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Robert Sinto
Faculty of Medicine University of Indonesia, Jakarta
Medicine & Pharmacology

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Peran Penting Pengendalian Resistensi Antibiotik pada Pandemi COVID-19 Sinto, Robert
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 4
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Profile of Patients Neutropenia Fever Unrelated to Chemotherapy in Dr. Cipto Mangunkusumo General Hospital Danasasmita, Gantira; Chen, Lie Khie; Sinto, Robert; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 4
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Introduction. The condition of neutropenia increases the risk of infection. The causes of neutropenia are widely discussed as side effects of chemotherapy, but patients with neutropenia who are not due to side effects of chemotherapy are increasing in number. This study aims to provide an overview of the characteristics of neutropenic fever population unrelated to chemotherapy. Method. The study was conducted retrospectively on the medical records of neutropenic fever patients who were not chemotherapy-related in the National Hospital Dr. Cipto Mangunkusumo in January 2018-November 2019. Variables studied included demographic, clinical characteristics, classification of multinational association of supportive care in cancer (MASCC) scores and their etiology, and mortality outcomes within 5 days of treatment. Results. Total of 68 subjects were included in this study, consist of 50% female and 50% male with median age was 38.5 years (interquartile range 27). Diagnosis data showed that 86.8% subjects were patients with hematological abnormalities, 3 patients had solid tumors (lymphoma, colon cancer and lung cancer), and the rest were non-malignant diseases. Analysis showed that 72.1% onset of fever was found in outpatient care, the rest was inpatient care. The mean value of absolute neutrophil count was 201.50 (SD 173.18), meanwhile the mean MASCC score was 21 (SD 4.54) in the low-risk category. A total of 35 subjects (51.5%) had a MASCC low risk score and 33 subjects (48.5%) had a high risk. The median procalcitonin subject was 1.99 ng / mL (range 0.11 - 178.30). The 5-days mortality incidence was 54.4%. Chi-square analysis of the two groups found significant differences in care mortality (p <0.05). Analysis with Independent T-test also showed a significant differences in the parameters of age and systolic blood pressure values between the high risk and low risk groups. Conclusions. The majority etiologies among subjects were haematological disorders. Based on the MASCC score, most of the subjects were in the high-risk group. Total of mortality incidence was 54.4%.
Association between Early Antibiotic Administration and In-Hospital Mortality in Moderate and Severe COVID-19 Patients Chen, Lie Khie; Nathanael, Jason; Shakinah, Sharifah; Pasaribu, Adeline; Sinto, Robert; Nainggolan, Leonard; Susilo, Adityo
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 4
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Introduction. Patients with moderate and severe COVID-19 generally receive antibiotic therapy with consideration of the possibility of co-infection or secondary bacterial infection which clinically is difficult to distinguish from COVID-19 symptoms. Overuse of antibiotics can lead to an increased risk of bacterial resistance to antibiotics which is associated with poor outcomes in COVID-19 patients. This study aimed to assess the effect of early antibiotic administration on mortality in moderate and severe COVID-19 patients. Methods. An observational study with a retrospective cohort design was conducted at Dr. Cipto Mangunkusumo Hospital. Data were obtained from medical records of patients admitted from March to September 2020. Patients who received early antibiotics were defined as patients who received antibiotics hospital, 108 subjects were included in this study, 74 (68.5%) with moderate degrees and 34 (31.5%) with severe degrees. Early antibiotics were administered to 79 (73.1%) subjects with a median start time of one day. The results of the bivariate analysis did not find a significant effect of early antibiotic administration on mortality in moderate or severe COVID-19 patients (p=0.42). Subgroup analysis based on the degree of disease also found no significant results. Conclusion. There is no relationship between early antibiotic administration and mortality of moderate and severe COVID-19 patients.
Current Clinical Approach of Nosocomial Clostridium difficileInfection Liwang, Frans; Sinto, Robert
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 2
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Hospital-acquired Clostridium difficile infection (CDI) has become one of the global threats because the incidence has increased in recent decades. This nosocomial infection is closely related to antibiotic use in health services and is commonly found in the elderly. Antibiotics can promote colonization and CDI by intestinal microbiota dysbiosis and complex innate immune system activation. The manifestation also has a wide spectrum, ranging from mild diarrhea to fulminant colonic mucosal necrosis. Given that not all colonized subjects will be infected, further investigations such as toxigenic culture, nucleic-acid detection, and stool immunologic tests are only useful in symptomatic cases. In all CDI cases, an effort to control and prevent infections, including rational use of antibiotics, is warranted. Besides the use of antibiotics to eradicate the bacteria, surgery is often indicated in fulminant cases—another novel therapy for recurrent CDI as follows fecal microbiota transplantation, antitoxin antibody, and novel antibiotics.
Pemeriksaan Kadar Laktat pada Tata Laksana Sepsis:Apakah Benar Diperlukan? Sinto, Robert
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 1
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Coronavirus Disease 2019: Review of Current Literatures Susilo, Adityo; Rumende, C. Martin; Pitoyo, Ceva W; Santoso, Widayat Djoko; Yulianti, Mira; Herikurniawan, Herikurniawan; Sinto, Robert; Singh, Gurmeet; Nainggolan, Leonard; Nelwan, Erni J; Chen, Lie Khie; Widhani, Alvina; Wijaya, Edwin; Wicaksana, Bramantya; Maksum, Maradewi; Annisa, Firda; Jasirwan, Chyntia OM; Yunihastuti, Evy
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 1
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Parameter Akhir Resusitasi Makrosirkulasi dan Mikrosirkulasi pada Sepsis Berat dan Renjatan Septik Sinto, Robert; Suwarto, Suhendro
Jurnal Penyakit Dalam Indonesia Vol. 1, No. 1
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Sepsis berat dan renjatan septik telah menjadi masalah kesehatan yang utama di seluruh dunia. Untuk menekan angkamortalitas dini, upaya resusitasi yang dilakukan pada keadaan sepsis berat dan renjatan septik harus ditujukan padapencapaian target parameter makrosirkulasi maupun mikrosirkulasi, khususnya yang telah terbukti berhubungan denganmortalitas dini. Parameter tersebut meliputi tekanan vena sentral, rerata tekanan arteri, produksi urin, saturasi oksigen venasentral, hematokrit, laktat, bersihan laktat, dan ekses basa standar. Kelebihan dan keterbatasan tiap parameter harusdipahami dengan baik dalam upaya interpretasi yang tepat terhadap hasil pemeriksaan parameter tersebut.
Peningkatan Leukosit, Neutrofil, dan Prokalsitonin Persisten Tanpa Bukti Infeksi pada Kanker Stadium Akhir: Sebuah Laporan Kasus Yanuar, Santosa; Ahani, Ardhi Rahman; Setiabakti, Andrian; Rizka, Aulia; Sinto, Robert
Jurnal Penyakit Dalam Indonesia Vol. 11, No. 2
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Elevation of leukocyte, neutrophil, and procalcitonin (PCT) has been known as a marker of bacterial infection independent of the underlying disease. This article will describe a case of end-stage cancer with persistent elevation of leukocyte, neutrophil, and procalcitonin with no evidence of infection. A 45-year-old female presented with abdominal distension for three months prior to hospital admission. The patient was suspected to have breast cancer with hepatic metastasis based on diagnostic tests. Throughout treatment, the patient experienced persistent elevation of leukocytes, neutrophils, and PCT despite no signs or symptoms of infection from history, physical examination, and diagnostic tests. The patient received antibiotic therapy including ciprofloxacin escalated to meropenem, but leukocytes, neutrophils, and PCT did not decrease. A breast tumor biopsy was performed. The result of biopsy revealed after the patient had passed away. The histopathology was invasive carcinoma, No Special Type (NST) of right breast. The immunohistochemistry showed luminal B type, HER2 positive. The persistent increase in leukocytes and neutrophils in this patient indicates poor prognosis, disease progression, metastasis, and pro-cancer activity of neutrophils. The elevated PCT in this patient may be due to systemic inflammation and/or aberrant secretion from the cancer itself.
Penggunaan Antibiotik Empiris yang Rasional pada Era Infeksi oleh Organisme Multi Drug Resistant Sinto, Robert
Jurnal Penyakit Dalam Indonesia
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Resistensi antimikroba (antimicrobial resistance, AMR), secara khusus antibiotik, telah menjadi masalah dunia saat ini. Masalah resistensi antibiotik terjadi pada seluruh jenis antibiotik yang ada, dan terjadi di seluruh negara, termasuk Indonesia. Dalam skala global, Perserikatan Bangsa-Bangsa mengeluarkan World Health Assembly Resolution WHA 68.7 dengan judul Global Action Plan on Antimicrobial Resistance sebagai wujud perhatian yang mendalam terhadap masalah global ini.
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.
Co-Authors Adityo Susilo, Adityo Adna, Rury Maharani Ahani, Ardhi Rahman Alvina Widhani, Alvina Andi Kristanto Annisa, Firda Aulia Rizka, Aulia Benny N Kurniawan, Benny N C. Martin Rumende, C. Martin Ceva W. Pitoyo Danasasmita, Gantira Djoko Widodo Edwin Wijaya, Edwin Em Yunir, Em Erni J Nelwan, Erni J Evi Indrasanti, Evi Evy Yunihastuti Farida Nurchaida, Farida Finna Christianty, Finna Gurmeet Singh Herikurniawan, Herikurniawan Ikhwan Rinaldi Jasirwan, Chyntia OM Khie Chen Leonard Nainggolan Liwang, Frans Maksum, Maradewi Marbun, Maruhum Bonar Hasiholan Mira Yulianti, Mira Nathanael, Jason Pasaribu, Adeline Pringgodigdo Nugroho, Pringgodigdo Randy Adiwinata, Randy Rustadi Sosrosumihardjo Setiabakti, Andrian Shakinah, Sharifah Silvia Suminto, Silvia Suhendro Suwarto, Suhendro Sukamto Koesnoe Wicaksana, Bramantya Widayat Djoko Santoso, Widayat Djoko Yanuar, Santosa