anak sakit kritis yang menggunakan ventilasi mekanik dan obat vasoaktif dibandingkan dengan kelompok subjek yang tidak.
Pemberian Antitrombin III pada Sepsis Neonatal Septhiandi, Nathanne; Pudjiadi, Antonius; Amalia, Pustika
Sari Pediatri Vol 18, No 1 (2016)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp18.1.2016.74-80

Abstract

Latar belakang. Kadar antitrombin III (AT III) dalam darah rendah pada pasien sakit berat dan penurunan kadarnya berkorelasi dengan derajat penyakit. Fungsi AT III sebagai antikoagulan, mempunyai peran penting untuk mencegah disfungsi mikrovaskular dan mengakibatkan kerusakan multi organ pada sepsis. Namun, peran teurapetik AT III pada sepsis masih diperdebatkan.Tujuan. Melakukan evaluasi apakah pemberian AT III pada sepsis neonatal berat memiliki prognosis yang lebih baik bila dibandingkan dengan plasebo.Metode. Penelusuran pustaka database elektronik yaitu Pubmed, Highwire, Google dan Yahoo.Hasil. Didapatkan 12 artikel yang dianggap relevan dengan rumusan masalah, terdiri atas 3 meta-analisis, 8 randomized controlled trial (RCT), dan 1 review. Hasil meta-analisis pertama menyatakan bahwa pemberian preparat AT III aman dan dapat ditoleransi dengan baik. Dilaporkan AT III menurunkan tingkat mortalitas 22,9% pada hari ke-30 pasca intervensi. Hasil meta-analisis keduamendapatkan pemberian AT III tidak menurunkan risiko mortalitas secara keseluruhan (RR 0,96, IK95%: 0,89;1,03), dan meningkatkan risiko perdarahan (RR 1,52, IK95%: 1,3;1,78). Hasil meta-analisis ketiga menunjukkan pemberian AT III mengurangi risiko mortalitas dalam 28 sampai 30 hari (OR 0,649, IK95%: 0,422; 0,998). Risiko perdarahan pada kelompok AT III tidak berbeda signifikan dengan kelompok plasebo.Kesimpulan. Secara statistik penggunaan AT III apabila dibandingkan dengan plasebo pada keadaan sepsis neonatal tidak memperbaiki prognosis dalam hal menurunkan tingkat mortalitas selama 28-30 hari. Walaupun demikian, tingkat mortalitas kelompok AT III lebih rendah dibandingkan dengan placebo. 
Faktor–Faktor yang Berhubungan dengan Kualitas Hidup Pasien Thalassemia Mayor di Pusat Thalassemia Departemen Ilmu Kesehatan Anak RSCM Aji, Daniel Nugraha; Silman, Christopher; Aryudi, Citra; Cynthia, Cynthia; Centauri, Centauri; Andalia, Damara; Astari, Desi; DMP, Diah Pitaloka; Wawolumaya, Corry; Sekartini, Rini; Amalia, Pustika
Sari Pediatri Vol 11, No 2 (2009)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp11.2.2009.85-9

Abstract

Latar belakang. Transfusi darah dan terapi kelasi yang diberikan seumur hidup pada anak dengan thalassemiamayor memberikan harapan hidup yang sama dengan anak sehat. Kualitas hidup menjadi hal yang pentingdengan bertambahnya angka harapan hidup pasien thalassemia.Tujuan. Mengetahui kualitas hidup anak dengan thalassemia mayor di Pusat Thalassemia Departemen IlmuKesehatan Anak FKUI-RSCM serta faktor-faktor yang berhubungan.Metode. Penelitian menggunakan rancangan cross-sectional. Pengambilan sampel dilakukan secara konsekutifpada bulan Juli 2009. Subjek penelitian adalah anak berusia 13-18 tahun di Pusat Thalassemia DepartemenIlmu Kesehatan Anak FKUI-RSCM yang datang selama periode penelitian. Penilaian kualitas hidupmenggunakan kuesioner baku PedsQL yang diisi sendiri oleh subjek. Analisis data dengan metode univariatdengan tingkat kemaknaan􀀀􀁁=0,05.Hasil. Dari 97 subjek, 49 (50,5%) memiliki kualitas hidup buruk. Sebaran usia, jenis kelamin, dan pendapatanorang tua berturut-turut didapatkan pada 53 subjek (54,6%) berusia 13-15 tahun, 49 subjek (50,5%) perempuan,dan 53 subjek (54,6%) memiliki orang tua berpendapatan menengah. Kelompok suku bangsa terbanyakadalah Sunda-Sunda (32%). Perubahan fisis dialami oleh 78% subjek yang terdiri dari facies Cooley (58%),hiperpigmentasi (64%), dan perut membuncit (26%). Faktor yang berhubungan dengan kualitas hidup adalahtingkat pendapatan orang tua (p=0,037), suku bangsa (p=0,019), dan tampilan facies cooley (p=0,006).Kesimpulan. Separuh anak dengan thalassemia mayor di Pusat Thalassemia RSCM (50,5%) memiliki kualitashidup yang buruk. Kualitas hidup tersebut berhubungan dengan tingkat pendapatan orang tua, suku, dantampilan facies Cooley.
Anemia pada Penyakit Keganasan Anak Rouli, Nababan; Amalia, Pustika
Sari Pediatri Vol 6, No 4 (2005)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (202.98 KB) | DOI: 10.14238/sp6.4.2005.176-81

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Anemia merupakan komplikasi yang paling sering terjadi pada penyakit keganasan.Mekanismenya sangat kompleks, yaitu anemia dapat terjadi sebagai dampak langsungdari penyakit keganasan atau akibat dari pengobatannya. Angka kejadian anemia padapasien dengan penyakit keganasan berkisar antara 35% hingga 95% bergantung padajenis penyakit keganasan dan regimen kemoterapi yang dipakai. Radioterapi dankemoterapi seperti cisplatin, etoposid, dan kombinasi dari siklofosfamid, metotreksatdan 5-fluorourasil terbukti dapat menyebabkan anemia derajat sedang sampai berat,oleh sebab itu anemia pada pasien keganasan sangat membutuhkan penanganan yangbaik karena dapat mempengaruhi proses pengobatan, dan kualitas hidup.
Hemofilia A dengan Komplikasi Epilepsi Pasca Perdarahan Intrakranial Puspita, Irma Rochima; Amalia, Pustika; Mangunatmadja, Irawan
Sari Pediatri Vol 8, No 2 (2006)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp8.2.2006.159-62

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Seorang bayi laki-laki berumur 9 bulan dengan hemofilia A dirawat di RS Dr.Ciptomangunkusumo Jakarta epilepsi pasca perdarahan intrakranial akibat trauma dikepala. Adanya perdarahan intrakranial dipastikan oleh pemeriksaan CT Scan kepala.Diagnosis hemofilia A ditegakkan pada waktu penderita mengalami perdarahanintrakranial, sedangkan diagnosis epilepsi ditegakkan berdasarkan hasil pemeriksaan EEG.Pengobatan yang diberikan kepada penderita pada saat terjadinya perdarahan intrakranialialah konsentrat faktor VIII karena penderita alergi terhadap kriopresipitat. Tindakanbedah tidak dilakukan karena orang tua pasien menolak. Asam valproat diberikan untukpengobatan epilepsi.
The relationship between thrombocytopenia and intraventricular hemorrhage in neonates with gestational age Yulandari, Idha; Rundjan, Lily; Kadim, Muzal; Amalia, Pustika; Wulandari, Haryanti F.; Handryastuti, Setyo
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (303.481 KB) | DOI: 10.14238/pi56.4.2016.242-50

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Background The prevalence of thrombocytopenia in neonates ranges from 22 to 35%, and one of the most feared complica­tions is intraventricular hemorrhage (IVH). Previous research in Cipto Mangunkusumo Hospital (CMH), Jakarta reported a high incidence of IVH (43.47%) in infants with a gestational age of <35 weeks. Intraventricular hemorrhage causes disturbances in neurological development and can be fatal. In Indonesia, re­search on the relationship between thrombocytopenia and IVH has been limited.Objective To study the relationship between thrombocytopenia and IVH in neonates with gestational age <35 weeks and assess for a correlation between the severity of thrombocytopenia and the severity of IVH.Methods This cross-sectional study was performed by reviewing medical records in the Neonatology Division of the Child Health Department, University of Indonesia, CMH. Subjects were neonates hospitalized from January 2012 to December 2014 with IVH. Subjects were categorized into either mild to moderate IVH (grade ≤2) or severe IVH (grade >2). Thrombocyte counts were recorded on the same day as the diagnosis of IVH.Results The risk of severe IVH was 28.2% in neonates with thrombocyte counts <100,000/uL, and 10.4% in neonates without thrombocytopenia (P=0.014). Multivariate analysis revealed that gestational age <32 weeks and the use of respira­tory support (ventilator and high frequency oscillatory ventila­tion) had significant associations with severe IVH. However, multivariate analysis did not show a significant relationship between thrombocytopenia and severe IVH (correlation coef­ficient = 0.21).Conclusion Thrombocytopenia is not significantly associated with the incidence of severe IVH based on multivariate analysis. Also, the severity of thrombocytopenia has no correlation with the severity of IVH.
Expression of Hepcidin and Growth Differentiation Factor 15 (GDF-15) Levels in Thalassemia Patients with Iron Overload and Positive Anti Hepatitis C Virus Indrasari, Nuri Dyah; Timan, Ina Susianti; Amalia, Pustika
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 (162.431 KB) | DOI: 10.24871/1722016106-111

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Background: Thalassemia patients who undergo life-long recurrent blood transfusion will experience iron overload in various organs including the liver and possibly suffer from chronic hepatitis C infection which may lead to liver impairment. The liver produces hepcidin, a hormone which plays role in the regulation of iron level in the blood. Various factors may influence hepcidin level in the blood. Chronic hepatitis C causes iron overload and liver impairment. Liver impairment and haemolytic anaemia due to haemoglobinopathy will suppress hepcidin production. Anaemia stimulates growth differentiation factor 15 (GDF-15) to increase erythropoiesis and suppress hepcidin production. Iron overload causes increase in hepcidin level. Presence of factors which decrease or increase hepcidin production will express various levels of hepcidin. This study aimed to identify the expression of hepcidin and GDF-15 levels in thalassemia patients with iron overload and positive anti-HCV. Information on hepcidin and GDF-15 levels are beneficial in the management of iron overload in thalassemia with positive anti-HCV.Method: This study was a descriptive analytic study in thalassemia patients who had received recurrent blood transfusion ≥ 12 times, suffered from iron overload (transferrin saturation > 55% and ferritin > 1,000 ng/mL), which consisted of 31 individuals with positive anti-HCV and 27 individuals with negative anti-HCV. This study was performed in Thalassemia Centre Department of Child Health and Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, in October 2011–January 2012. Serum hepcidin and GDF-15 examinations were performed using enzyme-linked immunosorbent assay (ELISA) method. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) examinations were performed using colorimetry method. Data on ferritin and transferrin saturation were obtained from medical records in the last 3 months. Data was analysed using SPSS Windows version 17 software.Results: Characteristics of subjects in this study included ferritin level, transferrin saturation, AST, and ALT were 5,289 (SD 2,492) ng/mL, 96.7 (SD 9.2)%, 41.8 (SD 26.7) U/L, and 50.6 (24.9) U/L, respectively.  It was obtained that the hepcidin levels were within the normal limits with median of 51.5 (19-166) pg/mL, while GDF-15 levels were higher than the normal range with median of 1,936 (643-2,475) pg/mL. There was no significant difference of hepcidin and GDF-15 levels between positive and negative anti-HCV groups, with p value of 0.842 and 0.115, respectively.Conclusion: We obtained that the hepcidin levels were within normal limits and GDF-15 levels were higher than the normal range. There was no significant difference of hepcidin and GDF-15 levels between positive and negative anti-HCV group. 
Some aspects of thyroid dysfunction in thalassemia major patients with severe iron overload Rindang, Cynthia; Batubara, Jose R. L.; Amalia, Pustika; Satari, Hindra
Paediatrica Indonesiana Vol 51 No 2 (2011): March 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.2.2011.66-72

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Background Severe iron overload due to recurrent transfusions for chronic anemia and inadequate iron chelation therapy in thalassemia major patients result in various complications, including hypothyroidism. Currently, there has been no data on the prevalence of hypothyroidism in thalassemia major patients at the Thalassemia Centers, Department of Child Health, CiptoMangunkusumo Hospital (DCH CMH).Objective To study the prevalence of primary hypothyroidism in thalassemia major patients in the Thalassemia Center, DCH MCH.Methods We performed a cross-sectional, descriptive study. All thalassemia major subjects aged O􀁬18 years with severe iron overload underwent thyroid functionexamination. Primary hypothyroidism was defined as either normal (compensated) or decreased (decompensated) free T4 (FT4) levels, along with elevated sensitive thyroid􀁬stimulatinghonnone (TSH)levels. Results 179 subjects enrolled this study Mth male: female ratio of 1: 1.6. The prevalence of primary hypothyroidism in thalassemia majorpatients Mth severe iron overloadws26.8% (48/179). Of those 48,45 had compensated hypothyroidism and 3 had decompensated hypothyroidism, 25.1% and 1.7% of the total subjects, respectively. Compensated hypothyroidism was observed in 17 subjects aged ≤1O years and in 28 subjects aged> 10 years. All 3 decompensated hypothyroidism cases were> 10 years of age. No relationship was found between the occurrence of primary hypothyroidism and mean pre-tr811sfusion Hb levels (P=0.481, OR 1.30; 95% CI 0.63 to 2.68), elevated serum ferritin levels (P=0.74, OR 0.89; 95% CI 0.46 to 1.75), and compliance to iron chelation therapy (P=0.570, OR 0.76; 95% CI 035 to 1.65). Based on multivariate analysis, only age of <10 year-old (P=O.029, OR 0.469; 95% CI 0.23 to 0.93) was significantly associated Mth primary hypJthyroidism. Further analysis using receiver operator curve (ROC) technique found that age of 8.5 year-old was the cutoff value to predict the risk of hypothyroidism. Conclusion The prevalence of primary hypothyroidism in our study is high. The occurrence of hypothyroidism is associated with age.