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Korelasi antara skor Child-Pugh dengan gastropati hipertensi portal pada penderita sirosis hati Faisal Parlindungan; Mabel Sihombing
Majalah Kedokteran Nusantara The Journal Of Medical School Vol 46, No 1 (2013): The Journal of Medical School
Publisher : Fakultas Kedokteran USU

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Introduction : Hypertensive portal gastropathy (PHG) is a pathologic appearance on the gastric mucosa which can cause acute or chronic bleeding in liver cirrhotic patients. The pathogenesis of PHG is controversial and there is no agreement on the effect of liver dysfunction to PHG. This study aims to evaluate correlation between liver dysfunction severity that is assessed by Child-Pugh score and PHG in liver cirrhotic patients.Methods : This is an analytic cross sectional study. The demographics and clinical data were recorded, laboratory tests were performed (albumin, INR and bilirubin) to calculate Child-Pugh score, and patients underwent esophagogastroduodenoscopy (EGD) to assess PHG. Correlation between Child-Pugh score and PHG were tested with Spearman correlation analysis. Cut-off value of Child-Pugh score was determined with receiver operating characteristics (ROC) analysis which is followed by diagnostic performance analysis.Results : From 41 subjects, there were 8, 18, 15 patients with Child-Pugh class A,B, and C respectively. On endoscopic examination, there were 10,19, and 12 patients without PHG, with mild PHG, and with severe PHG respectively. There is a positive correlation between Child-Pugh score and the severity of PHG (r = 0.556; P = 0.0001). Among Child-Pugh score components, ascites and bilirubin showed positive correlation with PHG. Using cut off point of • 7, Child Pugh score showed 87.1% sensitivity, 40% specificity, 81.8% PPV, 50% NPV, 1.45 LR(+), 0.32 LR(-), accuracy diagnostic was 75.6% and the AUROC was 0.65 (95% CI:0.437-0.860; P = 0.163)Conclusion: Child-Pugh score has a positive correlation with severity of PHG, in which higher Child-Pugh score is correlated with more severe PHG.Keywords : Child-Pugh Score; portal hypertensive gastropathy; liver cirrhotic; endoscopy

Characteristics of Patients with Autoimmune Rheumatic Disease in the Era of COVID-19 Pandemic in Indonesia Rudy Hidayat; Harry Isbagio; Anna Ariane; Faisal Parlindungan; Laniyati Hamijoyo; I Nyoman Suarjana; Dwi Budi Darmawati; Rakhma Yanti Hellmi; Gede Kambayana; IA Ratih Wulansari Manuaba; Awalia Awalia
Indonesian Journal of Rheumatology Vol. 12 No. 1 (2020): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v12i1.159

Background Coronavirus Disease 2019 (COVID-19) could be fatal in high-risk patient including autoimmune rheumatic patients. Nowadays, the management of these patients becomes dilemma because the use of steroids and disease-modifying anti-rheumatic drugs could suppress the immune system however, poor control of the underlying disease increases the infection risk. Understanding the characteristics of these patients in the COVID-19 pandemic is essentials to establish management guidelines and identify patients who are more susceptible to COVID-19. This study aimed to determine the characteristics of autoimmune rheumatic patients in the era of COVID-19 pandemic in Indonesia. MethodA descriptive study using national scale survey method was conducted. The subjects were autoimmune rheumatic patients in Indonesia and recruited using consecutive sampling. The variables evaluated in this study were demographic data, history of disease, current medications taken, daily activities in the COVID-19 pandemic, and also data related to COVID-19. The surveys distributed in online form to patients with autoimmune rheumatic disease in Indonesia. ResultTotal participants in this study were 570 patients, mostly women (93.9%), aged <60 years old (97.2%), and diagnosed with systemic lupus erythematosus (62.8%). Glucocorticoid (70.2%) especially low dose glucocorticoid (52.6%) is the most medication taken by patients. A 30.5% of patients is taking hydroxychloroquine/chloroquine and 88.1% of them have good compliance. During COVID-19 pandemic, 76.5% respondents still do normal activities/work and only 53.2% use personal protective equipment. Eleven of 541 respondents had positive PCR test and confirmed to COVID-19. The risk of COVID-19 infection based on British Society of Rheumatology (BSR) scoring system showed that 57.9%, 28.6%, and 13.5% patients in high, moderate and low risk, respectively. ConclusionPatients with autoimmune rheumatic diseases might be more susceptible to COVID-19 than the general population. Interplay of aging, therapies and disease-specific factors, comorbidities and the proper use of personal protective equipment seem to contribute. Keywords :autoimmune rheumatic disease, characteristic, COVID-19, Indonesia

Indonesian Rheumatology Association Recommendation for Management of Autoimmune Rheumatic Disease Patients During COVID-19 Pandemic Cesarius Singgih Wahono; Perdana Aditya; Herlina Yani; RM Suryo Anggoro KW; Faisal Parlindungan; Anna Ariane; Andi Raga Ginting; Ika Vemilia; Lisa Kurnia Sari
Indonesian Journal of Rheumatology Vol. 12 No. 1 (2020): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v12i1.160

Background: Coronavirus-19 (COVID-19) disease is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), first reported from Wuhan, the capital of Hubei province, China, in December 2019. Since the occurrence of COVID-19 pandemic, there have been concerns about the risk of SARS-CoV-2 infection and complications in systemic autoimmune-rheumatic patient. Therefore, we intend to make recommendations for the management of autoimmune rheumatic diseases during this pandemic. Method: Indonesian Rheumatology Association (IRA) held an online meeting on May 17th2020 and formed a task force that was in charge to make recommendation for management of adult autoimmune rheumatic disease patients during COVID-19 pandemic. This task force consisted of 9 IRA members that held their first online meeting on May 18th2020. The draft of the recommendation were reviewed in three online meetings that resulted in final recommendation through consensus from all of task force members. The final draft of recommendation was approved by IRA executive board on July 10th2020. Result: The management of autoimmune-rheumatic diseases during the COVID-19 pandemic must consider several important factors such as underlying rheumatic-autoimmune disease factors, risk factors for COVID-19 exposure in autommune-rheumatic disease patients and the presence of COVID-19 infection symptoms Discussion: Recommendations for pharmacological management of autoimmune rheumatic disease patients during COVID-19 pandemic are according to exposure to COVID-19 and the presence of symptoms. There are four groups of patients that are the focus of this recommendation: 1) autoimmune rheumatic disease patients without symptoms of infection AND without risk of exposure to COVID-19; 2)autoimmune rheumatic disease patients without symptoms of infection AND with close contact (exposure) to COVID-19 probable or confirmed patients; 3) autoimmune rheumatic disease patients with symptoms of COVID-19 infection but the infection status is not yet known (suspected and probable case of COVID-19); and 4) autoimmune rheumatic disease patients with confirmed COVID-19 infection. Each groups have different management approaches. Conclusion: Recommendations for the management of autoimmune rheumatic diseases during this pandemic is needed to guide doctors that treat autoimmune rheumatic diseases.

Should Patient with Autoimmune Inflammatory Rheumatic Diseases (AIIRD) be vaccinated with COVID-19 Vaccines? Cesarius Singgih Wahono; Perdana Aditya; Faisal Parlindungan; RM. Suryo Anggoro KW; Anna Ariane; Herlina Yani; Andi Raga Ginting; Lisa Kurnia Sari; Pande Ketut Kurniari; Ratih Manuaba; Ika Vemilia; Rudy Hidayat; Sumariyono Sarmidi; Harry Isbagjo
Indonesian Journal of Rheumatology Vol. 13 No. 1 (2021): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v13i1.167

Vaccination is a very important measure for the prevention of various infections worldwide including the recent COVID-19 disease. However, until now the COVID-19 vaccine with various platforms has not been clinically tested on autoimmune inflammatory rheumatic disease (AIIRD) patients, due to caution against possible side effects and unknown efficacy. Several recent studies proved that there is increased risk of SARS-CoV-2 infection in AIIRD patients and moreover, those patients also have worse COVID-19 outcomes. Thus, patients with AIIRD should be prioritized for vaccination because they have an increased burden of infections, including COVID-19. Many studies showed that inactivated/non-live vaccine is safe for AIIRD patients and do not cause disease exacerbations. We conclude that benefits of vaccination greatly outweigh the risks of infection and therefore, COVID-19 vaccines can also be administered safely in stable AIIRD patients.

Indonesian Rheumatology Association (IRA) Recommendations for Diagnosis and Management of Glucocorticoid-induced Osteoporosis Bagus Putu Putra Suryana; Rudy Hidayat; Laniyati Hamijoyo; Radiyati Umi Partan; Yulyani Werdiningsih; Surya Darma; RM Suryo Anggoro; Anna Ariane; Faisal Parlindungan; Mirza Zaka Pratama; Harry Isbagio; Handono Halim; Cesarius Singgih Wahono; Sumariyono
Indonesian Journal of Rheumatology Vol. 14 No. 2 (2022): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v14i2.216

Background: Patients receiving long-term glucocorticoid therapy are at risk of developing GIOP. However, until today, there is still no guideline that specifically explains how to diagnose and manage GIOP patients in Indonesia. Methods: 10 selected rheumatologists from the Indonesian Rheumatologist Association (IRA) made recommendations based on key questions formed by a steering committee from IRA. These recommendation materials were taken from several online databases such as Pubmed, Science Direct, and Cochrane. Level of evidence and grades of recommendation were then assigned, and every member of the panelist team will assign a score for the level of agreement. Results: A total of 17 recommendations regarding screening, prevention, diagnosis, therapy, and monitoring for GIOP were made. Conclusion: These recommendations can be used for adult patients receiving long-term glucocorticoids with or at risk of developing GIOP. The prevention measure, diagnostic, therapy, and monitoring algorithm in this recommendation are all created with the consideration of Indonesia’s clinical setting, facility, and drug availability.

The Importance Of Oral Health Care Optimization In Bedridden Medicocompromised Patients: A Case Series Zahra, Faradina Siti; Parlindungan, Faisal; Aini, Muhammad Hafiz; Wardhany, Indriasti Indah
Odonto : Dental Journal Vol 12, No 3 (2025): December 2025
Publisher : Faculty of Dentistry, Universitas Islam Sultan Agung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30659/odj.12.3.346-353

Background: Bedridden patients were highly susceptible to oral complications due to prolonged immobilization, impaired oromotor function, and limited capacity for self-care. The accumulation of debris and reduced salivary flow can become pathological, leading to infection in the oral cavity. This case report aims to describe two cases of medico-compromised bedridden inpatient highlighting the importance of optimizing oral health care. Case Report: Two bedridden inpatients were reffered to Oral Medicine Division, Universitas Indonesia hospital from internist. First case, was a 59-year-old female inpatient with stage IV breast carcinoma and bone metastasis. The second case, was a 68-year-old male inpatient with acute encephalopathy and multiple comorbidities. Both patients shows decreased consciousness, severe oral dryness with high Clinical Oral Dryness Scores (CODS), poor oral hygiene with a abundant plaque and debris, inflamed periodontal tissue and lip lesion. Oral health care maintenance by cleaning and wipping teeth and oral mucosa using sterile gauze moistened in 0.9% NaCl was done and demonstrated to caregiver to be done daily. Petroleum Jelly was perscribe for the lips lesions. Both patients showed improved mucosal hydration, debris reduction, and greater comfort. Discussion: Oral cavity infection is one of the factors that plays an important role in accomplishing the successful overall treatment while bedridden patients had increased risks of oral infection due to limited abilities. Cleaning and wipping with 0,9% NaCl was a safe choice for patient with high risk of aspiration, had a mild antiseptic properties and maintain mucosal hydration. Conclusion: Optimization of oral care in bedridden patients begin with the selection of oral health care maintenance methods by considering the patient's systemic condition.

The Importance Of Oral Health Care Optimization In Bedridden Medicocompromised Patients: A Case Series Zahra, Faradina Siti; Parlindungan, Faisal; Aini, Muhammad Hafiz; Wardhany, Indriasti Indah
Odonto : Dental Journal Vol 12, No 3 (2025): December 2025
Publisher : Faculty of Dentistry, Universitas Islam Sultan Agung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30659/odj.12.3.346-353

Background: Bedridden patients were highly susceptible to oral complications due to prolonged immobilization, impaired oromotor function, and limited capacity for self-care. The accumulation of debris and reduced salivary flow can become pathological, leading to infection in the oral cavity. This case report aims to describe two cases of medico-compromised bedridden inpatient highlighting the importance of optimizing oral health care. Case Report: Two bedridden inpatients were reffered to Oral Medicine Division, Universitas Indonesia hospital from internist. First case, was a 59-year-old female inpatient with stage IV breast carcinoma and bone metastasis. The second case, was a 68-year-old male inpatient with acute encephalopathy and multiple comorbidities. Both patients shows decreased consciousness, severe oral dryness with high Clinical Oral Dryness Scores (CODS), poor oral hygiene with a abundant plaque and debris, inflamed periodontal tissue and lip lesion. Oral health care maintenance by cleaning and wipping teeth and oral mucosa using sterile gauze moistened in 0.9% NaCl was done and demonstrated to caregiver to be done daily. Petroleum Jelly was perscribe for the lips lesions. Both patients showed improved mucosal hydration, debris reduction, and greater comfort. Discussion: Oral cavity infection is one of the factors that plays an important role in accomplishing the successful overall treatment while bedridden patients had increased risks of oral infection due to limited abilities. Cleaning and wipping with 0,9% NaCl was a safe choice for patient with high risk of aspiration, had a mild antiseptic properties and maintain mucosal hydration. Conclusion: Optimization of oral care in bedridden patients begin with the selection of oral health care maintenance methods by considering the patient's systemic condition.

Achieving and Sustaining Treatment Targets in Rheumatoid Arthritis: A Retrospective Cohort Analysis in Indonesia Fauzia, Fara; Hidayat, Rudy; Kusumo Wibowo, Suryo Anggoro; Sumariyono, Sumariyono; Parlindungan, Faisal; Ariane, Anna; Damanik, Johanda; Araminta, Abirianty Priandani; Damaratri, Suci
Kesmas Vol. 21, No. 1
Publisher : UI Scholars Hub

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Achieving and sustaining low disease activity (LDA) and remission in rheumatoid arthritis (RA) remains challenging. This study examined the rates and predictors of LDA/remission and sustained LDA/remission in an Indonesian RA cohort. A retrospective study of newly diagnosed adult patients attending a rheumatology clinic in 2020-2021 was conducted. Patients were followed for 12 months to evaluate achievement of LDA/remission, defined as DAS28-ESR ≤3.2, and those meeting the target were observed for an additional 12 months to evaluate sustained LDA/remission. Cox regression was used to identify predictors of time to LDA/remission and loss of LDA/remission. Of 166 participants, 91 (54.8%) achieved LDA/remission, with a median time of 10 months. Among these, 39 (41.8%) maintained LDA/remission for 12 months. The median time to loss of LDA/remission was also 10 months. In multivariate analysis, no baseline variables (age, sex, rheumatoid factor (RF) positivity, disease activity, obesity, or disease duration) predicted achieving or sustaining LDA/remission. In this Indonesian cohort, over half of patients reached LDA/remission within 12 months. However, fewer than half sustained it over the following year, highlighting the need for ongoing monitoring and timely treatment adjustments, even after remission is achieved.

Pseudogout Overlapping with Pre-Existing Joint Pathologies: A Case Series Johanda Damanik; Rizki Fauzi Suskhan; Rendy Asmaradhana Sahara; Rudy Hidayat; Suryo Anggoro Kusumo Wibowo; Anna Ariane; Faisal Parlindungan; Abirianty Priandani Araminta
Indonesian Journal of Rheumatology Vol. 18 No. 1 (2026): IJR VOL 18 NO 1
Publisher : Indonesian Rheumatology Associantion

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66446/IJR.v18i1.82

Pseudogout, or calcium pyrophosphate deposition disease (CPPD), is a crystal-induced arthritis frequently mistaken for gout or septic arthritis, particularly in elderly patients or those with inflammatory disorders. We present two cases highlighting the diagnostic value of synovial fluid analysis and musculoskeletal ultrasonography (MSUS). A 34-year-old man diagnosed with ankylosing spondylitis presented with acute right knee pain after running; synovial fluid revealed rhomboid-shaped crystals with high leukocyte count, confirming pseudogout, while MSUS showed intra-cartilaginous crystal deposits. An 87-year-old man presented with mild left knee pain and swelling; synovial fluid again demonstrated rhomboid-shaped crystals, and MSUS confirmed intra-cartilaginous crystal deposition, consistent with pseudogout coexisting with osteoarthritis. These cases highlight the diagnostic challenges of acute monoarthritis in chronic inflammatory disease and advanced age, where inflammatory markers may mislead. Synovial fluid crystal analysis remains crucial, while MSUS offers a non-invasive alternative when aspiration poses challenges, ensuring accurate diagnosis and appropriate anti-inflammatory therapy.

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