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All Journal Medical Journal of Indonesia Indonesian Journal of Rheumatology Indonesian Journal of Cardiology Indonesian Journal of Kidney and Hypertension Jurnal Penyakit Dalam Indonesia
Pringgodigdo Nugroho, Pringgodigdo
Divisi Ginjal Hipertensi, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia
Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Interstitial lung disease in mixed connective tissue disease Tendean, Marshell; Nuriawan, Sazkia Aziza; Nugroho, Pringgodigdo
Indonesian Journal of Rheumatology Vol 9, No 1 (2017)
Publisher : Indonesian Rheumatology Association

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Abstract

Interstitial lung diseases (ILD) are known as a debilitating pulmonary complications that may be occured in almost all systemic connective tissue diseases (CTD), including mixed connective tissue disease (MCTD). ILD is usually found in more than half of MCTD patients after 2-4years after the diagnosis made. A-47-years-old female initially diagnosed as systemic lupus erythematosus (SLE) developed a severe progressive dyspnea. She has recently diagnosed as MCTD with ILD after 9 months of initial symptoms. She was giving with Cyclophosphamide 500 mg IV pulse dose. However, after 1 months she developed severe pneumonia andpronounced demise due to intractable septic shock. The debilitating course of ILD is commonly seen in most systemic CTD. Therefore, it is important to perform initial screening and prevention. Systemic corticosteroid with or without immunosupressor agent(s) are indicated inILD-MCTD. Patients with progressive diseases will have poor prognosis.Keywords : ILD, MCTD, Corticosteroid
Diagnostic values of DAS28 and DAS28-squeeze in evaluating Rheumatoid Arthritis disease Santosa, David; Hidayat, Rudy; Prasetyo, Marcel; Nugroho, Pringgodigdo
Indonesian Journal of Rheumatology Vol 8, No 2 (2016)
Publisher : Indonesian Rheumatology Association

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Background : In recent years, rheumatoid arthritis (RA) uses a “treat to target”  treatment strategy. This strategy requires a valid and accurate tool for assessing disease activity. The most widely used tool is DAS28, which was developed from DAS with the omission of ankle and foot joints. There has been many critization aboutthe accuracy of DAS28 in classifying the state of RA disease. Most importantly, when an active disease state was misclassified as an inactive state (false negative)which lead to under treat and subsequently to disability. The difference between DAS28 and DAS lies mainly in the exclusion of ankle and foot joints, thus DAS28-squeeze, a new and simple tool has been proposed. It comprises the same 28 joints in DAS28 added with a sqeeze test on both metatarsophalangeal joints. However, this new tool has never been validated with any imaging techniques.Objective : To assess the diagnostic values of DAS28 and DAS28-squeeze.Methods : This study comprised a cross-sectional diagnostic study, using Power Doppler sonography as a standard reference in evaluating the diagnostic value ofDAS28 and DAS28-squeeze. This study uses the most sringent sonography criteria of active disease which is an active Doppler signal with a moderate synovial hypertrophy on B-mode. Results : Over the study period, 56 subjects underwent diagnostic tests using DAS28, DAS28-squeeze and Power Doppler sonography. There were 4 false negativecases in DAS28 and 1 case in DAS28-squeeze. The sensitivities of DAS28 and DAS28-squeeze to identify active disease using Power Doppler sonography as reference standard were 73.3% (95%CI ± 11.59) and 93.3% (95%CI ± 6.55), respectively. While the specificities of DAS28 and DAS28-squeeze were 36.6% (95%CI ± 12.62) and 34.1% (95%CI ± 12.42), respectively. Furthermore the negative likelihood ratioof DAS28 and DAS28-squeeze were 0.73 and 0.19, respectively.Conclusion : This study is the first to validate DAS28- squeeze using imaging techniques. From this study the false negative rate of DAS28-squeeze is lower thanDAS28. DAS28-squeeze has a better sensitivity and negative likelihood ratio than DAS28 in identifying RA disease state.Keywords : Rheumatoid Arthritis, DAS28, DAS28-squeeze, treat to target, Power Doppler, squeeze test
Kajian Efikasi dan Keamanan Terapi Antikoagulan Baru pada Pasien Deep Vein Thrombosis Ridwan Rasyid; Pringgodigdo Nugroho; Yoga Yuniadi
Jurnal Kardiologi Indonesia Vol. 33, No. 4 Oktober - Desember 2012
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v33i4.31

Abstract

Background. Warfarin is a standard medication for deep vein thrombosis (DVT). However, there are some limitations of its use due to the need of regular monitoring and problems of drug to drug and drug to food interactions. Newer  oral anticoagulants (NOAC) is being considered as substitution to warfarin, yet they need some evidences on its safety and efficacy. This evidence case report is aimed to elaborate safety and efficacy of NOAC (dabigatran and rivaroxaban) in the setting of DVT.Methods  and Results.  Relevant articles are searched in Pubmed and Proquest database. Only recent article which less than 5 year publication included in this study. RE-COVER  study showed  non-inferiority of dabigatran as compare to warfarin in treating DVT patients. Mortality rate and recurrent rate of DVT were 2.4% vs. 2.1% in dabigatran and warfarin respectively (HR=1,10 CI 95%  = 0,65-1,84). Dabigatran showed less bleeding rate compare to warfarin, 5.6% vs. 8.8% respectively (HR = 0,63CI95% = 0,47 - 0,84; RRR =29%, p = 0,0002). Similar results is shown in EINSTEIN study that compares rivaroxaban with warfarin. Mortality rate and recurrent rate of DVT were 2.1% vs. 3% in rivaroxaban and warfarin respectively (HR=0,68  CI 95% = 0,44-1,04). Total bleeding rate were7.3% vs. 7% and major bleeding were 0.8% vs. 1.2% in rivaroxaban and warfarin respectively.Conclusion. Both dabigatran and rivaroxaban showed non inferior efficacy as compare to warfarin in the treatment of DVT, and slightly better bleeding rate.
Management of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 4
Publisher : UI Scholars Hub

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Abstract

Chronic kidney disease (CKD) is still a burden on worldwide health issues affecting about 11-13% of the general population. Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a common complication in CKD, which occurs early in the disease, and progresses as kidney function deteriorates. With declining kidney function, mineral homeostasis becomes progressively dysregulated, including alterations in several parameters such as calcium, phosphate, intact parathyroid hormone (iPTH). Changes in these parameters are associated with bone disorders and vascular abnormalities, which are strongly correlated with increased cardiovascular (CV) morbidity and mortality, and overall mortality. Currently, CKD-MBD and its complication management have been focusing on correcting biochemical and hormonal abnormalities to limit their potential effects. All therapeutic decisions are based on circulating levels of calcium, phosphate and PTH considered together. CKD-MBD management should also be individualized since it might differentially benefit the patients.
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
Publisher : UI Scholars Hub

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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%.
Factors Associated with Late Referral in End Stage Renal Disease Patients at Dr. Cipto Mangunkusumo Hospital Lydia, Aida; Rachmaningrum, Grecia; Shatri, Hamzah; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 2
Publisher : UI Scholars Hub

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Predictors of Virological Failure in HIV Patients Receiving FirstLine Antiretroviral Therapy with Good Adherence Kurniawan, Farid; Djauzi, Samsuridjal; Yunihastuti, Evy; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia Vol. 4, No. 1
Publisher : UI Scholars Hub

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Introduction. Antiretroviral therapy (ART) effectively suppress HIV replication. Viral load (VL) measurement is better predictor than clinical or immunological criteria to evaluate success or failure of ART. However, in country with limited resources, viral load measurement is not easily accessible by HIV patients receiving ART. Therefore, it is necessary to know which factors that can predict virological failure. In previous studies, adherence was an important factor for suppression of HIV viral load. This study is aimed to know predictors of virological failure in HIV patients receiving recent first line ART regimen with good adherence in Indonesia. Methods. A retrospective cohort study was conducted among adult HIV patients in Out-patient Clinic of Cipto Mangunkusumo Hospital that started ART during periode of January 2011-June 2014. HIV patients with good adherence that had viral load data 6-9 months after initiation of ART were included in this study. Virological failure was defined as viral load ≥ 400 copies/ mL after minimum of 6 months therapy with good adherence. Age at starting ART, risk factor for HIV infection, HIV clinical stage, HIV-TB co-infection, baseline CD4 value, CD4 count increase, baseline hemoglobin level and body mass index, weight changes during therapy, and ART based regimen were analyzed in this study. Results. A total of 197 patients were included in this study. Virological failure was found in 21 patients (10,7%). CD4 increase /mm3 after minimum 6 months of ART was predictor of virological failure (p = 0,003; OR 5,802, 95%CI 1,842-18,270). Conclusion. CD4 increase /mm3 after minimum 6 months therapy can predict virological failure in HIV patients receiving first line ART with good adherence
Change of Interleukin-6, C-Reactive Protein and Soluble VascularCell Adhesion Molecule-1 Concentrations in HemodialysisPatients with Reprocessed Dialyzer Nugroho, Pringgodigdo; Lydia, Aida; Panggabean, Marulam MP
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 3
Publisher : UI Scholars Hub

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Introduction. Cardiovascular disease is a major cause of morbidity and mortality in hemodialysis patients. In addition to traditional cardiovascular risk factors, non-traditional cardiovascular risk factors such as inflammation were also involved. Reprocessed dialyzer has been showed to induce less inflammation than new dialyzer, but data in diacetate cellulose membrane have not been presented. Methods. Twenty hemodialysis (HD) patients were enrolled. Pre and post study design was conducted to know post dialysis concentration changes of interleukin 6 (IL-6), C-reactive protein (CRP) and soluble vascular cell adhesion molecule-1 (sVCAM-1) at reuse 0, 5 and 10. Patients were recruited if medically stable, on maintenance HD >3 months, using reprocessed diacetate cellulose membrane by automated machine with mixture of periacetic acid and hydrogen peroxide solution. Urea reduction ratio (URR) and delivered dialysis dose were used to evaluate dialysis adequacy at reuse 0, 5, and 10. Results. CRP concentration was decreased. Median concentration of CRP at reuse 0, 5 and 10 were 3.55 mg/L, 2.97 mg/L and 2.92 mg/L, p=0.074. There were no significant changes of IL-6 concentration. Median concentration of IL-6 at reuse 0, 5, and 10 were 9.05 pg/ml, 10.64 pg/ml and 8.51 pg/ml, p=0.316. Concentration of sVCAM-1 was not changed significantly, with mean sVCAM-1 concentration 3078±786 ng/ml, 3260±836 ng/ml and 3154±631 ng/ml at reuse 0, 5 and 10,p=0.746. During use of reprocessed dialyzer through 10 times, there were no significant changes of hemodialysis adequacy using URR and Kt/V.
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
Apakah Hemodialisis Tiga Kali Seminggu Lebih Baik? Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia Vol. 4, No. 3
Publisher : UI Scholars Hub

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Co-Authors Adhiatma, Kresna Agnes Stephanie Harahap Ahani, Ardhi Rahman Aida Lydia Aida Lydia Aida Lydia, Aida Antono, Akbarbudhi Ardhi Rahman Ahani Ari Fahrial Syam Ari Fahrial Syam Arshita Auliana Birry Karim Cleopas Martin Rumende Danasasmita, Gantira Dicky Levenus Tahapary Dono Antono Dyah Purnamasari E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Eka Ginanjar Em Yunir Em Yunir, Em Endang Susalit Endang Susalit Erni Juwita Nelwan, Erni Juwita Evy Yunihastuti Farid Kurniawan Farid Kurniawan, Farid Gantira Wijayakusumah Danasasmita Grecia Rachmaningrum Hakim, Manfaluthy Hendra Dwi Kurniawan Hendra Dwi Kurniawan, Hendra Dwi Ikhwan Rinaldi Imam Subekti Iris Rengganis Khie Chen Krishna Adi Wibisana Krishna Adi Wibisana, Krishna Adi Kuntjoro Harimurti Luthfia, Farissa Marcel Prasetyo Marshell Tendean Maruhum B.H. Marbun Miranda, Monik Ediana Nunuk Mardiana, Nunuk Nuriawan, Sazkia Aziza Panggabean, Marulam MP Rachmaningrum, Grecia Ridwan Rasyid Robert Sinto Robert Sinto Rudi Putranto Rudy Hidayat Rudy Hidayat Samsuridjal Djauzi Samsuridjal Djauzi Santosa, David Sarasawati, Meilania Subekti, Imam Sulistianingsih, Dyah Purnamasari Tri Juli Edi Tarigan Virnanda Amu, Ivan Wardhani, Ariani Intan Wardoyo, Elizabeth Y Wismandari Wisnu Yoga Yuniadi