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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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Relationship between Neutrophil Lymphocyte Ratio and Lower Extremity Peripheral Artery Disease in Patients with Type 2 Diabetes Mellitus Wibisana, Krishna Adi; Subekti, Imam; Antono, Dono; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 4
Publisher : UI Scholars Hub

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Introduction. Lower extremity peripheral artery disease (PAD) is one of diabetic macrovascular complication which has high rate of morbidity and mortality. Chronic inflammation has been known to have a role in the pathogenesis of PAD in diabetic patient. Recently, neutrophil lymphocyte ratio (NLR) has been used as a marker of chronic inflammation. This study aimed to determine the relationship between neutrophil lymphocyte ratio and lower extremity peripheral artery disease in type 2 diabetic patient in Cipto Mangunkusumo hospital. Methods. A cross sectional study was conducted on 249 patients with type 2 diabetes mellitus who underwent ankle brachial index (ABI) examination at Metabolic and Endocrinology Divison in Cipto Mangunkusumo Hospital between October 2015 – September 2016. The data were retrospectively collected from medical record. Lower extremity PAD was defined as having ABI value ≤ 0,9 by probe Doppler examination. Neutrophil lymphocyte ratio was categorized based on the median value and the relationship with lower extremity PAD were determined. Chi square test was used for bivariate analysis and logistic regression was used for multivariate analysis against confounding variables. Results. Lower extremity peripheral artery disease was found in 36 subject (14.5%). Median of NLR was 2.11. The median value of NLR was found higher in subjects with lower extremity PAD than without PAD (2.46 vs 2.04). There was an association between NLR value ≥ 2.11 and lower extremity PAD in type 2 diabetic patient (p=0.007; PR 2.46 and 95% CI 1.23 – 4.87). By using logistic regression, it was known that hypertension was the confounding variable. Conclusion. There is an association between neutrophil lymphocyte ratio and lower extremity peripheral artery disease in type 2 diabetic patients in Cipto Mangunkusumo Hospital.
Association of Proprotein Convertase Kexin/Type 9 with Atherosclerosis in People with Type 2 Diabetes Mellitus: a Systematic Review Luthfia, Farissa; Wisnu, Wismandari; Tahapary, Dicky Levenus; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 2
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Introduction. Type 2 diabetes melitus is the leading cause of cardiovascular event with high level of low-density lipoprotein as the main predictor marker of atherosclerosis. PCSK9 plays a role in LDL-receptor regulation, its association with atherosclerosis had been investigated but the result is inconsistent. This study aimed to examine the association between PCSK9 level and atherosclerosis in people with type 2 diabetes. Methods. A systematic review was done in July 18 – September 02, 2020 and registered in PROSPERO. Risk of bias of each study was analyzed with Newcastle Ottawa scale tools. Studies involved in this systematic review then narratively analyzed by two independent reviewers. Results. There are 430 subjects involved from 4 studies. Guo, et al. reported that there was a significant association between PCSK9 level with atherosclerosis in type 2 diabetes melitus (OR: 1.12 (CI 95% 1.041 – 1.204), p: 0.002), those association was also reported by Ma, et al. with p value Conclusions. There is still insufficient evidence that show the association between PCSK9 level and atherosclerosis in type 2 DM. Therefore, longitudinal primary research is needed.
The Prevalence of Irritable Bowel Syndrome Using Rome IV Criteria in Medical Student and The Related Factors Ahani, Ardhi Rahman; Syam, Ari Fahrial; Putranto, Rudi; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 1
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Introduction. Medicine is a long study time. Medical student will take five years study to accomplish the education. Because the lot of task and some taken test, some medical student will face irritable bowel syndrome in their study periods. This study aims to identify the prevalence of IBS in medical student and related factors.Methods. A cross-sectional study of 350 medical student Universitas Indonesia from first grade until fifth grade was done during November-December 2016. This study used stratified randomized sampling. The Rome IV criteria was used for diagnosing IBS. Interview with questionnaire guided was applied to all subjects. A bivariate analysis was done to know relationship between IBS and its related factors using chi-square, unpaired t-test, and their alternatives. Multivariate analysis was done using logistic regression test.Results. The IBS proportions were 18.3% in the female medical students and 9.7% in the male medical students (95% CI 1.11- 3.91). The highest subtype was diarrhea subtype (53.1%). Both student-life stress inventory score (stressor and response to stressor) were higher in IBS group than in non-IBS group (For stressor (66.4 (SB 11.4) vs 60.0 (SB 12.2), p=0,001) and for responseto stressor (64.0 (41-97) vs 55,0 (35-88), p<0,0001). Female sex and anxiety were related to IBS ((aOR 2.14; 95% CI 1.12-4.08) and (aOR 2.89; 95% CI 1.43-5.83)).Conclusions. The IBS proportions were 18.3% in the female medical students and 9.7% in the male medical students (95% CI 1.11- 3.91) with predominant diarrhea subtype (53.1%). Anxiety and woman were related to IBS.
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.
Contemporary Issues in Kidney Disease: Addressing Acute Kidney Injury and Inflammation Nugroho, Pringgodigdo
Indonesian Journal of Kidney and Hypertension Vol 1 No 2 (2024): Volume 1 No. 2, August 2024
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v1i2.145

Abstract

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Korelasi Stenosis Penyakit Arteri Perifer di Bawah Lutut dengan Kecepatan Hantar Saraf pada Penyandang Neuropati Perifer Diabetes Melitus Tipe 2 Antono, Akbarbudhi; Antono, Dono; Karim, Birry; Hakim, Manfaluthy; Harimurti, Kuntjoro; Sulistianingsih, Dyah Purnamasari; Ginanjar, Eka; Nelwan, Erni Juwita; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia
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Introduction. One consequence of DM is the emergence of peripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN). Diabetic peripheral neuropathy is a complication of diabetes that presents signs and symptoms of motor and sensory disturbances, while PAD is an atherosclerosis condition that gradually develops in the arterial vessels. This study aimed to determine correlation of arterial obstruction assessed using arteriography and the nerve impairment assessed using nerve conduction velocity (NCV) in DM patients with PAD and DPN. Methods. This is a cross-sectional study that takes secondary data from previous research conducted from July 2018 to June 2021 in Cipto Mangunkusumo hospital. Subjects were people with DM type 2 who had NPD and PAP who met the inclusion criteria and did not meet the exclusion criteria. Subjects underwent an arteriography examination to assess the stenosis in the peroneal artery, anterior tibial artery, and posterior tibial artery. Subjects also underwent nerve conduction velocity (NCV) examinations in the peroneal N. communis, N. peroneal superficialis, N. tibialis, and N. suralis. The correlation between the two variables was then tested using the Spearman correlation test. Results. The peroneal artery stenosis had a moderate negative correlation (r = - 0.420) with the sensory NCV of the superficial peroneal nerve which was statistically significant (p = 0.023). Meanwhile, the correlation of stenosis and NCV disorders in the peroneal nerve with the common peroneal nerve, anterior tibial nerve with tibialis nerve and posterior tibial nerve with sural nerve was not statistically significant. This can be explained by the possibility of collaterals appearing in people with PAD, the structure of vasculature on the nerves, and the small number of samples. Conclusions. There is a moderate negative correlation between the stenosis of the peroneal nerve and the sensory NCV of the peroneal superficialis. However, insignificant results were found in the correlation between peroneal artery with common peroneal nerve, anterior tibialis artery with tibial nerve, and posterior tibial artery with sural nerve.
Vitamin D levels and depression in type 2 diabetes mellitus patients: a cross-sectional study Putranto, Rudi; Adhiatma, Kresna; Tarigan, Tri Juli Edi; Rumende, Cleopas Martin; Shatri, Hamzah; Rengganis, Iris; Nugroho, Pringgodigdo; Rinaldi, Ikhwan
Medical Journal of Indonesia Vol. 32 No. 3 (2023): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.237005

Abstract

BACKGROUND The prevalence of type 2 diabetes mellitus (T2DM) is increasing and commonly accompanied by comorbidities, such as depression. Vitamin D levels have been associated with T2DM and depression although the mechanism is uncertain. This study aimed to compare vitamin D levels between patients with T2DM with and without depression in the Indonesian community, where such research is rare. METHODS This cross-sectional study was conducted at Cipto Mangunkusumo Hospital. The participants who met the inclusion criteria on an outpatient basis were screened for depression using the Beck Depression Inventory-II (BDI-II) questionnaire and then divided into 2 groups: patients with T2DM with (BDI-II ≥14) and without (BDI-II <14) depression. Both groups were examined for vitamin D levels using the ELISA method, and an analysis of the mean difference between both groups was performed. RESULTS Of 60 patients, 23 (38%) experienced depression. The median vitamin D levels were 21.8 ng/ml (IQR 14.9–26.6) in the depression group and 26.5 ng/ml (IQR 23.96–34.08) in the non-depression group (p = 0.001). After performing multivariate analysis with confounding variables, the adjusted OR of variables (sex, sun exposure score, and body mass index) was 1.123 (95% CI: 1.003–1.259; p = 0.045). CONCLUSIONS Vitamin D levels were significantly lower in patients with T2DM with depression. Future studies should be carried out to determine the benefits of vitamin D supplementation in patients with T2DM with depression and their pathophysiology.
Faktor Prediktif Post Dialysis Fatigue Sedang pada Pasien yang Menjalani Hemodialisis Reguler Amu, Ivan Virnanda; Marbun, Maruhum Bonar H; Nugroho, Pringgodigdo; Rinaldi, Ikhwan; Shatri, Hamzah; Mardiana, Nunuk; Hidayat, Rudy; Susalit, Endang; Yunihastuti, Evy; Purnamasari, Dyah; Wardoyo, Elizabeth Y
Jurnal Penyakit Dalam Indonesia
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Introduction. Fatigue is often found in patients with CKD-HD. Fatigue serves as an indicator of mortality and may be a viable target in a treatment strategy. Current research has not established the determinants of moderate PDF in individuals with CKD who are undergoing HD. Therefore, this study was conducted to prove the predictor factors of moderate PDF. Methods. A retrospective cohort study in CKD-HD patients at Fatmawati Central General Hospital during the period of November-December 2024. The independent variables of this study are comorbidities, MIS, depression, intradialytic SBPV, dialysis vintage, UFG, IDWG, and anemia status. Primary data from the PDF Scale, MIS, and BDI II questionnaire were collected through patient interviews during the eighth hemodialysis session. Demographic and clinical information of the patients was obtained from medical records. Intradialytic SBPV was determined by the ARV. All variables were examined using the chi-square test, except for the depression variable, which failed to fulfil the requirements and was assessed using the Fisher exact test. A logistic regression analysis was performed to identify the most significant association among the predictor variables of moderate PDF. Results. A total of 135 research subjects were included in the study. Based on the results of the bivariate analysis, MIS, depression, and the type of dialysis were significantly linked to moderate post dialysis fatigue (p < 0.05). From the results of the multivariate analysis, inflammatory malnutrition (RR 1.580; 95% CI 1.017–2.455; p = 0.042), dialysis vintage (RR 1.850; 95% CI 1.208–2.834; p = 0.005), and depression (RR 2.165; 95% CI 1.542–3.039; p < 0.001) were obtained. The logistic regression model shows a significant relationship between moderate PDF and severe malnutrition inflammation score, mild to moderate depression, and dialysis vintage exceeding 12 months. Conclusion. Our findings underscore a significant association between depression, dialysis vintage, and malnutrition inflammation score (MIS) with moderate PDF in CKD-HD patients.
Polisitemia Sekunder pada Pasien Laki-Laki Muda dengan Sindrom Nefrotik Wardhani, Ariani Intan; Nugroho, Pringgodigdo; Rinaldi, Ikhwan; Sarasawati, Meilania; Miranda, Monik Ediana; Harahap, Agnes Stephanie
Jurnal Penyakit Dalam Indonesia
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Polycythemia is a condition characterized by an abnormal increase in the total red blood cell mass and is classified into primary and secondary polycythemia. Secondary polycythemia occurs as a physiological response to tissue hypoxia or increased erythropoietin production, without intrinsic abnormalities in erythroid progenitor cells. This condition is rare, particularly when associated with nephrotic syndrome. This report aims to describe a case of secondary polycythemia associated with focal segmental glomerulosclerosis (FSGS). A 20-year-old man presented with generalized edema for five months prior to admission, accompanied by foamy urine. Physical examination revealed peripheral edema and minimal ascites. Laboratory investigations demonstrated massive proteinuria and elevated hemoglobin levels. Renal biopsy confirmed the diagnosis of FSGS, while bone marrow biopsy showed normocellular findings without evidence of malignancy or fibrosis. The patient was treated with methylprednisolone, ramipril, and simvastatin, and underwent four sessions of phlebotomy along with antiplatelet therapy. Following treatment, there was improvement in hemoglobin levels, proteinuria, and blood pressure control. Secondary polycythemia has been reported to be associated with various parenchymal kidney diseases, including FSGS. The proposed mechanisms include increased erythropoietin production due to renal ischemia or dysregulation of erythropoiesis feedback mechanisms. Phlebotomy is an important therapeutic intervention to prevent complications related to hyperviscosity and thromboembolism and has been shown to result in clinical improvement. This case illustrates a rare occurrence of secondary polycythemia in a patient with nephrotic syndrome due to FSGS. Accurate diagnosis and comprehensive management, including phlebotomy, can lead to meaningful clinical improvement. This report is expected to contribute to the literature on the diagnosis and management of secondary polycythemia in kidney disease.
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