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All Journal Jurnal Plastik Rekonstruksi Cermin Dunia Kedokteran The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia Cermin Dunia Kedokteran
Noto Dwimartutie
Divisi Geriatri, Departemen Ilmu Penyakit Dalam, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo, Fakultas Kedokteran Universitas Indonesia, Jakarta, Indonesia
Civil Engineering, Building, Construction & Architecture Health Professions Medicine & Pharmacology Public Health Other

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Vitamin D dan Kalsium untuk Pencegahan Fraktur pada Usia Lanjut Kevin Yonathan Widianto Thio; Noto Dwimartutie
Cermin Dunia Kedokteran Vol 49, No 7 (2022): Vitamin D
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v49i7.1937

Abstract

Latar Belakang: Fraktur pada usia lanjut berhubungan dengan peningkatan angka hospitalisasi, disabilitas, penurunan status fungsional, dan kematian. Oleh karena itu, fraktur pada usia lanjut masih menjadi suatu masalah kesehatan global yang cukup signifikan. Suplementasi vitamin D dan kalsium dapat menurunkan risiko fraktur, walaupun bukti-bukti yang ada masih inkonklusif. Tujuan: Untuk mengumpulkan dan menganalisis studi-studi yang berkaitan dengan kombinasi suplementasi vitamin D dan kalsium dan hubungannya dengan risiko kejadian fraktur pada usia lanjut. Metode: Kami menelusuri database Pubmed, Proquest, EBSCOhost, dan Cochrane untuk mencari dan menganalisis studi terkait dalam bentuk randomized controlled trial (RCT) atau tinjauan sistematis dengan atau tanpa meta-analisis. Hasil: Didapatkan dan dipilih 2 artikel tinjauan sistematis dengan meta-analisis pada akhir pencarian literatur. Kedua studi menunjukkan hasil signifikan pemberian vitamin D dan kalsium dibandingkan plasebo/tanpa intervensi terhadap risiko total fraktur (RR 0.74, 95%KI 0.58-0.94 dan RR 0.94, 95%KI 0.89-0.99) dan risiko fraktur tulang pinggul (RR 0.61, 95%KI 0.4-0.92 dan RR 0.84, 95%KI 0.72-0.97) pada usia lanjut. Simpulan: Suplementasi vitamin D dengan kalsium memiliki potensi menurunkan risiko fraktur pada usia lanjut. Studi dengan skala lebih besar mengenai dosis optimal dan keamanan masih diperlukan untuk mendapatkan bukti yang lebih kuat.Background: Fractures in older adults are associated with hospitalization, disability, functional decline, and mortality. It becomes an important public health problem. Combined vitamin D and calcium supplementation can decrease fracture risk, although recent evidence shows conflicting results. Aim: To collect and analyze studies related with combined vitamin D and calcium supplementation and its impact on fracture risk in older adults. Methods: A systematic search was conducted on Pubmed, Proquest, EBSCOhost, and Cochrane based on clinical query. Randomized controlled trials and meta-analyses were screened and critically appraised. Results: Two meta-analyses were obtained. The two studies showed that vitamin D and calcium supplementation, compared to placebo or no treatment, decreased risk of any fracture (RR 0.74, 95%CI 0.58-0.94 dan RR 0.94, 95%CI 0.89-0.99) and risk of hip fractures (RR 0.61, 95%CI 0.4-0.92 dan RR 0.84, 95%CI 0.72-0.97) significantly in older adults. Conclusion: Combined vitamin D and calcium supplementation in older adults decreases risk of fractures. Further studies on optimal dose and safety profiles are needed to ensure stronger evidence.
Abdominal Tuberculosis: Diagnostic and Management Problems Noto Dwimartutie; Iskandar A; Marcellus Simadibrata; Ari F Syam; Ceva W Pitoyo; Andri Sulaiman; Tony Loho
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 1, April 2006
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/71200621-27

Abstract

Abdominal tuberculosis, as one of the manifestations of extrapulmonary tuberculosis, may involve gastrointestinal tract, peritoneum, mesenteric lymph nodes, liver, and also spleen. Most patients have constitutional symptoms of fever, pain, diarrhea, constipation, alternating constipation and diarrhea, weight loss, anorexia and malaise. It also has an insidious course without any specific laboratory, radiological or clinical findings and makes it difficult to diagnosis. Anti tuberculosis treatments with initiation phase for 2 months and continue with continuation phase for 7 months is effective. Steroids may be used to reduce acute inflammation and limit delayed fibrotic complications. We report a male patient with abdominal tuberculosis involving peritoneum, liver, colon, paraaorta lymph nodes, and spleen, which at first suggested as a malignancy. Drug induced hepatitis due to anti tuberculosis drug during treatment was emerged and substituted with other regimen. After given anti tuberculosis treatment and steroid as adjunctive treatment, the clinical condition of patient was improved. Keywords: abdominal tuberculosis, anti tuberculosis treatment, drug induced hepatitis
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

Elderly Mistreatment: Risk Factors and Therapy Madina, Ummi Ulfah; Dwimartutie, Noto
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 1
Publisher : UI Scholars Hub

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Abstract

Elderly mistreatment is a preventable serious health problem that lowering older adults quality of life. Elderly mistreatment can be done by the caregiver or even the patient himself, regardless the intention. Meanwhile, defining an elderly mistreatment is still a challenge due to varied risk factors and cultural differences in each country. Those conditions result in challenges in identifying and managing elderly mistreatment. This review will also discuss screening modalities to identify elderly who is at risk or currently abused to prevent and manage elderly mistreatment properly.
Prediction Model of 30-Days Postoperative Pneumonia in Elderly Patient Undergoing Abdominal Surgery Dwimartutie, Noto; Oktadiana, Harini; Singh, Gurmeet; Jeo, Wifanto Saditya; Harimurti, Kuntjoro
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 1
Publisher : UI Scholars Hub

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Abstract

Introduction. Physiologic changes in respiratory tract in elderly increase incidence of post-operative pneumonia. Post-operative pneumonia in non-thoracic surgery was found higher in abdominal surgery. This study aimed to develop a prediction model of 30-day post-operative pneumonia in elderly patients undergoing abdominal surgery. Methods. A retrospective cohort study was conducted using elderly patient’s medical records who underwent abdominal surgery in Cipto Mangunkusumo General Hospital. Multivariate analysis using logistic regression was used to determine Odds Ratio (OR). Model’s calibration performance was determined by Hosmer-Lameshow test and its discrimination performance was determined by calculating area under the curve (AUC). Results. Of 753 subject who underwent abdominal surgery, postoperative pneumonia was found in 9.2% subjects. Independent predictors for 30-day postoperative pneumonia were functional status [ADL Barthel 0-11, odds ratio (OR) 6.908 (95% confidence interval (CI) 2.933-16.273); ADL Barthel 12-19, OR 3.191 (95%CI 1.53-6.657)], upper abdominal surgery [OR 4.869 (95%CI 1.805-13.132)], chronic obstructive pulmonary disease [OR 6.888 (95%CI 2.001-23.709)], and albumin level /dl [OR 2.54 (95%CI 1.404-4.596)]. Prediction model of pneumonia was stratified into lower risk (score 3; probabililty 60.42%). Hosmer-Lemeshow test revealed p-value 0.452 and the AUC value is 0.811 (95%CI 0.87-0.97). Conclusion. A simple prediction model of 30-day post-operative pneumonia for elderly patients undergoing abdominal surgery consisted of 4 predictors (functional status, upper abdominal surgery, COPD and albumin level /dl) has a good performance.
Model Prediksi Mortalitas Pembedahan Pasien Usia Lanjut yang Menjalani Pembedahan Elektif di Rumah Sakit Cipto Mangunkusumo Djafar, Fitria; Dwimartutie, Noto; Chandra, Susilo; Harimurti, Kuntjoro
Jurnal Penyakit Dalam Indonesia Vol. 11, No. 2
Publisher : UI Scholars Hub

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Abstract

Introduction. Elderly patients are at high risk of mortality after elective surgery. The aim of this study was to obtain and evaluate the performance of a mortality prediction model for elderly patients undergoing elective surgery. Methods. The design of this study was a retrospective cohort using medical record data from 747 elderly subjects who underwent elective surgery in the period January 2015–December 2017 at Cipto Mangunkusumo Hospital (RSCM), Jakarta. This study used multivariate analysis with logistic regression to determine significant predictors that were included in the prediction model. The performance of the prediction model was assessed using the Hosmer-Lameshow test, and its discrimination ability was determined by calculating the Area Under the Curve (AUC). Results. Of the total 747 elderly subjects, the elective surgery mortality rate was 14.5%. The predictor variables were functional status [ADL 9-11, OR 1.808 (95% CI 0.848-3.854); ADL 0-8, OR 3.382 (95% CI 1.724-6.634)], comorbidities [CCI 3-4, OR 12.206 (95% CI 5.317-28.018); CCI >5, OR 15.820 (95% CI 6.701-37.347)], albumin level <3 g/dL [OR 3.777 (95% CI 2.105-6.779)], type of surgery [grade II, OR 3.827 (95% CI 1.849- 7.923); grade III, OR 6.560 (95% CI 3.378-12.739)], and ASA status with an ASA score > 3 [OR 5.106 (95% CI 1.841-14.159)] were further included in the components of the surgical mortality predictor scoring system. The mortality prediction model was categorized into low risk (score < 7; probability of mortality 2.33%), medium risk (score 7-10; probability of mortality 25.22%), and high risk (score > 10; probability of mortality 74.67%). The prediction model showed good discrimination [AUC score 0.900 (95% CI: 0.873-0.927)] and good calibration (p=0.718 on Hosmer-Lameshow test). Conclusion. The prediction model of mortality among elderly patients undergoing elective surgery, incorporating factors like functional capacity, comorbidities, preoperative serum albumin concentrations, surgical procedure type, and ASA classification, showed good performance.
Honey Accelerates Wound Healing in Pressure Ulcer: A Review Halim, Jessica; Dwimartutie, Noto
Jurnal Plastik Rekonstruksi Vol. 7 No. 1 (2020): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (704.732 KB) | DOI: 10.14228/jpr.v7i1.291

Abstract

Introduction: Pressure ulcer (PU) is a result of prolonged pressure and shear over a bony prominence resulting in tissue injury of varying depth. To date, there is no standardized wound dressings for PU. Due to its availability and affordability, honey is suitable as PU wound dressing considering its anti-oxidant, anti-inflammatory, and antibacterial properties. This review article will provide evidence of the superiority of honey dressing.Methods: Literature source was searched through online databases with relevant keywords and then appraised for their validity, importance, and applicability. Total of three articles were appraised.Results: All articles agreed that application of honey on PU wounds reduced wound size and alleviate pain. Honey-impregnated gauze dressing promoted faster pain relief throughout treatment and less discomfort during each dressing change. Healing rate was proven 4 times faster with honey compared to other topical ointments. However, the antibacterial effect of honey was not significantly confirmed in the study. Nonetheless, topical application of honey successfully accelerates wound healing in PU.Conclusion: Honey is a promising alternative for topical dressings in patients with PU.
Vitamin D dan Kalsium untuk Pencegahan Fraktur pada Usia Lanjut Kevin Yonathan Widianto Thio; Noto Dwimartutie
Cermin Dunia Kedokteran Vol 49 No 7 (2022): Nutrisi - Vitamin D
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v49i7.258

Abstract

Latar Belakang: Fraktur pada usia lanjut berhubungan dengan peningkatan angka hospitalisasi, disabilitas, penurunan status fungsional, dan kematian. Oleh karena itu, fraktur pada usia lanjut masih menjadi suatu masalah kesehatan global yang cukup signifikan. Suplementasi vitamin D dan kalsium dapat menurunkan risiko fraktur, walaupun bukti-bukti yang ada masih inkonklusif. Tujuan: Mengumpulkan dan menganalisis studi-studi yang berkaitan dengan kombinasi suplementasi vitamin D dan kalsium serta hubungannya dengan risiko kejadian fraktur pada usia lanjut. Metode: Kami menelusuri database Pubmed, Proquest, EBSCOhost, dan Cochrane untuk mencari dan menganalisis studi terkait dalam bentuk randomized controlled trial (RCT) atau tinjauan sistematis dengan atau tanpa meta-analisis. Hasil: Didapatkan dan dipilih 2 artikel tinjauan sistematis dengan meta-analisis pada akhir pencarian literatur. Kedua studi menunjukkan hasil signifikan pemberian vitamin D dan kalsium dibandingkan plasebo/tanpa intervensi terhadap risiko fraktur secara umum (RR 0,74; 95%KI 0,58-0,94 dan RR 0,94; 95%KI 0,89-0,99) dan risiko fraktur tulang pinggul (RR 0,61; 95%KI 0,4-0,92 dan RR 0,84; 95%KI 0,72-0,97) pada usia lanjut. Simpulan: Suplementasi vitamin D dengan kalsium memiliki potensi menurunkan risiko fraktur pada usia lanjut. Studi dengan skala lebih besar mengenai dosis optimal dan keamanan masih diperlukan untuk mendapatkan bukti yang lebih kuat. Background: Fractures in older adults are associated with hospitalization, disability, functional decline, and mortality. It becomes an important public health problem. Combined vitamin D and calcium supplementation could decrease the risk of fracture, although recent evidence shows conflicting results. Aim: To collect and analyze studies related with combined vitamin D and calcium supplementation and its impact on fracture risk in older adults. Methods: A systematic search was conducted on Pubmed, Proquest, EBSCOhost, and Cochrane based on clinical query. Randomized controlled trials and meta-analyses were screened and critically appraised. Results: Two meta-analyses were obtained. The two studies showed that vitamin D and calcium supplementation, compared to placebo or no treatment, decreased risk of any fracture (RR 0.74, 95%CI 0.58-0.94 dan RR 0.94, 95%CI 0.89-0.99) and risk of hip fractures (RR 0.61, 95%CI 0.4-0.92 dan RR 0.84, 95%CI 0.72-0.97) significantly in older adults. Conclusion: Combined vitamin D and calcium supplementation in older adults decreases risk of fractures. Further studies on optimal dose and safety profiles are needed to ensure stronger evidence.
Tata Laksana Fraktur Panggul pada Geriatri: Sudut Pandang Internis Jannah, Laila M; Dwimartutie, Noto
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Abstract

Hip fracture are a common issue in geriatric patients, associated with increased risk of morbidity and mortality. The complex and multimorbid characteristics of geriatric patients presents significant challenge in their management. Optimal outcomes require a comprehensive interdisciplinary approach to care, aiming to restore functional status and reduce postoperative complications. A holistic strategy, grounded in thorough Comprehensive Geriatric Assessment (CGA), is essential to guide individualized treatment and ensure effective, patient-centered management.
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 Achmad Fauzy, Achmad Alvina Widhani, Alvina Andri Sulaiman Anggoro, RM Suryo Ari F Syam Aulia Rizka, Aulia Ceva W. Pitoyo Djafar, Fitria Dono Antono Edy Rizal Wahyudi Evy Yunihastuti Findy Prasetyawaty, Findy Gurmeet Singh Gurmeet Singh Halim, Jessica Harini Oktadiana Harini Oktadiana, Harini Hasan Maulahela, Hasan Ikhwan Rinaldi Iskandar A Jannah, Laila M Jeo, Wifanto Saditya Kevin Yonathan Widianto Thio Kevin Yonathan Widianto Thio Kuntjoro Harimurti Marcellus Simadibrata Marcellus Simadibrata Martini, Rose D Mira Yulianti, Mira Roza Mulyana Rudi Putranto Sabrina Munggarani Yusuf Satrio, Trian Setiati, Slti Siti Setiati Siti Setiati Susilo Chandra Tony Loho Ummi Ulfah Madina Ummi Ulfah Madina, Ummi Ulfah Wifanto Saditya Jeo