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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 414 Documents
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Non-Operative Management of Diabetic Foot Osteomyelitis: ACase Report Yunir, Em; Aziza, Yully Astika Nugrahayning
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 2
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Diabetic foot osteomyelitis is an advanced complication of diabetic foot infection which can increase the risk of amputation. This report discusses a case of a 50-year-old female with a wound on the thumb of her left foot that became more swollen with a bluish red color within one month. The patient delayed her treatment due to the COVID-19 pandemic. She has had diabetes and hypertension for 20 years which is uncontrolled. Physical examination showed a sausage toe digiti 1 left pedis with wound 4 x 2 cm with purulent discharge, Probe to Bone (PTB) positive. Laboratory and x-ray examination showed leukocytosis, increased erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP), glucose level 415 mg/dL, and HbA1c 13.1%, with destruction and fragmentation in first toe bone of the left foot. Because she refused minor surgery, the wound was treated regularly by removing infected bone fragments and giving intravenous (IV) antibiotics for four weeks. For glucose level control, continuous IV insulin was given with subcutaneous basal-bolus insulin, then continued by outpatient care with oral antibiotics. After seven weeks, manifestations of infection improved, the wound area was reduced, and antibiotics were discontinued, but wound care was continued. Metabolic control along with long-term antibiotics and wound care for diabetic foot osteomyelitis can be used as an alternative to surgery
Current Clinical Approach of Nosocomial Clostridium difficileInfection Liwang, Frans; Sinto, Robert
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 2
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Hospital-acquired Clostridium difficile infection (CDI) has become one of the global threats because the incidence has increased in recent decades. This nosocomial infection is closely related to antibiotic use in health services and is commonly found in the elderly. Antibiotics can promote colonization and CDI by intestinal microbiota dysbiosis and complex innate immune system activation. The manifestation also has a wide spectrum, ranging from mild diarrhea to fulminant colonic mucosal necrosis. Given that not all colonized subjects will be infected, further investigations such as toxigenic culture, nucleic-acid detection, and stool immunologic tests are only useful in symptomatic cases. In all CDI cases, an effort to control and prevent infections, including rational use of antibiotics, is warranted. Besides the use of antibiotics to eradicate the bacteria, surgery is often indicated in fulminant cases—another novel therapy for recurrent CDI as follows fecal microbiota transplantation, antitoxin antibody, and novel antibiotics.
Low Serum Irisin as A Risk Factor of Sarcopenia in Elderly Aryana, I Gust Putu Suka; Putrawan, I.B.; Purnami, Ni Ketut Rai; Kuswardhani, R.A. Tuty; Astika, I Nyoman; Suastika, Ketut; Adiatmika, I Putu Gede; Jawi, I Made; Wande, I Nyoman
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 4
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Introduction. Sarcopenia is a condition characterized by a decrease in muscle mass accompanied by a decrease in strength and/or function. Sarcopenia is closely related to the aging process, but the mechanism of its occurrence is still not fully understood. Skeletal muscle is the largest organ in the human body, so the myokine produced through muscle contraction opens a new paradigm regarding the central role of muscles in regulating metabolism and other organ functions. One of the myokines that are currently found to affect physical activity is Irisin. This study aims to determine the role of low Irisin levels in serum as a risk factor for sarcopenia in the elderly. Methods. This case-control study was conducted in Denpasar City from January 2020 to October 2020. The sample was selected using purposive consecutive sampling with matching age and gender, with 54 subjects, 27 case groups, and 27 control groups aged ≥60 years. Sarcopenia status is enforced by the criteria of the Asian Working Group for Sarcopenia (AWGS). Irisin serum levels were measured by enzyme-linked immunosorbent assay (ELISA). Results. Based on 54 subjects, the mean age in cases was 69.79 (SD 5.00) years and controls 67.89 (SD 4.50) years (p = 0.152), the proportion of male:female both in cases and controls group was 9:18. The cut-off point value wass based on the irisin ROC curve 4.51 ng/L. Nutritional status (OR = 3.40 (95% CI = 1.11 - 10.40); p = 0.029) and irisin (OR = 25.30 (95% CI = 6,00 - 106.66); p = <0.001) had an effect on sarcopenia. Factors that purely influence sarcopenia were found in low irisin (OR = 103.41 (95% CI = 7.83 – 1,364.99; p = <0.001). Conclusions. Low Irisin level is a risk factor for sarcopenia in the elderly. Irisin could be considered for further investigation in an effort to become a target for both preventive and curative therapy for sarcopenia.
Correlation of the Quality of Antibiotic Usage by Utilising Gyssens Flow and The Success of Treatment in Negative Gram MDR Sepsis in Tertiary Hospital Lardo, Soroy; Chen, Lie Khie; Santoso, Widayat Djoko; Rumende, Cleopas Martin
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 4
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Introduction. Multi Drug Resistance (MDR) antibiotics have become a global health threat to the community. The use of appropriate antibiotics makes preventive and curative measures very important for the success of overcoming MDR and intervening the complexity of resistance, at least slowing the rate of occurrence of MDR. This study aimed to identify the difference in the quality of antibiotic use quality of use using gyssens flowchart and the success in sepsis patients’ treatment due to gram-negative MDR bacteria with non-MDR bacterial infections in tertiary hospitals. Methods. A retrospective cohort study was conducted using secondary data from patient with age more or equal than 18 years who were hospitalized in inpatient unit or ICU in Indonesia Army Central Hospital Gatot Soebroto from 2017-2019. Both the MDR and non-MDR gram-negative inclusion groups were assessed for the quality of antibiotic using the Gyssen flowchart. Results. There was a significant difference between antibiotic quality on gram negative MDR bacteria and non-MDR (20.6% vs. 13.6%; RR 1.517 (CI 95% 1.1 – 2.1); p value = 0.015) which showed that gram-negative MDR experienced 1.517 times better quality than non-MDR. This study also found that there was a significant difference between therapeutic success on gram negative MDR bacteria and non-MDR (57.4% vs. 39.1%; RR 1,431 (CI 95% 1.0 – 2.1); p value = 0.02). Conclusions. There is a better quality on the utilization of antibiotics with Gyssens index patients resulted from MDR negative gram bacterial infection in comparison to non-MDR in tertiary hospital. There is also a better success in treating the sepsis patient with MDR negative gram bacterial infection in comparison with non-MDR.
Validity and Reliability Test of European Organization for Research and Treatment of Cancer Quality of Life QuestionnaireBreast 23 in Breast Cancer Patient on Treatment Adli, Mizanul; Shatri, Hamzah; Sutandyo, Noorwati; Suwarto, Suhendro
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 4
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Introduction. Improved survival of breast cancer patients are not necessarily followed by improvement of quality of life. According to the European Organization for Research and Treatment of Cancer (EORTC), cancer patients’ quality of life are very important to be evaluated. In Indonesia, breast cancer patients cannot be assessed their quality of life accurately because there is no valid and reliable questionnaire. This study aims to prove that the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Breast 23 (EORTC QLQ-BR23) is a valid and reliable measuring instrument to be used in Indonesia. Methods. This study was a cross-sectional study. The EORTC QLQ-BR23 questionnaire was first translated into Indonesian language before being tested on 10 respondents. The translation results were then used in 100 breast cancer patients. Test-retest was assessed with intraclass correlation coefficient (ICC), while the internal consistency was assessed by Cronbach’s alpha. Construct validity was assessed by multi-trait scaling analysis and the criteria validity assessed by identifying the correlation between domains of European Organization for Research and Treatment of Cancer Quality of Life QuestionnaireCancer 30 (EORTC QLQC30) and EORTC QLQ-BR23 with Short Form 36 (SF36). Results. From September to October 2015, a total of 100 breast cancer patients on treatment were enrolled in this study. ICC value (1 hour interval) of all EORTC QLQ-BR23 domains were very good (ICC> 0.8). ICC values (30 day interval) decrease in all EORTC QLQ-BR23 domains. Almost all of the EORTC QLQ-BR23 domains have a cronbach’s alpha value > 0.7 except for the arm symptom domain (Cronbach’s alpha: 0.643). Multi-trait scaling analysis showed a fairly high correlation between the score of the questions with a score of his own domain, while the relationship of the questions to different domains always have a lower correlation than the domain itself. In criteria validity test, obtained 19 correlation with r > 0.3 between domains of EORTC QLQ-C30 and EORTC QLQ-BR23 with SF36. Conclusion. EORTC QLQ-BR23 is a valid and reliable instrument for assessing quality of life of breast cancer patients in Indonesia
The Selection of Oral Antidiabetic Drugs in Type 2 Diabetes Mellitus Patients with High Risk for Cardiovascular Events Leander, Derlin J.; Tahapary, Dicky L.
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 4
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Type 2 diabetes mellitus (DMT2) patients are associated with an increased risk of cardiovascular events. Prior to the era of cardio-vascular trial outcome (CVOT) evidence on the efficacy of old oral diabetes (OAD) drugs such as metformin, sulfonylurea, thiazolidindion, glinid, and alpha glucosidase inhibitors in reducing the risk of cardiovascular events was very limited. Since 2008, all OADs must have CVOT data. DPP-4 inhibitors are neutral against the risk of cardiovascular events while SGLT-2 inhibitors are reported to significantly reduce the risk of cardiovascular events. This finding even helped to change the DMT2 management guidelines issued by American Diabetes Association (ADA-EASD) in late 2018. However, SGLT-2 inhibitor applications in Indonesia are likely to be constrained in terms of costs. When compared with an intensive multifactorial approach that seeks to reduce blood glucose, lipids, blood pressure, weight, and aspirin; it turns out that this multifactorial approach is associated with a lower risk of higher cardiovascular events and lower costs. In the JKN era, where quality control and cost control are needed, it seems that the multifactorial approach will still be the main choice in reducing cardiovascular events in people with T2DM in Indonesia.
Comparison of Hospital Mortality, Length of Stay, Renal Recovery, and Needs for Hemodialysis in Acute Kidney Injury (AKI) Patients due to Septic and Non-septic, and Factors Affecting Patients’ Mortality Marzuki, Mochammad Jalalul; Nursamsu, Nursamsu; Rifai, Achmad
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 1
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Introduction. Acute kidney injury (AKI) is a major complication in critically ill patients that affects mortality. Sepsis is a major predisposing factor for AKI and provides a poor prognosis and high mortality rate. Thisstudy aimed toidentifythe difference of hospital mortality, length of stay, renal recovery, and needs for hemodialysis between AKI patients due to sepsis and non-sepsis, as well as to determine the factors that influence the mortality of patients with AKI.Methods. An analytical observational study was conducted among patients with AKI according to the KDIGO criteria and aged ≥40 years old. Data were obtained from patients’ medical records in Saiful Anwar Hospital Malang in January-June 2019. Patients were categorized into sepsis or non-sepsis group. Patients were then followed during hospitalization for mortality, length of stay, renal recovery, and need of hemodialysis outcome. The difference in the incidence of mortality, renal recovery, and need of hemodialysis between the two groups were analyzed by Chi Square bivariate analysis, while the difference in length of stay was analyzed by Mann Whitney test. Risk factors that influence mortality will be tested by multivariate analysis of binary logistic regressionResults. There were 135 subject consist of 80 (59.25%) subjects of AKI due to sepsis and 55 (40.74%) subjects of AKI non-sepsis. Patients with AKI due to sepsis has higher hospital mortality (p=0.002), increased needs for hemodialysis (p=0.017), low renal recovery (p=0.022), and longer length of stay (p=0.004) compared to non-sepsis. From multivariate analysis, we revealed that the contributing factors for mortality in patients with AKI were sepsis [OR 3.468 (IK 95% 1.438-8.366); p=0.006], oligoanuria [OR 2.923 (IK 95% 0.950-8.990); p=0.041], and decreased of consciousness [OR 3.817 (IK 95% 1.589-9.168); p=0.003].Conclusion. Higher hospital mortality, longer length of stay, increased needs for hemodialysis, and lower renal recovery in patients with AKI due to sepsis compared to those without sepsis. The conditions of sepsis, oligoanuria and decreased of consciousness have a very significant influence on the mortality of AKI patients.
Abnormal Liver Function in Predicting COVID-19 Patients’ Prognosis Sari, Sakinah Rahma; Kurniawan, Juferdy
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 1
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Despite of the high prevalence of liver enzyme elevation in COVID-19 patients, its effect on predicting COVID-19 patients’ prognosis was still debatable. This evidence-based case report aims to evaluate the effect of abnormal liver function in the prognosis of COVID-19 patients. Literature searching was performed on August 16-17 2021 using 3 databases: PubMed, Scopus, and Proquest. The articles selected by title/abstract screening, duplication elimination, and applying eligibility criteria were then appraised using Centre of Evidence Based Medicine (CEBM), University of Oxford. Some of the studies reported there were no significant difference in the prognosis of COVID-19 patient with and without abnormal liver function. However, most of the studies reported abnormal liver function as an independent poor prognosis predictor in COVID-19 patients. Based on the study with the highest level of evidence, the elevation of AST and ALT increase the risk of poor prognosis in COVID-19 patients [OR 2.98 (95% CI 2.35-3.77), p<0.0001) and OR 1.73 (95% CI 1.32-2.27, p<0.001)]. Based on the 34 studies appraised, we conclude that abnormal liver function will increase the risk of poor prognosis in COVID-19 patients. Thus, careful monitoring must be done in COVID-19 patients with abnormal liver function.
Pain Management in Advanced Hepatocellular Carcinoma:A Case Study Fitrianti, Fita; Shatri, Hamzah; Faisal, Edward; Putranto, Rud; Agung, Ratih Arianita; Nainggolan, Leonard; Kalista, Kemal Fariz; Irawan, Cophiadi
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 1
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Hepatocelullar carcinoma (HCC), the most common primary liver malignancy is the fifth most common cancer and the third most frequent cause of cancer related death globally. Pain comprises one the most common symptoms of HCC and may have severely negative effects on patient’s quality life. Furthermore, patients with HCC often presented with a cirrochis,so to control pain in this patient poses a clinical challenge. This case report discuss about a young 26-years-old male patient who presented with a four-month history of right upper quadrant abdominal pain and weight loss. HbsAg positive and serum alpha-fetoprotein level was high. Computed tomography (CT) and liver biopsy confirmed the presence of primary hepatocellular carcinoma.,with lung metastatic from the radiologic x-ray. Patient came with a loss of consciousness due to hypoglicemia. During hospitalization, patient complaint of abdominal pain and was given morphine intermediate release (MIR) to control the pain. By administering measurable and well-controlled opioids, the patient’s suffering can be reduced, thus improving the patient’s quality of life
Revaksinasi COVID-19 pada Kelompok Lansia dengan Frailty Fitriana, Ika
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 2
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