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All Journal International Journal of Electrical and Computer Engineering Medical Journal of Indonesia The Indonesian Biomedical Journal Jurnal Epidemiologi Kesehatan Komunitas Indonesian Journal of Global Health research Narra J Indonesia Journal of Physical Medicine and Rehabilitation Indonesia Journal Physical Medicine and Rehabilitation The Indonesian Journal of Community and Occupational Medicine Journal of Endocrinology, Tropical Medicine, and Infectious Disease (JETROMI) eJournal Kedokteran Indonesia Jurnal Penyakit Dalam Indonesia Proceeding International Health Conference Indonesian Journal of Endocrinology Metabolism and Diabetes (InaJEMD) Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)
Em Yunir, Em
Department Of Internal Medicine, Faculty Of Medicine, Universitas Indonesia, Jakarta
Biochemistry, Genetics & Molecular Biology Computer Science & IT Decision Sciences, Operations Research & Management Education Electrical & Electronics Engineering Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Medicine & Pharmacology Neuroscience Nursing Physics Public Health

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Hubungan Albumin Serum Awal Perawatan dengan Perbaikan Klinis Infeksi Ulkus Kaki Diabetik di Rumah Sakit di Jakarta Kurniawan, Hendra Dwi; Yunir, Em; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 1
Publisher : UI Scholars Hub

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Latar Belakang: Ulkus kaki diabetik terinfeksi merupakan kasus DM yang paling banyak dirawat di RS, berhubungan dengan morbiditas, mortalitas, biaya yang tinggi dan bersifat multifaktorial. Salah satu faktor yang berpengaruh adalah albumin. Belum ada penelitian yang secara langsung menghubungkan konsentrasi albumin serum awal perawatan dengan perbaikan klinis infeksi ulkus kaki diabetik. Belum ada batasan mengenai konsentrasi albumin yang dapat mempengaruhi perbaikan klinis infeksi ulkus kaki diabetik. Penelitian ini bertujuan Mendapatkan data mengenai konsentrasi albumin serum awal perawatan dan hubungannya dengan perbaikan klinis infeksi ulkus kaki diabetik. Metode: Penelitian dengan desain kohort prospektif terhadap 71 pasien diabetes dengan ulkus kaki terinfeksi yang dirawat inap di RSUPNCM, RSPADGS atau RSP pada kurun waktu April-Agustus 2014. Diagnosis dan klasifikasi ulkus kaki diabetik terinfeksi menggunakan kriteria IDSA. Data klinis dan albumin serum diambil dalam 24 jam pertama perawatan dan diikuti dalam 21 hari perawatan dengan terapi standar untuk dilihat perbaikan klinis infeksi ulkus kaki diabetik. Perbedaan rerata konsentrasi albumin antara subjek yang mengalami perbaikan klinis infeksi dan yang tidak, diuji dengan uji t tidak berpasangan dengan batas kemaknaan p
Non-Operative Management of Diabetic Foot Osteomyelitis: ACase Report Yunir, Em; Aziza, Yully Astika Nugrahayning
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 2
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Diabetic foot osteomyelitis is an advanced complication of diabetic foot infection which can increase the risk of amputation. This report discusses a case of a 50-year-old female with a wound on the thumb of her left foot that became more swollen with a bluish red color within one month. The patient delayed her treatment due to the COVID-19 pandemic. She has had diabetes and hypertension for 20 years which is uncontrolled. Physical examination showed a sausage toe digiti 1 left pedis with wound 4 x 2 cm with purulent discharge, Probe to Bone (PTB) positive. Laboratory and x-ray examination showed leukocytosis, increased erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP), glucose level 415 mg/dL, and HbA1c 13.1%, with destruction and fragmentation in first toe bone of the left foot. Because she refused minor surgery, the wound was treated regularly by removing infected bone fragments and giving intravenous (IV) antibiotics for four weeks. For glucose level control, continuous IV insulin was given with subcutaneous basal-bolus insulin, then continued by outpatient care with oral antibiotics. After seven weeks, manifestations of infection improved, the wound area was reduced, and antibiotics were discontinued, but wound care was continued. Metabolic control along with long-term antibiotics and wound care for diabetic foot osteomyelitis can be used as an alternative to surgery
Diagnosis and Treatment of Acquired Hemophilia A (AHA) with Bullous Pemphigoid Sihombing, Rasco Sandy; Silalahi, Henry Ratno Diono; Shatri, Hamzah; Sukrisman, Lugyanti; Rinaldi, Ikhwan; Prasetyawati, Findy; Novianto, Endy; Yunir, Em
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 4
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The Association between Degree of Diabetic Peripheral Neuropathy with Ankle Brachial Index, Toe Brachial Index, and Transcutaneus Partial Oxygen Pressure in Patients with Type 2 Diabetes Mellitus Asir, Taufik Rizkian; Antono, Dono; Yunir, Em; Shatri, Hamzah
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 3
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Introduction. Diabetic peripheral neuropathy (DPN) in the lower extremity caused by complications of diabetes in the microvascular which can damage nerve in the lower extremity. Then, it is necessary to be aware of the process of aterosclerosis elsewhere, both in the macro and microvascular arteries in the lower extremity. This study was conducted to assess the association of the degree of diabetic peripheral neuropathy assessed by Toronto clinical scoring system (TCSS) with the process of atherosclerosis in the blood vessels of the lower extremity, both macrovascular with ankle brachial index (ABI) and toe brachial index (TBI), as well as microvascular with transcutaneus partial oxygen pressure (TcPO2 ) in patients with type 2 diabetes mellitus. Methods. Cross-sectional study was carried out in patients with type 2 DM with DPN with TCSS values> 5 in the Integrated Cardiac Polyclinic, Endocrine and Metabolic Polyclinic, and Internal Medicine Polyclinics at Cipto Mangunkusumo Hospital. Data were obtained from interviews, medical records, as well as ABI, TBI and, TcPO2 examinations. Bivariate analysis of each variable was performed using Spearman test. Results. Total of 36 subjects who met the selection criteria were included in the study, the average age was 62 years (SD 9.2) with 20 (55.6%) of whom were women and the median duration of diabetes was 12 years. Based on bivariate analysis with the Spearman test, there was a statistically significant negative correlation with moderate correlation coefficient between the degree of diabetic peripheral neuropathy assessed by TCSS with ABI (r = -0.475, p = 0.003) and TBI (r = -0.421, p = 0.010). The TcPO2 examination also found a statistically significant negative correlation with moderate correlation coefficient (r = -0.399, p = 0.016). Conclusion. There is a statistically significant negative correlation between the degree of diabetic peripheral neuropaty with ABI, TBI, and TcPO2 examinations.
Pengaruh Depresi Terhadap Perbaikan Infeksi Ulkus Kaki Diabetik Auliana, Arshita; Yunir, Em; Putranto, Rudi; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 4
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Pendahuluan. Pasien Diabetes Melitus (DM) dengan ulkus kaki lebih banyak yang mengalami depresi dan memiliki kualitas hidup yang buruk. Dalam tatalaksana ulkus kaki diabetik perlu diperhatikan faktor psikososial karena diperkirakan dapat mempengaruhi penyembuhan luka melalui induksi gangguan keseimbangan neuroendokrin-imun. Penelitian ini bertujuan untuk mengetahui pengaruh depresi terhadap proses perbaikan infeksi ulkus kaki diabetik, serta tingkat depresi pada pasien ulkus kaki diabetik yang dirawat inap. Metode. Studi kohort prospektif dilakukan pada 95 pasien ulkus kaki diabetik terinfeksi yang dirawat di RSCM dan RS jejaring pada Maret-Oktober 2014. Subjek dibagi ke dalam dua kelompok yaitu kelompok depresi dan kelompok tidak depresi. Data klinis, penilaian depresi, dan data laboratorium diambil saat pasien masuk rumah sakit kemudian dinilai perbaikan infeksi ulkus kaki diabetik dalam 21 hari masa perawatan. Hasil. Dari 95 subyek penelitian, 57 orang (60%) masuk dalam kelompok depresi, yang didominasi oleh kelompok perempuan (70%). Penyakit komorbid terbanyak adalah hipertensi, dengan angka komorbiditas dan penyakit kardivaskular lebih tinggi pada kelompok depresi. Malnutrisi dan obesitas juga lebih banyak pada kelompok depresi (64,9% dan 31,6%), demikian pula dengan kontrol glikemik yang buruk (73,7%). Sebagian besar pasien (73,7%) yang masuk dalam kelompok depresi memiliki depresi ringan. Pada kelompok depresi 40,4% mengalami perbaikan infeksi dalam 21 hari masa perawatan, sedangkan 68,4% pada kelompok tidak depresi. Depresi cenderung meningkatkan risiko atau kemungkinan tidak terjadinya perbaikan infeksi ulkus kaki diabetik, walaupun setelah dilakukan penyesuaian terhadap variabel perancu, hasil tersebut tidak bermakna secara statistik (p = 0,07, adjusted OR 2,429 dengan IK 95% 0,890-6,632). Lebih banyak subjek dengan depresi sedang yang tidak mengalami perbaikan infeksi ulkus kaki diabetik dibandingkan dengan subjek dengan depresi ringan (93,3% dan 47,6%). Simpulan. Depresi cenderung meningkatkan risiko atau kemungkinan tidak terjadinya perbaikan infeksi ulkus kaki diabetik.
Perubahan Kendali Glikemik dan Plasminogen Activator Inhibitor-1 (PAI-1) pada Penyandang Diabetes Melitus Tipe-2 yang Berpuasa Ramadhan di RSUPN Cipto Mangunkusumo Khomimah, Khomimah; Waspadji, Sarwono; Yunir, Em; Abdullah, Murdani
Jurnal Penyakit Dalam Indonesia Vol. 1, No. 1
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Pendahuluan: Penyandang diabetes melitus (DM) mempunyai risiko tinggi mengalami penyakit kardiovaskular (PKV), yang progresivitasnya dipercepat oleh penurunan kapasitas fibrinolisis. Penyandang DM yang berpuasa Ramadhan mengalami berbagai perubahan yang dapat memengaruhi kendali glikemik dan status fibrinolisisnya. Penelitian ini bertujuan mengetahui penurunan fruktosamin dan plasminogen activator inhibitor-1 (PAI-1). Metode: Penelitian dikerjakan dengan metode kuasi eksperimental one group design self control study pada penyandang DM tipe-2 yang berpuasa Ramadhan dan berusia 40-60 tahun. Hasil: Penelitian ini menunjukkan sebagian besar subjek memiliki 3 faktor risiko PKV dan dengan kendali glikemik yang jelek sebelum puasa Ramadhan. Terdapat penurunan yang bermakna pada glukosa puasa plasma, tetapi tidak bermakna pada glukosa darah 2 jam setelah makan. Tidak terdapat perbedaan asupan kalori pada 18 subjek yang dianalisis. Tidak didapatkan penurunan yang bermakna pada fruktosamin serum maupun PAI-1 plasma. Kendali glikemik yang dicapai sebelum dan asupan kalori selama berpuasa Ramadhan kemungkinan merupakan faktor yang memengaruhi penurunan fruktosamin. Selain glukosa darah, faktor yang memengaruhi kadar PAI-1 plasma di antaranya adalah insulin plasma, angiotensin II, faktor pertumbuhan dan inflamasi, yang tidak diukur dalam penelitian ini. Simpulan: Tidak terdapat penurunan kadar fruktosamin serum sesudah berpuasa Ramadhan lebih dari sama dengan 21 hari pada penyandang DM tipe-2. Tidak terdapat penurunan kadar plasminogen activator inhibitor-1 (PAI-1) plasma sesudah berpuasa Ramadhan lebih dari sama dengan 21 hari pada penyandang DM tipe-2.
Testicular Volumes Measurement Comparison by Ultrasound and Orchidometer and Its Relationship with Nutritional Status in Transfusion-dependent Thalassemia Rahmad Mulyadi; Joedo Prihartono; Em Yunir; Dian Anindita Lubis; Reyhan Eddy Yunus
The Indonesian Biomedical Journal Vol 15, No 3 (2023)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v15i3.2291

Abstract

BACKGROUND: One type of thalassemia known as transfusion-dependent thalassemia (TDT) requires a lifelong blood transfusion. Iron overload from prolonged blood transfusions causes nutritional disorders and several organs impairment, including the testicles. In contrast to an orchidometer, ultrasound shows more details of the testicles. This study aimed to compare testicular volumes based on ultrasound and orchidometer measurements and correlate testicular volume with nutritional status in TDT patients.METHODS: A cross-sectional study including 27 male thalassemia subjects who underwent routine check-ups was conducted. Measurements of testicular volume using an orchidometer and ultrasound, and body mass index (BMI) was performed. Ultrasound measurement of testicular volume was calculated using the Lambert Formula, while the orchidometer was performed by matching the bead next to the testicle.RESULTS: Most subjects were underweight (63%) or normal weight (37%). However, no significant correlation between BMI and testicular volume was found. As measured using an orchidometer, the mean volume of the right and left testes were 9.22±4.92 mL and 8.67±4.45 mL, respectively. Ultrasound measurement showed the mean values of the right and left testicles were 7.68±3.96 mL and 7.09±4.03 mL, respectively. Testicular measurements obtained using ultrasound showed a significant difference (p<0.05) when compared with the orchidometer. The testicle measured by ultrasound was smaller, which was more accurate. However, the comparison between the right and the left testicular volumes showed no significance.CONCLUSION: Thalassemia patients are mainly underweight, and their nutritional status have no relationship with testicular volume. Ultrasound, as compared to an orchidometer, is better for measuring testicular volume.KEYWORDS: thalassemia, testicle, orchidometer, ultrasound, body mass index
Overview of Glycemic Control in Workers with Diabetes at An Occupational Clinic in Jakarta Edwin Halim; Em Yunir; Amilya Agustina; Astrid Sulistomo; Levina Chandra Khoe
The Indonesian Journal of Community and Occupational Medicine Vol. 3 No. 1 (2023): ijcom
Publisher : ILUNI MKK FKUI and PRODI MKK FKUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53773/ijcom.v3i1.72.17-23

Abstract

Introduction: Based on Indonesia’s population data in 2018 and International Diabetes Federation in 2019, an estimated 1 in every 10 Indonesian workers have type 2 diabetes mellitus (T2DM). Diabetes is a chronic illness with costly implications, especially in working population. Workers with diabetes experience 12% reduction in productivity adjusted life years (PALY) and additional $USD 467 monthly average healthcare cost. This study aims to determine glycaemic control in workers with diabetes.Methods: Cross-sectional study utilizing laboratory medical records from 2015-2021 in an occupational clinic in Jakarta’s Central Business District is performed. Data collected through accessing in-clinic laboratory and client lists’ electronic medical records, is paired with their respective anthropometric parameters stored in paper archives. Criteria of Fasting Blood Glucose (FBG), lipid profile, HbA1c and Body Mass Index (BMI) are based on PERKENI 2019. Inclusion criteria are workers with prior history of T2DM who underwent HbA1c examination.Results: 2,796 employees who underwent HbA1c examination were found; 65.8% normal, 29.6% pre-diabetic, and 4.6% exceeded T2DM cut-off. Amongst 2,796 employees, 1,322 had their FBG examined; 62% normal, 33.1% had increased fasting glucose and 5% exceeded T2DM cut-off; another 1,316 also had their lipid profile examined, in which 80.5% had dyslipidaemia. From 2015-2021, 160 employees had a history of T2DM, of which 86 had matching laboratory medical records, with 42 of those undergoing HbA1c examination. Of 42 respondents with diabetes who underwent HbA1c examinations, 54.8% had sub-optimal glycaemic control. FBG is the only risk factor significantly correlated to optimal glycaemic control (p <0.05).Conclusion: Health programs and policies in the workplace enacted by management and health institutions who offer medical services may play a vital role in the improvement of prevention and intervention of diabetes amongst workers.
Perbedaan Serotonin Plasma dan Kortisol Saliva terhadap Gejala Depresi pada Pasien Pasca Sindrom Koroner Akut Firmansyah, Irman; Shatri, Hamzah; Putranto, Rudi; Ardani, Yanuar; Ginanjar, Eka; koesnoe, sukamto; Rizka, Aulia; Isbagio, Harry; Yunir, Em
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
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Introduction. Psychological disorders are closely associated with hormonal factors, including cortisol and serotonin. In patients with acute coronary syndrome (ACS), autonomic dysfunction and dysregulation of the hypothalamic-pituitaryadrenal (HPA) axis can occur, leading to an increase in cortisol levels that may worsen the prognosis of ACS patients. Therefore, it is important to understand the hormonal impact, namely cortisol and serotonin levels, on depressive symptoms, which will be examined in this study. Methods. This was a cross-sectional study to determine the impact of cortisol and serotonin in the incidence of depression in post-treatment ACS patients at the ICCU RSUPN dr. Cipto Mangunkusumo, Jakarta. Data collection from patients meeting the inclusion criteria was carried out 10-14 days post-treatment through interviews, HADS questionnaire completion, physical examinations, and laboratory tests. The Mann-Whitney test was used to examine the differences between serotonin and salivary cortisol levels in patients with and without depression. Results. Among the 73 ACS patients included in this study, the average age was 57.53 (9.97) years, with 68.5% was male. Posttreatment depression was observed in 15.1% of subjects. The median serotonin levels were lower in patients with depression [175 (147 – 227.64) ng/mL vs. 189.31 (152.87-235.44) ng/mL], while cortisol levels were higher in patients with depression [3.09 (1.46-6.26) ng/mL vs. 2.15 (0.92-3.91) ng/mL]. However, the statistical analysis showed no significant differences between plasma serotonin and depression (p=0.482) or saliva cortisol and depression (p=0.275). Conclusions. There were no significant differences in cortisol and serotonin levels concerning depressive symptoms among post-acute coronary syndrome patients. Nevertheless, this study holds clinical importance due to the observed lower plasma serotonin levels and higher saliva cortisol levels in ACS patients with depression.
A Case Report of a Giant Pheochromocytoma Lubis, Dian Anindita; Harahap, Agnes Stephanie; Em Yunir
Journal of Endocrinology, Tropical Medicine, and Infectious Disease (JETROMI) Vol. 2 No. 1 (2020): Journal of Endocrinology, Tropical Medicine, and Infectiouse Disease (JETROMI)
Publisher : TALENTA Publisher, Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (655.112 KB) | DOI: 10.32734/jetromi.v2i1.2037

Abstract

Pheochromocytoma is a rare catecholamine secreting tumor that are usually arise from adrenal medulla and produces signs and symptoms of excessive catecholamine secretion from tumor. A 32 years old female presented to the hospital, with dyspeptic symptoms. She had fluctuative hypertension, palpitation and sweating. Abdominal ultrasonography showed a right adrenal mass, and computed tomography of the adrenal glands confirmed a right adrenal mass. However, clinical biochemistry tests specific for pheochromocytoma was not performed. Laparoscopic right adrenalectomy was done and the adrenal tumor was excised. Histopathology and immunohistochemistry confirmed the diagnosis of adrenal pheochromocytoma; the tumor cells being positive for chromogranin, synaptophysin, S-100 protein, and inhibin. Following the surgery, the patient did well and showed full recovery at follow-up after 1 month.
Co-Authors A.A. Ketut Agung Cahyawan W Achmad Rudijanto Adeputri Tanesha Idhayu Aditya Wardhana Adna, Rury Maharani Agnes Stephanie Harahap Alvita Dewi S Amalina, Nida Amilya Agustina Andra Aswar, Andra Angela Sarumpaet Anggono, Rendi F. Anis Karuniawati Ardani, Yanuar Arini Setiawati Arshita Auliana Asir, Taufik Rizkian Astrid Sulistomo Aulia Rizka, Aulia Aziza, Yully Astika Nugrahayning Ceva W. Pitoyo Cleopas Martin Rumende Cosphiadi Irawan Dante S Harbuwono, Dante S Dante S. Harbuwono Dharmeizar Dharmeizar Diah Martina, Diah Dian Anindita Lubis Dian R. Sawitri, Dian R. Dono Antono Dwi Yulia E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Edwin Halim Eka Ginanjar Eka Susanto Elida Ilyas Endy Novianto, Endy Eni Iswati Erni Juwita Nelwan, Erni Juwita Erwin Danil Julian Esa, Dekta Filantropi Evy Yunihastuti Febriyanti Febriyanti Febriyanti Ferry Sandra Findy Prasetyawati, Findy Franciscus D. Suyatna Gurmeet Singh Hanif Assyarify Harahap, Agnes S. Hardigaloeh, Amanda Trixie Hari Hendarto, Hari Harry Isbagio Hendra Dwi Kurniawan, Hendra Dwi Henry Ratno Diono Silalahi, Henry Ratno Diono Heri Wibowo Idrus Alwi Idrus Alwi Ika Prasetya Wijaya Ikhwan Rinaldi Imam Subekti Indrapriyatna, Ahmad Syafruddin Ira Laurentika Irman Firmansyah Joedo Prihartono Juli Edi Tarigan, Tri Jusuf Rachmat Jusuf Rachmat Katarina, Matilda Khomimah Khomimah, Khomimah Kumala, Poppy Kumalawati, July Kuntjoro Harimurti Laurentius A Pramono, Laurentius A Laurentius A. Pramono Leonard Nainggolan Levina Chandra Khoe Lubis, Dian Anindita Lugyanti Sukrisman Luhuna, Muslimah Mandang, Veny VV Marbun, Maruhum Bonar Hasiholan Marcellus Simadibrata Masrul Masrul Masrul Masyur, Muhtaruddin Mirta Hediyati Reksodiputro Mirta Hediyati Reksodiputro Mudjiran Mudjiran Mudjiran Muhammad Hanif Nadhif Muhammad Irsyad Murdani Abdullah Najirman Najirman Najirman Noorwati Sutandyo Prahasary, Adelia Nova Pringgodigdo Nugroho, Pringgodigdo Puteri, Happy HS Rahmad Mulyadi Rasco Sandy Sihombing, Rasco Sandy Ratna Djuwita Reyhan Eddy Yunus Ricardo, William Rima Semiarty Robert Shinto Robert Sinto Ronald Winardi Kartika Rudi Putranto Rustam, Musfardi Saleha Sungkar Saptawati Bardosono Saptawati Bardosono Saraswati, Made R Sarwono Waspadji Sarwono Waspadji Sarwono Waspadji Sarwono, Sugeng J. Setyo Widi Nugroho Siti Setiati Siti Taqwa Fitria Lubis, Siti Taqwa Fitria Stella Ilone Sukamto Koesnoe Suzanna Immanuel Suzzana Immanuel Tahapary, Dicky Tahapary, Dicky L. Taufik Agung Tedjasaputra, Shirly Elisa Teguh Harjono Karjadi, Teguh Harjono Tjhin Wiguna Tjie Haming Setiadi Todung Silalahi Todung Silalahi Tri J.E. Tarigan Tri Juli Edi Tarigan Veronica, Raja Merlinda Widjajalaksmi Wijaya, Indra Yulia, Dwi