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All Journal Medical Journal of Indonesia Indonesian Journal of Rheumatology JFIOnline Narra J Pharmaceutical Sciences and Research (PSR) The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)
Siti Setiati
Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Bone Mass Density in HIV/AIDS Patients Mulansari, Nadia Ayu; Sukmana, Nanang; Setyohadi, Bambang; Setiati, Siti
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 4
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Pengembangan Model Prediksi Mortalitas 3 Bulan Pertama pada Pasien Penyakit Ginjal Kronik yang Menjalani Hemodialisis Umami, Vidhia; Lydia, Aida; Nainggolan, Ginova; Setiati, Siti
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 3
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Pendahuluan: Mortalitas pasien yang menjalani hemodialisis (HD) paling tinggi pada tiga bulan pertama. Data mengenai insidens dan prediktor mortalitas dini pada pasien HD sangat terbatas. Suatu model prediksi dapat menjadi alat bantu yang sederhana untuk mengetahui pasien yang berisiko tinggi sehingga pada akhirnya upaya pencegahan dapat dilakukan. Penelitian ini bertujuan untuk mengetahui insidens dan prediktor mortalitas 3 bulan pada pasien hemodialisis baru dan membuat suatu model prediksi. Metode: Penelitian dengan disain kohort retrospektif terhadap 246 pasien PGTA yang baru menjalani HD di Unit HD RSCM antara Januari 2011-Januari 2012. Dilakukan analisis chi-square untuk mendapatkan nilai OR (Odds Ratio) terhadap variabel usia, pembiayaan, jenis HD, akses pembuluh darah, anemia, hipoalbuminemia, kelainan EKG, kardiomegali, komorbid, waktu rujukan ke nefrologis, dan kepatuhan. Prediktor yang bermakna kemudian dimasukkan pada model regresi logistik untuk mendapatkan sistem skor. Hasil: Sebanyak 78 (31,7%) dari 246 pasien meninggal dalam 3 bulan pertama. Terdapat 5 variabel yang berhubungan dengan terjadinya mortalitas 3 bulan yaitu usia > 60 tahun, hemoglobin/dl, albumin serum Simpulan: Insidens mortalitas 3 bulan pada pasien HD baru sebesar 31,7%. Usia > 60 tahun, hemoglobin/dl, albumin serum
Serokonversi Hepatitis C pada Pasien Hemodialisis di Rumah Sakit Cipto Mangunkusumo Widhani, Alvina; Lydia, Aida; Gani, Rino A; Setiati, Siti
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 1
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Pendahuluan. Pasien hemodialisis (HD) tergolong kelompok risiko tinggi terinfeksi virus hepatitis C. Penelitian mengenai serokonversi hepatitis C di RS Cipto Mangunkusumo belum pernah dilakukan. Agar transmisi hepatitis C dapat diturunkan, faktor risiko serokonversi hepatitis C penting diketahui. Penelitian ini bertujuan mengetahui proporsi dan faktor risiko serokonversi hepatitis C pada pasien yang menjalani HD di RS Cipto Mangunkusumo. Metode. Penelitian potong lintang terhadap pasien yang menjalani HD di RS Cipto Mangunkusumo pada bulan Juni-Juli 2011. Pemeriksaan anti-HCV menggunakan Roche Elecsys ECLIA, Analisis multivariat menggunakan regresi logistik. Hasil. Pada bulan Juni-Juli 2011 terdapat 135 pasien HD yang memenuhi kriteria inklusi dan eksklusi. Serokonversi mencapai 21,5%. Analisis bivariat menunjukkan hubungan yang bermakna antara lama dialisis (p=0,003) dan jenis kelamin pria (OR 2,43; 95%CI 0,99-5,98; p=0,048) dengan serokonversi hepatitis C. Pasien yang menjalani dialisis >42 bulan (sebelum pemrosesan ulang dialiser menggunakan mesin) lebih banyak yang mengalami serokonversi dibandingkan pasien yang menjalani dialisis ≤42 bulan. Terdapat dua variabel yang marginally statistically significant yaitu HBsAg negatif (p=0,07) dan menggunakan dialiser proses ulang (p=0,07). Pada analisis multivariat, didapatkan jenis kelamin pria (OR 2,91; 95%CI 1,14-7,48; p=0,03) dan lama dialisis (OR 1,02; 95%CI 1-1,03; p=0,007) berhubungan dengan serokonversi hepatitis C. Simpulan. Serokonversi hepatitis C pada pasien yang menjalani HD di RS Cipto Mangunkusumo mencapai 21,5%. Terdapat hubungan signifikan antara jenis kelamin pria dan lama dialisis dengan serokonversi hepatititis C.
Factors Related to 30 day Mortality in Critically Ill Patients withInvasive Candidiasis in Cipto Mangunkusumo Hospital Ardian, Ardi; Pitoyo, Ceva W; Adhitianingsih, Dita; Santoso, Widayat Djoko; Setiati, Siti
Jurnal Penyakit Dalam Indonesia Vol. 4, No. 1
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Introduction. Mortality rate of invasive candidiasis is still high, approximately 30-70%. Every study has a variety mortality rate depend on study design and sample. There is no data in Indonesia about profile and mortality factors analysis in critically ill patients with invasive candidiasis. Methods. The Study design was cross sectional. We studied 102 hospitalized critically ill patients with invasive candidiasis. The demographic, clinical and laboratory data, the risk factors for invasive candidiasis and the outcome of each patient in 30 days were recorded. An analysis bivariate with chi square or Fisher’s test was carried out to analyse some factors such as age > 60 years old, severe sepsis, APACHE score > 20, respiratory failure, renal failure, delayed antifungal treatment > 72 hours after positive culture, Charlson index score, and ICU or non ICU patients. The logistic regression of multivariate analysis was carried out to identify the most influence of all mortality factors. Results. Among 102 identified sample, the majority was male (52.9%), the median age was 53 years old and the mortality rate was 68,6%. Laboratory candida findings came from blood sample (candidemia) (98.03%), liquor cerebrospinal (1.5%) and retina exudate (1.5%). The most common candida species were candida non albicans especially Candida tropicalis (34.3%) and Candida parapsilosis (34.3%). The risk factors for invasive candidiasis from this study related to underlying disease were sepsis (78.9%), malignancy (42.15%), diabetes mellitus (29.4%) and related to therapy or treatment were the usage of broad spectrum antibiotic (99%), central vein catheter (77.5%), and parenteral nutrition (70.6%). The result from multivariate analysis, severe sepsis (p 0.001, OR 7.7, IK95% 2.4 – 24.7), Charlson Index ≥3 (p 0.022, OR 3.5, IK95% 1.2–10.2), and respiratory failure (p 0.066, OR 2.7 IK95% 0.9 – 8.0) were independently associated with mortality. Conclusions. In Cipto Mangunkusumo hospital, most critically ill patients with invasive candidiasis was male, median age was 53 years old, and mortality rate was 68,6%. The most species candida caused infection were Candida tropicalis and Candida parapsilosis. The most risk factors of invasive candidiasis from underlying disease was sepsis and from the treatment was the usage of broad spectrum antibiotic. Severe sepsis, and Charlson index ≥3 were associated with a 30 day mortality in critically ill patients with invasive candidiasis.
The Association between Vitamin D 25(OH)D Level andAlbuminuria in Type 2 Diabetes Mellitus Indra, Tities Anggraeni; Lydia, Aida; Purnamasari, Dyah; Setiati, Siti
Jurnal Penyakit Dalam Indonesia Vol. 4, No. 1
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Introduction. Vitamin D 25(OH)D deficiency was reported as a possible risk factor for the development of diabetic nephropathy in several epidemiologic studies. Whether vitamin D 25(OH)D deficiency plays a role in the development of diabetic nephropathy in Indonesia is unknown. This study aims to determinate the association between vitamin D 25(OH)D level with albuminuria in patients with type 2 diabetes mellitus in Indonesia. Methods. A cross-sectional study was conducted in 96 patients with type 2 diabetes mellitus at outpatient clinic of MetabolicEndocrine Cipto Mangunkusumo Hospital. Serum vitamin D level was assessed using Diasorin kit with CLIA method, while albuminuria was assessed using random urine sample. Statistical analysis was conducted using chi square for bivariate analysis and regression logistic method for multivariate analysis. Results.The prevalence of vitamin D 25(OH)D deficiency in patients with type 2 diabetes mellitus was 49% with a median value 16,35 (4,2-41,4) ng/mL. There was no significant correlation between vitamin D deficiency with the severity of albuminuria (OR 0,887; 95% CI 0,335 to 2,296). Confounding factors such as poor blood glucose control and overweight strongly influenced the association between vitamin D deficiency with the incidence of albuminuria in patients with type 2 diabetes mellitus. Conclusion. The results of this study showed that there was no association between vitamin D deficiency with the severity of albuminuria in patients with type 2 diabetes mellitus in Indonesia.
Five-Year Survival in Patients with 3-Vessels Coronary ArteryDisease and Diabetes Mellitus Undergoing Coronary ArteryBypass Graft, Coronary Percutaneus Intervention, or ReceivingPharmacological Therapy in Cipto Mangunkusumo Hospital Setiawan, Andreas Arie; Panggabean, Marulam; Yamin, M; Setiati, Siti
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 2
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Introduction. Revascularization results in patients with diabetes mellitus (DM) and coronary artery disease involving 3 vessels (CAD 3VD) undergo coronary artery bypass surgery (CABG) are better compared with those undergo percutaneous coronary intervention (PCI) or medical therapy. However, CABG is not always done despite being recommended in accordance with Syntax Score because some patients unwilling to undergo CABG or PCI . This trial determined whether the choice of revascularization affect 5-years survival. Methods. This was a retrospective cohort study with survival analysis to examine the 5-years survival rate of CAD 3VD DM patients undergoing CABG, PCI, or medical therapy. The study was conducted using secondary data of 126 CAD 3VD DM patients who underwent CABG, PCI, or medical therapy at Cipto Mangunkusumo Hospital in 2006-2007 and followed up to 2011-2012 if there any incident died. Results. Best survival was seen in the CABG group (93.5%). The largest proportion of death occured in the medical therapy group (36.1%). The CABG survival was significantly better than the IKP (p=0.01) and medical therapy (p=0.001). PCI group had better survival than medical therapy (69.5% vs. 63.9%). Although not statistically significant, but the proportion of complaints after revascularization in PCI group were found less than medical therapy group (52% vs. 38%). Syntax score that assesses the complexity of stenosis had a significant association with survival (p 0.039). Conclusions.5-years survival of CAD 3VD DM patients is best obtained in the group that underwent CABG. 5-year survival of CAD 3VD DM patients who underwent PCI better than medical therapy but was not statistically significant. Factor that affect the 5-years survival is the complexity stenosis viewed by the Syntax score.
Prevalence and Predictors of Atopy in HIV/AIDS Patients Tesiman, Jimmy; Sundaru, Heru; Karjadi, Teguh H.; Setiati, Siti
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 2
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Introduction. HIV infection attacks the center of immune control system resulting opportunistic infection, malignancy and death. Immune system dysregulation plays the central role in the progression of the disease. Some studies reported that HIV-infected patient prone to have allergic disease such as sinusitis, asthma and atopic dermatitis. Elevated serum immunoglobulin E (IgE) and increased prevalence of atopy had also been reported in HIV-infected patient. Methods. A cross sectional study was performed in 92 HIV-infected persons and 90 non-HIV persons. Atopy diagnosis was based on immediate hypersensitivity to six common aeroallergen using skin prick test. CD4 cell count, total serum immunoglobulin level and medical history were taken. Results. Among total of 92 HIV/AIDS patients and 90 non-HIV persons, there were 65 males (70.7%) and 27 female (29.3%) in HIV group and 40 males (44.4%) and 50 females (55.6%) in non-HIV group. Age of all subjects range from 20 to 55 years old, mean age of HIV-infected patients was 29.3 (SD 5.7) years while mean age of controls was 27.9 (4.5) years old. Based on HIV route transmission, there were 56.5% subjects infected from intravenous drug user, 38% from heterosexual intercourse and 5.5% subjects had both risk. CD4+ lymphocyte counts of the subject range from 2-674 cells, median 160 cells/uL. Serum total IgE levels range from 3-20.000 IU/mL with median 283.5 IU/mL. Atopy was higher in subjects with HIV than non-HIV (p= 0,001). The most common aeroallergen is Dermatophagoides farinae (50%) and Dermatophagoides pteronyssinus (30%). There was a negative correlation between CD4+ lymphocyte count and total IgE level (r=-0,544, p<0,001), but there is no relation between gender, HIV route of transmission, allergic history in family and CD4+ lymphocyte count with atopy. Conclusions. Prevalence of atopy based on skin prick test among HIV/AIDS patients was higher than non-HIV group. There was a negative correlation between CD4+ lymphocyte count and total IgE level.
Auto Immune Hemolytic Anemia (AIHA) Patients Profile and Treatment Response to Corticosteroids in Cipto Mangunkusumo Hospital Rajabto, Wulyo; Atmakusuma, Djumhana; Setiati, Siti
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 4
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Determinan Diagnostik Klinis Defisiensi Vitamin D pada Wanita Berusia Lebih dari 50 Tahun Vera, Vera; Setiati, Siti; Govinda, Arya
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 1
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Pendahuluan: Prevalensi deifisiensi vitamin D pada wanita 50 tahun ke atas di Indonesia cukup tinggi namun pemeriksaan kadar vitamin D serum sangat mahal. Oleh karena itu, diperlukan alat penyaring defisiensi vitamin D yang cukup ekonomis dan sederhana untuk dikerjakan di layanan kesehatan primer. Metode: Penelitian ini merupakan penelitian diagnostik, menggunakan desain potong lintang (cross-sectional) sehubungan dengan pengambilan data hanya dilakukan sewaktu saja. Penelitian ini dilakukan di Kotamadia Bandung selama Agustus–Oktober 2012. Pada 240 subjek, dilakukan pengumpulan data berupa karakteristik responden, diabetes mellitus, penyakit ginjal kronik, riwayat jatuh, riwayat fraktur setelah menopause, nyeri tulang, skor paparan sinar matahari, skor proteksi sinar matahari, status gizi, kinerja fisik (5 timed chair-stands dan uji sikap tandem), status kesehatan (jumlah dan derajat berat penyakit kronis), kadar vitamin D serum. Untuk pengujian statistik hubungan antara dua variabel kualitatif dikotom dilakukan dengan uji Chi-square dilanjutkan dengan uji multivariat. Hasil: Penelitian ini menemukan hubungan yang bermakna secara statistik antara diabetes mellitus, skor proteksi matahari, kelemaan otot ekstremitas bawah dengan defiisensi vitamin D. Berdasarkan ketiga determinan tersebut, dapat dibuat sistem skoring yang dapat digunakan untuk menyaring kelompok wanita 50 tahun ke atas yang mempunyai probabilitas besar menderita defisiensi vitamin D. Simpulan: Determinan diagnostik defisiensi vitamin D berat yang ditemukan pada penelitian ini meliputi: adanya diabetes melitus, skor proteksi matahari, kelemahan otot tungkai bawah. Sistem skoring untuk menyaring defisiensi vitamin D berat pada wanita berusia 50 tahun ke atas dapat dibuat berdasarkan ketiga determinan tersebut di atas. Bobot untuk masing-masing determinan adalah: 1 untuk diabetes mellitus dan kelemahan otot tungkai bawah serta 2 untuk skor proteksi matahari. Bila penjumlahan dari skor ketiga komponen tersebut ³2, maka subjek tersebut diprediksi menderita defisiensi vitamin D berat.
Proporsi dan Faktor-Faktor yang Berhubungan dengan Kejadian Hipotensi Postprandial pada Usia Lanjut Hamonangan, Rachmat; Alwi, Idrus; Wahyudi, Edy Rizal; Setiati, Siti
Jurnal Penyakit Dalam Indonesia Vol. 1, No. 1
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Pendahuluan: Hipotensi postprandial sebenarnya sering terjadi dan saat ini dikenal sebagai masalah klinis yang penting. Studi-studi yang ada menunjukkan bahwa prevalensi hipotensi postprandial pada usia lanjut cukup tinggi. Hipotensi postprandial merupakan prediktor mortalitas pada orang usia lanjut dan menyebabkan banyak sekuele yang signifikan pada subyek yang terkena. Hingga saat ini, penelitian-penelitian yang berkaitan dengan hipotensi postprandial lebih banyak dilakukan pada kelompok usia lanjut di negara-negara maju yang definisi usia lanjut, proporsi penyakit, proporsi obat-obatan yang digunakan serta proporsi asupan yang berbeda dengan kelompok usia lanjut di negara berkembang khususnya Indonesia. Tujuan. Mengetahui proporsi dan faktor-faktor yang berhubungan dengan kejadian hipotensi postprandial pada kelompok usia lanjut. Metode: Penelitian studi potong-lintang dilakukan pada subjek usia lanjut di RSCM. Dilakukan pengisian kuesioner dan pengukuran tekanan darah sebelum makan dan setiap 15 menit sampai 2 jam setelah makan. Makanan yang dimakan dicatat untuk dianalisis. Hasil: Selama periode Januari – Maret 2010 terkumpul 119 subjek usia lanjut dengan rerata umur 67,50 ± 5,92 tahun. Sebanyak 53,8% memiliki hipertensi dan menggunakan obat anti hipertensi, 36.1% memiliki riwayat diabetes mellitus dan menggunakan obat pengontrol gula darah, 9,2% pernah mengalami stroke, 7.6% menggunakan terapi digoksin, 29.4% menggunakan terapi nitrat dan 3.4% menjalani hemodialisis rutin. Hipotensi postprandial didapatkan pada 55% subjek. Penggunaan obat diuretik loop dan insulin berhubungan dengan kejadian hipotensi postprandial. Selain itu diketahui pula bahwa penurunan tekanan darah postprandial lebih besar pada subjek dengan hipertensi, menggunakan obat ACE inhibitor, menggunakan obat diuretik loop/furosemid, menggunakan diuretik HCT, menggunakan insulin dan menggunakan obat nitrat. Simpulan: Penelitian ini menyimpulkan bahwa proporsi hipotensi postprandial pada subjek usia lanjut adalah 55%. Penggunaan obat diuretik loop dan insulin berhubungan dengan kejadian hipotensi postprandial. Penurunan tekanan darah postprandial lebih besar pada subjek dengan hipertensi, menggunakan obat ACE inhibitor, menggunakan obat diuretik loop/furosemid, menggunakan diuretik HCT, menggunakan insulin dan menggunakan obat nitrat.
Co-Authors Abdul Aziz Rani Abdul Aziz Rani Abellia, Gaby Adityo Susilo, Adityo Afistianto, Muhammad Fikri Agus Rizal Ardy Hariandy Hamid, Agus Rizal Ardy Hariandy Agus Siswanto Aida Lydia, Aida Alimuddin, Suriani Alvina Widhani, Alvina Amalialjinan, Nadia Andreas Arie Setiawan, Andreas Arie Andri Sanityoso Andri Sanityoso Anindyanti, Risma Debby Ardi Ardian, Ardi Ari F Syam Ari Fahrial Syam Arif Mansjoer Arya Govinda Arya Govinda Roosheroe, Arya Govinda Aulia Rizka, Aulia Ayatullah Khomaini Bambang Setyohadi Bambang Sutrisna Budi I Santoso, Budi I Budi Iman Santoso Budi Tan Oto Catarina Budyono, Catarina Ceva W. Pitoyo CHAIDIR A MOCHTAR, CHAIDIR A Cleopas M Rumende, Cleopas M Dadang Makmun Dharmeizar Dharmeizar Dian Handayani Diana, Nyimas Dienillah, Syifa Sarah Dita Adhitianingsih, Dita Djumhana Atmakusuma, Djumhana Dono Antono Drupadi Harnopidjati Singh Dillon Dyah Purnamasari E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Edy Rizal Wahyudi Em Yunir, Em Eric Daniel Tenda Ernawati Erwinanto Esthika Dewiasty, Esthika Euphemia Seto, Euphemia Febriyani Fiastuti Witjaksono Findy Prasetyawaty, Findy Firtantyo A Syahputra, Firtantyo A Ginova Nainggolan Harrina E Rahardjo, Harrina E Harrina Erlianti Rahardjo, Harrina Erlianti Harry Isbagio Herikurniawan, Herikurniawan Heru Sundaru Idrus Alwi Ika P Wijaya, Ika P Ika Prasetya Wijaya Imam Subekti Ina Susianti Timan Indra G Mansur, Indra G Iris Rengganis Irsan Hasan Jimmy Tesiman, Jimmy Joedo Prihartono Junizaf Junizaf Kuntjoro Harimurti Laura A Siahaan, Laura A Lugyanti Sukrisman Lukman Hakim M Sadikin M Yamin Marcel Prasetyo Marcellus Simadibrata Marcellus Simadibrata Martini, Rose D Marulam Panggabean, Marulam Megantara, Marcelino A. Meilania Saraswati Merry Christianie Merry Christianie, Merry Muhammad Yamin Murdani Abdullah Nadia Ayu Mulansari, Nadia Ayu Nafrialdi Nafrialdi Nanang Sukmana Nasrun, Martina W. Noto Dwimartutie Nur Rasyid Nur Riviati, Nur Nurhadi Ibrahim Partini P Trihono, Partini P Ponco Birowo Pradana Soewondo Pudji Rahardjo Purwita W Laksmi, Purwita W Purwita Wijaya Laksmi Rachmat Hamonangan, Rachmat Radhiyatam Mardhiyah, Radhiyatam Ralph Girson Gunarsa Retnosari Andrajati Rino A Gani Rochani Sumardi, Rochani Roza Mulyana Rudi Putranto Rudy Hidayat Saraswati, Mita Hafsah Savitri, Ary Indriana Simon Salim Siti A Nuhonni, Siti A Stevent Sumantri, Stevent Suhendro Suwarto, Suhendro Suksmono Haricahyo Sumariyono Supartondo Supartondo Surahman Hakim Suzanna Immanuel Tanadi, Caroline Tedjasaputra, Shirly Elisa Teguh H Karjadi, Teguh H Teguh H. Karjadi, Teguh H. Tirza Z Tamin Tities Anggraeni Indra, Tities Anggraeni Tri B.W. Rahardjo Uiterwaal, Cuno Ummi Ulfah Madina, Ummi Ulfah vera vera, vera Vidhia Umami, Vidhia Wasilah Rochmah Widayat Djoko Santoso, Widayat Djoko Widi Atmoko Widjajalaksmi Kusumaningsih, Widjajalaksmi Wiguno Prodjosudjadi Wijaya, Indra Wismandari Wisnu Wresti Indriatmi B. Makes Wulyo Rajabto Yulia Trisna Yulia Trisna, Yulia