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All Journal Paediatrica Indonesiana Pharmaceutical Sciences and Research (PSR) The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia
Evy Yunihastuti
Departemen Ilmu Penyakit Dalam FK Universitas Indonesia-RSUP Nasional Dr. Cipto Mangunkusumo
Health Professions Medicine & Pharmacology

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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.
Perubahan Perilaku Penggunaan Alat Pelindung Diri (APD) Pasca Terinfeksi COVID-19 pada Dokter di Indonesia: Sebuah Survei Nasional pada Awal Pandemi Herikurniawan, Herikurniawan; Yunihastuti, Evy; Syam, Ari F; Soemarko, Dewi Sumaryani Sumaryani; Wiraguna, Andrian
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 2
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Introduction. Doctors have greater risk of acquiring COVID-19 due to occupational exposure. Personal protective equipment (PPE) is an essential factor in reducing COVID-19 transmission. We aimed to evaluate the behavior changes of PPE usage among doctors in Indonesia before and after getting COVID-19 infection in early pandemic. Methods. This was a descriptive online survey with cross-sectional design. This survey was conducted from October-December 2020 among Indonesian doctors who were COVID-19 survivors. Results. A total of 389 doctors who survived COVID-19 infection across Indonesia were included in the final analysis. Most participants were general practitioners and residents (69.2%) with a median age of 40 (22-28) years. After being infected, there was an improvement in the use of N95 respirator masks in isolation rooms (always: 80.9% from 70.2%; sometimes: 13.2% from 15.8%). An improvement in the use of other PPE before and after being infected with COVID-19 was also shown by the use of other PPE such as headcap (93.9% from 83.3%), face shield (90.4% from 83.3%), goggles (70.2% from 62.3%), gown (61.4% from 53.6%), hazmat suit (88.6% from 81.6%), boots (82.5% from 71.1%), and gloves (91.3% from 86.8%). Similar results were also shown in the use of PPE in other non-isolation rooms. Conclusion. After recovering from COVID-19 infection, these doctors showed an increase usage of adequate PPE both while on duty in isolation and non-isolation rooms.
Pentingnya Edukasi Pasien Lupus Eritematosus Sistemik Yunihastuti, Evy; Harinda, Fadlika
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
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Lupus eritematosus sistemik (LES) merupakan penyakit kronik yang dapat mengenai berbagai macam organ dengan manifestasi ringan hingga serius. Karakteristik LES adalah sangat dinamis, bervariasi, dengan perjalanan penyakit yang kadang tidak dapat diprediksi. Walau saat ini semakin tinggi pengetahuan tentang patofisiologi, optimalisasi penanganan, dan banyak ditemukan obat yang lebih baik untuk terapi LES, masih banyak ODAPUS (orang dengan lupus) mengalami morbiditas, mortalitas, dan kualitas hidup yang kurang baik. Tanpa penanganan yang baik, pemantauan dan pengobatan yang teratur, tentu luaran yang baik akan lebih sulit didapatkan.
Efektivitas Terapi Antituberkulosis Empirik pada Pasien dengan Penyakit HIV Stadium Lanjut: Sebuah Laporan Kasus Berbasis Bukti Chandra, Natasha; Elita, Dina; Yunihastuti, Evy
Jurnal Penyakit Dalam Indonesia Vol. 11, No. 1
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Patients with advanced human immunodeficiency virus (HIV) disease have a high risk of mortality, with tuberculosis (TB) being one of the leading causes. Empiric antituberculosis therapy could be considered as a strategy to reduced mortality although there is no strong evidence. This study aims to review the efficacy of empiric antituberculosis therapy in patient with advanced HIV disease compared to isoniazid prophylaxis therapy and assessed with mortality as outcome. A 46- year old male patient with advanced HIV disease on antiretroviral therapy (ARV) and liver cirrhosis was admitted to hospital due to difficulties in sleeping and walking. During hospitalization he had seizure followed by decreased consciousness hence TB meningitis was suspected. Latest laboratory results showed CD4 count of 132 cells/mm3 and negative TB examinations. He was given empiric antituberculosis therapy but later died during hospitalization. A systematic literature searching was conducted in PubMed, ScienceDirect, Scopus, Cochrane, and EMBASE using keywords according to clinical question resulting in 69 studies. Study selection was conducted according to eligibility criteria and two studies with open-label randomized trial design were selected. Eligible studies were critically appraised using the Oxford Center for Evidence-Based Medicine Critical Appraisal Worksheet. Both studies had good validity. In patients with advanced HIV disease, mortality at week 24 was 5.2% (95%CI 3.5-7.8%) in empiric antituberculosis therapy group and 5.2% (95%CI 3.4-7.8%) in isoniazid prophylaxis therapy group, with an absolute risk difference of -0.06% (95%CI −3.05-2.94%; p=0.97). Meanwhile, mortality at week 96 was 10.1% (95%CI: 7.5- 13.6%) in empiric antituberculosis therapy group and 10.5% (95%CI 7.9-13.9%) in isoniazid prophylaxis therapy group, with absolute risk difference of 0.4% (95%CI −3.8-4.6%; p=0.86). Based on critical appraisal on both studies, it can be concluded that empiric antituberculosis therapy is not effective in significantly reducing mortality compared to isoniazid prophylaxis therapy in patients with advanced HIV disease.
Etika Publikasi di Bidang Kedokteran Jasirwan, Chyntia Olivia Murine; Faisal, Edward; Yunihastuti, Evy
Jurnal Penyakit Dalam Indonesia Vol. 11, No. 1
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Publikasi ilmiah merupakan penjelasan sistematis mengenai hipotesis, bukti, dan kesimpulan dari sebuah penelitian yang dimaksudkan untuk mengedukasi masyarakat. Publikasi merupakan tujuan utama dari penelitian, dan peer-review dilakukan untuk memverifikasi temuan dan meningkatkan kepercayaan penulis untuk evaluasi penelitian yang dipublikasi. Publikasi merupakan salah satu persyaratan khusus dalam suatu institusi akademik dan dapat mendukung promosi ke jabatan akademis. Publikasi (nasional dan internasional) telah menjadi norma yang dapat dikatakan wajib dalam dunia pendidikan. Berbagai pelanggaran etika banyak terjadi dan kita temukan, seperti plagiarisme, tata bahasa yang tidak pantas, dan praktik pengelolaan data yang meragukan. Kurangnya pemahaman tentang etika penelitian seringkali menjadi akar dari masalah ini.
Efektivitas Vaksin COVID-19 mRNA Booster Kedua pada Tenaga Kesehatan di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo dan Faktor yang Memengaruhinya Lubis, Siti Taqwa Fitria; Koesnoe, Sukamto; Yunihastuti, Evy; Shatri, Hamzah; Karjadi, Teguh Harjono; Harimurti, Kuntjoro; Pitoyo, Ceva Wicaksono; Yunir, Em
Jurnal Penyakit Dalam Indonesia
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Introduction. The emergence of the Omicron variant during the pandemic had an impact on the effectiveness of the COVID-19 vaccine. The spread of Omicron increased rapidly even in populations that had been vaccinated with booster doses, causing a high incidence of infection. This study aimed to determine the effectiveness and factors related to the effectiveness of the second mRNA booster vaccine as well as antibody levels after the second mRNA booster vaccine in healthcare workers at Cipto Mangunkusumo National General Hospital. Methods. This study used a cohort design. Total sampling of 271 healthcare workers were obtained from previous research and continued with consecutive sampling. Selected subjects were interviewed, and blood samples were taken to measure IgG sRBD antibody levels. The effectiveness of the vaccine was calculated, and bivariate and multivariate analysis was carried out to assess the factors that influenced the effectiveness of the second mRNA booster vaccine. Results. A total of 9 subjects (5.6%) were infected with COVID-19 in the second booster vaccine group and 11 subjects (9.7%) in the first vaccine group. The effectiveness of the vaccine against COVID-19 infection was 42% (CI 95% -37 – 75%), p = 0,215. Age, gender, hypertension, type 2 DM, obesity, smoking, and COVID-19 infection before booster have no relationship to the effectiveness of the second booster mRNA vaccine. In 48 subjects who had their antibody levels checked during the first and second boosters, there was an increase from 4,743 AU/ml (IQR 6,053.3) to 8,532 AU/ml (IQR 8,040.3). Conclusions. The effectiveness of the second mRNA booster vaccine against COVID-19 infection in healthcare workers was 42%. There were no factors related to the effectiveness of the second mRNA booster vaccine. The sRBD antibody levels after the second booster vaccine were higher than the first booster vaccine.
Incidence and Factors of Hepatocellular Carcinoma in Hepatitis C Virus Patients Achieving Sustained Virological Response After Direct-Acting Antiviral Treatment Kurniawan, Juferdy Kurniawan; Wicaksono, Dhaneswara Adhyatama; Yunihastuti, Evy; Masnjoer, Arif
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 3 (2024): VOLUME 25, NUMBER 3, December, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

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Background: The incidence and risk factors for Hepatocellular Carcinoma (HCC) in Hepatitis C Virus (HCV) patients who have achieved Sustained Virological Response (SVR) after Direct-Acting Antiviral (DAA) therapy are not well established. Considering there are differences in DAA types, virus genotypes, and patient profiles in Indonesia, this study was conducted to assess the incidence and factors influencing HCC in HCV patients after SVR post DAA therapy. The objective of this study to determine the incidence and factors influencing HCC in HCV patients achieving SVR after DAA treatment.Methods: Retrospective cohort study conducted at Cipto Mangunkusumo National General Hospital, sample of HCV patients had SVR after DAA therapy in 2017 – 2019, followed until 2024. Patients were screened for abdominal ultrasound, alpha-fetoprotein (AFP) and 3-phase abdominal CT scan, if indicated. Descriptive, bivariate analysis with Fisher's exact, and multivariate analysis with logistic regression were conducted.Results: Among 180 subjects, the incidence and incidence ratio of HCC is 4.4% (0.91/100PY). Significant correlation in bivariate analysis from the variables liver cirrhosis (RR 10.5; CI 95% (1. 32 – 83.5); p = 0.0073) and type 2 DM (RR 8.47; CI 95% (2, 3 – 31.1) p = 0.0048). In multivariate analysis, there was significant correlation from type 2 DM variable (aRR 3.1; CI 95% (0.86 – 3.83); p=0.002).Conclusion: The incidence of HCC reaches 4.4% of the total population. Type 2 DM has significant correlation with the incidence of HCC in HCV patients who achieve SVR after DAA treatment. 
Advanced HIV Disease: Wajah HIV yang Hampir Terlupakan Yunihastuti, Evy; Wicaksana, Bramantya
Jurnal Penyakit Dalam Indonesia
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Gejala Neuropsikiatri Pasien HIV Setelah Menjalani Transisi Antiretrovirus Nevirapin ke Dolutegravir di Rumah Sakit Cipto Mangunkusumo, Jakarta Pratama, Metra Adi; Putranto, Rudi; Herqutanto, Herqutanto; Syahrani, Aisyah; Hapsari, Aljira Fitya; Natali, Veritea; Pane, Meivina Ramadhani; Yunihastuti, Evy
Jurnal Penyakit Dalam Indonesia
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Introduction. Dolutegravir (DTG) is one of the effective antiretroviral therapies (ART) for suppressing HIV replication and has a favorable safety profile. However, reports regarding neuropsychiatric side effects, especially in patients transitioning from a nevirapine (NVP) regimen to dolutegravir, have started to emerge. This study aimed to describe the changes in neuropsychiatric symptoms before and after the transition from a NVP-based ARV regimen to DTG in HIV patients at Cipto Mangunkusumo Hospital (RSCM), Jakarta. Methods. This study employed a prospective cohort design involving 292 HIV patients at Cipto Mangunkusumo Hospital who were transitioning from NVP to DTG regimen. Participants were monitored for six months, and neuropsychiatric symptoms were assessed using a modified HIV symptom index (mHSI). Data collection was conducted at the beginning of the transition (baseline) and during follow-up through interviews regarding HIV-related symptoms and ART. Results. At the start of the study, 70.2% of participants reported at least one neuropsychiatric symptom, which increased to 80.1% after 6 months of transitioning to TLD. The most commonly reported symptoms were insomnia, headaches, and anxiety, with women reporting more symptoms than men. Statistical analysis showed a significant increase in symptoms of sadness, headaches, and irritability (p < 0.01) after the transition to dtg. Conclusions. Although DTG shows good viral suppression capabilities, significant neuropsychiatric side effects still arose, especially in patients with a history of mental disorders. Close monitoring of neuropsychiatric symptoms and adjustments to the ART regimen need to be carried out to improve the quality of life for HIV patients undergoing DTG therapy.
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 . Andriansjah Achmad Fauzy, Achmad Ade Rosanti Adik Wibowo Adityo Susilo, Adityo Agnes Kurniawan Alvina Widhani, Alvina Amal C Sjaaf Andri Sanityoso Sulaiman Angga Pramudita Anggraini Alam Anggriani, Yusi Anna Rozaliyani Anna Ujainah Anna Ujainah, Anna Annisa, Firda Annisa, Rifka Ari F Syam Ari Fahrial Syam Arya Govinda Roosheroe Arya Govinda Roosheroe, Arya Govinda Astrid Citra Padmita Astrid Citra Padmita, Astrid Citra Bambang Sutopo Bramantya Wicaksana Budiman Bela C. Martin Rumende, C. Martin Ceva W. Pitoyo Chandra, Natasha Christy Efiyanti Chyntia Olivia Maurine Jasirwan, Chyntia Olivia Maurine Chyntia Olivia MJ Cleopas Martin Rumende Cleopas Martin Rumende Cleopas Martin Rumende Cynthia Olivia Maurine Jasirwan Daldiyono Daldiyono Daldiyono Daldiyono Desi Salwani, Desi Dewi Mira Ratih Dewi Rizki Agustina Dewi Rizki Agustina, Dewi Rizki Dewi Sumaryani Soemarko Dhaneswara Adhyatama Wicaksono Djoerban, Zubair Dyah Purnamasari Dyah Purnamasari E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Edwin Wijaya Edwin Wijaya, Edwin Elita, Dina Em Yunir, Em Erni J Nelwan, Erni J Erni Juwita Nelwan, Erni Juwita Esthika Dewiasty Esthika Dewiasty, Esthika Estie Puspitasari Estie Puspitasari, Estie F Witjaksono F Witjaksono, F Faisal, Edward Farid Kurniawan Farid Kurniawan, Farid Firda Annisa Gita Aprilicia Gurmeet Singh Gurmeet Singh H.M. Sjaifoellah Noer Hapsari, Aljira Fitya Harimurti, Kuntjro Harinda, Fadlika Hasan Maulahela, Hasan Heri Wibowo Herikurniawan Herikurniawan Herikurniawan, Herikurniawan Herqutanto - Ikhwan Rinaldi Iris Rengganis Iris Rengganis Irsan Hasan Jasirwan, Chyntia Olivia Murine Jasirwan, Chyntia OM Julius R Samban Karmel Tambunan Ken Ayu Mastini Ken Ayu Mastini, Ken Ayu Khie Chen Kuntjoro Harimurti Kurniawan, Juferdy Kurniawan L A Lesmana Leonard Nainggolan Lestari, Regina Maksum, Maradewi Maradewi Maksum Marcellus Simadibrata Maruhum B.H. Marbun Masnjoer, Arif Mira Yulianti Mira Yulianti, Mira Mondrowinduro, Prionggo Murdani Abdullah Murdani Abdullah Nababan, Saut Horas Nasir, Ujainah Zaini Natali, Veritea Nia Kurniati Noto Dwimartutie Nugroho, Pringgodidgo Nur Ainun Nur Ainun Pane, Meivina Ramadhani Parhusip, Santi Sumihar Rumondang Pramita Gayatri Praptini, Mirna Nurasri Pratama, Metra Adi Prima Yuriandro Prima Yuriandro Pringgodigdo Nugroho Pringgodigdo Nugroho, Pringgodigdo Ratih, Dewi Mira Ratu Ratih Kusumayanti Ratu Ratih Kusumayanti Regina Lestari Reise Manninda Rifka Annisa Rino A Gani Rino A Gani Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Robert Sinto Robert Sinto Rosanti, Ade Rudi Putranto Sabrina Munggarani Yusuf Samsuridjal Djauzi Samsuridjal Djauzi Samsuridjal Djauzi Siti Taqwa Fitria Lubis, Siti Taqwa Fitria Sri Wahdini Sukamto Koesnoe Sukamto Koesnoe Sulaiman, Andri Andri Syahrani, Aisyah Teguh Harjono Karjadi, Teguh Harjono Tito Ardi Ujainah Zaini Nasir Unggul Budihusodo Wicaksana, Bramantya Widayat Djoko Santoso Widayat Djoko Santoso, Widayat Djoko Wiraguna, Andrian Yulia Trisna Yulia Trisna, Yulia Yulidar Yulidar Yulidar Yulidar Yusi Anggriani Zakiudin Munasir Zubairi Djoerban Zubairi Djoerban Zubairi Djoerban