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ISSN : 23381426 EISSN : 23386037 DOI : http://doi.org/10.23886/ejki

Core Subject : Health, Science,

Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

eJournal Kedokteran Indonesia (eJKI) is a general medical journal, published quadrimester (April, August, December) by Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia. eJKI aims to published the manuscript of students (Bachelor of Medicine (S.Ked), study Program of Medical Profession, magister/specialist, doctoral, and fellow). The journal is a general medical journal that covering all areas of biomedical science, basic medical science, clinical science, medical technology, and medical education. The journal accepts editorial, research article, reviews, evidence-based case report, and also interesting case reports/case study. This work was supported by Faculty of Medicine, Universitas Indonesia.

Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)

Articles 162 Documents

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Nasal and Sinus Diseases: Common Causes of Upper Airway Cough Syndrome Niken Lestari Poerbonegoro; Nina Irawati; Sonia Miyajima Anjani
eJournal Kedokteran Indonesia Vol 9, No. 3 - Desember 2021
Publisher : Faculty of Medicine Universitas Indonesia

Upper airway cough syndrome (UACS), previously known as post-nasal drip syndrome, is a persistent cough that lasts more than four weeks in children or more than eight weeks in adults, which is associated with nasal and sinus diseases, such as allergic rhinitis (AR), chronic rhinosinusitis (CRS), and adenoid hypertrophy (AH). UACS is one of the major causes of chronic cough. Several theories support the pathophysiology of chronic cough in UACS, namely post-nasal drip, airway inflammation, and sensory neural hypersensitivity theories. Persistent and excessive cough generates a deterioration in patient’s quality of life and social interaction. This review summarizes the knowledge on pathophysiology and underlying disease of UACS, aims to help clinicians identify and treat this syndrome.

Clinicopathologic and Histomorphological Aspect of Basal Cell Carcinoma in Dr. Cipto Mangunkusumo Hospital: A Retrospective Analysis of Twenty Years Experience Riesye Arisanty; Muhammad Habiburrahman; Maria Angela Putri
eJournal Kedokteran Indonesia Vol 9, No. 2 - Agustus 2021
Publisher : Faculty of Medicine Universitas Indonesia

Basal cell carcinoma (BCC) is the most common skin malignancy, and the incidence increases over time. However, epidemiological data and analysis of the histopathological characteristic of BCC in Asia and Indonesia are limited. This study evaluates the clinicopathological and histomorphological features of BCC cases at Dr. Cipto Mangunkusumo Hospital (CMH) for the last 20 years (2000-2019). This is a cross-sectional retrospective study, using medical records and slides data screened based on inclusion and exclusion criteria. The re-diagnostic assessment was performed independently by two investigators. Data were analyzed statistically by the chi-square test, Kruskal Wallis, and Mann Whitney tests. There were 896 cases of total 20 years, with an increase of 51.4% between the first and second decades, female: male ratio was 1.34: 1, the median age was 63 y.o (0-99), and 54% patient was 60-79 y.o. The majority of cases are located on the head, face, and neck (95.8%), nodular as the most common histological subtypes (49.2%), with adenoid as the highest number of variants (63.1%). Single vs mixed subtype BCC (58.4% vs 41.6%), low-risk vs high-risk BCC (53.9% vs 46.1%). There were different levels of risk and a number of subtypes based on anatomical location. The differences were also found in the number of subtypes, the aggressiveness of subtypes, and risk levels based on gender and histological subtypes based on anatomical location. Residual tumours were present in 2.8% of cases. Thus the cases of BCC in CMH have increased in the last 20 years, and differences are observed in anatomical distribution, gender, age, risk, number of subtypes, histological subtypes, and aggressiveness. Keywords: basal cell carcinoma, retrospective, epidemiology, histomorphological characteristics. Aspek Klinikopatologis dan Histomorfologikal Karsinoma Sel Basal di Rumah Sakit Dr. Cipto Mangunkusumo: Analisis Retrospektif 20 Tahun Abstrak Karsinoma sel basal (KSB) merupakan keganasan kulit yang paling sering. Namun data epidemiologi dan telaah karakteristik histopatologi KSB di Asia dan Indonesia sangat terbatas. Penelitian ini bertujuan mengevaluasi kasus KSB di Rumah Sakit Dr. Cipto Mangunkusumo (RSCM) dan meninjau gambaran klinikopatologis serta histomorfologinya selama 20 tahun terakhir (2000-2019). Penelitian ini menggunakan desain potong lintang retrospektif dengan mengambil data dari rekam medis dan slide tersimpan. Skrining formulir permintaan patologi berdasarkan kriteria inklusi dan eksklusi. Penilaian diagnosis ulang dilakukan secara independen oleh dua peneliti. Data dianalisis dengan uji chi square, Kruskal Wallis, dan Mann Whitney. Terdapat 896 kasus KSB dalam waktu 20 thn dengan peningkatan 51,4% KSB antara dekade ke-1 dan ke-2, rasio perempuan: laki-laki adalah 1,34:1, median usia 63 tahun (0-99) dan 54% berusia 60-79 tahun. Lokasi anatomis terbanyak di kepala, wajah, dan leher (95,8%), subtipe nodular (49,2%) dengan varian adenoid tertinggi (63,1%). KSB subtipe tunggal vs. campuran (58,4% vs. 41,6%), KSB risiko rendah vs. tinggi (53,9% vs. 46,1%), terdapat beda tingkat risiko dan jumlah subtipe berdasarkan lokasi anatomis, jumlah subtipe, sifat agresivitas subtipe, dan tingkat risiko berdasarkan jenis kelamin, serta beda jenis subtipe dengan lokasi anatomis. Tumor residif terdapat pada 2,8% kasus. Kasus KSB di RSCM meningkat dalam 20 tahun terakhir dan perbedaan diamati pada distribusi anatomi, jenis kelamin, usia, risiko histopatologik, jumlah subtipe, berbagai subtipe histopatologi, dan agresivitasnya. Kata kunci: karsinoma sel basal, retropsektif, epidemiologi, karakter histomorfologi.

The Role of Neutrophil Lymphocyte Ratio , Vitamin D, and NGAL as Cardiovascular Disease Marker in Chronic Kidney Disease Sri Suryo Adiyanti; Yusra Yusra; Suzanna Immanuel; Diana Aulia; Fify Henrika; July Kumalawati
eJournal Kedokteran Indonesia Vol 9, No. 3 - Desember 2021
Publisher : Faculty of Medicine Universitas Indonesia

Chronic kidney disease (CKD) patients have higher risk to develop cardiovascular disease (CVD) than non-CKD patients. Neutrophil lymphocyte ratio (NLR) in CKD patients reflects inflammation status and role as complementary prognostic marker to evaluate cardiovascular risk in stage 3 to 5 CKD. High prevalence of vitamin D deficiency commonly found in CKD patients, leads to endothelial dysfunction and increase inflammation. NGAL is used as renal injury biomarker but nowadays NGAL has been known plays important role in CVD pathophysiology. CVD identification in CKD patients is necessary to obtain CVD risk and to stratify mortality earlier in CKD patients. This study aimed to obtain the differences and continued to obtain cut off of NLR, vitamin D and NGAL in CKD patients undergoing hemodialysis (HD) with and without CVD if the differences was significantly. A cross-sectional study was conducted in dr. Cipto Mangunkusumo National Hospital Jakarta, in December- February 2020. Total subjects were 83, consists of two groups with and without the CVD. There were no significant differences of NLR and vitamin D in CKD patients undergoing hemodialysis (HD) with and without CVD. The significant difference was found only in NGAL with cut off 5.64 ng/ml. NLR was lower, meanwhile vitamin D and NGAL were higher in CKD patients undergoing HD with and without CVD.

Salivary Gland Dysfunction and Dysphagia in Post-Chemoradiotherapy Head and Neck Malignancy Patients Susyana Tamin; Marlinda Adham; Elvie Z. Rachmawati; Sabda Ardiantara; Eka D. Safitri
eJournal Kedokteran Indonesia Vol 9, No. 3 - Desember 2021
Publisher : Faculty of Medicine Universitas Indonesia

Radiotherapy can potentially cause damage to the salivary gland, muscles, and nerve that is important to oropharyngeal swallow, leading to xerostomia and dysphagia. Reporting a case of radiotheraphy-induced xerostomia and dysphagia in HNC patients. A 34 years old man with NPC stage IV B (T4N3M0) came with difficulty swallowing, dryness in the throat and mouth, coughing while eating and drinking, choking, hoarseness, and pain when swallowing. The patient had done 14 times of radiation administration with a total dose of 60 Gy with conformal 3D radiation technique. The amount of saliva measured 0.02 ml/minute. A standing secretion was found in the vallecula, right and left piriformis and postkrioid sinuses in preswallowing assessment. The presence of penetration or aspiration of secretions into the airway were detected. The patient was diagnosed with neurogenic dysphagia and advised to use NGT for diet and consult medical rehabilitation. Literature searching was conducted on March 31, 2021 in the 3 journal database, including PubMed, Cochrane, and EBSCOhost, using particular keywords based on PICO. The inclusion criteria were full text article, observational studies, case-control, cohort, randomized controlled trial, systematic review, written in English, and studies investigating the correlation between HNC patient with radiotherapy and dysphagia or xerostomia. There were 3 systematic reviews, 1 cohort, and 2 cross-sectional studies investigating the correlation between chemoradiotherapy in head and neck cancer and xerostomia/dysphagia. Chemoradiotherapy correlated with dysphagia and xerostomia in head and neck cancer. Xerostomia and disfagia were prevalent in HNC patients after radiotherapy. Besides, there was association between the dose of radiotherapy and incidence or severity of xerostomia and dysphagia.

Anti-Müllerian Hormone Levels as Predictor of In Vitro Fertilization Outcomes Mila Maidarti; Prini Diandara Garinasih; Aprilia Asthasari Siregar; Gita Pratama; Achmad Kemal Harzif; Kanadi Sumapraja; Budi Wiweko
eJournal Kedokteran Indonesia Vol 9, No. 2 - Agustus 2021
Publisher : Faculty of Medicine Universitas Indonesia

A decrease in serum anti-müllerian hormone (AMH) concentration suggests the reduction of antral follicle number. AMH serum level was correlated with ovarian stimulation outcomes, oocyte quantity and quality, embryo quality and in vitro fertilization (IVF) outcomes. However, the use of AMH to predict pregnancy rates in IVF is still debatable. This study aimed to determine the role of AMH in predicting ovarian response and pregnancy rates in IVF programs. This was a retrospective cohort study involving patients who underwent a short protocol of ovarian stimulation for IVF at the Yasmin clinic, dr Cipto Mangunkusumo General Hospital. from March 2013 to March 2021. A total of 1,527 out of 3,880 IVF cycles were included. Poor ovarian response was determined as a collection of fewer than four oocytes following ovarian stimulation. The data was then analyzed using the Mann Whitney test if the data distribution was not normal or the unpaired t-test if the data distribution was normal. Median AMH levels were higher in the normal (2.5(0.01-32)) compared to poor responder (0.68(0.01-6.86)) group (p<0.05; Mann Whitney). Serum AMH level and age had predictive value for pregnancy rate (p<0.05; Mann Whitney). Keywords: AMH, ovarian response, pregnancy rate, IVF. Kadar Hormon Anti-Müllerian sebagai Prediktor Luaran Fertilisasi in Vitro Abstrak Penurunan konsentrasi serum hormon anti-müllerian (HAM) menunjukkan penurunan jumlah folikel antral. HAM serum berkorelasi dengan luaran stimulasi ovarium kuantitas dan kualitas oosit serta kualitas embrio dan luaran fertilisasi in vitro (FIV). Namun, penggunaan HAM untuk memprediksi angka kehamilan dengan stimulasi ovarium pada FIV masih diperdebatkan. Tujuan penelitian ini untuk mengetahui peran serum HAM dalam memprediksi respons ovarium dan laju kehamilan pada program FIV. Penelitian ini adalah studi kohort retrospektif yang melibatkan pasien yang menjalani protokol singkat stimulasi ovarium pada program FIV di klinik Yasmin rumah sakit dr Cipto Mangunkusumo.dari bulan Maret 2013 sampai Maret 2021. Sebanyak 1.527 dari 3880 siklus IVF dimasukkan ke dalam penelitian. Dikatakan perespon buruk apabila diperoleh kurang dari empat oosit setelah stimulasi ovarium. Data kemudian dianalisis dengan menggunakan uji Mann Whitney bila sebaran data tidak normal atau uji t tidak berpasangan bila sebaran data normal. Median kadar HAM lebih tinggi pada kelompok perespons baik (2.5 (0.01-32)) dibandingkan perespons buruk (0.68 (0.01-6.86)) (p<0,05; Mann Whitney). Kadar HAM serum dan usia memiliki nilai prediktif terhadap angka kehamilan (p<0,05; Mann Whitney). Kata kunci: hormon anti-Müllerian, respons ovarium, angka kehamilan, FIV.

Penuntasan Stunting pada Anak sebagai Masalah Multi-Faktorial: Medis, Sosial, Ekonomi, Politik, dan Emosional Aman Pulungan
eJournal Kedokteran Indonesia Vol 9, No. 2 - Agustus 2021
Publisher : Faculty of Medicine Universitas Indonesia

Mitochondrial Adaptations of Obese Adult Rat Visceral Adipocytes which Differ in Nutritional Status during Childhood Lailan Safina Nasution; Ahmad Aulia; Sri Widia A. Jusman; Mohamad Sadikin
eJournal Kedokteran Indonesia Vol 9, No. 3 - Desember 2021
Publisher : Faculty of Medicine Universitas Indonesia

Mitochondria are highly dynamic organelles that can adapt to different environmental stimuli. This study aims to analyze differences in the function and biogenesis of mitochondria and anaerobic glycolysis activity between obese adult rats that were undernourished in childhood (LCD28) and those which were normal (SD28) or already fat (HFD28). Sprague-dawley rats were assigned groups and given diet treatments from December 2017 until August 2018 in the Laboratory Animal Management Unit, Faculty of Veterinary Medicine, Bogor Agricultural Institute. To observe mitochondrial function and biogenesis, MnSOD activity and PGC1α levels were analyzed using ELISA. To investigate the existence of anaerobic glycolysis, LDH activity was analyzed using a spectrophotometry method. The results showed that MnSOD activity and PGC1α levels of LCD28 increased compared to the other groups, signifying higher mitochondrial function and biogenesis. Meanwhile, no significant difference in LDH activity was found, signifying similar levels of anaerobic glycolysis.

Mekanisme Penuaan Kulit sebagai Dasar Pencegahan dan Pengobatan Kulit Menua: Mechanism of Skin Aging Shannaz Nadia Yusharyahya
eJournal Kedokteran Indonesia Vol 9, No. 2 - Agustus 2021
Publisher : Faculty of Medicine Universitas Indonesia

Seiring dengan meningkatnya populasi geriatri di Indonesia, masalah penuaan kulit juga turut meningkat. Pada populasi tersebut terjadi berbagai perubahan kulit sehingga kelainan yang ditimbulkan juga berbeda. Stres oksidatif merupakan mekanisme yang diduga kuat sebagai penyebab utama penuaan kulit. Penuaan kulit merupakan proses kompleks yang melibatkan faktor intrinsik dan ekstrinsik. Faktor intrinsik yang berperan adalah genetik, metabolisme sel, dan perubahan hormonal. Selain itu, terdapat faktor ekstrinsik seperti radiasi ultraviolet, inframerah, dan karsinogen lingkungan yang turut berperan pada penuaan kulit. Kedua faktor tersebut menyebabkan perubahan di seluruh lapisan kulit. Untuk mengatasi penuaan kulit, kini telah tersedia berbagai modalitas terapi, namun untuk menentukan terapi yang paling sesuai perlu diketahui fisiologi kulit menua, mekanisme penuaan kulit, dan manifestasi kelainan klinis kulit menua. Secara fisiologi terjadi perubahan permeabilitas, biokimia, vaskularisasi, termoregulasi, respons terhadap iritan, respons imunitas, kapasitas regenerasi, respons terhadap cedera, persepsi neurosensori dan pada tingkat genom. Jumlah sel epidermal dan laju pergantian epidermal menurun sedangkan di adneksa terjadi penurunan jumlah kelenjar sebasea yang mengakibatkan kulit kering dan mudah pecah. Penurunan jumlah melanosit menyebabkan warna rambut menjadi abu-abu keputihan dan muncul pigmentasi atipik di kulit. Folikel rambut kurang aktif sehingga meningkatkan kerontokan dan kebotakan. Di lapisan basal ukuran sel berkurang dan rerata ukuran sel bertambah. Sel keratinosit menjadi lebih pendek dan besar di kulit yang menua. Kata kunci: geriatri, mekanisme penuaan kulit, patofisiologi. Skin Aging Mechanism as A Basic Prevention and Treatment of Skin Aging Abstract Growing geriatric population generates a rise of aging issues. Process of aging develops multiple skin changes that further emerge other related skin problems. Oxidative stress is believed playing vital role related to aging. The aging process in the skin is complex and influenced by intrinsic and extrinsic factors. Intrinsic factors can be in the form of genetics, cell metabolism, and hormonal changes. Meanwhile, for extrinsic factors, such as exposure to ultraviolet, infrared, and carcinogenic agent also have crucial part in aging process. These factors contribute to all layers of the skin. Nowadays, many treatment modalities available to reverse skin aging, however, better understanding on skin aging mechanism, the pathophysiology, and clinical manifestations of aging skin is important to choose the appropriate treatment for patients. In aging, there are physiological changes in permeability, biochemical structures, vascularisation, thermoregulation, irritative response, immunity response, regenerative capability, inflammatory response, neurosensory perception and in genom level. The number of epidermal cells and epidermal overturn rate decline while there is also reduction of sebaseous glands at adnexa which both are accounted for skin xerosis. Decreasing melanocytes can caused gray hair and atypical pigmentation. Hair follicles also show less activity resulting in hair loss. Basal layer cells are downsizing and rise of average cells size are occured. Keratinocyte becomes shorter and bigger in aging skin. Keywords: geriatric, mechanism, skin aging, pathophysiology.

Necrotizing Fasciitis in a Leprosy Patient Nie Nie; Augustine Natasha; Sweety Pribadi; Yulia R. Saharman; Chairunissa T. Rizal; Anis Karuniawati; Pratiwi Sudarmono
eJournal Kedokteran Indonesia Vol 10, No. 1 - April 2022
Publisher : Faculty of Medicine Universitas Indonesia

Leprosy is an infection caused by Mycobacterium leprae. Disability after the infection is common and necrotizing fasciitis could deteriorate the patient current condition. We present the case of necrotizing fasciitis of the right limb inpatient with tarsal disintegration and plantar ulcer due to previous leprosy infection. The microbiology culture was inadequate in the early stage of management, which delayed the definitive antibiotic for patient and the progressive necrotic infections were uncontrolled. Amputation was done to save the patient’s life and the latter microbiology culture was able to determine the definitive antibiotic therapy. This report highlights the needs of disability management and infection control for leprosy patient after the treatment is completed.

Efektivitas Pelatihan Kecakapan Hidup Menggunakan Modul Pengelolaan Emosi pada Remaja Perempuan dengan Lupus Eritematosus Sistemik Safira A Tjandrasari; Fransiska Kaligis; Tjhin Wiguna; Raden Irawati Ismail; Dina Muktiarti
eJournal Kedokteran Indonesia Vol 9, No. 2 - Agustus 2021
Publisher : Faculty of Medicine Universitas Indonesia

Lupus eritematosus sistemik (LES) merupakan penyakit kronik yang dapat menyebabkan masalah emosi pada remaja, khususnya perempuan sehingga fokus perawatan pada remaja dengan LES adalah mengatasi gangguan yang dialami secara keseluruhan. Studi ini bertujuan untuk mengetahui masalah emosi pada remaja perempuan dengan LES dan efektivitas pelatihan kecakapan hidup-modul pengelolaan emosi (PKH-MPE) dalam mengatasi masalah emosi. Studi ini menggunakan desain uji klinis teracak dalam 2 grup di RSUPN dr. Cipto Mangungkusumo pada bulan Januari hingga Desember 2019. Subjek adalah 30 remaja perempuan dengan LES yang sudah mendapat terapi dan memiliki skor Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) 0-5. Masalah emosi dinilai dengan Strength and Difficulties Questionnaire (SDQ) pada awal dan 4 minggu pasca perlakuan. Sebanyak 6/30 remaja perempuan memiliki nilai SDQ abnormal pada awal studi. PKH-MPE efektif menurunkan masalah emosi pada kelompok perlakuan dibandingkan kontrol (uji Wilcoxon, p=0,002). Pada kelompok perlakuan terdapat perbaikan total skor SDQ (p=0,001), masalah emosi (p = 0,002), masalah perilaku (p=0,027) dan perilaku hiperaktif (p=0,040) dibandingkan awal studi. PKH-MPE secara bermakna mengurangi keluhan nyeri, kecemasan dan perasaan gugup pada kelompok perlakuan. Disimpulkan PKH-MPE efektif memperbaiki masalah emosi pada remaja perempuan dengan LES, terutama keluhan nyeri, cemas, dan perasaan gugup. Kata kunci: lupus, penyakit kronis, masalah emosi, pelatihan kecakapan hidup, SDQ. Effectiveness of Life SkillsTraining-Emotional Management Module in Female Adolescent with Systemic Lupus Erythematosus Abstract Systemic lupus erythematosus (SLE) is a chronic disease that can cause emotional problems in adolescents, predominantly female thus, the focus of care in adolescents with SLE is to treat the patients holistic. The study aims to assess the emotional problems in female adolescents with SLE and the effect of life skills training-emotional management module in female adolescents with SLE. This study is a randomized clinical trial with no blinding which located in Cipto Mangunkusumo Hospital Jakarta. Thirty female adolescents with treated SLE and had Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score 0-5 were included. Emotional problems were assessed at the beginning of the study and four weeks after intervention. It was found that there were 6/30 subjects with abnormal SDQ at the beginning of the study. Life skills training was found effective in treating emotional problems, compared to control with (Wilcoxon test, p=0.002). Life skill straining was also found effective in improving SDQ score (p=0.001), emotional problem (p=0.002), conduct problems (p=0.027),and hyperactivity (p=0.040) in the intervention group compared to baseline. Life skill straining reduced physical pain, worries, and nervousness in the intervention group. In conclusion, the life skill straining-emotional management module was effective in improving emotional problems in a female adolescent with SLE, especially physical pain, worries, and nervousness. Keywords: SLE, chronic disease, emotional problems, life skills training, SDQ.

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Home Page

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Contact Name Saleha Sungkar

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Editorial Address Departemen Parasitologi FKUI Jl. Salemba Raya No. 6 Jakarta Pusat

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Saleha Sungkar

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ejki.fkui@ui.ac.id

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+6282123550275

Journal Mail Official
ejki.fkui@ui.ac.id

Editorial Address
Departemen Parasitologi FKUI Jl. Salemba Raya No. 6 Jakarta Pusat

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