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All Journal Medula Juke Qanun Medika - Medical Journal Faculty of Medicine Muhammadiyah Surabaya Jurnal Ilmu Kedokteran dan Kesehatan JURNAL PENELITIAN PERAWAT PROFESIONAL JK Unila (Jurnal Kedokteran Universitas Lampung) Jurnal Kesehatan Tambusai Anoa : Jurnal Pengabdian Masyarakat Sosial, Politik, Budaya, Hukum. Ekonomi Majority JIMKI: Jurnal Ilmiah Mahasiswa Kedokteran Indonesia JPM (Jurnal Pengabdian Masyarakat) Ruwa Jurai Jurnal Agromedicine Unila: Jurnal Kesehatan dan Agromedicine
Iswandi Darwis
Faculty Of Medicine, Universitas Lampung, Bandar Lampung
Agriculture, Biological Sciences & Forestry Humanities Biochemistry, Genetics & Molecular Biology Dentistry Economics, Econometrics & Finance Education Environmental Science Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences Veterinary

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PERBANDINGAN EFIKASI, KEAMANAN, DAN EFISIENSI PULSED FIELD ABLATION (PFA) DAN THERMAL ABLATION PADA PASIEN FIBRILASI ATRIUM : TINJAUAN LITERATUR Hafizh, Ahmad Fauzan; Darwis, Iswandi; Febriani, Wiwi; Saragih, Pieter
Jurnal Kesehatan Tambusai Vol. 6 No. 4 (2025): DESEMBER 2025
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jkt.v6i4.51876

Abstract

Fibrilasi atrium (Atrial Fibrillation, AF) merupakan aritmia supraventrikular yang paling umum ditemui dalam praktik klinis dan memiliki risiko komplikasi serius seperti stroke dan gagal jantung. Terapi ablasi kateter telah menjadi pendekatan utama untuk kontrol irama pada pasien dengan AF yang tidak respons terhadap terapi farmakologis. Ablasi termal konvensional, seperti radiofrequency ablation (RFA) dan cryoballoon ablation (CBA), telah digunakan secara luas namun memiliki keterbatasan terkait risiko cedera pada struktur nontarget. Pulsed field ablation (PFA) hadir sebagai teknologi baru dengan profil keamanan yang lebih baik berkat mekanisme nontermal nya. Tinjauan literatur ini bertujuan untuk membandingkan efikasi, keamanan, dan efisiensi PFA dengan ablasi termal berdasarkan data dari studi klinis yang relevan. Tinjauan literatur ini menggunakan metode narrative review dengan meninjau studi dari hasil penelusuran pada 3 database utama yaitu PubMed, ScienceDirect, dan MDPI dengan rentang studi 5 tahun terakhir. Berdasarkan hasil penelusuran, didapatkan 5 artikel yang relevan. Hasil studi menunjukkan bahwa PFA noninferior dibandingkan ablasi termal dalam hal keberhasilan mempertahankan irama sinus jangka panjang, dan dalam beberapa studi menunjukkan hasil yang superior. PFA juga menunjukkan keunggulan dalam efisiensi prosedur dan profil keamanan, khususnya dalam menurunkan komplikasi neurologis dan kerusakan struktur sekitar atrium. Meskipun demikian, data jangka panjang dan studi dari populasi negara berkembang masih terbatas. Oleh karena itu, diperlukan penelitian lebih lanjut untuk mengevaluasi manfaat jangka panjang dan implementasi PFA secara lebih luas di berbagai sistem layanan kesehatan.
Dampak Konsumsi Pemanis Buatan terhadap Profil Glukosa dan Risiko Diabetes Mellitus: Tinjauan Pustaka Prameswari, Putu Arya Indira; Darwis, Iswandi; Graharti, Risti
Medula Vol 16 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i1.1740

Abstract

Diabetes Mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia resulting from impaired glucose regulation, and its global prevalence continues to rise substantially. Effective management of DM requires an integrated approach involving pharmacological therapy, lifestyle modification, and appropriate dietary strategies, including carbohydrate regulation, consumption of low–glycemic index foods, and restriction of added sugars. Artificial sweeteners such as aspartame, sucralose, saccharin, and stevia are widely utilized as low-calorie sugar substitutes because they provide sweetness without elevating blood glucose levels. Nevertheless, accumulating evidence indicates that the metabolic effects of artificial sweeteners are heterogeneous and depend on the specific compound as well as the physiological condition of the consumer. Experimental studies have shown that stevia and nano-stevia can reduce hyperglycemia in diabetic rat models, while the Rebaudioside M (Reb M) form of stevia has been reported to enhance insulin sensitivity and attenuate weight gain in obese rats. In contrast, intake of sucralose and acesulfame-K at Acceptable Daily Intake levels has been associated with increased subcutaneous and perirenal adipose tissue accumulation, along with vascular endothelial dysfunction in Wistar rats, suggesting a potential elevation in cardiometabolic risk. Saccharin has similarly been shown to disrupt glucose homeostasis and decrease GLP-1 secretion in animal models, independent of insulin release. Human studies yield more variable outcomes. Most individuals with type 2 diabetes exhibit no significant changes in body weight or glycemic control following artificial sweetener consumption, although more than half report gastrointestinal disturbances such as bloating and diarrhea. These divergent findings underscore that each artificial sweetener possesses a distinct metabolic profile; therefore, their use should be tailored to individual needs, particularly among populations with heightened metabolic vulnerability, including patients with diabetes.
PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY IN CHRONIC KIDNEY DISEASE PATIENTS WITH CENTRAL VEIN STENOSIS POST HEMODIALYSIS CATHETER IMPLANTATION darwis, iswandi; hariawan, hariadi; ismail, muhammad taufik
Jurnal Kedokteran Universitas Lampung Vol. 9 No. 2 (2025): JK Unila
Publisher : Fakultas Kedokteran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23960/jkunila.v9i2.pp334-346

Abstract

Background. The use of central venous catheters as temporary vascular access is found in 20% of CKD patients undergoing routine hemodialysis. Apart from having benefits, the use of a central venous catheter also has risks. One of the complications of using a central venous catheter is central venous stenosis. Central vein stenosis is associated with the placement of a subclavian catheter as a hemodialysis access. Case Report. Three cases of central venous stenosis after placement of a hemodialysis catheter in the subclavian vein were reported. Complaints of swelling on the side where the hemodialysis catheter is inserted are felt 1-2 months after removing the hemodialysis catheter. Apart from that, a complaint that often arises is that there are obstacles to the flow during the hemodialysis process. The subclavian vein is a common site for hemodialysis catheter implantation, but the incidence of central vein stenosis is consistent with these three patient cases. Doppler ultrasonography is the initial examination and is important for detecting central vein stenosis even though it cannot make a definitive diagnosis. Venography and Digital Subtraction Angiography examinations are the gold standard examinations for confirming central vein stenosis. These three patients were found to have stenosis and total occlusion of the central vein. The patient underwent percutaneous transluminal angioplasty but the vein patency was still low so a stent was placed. To prevent intrastent stenosis, antiplatelets are given for life. The patient underwent an evaluation after stent installation and found clinical improvement in the form of reduced swelling. Conclusion. Central venous stenosis that occurs in patients with chronic kidney disease due to complications after installing temporary access for hemodialysis using a central venous catheter is effective for percutaneous transluminal angioplasty and stent installation.
Efektivitas Terapi Kombinasi Obat pada Pasien Penyakit Jantung Koroner RSUD Dr. H. Abdul Moeloek Provinsi Lampung 2024 Putra, Pandya Fisatama; Asep Sukohar; Linda Septiani; Iswandi Darwis
JIMKI: Jurnal Ilmiah Mahasiswa Kedokteran Indonesia Vol 12 No 3 (2026): JIMKI: Jurnal Ilmiah Mahasiswa Kedokteran Indonesia Vol. 12.3 (2026) : Article i
Publisher : BAPIN-ISMKI (Badan Analisis Pengembangan Ilmiah Nasional - Ikatan Senat Mahasiswa Kedokteran Indonesia)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53366/jimki.v12i3.1067

Abstract

Pendahuluan : Penyakit jantung koroner (PJK) tetap menjadi penyebab kematian utama di dunia dan sering berhubungan dengan hipertensi serta gangguan lipid. Pada tahun 2021, PJK diperkirakan menyebabkan 20,5 juta kematian, hampir sepanjang keseluruhan global. Penelitian ini menunjukkan efektivitas berbagai kombinasi obat dalam menurunkan tekanan darah, Kolesterol total, dan kadar LDL ( Low-Density Lipoprotein ). Metode : Penelitian ini merupakan jenis penelitian deskriptif dengan desain cross-sectional yang melibatkan 34 pasien PJK yang dipilih melalui teknik total sampling. Data diperoleh dari rekam medis pasien yang menerima terapi kombinasi di RSUD Dr. H. Abdul Moeloek Provinsi Lampung pada periode September hingga Desember 2024. Data hasil penelitian di cluster menjadi 12 kombinasi obat. Hasil : Dua belas kombinasi obat (Kombinasi I–XII) diidentifikasi dalam penelitian ini. Kombinasi I (klopidogrel, ISDN, aspirin, bisoprolol, atorvastatin) merupakan regimen yang paling sering diresepkan (29,4%) dan menghasilkan penurunan tekanan darah terbesar (26,5%). Penurunan kolesterol total tercatat pada 14,7% pasien, dengan efektivitas tertinggi pada Kombinasi IX (klopidogrel, ISDN, ramipril, bisoprolol, simvastatin). Perbaikan LDL terjadi pada 23,5% pasien, dan Kombinasi IX kembali menunjukkan efek paling kuat. Pembahasan : Terapi kombinasi memberikan pengaruh lebih besar terhadap penurunan tekanan darah dibandingkan perbaikan profil lipid, sehingga pemilihan regimen perlu disesuaikan dengan target klinis pasien. Simpulan : Terapi kombinasi lebih efektif dalam menurunkan tekanan darah, dengan Kombinasi I memberikan hasil terbaik, sedangkan Kombinasi IX paling efektif dalam memperbaiki kolesterol total dan LDL.
Analisis Kadar Ureum Pra-Hemodialisis dan Mortalitas pada Pasien Penyakit Ginjal Kronis Stadium 5 di RSUD Dr. H. Abdul Moeloek Bandar Lampung Niswah, Vira Kamalia; Yonata, Ade; Komala, Ramadhana; Darwis, Iswandi
JIMKI: Jurnal Ilmiah Mahasiswa Kedokteran Indonesia Vol 12 No 3 (2026): JIMKI: Jurnal Ilmiah Mahasiswa Kedokteran Indonesia Vol. 12.3 (2026) : Article i
Publisher : BAPIN-ISMKI (Badan Analisis Pengembangan Ilmiah Nasional - Ikatan Senat Mahasiswa Kedokteran Indonesia)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53366/jimki.v12i3.1034

Abstract

Background: Chronic kidney disease (CKD) stage 5 is the final phase that requires patients to undergo hemodialysis as the main treatment. Monitoring blood urea levels before hemodialysis is an important aspect because these values can reflect the risk of death in patients. Based on this, the study aims to examine the relationship between pre-hemodialysis urea levels and mortality rates in CKD stage 5 patients at Dr. H. Abdul Moeloek Regional General Hospital in Lampung Province. Method: This study applied a quantitative observational design with a retrospective cohort approach. The data analyzed were obtained from secondary sources, namely, medical records of patients diagnosed with stage 5 CKD. The sample included 150 patients who received hemodialysis in 2023–2024, selected through consecutive sampling. Data were analyzed univariately; normality was assessed using the Shapiro-Wilk test, and bivariate analysis was conducted using the Mann-Whitney Test. Results: The mean pre-hemodialysis urea level in deceased patients was higher than in discharged patients. The Mann-Whitney test showed a significant difference in urea levels between the two groups (p=0.0001), indicating a relationship between pre-hemodialysis urea levels and patient mortality. Discussion: The findings suggest that pre-hemodialysis urea levels can serve as an indicator of mortality risk in patients with stage 5 CKD. Patients with higher urea levels tend to have a greater risk of death. Conclusion: There is a significant correlation between pre-hemodialysis urea levels and mortality in patients with stage 5 CKD. Patients with higher urea levels have a higher risk of death.
Co-Authors Ade Yonata, Ade Agustyas Tjiptaningrum Akbar, Dafa Rafiqi Aldi Setia Aminuyati Angelia, Tisa Anggoro Budi Hartapo Anggoro Budi Hartopo Asep Sukohar Assidiq, Hans Pratama Ayu Agustira Ayu Dinda Fatimah Buana, Faris Agung Dian Isti Angraini Evingelinda, Shania Fayola, Diva Fitria Saftarina Gultom, Dea Debora Romauli Gusti Ngurah P Pradnya Wisnu Hadibrata, Exsa Hafizh, Ahmad Fauzan Hariadi Hariawan Hartapo, Anggoro Budi Hendra Tarigan Sibero Hendri Busman Indri Windarti Intanri Kurniati Ismail, Muhammad Taufik Janar Wulan, Anggraeni Jausal, Anisa Nuraisa Khairun Nisa Linda Septiani Lusina, Septia Eva Marcellia, Selvi Marzel, Rivaldi Muhammad Gahan Sarwiko Muhammad Gahan Sarwiko Muhammad Maulana Muhammad Ricky Ramadhian Natasya Hayatillah Neema Putri Prameswari Niswah, Vira Kamalia Prameswari, Putu Arya Indira Probosuseno Probosuseno Prof. Sutyarso Purnama, Dara Marissa Widya Putra, Pandya Fisatama Putu Ristyaning Ayu Rahmayani, Fidha Ramadhan, Rifqi Ihza Ramadhana Komala Ratna, Maya Ganda Reni Zuraida Risal Wintoko Risti Graharti Rizka Humardewayanti Asdie Roro Rukmi Windi Perdani, Roro Rukmi Saragih, Pieter Sarwiko, Muhammad Gahan Sekar Mentari Sharlene Sabrina Sudarmanto, Syifa Hasna Susianti, Susianti Suwaib Amiruddin Wiwi Febriani