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All Journal Dentika Dental Journal Medical Journal of Indonesia Oto Rhino Laryngologica Indonesiana Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Indonesian Journal of Cancer eJournal Kedokteran Indonesia Jurnal Penyakit Dalam Indonesia
Rahmat Cahyanur
Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia/ Rumah Sakit Cipto Mangunkusumo, Jakarta
Biochemistry, Genetics & Molecular Biology Dentistry Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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GAMBARAN KLINIS DAN PROPORSI HIPOTIROIDISME SEKUNDER PADA PASIEN ADENOMA HIPOFISIS DI RUMAH SAKIT CIPTO MANGUNKUSUMO Cahyanur, Rahmat; Soewondo, Pradana; Darmowidjojo, Budiman; Aman, Renindra Ananda; Dewiasty, Esthika
Majalah Kedokteran Indonesia Vol 68 No 6 (2018): Journal of the Indonesian Medical Association Majalah Kedokteran Indonesia Volum
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

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Abstract

Pendahuluan: Adenoma hipofisis merupakan tumor yang berasal dari jaringan hipofisis anterior. Manifestasi klinis timbul akibat pendesakan massa dan gangguan sekresi hormon. Salah satu gangguan hormonal yang ditimbulkan adalah hipotiroidisme sekunder. Hipotiroidisme sekunder terkait dengan penurunan kualitas hidup serta peningkatan risiko kardiovaskular. Tujuan: Mengetahui proporsi hipotiroidisme sekunder dan gambaran klinis pasien adenoma hipofisis. Metode: Penelitian ini adalah studi potong lintang. Data diambil dari rekam medis pasien di Rumah Sakit Cipto Mangunkusumo antara tahun 2007-2012. Data demografis (usia, jenis kelamin), karakteristik klinis, jenis adenoma, data radiologis, pemeriksaan hormon (T4 bebas dan TSH) dievaluasi pada peneltian ini. Hasil: Terdapat 45 pasien yang memenuhi kriteria penelitian ini. Sebagian besar subyek adalah wanita (62,2%). Keluhan utama subyek adalah gangguan penglihatan (55,6%). Gejala yang sering ditemukan adalah sakit kepala (86,7%), gangguan penglihatan (77,8%). Pada subyek wanita manifestasi yang pertama kali muncul adalah gangguan penglihatan dan gangguan fungsi seksual (39,3% dan 32,1%). Pada Usia muda, gejala pertama kali muncul lebih pada kelompok adenoma fungsional dibandingkan non fungsional (32,9 vs. 40,6). Hampir seluruh kasus yang ditemukan adalah makroadenoma (97,8%). Proporsi subyek yang mengalami hipotiroidisme sekunder adalah 40%. Subyek dengan hipotiroidisme sekunder lebih banyak mengeluhkan gangguan penglihatan dan gangguan ereksi. Kesimpulan: Gangguan penglihatan adalah keluhan utama yang sering ditemukan. Pada subyek wanita, keluhan gangguan fungsi seksual bersama dengan gangguan penglihatan adalah manifestasi yang pertama kali muncul. Proporsi hipotiroidisme sekunder pada penelitian ini adalah 40,0%. Subyek dengan hipotiroidisme sekunder lebih banyak mengeluhkan gangguan penglihatan, gangguan ereksi.
KONSUMSI KOPI MENGURANGI ANGKA KEMATIAN PADA PASIEN DENGAN INFARK MIOKARD AKUT Kenneth Johan; Rahmat Cahyanur; Resultanti
Majalah Kedokteran Indonesia Vol 70 No 2 (2020): Journal of the Indonesian Medical Association Majalah Kedokteran Indonesia Volum
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.1234/jinma.v70i2.172

Abstract

Tujuan: Infark Miokard Akut adalah penyebab kematian nomor satu pada tahun 2000. Biasanya, pembatasan konsumsi kopi dianjurkan kepada pasien dengan penyakit kardiovaskular. Studi menunjukan bahwa konsumsi kopi dapat mempunyai efek kardioprotektif.Metode: Pencarian sistematis dilakukan dengan pada Pubmed dan Cochrane. Pembacaan judul dan abstrak dilakukan pada 12 artikel, kemudian dilakukan pemilihan dengan kriteria inklusi dan eksklusi, dan didapatkan satu studi meta-analisis. Kemudian dilakukan telaah kritis pada studi tersebut.Hasil: Telaah kritis pada studi meta-analisis didapatkan nilai yang baik. Ditemukan penurunan angka kematian dan hubungan bertolak belakang antara konsumsi kopi dengan angka kematian dibandingkan dengan tanpa konsumsi kopi. RR = 0.54 95% CI [0.45 ? 0.65].Kesimpulan: Konsumsi kopi dan angka kematian pada pasien dengan infark miokard akut memiliki hubungan yang berkebalikan, dengan penurunan resiko tertinggi ditemukan pada peminum kopi.
Cyclin D1 and Chemotherapy Response Rahmat Cahyanur; Cosphiadi Irawan
Indonesian Journal of Cancer Vol 15, No 1 (2021): March
Publisher : National Cancer Center - Dharmais Cancer Hospital

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (222.81 KB) | DOI: 10.33371/ijoc.v15i1.782

Abstract

Cyclin D1 is a protein that plays a role in the transition from the G1 to S phase of the cell cycle. Cyclin D1 expression has been found to increase in various malignancies and, in many studies, was associated with tumor growth, stage, lymph node involvement, distant metastases, and poor prognosis. Until now, studies on the association of cyclin D1 expression level with chemotherapy response have shown different results. An in-depth understanding of the cell cycle will allow doctors to develop target therapies that work when specific interventions are carried out at certain stages. Some studies reported that cyclin D1 expression was inversely related to chemotherapy response, while others showed opposite results. A significant number of studies have attempted to elucidate this ambiguous effect of cyclin D1. The suggested mechanism involves the difference of cancer cell types, the effect of chromosome instability in a few malignancies, trigger to an excessive DNA repair protein expression stimulus, and the response to DNA damage severity. The ambiguous effect of cyclin D1 towards chemotherapy was thought to arise from the difference in tumor type, chemotherapy agents used, and cell damage severity caused by cytostatics as per different research works. More in-depth research with parallel evaluation of other possible mechanisms such as DNA repair should elucidate the reason behind the inconsistent findings.
Neutrophil Lymphocyte Ratio, Three Year Survival of Locally Advanced and Advanced Nasopharyngeal Carcinoma Cahyanur, Rahmat; Nufus, Hayatun; Irawan, Cosphiadi
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 3
Publisher : UI Scholars Hub

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Abstract

Introduction. Nasopharyngeal carcinoma (NPC) is the most prevalent head and neck malignancy in Indonesia, as NPC-related mortality in Indonesia is the second-highest in Asia after China. Inflammation has been studied to be associated with cancer progression. Neutrophil lymphocyte ratio describes the balance between the unfavorable suppression of immune response against cancer by neutrophils and the beneficial effect of adaptive immunity by lymphocytes. This study aimed to determine the relationship between NLR and the survival of locally advanced and advanced NPC patients.Methods. A retrospective cohort study was conducted using the medical records of NPC patients treated at the hematology clinic RSCM from 2015 to 2018. The difference in 3-year survival between NPC patients with and without metastasis, also high and low NLR, was analyzed with the Kaplan-Meier method. At the same time, multivariate Cox regression analysis was used to obtain adjusted hazard ratios (HR) after comparing with patients’ age, gender, T stage, N stage, NLR level, and metastasis status.Results. There were 143 patients included in this study; a total of 49 (34.3%) had metastasis. There was a significant difference in survival between those with and without metastasis (p=0.001), with 3-year survival of 24.5% in patients with metastasis. The AUC of NLR was 0.600 (CI 95% 0.502—0.698; p=0.049). The optimal cut-off value determined for NLR was 4.7 with a sensitivity of 56.00%, specificity of 62.37%, PPV of 59.81%, and NPV of 58.64% in predicting survival. Based on that value (≥4,7), there was a significant difference in proportion between those with and without metastasis (63.3% vs. 33.0%, p=0.001). Multivariateanalysis showed that metastasis (HR 3.349, CI 95% 1.909—5.874, p<0.001) was associated with poorer survival.Conclusions. There was no association between NLR and 3-year survival in NPC patients. The proportion of subjects with high NLR was found higher in those with metastasis. Metastasis status was associated with 3-year survival.
Effectivity of Acupuncture Therapy in Reduction of Pain Intensity in Cancer Pain Affadhia, Hanna Lianti; Cahyanur, Rahmat; Wahdini, Sri; Rachman, Andhika
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 3
Publisher : UI Scholars Hub

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Abstract

Pain is one of the most common complaints and interferes with the quality of life of cancer patients. Several studies recommend multimodal interventions that combine pharmacological and non-pharmacological therapies. Acupuncture therapy is one of the non-pharmacological treatment options that could be considered. This evidence-based case report aimed to examine the effectiveness of acupuncture therapy in reducing pain intensity in patients with cancer pain. Literature searching was performed on three databases (PubMed, Scopus, and Embase). The keywords used are cancer pain, malignant pain, acupuncture, acupuncture therapy, pain intensity, pain assessment, pain scale. The critical review was carried out using guidelines from the University of Oxford Center for Evidence-based Medicine. Four articles relevant to the clinical question were included in the study. Acupuncture therapy has been consistently shown to reduce pain intensity, shorter pain onset time, reduced dose and number of analgesics used, and better quality of life with minimal side effects, compared to drug therapy alone. Acupuncture therapy should be considered as a complementary therapy in the management of cancer pain, but not to replace standard regiment of pain protocols. Clinical decisions in applying acupuncture therapy need to assess patient preferences, accessibility, and cost-effectiveness.
Polycythemia: A Clinical Approach Cahyanur, Rahmat; Rinaldi, Ikhwan
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
Publisher : UI Scholars Hub

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Polycythemia or erythrocytosis is an increase in the number of red blood cells in circulation marked by the increase in hematocrit. Polycythemia is a case that still raises questions and dilemma for doctors. In this paper, it will be discussed about the diagnostic approach and management of polycythemia. The initial complaints of polycythemia are generally nonspecific, such as weakness and dizziness due to blood hyperviscosity. It is also essential to know accompanying diseases, routine medications, habits, and family histories of the patients. Patients with polycythemia commonly exhibit plethora. In vital sign examination, hypertension can be found in polycythemia vera. In general examination, we should look for signs that lead to secondary polycythemia, such as low oxygen saturation that can be found in secondary polycythemia. Initial workup that should be done is a complete blood count. Ferritin and transferrin saturation are evaluated to assess the iron status that can disguise the incidence of polycythemia, especially when the image of the blood smear indicates a microcytic hyperchromic. Advanced work up that can be done is genetic examination. In the case of polycythemia vera, the primary purpose of treatment is to prevent thrombotic events. In the case of secondary polycythemia, the aim of management is to identify the underlying disease and treat it, which one of them is phlebotomy.
Diagnosis dan Tata Laksana Metastasis Tulang Rahmat Cahyanur; Thariqah Salamah
eJournal Kedokteran Indonesia Vol. 11 No. 2 - Agustus 2023
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23886/ejki.11.214.181

Abstract

Tulang merupakan salah satu organ yang sering menjadi lokasi metastasis kanker, misalnya kanker payudara, prostat, dan paru. Metastasis tulang berpotensi memicu peningkatan mortalitas dan morbiditas, serta penurunan kualitas hidup. Gejala dan tanda klinis metastasis tulang mencakup nyeri, fraktur patologis, hiperkalsemia, serta kompresi medula spinalis. Oleh karena itu, deteksi dini dan tata laksana metastasis tulang yang tepat diperlukan untuk mencegah komplikasi lebih lanjut. Pertimbangan dalam memilih modalitas pemeriksaan radiologi, sebagai langkah utama dalam diagnosis, harus dilakukan secara rasional berdasarkan lokasi lesi metastasis tulang. Selain itu, pemeriksaan alkalin fosfatase dan biopsi juga dapat menjadi pilihan pemeriksaan penunjang. Tata laksana metastasis tulang mencakup terapi suportif, seperti kontrol nyeri, pemberian bifosfonat, pemberian denosumab atau terapi sistemik, penggunaan radiofarmaka, dan kontrol lokal, yaitu radiasi eksterna atau pembedahan.
Efektivitas dan Keamanan Beraprost untuk Pengobatan Klaudikasio Intermiten pada Critical Limb Threatening Ischemia (CLTI) Pangestu, Andhika; Asicha, Nur; Cahyanur, Rahmat; Resultanti, Resultanti
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 2
Publisher : UI Scholars Hub

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Critical limb threatening ischemia (CLTI) is the most advanced stage of peripheral arterial diseases. Alternative treatment for claudication in CLTI patients is beraprost. We aim to review effectiveness and safety beraprost for relieve symptoms in CLTI. We conducted systematic literature searching using PubMed/MEDLINE, Embase, ProQuest, and Cochrane databases. Selected articles were examined for duplication and screened by abstract and title. Then, we appraised the articles based on the critical appraisal sheet from Centre for Evidence-Based Medicine (CEBM) University of Oxford. We found one systematic review-meta analysis (SR-MA) which involved 4,477 randomized participants. The results from this study are moderate quality evidence that prostanoids reduced rest pain (RR 1.30; 95%CI 1.06 – 1.59) and promoted ulcer healing (RR 1.24; 95%CI 1.04 – 1.48). In adult patients with CLTI and intermittent claudication as the primary complaint, vasodilator agents such as beraprost have a beneficial effect and a favorable therapeutic response. Numerous effects, including cardiovascular benefit, adverse events, resting pain relief, ulcer healing, outcome maximum walking distance (MWD), and pain-free walking distance, demonstrate the benefit (PFWD). The benefits of beraprost differ depending on the mechanism of action and pharmacokinetics of the drugs.
Survei Kebutuhan Edukasi Pasien Lupus Eritematosus Sistemik Josephine, Jennifer; Widhani, Alvina; Cahyanur, Rahmat; Karjadi, Teguh Harjono
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
Publisher : UI Scholars Hub

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Introduction. Patients with systemic lupus erythematosus (SLE) who suffer from chronic illness, need tailored education to better manage their condition. As nowadays education through internet and social media contributes significantly. This study aimed to assess internet usage related to lupus, educational needs, and education sources preferences among patients. Methods. This study was a cross-sectional study conducted on adult SLE patients at Allergy and Clinical Immunology Clinic, Internal Medicine Department, Cipto Mangunkusumo Hospital, Jakarta, between July-August 2023. Respondents completed a set of questionnaires regarding their internet usage related to lupus, education platform preferences, and educational needs assessment tool (ENAT). Results. Sixty-five female subjects participated, with a median (range) age of 32 (19-56) years. Respondents who used the internet and social media for lupus-related matters were 92.3%. The ENAT domains prioritized by patients were knowledge about the disease (score 89%) and emotional management (score 85%). The primary sources of education desired by patients were direct education from doctors/nurses (87.7%), Instagram (55.4%), and YouTube (55.4%). Conclusions. SLE patients expressed a strong need for knowledge about the disease and emotional management, with doctors/nurses as the preferred sources of education. The widespread use of the internet for lupus-related information indicates a great opportunity for providing education through online platforms, particularly through Instagram, and YouTube.
Penyakit Sel Sabit pada Pasien Laki-laki Berusia 27 Tahun yang Sebelumnya Didiagnosis sebagai Talasemia: Sebuah Laporan Kasus Cahyanur, Rahmat; Kurniawan, Andree; Sharfina, Ratuafni; Mulansari, Nadia Ayu
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
Publisher : UI Scholars Hub

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Sickle cell disease (SCD) is a hemoglobinopathy inherited in an autosomal recessive pattern arising from a mutation causing substitution of valine for glutamic acid in the sixth amino acid of the β-globin chain. The clinical manifestation of SCD varies from acute pain, chronic anemia, to multi-organ infarct and failure. SCD is known to be rare in Indonesia. However, we recently encountered a SCD patient presenting with recurrent pain and hypesthesia since a year ago. The diagnosis of SCD in this patient was established based on the results of peripheral blood smear and hemoglobin electrophoresis. The patient had previously been diagnosed with thalassemia at the age of 19 years old due to a history of icterus, thus delaying prompt treatment. This further emphasizes the challenges in distinguishing SCD, which is relatively rare in Indonesia compared to thalassemia, especially considering the complexity and the variability in the phenotypic presentation of SCD. The patient was then given supportive therapy consisting of blood transfusion and symptomatic treatment, as well as consideration to administer hydroxyurea if the patient’s clinical condition worsens.
Co-Authors Affadhia, Hanna Lianti Alvina Widhani, Alvina Anandina Irmagita Andhika Rachman Andree Kurniawan Anshari S. Hasibuan Asicha, Nur Budiman Darmowidjojo Budiman Darmowidjojo, Budiman Cosphiadi Irawan Dimas Priantono, Dimas Esthika Dewiasty, Esthika Gregorius Ben Prajogi Gurmeet Singh Hasan Maulahela Hayatun Nufus Hayatun Nufus Ika Dewi Mayangsari Ikhwan Rinaldi Johannes Sarwono Josephine, Jennifer Kenneth Johan Kenneth Johan Linda Armelia Madadika, Annisa Tsana Maharani, Sausan Hana Marlinda Adham Maruhum B.H. Marbun Mayangsari, Ika Dewi Muhammad Ade Rahman Nadia Ayu Mulansari, Nadia Ayu Nur Atikah Pangestu, Andhika Pantoro, Nico Iswanto Pradana Soewondo Prajogi, Gregorius Ben Pravita, Aravinda Rahman, Muhammad Ade Rakanda Rizki Ramdhani Duddyarto Ramadan, Edwin Ti Renindra Ananda Aman Resultanti Resultanti Resultanti Resultanti, Resultanti Safitri, Eka Dian Sharfina, Ratuafni Sri Wahdini Teguh Harjono Karjadi, Teguh Harjono THARIQAH SALAMAH, THARIQAH Wulyo Rajabto