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All Journal International Journal of Electrical and Computer Engineering 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) Jurnal Penyakit Dalam Indonesia Jurnal Kefarmasian 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 Chemistry 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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Studi Tinjauan Pustaka: Faktor Risiko Kejadian Amputasi pada Pasien Kaki Diabetes Mellitus Amalina, Nida; Djuwita, Ratna; Yunir, Em
Jurnal Epidemiologi Kesehatan Komunitas Vol 10, No 1: Februari 2025
Publisher : Master of Epidemiology, Faculty of Public Health, Diponegoro University, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jekk.v10i1.11932

Abstract

Background: Diabetes mellitus increased from 6.9% in 2013 to 8.5% in 2018. This figure shows that only about 25% of people with diabetes know that they have diabetes. According to the International Working Group on the Diabetic Foot (IWGDF), 1 in 4 people with DM will develop an ulcer on their foot during their lifetime with a proportion of 19-34% of the total DM patients. Wound healing of DM ulcers often requires longer time and considerable resources and has a 40% risk of re-formation at 1 year and increases to 60% after 3 years.Methods: Articles selected based on the inclusion criteria were journals that examined the relationship between diabetic foot and amputation, either using a longitudinal design, cohort study (retrospective or prospective) or case control. The exclusion criteria were journals that were systematic literature reviews, screening, diagnosis.Results: Obesity in 2 articles mentioned that OR=1.20-3.20 had a significant association with amputation while blood glucose factor in 2 articles mentioned that OR=2.92-9.43 had a statistically significant association with amputation. It was found in these 3 articles with OR range=6.9-13.97, poorly controlled HbA1c had a statistically significant association with amputation.Conclusion: This literature review study concluded that amputation risk factors are influenced by BMI and blood sugar levels.  Patients should be educated on the importance of maintaining good blood sugar control, in addition to wearing proper footwear, avoiding repetitive mechanical trauma to the foot, and performing regular foot examinations.
Primary Adrenal Insufficiency due to Tuberculosis Infection Pitfalls in Diagnosis and Management Ira Laurentika; Em Yunir; Tri Juli Edi Tarigan; Agnes Stephanie; Robert Shinto; Taufik Agung
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 1 (2024): InaJEMD Vol. 1, No. 1
Publisher : PP PERKENI

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Abstract

Primary adrenal insufficiency (PAI) is a chronic condition in which both adrenal glands are not able to produce steroid hormones. In this article we reported a-20-year-old male with history of soft tissue tumor in thoracalregion and general hyperpigmentation of skin and mucous. Laboratory findings showed hypocortisolism and adrenal computed tomography (CT) scan showed bilateral enlargement of adrenal with multiple necrotic nodular lesion and calcification, suggesting adrenal metastasis or tuberculosis infection. The interferon gamma release assay (IGRA) and histopathology review of the specimen from soft tissue tumor in thoracal region showed confirmed the diagnosis of adrenal tuberculosis. Antituberculosis drugs were started, and hydrocortisone dose were frequently adjusted. Five months after therapy the patient is clinically improved with a minimal dose of steroid.
Secondary Hypogonadism in Recurrent Adamantinomatous Craniopharyngioma: Fertility Evaluation and Management Adeputri Tanesha Idhayu; Tri Juli Edi Tarigan; Em Yunir; Setyo Widi Nugroho; Eka Susanto
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
Publisher : PP PERKENI

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Craniopharyngioma is an intracranial tumor with pituitary hormone deficiencies and affects 40% of gonadotropins deficiency. Gonadotropin deficiency causes secondary hypogonadism and male infertility which need to investigation for male infertility therapy options. A 22-year-old man presented with history of intermittent headaches, visual impairment, mild left- side hemiparesis, and developed erectile dysfunction. On clinical examination, there was abnormal penile and testicular size. The radiological examination showed a solid intrasellar mass with cystic lesion. The histological diagnosis was adamantinoma Tous craniopharyngioma. The hormonal evaluation showed low testosterone level, LH and FSH, and semen analysis showed azoospermia. The human chorionic gonadotropin stimulation test showed testosterone increase times from baseline, but evaluation semen test remained azoospermia. Craniopharyngioma morbidity is associated with tumor related and or treatment-related risk factors such as hormone deficiencies. Pituitary hormone deficiencies have been reported in 54–100% of patients that affect secretion of growth hormone, gonadotropin, TSH and ACTH. Gonadotropin deficiency associated with infertility in men. In this case, gonadotropin deficiency was due to the tumor because the symptoms had developed before surgery. Hypogonadism in this case occurs after puberty and he willing to have offspring. The hormonal therapy is effective in restoring spermatogenesis relates to the regulatory of the hypothalamic pituitary gonadal axis. The administration of HCG alone or combined with FSH, restores spermatogenesis of patients with hypogonadotropic hypogonadism, with reported pregnancy rates of up to 65%. Gonadotropin stimulation therapy will be planned after ruling out seminal tract obstruction and testicular fibrosis. Infertility in secondary hypogonadism can be managed with hormone therapy, but a complete investigation is required before starting treatment to determine therapy options.
FEBI (Focused Interaction-Based Education) Education Model with Application in Blood Glucose Control in Type 2 Diabetes Mellitus Patients Febriyanti; Masrul; Najirman; Indrapriyatna, Ahmad Syafruddin; Yunir, Em; Mudjiran; Semiarty, Rima; Yulia, Dwi
proceedinginternational Vol. 5 (2025): Proceeding International Conference 15th Desember 2024
Publisher : POLTEKKES KEMENKES PADANG

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33761/jd.v5i.55

Abstract

Background: Optimal blood glucose control is the main key to preventing complications of type 2 Diabetes Mellitus (DM). However, many patients have difficulty maintaining glycemic control due to limited knowledge, ongoing education and lack of therapeutic interaction. The FEBI Education Model (Focused Interaction-Based Education) is designed to increase patient engagement through an interactive educational approach based on digital applications. Objective: This study was to test the effectiveness of the FEBI Education Model in helping control blood glucose in patients with type 2 DM. Method: The study used a quasi-experimental design with a one-group Pretest-Posttest design approach. With a sample of 30 patients with type 2 DM in the working area of Andalas Health Center and Ambacang Kuranji Health Center, with a purposive sampling technique and data analysis using Paired T-test samples. The FEBI model integrates self-education, glucose monitoring, medication reminders, and online consultative interaction features. The main parameters measured were changes in knowledge and attitudes and glycated albumin levels during one month of intervention. Results: The results of the study showed that there was an increase in knowledge and attitudes with a p-value of 0.00 and a decrease in glycated albumin levels with a -value of 0.025, statistically it can be concluded that there is an influence of the FEBI education model with an increase in knowledge and attitudes and a decrease in glycated albumin levels. Conclusion: The application-based FEBI Education Model is effective in improving blood glucose control in patients with type 2 DM. This interactive approach has the potential to be an innovative strategy in supporting technology-based diabetes management. Keywords: Type 2 Diabetes Mellitus, Interactive Education, Mobile Application, Blood Glucose Control
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
Publisher : UI Scholars Hub

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Abstract

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.
Penggunaan Continous Glucose Monitoring pada Pasien DM Tipe 2 dengan Insulin Dosis Tinggi Hardigaloeh, Amanda Trixie; Tahapary, Dicky; Yunir, Em; Juli Edi Tarigan, Tri
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Abstract

Type 2 diabetes mellitus (T2DM) is a chronic disease with a high risk of complications, requiring optimal glycemic control. This case report aims to describe the use of continuous glucose monitoring (CGM) in the evaluation of a patient with T2DM and obesity whose glycemic levels remained uncontrolled despite high-dose insulin therapy. A 58-year-old woman with an 18-year history of T2DM presented to the Endocrinology Clinic of Cipto Mangunkusumo Hospital with uncontrolled blood glucose accompanied by classic diabetic symptoms. CGM revealed that the majority of glucose levels were within the time above range (TAR) at 83% without hypoglycemia, while the time in range (TIR) was only 17%. Contributing factors included a high-carbohydrate diet, limited physical activity, and technical difficulties with insulin injection. Interventions consisted of dietary re-education, gradual physical activity, optimization of injection technique, and insulin dose adjustment. CGM provided a comprehensive glycemic profile and helped identify non-pharmacological factors hindering glycemic control. This case highlights the role of CGM as an essential tool for individualized therapy in patients with T2DM requiring high-dose insulin.
Tertiary Hyperparathyroidism in Patient with End-Stage Chronic Renal Disease Stella Ilone; Em Yunir; Alvita Dewi S; Erwin Danil Julian
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 1 (2025): InaJEMD Vol. 2, No. 1
Publisher : PP PERKENI

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Abstract

Mineral and bone disorder is frequently associated with chronic kidney disease (CKD) which starts early and worsens with renal progression. This condition depends on calcium and phosphate metabolism which will change parathyroid hormone (PTH) release. Understanding the pathophysiology of both secondary and tertiary hyperparathyroidism can reduce the development of its complications, such as renal osteodystrophy and cardiovascular disease. To describe a case of hypercalcemia patient caused by tertiary hyperparathyroidism with end-stage renal disease (ESRD) who underwent continuous ambulatory peritoneal dialysis (CAPD). A 50-years old patient was consulted for treatment of hyperparathyroidism due to mineral bone disease-related CKD. The patient has high levels of serum calcium, phosphate, and parathyroid hormone levels. She has already taken a phosphate binder and does CAPD 4 times daily. She underwent several radiology tests and knew that there was enlargement of her parathyroid glands. Based on that, she underwent parathyroidectomy with implantation. Until now, we still need to evaluate the changes in serum calcium, phosphate, and PTH level after the surgery. Hyperparathyroidism is a condition related to disturbance in calcium and phosphate homeostasis in CKD patients. Many factors contribute to the development of its progression. Early recognition and holistic treatment will be the most important thing to reduce the complication of hyperparathyroidism in CKD patients.
Multidrug-Resistant Organisms Infection on Mortality of Burn Patients at Public Hospital X in Jakarta: A Retrospective Study Veronica, Raja Merlinda; Kumalawati, July; Rumende, Cleopas Martin; Nainggolan, Leonard; Simadibrata, Marcellus; Shatri, Hamzah; Yunir, Em; Wardhana, Aditya; Nelwan, Erni Juwita; Rustam, Musfardi
Kesmas Vol. 19, No. 5
Publisher : UI Scholars Hub

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Abstract

Susceptibility to infection and increasing antibiotic resistance put burn patients at risk of developing infections caused by multidrug-resistant organisms (MDRO). This condition can progress to sepsis, increasing morbidity and mortality. This retrospective cohort study employed the medical record data of patients treated at Public Hospital X in Jakarta, Indonesia, from January 2020 to June 2022. Of 160 subjects, most were aged <60 years (82.5%) and had comorbidities (16.88%). The most common cause of burns was fire (86.25%). The use of medical devices was 90.63%, with a 14-day median length of stay. The most common gram-negative MDRO pathogens were K. pneumoniae (29.91%), Enterobacter sp (22.32%), and Acinetobacter (20.54%); 45% of patients infected with MDRO died. The bivariate analysis found an increased risk of death due to MDRO infection in burn patients (RR 1.103; 95%CI 1.004-1.211, p-value = 0.046). After adjusting for role variables (age, comorbidities, total body surface area, use of medical devices, length of stay) and from multivariate analysis, the confounding variables for MDRO infection and mortality were length of stay and age. MDRO infection increases the mortality rate in burn patients. Mortality in burn patients due to MDRO infection is greater than non-MDRO.
Behavioral Study of Diabetes Mellitus Patients in Blood Glucose Control: A Phenomenological Study Febriyanti, Febriyanti; Masrul, Masrul; Najirman, Najirman; Indrapriyatna, Ahmad Syafruddin; Yunir, Em; Mudjiran, Mudjiran; Semiarty, Rima; Yulia, Dwi
Indonesian Journal of Global Health Research Vol 6 No S6 (2024): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v6iS6.4918

Abstract

The disease pattern in Indonesia is currently shifting from infectious diseases to degenerative diseases. This pattern is accompanied by the problem of a double burden of disease. The incidence of degenerative diseases is increasing along with changes in lifestyle and environmental behavior. One of the threats of degenerative diseases to public health is diabetes mellitus. The prevalence of diabetes in people aged over 15 years increased from 10.9% in 2018 to 11.7% in 2023. This shows that this disease is not only a problem for the elderly but also affects the productive age group. The main causes include unhealthy diet, lack of physical activity, and obesity. This study aims to observe and explore the behavior of people with diabetes in controlling blood glucose while suffering from diabetes. The research method used in this study is qualitative research with a phenomenological approach, with the informant selection technique using the snowball technique of 25 people. The main instrument of qualitative research is the researcher herself. The researcher is a nurse with a Masters in Nursing. The researcher as a facilitator also uses the tools used in the study as data collection instruments, namely the Digital Voice Recorder in this case the researcher's cellphone (Oppo A92) and interview guidelines and field notes and the researcher conducted in-depth interviews for approximately 3 weeks, data processing and data analysis using the Colaizzi method which consists of seven stages. Based on the results of in-depth interviews with 25 informants, 16 themes of the phenomenon of factors causing uncontrolled blood glucose were obtained, including incorrect knowledge about diabetes, the assumption that diabetes is a harmless disease, boredom factors in managing diet, poor behavior in daily eating habits, taking medication not according to the given dose, rarely or not doing sports activities, having an attitude that ignores the rules in following a diet while suffering from diabetes, information obtained from health workers and family is minimal, information from various media such as the internet is not utilized, limited health workers in providing education, feelings of hopelessness while suffering from diabetes mellitus, feeling that they do not get support from family or health workers in treating diabetes while suffering from diabetes mellitus, alternatives to drugs from the hospital are taking herbal medicines. The phenomenon of the dominant factors causing uncontrolled blood glucose is incorrect knowledge about diabetes, as well as the assumption that diabetes is a harmless disease, as well as boredom factors in regulating diet, and poor behavior in daily eating habits, as well as rarely or never doing sports activities, and having attitudes and behaviors that ignore the rules in undergoing treatment while suffering from diabetes.
Socioeconomic and Clinical Profile of Diabetic Foot Ulcer Patients with National Health Insurance during Pandemic COVID-19 in Indonesia Fitrianingsih, Fitrianingsih; Sauriasari, Rani; Yunir, Em; Banun Saptaningsih, Agusdini
Jurnal Kefarmasian Indonesia VOLUME 15, NUMBER 1, FEBRUARY 2025
Publisher : Pusat Penelitian dan Pengembangan Biomedis dan Teknologi Dasar Kesehatan

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Abstract

During the COVID-19 pandemic, the mandatory lockdown and government policy in prioritizing COVID-19 patients affected patients with diabetic foot ulcers (DFU). Most DFU patients experienced difficulties visiting hospitals and covering the cost of treatment, which led to changes in patient characteristics, poor clinical outcomes, and higher total costs. This study aimed to determine the sociodemographic and clinical outcomes profile of DFU patients under National Health Insurance (NHI-DFU) during the COVID-19 pandemic and their effect on the total direct medical cost. This cross-sectional study enrolled all JKN-DFU hospitalized patients at the National Referral Hospital, Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia, during COVID-19 pandemic (March 2nd, 2020, to December 2022). We used electronic health records, electronic billing, and foot registry systems. Participants were over 18 years old in a single admission period. Statistical analysis used Mann-Whitney and Kruskal-Wallis; Post hoc used the Mann-Whitney test. There were 158 JKN-DFU patients with predominated criteria: female patients (55.1%), aged over 60 years old (55.1%) with a mean age of 59.3 ± 11.0 years, unemployed (63.9%), intermediate educated (41.8%), Jakarta residents (68.4%), and mostly severe infection (63.3%). The total cost was much higher than INA-CBG’s coverage. The occupation (p=0.048), length of stay (LOS) (p=0.001), and amputation status (p<0.001) significantly affected total cost. Civil servants, longer LOS, and major amputation status leading higher total costs.
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 Banun Saptaningsih, Agusdini 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 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 Fitrianingsih Fitrianingsih Franciscus D. Suyatna Gurmeet Singh Hanif Assyarify Harahap, Agnes S. Hardigaloeh, Amanda Trixie Hari Hendarto 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 Masyur, Muhtaruddin Mirta Hediyati Reksodiputro Mirta Hediyati Reksodiputro 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 Rani Sauriasari, Rani 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