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All Journal World Nutrition Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia
Purwita Wijaya Laksmi
Divisi Geriatri, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia - RSUPN Cipto Mangunkusumo, Jakarta
Medicine & Pharmacology Public Health

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Nutrition for elderly individuals during the Covid-19 pandemic Purwita Wijaya Laksmi
World Nutrition Journal Vol. 5 No. S3 (2022): Selected conference proceedings of the Nutri Virtual Symposium 2021
Publisher : Indonesian Nutrition Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25220/WNJ.V05.S3.0018

Abstract

Aging process, genetic factor, lifestyle, and disease(s) give contribution to the phenotype of robust, prefrail or frail elderly. The frailer the elderly, the more vulnerable they become to poor health outcomes. Aged patients are more likely to have adverse outcomes from Coronavirus disease-19 (COVID-19). Recovery from such disease also take a longer time compared to the younger age group
Complications of Biliary Atresia in a 27-Year-Old Male Patient Nata Pratama Hardjo Lugito; I Gede Resmino Tyasto; Purwita Wijaya Laksmi
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 1, April 2013
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (501.69 KB) | DOI: 10.24871/141201344-48

Abstract

Biliary atresia (BA) is a disease of the extrahepatic biliary tree that presents with biliary obstruction in the neonatal period, which is caused by fibro-obliterative process. Kasai procedure, a hepatoportoenterostomy(HPE) as an attempt to restore bile flow from the liver to the proximal small bowel, has been shown to improve survival in BA patients. Many BA survivals who had undergone Kasai HPE will have slowly progressive liverdisease and the majority of patients will ultimately require liver transplantation. In spite of many experimental treatments, cirrhosis still occurs in BA patients survival.This case report presents a male patient with biliary atresia that has survived for 27 years after Kasai procedure. He had been repeatedly admitted to hospital with complications caused by cirrhosis, such as repeated variceal and hemorrhoid bleeding and also refractory ascites. These complications are indications for liver transplantation. Although Kasai HPE procedure improves survival in BA patients in Indonesia, long-termcomplications of cirrhosis makes the patient awaits for liver transplantation. Keywords: biliary atresia, Kasai procedure, hepatoportoenterostomy, cirrhosis, liver transplantation
Predictors of Handgrip Strength Changes in Elderly Patients Madina, Ummi Ulfah; Setiati, Siti; Laksmi, Purwita Wijaya; Mansjoer, Arif
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 3
Publisher : UI Scholars Hub

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Abstract

Introduction. The increasing elderly population throughout the world has been related to the increased prevalence of sarcopenia and frailty. Handgrip strength is a component of sarcopenia, one of frailty syndrome phenotypes. Previous studies have assessed the association of age, sex, nutritional status, functional status, mental status, and comorbidity, but varied results. No longitudinal study has been done to determine the correlation of handgrip strength changes with age, sex, nutritional status, functional status, mental status, and comorbidity in Indonesia. The aim of this study was to determine the correlation between age, sex, nutritional status, functional status, depressive symptoms, comorbidity, and handgrip strength changes in elderly patients. Methods. A prospective cohort study using secondary data of elderly patients who were routinely visiting Geriatric OutPatients Clinic at Cipto Mangunkusumo Hospital, Jakarta, from the INA-FRAGILE register observed for one year (2013- 2014). The multivariate logistic regression analysis was used to assess the correlation between sex, age, nutritional status (MNA score), functional status (ADL score), depressive symptoms (GDS-SF score), comorbidities (CIRS score), and handgrip strength changes. Results. From 162 subjects which were included in the study, the mean age was 72.9 (SD 5.9) years, predominantly female (57.41%), with good nutrition (83.9%), independent (median 9- 20), not depressed (median 0-11), has average comorbidity index 11.8 (SD 3.7), and 53.1% experienced decreased handgrip strength. Nutritional status (OR = 2.7, p = 0.033) and comorbidity (OR 0.3, p <0.002) correlated with handgrip strength changes
Performa Diagnostik Global Leadership Initiative on Malnutrition (GLIM) dibandingkan dengan Malnutrition Nutritional Assessment (MNA) dalam Pengkajian Malnutrisi pada Pasien Geriatri di Rawat Inap Leoni, Astrine Permata; Amelia, Wita Rizki; Laksmi, Purwita Wijaya; Syauqy, Ahmad
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 1
Publisher : UI Scholars Hub

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Introduction. As many as 76.6% of patients aged 60 years and above (elderly) are malnourished or at risk of malnutrition based on MNA within the first 48 hours of hospital admission. The prevalence of malnutrition varies widely depending on the population studied, the healthcare setting and the tools used for the assessment. To date, SGA is widely used in the diagnosis of malnutrition for adults and MNA for elderly patients. Recently, experts proposed empirical consensus of GLIM criteria for determining the diagnosis of malnutrition in adults. This study aimed to investigate the diagnostic performance of GLIM criteria as a new consensus in determining the diagnosis of malnutrition in comparison to MNA as a semi-gold standard for nutritional assessment in the elderly. Methods. A cross-sectional study was conducted from January to April 2022 on 103 consecutively recruited elderly patients aged ≥60 years in the Internal Medicine Wards at Dr. Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia. Results. There were 91.3%, 57.3% and 54.4% malnourished elderly patients upon admission to the hospital, based on GLIM criteria, MNA-SF and MNA-LF, respectively. GLIM has good accuracy compared to both MNA-SF and MNA-LF, as long as the category of malnourished in MNA is a combination of malnutrition and at risk of malnutrition. GLIM had 97.9% sensitivity, 87.5% specificity, AUC 0.93, 98.9% PPV, 77.8% NPV, 7.83 positive LR and 0.02 negative LR towards MNA-SF, and a sensitivity value of 98.9%, specificity 88.9%, AUC 0.94, PPV 98.9%, NPV 88.9%, positive LR 8.91, and negative LR 0.01 towards MNA-LF. Conclusion. GLIM showed good diagnostic accuracy to determine nutritional status in the elderly, especially upon admission to the hospital, so that appropriate early nutritional interventions can be given. Keywords: diagnostic performance, elderly, GLIM, malnutrition, MNA
Sarkopenia sebagai Faktor Risiko Varises Esofagus Risiko Tinggi berdasarkan Stratifikasi Child-Pugh Pasien Sirosis Hati Sepmeitutu, Iwandheny; Kurniawan, Juferdy; Maulahela, Hasan; Rinaldi, Ikhwan; Shatri, Hamzah; Pramana, Triyanta Yuli; Makmun, Dadang; Lesmana, Cosmas Rinaldi A; Hidayat, Rudy; Laksmi, Purwita Wijaya; Sunardi, Diana
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Abstract

Background The high prevalence of sarcopenia in chronic liver disease negatively impacts the quality of life and increases the risk of various complications of cirrhosis, one of which is the development of esophageal varices. The aim of this study was to determine the prevalence of sarcopenia in cirrhosis patients based on the severity of liver cirrhosis and to explore the association of sarcopenia with high-risk esophageal varices stratified by Child-Pugh. Methods This observational cross-sectional study involved patients with liver cirrhosis at Cipto Mangunkusumo Hospital between January and September 2023. Sarcopenia was defined as a reduction in muscle mass accompanied by decreased grip strength or walking speed, according to the AWGS 2019 criteria (Asian Working Group for Sarcopenia). Multivariate logistic regression analysis was conducted to evaluate the association between sarcopenia and high-risk esophageal varices. Results A total of 155 patients with liver cirrhosis were included in this study. The majority of liver cirrhosis patients were males, with hepatitis B being the most commonly found etiology. The prevalence of sarcopenia was found in 40.0% of Child-Pugh A patients, 53.8% of Child-Pugh B patients, and 50.0% of Child-Pugh C patients with a p-value of 0.411. The high-risk of esophageal varices was found more frequently in Child-Pugh B (53.8%) and Child-Pugh C (50.0%) compared to Child-Pugh A (25.6%) with a p-value of 0.013. Bivariate analysis showed that the presence of sarcopenia in liver cirrhosis patients has a statistically significant association with an increased risk of high-risk esophageal varices, especially in the Child-Pugh B and C subgroups of liver cirrhosis patients (OR = 7.50 (95% CI: 1.48 – 37.91, p<0.030)). However, no association was found between sarcopenia and high-risk esophageal varices in the Child-Pugh A subgroup (OR = 1.46 (95% CI: 0.65 – 3.29, p<0.477)). Conclusion Sarcopenia significantly increases the risk of high-risk esophageal varices in liver cirrhosis, especially in those with Child-Pugh B and C classification.
Efek Terapeutik Analog Somatostatin dalam Menghambat Perkembangan Autosomal Dominant Polycystic Kidney Disease Sitompul, Irvin Rembrant Holleritz; Putri, Grasella Angelika; Laksmi, Purwita Wijaya
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Abstract

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a hereditary disorder characterized by formation and progressive growth of cysts in the kidneys and other organs such as liver, spleen, and pancreas. Recent advances have led to possibilities to target the main cause of cyst growth, cAMP. Somatostatin targets cAMP and inhibits its production directly and indirectly in kidney and liver, which might potentially prevent renal and liver cyst progression in ADPKD. This report aims to evaluate the effectiveness of somatostatin analogue therapy in slowing disease progression in ADPKD patients, according to the latest evidence. A literature search was conducted on five databases, namely the Cochrane Library, EBSCO, Embase, ProQuest, and PubMed/MEDLINE. Selected articles are screened for duplication, title and abstract, as well as based on eligibility criteria. The selected articles were then critically appraised using the Oxford Center for Evidence Based Medicine (CEBM) critical appraisal tools for therapeutic study and systematic review as a guide. The systematic search resulted in one meta-analysis assessing the effectiveness of somatostatin analogues in ADPKD patients in terms of Total Kidney Volume (TKV), Total Liver Volume (TLV), and eGFR. This article analyzed 10 RCTs with a total sample size of 854 subjects. This study showed that somatostatin analogue is associated with lower TLV (%TLV) growth (MD -6.37%; 95% CI -7.90 to -4.84; p<0.001; I2 = 14%), and lower TKV (%TKV) growth rate (MD -3.66%; 95% CI -5.35 to -1.97; p<0.001; I2 = 56%). However, it was not associated with eGFR decline (MD -0.96 mL/min/1.73m2; 95% CI -2.38 to 0.46; p = 0.19; I2 = 74%). Adverse effects were mainly gastrointestinal tract symptoms, and approximately 15% of test subjects administered with somatostatin analogue permanently discontinued the drug. Somatostatin analogue therapy has benefit in slowing TLV and TKV growth which outweigh the cost and risk of therapy. In conclusion, somatostatin can be recommended as therapy in ADPKD patients presenting with both kidney and liver cyst.
Co-Authors Ahmad Syauqy Amelia, Wita Rizki Arif Mansjoer C Rinaldi A Lesmana Dadang Makmun Diana Sunardi E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Hasan Maulahela, Hasan I Gede Resmino Tyasto Ikhwan Rinaldi Joedo Prihartono Juferdy Kurniawan Leoni, Astrine Permata Nafrialdi Nafrialdi Nata Pratama Hardjo Lugito Pradana Soewondo Putri, Grasella Angelika Rudy Hidayat Sepmeitutu, Iwandheny Siti Setiati Siti Setiati Sitompul, Irvin Rembrant Holleritz Tirza Z Tamin Triyanta Yuli Pramana Ummi Ulfah Madina Ummi Ulfah Madina, Ummi Ulfah Wasilah Rochmah