Subekti, Imam
Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta

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Evidence-based Medicine dalam Pelayanan Penyakit Dalam Subekti, Imam
Jurnal Penyakit Dalam Indonesia Vol. 1, No. 1
Publisher : UI Scholars Hub

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Abstract

Perkembangan masalah di bidang kedokteran, tidak terkecuali di bidang Penyakit Dalam, mengharuskan seorang dokter yang berkecimpung di pelayanan penyakit dalam untuk terus mengembangkan diri. Ada dua aspek penting yang terkandung di dalam pengertian "mengembangkan diri". Pada satu sisi, seorang dokter harus secara aktif menelaah dan meneliti, diawali dengan membuat pertanyaan untuk masalah kedokteran dari fenomena yang ada di pelayanan kedokteran sehari-hari, membuat hipotesis untuk memberikan jawaban sementara terhadap pertanyaan, dan selanjutnya membuktikan kebenaran yang digagasnya.
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
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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 between Thyroid Status and Glucose Intolerance inHyperthyroid Patients Wisnu, Wismandari; Soewondo, Pradana; Subekti, Imam
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 1
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Introduction. The most common endocrinopathy in adults are diabetes mellitus (DM) and thyroid disease. Hyperthyroidism decreases blood glucose control and increased the need of insulin. However, the mechanism of abnormal glucose metabolism in hyperthyroidism is not fully understood. This study aims to determine the relationship of thyroid status with incidence of glucose intolerance in hyperthyroid patients compared to hyperthyroid patients who have achieved clinical status of eutyroid and normal population. Methods. This study was cross sectional design in outpatients with hyperthyroidism in hyperthyroid and euthyroid/subclinical hyperthyroid status, and healthy volunteers who had matching age and sex. An oral glucose test and Homeostatic Model Assesment Insulin Resistance was performed after the diagnosis of hyperthyroidism by FT4 and TSH measurement. Data analysis was performed using SPSS for Windows version 20.0. Results. There were 114 eligible patients (40 case hyperthyroid, 40 case euthyroidism/subclinical hyperthyroidism and 34 healthy subjects). Proportion of glucose intolerance in hyperthyroidism is 52,5% (10% DM, 32,5% impaired glucose tolerance (IGT), and 10% impaired fasting glucose (IFG)), in euthyroidism/subclinical hyperthyroidism was 20% (5% DM, 15% IGT, and 0% IFG), and in healthy subjects was 11,8% (0% DM, 8,8% IGT, and 2,9% IFG). Glucose intolerance in hyperthyroidism was significantly different than euthyroidism/subclinical hyperthyroidism (p=0.002). We also found that the association between thyroid status and glucose intolerance in the group without insulin resistance was significantly different (p=0.004). Conclusions. Our study conclude that there is association between hyperthyroidism and glucose intolerance. Hyperthyroid patients in euthyroidism/subclinical hyperthyroidism status have the same risk as the healthy subject to became glucose intolerance.