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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
Articles 9 Documents
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Search results for , issue "Vol. 6, No. 3" : 9 Documents clear
Tenofovir dan Gangguan Fungsi Ginjal pada HIV Hustrini, Ni Made
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
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Bile Reflux Gastritis Patient Profile in DR. Saiful Anwar Malang Hospital Nurisa, Fadhila; Supriono, Supriono
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
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Introduction. Bile reflux gastritis is bile reflux to gaster with fullness sensation, uncomfort, nausea, and vomiting. Bile reflux gastritis usually happens after surgery, as partial gastrectomy, truncal vagotomy, pyloroplasty, cholecystectomy, or sphinchteroplasty. This study aimed to determine the description of endoscopic of patients with bile reflux gastritis and the location of abnormalities found in endoscopy patient at Saiful Anwar Hospital Malang. Methods. Data were taken from the medical record of endoscopy patient in Saiful Anwar Hospital Malang from 2012 January the 1st until 2016 December the 31st that fulfill bile reflux gastritis inclusion criteria. Abnormality location divided near and far from pyloric. The location that near from pyloric is antrum, pyloric, duodenum, and distal duodenum. The location that far from pyloric is esophagus, esophagogastric-junction, fundus, corpus, and angulus. Results. Among 3,491 endoscopic patients, there were 1,949 gastritis patients (55.83%). A total of 1,949 gastritis patient, 124 fulfill bile reflux gastritis criteria. Four exclusion criteria (incomplete data), 120 patients bile reflux gastritis, 62 men (51.67%) and 58 women (48.33%). Hyperemia mostly at antrum (96), erosion mostly at antrum (43), edema mostly at pyloric (18), ulcer mostly at antrum (14). Presentation of hyperemia, erosion and edema far from pyloric as many as near the pyloric. More ulcer found near the pyloric (75.68%). Conclusions. Hyperemia, erosion, and ulcer mostly found at antum, edema mostly found at pyloric. Hyperemia, erosion, and edema spread in all of the parts. More ulcer found near the pyloric.
Neutrophil Lymphocyte Ratio as A Predictor of The First Onset Acute Neutropenia After R-CHOP Chemotherapy in Diffuse Large B-cell Lymphoma Patients Christine, Griskalia; Sukrisman, Lugyanti; Sutandyo, Noorwati; Rumende, Cleopas Martin
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
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Background. Diffuse Large B-cell Lymphoma (DLBCL) is the most common lymphoma in Indonesia. R-CHOP chemotherapy has a moderate risk for neutropenia / febrile neutropenia. Lymphocytes can describe host immunity, while neutrophils and monocytes can describe the inflammatory response. No study has assessed differential count of leukocytes as a predictor of the first onset acute neutropenia after R-CHOP chemotherapy in DLBCL patients. This study aimed to determine the relationship between differential count of leukocytes before chemotherapy as a predictor of the first onset acute neutropenia after R-CHOP chemotherapy in DLBCL patients. Methods. A retrospective cohort study was conducted among 18–60 years old DLBCL patients with ECOG 0–1 and no comorbidity related to chemotherapy 18–60 years old. Subjects were given with the first 3 cycles of R-CHOP chemotherapy without G-CSF prophylaxis. Results. Of the 95 patients, first onset acute neutropenia after chemotherapy occurred in 83 (87.4%) subjects or 83 (55.3%) cycles of 150 chemotherapy cycles. Febrile neutropenia occurs in 50.6% of the onset of neutropenia. Severe neutropenia occurs in 34 (41.0%) cycles of 83 neutropenic episodes. The first onset of acute neutropenia was the most common at 7–15 days after chemotherapy. The AUC of neutrophil lymphocyte ratio was 0.74 (95% CI 0.65–0.82); while absolute lymphocytes, absolute neutrophils, absolute monocytes, and monocyte lymphocyte ratios were 4.1 neutrophil lymphocyte ratio were able to predict the first onset of acute neutropenia after RCHOP chemotherapy in DLBCL patients (sensitivity 71.1%; specificity 64.2%; positive predictive value 71.1%; negative predictive value 64.2%). Conclusion. Neutrophil lymphocyte ratio before chemotherapy > 4.1 is a predictor of the first onset acute neutropenia after R-CHOP chemotherapy in DLBCL patients.
The Additive Effect of Rosmarinic Acid for The Reduction of Glomerular NF-kB Expression in Diabetes Rat that was given Telmisartan Fachrureza, Mochamad; Samsu, Nur; Rudijanto, Achmad
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
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Introduction. Diabetic nephropathy is one of the common complications of diabetes, which one of its causes is the increase of free radicals through the activation of NF-kβ and Angiotensin II. Rosmarinic acid has the activity as the anti-oxidant and anti-inflammatory, and the telmisartan is the partial PPAR-γ agonist that has the anti-fibrotic effect. This study aimed to identify the effect of rosmarinic acid and telmisartan in the reduction of subunit p65 NF-kB expression on the glomerular diabetes rat. Methods. An experimental study with a post-test only controlled group was conducted in a group of rats (Rattus norvegicus). Rats were randomly divided into five groups (n=3-4 per group): three treatment groups (group 1: rosmarinic acid 75 mg/kg/ day; group 2: telmisartan 1 mg/kg/day, group 3: combination of rosmarinic acid 75 mg/kg/day and telmisartan 1mg/kg/ day per day), and two control groups (negative and positive control group). After eight weeks, rats were dissected. Blood sugar more than 270 mg/dl confirmed that the rats in diabetes state. The measurement of albuminuria was done using ELISA and the expression of subunit p65 NF-kβ using the immunofluorescence method. Results. The expression of subunit p65 NF-kβ in negative control group was 519.70 (SD 158.12), 702.19 (SD 189.69) in positive control group, 631.19 (SD 119.21) in the rosmarinic acid group, 355.68 (SD 44.71) in the telmisartan group, and 572.37 (SD 98.09) in the combination group (p<0.001). The post hoc test showed that the mean value of subunit p65 NF-kβ expression was significantly different between the positive control group and the telmisartan group (p<0.001). But, there was no significant mean difference of subunit p65 NF-kβ expression between the positive control group and the rosmarinic acid group (p=1.000), as well as between the combination rosmarinic acid and telmisartan group. Conclusion. The addition of telmisartan can reduce expression of the subunit p65 NF-kB. However, adding the rosmarinic acid in diabetes rats given telmisartan did not reduce the expression of subunit p65 NF-kB in the same level with the negative control group.
Meningoensefalitis Manifestation in Wegener’s Granulomatosis with Anca Negative: Case Report Sudibyo, Triyanti Kurniasari Ananta Putri; Mulya, Deshinta Putri; Budiono, Eko; Satiti, Sekar; Rosalia, Levina Prima
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
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Wegener’s granulomatosis is a vasculitis that affects small to medium blood vessels, generally occurring at the age of 64- 75 years with an incidence of 8-10 / 1,000,000 people. Meningoencephalitis manifestations are rarely found in Wegener’s granulomatosis with the incidence only in the range of 0-7%. Anti-neutrophil cytoplasmic antibody (ANCA) is often used in diagnosing Wegener’s granulomatosis, but negative ANCA can be found in 10-20% of cases. A 30-year-old man came with a decrease in consciousness. His anamnesis and physical examination showed signs that led to Wegener’s granulomatosis, despite negative ANCA examination results. After getting therapy according to the management of the Wegener’s granulomatosis there is a clinical improvement in the patient. This case is raised because it is a rare case and needs sharpness in establishing a diagnosis. Wegener’s granulomatosis can cause very bad progress, but if handled properly, complete remission can be achieved.
Arterial and Venous Thrombosis in Patients with Myeloproliferative Neoplasms Sukrisman, Lugyanti
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
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Introduction. Myeloproliferative neoplasm (MPN) is a hematologic disorder that consists of polycythemia vera (PV), essential thrombocythemia (ET and primary myelofibrosis (PMF) and complication of thrombosis is frequently found in patients with MPN. This study was conducted to observe complication of thrombosis in patients with MPN. Methods. A descriptive study was conducted among patients with MPN at MMC Hospital. Clinical data was obtained from medical records of patients with MPN who sought treatment with investigator between 2010 and 2018 and the data was collected consecutively. Evaluation on JAK2 mutation was performed at either the Research and Development Laboratory of Dharmais Cancer Hospital or Kalgen® Laboratory. Complication of thrombosis was found based on radiological data, which could provide evidences on the presence of thrombosis except for complication of sudden deafness and erythromelalgia, which were found based on clinical diagnosis. Results. We found 23 subjects with MPN during the study period, which consisted of 12 subjects with PV, 8 subjects with ET, 2 subjects with PMF and 1 subject with post-ET MF. Evaluation on JAK2 mutation was performed in 16 out of 23 subjects. Thirteen subjects showed mutation of JAK2 gene except in 2 subjects with PMF and 1 subject with ET, who did not show V617F mutation of JAK2 gene. Subject with JAK2 mutation aged between 45 – 71 years. Complications were found in 12 out of 23 MPN subjects including ischemic stroke, DVT, portal vein thrombosis, thrombosis of mesenteric veins and arteries, non-ST elevated myocardial infarction (NSTEMI), peripheral artery disease (PAD), sudden deafness and erythromelalgia. The thrombotic complications occurred in subjects with polycythemia vera, essential thrombocythemia and myelofibrosis, either primary or the post-ET. Ischemic stroke is the most common complication, i.e. in 6 out of 12 (50%) of those with thrombotic complication and in all of subjects with polycythemia vera. There were 2 subjects experienced 2 multiple thromboses at unusual sites with consecutive episodes despites anticoagulant therapy, i.e. thrombosis of portal vein followed by mesenteric artery; and thrombosis of portal vein and mesenteric vein simultaneously followed by non-ST elevated myocardial infarction (NSTEMI) in less than 2 months. Both subjects experienced multiple thromboses during full-dose of anticoagulant therapy. Conclusions. Complication of thrombosis in MPN patients may exist in the form of arterial and venous thrombosis with ischemic stroke as the most common complication in subjects with polycythemia vera. Multiple thrombosis and splanchnic thrombosis as portal vein, mesenteric vein and artery thrombosis can also be found in subjects with MPN.
Use of Clinical Parameters and Strain Echocardiography to Predict Stenosis Severity based on Gensini’s Score in Stable Coronary Artery Disease Sejati, Arif; Alwi, Idrus; Muhadi, Muhadi; Shatri, Hamzah
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
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Introduction. In patient with stable coronary artery disease (CAD), severity of stenosis is closely related to prognosis. It is known that several clinical parameters and recently-developed strain echocardiography can predict severity of stenosis. Assessment of clinical parameters, altogether with strain echocardiography is expected to make better prediction. This study aim to determine whether clinical factors, i.e. age, sex, diabetes, typical angina, and history of myocardial infarction, and strain echocardiography parameter, i.e. global longitudinal strain (GLS), can predict severity of coronary artery stenosis measured with Gensini score,and to further develop a prediction model based on significant parameters. Methods. This is a cross-sectional study taken at Dr. Cipto Mangunkusumo National Central General Hospital during period March – May 2019. Patient with stable CAD scheduled to undergo coronary angiography is recruited consecutively. Bivariate analysis using chi-square is performed to each predictor. Significant predictors are further analysed using backward stepwise logistic regression. A prediction model is then developed based on significant predictors by multivariate analysis. Results. The study group include 93 subjects. Significant predictors on bivariate analysis include diabetes melitus (OR 2.79; 95% CI:1.08-7.23), history of myocardial infartion (OR 4.04; 95% CI:1.51-10.80), typical angina (OR 5.01; 95% CI:1.91-13.14), and GLS ≥-18.8 (OR 30.51; 95% CI:10.38-89.72). Significant predictors on multivariate analysis are typical angina (OR 4.48; 95% CI:1.39-14.47) and GLS ≥18.8 (OR 17.30; 95% CI:5.38-55.66). Predicton model is not developed because there are only two significant predictors. Conclusions. Typical angina and GLS are predictors of stenosis severity in patient with stable CAD. Age, sex, diabetes, and history of myocardial infarction are not significant predictors. A prediction model can not developed because there are only 2 significant predictors.
Factors Affecting Rapid Decline in Glomerular Filtration Rate in HIV/AIDS Patients Using Tenofovir Disoproxil Fumarate Yuriandro, Prima; Yunihastuti, Evy; Marbun, Maruhum Bonar H; Nugroho, Pringgodidgo
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
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Introduction. Tenofovir disoproxil fumarate (TDF) treatment in HIV/AIDS patient has particular effect to the kidney, which is rapid decline in glomerular filtration rate (GFR) (> 5 cc/min/1.72 m2 one year after using the drug). The incidence rate for rapid decline in GFR and factors affecting it are still contradictive and not assessed completely. This study was done to identify cumulative incidence and factors affecting TDF related nephrotoxicity. Methods. A retrospective cohort study was conducted in HIV/AIDS outpatient clinic Cipto Mangunkusumo Hospital Jakarta. We included patients who start taking TDF as their medication from January 2010 until January 2015 with consecutive sampling method. Inclusion criterias were minimum one year of TDF treatment and baseline GFR > 60 cc/minute/1.72 m2. The study used secondary data from medical record, therefore subject with no GFR evaluation after one year was excluded. Logistic regression test was used to evaluate variabel that could potentially affect rapid decline in GFR. Results. 164 subjects were included for analysis and we found rapid decline in GFR after one year of TDF medication in 87 subjects (cumulative incidence 53%; 95% CI 45-60.4%). Factors affecting rapid decline in GFR were male gender (RR 4.0; 95% CI 1.1-4.8), CD4 cell count below 100 cell/mm3 (RR 3.7; 95% CI 1.7-8.1), weight increase above 20 % (RR 4.0; 95% CI 1.0-4.8), and baseline GFR above 90 cc/min/1.72 m2 (RR 9.8; 95% CI 2.3-42.1). Conclusion. The incidence rate for rapid decline in GFR after a year of TDF medication in HIV/AIDS patients in Cipto Mangunkusumo hospital was 53%. Risk factors that affecting this nephrotoxicity were male gender, CD4 cell count below 100 cell/mm3, weight increase above 20%, and baseline GFR above 90 cc/min/1.72 m2.
Polycythemia: A Clinical Approach Cahyanur, Rahmat; Rinaldi, Ikhwan
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
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Polycythemia or erythrocytosis is an increase in the number of red blood cells in circulation marked by the increase in hematocrit. Polycythemia is a case that still raises questions and dilemma for doctors. In this paper, it will be discussed about the diagnostic approach and management of polycythemia. The initial complaints of polycythemia are generally nonspecific, such as weakness and dizziness due to blood hyperviscosity. It is also essential to know accompanying diseases, routine medications, habits, and family histories of the patients. Patients with polycythemia commonly exhibit plethora. In vital sign examination, hypertension can be found in polycythemia vera. In general examination, we should look for signs that lead to secondary polycythemia, such as low oxygen saturation that can be found in secondary polycythemia. Initial workup that should be done is a complete blood count. Ferritin and transferrin saturation are evaluated to assess the iron status that can disguise the incidence of polycythemia, especially when the image of the blood smear indicates a microcytic hyperchromic. Advanced work up that can be done is genetic examination. In the case of polycythemia vera, the primary purpose of treatment is to prevent thrombotic events. In the case of secondary polycythemia, the aim of management is to identify the underlying disease and treat it, which one of them is phlebotomy.

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