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All Journal Indonesian Journal of Cancer Indonesian Journal of Rheumatology World Nutrition Journal Indonesian Journal of Cancer eJournal Kedokteran Indonesia The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia
Ikhwan Rinaldi
Divisi Hematologi Onkologi Medik, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia, Rumah Sakit Dr. Cipto Mangunkusumo
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Profil of Implementation of Post Exposure Prophylaxis of Hepatitis B, Hepatitis C and Human Immunodeficiency Virus to Health Care Worker in Cipto Mangunkusomo Hospital 2014-2016 Ratih, Dewi Mira; Yunihastuti, Evy; Lestari, Regina; Sulaiman, Andri Andri; Rinaldi, Ikhwan
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 1
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Introduction. Health care workers (HCW) have a high risk of infectious substance exposure. Hepatitis B, hepatitis C, or human immunodeficiency virus (HIV) are some diseases transmitted by body fluid or body tissue. Cipto Mangunkusumo Hospital Jakarta has been implementing post-exposure prophylaxis (PEP)s towards HIV, hepatitis B, and hepatitis C. This study aimed to identify the implementation of post-exposure prophylaxis of HIV, Hepatitis B, and Hepatitis C among HCW in Cipto Mangunkusumo Hospital Jakarta. Methods. A cross-sectional study was conducted to exposed workers in Cipto Mangunkusumo Hospital Jakarta between 2014-2016 who had been recorded by report. Demographic data were collected through medical record and interview was conducted to gather additional data. Statistical analysis was conducted with SPSS 20. Results. Among 196 reports, most HCW were female (69.9%), worked as nurse (38.3%), medical doctor (49.5%), and exposed percutaneously (93.4%). There were 183 risky exposures, with 19 (10.4%) reactive anti-HIV, 11 (6.0%) positive HBsAg, and 12 (6.6%) reactive anti-HCV in source of exposure. Almost all of the HCW has no HIV, hepatitis B, nor hepatitis C at the moment of exposure. Recommendation for antiretroviral (ARV) was given to 81 HCW, but only 49.4% completed the course. Anti-HIV follow up was done only by 21.3% workers. Recommendation of PEP for hepatitis B was given to 37 HCW. But, only 13.5% and 13.3% receive hepatitis B vaccination and hepatitis B immunoglobulin, respectively. Follow-up of HBsAg and anti-HBs on 3rd and 6th months were done by 41 (31.1%), 38 (28.8%), and 2 (1.5%) workers who were recommended to receive prophylaxis. In 182 workers recommended to do the follow-up of anti-HCV, 39 (21.4%), and 37 (20.3%) workers did the follow-up on 3rd and 6th month. Majority of exposed workers were not re-evaluated for HBsAg (64.9%) and anti-HCV (69.9%). Conclusions. The implementation of post-exposure prophylaxis for HIV, Hepatitis B, and Hepatitis C was still low especially in re-evaluation serologic marker. Comprehensive management is recommended including improving knowledge of health care workers, re-evaluation of operational procedure standard, and effective communication.
Pica sebagai Manifestasi Anemia Defisiensi Besi: Suatu Laporan Kasus murwaningrum, artati; Rinaldi, Ikhwan; Mustopa, Inna Intani
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 2
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Prevalence of anemia in Indonesia based on Basic Health Research (2018) was 23.7%. Symptoms of iron deficiency anemia were pallor, malaise, palpitation, shortness of breath, headache, sore tongue. But sometimes can be found abnormal behavior in the form of PICA. This article reports on a-52-year-old man who sought medical treatment and was diagnosed with iron deficiency anemia with pica manifestation. The pica manifestation was characterized by a repeated desire to consume raw rice due to bleeding from hemorrhoids. Patient was given oral iron replacement therapy contain 100 mg of Fe (III) hydroxide polymaltose complex and folic acid 0.35 mg alternating with vitamin C 500 mg daily. Total iron daily dose given were 200 mg, divided in two doses. The patient received dietary education and was advised to consult a Gastroenterohepatology Subspecialist for the management of hemorrhoids, but it has not been done yet. The desire for raw rice consumption disappeared and the hemoglobin level increased to 12.4 g/dL after six weeks of therapy. The patient continued to take iron supplements until January 2023 but did not have follow-up visits to the clinic. In January 2023, the patient underwent hemorrhoid surgery due to bleeding accompanied by and a non-reducible lump that had been present for three days. Iron supplements continued for one month post-operation and then discontinued. The latest hemoglobin level was 15.3 g/dL without iron supplements. The symptoms of pica in this patient disappeared along with an increased hemoglobin level, and the management of severe anemia in this patient showed an adequate response. Bleeding has never occurred again after the surgery. Curative measures for hemorrhoidal bleeding are crucial, while iron supplementation is only a supportive therapy.
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
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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.
Beyond COVID-19 Paradigm: Devastating Rare Fungal Ocular Complication Edwar, Lukman; Kusumowidagdo, Gladys; Djatikusumo, Ari; Yudantha, Anggun R.; Mardianto, Umar; Rozaliyani, Anna; Rinaldi, Ikhwan; Rachmadi, Lisnawati
eJournal Kedokteran Indonesia Vol. 12 No. 3 (2024): Vol. 12 No. 3 - Desember 2024
Publisher : Faculty of Medicine Universitas Indonesia

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Ocular involvement in COVID-19 is rare and often mild. We report a case of severe bilateral ocular candidiasis post-COVID-19 infection. A male, 48 years old, suffered from sudden blurry vision in the right eye (RE). The patient had a history of COVID-19, ICU stay, ventilator use, and a hypercoagulable state. The patient had a history of tocilizumab and steroid use. The initial best corrected visual acuity (BCVA) was 6/30 (RE), with progressive worsening of light perception and 6/6 on the left eye (LE) to 3/60. Examination revealed string-of-pearls and snowball on vitreous, fibrovascular tissue with exudates and subretinal fluid on the macula. Tractional retinal detachment was found in both eyes, and these findings were consistent with fungal endophthalmitis. Culture was taken from a chest lump and it was positive for Candida albicans. The patient was diagnosed with bilateral ocular candidiasis and treated with a 14-day course of intravenous voriconazole and vitrectomy. The final BCVA was hand movement (RE) and 6/45 (LE).
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
Hubungan Hiperurisemia dengan Penurunan LFG pada Pasien Penyakit Ginjal Diabetes di RSCM Jakarta Adna, Rury Maharani; Marbun, Maruhum Bonar Hasiholan; Rinaldi, Ikhwan; Yunir, Em; Koesnoe, Sukamto; Singh, Gurmeet; Sinto, Robert
Jurnal Penyakit Dalam Indonesia
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Introduction. Elevated serum uric acid levels are associated with the progression of kidney disease in patients with type 2 diabetes mellitus (DM), through mechanisms involving endothelial dysfunction, oxidative stress, and chronic inflammation. Research in Indonesia on the relationship between uric acid levels and the decline of glomerular filtration rate (GFR) in diabetic patients remains limited. This study aimed to determine the association between serum uric acid (SUA) levels and decline in glomerular filtration rate among patients with diabetes mellitus diagnosed with diabetic kidney disease at Cipto Mangunkusumo Hospital, Jakarta, over a one-year period. Methods. This retrospective cohort study analyzed medical records of 192 type 2 diabetes melitus patients attending the Endocrinology and or Kidney Hypertension Clinics at Cipto Mangunkusumo National General Hospital , Jakarta. Inclusion criteria were baseline glomerular filtration rate ≥60 mL/min/1.73 m², available baseline serum uric acid, and follow-up glomerular filtration rate after one year. Bivariate and multivariate analyses were performed, adjusting for confounders including age, sex, hypertension, body mass index (BMI), triglycerides, HDL, LDL, total cholesterol, HbA1c, fasting blood glucose, and albuminuria. Results. Hyperuricemia prevalence was 85.94%. Multivariate analysis revealed that elevated SUA levels (≥6 mg/dL in women, ≥7 mg/dL in men) were associated with a 13.5% higher risk of GFR decline compared to normal serum uric acid (RR 1.135; 95% CI 1.015–1.268) after adjustment. Higher Body mass index was protective against glomerular filtration rate decline, while lipid profile, HbA1c, and fasting blood glucose were not significantly associated with diabetic kidney disease progression. Conclusions. Hiperuricemia is an independent risk factor for diabetic kidney disease progression in type 2 diabetes mellitus. Regular monitoring and management of serum uric acid may be crucial in preventing kidney function decline in this population.
Faktor-Faktor yang Berhubungan dengan Gejala Depresi pada Pasien Insomnia Usia Lanjut di Rawat Jalan Pratiwi, Amalia Nur; Wahyudi, Edy Rizal; Kusumaningrum, Profitasari; Shatri, Hamzah; Rinaldi, Ikhwan; Gani, Rino Alvani; Wijaya, Ika Prasetya; Susilo, Adityo; Renaldi, Kaka
Jurnal Penyakit Dalam Indonesia
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Introduction. The elderly population is increasing globally, including in Indonesia, where 10.7% of the population in 2020 were elderly. Insomnia is a common health issue among older adults and has been identified as a predictor of depression. This study aims to identify factors associated with depressive symptoms in elderly outpatients with insomnia. Methods. This cross-sectional study was conducted in 2024 on patients aged ≥60 years at the outpatient unit of Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia, using consecutive sampling to select participants. Elderly patients were screened using the Pittsburgh sleep quality index (PSQI), and those with a score >5 (indicating insomnia) were included as study subjects. Data were collected through interviews, covering sociodemographic characteristics, level of loneliness, duration of insomnia, depressive symptoms [Geriatric Depression Scale–15 (GDS-15) items], functional status [Barthel Activities of Daily Living (B-ADL)], cognitive status [Mini-Mental State Examination (MMSE)], nutritional status [Mini Nutritional Assessment (MNA)], and chronic diseases [Cumulative Illness Rating Scale for Geriatrics (CIRSG) score]. Results. The study included 209 elderly subjects with insomnia, with a mean age of 72.88 (SD 6.98) years, and a depression prevalence of 6.7%. Bivariate analysis showed significant associations between dependency (PR 5.24; 95% CI 1.50 – 18.29), malnutrition (PR 11.54; 95% CI 4.77 – 27.92), and chronic disease with a CIRSG score ≥9 (PR 4.15; 95% CI 1.18 – 14.50) and depressive symptoms in elderly patients with insomnia. No significant associations were found between sociodemographic factors, loneliness, duration of insomnia, or cognitive status and depression. Multivariate logistic regression analysis revealed a statistically significant association between malnutrition and depressive symptoms (p < 0.001). Conclusions. There is a significant association between malnutrition and depressive symptoms in elderly outpatients with insomnia. Further cohort studies are recommended to explore the causal relationship between malnutrition and depression in elderly patients with insomnia.
Co-Authors Achmad Fauzy, Achmad Adityo Susilo, Adityo Adna, Rury Maharani Afifah Is Andhika Rachman Andri Sanityoso Sulaiman Anna Rozaliyani Ari Fahrial Syam Arif Harryanto Reksodiputro Arif Harryanto Reksodiputro, Arif Harryanto Arini Setiawati Arry Haryanto Reksodiputro Artati Murwaningrum, Artati Bambang Setyohadi Bambang Setyohadi Birry Karim C Rinaldi A Lesmana Ceva W. Pitoyo Cleopas Martin Rumende Cleopas Martin Rumende Dadang Makmun Dewi Mira Ratih Diana Sunardi Djatikusumo, Ari Dono Antono E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Edy Rizal Wahyudi Em Yunir Em Yunir, Em Endy Novianto Endy Novianto, Endy Evy Yunihastuti Findy Prasetyawati Findy Prasetyawati, Findy Gurmeet Singh Hasan Maulahela, Hasan Henry Ratno Diono Silalahi Henry Ratno Diono Silalahi, Henry Ratno Diono HILMAN TADJOEDIN, HILMAN Ika Prasetya Wijaya Jerry Eddya Putra Boer Juferdy Kurniawan Kaka Renaldi Karmel L Tambunan, Karmel L Kuntjoro Harimurti Kusumaningrum, Profitasari Kusumowidagdo, Gladys Lestari, Regina Lisnawati Rachmadi Lugyanti Sukrisman Lukman Edwar Marbun, Maruhum Bonar Hasiholan Mardianto, Umar Muhadi Muhadi Muhadi Muhadi, Muhadi Muningtya Philiyanisa Alam Murdani Abdullah Murdani Abdullah Mustopa, Inna Intani Nabil Mubtadi Falah Nabil Mubtadi Falah, Nabil Mubtadi Noto Dwimartutie Pratiwi, Amalia Nur Purwita Wijaya Laksmi Rahmat Cahyanur Rahmat Cahyanur Rasco Sandy Sihombing Rasco Sandy Sihombing, Rasco Sandy Ratih, Dewi Mira Regina Lestari Reinaldo Alexander Reksodiputro, Arry H. Reza Yogaswara Rino Alvani Gani Robert Sinto Rudi Putranto Rudi Putranto Rudy Hidayat Rudy Hidayat Sabrina Munggarani Yusuf Sepmeitutu, Iwandheny Shufrie Effendi, Shufrie Sukamto Koesnoe Sulaiman, Andri Andri T. Djumhana Atmakusuma, T. Djumhana Tengku Riza Zarzani N Triyanta Yuli Pramana Yogaswara, Reza Yudantha, Anggun R.