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All Journal Universa Medicina Paediatrica Indonesiana Narra J Indonesian Journal of Cancer eJournal Kedokteran Indonesia The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia
Kuntjoro Harimurti
DIvisi Geriatri, Kelompok Staf Medis Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia - RSUPN Dr Cipto Mangunkusumo
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Serum lactate as predictor and diagnostic biomarker of plasma leakage in adult dengue patients Bur, Rika; Suwarto, Suhendro; Santoso, Widayat Djoko; Harimurti, Kuntjoro
Universa Medicina Vol 35, No 3 (2016)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2016.v35.213-221

Abstract

Background Dengue fever (DF) and dengue hemorrhagic fever (DHF) are differentiated by the occurrence in DHF of plasma leakage into the interstitial space as shown by pleural and peritoneal effusion, hemoconcentration, and intravascular hypovolemia. Perfusion dysfunction causes anaerobic metabolism, which leads to increased serum lactate. This study was to determine serum lactate as prognostic predictor and diagnostic biomarker of plasma leakage in adult dengue patients.Methods A cross-sectional retrospective cohort study was conducted on 57 adult dengue patients hospitalized in the internal medicine ward of Cipto Mangunkusumo Hospital and Persahabatan Hospital in Jakarta. Serum lactate was examined to determine its mean difference between DF and DHF. The data was analyzed by independent t-test and the cut-off points were identified for presence as well as absence of plasma leakage, then the receiver operating characteristics (ROC) curve was used to determine sensitivity and specificity.Results Mean serum lactate was significantly higher in DHF than in DF. From the ROC curve, the cut-off point for serum lactate as prognostic predictor on day 3 of fever was ³2.65 mmol/L with AUC of 0.626 (95% CI 0.480-0.772; p=0.108). The cut-off point for diagnostic biomarker of plasma leakage on day 5 of fever was 2.55 mmol/L with sensitivity 66.6%, specificity 54.2%, and AUC 0.668 (95% CI 0.550-0.826; p=0.016).Conclusion There was a significant difference in serum lactate between DF and DHF. In the critical phase, serum lactate of 2.55 mmol/L could be used as plasma leakage diagnostic marker of low accuracy.
Factors Associated with Surveillance for Early Detection of Hepatocellular Carcinoma in Liver Cirrhosis Patients Ario Perbowo Putra; Andri Sanityoso Sulaiman; Juferdy Kurniawan; Kuntjoro Harimurti
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 3 (2017): VOLUME 18, NUMBER 3, DECEMBER 2017
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (167.745 KB) | DOI: 10.24871/1832017153-158

Abstract

Background: Minimal number of KHS patients diagnosed through surveillance is thought to be the cause of continued low survival. It is important knowing the proportion of surveillance for early detection of KHS in patients with liver cirrhosis and related factors.Objective: Determine the proportion of surveillance for early detection of KHS in patients with liver cirrhosis and related factors.Method: Cross-sectional study of patients with liver cirrhosis at RSCM from January to December 2013. Data obtained from medical records and reconfirmed by telephone. Surveillance is required for abdominal ultrasound with or without AFP at least once a year within 3 years after that period. Factors studied were gender, ethnicity, education level, income level, availability of medical assurance, location of residence, surveillance education, cirrhosis etiology, and severity of cirrhosis. Then logistic regression test is used in the multivariate analysis.Results: From 200 patients, 50 patients (25,0%) underwent surveillance, 150 patients (75,0%) did not. Bivariate analysis resulted in 4 variables with p 0.25, gender (p = 0,056), ethnicity (p = 0, 231), surveillance education (p = 0,005), and severity of cirrhosis (p = 0, 005). Multivariate analysis resulted risk factors for surveillance were surveillance education (OR = 2,598; CI 95% (1,325 - 5,094), p = 0,005) and severity of cirrhosis (OR = 1.815; CI 95% = 1,210-2,724; p = 0,004).Conclusion: Surveillance education and severity of cirrhosis are factors associated with surveillance for early detection of KHS in liver cirrhosis patients.
Papilla Vaterƒs Tumor in Elderly: an Interdisciplinary Issue Eric Daniel Tenda; Murdani Abdullah; Kuntjoro Harimurti; Edy Rizal Wahyudi; Czeresna Heriawan Soejono
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 3, December 2010
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/1132010155-159

Abstract

Tumors of the papilla Vater are very rare. Papilla Vater’s tumors are benign or malignant tumors in the ampulla of Vater and periampullary region. Blockage of ampulla leads to the development of obstructive jaundice; intermittent cholangitis, epigastric discomfort and weight loss. Treatment possibilities include endoscopic ampulectomy, surgical transduodenal excision of tumors of the ampulla and pancreatoduodenectomy (PDE). Prognosis depends on histological typing of the tumor and their clinical stage. We report a case of papilla Vater’s tumor in elderly with comorbidities based on literature review. A 68-year-old female patient was referred for evaluation of intra and extra hepatic bile duct dilatation noted on abdominal ultrasonography. She complained of intermittent epigastric and right upper abdominal pain, with yellowish skin for two months. The laboratory findings showed leukocytosis, hyperbilirubinemia, abnormal liver function test, and high Ca 19-9. An endoscopic retrograde cholangiopancreatography (ERCP) revealed a distal obstruction caused by papilla Vater’s tumor. Abdominal computed tomography (CT) with contrast, revealed a dilated common bile duct and pancreatic duct. The histologic evaluation was highly suggestive for dysplasia. She is now on a schedule for a Whipple procedure. To make a true diagnosis and optimal treatment of papilla Vater’s tumor is multimodal. By doing a comprehensive geriatric assessment, with a careful modality selection, a Whipple procedure can be performed in elderly (65 years) safely. The post operative morbidity and mortality depends on their multi morbidity. Surgical, endoscopic, or radiologic biliary decompression; relief of gastric outlet obstruction; and adequate pain control may improve the quality of life but do not affect overall survival rate. By building a great interdisciplinary teamwork, the quality of life increased as follows.Keywords: papilla Vater tumor, elderly, Whipple procedure
CD4+ and CD8+ Counts in Liver and Their Correlation with Necroinflammatory and Fibrosis Grades in Chronic Hepatitis C Chyntia Olivia Maurine; Rino Alvani Gani; Ening Krisnuhoni; Kuntjoro Harimurti
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 3, Desember 2012
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (364.96 KB) | DOI: 10.24871/1332012145-150

Abstract

ABSTRACTBackground: Studies on the characteristics CD4+ and CD8+ in hepatitis C and their correlation with the severity of the disease have been rarely conducted. This study was aimed to obtain the mean difference between CD4+ and CD8+ count in liver to evaluate their correlation with fibrosis and necroinflammatory grades in chronic hepatitis C. Method: A cross-sectional study was conducted between March and July 2010 with 30 liver biopsies obtained from patients with non-B and non-HIV chronic hepatitis C who visited the Outpatient Clinic of Hepatology Unit at Cipto Mangunkusumo Hospital in January 2008–February 2010. Fibrosis and necroinflammatory grades were determined using METAVIR methods on liver biopsies. The mean values of CD4+ and CD8+ in portal tracts and hepatic lobules in liver biopsy specimens were evaluated. Statistical analysis was performed by using independent T-test and Spearman test. Results: There was a difference in mean CD4+ counts between portal tracts and the lobules (95% CI = 4.3-17.9; p = 0.002) and also differences in mean CD8+ counts in portal tracts and hepatic lobules (95% CI = 15.4-35.6; p 0.001). There was no correlation between CD4+ and CD8+ counts, either in portal tracts or the lobules, and inflammatory grades as well as the liver fibrosis. Conclusion: CD4+ and CD8+ counts are greater in portal area compared to the hepatic lobules, with greater CD8+ counts than CD4+. However, both CD4+ and CD8+ counts are not correlated to the severity of liver damage.  Keywords: CD4+, CD8+, intrahepatic, chronic hepatitis C, METAVIR
Prediction Model of 30-Day Mortality in Elderly Patients Admitted to Geriatric Acute Ward Using Comprehensive Geriatric Assessment Domain Dwimartutie, Noto; Setiati, Slti; Wahyudi, Edy Rizal; Harimurti, Kuntjoro
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 2
Publisher : UI Scholars Hub

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Abstract

The Role of Clinical Sign and The Added Value of Procalcitonin in Determining The Existance of Infection in The Treated Diabetic Foot Ulcer Aswar, Andra; Yunir, Em; Karuniawati, Anis; Harimurti, Kuntjoro
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 2
Publisher : UI Scholars Hub

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Factors Related to Diagnosis of Community-Acquired Pneumonia in the Elderly Sari, Elza Febria; Rumende, C. Martin; Harimurti, Kuntjoro
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 4
Publisher : UI Scholars Hub

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Introduction. Diagnosing community-acquired pneumonia (CAP) in the elderly remains a clinical challenge for various reasons. The clinical manifestation in the elderly is not frank and atypical manifestations, e.g. falls, decrease of functional status and food intake or urinary incontinence, may be present. These reasons may be associated with under or over diagnosis, which consequently contribute to the higher observed mortality rate in the elderly population with CAP. Study about factors related to diagnosis of CAP in the elderly was ra rely performed. Methods. From January to October 2010, 158 elderly patients suspected of having pneumonia at RSCM were registered. Relationship between clinical, laboratory and radiologic factors which consist of classic manifestations (cough, productive cough, dyspnea, fever, rales, leucocytosis, infiltrates) and atypical manifestations (decrease of intake and functional status, falls, urinary incontinence) with diagnosis community acquired pneumonia were analyzed. Receiver operating characteristics analysis of C-reactive protein was performed to find its association with diagnosis of pneumonia. Results. Of 158 subject, 106 were confirmed of having pneumonia. Final model of multiple logistics regression analysis revealed three factors: cough (p Conclusions. Factors related with diagnosis of community-acquired penumoni in the elderly are cough, rhales and infiltrates. All four atypical manifestations are proven unrelated with diagnosis of pneumonia. C-reactive protein does not predict diagnosis of CAP in the eldery.
Hipoalbuminemia pada Pasien Usia Lanjut dengan Pneumonia Komunitas: Prevalensi dan Pengaruhnya Terhadap Kesintasan Kurniawan, Wawan; Rumende, C. Martin; Harimurti, Kuntjoro
Jurnal Penyakit Dalam Indonesia Vol. 1, No. 2
Publisher : UI Scholars Hub

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Abstract

Pendahuluan. Hipoalbuminemia merupakan salah satu penanda risiko mortalitas, tetapi belum banyak yang mempertimbangkan faktor waktu (seberapa cepat terjadinya mortalitas). Penelitian ini mengevaluasi pengaruh hipoalbuminemia terhadap kecepatan terjadinya mortalitas pada pasien usia lanjut dengan pneumonia komunitas. Penelitian ini bertujuan untuk mengetahui prevalensi hipoalbuminemia dan pengaruhnya terhadap kesintasan pasien usia lanjut yang dirawat dengan pneumonia komunitas. Metode. Penelitian dengan disain kohort retrospektif dilakukan terhadap 142 pasien usia lanjut dengan pneumonia komunitas yang dirawat di RSCM pada kurun waktu Januari-Oktober 2010. Data klinis dan laboratoris diambil dalam 24 jam pertama kedatangan (data sekunder) dan kemudian diikuti dalam 30 hari untuk melihat status mortalitasnya. Perbedaan kesintasan hipoalbuminemia ditampilkan dalam kurva Kaplan Meier dan perbedaan kesintasan diantara dua atau lebih kelompok akan diuji dengan Log-rank test, dengan batas kemaknaan Hasil. Prevalensi hipoalbuminemia pada pasien usila dengan pneumonia komunitas sebesar 71,1% (IK95% 0,64-0,78). Rerata kesintasan pada kelompok dengan kadar albumin normal adalah 27 hari (IK95% 24,35-30,98), sedangkan pada kelompok albumin 2,5-3,4 g/dL rerata kesintasannya adalah 22 hari (IK95% 19,66-25,13) dan pada kelompok albumin kurang dari 2,5 g/dL rerata kesintasannya adalah 19 hari (IK95% 13,07-26,23). Crude hazard ratio (HR) pasien dengan kadar albumin antara 2,5-3,4 g/dL adalah 4,49 (IK95% 1,05-19,20) dan pada pasien dengan kadar albumin kurang dari 2,5 g/dL adalah 7,26 (IK95% 1,46-36,09) bila dibandingkan dengan pasien dengan kadar albumin normal (≥3,5 g/dL). Setelah penambahan variabel perancu, didapatkan fully adjusted hazard ratio sebesar 3,81 (IK95% 0,86-16,95) untuk kelompok albumin antara 2,5-3,4 g/dL dan 11,09 (IK95% 1,79-68,65) untuk kelompok albumin kurang dari 2,5 g/dL. Simpulan. Prevalensi hipoalbuminemia pada usia lanjut dengan pneumonia komunitas adalah 71,1%. Terdapat perbedaan kesintasan 30 hari pasien pneumonia usia lanjut yang mengalami hipoalbuminemia dibanding dengan yang normoalbuminemia (≥3,5 g/dL). Kesintasan pada pasien dengan keadaan hipoalbuminemia yang berat lebih buruk dibandingkan pada keadaan hipoalbuminemia ringan.
Peranan Gejala Klinis dan Pemeriksaan Darah Tepi dalam Diagnosis Dini Influenza pada Pasien dengan Gejala Influenza Like Illness Susilo, Adityo; Suwarto, Suhendro; Rengganis, Iris; Harimurti, Kuntjoro
Jurnal Penyakit Dalam Indonesia Vol. 1, No. 2
Publisher : UI Scholars Hub

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Pendahuluan. Influenza merupakan penyakit infeksi yang disebabkan oleh virus influenza. Pada manusia, influenza sering menimbulkan penyakit pernapasan akut dengan manifestasi klinis berupa influenza like illness. Penegakkan diagnosis influenza seringkali sulit oleh karena manifestasi klinis yang tidak khas. Demam disebut sebagai gejala klinis terpenting dan limfopenia didapatkan sebagai suatu temuan laboratoris yang konsisten. Usaha untuk mengetahui proporsi dan mengelaborasi gejala klinis dan pemeriksaan darah tepi sederhana diperkirakan dapat meningkatkan probabilitas diagnosis influenza. Tujuan. Mengetahui proporsi influenza serta mengevaluasi peranan gejala klinis dan pemeriksaan laboratorium sederhana pada pasien penyakit pernapasan akut dengan influenza like illness sehingga dapat digunakan sebagai faktor prediktif terhadap diagnosis influenza. Metode. Studi potong lintang berbasis diagnostic research pada pasien penyakit pernapasan akut dewasa dengan gejala influenza like illness di Puskesmas Kecamatan Pulo Gadung dan Puskesmas Kelurahan Rawamangun antara Maret hingga Juni 2011. Spesimen analisis virus menggunakan bahan apus nasofaringeal, dengan teknik analisis PCR kualitatif dan imunokromatografi antigen. Hasil. Dari 90 orang subyek penelitian didapatkan 13 orang (14,4%) terbukti terinfeksi virus influenza A melalui teknik PCR. Variabel demam menunjukkan hasil uji kemaknaan yang signifikan terhadap influenza (p 0,003) dengan prevalence ratio 6,28 (95% CI 1,476-26,759). Sensitifitas demam, batuk dan pilek terhadap influenza masing-masing adalah 85% dan negative predictive value demam sebesar 98%. Variabel determinan lainnya tidak menunjukkan hasil yang bermakna terhadap influenza pada uji kemaknaan statistik. Simpulan. Proporsi influenza pada pasien dengan gejala ILI diperoleh cukup tinggi dengan proporsi demam yang terbukti lebih tinggi pada pasien influenza. Sensitivitas demam, batuk dan pilek terhadap influenza tinggi dengan negative predictive value yang memuaskan untuk seluruh variabel determinan
Perubahan Kadar Fibrinogen Plasma dan Korelasinya dengan Perubahan Kadar hs-CRP dan Aktivitas Fibrinolisis pada Sindroma Koroner Akut Sudrajat, Dedy G.; Atmakusuma, Djumhana; Alwi, Idrus; Harimurti, Kuntjoro
Jurnal Penyakit Dalam Indonesia Vol. 1, No. 1
Publisher : UI Scholars Hub

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Abstract

Pendahuluan: Peningkatan kadar fibrinogen yang menetap merupakan faktor risiko yang kuat untuk kejadian penyakit jantung koroner (PJK). Di sisi lain peningkatan fibrinogen plasma dapat merupakan respon fase akut. Pada kondisi ini peningkatan fibrinogen plasma bukan merupakan faktor risiko PJK. Penelitian ini bertujuan untuk mengetahui apakah kadar fibrinogen plasma meningkat pada fase akut dan tetap tinggi pada fase pasca akut dan mengetahui korelasi antara perubahan kadar fibrinogen plasma dengan perubahan aktivitas inflamasi dan fibrinolisis. Metode: Desain penelitian adalah studi prospektif dengan metode pengambilan sampel secara konsekutif. Pengambilan sampel fase akut untuk hs-CRP, aktivitas fibrinolisis, dan fibrinogen masing-masing diambil pada hari ke-2, 5, dan 6 pasca awitan sedangkan fase pasca akut diambil pada hari ke-13 pasca awitan. Fibrinogen diperiksa dengan metode Clauss, hs-CRP dengan metode ELISA, dan aktivitas fibrinolisis dengan metode ECLT manual. Analisis beda rerata dilakukan dengan uji t-berpasangan dengan alternatif uji wilcoxon. Analisis korelasi dengan uji Spearman. Hasil: Sampai akhir penelitian didapatkan 38 subyek sesuai kriteria inklusi dan eksklusi. Terdapat penurunan median kadar fibrinogen plasma pada fase pasca akut dibandingkan fase akut (415,5vs380,5mg/dL;p Simpulan: Pada sindroma koroner akut, perubahan aktivitas fibrinolisis dan inflamasi memiliki korelasi positif lemah terhadap perubahan kadar fibrinogen. Pada kelompok dengan hiperfibrinogenemia yang menetap kadar fibrinogen pasca akut masih dominan dipengaruhi aktivitas inflamasi yang masih cukup aktif.
Co-Authors . Andriansjah A. Harryanto Achmad Fauzy, Achmad Adityo Susilo, Adityo Agus Joko Susanto, Agus Joko Agus Siswanto Agus Susanto Kosasih, Agus Susanto Andhika Rachman Andra Aswar Andra Aswar, Andra Andri Sanityoso Sulaiman Anis Karuniawati Anna Mira Lubis Antono, Akbarbudhi Ario Perbowo Putra Ario Perbowo Putra, Ario Perbowo Aru W Sudoyo Aru W Sudoyo Aulia Rizka Aulia Rizka, Aulia Birry Karim Bonar, Maruhum Bonar H C Martin Rumende C Martin Rumende C Martin Rumende C Rinaldi A Lesmana C. Martin Rumende, C. Martin Ceva W. Pitoyo Chyntia Olivia Maurine Cleopas M Rumende, Cleopas M Cleopas Martin Rumende Cleopas Martin Rumende Czeresna Heriawan Soejono Dedy G Sudrajat Dedy G Sudrajat, Dedy G Desi Salwani, Desi Dewi Gathmyr Dharmeizar Dharmeizar Dharmeizar Dharmeizar Djafar, Fitria Djumhana Atmakusuma Djumhana Atmakusuma, Djumhana Dono Antono E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Edy Rizal Wahyudi Eka Ginanjar Elza Febria Sari Elza Febria Sari Em Yunir Em Yunir, Em Ening Krisnuhoni Eric Daniel Tenda Erni Juwita Nelwan, Erni Juwita Esthika Dewiasty Esthika Dewiasty, Esthika Evy Yunihastuti Fiastuti Witjaksono Fifi Dwijayanti Ginova Nainggolan Gunawan Gunawan Gunawan Gunawan Gurmeet Singh Gurmeet Singh Hakim, Manfaluthy Harini Oktadiana Harini Oktadiana, Harini Harningtyas Jasmin Harryanto, A. Hasan Maulahela, Hasan Hikari Ambara Sjakti, Hikari Ambara HILMAN TADJOEDIN, HILMAN Idrus Alwi Idrus Alwi Idrus Alwi Ika P Wijaya, Ika P Ikhwan Rinaldi Imam Subekti Indra G Mansur, Indra G Irene Yuniar, Irene Iris Rengganis Iris Rengganis Jeo, Wifanto Saditya Juferdy Kurniawan Koesno, Soekamto M Sadikin Martini, Rose D Maruhum B.H. Marbun Megantara, Marcelino A. Mira Yulianti Mira Yulianti, Mira Muhadi Muhadi, Muhadi Muhammad Aini Murdani Abdullah Murdani Abdullah Murti Andriastuti, Murti Mururul Aisyi Nasrun, Martina W. Ni Made Hustrini, Ni Made Noto Dwimartutie Parlindungan Siregar Pringgodigdo Nugroho, Pringgodigdo Rachmat Hamonangan, Rachmat Rika Bur Rini Sekartini Rino Alvani Gani Rino Alvani Gani Roza Mulyana Rudi Putranto Sabrina Munggarani Yusuf Sally A Nasution, Sally A Saputra, Fahreza Setiati, Slti Shufrie Effendy Shufrie Effendy Siti Setiati Siti Setiati Siti Taqwa Fitria Lubis, Siti Taqwa Fitria Sudrajat, Dedy G. Suhardjono Suhardjono Suhardjono Suhardjono Suhendro Suwarto Suhendro Suwarto Suhendro Suwarto, Suhendro Sukamto Koesnoe Sukamto Koesnoe Sulistianingsih, Dyah Purnamasari Susilo Chandra Suzanna Immanuel Tagor, Alvin TB Djumhana TB Djumhana, TB Teguh Harjono Karjadi, Teguh Harjono Teny Tjitra Sari, Teny Tjitra Tri Juli Edi Tarigan Triyani Kresnawan Triyani Kresnawan, Triyani Ujainah Zaini Nasir Utomo, Ahmad Rusdan Handoyo Wahyuni Indawati Wawan Kurniawan Wawan Kurniawan Widayat Djoko Santoso, Widayat Djoko Wifanto Saditya Jeo Winnugroho Wiratman, Manfaluthy Hakim, Tiara Aninditha, Aru W. Sudoyo, Joedo Prihartono Wirahmadi, Angga Wulyo Rajabto Zulkifli Amin