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Exogenous Cushing Syndrome: When do We Get the Benefit of Glucocorticoid Stress Dose? Soelistijo, Soebagijo Adi; Gunawan, Hendra; Primasatya, Chandra Adi Irawan; Ariana, Audy Meutia; Mudjanarko, Sony Wibisono; Pranoto, Agung
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 3
Publisher : UI Scholars Hub

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Abstract

Exogenous cushing syndrome is the most common cushing syndrome found in clinical practice. Its most frequent etiology is the adverse effect of glucocorticoid therapy found in clinical practice or in the form of traditional medicine. The clinical manifestations of exogenous cushing syndrome are similar to the spontaneous counterpart, albeit with the presence of glucocorticoid consumption. We present a case series of exogenous cushing syndrome due to traditional medicine and glucocorticoid consumption with opportunistic infection as its initial manifestation. The first case did not need glucocorticoid supplementation while it was initiated in the second case. Comprehensive management of exogenous cushing syndrome should involve the decision of giving glucocorticoid stress dose, treatment to the underlying disease and education in order to prevent self-glucocorticoid consumption.
Association between the Duration of Steroid Therapy with Hyperglycemia in Patients with Systemic Lupus Erythematosus (SLE) Widyanrika, Farahdiva Audrey; Mudjanarko, Sony Wibisono; Rochmanti, Maftuchah; Ardiany, Deasy; Permana, Putu Bagus Dharma
Current Internal Medicine Research and Practice Surabaya Journal Vol. 5 No. 1 (2024): CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/cimrj.v5i1.53043

Abstract

Introduction: Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease which primary treatment consists of steroid drugs administration. Prolonged steroid administration is often associated with an increase in blood glucose, a condition known as hyperglycemia. Hence, this study aimed to evaluate the association between the duration of steroid therapy with hyperglycemia in patients with SLE treated at a tertiary healthcare center in Surabaya, Indonesia.Methods: A cross-sectional study was conducted under a purposive sampling frame from January to December of 2022 by utilizing secondary data from electronic medical health records in Dr. Soetomo General Academic Hospital, a tertiary healthcare center in Surabaya, Indonesia. The association between variables were analyzed using Fisher's exact test, chi square test, independent T-test, one-way ANOVA, Mann-Whitney, and Spearman's rank correlation.Results: Out of 150 included patients, 2.67% experienced hyperglycemia following steroid therapy for SLE. There were no significant associations between clinical variables and hyperglycemia occurence in SLE patients (p>0.05). Patients that received higher doses of steroid did not experience any significant difference in hyperglycemia (p=0.727 for <6 months; p=0.865 for ≥6 months). Daily steroid dose was also not significantly associated with the severity of SLE manifestations based on the SLEDAI score (p=0.081). Overall, no significant association was identified between the duration of steroid therapy with hyperglycemia among SLE patients in the hospital (p=0.365). Conclusion: The study found no significant correlation between clinical variables, hyperglycemia incidence, daily steroids dosage, methylprednisolone dosage, SLE severity, or steroid use duration in patients with Systemic Lupus Erythematosus.
Obesity and Clinical Outcomes of Acute Decompensated Heart Failure Nuvus, Alviyatul Ainin; Andrianto, Andrianto; Mudjanarko, Sony Wibisono
JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga Vol. 16 No. 1 (2025): Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/juxta.V16I12025.70-75

Abstract

Highlights: Clinical outcomes in obese acute decompensated heart failure patients were found to be better than those of non-obese patients but not statistically significant. Acute decompensated heart failure patients were dominated by males.   Abstract Introduction: Obesity is an independent risk factor that raises the prevalence of heart failure, but it is paradoxically associated with a better prognosis. This study examined the relationship between obesity and clinical outcomes of acute decompensated heart failure at Dr. Soetomo General Academic Hospital, Surabaya. Methods: This was an analytic observational study using a prospective cohort design. Patients with acute decompensated heart failure who were admitted to the inpatient care unit of Dr. Soetomo General Academic Hospital, Surabaya, from December 2021 to July 2022 were chosen using a purposive sample technique. The data were analyzed using the International Business Machines Corporation (IBM) Statistical Package for Social Sciences (SPSS) version 26.0. Results: There were 58 patients (n=58) representing different categories, with an average age of 55 years old, and were predominately males (58.6%). This study found that clinical outcomes in obese acute decompensated heart failure patients were better than those of non-obese patients in terms of shorter lengths of stay (p=0.825), lower rates of rehospitalization (p=0.458), and lower rates of all-cause mortality (p=0.673). Conclusion: The difference between the clinical outcomes in obese acute decompensated heart failure patients and non-obese patients was not statistically significant.
Challenges in the Diagnosis and Management of Adrenal Insufficiency Febri Kurniawati; Sony Wibisono Mudjanarko; Soebagijo Adi Soelistijo; Agung Pranoto
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 1 (2024): InaJEMD Vol. 1, No. 1
Publisher : PP PERKENI

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Abstract

Adrenal insufficiency (AI) is a rare endocrine condition. Primary adrenocortical insufficiency, or Addison diseases reduces the production of crucial hormones, including glucocorticoids, mineralocorticoids, and adrenal androgens. Due to the lack of proper cortisol response in adrenal crisis, it can be life-threatening during times of stress, emphasizing the need for a timely diagnosis. Despite this, diagnosing and managing AI still presents significant challenges. We report the case of a middle-aged woman who presented with complaints of weight loss, abdominalpain, lethargy, hyperpigmentation of the skin and mucosa, and a history of repeated hospitalizations for nausea, vomiting, dehydration, and hypovolemia. During the patient's previous hospitalization, Addison's crisis was suspected, and methylprednisolone therapy was administered, rendering the cortisol and ACTH assays inaccurate. The patient's condition subsequently improved. The subsequent monitoring revealed low cortisol levels, but an ACTH stimulation test was unavailable. The presence of pulmonary tuberculosis was indicated by a positive chest X-ray and IFN-Gamma Release Assay (IGRA) test. With a history of repeated hospitalizations, suspected Addison's crisis, hypoglycemia, mineralocorticoid involvement (hypotension, hyponatremia), and the presence of hyperpigmentation, a clinical diagnosis of primary adrenal insufficiency was made with limited conditions and testing tools. The patient was given anti-tuberculosis treatment and the lowest dose of hydrocortisone required to control the disease without causing side effects.
Risk Factor Pattern of Graves’ Ophthalmopathy at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia Akbar, Royhan; Mudjanarko, Sony Wibisono; Komaratih, Evelyn; Ardiany, Deasy
JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga Vol. 16 No. 2 (2025): Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/juxta.V16I22025.162-167

Abstract

Highlights: Female patients are more likely to suffer from GO. Most GO patients have high thyroid levels (hypothyroidism).   Abstract Introduction: Graves' ophthalmopathy (GO) is an autoimmune condition that extends beyond the thyroid gland. The development of GO may be influenced by various risk factors, some of which may interact with each other. This study aimed to identify the most prevalent risk factors for patients with GO from 2019 to 2022 at Dr. Soetomo General Academic Hospital, Surabaya. Methods: This study employed a descriptive cross-sectional design, examining 150 patients who met the inclusion and exclusion criteria. This study measured the age, gender, and systemic thyroid status of all patients. This study used Microsoft Word and Microsoft Excel for Mac version 16.87 to process data. Results: Between 2019 and 2022, 150 patients were diagnosed with GO at Dr. Soetomo General Academic Hospital, Surabaya. The condition was more prevalent in females than males, and the most common age group affected was between 30 and 50 years old. Additionally, 72% of patients with GO also had hyperthyroidism. Conclusion: Graves' ophthalmopathy was more prevalent in female patients, aged between 30 and 50 years old, with the majority having hyperthyroidism. Future studies should be conducted on the patterns of GO risk factors on a larger scale to more accurately represent the disease in the general population.
Pengaruh Senam Persadia Seri 1 terhadap Penurunan Gula Darah Puasa Pada Wanita Diabetes Melitus di Puskesmas Banyu Urip, Surabaya Farahiyah, Jihaan; Fatmaningrum, Widati; Mudjanarko, Sony Wibisono
Jurnal Ners Vol. 8 No. 1 (2024): APRIL 2024
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jn.v8i1.18911

Abstract

Diabetes Mellitus is characterized by high blood sugar levels. High blood sugar levels stimulate pancreatic beta cells to secrete insulin. In DM sufferers, physical activity is the main treatment for controlling blood sugar levels, one of which is the PERSADIA Series 1 Gymnastics which is a weight lifting exercise designed to increase muscle eccentricity which aims to increase glucose tolerance and reduce HbA1c. However, until now it is not known for sure the effect of PERSADIA Series 1 Gymnastics on reducing fasting blood sugar in women with Diabetes Mellitus. This study aims to determine and analyze the effect of PERSADIA Series 1 Gymnastics on reducing fasting blood sugar levels in women with Diabetes Mellitus. This research is a quasi-experimental type and was designed using a pre and post test group design with a control group. This study was followed by 60 women with Diabetes Mellitus and divided into 30 control groups who consumed OAD and carried out unstructured activities and 30 intervention groups who consumed OAD and did PERSADIA Series 1 Gymnastics which were carried out 3 times a week for a total of 12 times for 4 weeks with each training session lasting 40 minutes. Fasting blood sugar examination was carried out at the beginning and at the end of the study with subjects fasting at least 10 hours before the test. The research was processed using the SPSS 26 statistical test. Fasting blood sugar levels in both the control and intervention groups had an increase from pre-test GDP to post-test GDP. Statistically, there were no significant differences before and after the test in the control or intervention groups and also when the data between groups was compared with a p value = 0.403. PERSADIA Gymnastics Series 1 has not been able to significantly reduce fasting blood sugar levels in women with Diabetes Mellitus.
Effect of High Fat Diet on Body Weight, Visceral Fat Weight, and PPARG Expressions on Visceral Fat in Mice Melyana, Cantika Putri; Rejeki, Purwo Sri; Mudjanarko, Sony Wibisono; Herawati, Lilik; Al-Arif, Mohammad Anam
Folia Medica Indonesiana Vol. 57, No. 3
Publisher : Folia Medica Indonesiana

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Abstract

Obesity becomes a global epidemic nowadays. The high-fat diet is used as an alternative therapy for obesity. The optimal composition of a high-fat diet to reduce body weight is still unknown. This study aimed to determine which components of a high-fat diet can decrease body weight, visceral fat, and PPARG expression of visceral fat. This study was conducted at the Faculty of Veterinary Medicine, Universitas Airlangga, for three months by using a randomized post-test only control group design. Fifty male mice, 2-3 months old, 18-30 grams were adapted for one week given standard diet AIN93-M, then mice were divided into five groups, namely K1 (control group, 12% fat, 20% protein, 62% carbs); K2 (30% fat, 60% proteins, 0% carbs); K3 (45% fat, 45% protein, 0% carbs); K4 (60% fat, 30% protein, 0% carbs); and K5 (75% fat, 15% protein, 0% carbs). Bodyweight was measured before and after treatment, then the visceral fat and PPARG expressions were evaluated. Statistical comparisons were performed using Statistical Package for the Social Sciences (SPSS) software. After treatment, there were forty-three mice. The body weight and visceral fat weight of the mice with a high-fat diet were decreased. The most significant changes in body weight were in K4 with -9,60 ± 3,806 grams reduction. The bodyweight of mice in K5, slightly increased than K2-K4. This could be caused by the hormesis phenomenon. PPARG expressions decreased in groups with a high-fat diet but increased in K5. The composition of a high-fat diet in group K4 was the most optimal to decrease the body weight, visceral fat, and PPARG expressions in mice
Mortality among Heart Failure Patients in the Presence of Cachexia , Andrianto; Karman, Ula Nur Pramesti; Mudjanarko, Sony Wibisono; Ardiana, Meity; Hermawan, Hanestya Oky
Folia Medica Indonesiana Vol. 59, No. 1
Publisher : Folia Medica Indonesiana

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Abstract

Highlights: • Around 38.8% of heart failure patients with cachexia died during the 180-1,876-day follow-up period. • Cachexia increases the risk of mortality in heart failure patients. Abstract: Despite the fact that obesity has long been recognized as a risk factor for cardiovascular disease, the mortality rate of heart failure (HF) patients with cachexia is still high. Several studies have been conducted to investigate the association between cachexia and mortality in HF patients. However, the research results vary, as do the diagnostic criteria employed to assess cachexia. This meta-analysis aimed to conclusively summarize the association between cachexia and mortality in HF patients. The data were obtained from prospective or retrospective cohort studies with full texts in English or Indonesian and keywords related to "cachexia," "heart failure," and/ or "mortality". Studies that did not assess mortality in HF patients with cachexia and had no full text accessible were omitted. A literature search was conducted through four databases (PubMed, Web of Science, Scopus, and SAGE Journals) using keywords, reference searches, and/ or other methods on April 2022 in accordance with the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data from the selected studies were presented and analyzed using qualitative and quantitative synthesis methods. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias in the selected cohort studies. The qualitative synthesis contained nine studies, whereas the quantitative synthesis (meta-analysis) included six studies. Cachexia was found in 16.0% of the 4,697 patients studied. During the 180-1,876-day follow-up period, 33.0% of the patients died, with a mortality rate of 38.8% among the patients with cachexia. The pooled analysis revealed cachexia to be a significant predictor of mortality in HF patients (hazard ratio (HR)=3.84; 95% CI=2.28-6.45; p<0.00001), but with significant heterogeneity (p<0.00001; I2=88%). In conclusion, cachexia worsens HF prognosis.