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CRJIM (Clinical and Research Journal in Internal Medicine)
Published by Universitas Brawijaya
ISSN : 27235130     EISSN : 27235122     DOI : https://doi.org/10.21776/ub.crjim
Core Subject : Health, Science, Education,
Education Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health Other
Clinical and Research Journal in Internal Medicine is the official open access journal of Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia. It publishes articles two times per year. It is a peer reviewed publication of Indonesian Internal Medicine journals and accepting articles for publication from around the world. CRJIM only publishes articles in the English version. The objective of this journal is to publish the selected clinical and basic research relevant to Internal Medicine. It covers the following topics, nephrology, endocrinology, metabolic, and diabetes, rheumatology, geriatrics, tropic infection, hematology oncology. CRJIM publishes original researches, reviews, brief reports, editorial, case series, case reports, and commentary. Additionally, it also considers publishing animal studies relevant to Internal Medicine topic. It is an international journal dedicated to providing new information that could give new insight for alternative solutions, diagnosis, therapy and prevention for researchers and practitioners in Internal Medicine.
Arjuna Subject : Kedokteran - Kedokteran Internal
Articles 123 Documents
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Mortality Risk Factors in Continuous Ambulatory Peritoneal Dialysis Patients Widiaputro, Dandi; Gunawan, Atma; Rifai, Achmad
Clinical and Research Journal in Internal Medicine Vol. 7 No. 1: Volume 7 No 1, May 2026
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2026.007.01.03

Abstract

Background: Chronic Kidney Disease (CKD) is a common kidney disorder among elderly individuals and is a leading cause of global mortality. Patients undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) are at high risk of complications and mortality. Therefore, analyzing risk factors for mortality in CAPD patients is crucial. Aim: To identify mortality risk factors in CAPD patients. Methods: This study was an observational retrospective study design. The sample consisted of CAPD patients at Saiful Anwar Hospital in Malang, with data collection from August 1st, 2019 to July 31st, 2023. Information collected included demographic data, medical history, and laboratory parameters. Data were analyzed using chi-square tests, t-tests, Kolmogorov-Smirnov tests, and multiple logistic regression to evaluate relationships, normality, risk factor effects, and the mortality rate of CAPD patients. Results: There were 377 subjects who met the inclusion criteria, consist of deceased (n=89) and alive (n=288) subjects. Older age significantly increased mortality risk with an odds ratio (OR) of 1.277 (95% CI: 1.260-1.294; p = 0.007). Diabetes mellitus increased mortality risk in CAPD patients, with an OR of 3.185 (95% CI: 1.427-7.105; p = 0.005). Heart failure increased mortality risk in CAPD patients, with an OR of 4.201 (95% CI: 2.170-8.133; p = 0.000). Decreased potassium levels increased mortality risk in CAPD patients, with an OR of 1.352 (95% CI: 1.020-1.792; p = 0.036). Conclusion: Older age, diabetes mellitus, heart failure, and decreased potassium levels increase mortality risk in CAPD patients.
Diagnostic Challenges of Intraosseous Epidermal Inclusion Cysts in the Distal Phalanx: EIC of Distal Phalanx Goyal, Neha; Kumar, Nishith; Singh, Dharmendra; Prasad, Rajni; Bargunam, Priyadharshini
Clinical and Research Journal in Internal Medicine Vol. 7 No. 1: Volume 7 No 1, May 2026
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2026.007.01.12

Abstract

Abstract Introduction Epidermal inclusion cysts (EIC) of bone are rare, most commonly affecting the distal phalanx. Typically associated with trauma, they present as lytic expansile lesions, often mimicking other bony pathologies. Case report We report a 35-year-old male with a progressively enlarging swelling of the right little finger, following repeated blunt trauma. MRI revealed a well-defined lytic expansile lesion in the subungual region, suggestive of an EIC. FNAC was inconclusive, and a histopathological biopsy examination confirmed keratin flakes, consistent with EIC. Discussion EICs appear as radiolucent lytic lesions on X-rays, often confused with chronic infections, enchondromas, simple bone cysts, aneurysmal bone cysts, giant cell lesions, and malignant tumors. Accurate diagnosis relies on histopathology, which identifies EICs by keratin-filled cystic spaces lined with squamous epithelium. Conclusion Treatment typically involves curettage and removal of keratotic debris, underscoring the importance of precise diagnosis to avoid unnecessary interventions. This case highlights the necessity of including EICs in the differential diagnosis of radiolucent bony lesions to ensure appropriate management. Keywords- Epidermal Inclusion Cyst, Bone Cysts, Distal Phalanx, Lytic Bone Lesions, Intraosseous Epidermal Inclusion Cyst
Analysis of Lipid Profile and Body Mass Index in a Population of Type 2 Diabetes Mellitus Patients in First Level Health Facilities Malang Putri, Ghinantia Athaya; Bramantya, Rinadhi Reza
Clinical and Research Journal in Internal Medicine Vol. 7 No. 1: Volume 7 No 1, May 2026
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2026.007.01.04

Abstract

Background: Abnormal lipid profiles and body mass index (BMI) has a role in the risk of complications of DM. Aim: This research aimed to describe the lipid profile and BMI characteristics of type 2 DM patients. Methods: Cross-sectional observational study with a retrospective approach used secondary data from Chronic Disease Management Program (Prolanis) patients at First Level Health Facilities (FKTP) in Malang City and it through univariate and bivariate analysis. Results: From univariate analysis, most of patients had total cholesterol in the desired category, triglycerides in the normal category, very high category in LDL, high category in HDL, and obese II category in BMI. Meanwhile, from bivariate analysis, there was a significant relationship between sex and HbA1c on LDL, HDL, and BMI, and there was no significant relationship between age and LDL, HDL, and BMI. Conclusion: Therefore, close monitoring is needed regarding the patient's lipid profile and BMI because they are associated with high risk factors for complications. Keywords: diabetes mellitus, lipid profile, body mass index
Comparative Analysis of Cognitive Dysfunction in Chronic Kidney Disease Patients Undergoing Hemodialysis Versus Continuous Ambulatory Peritoneal Dialysis (CAPD) Sagala, Ida Meita; Rifai, Achmad; Gunawan, Atma
Clinical and Research Journal in Internal Medicine Vol. 7 No. 1: Volume 7 No 1, May 2026
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2026.007.01.05

Abstract

Background: The increasing prevalence of impaired cognitive function in patients with chronic kidney disease (CKD) represents a significant global health concern. Hemodialysis (HD) and Continuous Ambulatory Peritoneal Dialysis (CAPD) are two commonly employed treatment modalities for CKD; however, their effects on cognitive function in this patient population require further investigation. Aim: To compare the impairment of cognitive function between patients with CKD undergoing HD and those undergoing CAPD. Methods: This study employed a cross-sectional design utilizing observational methods conducted at Dr. Saiful Anwar Hospital from August 2024 to January 2025, involving 139 patients with CKD, comprising 50 patients undergoing CAPD and 89 patients undergoing HD. Cognitive function was assessed using the Montreal Cognitive Assessment-Indonesian version (MoCA-INA). Results: The prevalence of cognitive impairment was found to be 28.9% in patients undergoing HD and 40% in patients undergoing CAPD. The results of the comparative analysis indicated a significant difference between the cognitive scores of the CAPD group and those of the HD group, with a p-value of 0.008. Based on the comparison test of the degree of cognitive impairment, no significant differences were found between the HD and CAPD groups in the mild cognitive impairment (p = 0.471), moderate cognitive impairment (p = 0.317), and severe cognitive impairment (p = 0.480). Conclusion: There was a significant difference in the cognitive impairment scores between the CAPD group and the HD group.
The Comparative Value of MLR And NLR to CIMT Between HD and CAPD Patients Baridwan, Fakhri; Samsu, Nur; Winoto, Eden Suryoiman
Clinical and Research Journal in Internal Medicine Vol. 7 No. 1: Volume 7 No 1, May 2026
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2026.007.01.06

Abstract

Background: Research about the comparison of monocyte lymphocyte ratio (MLR) and neutrophil lymphocyte ratio (NLR) on Carotid Intima-Media Thickness (CIMT) between Hemodialysis (HD) and Continuous Ambulatory Peritoneal Dialysis (CAPD) patients is still very limited, therefore further research is needed. Aim: This study aims to investigate the relationship between MLR and NLR values and CIMT in HD and CAPD patients. Method: A cross-sectional observational study was conducted on 97 dialysis patients (52 HD and 45 CAPD patients) at Saiful Anwar General Hospital, Indonesia. Participants were over 18 years old, on dialysis for at least three months (HD at least twice weekly), and physically independent. Critically ill and pregnant patients were excluded. Statistical analysis was performed using Mann-Whitney test to see the difference of NLR and MLR between the two groups, Spearman test was used to analyse the correlation of NLR and MLR to CIMT in HD and CAPD. Results: This study revealed that CAPD patients had higher NLR values compared to HD patients (MD: 0.63; 95%CI: 0.07 - 1.15; p: 0.0253) and there was a significant association between MLR and increased Carotid Intima-Media Thickness (CIMT) in CKD patients undergoing CAPD (r: 0.3543; 95%CI: 0.05896 - 0.5927; p: 0.0169).   Conclusion: Our study underscores higher NLR values were found in CAPD patients compared to HD patient and the significant association between MLR values and CIMT in CAPD patients.
Pellagra Syndrome in Geriatric Patient: Insights from Pathogenesis and Diagnosis Raharjo, Fajar Maulana; Soenarti, Sri; Winoto, Eden Suryoiman; Adriansyah, Vito; Aditya, Muhammad Reva
Clinical and Research Journal in Internal Medicine Vol. 7 No. 1: Volume 7 No 1, May 2026
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2026.007.01.14

Abstract

Pellagra syndrome is a chronic niacin deficiency disease that is often underdiagnosed. We report a case of an 83-year-old woman presenting with the four classic symptoms (4D) of pellagra: dermatitis (Casal’s necklace), diarrhea, dementia, and a risk of death if left untreated. The patient also had severe malnutrition, multiple infections, and a history of stroke for five years. The diagnosis was established based on clinical findings and a history of inadequate nutritional intake. Management included fluid therapy, antibiotics, medical rehabilitation, enteral and parenteral nutrition, as well as niacin supplementation. Following treatment, the patient showed clinical improvement, including stabilization of hemoglobin levels. This case highlights the importance of early detection and understanding the pathogenesis of Pellagra syndrome to improve patient outcomes and quality of life. Keywords: Casal’s Necklace, Dementia, Malnutrition, Niacin, Pellagra syndrome
Circulating Tumor DNA: Unravelling the Treatment Response Uncertainty in Lymphoma: Systematic Review and Meta-Analysis Bulain, Stanley; Setiawan, Aurielle Annalicia; Nestovani, Anggella Christoferisa Ditya; Pamarta, Trisna Belani; Baliulina, Shintya Octaviana; Arifah, Nina Nur
Clinical and Research Journal in Internal Medicine Vol. 7 No. 1: Volume 7 No 1, May 2026
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2026.007.01.08

Abstract

Background: Uncertainty in lymphomas treatment response could negatively affect the disease course. Circulating tumor DNA (ctDNA), minimally invasive biomarker, can be useful to monitor treatment response, recurrence, yet minimally invasive. Aim: To evaluate the effectiveness of ctDNA for predicting early relapse (indicated by progression-free survival (PFS) and overall survival (OS)), and for predicting non-complete response (non-CR) in lymphomas. Methods: Comprehensive searches in PubMed, ScienceDirect, Wiley, Springer and Cochrane were conducted. Critical appraisal was conducted using the ROBINS-E tool for cohort and ROB 2.0 randomized controlled trials. hazard ratios (HRs) of pretreatment CtDNA for PFS and OS. The secondary outcome was the risk ratio (RR) of non-CR in detectable posttreatment CtDNA and its diagnostic accuracy analysis. RevMan 5.4 and STATA 17 was used for quantitative analysis. Results: 14 studies (1,144 patients) were included. Higher pretreatment ctDNA significantly increase the risk of worse PFS (HR 2.20, 95% CI 1.41-3.43) and worse OS (2.20, .14-4.26), also with optimal cut-off at 2.5 log10hGE/mL for PFS (2.46, 1.70-3.54) and OS (2.36, 1.30-4.29). The value was also significant in DLBCL, both for PFS (2.46, 1.71-3.55) and OS (2.70, 1.58-4.60), P<0.05 . Detectable posttreatment CtDNA also correlated with non-CR (RR 5.56 95% CI 2.82-10.95), with pooled sensitivities 0.91 (0.71-0.98), specificities 0.76 (0.51-0.90), positive-likelihood ratios 3.74 (1.71-8.19), negative-likelihood ratios 0.12 (0.04-0.39), and area under curve (AUC) 0.91 (0.88 - 0.93). Conclusion: Higher pretreatment CtDNA strongly correlated with the disease progression and survival, specifically at log10hGE/mL. Detectable posttreatment CtDNA were significantly correlated with non-CR.
Prevalence and Clinical Characteristics of Anemia Among Adults in a Highland Rural Community of East Java, Indonesia: Anemia in a Highland Village of East Java Nurarifah, Nina; Hermanto, Djoko Heri; Wardhani, Shinta Oktya; Brahmantyo, Herwindo Pudjo; Putri, Rakhmi Tika; Nainggolan, Freddy Chandra; Hapsari, Aulia Sita
Clinical and Research Journal in Internal Medicine Vol. 7 No. 1: Volume 7 No 1, May 2026
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2026.007.01.07

Abstract

Anemia is a persistent global health challenge, particularly affecting women of reproductive age and residents of rural regions. This descriptive cross-sectional study assessed the prevalence and clinical characteristics of anemia among adult residents of Ngadas Village, a highland community in East Java, Indonesia. A total of 57 adults (48 females, 9 males) participated in a single-day community screening conducted by the Faculty of Medicine, Brawijaya University. Data collection included structured questionnaires, clinical examinations, and hemoglobin testing using the Sinocare H101 analyzer. The mean hemoglobin level was 14.6 ± 1.7 g/dL, with an overall anemia prevalence of 7.0%, indicating mild public health significance according to WHO classification. Fatigue (35.1%) and dizziness (49.1%) were the most common symptoms, whereas clinical signs such as pallor and cheilitis were infrequent. Women of reproductive age predominated, yet no pregnant respondents were anemic, suggesting the possible effectiveness of iron–folate supplementation programs. Although dietary protein and iron intake appeared adequate, frequent tea and coffee consumption among women (62.5%) could inhibit non-heme iron absorption. The findings underscore the predominance of subclinical anemia and the need for routine hemoglobin screening and targeted nutrition education. Strengthening preventive strategies in rural highland communities remains essential to sustain low anemia prevalence and improve public health outcomes.
Analysis of User Experience and Patient Perceptions of an Artificial Intelligence (AI) Application for Diabetes Management: A Qualitative Study Yudha, Nyoman Satvika Dharma; Pratama, Mirza Zaka; Fajarpeni, Prisca Anindhita
Clinical and Research Journal in Internal Medicine Vol. 7 No. 1: Volume 7 No 1, May 2026
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2026.007.01.09

Abstract

Background: Diabetes mellitus is a chronic condition requiring significant long-term self-management. Artificial Intelligence (AI) technology offers novel potential to support patients in their daily self-care routines. However, patient perceptions and real-world user experiences with these AI applications, particularly in low- and middle-income settings, remain understudied. Objective: To explore the user experience and perceptions of patients with diabetes and their caregivers using Inadia, a WhatsApp-based AI application designed for diabetes management in Indonesia. Methods: This study employed a descriptive qualitative design. Semi-structured in-depth interviews were conducted with six participants (patients with diabetes and caregivers) who were users of the Inadia application. Data were analyzed using the six-phase thematic analysis framework developed by Braun & Clarke. Ethical approval was obtained from an institutional review board, and all participants provided written informed consent. Results: Five major themes emerged from the analysis: (1) Usability and accessibility through the familiar WhatsApp interface; (2) The functional value and positive clinical–psychological impact of the application; (3) The critical influence of AI communication style and its perceived emotional sensitivity; (4) Technical challenges, primarily server delays, and user cost concerns; and (5) User-specific needs and expectations for future development. Conclusion: The Inadia application demonstrates significant promise in supporting diabetes self-management, largely due to its high accessibility via WhatsApp. However, its sustained success and long-term user adoption are critically dependent on resolving technical stability issues and, crucially, refining the AI’s communication style to be more emotionally supportive and encouraging.
Diagnostic Delay in advanced Gastroesophageal Adenocarcinoma presenting as Chronic Neurogenic Dysphagia: Gastroesophageal Adenocarcinoma and Chronic Neurogenic Dysphagia Abshori, Nuril Farid; Kakiay, Ferdinandus Stevanus; Ahdi, Iwal Reza; Patikawa, Febria Rizky
Clinical and Research Journal in Internal Medicine Vol. 7 No. 1: Volume 7 No 1, May 2026
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2026.007.01.15

Abstract

Advanced adenocarcinoma of the esophagogastric junction (AEGJ) may mimic benign or neurogenic swallowing disorders, leading to delayed diagnosis. We report a 65-year-old man with a two-year history of progressive dysphagia initially attributed to neurogenic causes following an ischemic stroke. The patient developed recurrent vomiting, epigastric pain, and significant weight loss (16 kg). On admission, he appeared cachectic (BMI 16.7 kg/m²) with anemia (Hb 7.7 g/dL) and hypoalbuminemia (2.4 g/dL). Contrast-enhanced CT revealed an infiltrative mass involving the distal esophagus and gastric fundus with lymphadenopathy, while endoscopy showed a friable obstructive lesion confirmed as adenocarcinoma on biopsy. A feeding jejunostomy was performed for nutritional optimization prior to oncologic therapy. The diagnostic delay resulted from anchoring bias, in which dysphagia was misinterpreted as neurogenic rather than structural. This case emphasizes the importance of early endoscopic evaluation in elderly patients with chronic progressive dysphagia, weight loss, or anemia, and highlights the need for clinician awareness of cognitive biases to prevent late-stage presentation and improve clinical outcomes.

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