Kuntjoro Harimurti
DIvisi Geriatri, Kelompok Staf Medis Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia - RSUPN Dr Cipto Mangunkusumo

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Effects of cholecalciferol supplementation on depressive symptoms, C-peptide, serotonin, and neurotrophin-3 in type 2 diabetes mellitus: A double-blind, randomized, placebo-controlled trial Putranto, Rudi; Setiati, Siti; Nasrun, Martina W.; Witjaksono, Fiastuti; Immanuel, Suzanna; Subekti, Imam; Harimurti, Kuntjoro; Siswanto, Agus; Shatri, Hamzah; Suwarto, Suhendro; Megantara, Marcelino A.
Narra J Vol. 4 No. 3 (2024): December 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i3.1342

Abstract

The coexistence of depression and type 2 diabetes mellitus (T2DM) can significantly worsen disease prognosis and lower quality of life. Emerging evidence suggests that vitamin D deficiency contributes to the progression of T2DM and is closely associated with the development of depression. The aim of this study was to investigate the effects of cholecalciferol on depression in patients with T2DM, exploring its mechanisms by analyzing its impact on C-peptide, serotonin, and neurotrophin-3 levels. A double-blind, randomized, placebo-controlled clinical trial was conducted at Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, from April 2021 to September 2022. Patients with T2DM and depressive symptoms were randomly assigned to two groups: received 4000 IU of cholecalciferol daily and received a placebo for 12 weeks. Depression was assessed using the Beck Depression Inventory-II (BDI-II) before and 12 weeks after the intervention. The levels of C-peptide, serotonin, and neurotrophin-3 were measured at the end of the fourth week of intervention using the enzyme-linked immunosorbent assay (ELISA) method. Between-group comparisons were made using independent Student t-tests and Mann-Whitney U tests. Paired Student t-tests or Wilcoxon tests were applied for within-group comparisons between pre- and post-intervention. A total of 70 T2DM patients with depression were included in this study, comprising 38 patients in the cholecalciferol group and 32 in the placebo group. C-peptide levels increased significantly in the cholecalciferol group compared to the placebo group (p=0.006). No significant differences were observed in serotonin and NT-3 levels between the cholecalciferol group compared to the placebo group. The cholecalciferol group had a significantly greater reduction in BDI-II scores compared to the placebo group (p<0.001). This trial highlights that taking cholecalciferol might help ease mild to moderate depression symptoms in patients with T2DM by enhancing c-peptide levels, though its effects on serotonin and neurotrophin-3 are still unclear.
Unveiling the Survival Gap: Addressing the Challenges of Acute Lymphoblastic Leukemia in Adolescents Aisyi, Mururul; Kosasih, Agus Susanto; Utomo, Ahmad Rusdan Handoyo; Saputra, Fahreza; Sari, Teny Tjitra; Sjakti, Hikari Ambara; Dwijayanti, Fifi; Harimurti, Kuntjoro; Andriastuti, Murti
Indonesian Journal of Cancer Vol 19, No 2 (2025): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i2.1396

Abstract

Background: Acute Lymphoblastic Leukemia (ALL) remains the most common pediatric cancer, yet survival outcomes vary widely across age groups. In Indonesia, comprehensive data on ALL survival rates are sparse, particularly for adolescents who often fare worse than younger children. The underlying factors contributing to the difference in adolescent survival rates still need to be fully understood. This study aimed to evaluate and compare the survival rates of children and adolescents with ALL treated at Dharmais Cancer Hospital.Method: We conducted a retrospective cohort analysis of 94 ALL patients, including 37 adolescent patients and 71 patients with B-lineage ALL. All patients with ALL from 2021 to 2023 were identified. Children aged 1–18 years, diagnosed with ALL based on bone marrow results and not yet treated, are included in the study. Patients were stratified by risk stratification (Standard Risk [SR] vs. High Risk [HR]), lineage (B-lineage vs. T-lineage), and age group (children under 10 vs. adolescents 10 years and above). The survival curve was analyzed using the KaplanMeier method, and the log-rank test was used to assess and compare survival across groups.Results: The overall survival (OS) rate for ALL patients was 49.5%. Adolescents had a significantly lower OS rate of 23.2% compared to children. SR patients exhibited an OS rate of 95.7%, while HR patients had a 33.3%. B-cell lineage had a higher OS rate (59.8%) than T-cell lineage (15.9%). In B-cell ALL, OS was 61.4% in children but only 28.1% in adolescents. Conclusion: The survival rate for adolescents with acute lymphoblastic leukemia (ALL) is significantly lower than that of children, influenced by risk stratification, lineage, and age. Further research is needed to identify these risk factors through genetic and molecular analyses.Conclusion: The survival rate for adolescents with acute lymphoblastic leukemia (ALL) is significantly lower than that of children, influenced by risk stratification, cell type, and age. Unexplained factors, including lineage differences, remain a challenge in adolescents. Further research into genetic and molecular factors is essential to enhance treatment precision and improve survival rates for ALL patients in Indonesia, especially adolescents.Keywords: Overall Survival, Leukemia, Adolescent ALL, Stratification
Associations between genomic copy number alterations and clinical and laboratory results in pediatric B-cell acute lymphoblastic leukemia Aisyi, Mururul; Andriastuti, Murti; Kosasih, Agus Susanto; Utomo, Ahmad Rusdan Handoyo; Saputra, Fahreza; Sari, Teny Tjitra; Sjakti, Hikari Ambara; Dwijayanti, Fifi; Harimurti, Kuntjoro
Paediatrica Indonesiana Vol. 65 No. 2 (2025): March 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.2.2025.89-95

Abstract

Background Copy Number Alterations (CNAs) are changes in DNA structure that lead to gain or loss of copies of DNA sections in the genome. They correlate with unfavorable prognostic outcomes in pediatric leukemia, influencing treatment resistance, relapse rates, and overall survival. Identifying high-risk patients with a likelihood of CNA positivity is essential for understanding its association with clinical characteristics and laboratory findings. Since routine CNA testing is costly, recognizing simple clinical and laboratory markers that predict CNA presence can help focus screening efforts, enabling more efficient risk stratification and prognosis assessment in acute leukemia Objective To describe the characteristics and analyze for associations between CNA, clinical characteristics, and laboratory findings in pediatric ALL patients. Methods This cross-sectional observational study included B-cell acute lymphoblastic leukemia (ALL) patients from three hospitals, excluding those above 18 years. Data collected encompassed demographics, clinical features, and laboratory results. We performed multiplex ligation-dependent probe amplification (MLPA) testing to identify CNA positivity. Results From January to December 2019, there were 74 pediatric ALL patients incuded in our study; 26 of them had positive results and the remaining 48 had negative results. CNA-positive status was commonly found in subjects aged ? 5 years (38.6%), while CNA-negative status was highest in patients aged ? 10 years (72.7%). CNA-positive status was significantly higher in patients with lymphadenopathy, lower hemoglobin level (7.73 g/dL), and lower platelet level (52,019/µL) (P<0.05). Conclusion Patients with lymphadenopathy, lower hemoglobin, and lower platelet levels are more likely to test positive for CNA. However, more research is needed to fully understand the implications of this finding and its potential impact on patient care.
Peran Prediktif IL-6, IL-10, dan TNF-α Plasma terhadap Gagal Ginjal Akut pada Pasien dengan COVID-19 Derajat Sedang dan Berat Gathmyr, Dewi; Bonar, Maruhum Bonar H; Susilo, Adityo; Harimurti, Kuntjoro; Nainggolan, Ginova; Tagor, Alvin; Shatri, Hamzah; Lesmana, Cosmas Rinaldi Adithya; Amin, Zulkifli
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Abstract

Introduction. Acute kidney injury (AKI) is associated with higher mortality rate in COVID-19 patients due to inflammation and immune dysregulation. This study aimed to correlate serum levels of IL-6, IL-10, and TNF-α with serum creatinine changes and their roles to predict incidence of acute kidney injury (AKI) in patients with moderate and severe COVID-19. Methods. This prospective cohort study was conducted among patients with moderate to severe COVID-19 in Pertamina Central Hospital Jakarta, Indonesia during November 2020 to January 2021. All serum levels of cytokines (IL-6, IL-10, and TNF-α) and creatinine were collected on the first day and seventh day of hospitalization. They might be collected earlier if the patients died or discharged early. AKI was defined as deterioration in serum creatinine or urine output based on Kidney Disease Improving Global Outcomes (KDIGO) guideline. The correlation between cytokine and creatinine serum level changes were analyzed using Spearman test. Receiver operator characteristic curve was calculated to explore predictive roles of cytokines on AKI incidence. Results. A total of 43 patients were included in the study, with a mean age of 59.3 years (SD 12.59), and the majority were male (74%). The incidence of AKI was 7%. Serum creatinine changes were correlated with serum levels changes IL-10 (r= -0.343; p=0.024), but not for IL-6 (r=-0.198; p=0.202) and TNF-α (r=-0.129, p=0.409). Meanwhile, serum TNF-α level on the first day was able to predict AKI incidence on the seventh day of hospitalization (AUC 85%; p=0.045; 95% CI=0.737 to 0.963). Conclusions. TNF-α on the first day is potential to be predictor on AKI incidence on the seventh day in moderate and severe COVID-19 patients.
Korelasi Stenosis Penyakit Arteri Perifer di Bawah Lutut dengan Kecepatan Hantar Saraf pada Penyandang Neuropati Perifer Diabetes Melitus Tipe 2 Antono, Akbarbudhi; Antono, Dono; Karim, Birry; Hakim, Manfaluthy; Harimurti, Kuntjoro; Sulistianingsih, Dyah Purnamasari; Ginanjar, Eka; Nelwan, Erni Juwita; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Abstract

Introduction. One consequence of DM is the emergence of peripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN). Diabetic peripheral neuropathy is a complication of diabetes that presents signs and symptoms of motor and sensory disturbances, while PAD is an atherosclerosis condition that gradually develops in the arterial vessels. This study aimed to determine correlation of arterial obstruction assessed using arteriography and the nerve impairment assessed using nerve conduction velocity (NCV) in DM patients with PAD and DPN. Methods. This is a cross-sectional study that takes secondary data from previous research conducted from July 2018 to June 2021 in Cipto Mangunkusumo hospital. Subjects were people with DM type 2 who had NPD and PAP who met the inclusion criteria and did not meet the exclusion criteria. Subjects underwent an arteriography examination to assess the stenosis in the peroneal artery, anterior tibial artery, and posterior tibial artery. Subjects also underwent nerve conduction velocity (NCV) examinations in the peroneal N. communis, N. peroneal superficialis, N. tibialis, and N. suralis. The correlation between the two variables was then tested using the Spearman correlation test. Results. The peroneal artery stenosis had a moderate negative correlation (r = - 0.420) with the sensory NCV of the superficial peroneal nerve which was statistically significant (p = 0.023). Meanwhile, the correlation of stenosis and NCV disorders in the peroneal nerve with the common peroneal nerve, anterior tibial nerve with tibialis nerve and posterior tibial nerve with sural nerve was not statistically significant. This can be explained by the possibility of collaterals appearing in people with PAD, the structure of vasculature on the nerves, and the small number of samples. Conclusions. There is a moderate negative correlation between the stenosis of the peroneal nerve and the sensory NCV of the peroneal superficialis. However, insignificant results were found in the correlation between peroneal artery with common peroneal nerve, anterior tibialis artery with tibial nerve, and posterior tibial artery with sural nerve.
Cardiopulmonary Complications During and After Endoscopy in Elderly Patients:a Prospective Study Yusuf, Sabrina Munggarani; Dwimartutie, Noto; Maulahela, Hasan; Harimurti, Kuntjoro; Rinaldi, Ikhwan; Yunihastuti, Evy; Fauzy, Achmad; Putranto, Rudi
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 26, No 2 (2025): VOLUME 26, NUMBER 2, AGUSTUS, 2025
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2622025120-129

Abstract

Background: The high incidence of gastrointestinal and pancreaticobiliary diseases among elderly has led to increased endoscopic procedures in this population. Previous studies indicate a higher risk of cardiopulmonary complications during and after endoscopy in elderly patients compared to younger individuals. This study investigated the incidence and contributing factors of endoscopy-related cardiopulmonary complications in elderly patients.Methods: A prospective cohort study was conducted on 194 patients aged ≥ 60 years undergoing endoscopy at the Gastrointestinal Endoscopy Center, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia, from August to October 2023. Consecutive sampling method was used. Multivariate analysis with logistic regression was conducted. Results: Among the 194 patients included, 49.52% experienced cardiopulmonary complications. The most common complications were tachycardia (23.20%), hypoxemia (15.03%), and hypotension (6.20%). Multivariate analysis identified the complexity of the procedure (ASGE level ≥ 3) as a significant risk factor (RR 1.505, 95% CI 1.039-2.179; p=0.03), while mild-moderate sedation was associated with a reduced risk of complications (RR 0.668, 95% CI 0.458-0.975; p=0,037). Conclusion: The incidence of cardiopulmonary complications during and after endoscopy is high among Indonesian elderly. Procedure complexity is an independent risk factor, whereas mild-moderate sedation mitigates the risk. In opposite, advanced age, multimorbidities, high ASA class, long duration of procedure, poor nutritional and functional status, and type of procedure did not affect outcomes
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