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All Journal Universa Medicina The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia Journal Medical Informatics Technology
Khie Chen
Divisi Infeksi Dan Penyakit Tropis, Departemen Ilmu Penyakit Dalam, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo, Jakarta
Computer Science & IT Dentistry Engineering Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Culture-and nonculture-based antibiotics for complicated soft tissue infections are comparable Ronald Irwanto; Suhendro Suhendro; Khie Chen; Murdani Abdullah
Universa Medicina Vol. 32 No. 1 (2013)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2013.v32.20 - 28

Abstract

BACKGROUNDData collected in 2010 from Cipto Mangunkusumo Hospital indicate thatcomplicated skin and soft tissue infections accounted for more than 10% ofcases. Etiological diagnoses are based on the findings on bacterial culture andthus evaluation of the effectiveness of bacterial culture becomes a necessity.The purpose of this study was to evaluate the operational effectiveness ofbacterial culture for etiological diagnosis of complicated skin and soft tissueinfections.METHODSThis was a historical cohort study using secondary data of patients withcomplicated skin and soft tissue infections admitted for hospitalization to CiptoMangunkusumo Hospital, Jakarta from July 2011 to July 2012. The 90 subjectsmeeting the inclusion and exclusion criteria were divided into 2 groups of 45patients each. Group 1 comprised patients who received initial antibiotic therapyaccording to cultural results, while the patients in group 2 received initial antibiotictherapy without reference to cultural results. Successful diagnostic culture wasassessed by the absence of therapeutic failure. Therapeutic failure wasdetermined using 3 parameters that had to be fulfilled, viz. absence of antibioticescalation, repeat operations, and clinical deterioration. The latter parameterwas assessed by clinical judgement of the attending physician.RESULTSAfter controlling for confounding variables (age, severity of infection,comorbidity), there was no statistical difference in therapeutic success betweenculture-based and non-culture based initial antibiotic therapies (OR=0.45,p=0.085).CONCLUSIONThis study demonstrates the ineffectiveness of bacterial culture as a diagnosticcriterion for appropriate antibiotic therapy of complicated skin and soft tissueinfections.
Candidiasis in Malignancy Diany N Taher; Ari Fahrial Syam; Murdani Abdullah; Jumhana Atmakusuma; Khie Chen
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 1, April 2006
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/71200628-31

Abstract

Esophageal candidiasis presents with a range of clinical findings and is rarely found among immunocompetent patient without predisposing factors. Between 20-50% of patient may be asymptomatic. One of predisposing factor of candidiasis is immunocompromised condition due to malignancy. Dysphagia is the most frequently presented feature of esophageal carcinoma. We demonstrated a case of esophageal candidiasis as one of early clinical presentation in patient with esophageal carcinoma. Keywords: esophageal candidiasis, esophageal carcinoma
Approach for Diagnostic and Treatment of Achalasia Andree Kurniawan; Marcellus Simadibrata; Prima Yuriandro; Lie Khie Chen
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 2, August 2013
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (431.146 KB) | DOI: 10.24871/1422013109-116

Abstract

Achalasia is a rare motor disorder of the esophagus and lower esophageal sphincter. The incidence is approximately 1/100,000 per year and the prevalence rate is 10/100,000. Achalasia is quite difficult to establishbecause the symptoms might be insidious and therefore not many people come to seek medical attention until it deteriorates to final stage of the disease. There are several modalities that can be used as diagnostic toolssuch as manometry, barium esophagogram, esophagoduodenoscopy, esophageal CT-scan, until the recent one, high-resolution manometry that can classify achalasia into three different types. The treatment options are the pharmacologic intervention, endoscopic treatment, minimal invasive surgery, and radical surgery.We reported a case of 20 year old female with achalasia who came with dysphagia symptom since three years before. The diagnosis was made by historytaking, physical examination and barium meal and esophagogastroduodenoscopy. The patient underwent pneumatic dilatation and since then the symptom was relieved.Keywords: achalasia, diagnostic, treatment
Nosocomial Clostridium difficile Diarrhea in Patient with Malignancy Andree Kurniawan; Ari Fahrial Syam; Nata Pratama; Resti Mulya Sari; Khie Chen
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 2, August 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (948.419 KB) | DOI: 10.24871/1222011127-132

Abstract

Clostridium difficile (C. difficile) is the main pathogen causing antibiotics associated diarrhea and colitis. This bacterium increases with hospitalization with incidence of 20-60 cases per 100,000 patients/day. C. difficile is gram positive bacilli which produce toxins in 2,700 cases in every 100,000 exposures to particular antibiotics, such as clindamycin, cephalosporin, and ampicillin. These antibiotics disrupt the intestinal normal flora and predispose to colonization of C. difficile. This case described a 53-year old male patient with squamous cell carcinoma in his left ear who came to Department of Internal Medicine, Cipto Mangunkusumo Hospital, with the complain of diarrhea since two weeks after one month hospitalization in Department of Ear, Nose, and Throat. The characteristics of the diarrhea were 10 times per day ± 100 mL, watery consistency, green yellowish in color, and no blood in the feces. Additionally, the patient also complained of pain in all parts of his stomach, especially in the epigastric area. Earlier, patient was given ceftazidime for 30 days of hospitalization. The serology examination of C. difficile in the feces showed positive result (titer = 0.790 and control = 0.190). During the colonoscopy examination, pancolitis was found and the pathologic anatomy result was found appropriate for infective colitis. Thereafter, antibiotic administration was ceased and metronidazole was administered intravenously three times a day. The diarrhea stopped after seven days and the patient was discharged. Keywords: Clostridium difficile, nosocomial diarrhea, malignancy
Antibiotic Associated Diarrhea in Hospitalized Adult Patien Marcellus Simadibrata; Lie Khie Chen; Diana Aulia; Ina Sutanto Timan
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 19, No 1 (2018): VOLUME 19, NUMBER 1, April 2018
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (335.97 KB) | DOI: 10.24871/19120187-9

Abstract

Background: Antibiotic associated diarrhea (AAD) occurs from the first initiation until 2 months of the end of antibiotic treatment. The aims of this study were to know the incidence of AAD, Clostridium difficile infectionand other gastrointestinal symptoms in hospitalized adult patients.Method: The study is a cross sectional study. We studied the antibiotic associated diarrhea (AAD), Clostridiumdifficile infection and other gastrointestinal symptoms in patients who were admited in Cipto Mangunkusumo Hospital. Inclusion were male or female, age 18-75 years old, patients started receiving antibiotics maximal 2x 24 hours prior to hospitalization, gave written informed consent.Results: The incidence of AAD was 11.5%. The incidence of Clostridium difficile infection was 15.4%. The upper gastrointestinal symptom was present on 20 (38.5%) patients. Lower abdominal symptom was present on 10 (19.2%) patients.Conclusion: The Incidence of AAD and Clostridium difficile infection were 11.5% and 15.4% respectively.The clinical manifestations of AAD were diarrhea, other upper and lower abdominal symptoms.
Colonic Tuberculosis: a high Index of Suspicion Wulyo Rajabto; M Usman SM; Khie Chen; Ari F Syam; Murdani Abdullah; Djumhana A; C Martin Rumende
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 6, ISSUE 2, August 2005
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/62200555-59

Abstract

Tuberculosis remains to be one of the most common problems in developing countries such as Indonesia. It can involve many organs including gastrointestinal tract. Colonic tuberculosis is an ancient disease and has long been recognized. However, it is sometimes difficult to make early diagnosis due to nonspecific sign and symptoms. In endemic areas, correct diagnoses were made only 50% of the time. Without a high index of suspicion of the disease, it has been rarely diagnosed correctly. We reported a case of colonic tuberculosis in 18 years old female patient with lung tuberculosis.Endoscopic examination showed ulcerative mucosa, ‘halo lesion’, and pseudopolyp while PPD skin test, sputum smear and histopathological examination of endoscopic biopsy revealed negative for tuberculosis infection. The presence of lung tuberculosis had made high index of suspicion of colonic tuberculosis. Standard regimen of antituberculosis therapy was given and the patient showed good clinical response.   Keywords: high index suspicion, colonic tuberculosis
Profile of Patients Neutropenia Fever Unrelated to Chemotherapy in Dr. Cipto Mangunkusumo General Hospital Danasasmita, Gantira; Chen, Lie Khie; Sinto, Robert; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 4
Publisher : UI Scholars Hub

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Abstract

Introduction. The condition of neutropenia increases the risk of infection. The causes of neutropenia are widely discussed as side effects of chemotherapy, but patients with neutropenia who are not due to side effects of chemotherapy are increasing in number. This study aims to provide an overview of the characteristics of neutropenic fever population unrelated to chemotherapy. Method. The study was conducted retrospectively on the medical records of neutropenic fever patients who were not chemotherapy-related in the National Hospital Dr. Cipto Mangunkusumo in January 2018-November 2019. Variables studied included demographic, clinical characteristics, classification of multinational association of supportive care in cancer (MASCC) scores and their etiology, and mortality outcomes within 5 days of treatment. Results. Total of 68 subjects were included in this study, consist of 50% female and 50% male with median age was 38.5 years (interquartile range 27). Diagnosis data showed that 86.8% subjects were patients with hematological abnormalities, 3 patients had solid tumors (lymphoma, colon cancer and lung cancer), and the rest were non-malignant diseases. Analysis showed that 72.1% onset of fever was found in outpatient care, the rest was inpatient care. The mean value of absolute neutrophil count was 201.50 (SD 173.18), meanwhile the mean MASCC score was 21 (SD 4.54) in the low-risk category. A total of 35 subjects (51.5%) had a MASCC low risk score and 33 subjects (48.5%) had a high risk. The median procalcitonin subject was 1.99 ng / mL (range 0.11 - 178.30). The 5-days mortality incidence was 54.4%. Chi-square analysis of the two groups found significant differences in care mortality (p <0.05). Analysis with Independent T-test also showed a significant differences in the parameters of age and systolic blood pressure values between the high risk and low risk groups. Conclusions. The majority etiologies among subjects were haematological disorders. Based on the MASCC score, most of the subjects were in the high-risk group. Total of mortality incidence was 54.4%.
The Difference of C-Reactive Protein Levels in Acute Fever causedby Dengue and Typhoid Infections Idhayu, Adeputri Tanesha; Chen, Lie Khie; Suhendro, Suhendro
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 3
Publisher : UI Scholars Hub

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Abstract

Introduction. Dengue infection and typhoid fever are endemic disease in Indonesia. But in the early days of onset sometimes it is difficult to distinguish them. A simple modality test is needed to support the diagnosis. C-Reactive Protein (CRP) is an affordable, fast and relatively less expensive diagnostic tool to diagnose the causes of acute fever. This study was aimed to determine the differences of CRP level in the acute febrile caused by dengue infection or typhoid fever. Methods. A cross sectional study has been conducted among acute febrile patients with diagnosis of dengue fever/ dengue hemorrhagic fever or typhoid fever who admitted to the emergency room or hospitalized in Cipto Mangunkusumo Hospital, Pluit Hospital, and Metropolitan Medical Center Hospital Jakarta between January 2010 and December 2013. Data obtained from medical records. CRP used in this study was examined at 2-5 days after onset of fever. The other collected data were demographic data, clinical data, use of antibiotics, leukocytes, platelets, neutrophils, ESR, and length of stay in hospital. Results. 188 subjects met the inclusion criteria; 102 patients with dengue and 86 patients with typhoid fever. Median CRP levels in dengue infection was 11.65 (16) mg/L and in typhoid fever was 53 (75) mg/L. There were significant differences in median CRP levels between dengue infection and typhoid fever (p < 0.001). At the 99% percentile cut-off point, CRP levels for dengue infection was 45.91 mg/L and CRP levels for typhoid fever at 1% percentile was 8 mg / L. Conclusions. There was significantly different levels of CRP in acute fever due to dengue infection and typhoid fever. At the 99% percentile cut-off point, CRP level >45.91 mg/L was diagnostic for typhoid fever, CRP level /L was diagnostic for dengue infection. CRP level between 8 to 45.91 mg/L was a gray area for determinating diagnosis of dengue infection and typhoid fever.
The Role of Lactate Clearance in Severe Septic Patients Survival Hambali, Wirawan; Chen, Lie Khie; Widodo, Djoko; Dewiasty, Esthika; Pohan, Herdiman T.; Suhendro, Suhendro
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 1
Publisher : UI Scholars Hub

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Abstract

Introduction. Severe Sepsis is a major health problem that known to results high mortality rate, and still its incidents continue to rise. Lactate clearance represents kinetics alteration of anaerobic metabolism in severe septic patients that makes it to become a potential parameter to evaluate severity of one’s illness and intervention adequacy that received by the patient. However, the relationship between lactate clearance and occurrence of death in severe septic patients is still unknown. Methods. This is a prospective cohort study that conducted in Ciptomangunkusumo Hospital, from March to May 2011. Patients were categorized into high lactate clearance group if there were differences in lactate levels ≥ 10% in which occurred within the first 6 hours of the treatment, and contrary were categorized into low lactate clearance group. Occurrences of death were observed within the first 10 days. Afterward, the data were analyzed by means of survival analysis, Kapplan Meier curve were made, survival rate and median survival rate were determined, statistical test were calculated using log-rank test, and hazard ratios were calculated using Cox regression model test. Analysis of Confounder Variable was also performed using multivariate Cox regression test. Results. The survival rate for high and low lactate clearance group were 60.0% vs. 26.7%, respectively (p=0,004). In low lactate clearance group the median survival was 3 days, while the mortality rate did not reach 50% in high lactate clearance group. The first Interquartile for these two groups was 1 day and 4 days, respectively. The hazard ratio that obtained from the analysis was 2.87 (95% CI, 1.41 - 5.83). On multivariate analysis the presence of septic shock, SOFA score, the use of vasopresor/inotropic, blood transfusion, fluid resuscitation didn’t change the hazard ratio value more than 10%. For that reason, these parameters were not considered as confounder. Conclusions. Patients with high lactate clearance have a better survival rate compared to patients with low lactate clearance, and its relationship is not influenced by confounder.
Association between Early Antibiotic Administration and In-Hospital Mortality in Moderate and Severe COVID-19 Patients Chen, Lie Khie; Nathanael, Jason; Shakinah, Sharifah; Pasaribu, Adeline; Sinto, Robert; Nainggolan, Leonard; Susilo, Adityo
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 4
Publisher : UI Scholars Hub

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Abstract

Introduction. Patients with moderate and severe COVID-19 generally receive antibiotic therapy with consideration of the possibility of co-infection or secondary bacterial infection which clinically is difficult to distinguish from COVID-19 symptoms. Overuse of antibiotics can lead to an increased risk of bacterial resistance to antibiotics which is associated with poor outcomes in COVID-19 patients. This study aimed to assess the effect of early antibiotic administration on mortality in moderate and severe COVID-19 patients. Methods. An observational study with a retrospective cohort design was conducted at Dr. Cipto Mangunkusumo Hospital. Data were obtained from medical records of patients admitted from March to September 2020. Patients who received early antibiotics were defined as patients who received antibiotics hospital, 108 subjects were included in this study, 74 (68.5%) with moderate degrees and 34 (31.5%) with severe degrees. Early antibiotics were administered to 79 (73.1%) subjects with a median start time of one day. The results of the bivariate analysis did not find a significant effect of early antibiotic administration on mortality in moderate or severe COVID-19 patients (p=0.42). Subgroup analysis based on the degree of disease also found no significant results. Conclusion. There is no relationship between early antibiotic administration and mortality of moderate and severe COVID-19 patients.
Co-Authors A.A. Ketut Agung Cahyawan W Adeputri Tanesha Idhayu Adeputri Tanesha Idhayu Adityo Susilo, Adityo Alvina Widhani, Alvina Andree Kurniawan Anis Karuniawati Anna Ariane, Anna Annisa, Firda Ari F Syam Ari Fahrial Syam Artati Murwaningrum, Artati Bramantya Wicaksana C Martin Rumende C Martin Rumende C. Martin Rumende, C. Martin Ceva W. Pitoyo Cleopas Martin Rumende Cleopas Martin Rumende Cleopas Martin Rumende Cleopas Martin Rumende Cleopas Martin Rumende Cynthia Olivia Maurine Jasirwan Dana Dharaniyadewi Dana Dharaniyadewi, Dana Danasasmita, Gantira Diana Aulia Diana Aulia Diany N Taher Djoko Widodo Djumhana A Edwin Wijaya Edwin Wijaya, Edwin Erni J Nelwan, Erni J Erni Juwita Nelwan, Erni Juwita Erwin Christian Susanto Esthika Dewiasty Esthika Dewiasty, Esthika Evy Yunihastuti Falasiva, Rezyta Firda Annisa Gantira Wijayakusumah Danasasmita Gurmeet Singh Gurmeet Singh Herdiman T Pohan Herdiman T Pohan Herdiman T. Pohan Herikurniawan Herikurniawan Herikurniawan, Herikurniawan Ina Sutanto Timan Inge Sutanto Jasirwan, Chyntia OM Joko Widodo Joyce Bratanata Joyce Bratanata, Joyce Jumhana Atmakusuma Kemal Fariz Kalista, Kemal Fariz Leonard Nainggolan M Usman SM Maksum, Maradewi Maradewi Maksum Marcellus Simadibrata Marcellus Simadibrata Mira Yulianti Mira Yulianti, Mira Mohammad, Nurhidayat Murdani Abdullah Murdani Abdullah Murdani Abdullah Murdani Abdullah Muzellina, Virly Nanda Nata Pratama Nathanael, Jason Nully Juariah M Pasaribu, Adeline Prima Yuriandro Pringgodigdo Nugroho, Pringgodigdo Resti Mulya Sari Retno Wahyuningsih Retno Wahyuningsih Rezyta Falasiva Robert Sinto Robert Sinto Robert Sinto Ronald Irwanto Rumondor, Bayu B Shakinah, Sharifah Sitorus, Truly Panca Soroy Lardo Suhendro Suhendro Suhendro Suhendro Suhendro Suhendro Suhendro Suhendro Suhendro Suwarto Suhendro Suwarto, Suhendro Susanto, Erwin Christian Telly Kamelia Timan, Ina Sutanto Tonny Loho Truely Panca Sitorus Vera Yuwono Wicaksana, Bramantya Widayat Djoko Santoso Widayat Djoko Santoso Widayat Djoko Santoso, Widayat Djoko Wirawan Hambali Wirawan Hambali, Wirawan Wulyo Rajabto