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Karakteristik dan Keluaran Pasien COVID-19 dengan DM di RS Umum Pusat Dr. Kariadi (Tinjauan pasien periode Maret-Juli 2020) Minuljo, Tania Tedjo; Anindita, Yohana Prima Ceria; Seno, Heri Nugroho Hario; Pemayun, Tjokorda Gde Dalem; Sofro, Muchlis Achsan Udji
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (310.883 KB) | DOI: 10.36408/mhjcm.v7i1A.473

Abstract

Pendahuluan Jawa Tengah merupakan propinsi dengan kasus COVID-19 terbanyak ke-4 di Indonesia (lebih dari 8.000 kasus). RS Umum Pusat Dr. Kariadi (RSDK) sebagai RS rujukan memiliki 436 kasus terkonfirmasi COVID-19 per 10 Juli 2020. Diabetes mellitus (DM) diketahui menurunkan sistem imun dan memperburuk reaksi inflamasi. Karakteristik dan keluaran pasien COVID-19 dengan DM di RSDK belum pernah dilaporkan sebelumnya. Metode Data dari rekam medis RSDK. Diagnosis DM: riwayat DM dan/atau GDS >200 mg/dL atau HbA1c >7%. Diagnosis COVID-19: PCR usapan nasofaring-orofaring positif. Karakteristik dasar: usia, jenis kelamin, keluhan, riwayat kontak, riwayat perjalanan, jenis dan tempat perawatan, lama perawatan, komorbid, serta terapi DM. Pemeriksaan penunjang: GDS, HbA1c, kreatinin, saturasi O2, C-reactive protein (CRP), proklasitonin, D-dimer, dan fibrinogen dikelompokkan berdasarkan keluaran (hidup vs. mati); dilakukan uji beda. Analisis dengan SPSS v.24 (IBM, New York, USA). Hasil Pasien COVID-19 dengan DM periode Maret-10 Juli 2020 sebanyak 42 dari total 436 kasus (9,63%). Pria lebih banyak (59,5%). Kasus terbanyak usia >50 tahun (64,3%). Batuk, demam, dan sesak nafas adalah keluhan tersering. Mayoritas pasien menyangkal riwayat kontak ataupun bepergian (>75%). Hampir separuh perlu perawatan intensif sejak awal (40,5%). Komorbid terbanyak hipertensi. Separuh kasus mendapat insulin. Persentase kematian 42,9% (18 dari 42). Rerata kendali glikemik (HbA1c 9,7%) dan saturasi O2 (Sat O2 90%) buruk. Rerata penanda gangguan koagulasi (D-dimer, fibrinogen) dan inflamasi akut (CRP, prokalsitonin) meningkat, berturut-turut 3937,4 ng/mL; 496,1 mg/dL; 16,6 mg/L; 12 ng/mL. Tidak ada beda bermakna antara kelompok hidup dan mati. Kesimpulan Mortalitas dan morbiditas COVID-19 sangat tinggi pada DM. Hampir seluruh pasien mengalami gangguan koagulasi dan inflamasi akut. Kata kunci: COVID-19, DM, RS Kariadi Introduction Central Java province has the 4th largest cases of COVID-19 in Indonesia with more than 8.000 cases. Dr. Kariadi General Hospital (RSDK) is one of the referral hospital with 436 confirmed cases of COVID-19 until July 10th 2020. Diabetes mellitus (DM) known to decreases the immune system and worsens the inflammatory reaction. The characteristics and outcomes of patients with COVID-19 and DM in the RSDK have not been reported yet. Method Data were taken from the RSDK medical record. Diagnosis of DM: history of diabetes and/or RBG >200 mg/dL or HbA1c >7%. Diagnosis of COVID-19 infection: positive PCR from nasopharyngeal-oropharyngeal smear. Baseline characteristics: age, sex, chief complaints, contact and travel history, type and place of care, duration of treatment, comorbidity, and diabetes treatment options. Laboratory result: RBG, HbA1c, creatinine, O2 saturation, C-reactive protein (CRP), proclasitonin, D-dimers, and fibrinogen were grouped according to patient output (life vs. death) and different tests was performed. Data analysis was performed with SPSS v.24 (IBM, New York, USA). Result The number of patients with COVID-19 and DM was 42 out of 436 cases (9.63%). Men was more prevalent (59.5%). Most cases were >50 years of age (64.3%). Cough, fever, and shortness of breath were the most prevalent chief complaints. The majority of patients denied contact or travel history (>75%). Nearly half of the cases needed intensive care (40.5%) at arrival. Hypertension was the no.1 comorbid. Half cases received insulin therapy. Percentage of death was 42.9% (18 out of 42). Average of glycemic control (HbA1c 9.7%) and O2 saturation (Sat O2 90%) were poor. Coagulation (D-dimer, fibrinogen) and acute inflammatory (CRP, procalsitonin) markers were increased, respectively 3937.4 ng/mL; 496.1 mg/dL; 16.6 mg/L; 12 ng/mL. There was no significant difference between the life and death groups. Conclusion Mortality and morbidity of patients with COVID-19 and DM was very high. Almost all patients suffered from disseminated intravascular coagulation (DIC) and severe acute inflammation. Key words: COVID-19, DM, Kariadi Hospital
Cushing’s syndrome manifesting as chronic insomnia caused by adrenal cortical adenoma with incidental pituitary microadenoma: a case report Rakhmayanti, Rizky; Minuljo, Tania Tedjo; Suryawati, Herlina; Fitrikasari, Alifiati; Soedarso, Mohamad Adi; Priambada, Dody
Journal of Biomedicine and Translational Research Vol 7, No 1 (2021): April 2021
Publisher : Faculty of Medicine, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jbtr.v7i1.9247

Abstract

Background: Cushing’s syndrome is condition caused by excessive glucocorticoid with insomnia as one of its neuropsychiatric manifestation. Cushing’s syndrome may be caused by excessive adrenocorticotropin hormone (ACTH-dependent), for example from ACTH producing pituitary tumors, or by overproduction of cortisol by adrenocortical tumors. In this report, we presented a case with Cushing’s syndrome manifesting as chronic insomnia with adrenal cortical adenoma and pituitary microadenoma.Case presentation: A 30-year-old woman was consulted from the Neurologic Department to the Internal Medicine Department with the chief complaint of insomnia and worsening headache since 6 months prior to the admission. She had undergone head MRI and abdominal CT scan previously and was found to have both pituitary microadenoma and left adrenal mass. From the physical examination she had clinical signs of Cushing’s syndrome like Cushingoid face and purplish striae on her stomach. Midnight cortisol serum examination was done initially and showed high level of cortisol. High dose dexamethasone suppression test or DST (8 mg overnight) was later performed to help determine the main cause of Cushing’s syndrome. The result failed to reach 50% suppression of cortisol serum, suggestive that the Cushing’s syndrome was not ACTH-dependent from the pituitary but potentially from overproduction of cortisol by the left adrenal mass. Therefore, left adrenalectomy was performed and the histopathological study supported the diagnosis of adrenal cortical adenoma.Conclusion: Chronic insomnia is a very important symptoms of Cushing’s syndrome that should not be neglected. The patient had both microadenoma pituitary and left adrenal mass thus high dose DST test (8 mg overnight) needed to be performed to differentiate the source of Cushing’s syndrome. The result showed only little suppression therefore the pituitary microadenoma was not the source of Cushing’s syndrome and more suggestive from the adrenal etiology.
Active Cytomegalovirus Infection in Critically Ill Immunocompeten Patients Admitted in the ICU. A Molecular Diagnosis Approach Minuljo, Tania Tedjo; Gasem, Muhammad Hussein; Hadi, Purnomo
Journal of Biomedicine and Translational Research Vol 3, No 1 (2017): July 2017
Publisher : Faculty of Medicine, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (36.211 KB) | DOI: 10.14710/jbtr.v3i1.866

Abstract

Background: Active Cytomegalovirus (CMV) infection has long been related to immunocompromised conditions such as malignancy, HIV-AIDS, longterm use of corticosteroids and organ transplantation. Nowadays, several studies showed that active CMV infection also frequently found in formerly immunocompetent patients during critically ill condition. Alteration of immune system in critically ill condition might become the most possible reason enderlying this adverse event.Aim: To document the prevalence of active CMV infection in critically ill immunocompetent patient admitted to ICU and to find out the difference of the disease severity between group of patients with and without active CMV infection.Method: This was a cross sectional study. Study conducted from April 1st - June 30th 2013. Subjects were patient aged ≥14 years, hospitalized in the ICU of Dr. Kariadi Hospital, Semarang, Indonesia. Patients who had history of malignancy, HIV-AIDS, use of corticosteroids and organ transplatation were excluded from the study. Disease severity was calculated using APACHE II score in the first 24 hours of ICU admission. EDTA sample for qualitative PCR examination (procedure as described elsewhere) collected after 4 days of ICU admission. Primer for CMV were as follow CMV-F: CATGAAGGTCTTTGCCCAGTAC, CMV-R: GGCCAAAGTGTAGGCTACAATAG. Datas were analyzed using bivariate analysis.Result: Active CMV infection was detected in 16 out of 50 subjects. Mean score of disease severity in all subjects (based on APACHE II scoring system) was 11.8±6.43. Mean score of disease severity in group with active CMV infection was higher than group without active CMV infection, but not differ significantly (12.75 vs. 11.47; p=0,510).Conclusion: The prevalence of active CMV infection in critically ill immunocompetent patient is relatively high (16/50; 32%) in the ICU of Dr. Kariadi Hospital, Semarang, Indonesia. Degree of disease severity might influence the occurance of CMV infection. Qualitative PCR testing was an aqurate tool for diagnosing active CMV infection.