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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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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.
Penilaian Domain Pengkajian Paripurna Pasien Geriatri (P3G) sebagai Faktor yang Berpengaruh terhadap Kejadian Pneumonia Nosokomial pada Pasien Usia Lanjut yang Dirawat di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo Victor, Hildebrand Hanoch; Wahyudi, Edy Rizal; Rumende, C. Martin; Soejono, C. H.; Rooshoeroe, A. G.; Shatri, Hamzah; Nainggolan, Leonard; Irawan, Cosphiadi
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 1
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Introduction. Nosocomial pneumonia is a lung infection that occurs after the patient is hospitalized for more than 48 hours, without any signs of pulmonary infection at the time of treatment. When compared with young individuals, elderly individuals are more likely to have community-sourced and nosocomial infections with worse outcomes. Comprehensive Geriatric Assessment (CGA) domains are expected to explain the factors that contribute to nosocomial pneumonia in elderly patients. This study aimed to determine the proportion of elderly treated at Dr. Cipto Mangunkusumo National Central General Hospital who experienced nosocomial pneumonia and whether the CGA domains influence the occurrence of nosocomial pneumonia. Methods. A retrospective cohort study was conducted by analyzing the medical records of patients aged 60 years or older who were hospitalized in the medical ward of Geriatric Internal Medicine at Dr. Cipto Mangunkusomo National Central General Hospital in January – September 2019. We also collected secondary data from the geriatric division’s research. The sample consisted of inpatients aged ≥60 years who were hospitalized for more than 48 hours. Those who died within the first 48 hours of hospitalization and subjects with incomplete CGA domain data were excluded from the study. The criteria for nosocomial pneumonia used in this study followed the CDC’s pneumonia criteria for geriatric patients. Data processing was conducted using the application of Statistical Product and Service Solutions (SPSS) 16. Results. Of 228 subjects, the proportion of nosocomial pneumonia in elderly patients hospitalized was 31,14%. The mean age was 69 years with the subject’s age range between 60-89 years. Nutritional status (OR 2.226; CI95% 1.027-4.827) and functional status (OR 3.578; 95%CI 1.398-9.161) are factors that influence the incidence of nosocomial pneumonia in elderly patients who are hospitalized at Dr. Cipto Mangunkusumo National Central General Hospital. Conclusions. The proportion of elderly patients with nosocomial pneumonia was 31.14%. Nutritional status and functional status are factors that influence the incidence of nosocomial pneumonia in elderly patients who are hospitalized at Dr. Cipto Mangunkusumo National Central General Hospital. Keywords: Comprehensive geriatric assessment, elderly, nosocomial pneumonia
Pemeriksaan Bilasan Lambung: Alternatif Diagnostik Tuberkulosis pada Pasien HIV Dewasa? Yunihastuti, Evy
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 1
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Association of Clinical Features and Hematological Laboratoriesbetween Ph (+)/BCR-ABL (+) Chronic Myeloid Leukemia and Other Type of Ph/BCR-ABL Chronic Myeloid Leukemia Rajabto, Wulyo; Harryanto, A.; Tadjoedin, Hilman; Harimurti, Kuntjoro
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 1
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Introduction. Patients with chronic phase Chronic Myeloid Leukemia (CML) at Hematology-Medical Oncology Clinic Department of Internal Medicine dr. Cipto Mangunkusumo National Hospital who haveperformed cytogenetic and RTPCR BCR-ABL examination showed: Ph (+)/BCR-ABL (+) CML and other type of Ph/BCR-ABL CML. This study aims to identify the clinical features and hematological laboratories of chronic phase CML, the proportion of Ph (+)/BCR-ABL (+) CML, and association of clinical features and hematological laboratories between Ph (+)/BCR-ABL (+) CML and other type of Ph/ BCR-ABL CML. Methods. This is a cross-sectional study. The samples were taken by consecutive method. We used Chi-square test and logistic regression analysis. Association between variables considered significant when p value <0.05. Results. There were 80 subjects with chronic phase CML. Mean of age was: 39.4 (standard deviation 13.1) years. The comparison of clinical features and hematological laboratories between Ph (+)/BCR-ABL (+) CML and other type of Ph/ 12 | Jurnal Penyakit Dalam Indonesia | Vol. 5, No. 1 | Maret 2018 Wulyo Rajabto, A. Harryanto, Hilman Tadjoedin, Kuntjoro Harimurti BCR-ABL CML were: Symptomatic 80.6% : 100%; splenomegaly 82% : 92.3%; median of Hb 10,3 g/dL : 10,3 g/dL; median of white blood cell 124.620 : 127.050; median of thrombocyte 455.000 : 487.000. Bivariate and multivariate analysis showed no significant association of clinical features and hematological laboratories between Ph (+)/BCR-ABL (+) CML and other type of Ph/BCR-ABL CML. Conclusion. There was no significant association of clinical features and hematological laboratories between Ph (+)/BCRABL (+) CML and other type of Ph/BCR-ABL CML.
Validation of C-Reactive Protein and CURB-65 in The FirstHospital Admission Community Acquired Pneumonia Patient asA Predictor 30 Days Mortality Buharman, Borries Foresto; Pitoyo, Ceva Wicaksono; Singh, Gurmeet; Koesnoe, Sukamto
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 1
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Child Turcotte Pugh Score, diastolic dysfunction, liver cirrhosis, liver dysfunction
Association between Stigma, ARV Therapy and Complications ofPsychiatric Disorders iIn HIV / AIDS Patients Wicaksono, Yamaji Adi; Fitrikasari, Alifiati; Sofro, Muchlis Achsan Udji; Peni, Hari
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 1
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Introduction. Stigma and discrimination among HIV/AIDS patients cause varrious problems such as physical, psychological, and social. Therefore, its management requires comprehensive intervention. Antiretroviral therapy improves the patient’s clinical course, but may lead to neuropsychiatric complications especially anxiety disorders, depression, and psychotic disorders. This study aimed to know the associationbetween stigma,ARV therapy and complications of psychiatric disorders of HIV patients. Methods. A cross-sectional study was conducted among HIV/AIDS patients undergoing antiretroviral therapy in VCT-CST RSUP dr. Kariadi and RSUD RAA Soewondo Pati. Subjects were recruited using consecutive sampling method. Asessment of disorders and stigma was conducted using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and Questionnaire scale perception of PLWHA on community HIV/AIDS stigma. Analysis was performed using SPSS program. Correlation test analyzed with chi square test. Results. Total of 102 subjects were included in this study. The majority of subjects was male (51%) and the age mean value was 35.88 (SD 8.24) years. The most common type of antiretroviral drugs bas lamividine+zidovudine) + nevirapine (52.9%). The highest stigma scale of PLHIV was 95.1% positive stigma. Characteristics of psychiatric disorders consisted of 89.2% experienced psychiatric disorders, most depression 30.4%, and 6.9% psychotic disorders. Analysis showed that there was a statistically significant association between type of ARV therapy and psychiatric disorder. There was no statistically significant association between stigma and psychiatric disorders. Conclusions. There is an association between type of ARV therapy andpsychiatric disorders, but no association found between stigma and psychiatric disorders
Performance of Xpert MTB/RIF by Using Gastric Lavage Samplein The Diagnosis of Pulmonary Tuberculosis in HIV Patients withSuspected Pulmonary Tuberculosis Mboeik, Manuel Lamberto Willem; Pitoyo, Ceva Wicaksono; Karjadi, Teguh Harjono; Karuniawati, Anis; Dewiasty, Esthika
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 1
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Introduction. Xpert MTB/RIF test on gastric lavage sample may improve pulmonary tuberculosis (TB) case finding, but its performance as a diagnostic test for pulmonary TB in HIV-infected adults patients has not been studied widely, including in Indonesia. This study aims to determine the performance of the Xpert MTB/RIF test in diagnosing pulmonary tuberculosis 30 | Jurnal Penyakit Dalam Indonesia | Vol. 5, No. 1 | Maret 2018 Manuel Lamberto Willem Mboeik, Ceva Wicaksono Pitoyo, Teguh Harjono Karjadi, Anis Karuniawati, Esthika Dewiasty among HIV-infected adult patients with suspected pulmonary tuberculosis by using gastric lavage sample. Method. A cross-sectional study was conducted on adult HIV-infected patients with suspected pulmonary tuberculosis in Cipto Mangunkusumo hospital Jakarta between February 2016 and June 2017. Gastric lavage sample and sputum sample collection were performed for Xpert MTB/RIF test and acif fast bacilli (AFB) smear examination. Results. Among total of 117 subjects, 81 (69,2%) subjects were unable to expectorate sputum. M tuberculosis was detected on Xpert MTB/RIF using gastric lavage samples in 34 (29,1%) subjects, AFB in 4 of 36 sputum samples and 2 of 117 gastric lavage samples. The drug sensitivity test on all 34 Xpert MTB/RIF positive subjects showed no rifampicin resistance. Fifty-one (43.6%) subjects were diagnosed as clinical pulmonary tuberculosis, 26 subjects among them were positive on Xpert MTB/ RIF assay, 4 subjects were smear sputum positive and 1 subject was gastric lavage smear positive. Using clinical diagnosis of pulmonary TB as gold standard, a single Xpert MTB/RIF assay using gastric lavage sample showed sensitivity of 50.98% (95% CI: 36.6-65.25), specificity 87.88% (95% CI: 77,1-94,62), positive predictive value 76,47% (95%CI: 61,67-86,78) and negative predictive value 69,88% (95% CI: 63,36-75.68). Conclusion. Xpert MTB/RIF performed on gastric lavage samples showed sensitivity of 50.98% and specificity 87.88% in clinical diagnosis of pulmonary tuberculosis in HIV-positive patients with pulmonary tuberculosis.

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