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All Journal Majalah Kedokteran Bandung Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Althea Medical Journal Jurnal Farmasi Klinik Indonesia Global Medical and Health Communication Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Jurnal MedScientiae Indonesian Journal of Endocrinology Metabolism and Diabetes (InaJEMD)
Hikmat Permana
Department Of Internal Medicine, Faculty Of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung,
Biochemistry, Genetics & Molecular Biology Dentistry Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Laporan Kasus: Tantangan Pengelolaan Krisis Hiperglikemia Pasien Penyakit Ginjal Kronik (PGK) Tahap Akhir dalam Hemodialisa Rutin Davin Takaryanto; Maya Kusumawati; Nenny Agustanti; Rudi Supriyadi; Ervita Ritonga; Nanny N. M. Soetedjo; Hikmat Permana
Jurnal MedScientiae Vol. 2 No. 1 (2023): April
Publisher : Fakultas Kedokteran dan Ilmu Kesehatan Ukrida

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Abstract

Introduction Hyperglycemic crisis is a life threatening medical emergency which occur in any individuals, including end stage renal disease (ESRD). The altered renal, glucose, electrolyte, and body fluid dysregulation seen in ESRD patients affects the management. Objective: Hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA) are life threatening hyperglycemic emergencies that warrant immediate and adequate management. The incidence of hyperglycemic crises among ESRD patients who undergo routine hemodialysis remains unknown. Furthermore, several available studies reported in case reports. Methods: We hereby report a case of hyperglycemic crisis of 61years old woman with medical history of type 2 diabetes mellitus (DM) and ESRD as the complication, she undergoes routine hemodialysis. Results: The patient was admitted with decreased consciousness that was preceded by dyspnea, active cough and fever. Then, the patient treated for the hyperglycemic crisis as in ESRD patient and for the with septic shock due to pneumonia. Conclusion: The management of hyperglycemic crises consist of fluid, potasium corection and insulin administration, however there were some adjustment in ESRD patients. At present therere were no spesific guidelines to manage hyperglicemic crisis and ESRD which is challenging.
Characteristics and Clinical Outcomes of COVID-19 Patients with Hyperglycemia: Retrospective Cohort Study from a COVID-19 Referral Hospital, Bandung, Indonesia Permana, Hikmat; Ikhsanawati, Annisa; Susandi, Evan; Soetedjo, Nanny Natalia Mulyani; Alisjahbana, Bachti
Althea Medical Journal Vol 10, No 4 (2023)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v10n4.3111

Abstract

Background: COVID-19 often causes severe complications in patients with metabolic disorders such as diabetes mellitus. Conversely, inflammation caused by infection may also trigger insulin resistance, resulting in hyperglycemia and is related to the disease severity. This study aimed to describe the characteristics and clinical outcomes of COVID-19 patients with hyperglycemia at one of the COVID-19 referral hospitals in Bandung, Indonesia.Methods: This retrospective cohort study used secondary data from medical records of COVID-19 patients admitted to Dr. Hasan Sadikin General Hospital Bandung, Indonesia from March 2020 to March 2021. This study included all patients with confirmed COVID-19, aged >18 years, and had at least one blood glucose test at admission. Patients were grouped based on three possible types of hyperglycemia, namely diabetes mellitus, reactive hyperglycemia, and steroid-induced hyperglycemia; then their characteristics and disease outcomes were compared. Results: This study identified 1,114 patients’ medical records and included 1,013 data in the analysis. Hyperglycemia occurred in 45.1% of COVID-19 patients. The most common hyperglycemia types were diabetes mellitus (55.7%), reactive hyperglycemia (37.4%), and steroid-induced hyperglycemia (7%). The steroid-induced hyperglycemia group had similar characteristics as the diabetes group. The reactive hyperglycemia group exhibited a metabolic syndrome pattern resembling pre-diabetic conditions. The highest rates of severe disease and mortality were seen in the steroid-induced hyperglycemia group, followed by the diabetes group.Conclusions: There is an elevated prevalence of hyperglycemia in COVID-19 patients with diabetes. The steroid-induced hyperglycemia group has the most unfavorable outcomes. These observations emphasize the importance of identifying hyperglycemic conditions to improve management and outcomes.
Pharmacokinetics and Pharmacodynamics of Glyburide: Insights for Optimizing Treatment in Type 2 Diabetes Alfaqeeh, Mohammed; Khairinisa, Miski Aghnia; Permana, Hikmat
Indonesian Journal of Clinical Pharmacy Vol 13, No 2 (2024)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2024.13.2.48713

Abstract

Glyburide is a widely used oral antidiabetic agent for managing type 2 diabetes. Despite its long history, evolving insights into its pharmacokinetics (PK) and pharmacodynamics (PD) have highlighted knowledge gaps, especially in the context of genetic variability, drug-drug interactions, and use in special populations. This narrative scoping review synthesizes recent evidence to provide a comprehensive and updated understanding of glyburide’s PK/PD profiles.  A thorough literature search of studies published in English, including manual reference checks, was conducted. Glyburide exhibits complex pharmacokinetics, extensive absorption throughout the gastrointestinal tract, significant plasma protein binding, hepatic metabolism via CYP2C9 and CYP3A4 enzymes, and predominantly renal elimination. Its pharmacodynamic effects involve stimulating insulin secretion and enhancing peripheral insulin sensitivity. Common side effects include hypoglycemia and weight gain, while drug-drug interactions and monitoring are crucial for safe and effective use. Understanding glyburide’s pharmacokinetics and pharmacodynamics is key to optimizing diabetes management. Tailoring dosages based on patient factors can improve efficacy, minimize adverse effects, and enable personalized care. Further research on genetic influences, drug interactions, and its use in special populations is needed to refine treatment strategies and enhance safety and effectiveness.
Perbedaan Parameter Hematologi Neutrophil to Lymphocyte Ratio (NLR) Antara Pasien Diabetes Melitus dan Tanpa Diabetes Melitus berdasarkn Derajat Keparahan Sakit Covid-19 Loe, Luse; Soetedjo, Nanny Natalia Mulyani; Permana, Hikmat; Alisjahbana, Bachti
Majalah Kedokteran Indonesia Vol 75 No 1 (2025): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.75.1-2025-1125

Abstract

Background: Patients with diabetes mellitus (DM) have higher risk of complications caused by coronavirus 2019 (COVID-19). COVID-19 virus causes leukopenia and lymphopenia. The neutrophil to lymphocyte ratio (NLR) is a parameter in the complete blood count routinely performed on admission. Method: This study aims to evaluate the difference between NLR in diabetic and non-diabetic patients based on COVID-19 severity. This is a cross-sectional, retrospective, descriptive-analytical study, and the analysis was performed using the comparison test in COVID-19 patients admitted to Hasan Sadikin Hospital from March 2020 to March 2021 using secondary data collected from medical records. There were 612 subjects included in this study. Result: We found a higher NLR median in diabetic (4.1, IQR 2.3-6.2) than non-diabetic (2.9, IQR 2.0-4.0) subjects, with p<0.001. Increased NLR was seen in diabetic COVID-19 subjects with mild to moderate severity, median NLR in diabetic group 4.1 (IQR: 2.3-6.2) vs 2.9 (IQR: 2.0-4.0) in non-diabetic group (p=<0.001). The median NLR was significantly higher in severe-critical diabetic subjects (4.8, IQR 3.0-6.8) than in mild-moderate non-diabetic subjects (2.9, iQR 2.0-4.0). Conclusion: NLR differs between the diabetic and non-diabetic groups depending on the severity of the disease. The NLR is an important parameter in assessing the severity of disease in COVID-19.
Transition of Care of Disorders of Sexual Development: A Twist of Two Cases with Ambiguous Genitalia Marshell Tendean; Nanny Natalia. M Soetedjo; Maya Kusumawati; Ervita Ritonga; Hikmat Permana
‎ 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

Disorders of sexual development (DSD) is a congenital condition that requires an alteration in the development of chromosomal, gonadal, and anatomical sex is atypical. A report showed most of the patients in the 46XX DSD had congenital adrenal hyperplasia (CAH) at 69.23% followed by unknown under-virilization in the 46XY DSD group at 60.09%. Patient 1 diagnosed as DSD 46XX/non-classic congenital adrenal hyperplasia (NCAH) presented with primary amenorrhea, short stature, over-virilization (Prader 2), and 46XX karyotype. Laboratory examination showed elevated 17-hydroxyprogesterone (17OHP): 166.7 ng/ml (2.83 ng/ml), without salt wasting feature. Patient 2 diagnosed with DSD 46XY/type 2 5α -reductase deficiency (SAD) presented with cryptorchidism, under-masculinization (sinecker stage 3b), and 46XY karyotype. Laboratory examination showed elevated testosterone 613 ng/dL (4.6-38.3 ng/dL), decreased dihydrotestosterone (DHT) 11 ng/dL (>20 ng/dL), and elevated testosterone T/DHT ratio 55.73 (8-16). A deep understanding of pathophysiology, and approach to disease in each stage of life is important and warrants special treatment. Comprehensive multidisciplinary team management (MDT) is warranted in DSD management. Disease prognosis varies among each disorder: early detection, treatment compliance, and continuity of care are important to improve patient outcomes.
Parathyroid Carcinoma with Hungry Bone Syndrome Complication After Parathyroidectomy: A Case Report Muhammad Iman Pratama Putra; Nanny Natalia Mulyani Soetedjo; Maya Kusumawati; Ervita Ritonga; Yohana Azhar; Hasrayati Agustina; Hikmat Permana
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
Publisher : PP PERKENI

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Abstract

Riedel's thyroiditis is a rare fibrotic condition involving damage to the thyroid gland and infiltration of surrounding structures. Synonyms of Riedel's thyroiditis include Riedel's goiter, fibrous goiter, ligneous goiter, or chronic invasive fibrous thyroiditis. The inflammatory thyroid condition of Riedel's thyroiditis is a local manifestation of a systemic fibrous or autoimmune process and chronic sclerosis or productive thyroiditis. A 59-year-old man came to the Endocrinology Clinic at Wahidin Sudirohusodo Hospital and was consulted by an oncology surgeon colleague with complaints of a lump in his neck for 2 years before coming to the hospital. Initially the lump was the size of a marble then it got bigger, felt hard, and not painful. The patient had a history of biopsies by surgical colleagues 2 times, the first in May 2022 Fine Needle Aspiration Biopsy with Malignancy (Papillary) results at Bhayangkara Hospital, then the patient was referred to a surgical oncology colleague at Wahidin Sudirohusodo Hospital and a 1-month incision biopsy was performed before going to the endocrine polyclinic with the results of Riedel's Thyroiditis. The patient was then given therapy with Tamoxifen 20 mg per 24 hours orally, and Methylprednisolone 16 mg per 8 hours orally with tapering doses every 7 days. In the treatment during control there were no complaints but complaints of a lump in the neck tended to shrink so the treatment was continued for 2 months then the patient returned to control with a clinical lump in the neck shrinking (Improvement). Riedel's thyroiditis is a disease characterized by an overgrowth of connective tissue that can invade surrounding structures. This connective tissue growth may extend into the recurrent laryngeal nerve. This thyroid inflammatory condition is suspected as a local manifestation of a systemic fibrotic process or an autoimmune process. Commonly used therapies such as glucocorticoids and immunosuppressant agents such as tamoxifen. Steroid treatment is usually given at a dose of 100 mg of prednisolone daily.
Rhabdomyolysis in Thyroid Crisis Soetedjo, Nanny Natalia Mulyani; Loe, Luse; Kusumawati, Maya; Ritonga, Ervita; Permana, Hikmat
Majalah Kedokteran Indonesia Vol 72 No 5 (2022): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.72.5-2022-829

Abstract

Introduction: Hyperthyroidism might lead to rhabdomyolysis. Rhabdomyolysis in thyroid crisis is very rare, currently there are only 7 cases in the world. This is the eight cases in the world that had been reported.Cases: We reported a case of a 46-year-old man with Graves’ Disease who presented with thyroid crisis and rhabdomyolysis.Discussion: The patient came with shortness of breath and palpitations for 10 hours before admission. Tachycardia, tachypnea, thyroid enlargement, motoric weakness, and bilateral lung crackles were noted. The Burch-Wartofsky Point Scale was 60 and the Japan Thyroid Association grade was TS2 first combination. Laboratory showed hyperkalemia (7.7 meq/L), increase in urea (144 mg/dl), creatinine (1.92 mg/dl), fT4 ( greater than 5.0), TSHs (0.06 uIU/ml) creatine kinase (3645 U/L), positive TRAb and Anti-TPO. The patient was treated with thyroid crisis management (propylthiouracil, lugol, dexamethasone) and supportive treatment (dobutamine, digoxin, furosemide, antibiotics, hyperkalemia therapy). After hospitalized for 11 days, the patient was discharged with resolution clinical symptom and levels of CK, urea, and creatinine. Conclusion: Hyperthyroidism might lead to rhabdomyolysis. This condition needs to be recognized and becomes a differential diagnosis in non-traumatic rhabdomyolysis accompanied by acute kidney injury. Therefore, can lead to appropriate and prompt management.
Co-Authors Alfaqeeh, Mohammed Ame Suciati Setiawan Annisa Ikhsanawati, Annisa Augusta Y. L. Arifin Bachti Alisjahbana Davin Takaryanto Della Aprilliana Suherlim* Elin Yulinah Gaga Irawan Nugraha Guntur Darmawan Hasrayati Agustina I Ketut Adnyana Khairinisa, Miski Aghnia Kristina Wiharjo Kusumawati, Maya Leonardo Lubis Lira Mirandus Loe, Luse Marshell Tendean Miftahurachman Miftahurachman, Miftahurachman Mirandus, Lira Muhammad Iman Pratama Putra Nanny N. M. Soetedjo Nanny Natalia M Soetedjo Nanny Natalia Mulyani Soetedjo Nanny Natalia Mulyani Soetedjo Nanny Natalia. M Soetedjo Nenny Agustanti Noormartany Primal Sudjana Ritonga, Ervita Rizda Nurul Zartiana Rizda Nurul Zartiana, Rizda Nurul Rudi Supriyadi Samsudin Surialaga Siti Nur Fatimah Siti Nur Fatimah Sri Hartini K. S. Kariadi Stephanus Kristianto Witono Sudigdo Adi Susandi, Evan Sylvia Rachmayati Yohana Azhar Yumilia Hoo