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Jurnal Penyakit Dalam Indonesia
Published by Universitas Indonesia
ISSN : 24068969     EISSN : 25490621     DOI : https://doi.org/10.7454/
Core Subject : Health,
Medicine & Pharmacology
Jurnal Penyakit Dalam Indonesia contains the publication of scientific papers that can fulfill the purpose of publishing this journal, which is to disseminate original articles, case reports, evidence-based case reports, and literature reviews in the field of internal medicine for internal medicine and general practitioners throughout Indonesia. Articles should provide new information, attract interest and be able to broaden practitioners insights in the field of internal medicine, as well as provide alternative solutions to problems, diagnosis, therapy, and prevention.
Arjuna Subject : Kedokteran - Kedokteran Internal
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Search results for , issue "vol. 12, no. 4" : 9 Documents clear
Faktor-Faktor yang Berhubungan dengan Kualitas Hidup Pasien Geriatri yang Menjalani Hemodialisis Mohammad, Nurhidayat; Soejono, Czeresna Heriawan; Lydia, Aida; Rinaldi, Ikhwan; Syafiq, Muhammad; Wardoyo, Elizabeth Yasmine
Jurnal Penyakit Dalam Indonesia Vol. 12, No. 4
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Introduction. The decline in quality of life among geriatric patients undergoing hemodialysis has a negative impact on treatment adherence, physical functioning, dietary patterns, and mortality. This study was conducted to assess the quality of life of geriatric hemodialysis patients and its association with comorbidities, functional status, frailty, sarcopenia, nutritional status, depression, hemoglobin levels, hemodialysis vintage, vascular access, and hemodialysis adequacy. Methods. This study employed a cross-sectional design with primary data collection. Consecutive sampling was used to recruit participants. The study was conducted at the hemodialysis units of Cipto Mangunkusumo National General Hospital (RSCM), Persahabatan National General Hospital (RSP), and Fatmawati National General Hospital (RSF) from June 2024 to August 2024. The inclusion criteria were patients aged ≥60 years undergoing maintenance hemodialysis. Exclusion criteria were unstable clinical condition, cognitive or mental impairment, and refusal to participate. Quality of life was assessed using the EQ-5D-5L instrument. Data on medical history and laboratory findings were obtained from hospital medical records. Bivariate analysis was performed using the Mann–Whitney U test for comorbidities, sarcopenia, depression, hemoglobin level, vascular access, and dialysis adequacy; the Kruskal–Wallis test for frailty, functional status, and nutritional status; and Spearman’s correlation for hemodialysis vintage. Multivariate analysis was conducted using linear regression to identify factors associated with reduced quality of life. Results. A total of 124 subjects (mean age 67 years) were included in this study. The mean EQ-5D-5L index score was 0.76 (IQR 0.63–1.00), while the mean VAS score was 70. The majority of subjects (75%) reported no difficulties in self-care or daily activities. Functional status (p < 0.0001) and depression (p < 0.002) were significantly associated with the quality of life in geriatric patients undergoing hemodialysis, with an adjusted R² value of 0.642. Conclusions. Geriatric patients undergoing HD at RSCM, RSP, and RSF had an average EQ-5D-5L index score of 0.76 (out of 1.000), and 75% of the patients reported no issues with self-care and daily activities. Functional status and depression have been proven to play a significant role in determining their quality of life.
Rekam Medis Elektronik Berbasis Artificial Intelligence: Sudahkan Saatnya Digunakan? Koesnoe, Sukamto
Jurnal Penyakit Dalam Indonesia Vol. 12, No. 4
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Korelasi Kadar Serum VEGF-A dengan Rasio Albumin-Kreatinin Urin pada Pasien Penyakit Ginjal Diabetik Syaiful, Hannie Q; Priyono, Drajad; Harun, Harnavi; Murni, Arina W; Hanif, Akmal M; Faheri, Eifel; Arnelis, Arnelis; Yoga, Vesri
Jurnal Penyakit Dalam Indonesia Vol. 12, No. 4
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Introduction. Diabetic kidney disease (DKD) is a major microvascular complication of diabetes mellitus, characterized by persistent albuminuria and a progressive decline in glomerular filtration rate (GFR), making it a leading cause of chronic kidney disease (CKD) and end-stage renal disease. Vascular endothelial growth factor-A (VEGF-A) is implicated in the pathogenesis of DKD, being overexpressed in the kidneys and contributing to increased vascular permeability, inflammation, and fibrosis. Albuminuria, an early indicator of renal damage in DKD, is a strong predictor of CKD progression and cardiovascular events. The urine albumin-to-creatinine ratio (UACR) is the recommended test for detecting and monitoring albuminuria. This study aimed to investigate the correlation between serum VEGF-A levels and UACR in patients with DKD. Methods. This cross-sectional analytical observational study involving DKD patients at the Outpatient Clinic of Dr. M. Djamil General Hospital Padang from May to October 2024. Demographic and clinical data were collected. Blood samples were taken for serum VEGF-A measurement using ELISA, and morning spot urine samples were collected for UACR measurement using immunoturbidimetry. Correlation analysis was performed using the Spearman test. Ethical approval was obtained from the Health Research Ethics Committee of Dr. M. Djamil General Hospital Padang. Results. A total of 30 PGD patients were included in the study. The mean age was 61.9 years (SD 9.75), and 53.3% of the participants were male.The mean serum VEGF-A level in DKD patients was 131.34 (SD 83.9) pg/ml, and the mean UACR was 403.90 (SD 53.1) mg/g creatinine. There was a very strong positive correlation between serum VEGF-A levels and UACR (r = 0.993, p < 0.05). Conclusions. Serum VEGF-A levels are very strongly and positively correlated with UACR in DKD patients. Serum VEGF-A may serve as a potential marker for assessing DKD progression and risk of complications, as well as a potential therapeutic target.
Kadar Transthyretin Plasma pada Lanjut Usia Sarkopenia dan Non-Sarkopenia Fahrurozi, R. Ifan A.; Martini, Rose D; Mulyana, Roza; Murni, Arina W; Decroli, Eva; Miro, Saptino; Viotra, Deka; Yoga, Vesri
Jurnal Penyakit Dalam Indonesia Vol. 12, No. 4
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Introduction. Sarcopenia is a geriatric syndrome marked by an age-related decline in muscle mass, which is affected by protein intake. Transthyretin is a visceral protein used to evaluate nutritional status and acts as a positive regulator of muscle mass. This study aimed to assess the difference in plasma transthyretin levels between elderly groups with and without sarcopenia. Methods. This was an analytical observational study with a cross-sectional approach. Subjects were elderly patients who visited the Internal Medicine Polyclinic of Dr. M. Djamil Hospital Padang and met the inclusion and exclusion criteria from August to September 2024. Subjects were classified into sarcopenic and non-sarcopenic groups, followed by an examination of plasma transthyretin levels. Sarcopenia was diagnosed using bio-impedance analysis (BIA) measurement, handgrip strength with a Jamar hydraulic hand dynamometer, and physical performance with a walking speed test. Plasma transthyretin levels were measured using the enzyme-linked immunosorbent assay (ELISA) method. Comparative analysis was performed using the unpaired T-test using SPSS 29.0. Results. Among total of 46 subjects who participated in this study, the majority of elderly individuals with sarcopenia were predominantly female. The mean plasma transthyretin level in the sarcopenic elderly group was 10.9 (3.3) mg/dL, while in the non-sarcopenic elderly group was 20.3 (2.5) mg/dL. Comparative analysis demonstrated a significant difference in plasma transthyretin levels between sarcopenic and non-sarcopenic elderly individuals (p < 0.001). Plasma transthyretin levels in the sarcopenic elderly group were lower compared to the non-sarcopenic elderly group. Conclusion. There is a significant difference in plasma transthyretin levels between sarcopenic and non-sarcopenic elderly individuals.
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 Vol. 12, No. 4
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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.
Pengaruh Ivabradin terhadap Variabilitas Detak Jantung pada Gagal Jantung dengan Fraksi Ejeksi Rendah Akibat Penyakit Jantung Koroner Kurnia, Handy; Limantoro, Charles; Silitonga, Friska Anggraini Helena; Setiawan, Andreas Arie
Jurnal Penyakit Dalam Indonesia Vol. 12, No. 4
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Introduction. Heart failure is one of the major challenges in global health due to its significant contribution to morbidity and mortality. One of the pathophysiological aspects is autonomic nervous system dysfunction which can be monitored through heart rate variability (HRV) parameters. Ivabradine is a pharmacological agent that potentially improves the balance of sympathetic and parasympathetic tone. This study was designed to evaluate the impact of ivabradine administration on HRV parameters in heart failure with reduced ejection fraction (≤40%) due to coronary heart disease in Indonesian population. Methods. This study used a quasi-experimental research type with a pretest and posttest method without control which was conducted at Dr. Kariadi Hospital from October 2024 to February 2025. Sixteen patients diagnosed with heart failure with reduced ejection fraction due to coronary heart disease underwent intervention in the form of ivabradine administration at a fixed dose of 5 mg twice a day for 30 days. Evaluation of HRV was carried out through 24 hours holter recording before and after therapy. The HRV parameters analyzed included SDNN, SDANN, RMSSD, pNN50, and LF/HF ratio. Data processing was carried out using a paired t-test for normal distribution and the Wilcoxon Signed-Rank test for non-normal data. P value <0.05 was considered statistically significant. Results. A total of 16 subjects participated in this study, consisting of 14 men (87.5%) and 2 women (12.5%), with a mean age of 57 years. There was a significant increase in SDNN of 14.71 (SD 24.15) milliseconds (p = 0.028), SDANN of 56.99 (SD 26.94) milliseconds (p < 0.001), RMSSD of 18.39 (SD 27.05) milliseconds (p = 0.007), and pNN50 of 6.96% (SD 7.87) (p < 0.001), as well as a decrease in the LF/HF ratio of 1.42 (SD 0.85) (p < 0.001) after 30 days of ivabradine therapy. Conclusions. The administration of ivabradine had a significant effect on improving heart rate variability parameters in both the time and frequency domains in patients with heart failure with reduced ejection fraction due to coronary heart disease. These findings indicate enhanced parasympathetic dominance and reduced sympathetic nervous system activity.
Perbandingan Ablasi Radiofrekuensi dengan Transplantasi Hati sebagai Terapi Kuratif pada Karsinoma Hepatoseluler Stadium Awal: Laporan Kasus Berbasis Bukti Gunawan, Mikhael Fabian; Safira, Ranindita Amaida; Singh, Gurmeet; Kalista, Kemal Fariz
Jurnal Penyakit Dalam Indonesia Vol. 12, No. 4
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Hepatocellular carcinoma (HCC) is the most common type of liver cancer and the second leading cause of cancer-related mortality worldwide. Liver transplantation is considered the definitive treatment for HCC; however, in Indonesia, adult liver transplantation is still rarely performed due to donor limitations and high costs. Radiofrequency ablation (RFA) has therefore become a preferred therapeutic option in the management of HCC. This report discuss about the survival and recurrence rates of HCC in patients treated with RFA compared with those undergoing liver transplantation. A literature search was conducted using the PubMed, Cochrane, Embase, and Scopus databases. Selected articles were screened according to the predefined clinical question as well as inclusion and exclusion criteria. Critical appraisal was performed based on the 2011 Oxford Centre for Evidence-Based Medicine framework, assessing validity, importance, and applicability. Critical appraisal was conducted on two selected articles. One study reported comparable survival rates between the two groups. However, overall, both articles demonstrated that liver transplantation was associated with higher survival rates and lower recurrence rates compared with RFA. In conclusion, survival outcomes are superior with liver transplantation compared with RFA. Nevertheless, RFA may be considered in the management of hepatocellular carcinoma as a bridging therapy to liver transplantation or in situations where liver transplantation is not available.
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 Vol. 12, No. 4
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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.
Optimalisasi Rekam Medis Elektronik Berbasis Artificial Intelligence Rinaldi, Ikhwan; Sulistiadi, Wahyu
Jurnal Penyakit Dalam Indonesia Vol. 12, No. 4
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Electronic medical records (EMRs) are essential to modern healthcare systems, yet their implementation continues to face challenges such as disruption of doctor–patient communication, administrative burden, and documentation structures misaligned with clinicians’ clinical reasoning processes. This narrative review aims to assess the limitations of conventional EMRs and examine the potential of artificial intelligence (AI) to improve documentation efficiency, accuracy, and overall clinical performance. The literature indicates that AI technologies, including machine learning, deep learning, and natural language processing, can automate documentation, streamline workflows, enhance decision support, and reduce physician burnout, thereby allowing clinicians to devote more attention to patient care. Nevertheless, the integration of AI into EMRs must address ethical concerns such as algorithmic bias, data privacy, and accountability for AI-assisted decisions. In conclusion, AI-driven EMR optimization has the potential to create a more human-centered, efficient, and data-driven documentation ecosystem when supported by strong regulatory and ethical frameworks.

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