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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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In-Hospital Mortality Risk Factors among Hospitalized Geriatric Patients: A Cohort Study on Tertiary Referral Hospital in Indonesia Yofi, Fadhil Abiyyu; Damayanti, Arlia Ayu; Widajanti, Novira
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 3
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Introduction. Decreasing fertility rates and increasing life expectancy cause an increase in the population of the elderly, with the number of elderly in the world is estimated to increase from 9.3% in 2020 to 16.0% in 2050. 24.35% of the elderly in Indonesia experience illness, and 8.71% have been hospitalized in one year. This study aimed to determine the risk factors for the death of elderly who were hospitalized.
The Role of Albumin and Hemoglobin as Predictors of 28-day Mortality in Elderly Sepsis Patients in Mohammad Hoesin Hospital Palembang Gultom, Widya Mandala Sari; Riviati, Nur; Perdana, Rizky; Husin, Syarif
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 3
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Introduction. Sepsis is defined as organ dysfunction caused by dysregulation of the host’s response to infection. The majority of sepsis are experienced by elderly patients with high mortality rates. In the condition of sepsis, there are various body mechanisms that cause a decrease in albumin and hemoglobin. This study is to determine the predictive value of albumin and hemoglobin levels on 28-day mortality of elderly sepsis patients.
Nucleoside/Nucleotide Analogues for the Treatment of Chronic Hepatitis B: A 3-Year Follow Up Study Sulaiman, Andri Sanityoso; Hasan, Irsan; Lesmana, Cosmas Rinaldi A; Jasirwan, Chyntia Olivia M; Nababan, Saut Horas H.; Kalista, Kemal Fariz; Aprilicia, Gita; Gani, Rino Alvani
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 3
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Introduction. Chronic hepatitis B (CHB) is endemic in Indonesia, where it is usually treated with pegylated interferon and nucleoside/nucleotide analogs (NA). The aim of this study was to determine the efficacy of treating CHB infection among Indonesian patients with NA (lamivudine, telbivudine, and tenofovir) for a 3-year period.Methods. We retrospectively reviewed the records of patients with CHB infection attending the Hepatology Clinic Cipto Mangunkusumo during 2010-2013 period. Subjects with inclusion criteria were all patients aged above 18 years treated with NA for at least three years. The degree of liver stiffness, hepatitis B virus deoxyribonucleic acid (HBV-DNA), alanine aminotransferase (ALT) levels, and hepatitis B antigen (HBeAg) were assessed before and after 3-years therapy.Results. A total of 62 subjects were included in the study. Forty-eight patients (77%) were treated with telbivudine, 9 (15%) with tenofovir, and 5 (8%) with lamivudine. At baseline prior to the onset of therapy, 52 patients (84%) had a positive HBeAg test, 15 patients (24%) had F3 liver disease (advance fibrosis), and 36 (58%) had liver cirrhosis using transient elastography. At the end of the 3 year study period, median of liver stiffness significantly decline from baseline (14.5 (3.3 – 59.3) kPa to 6.7 (3.3 – 37.2) kPa, p = 0.001), HBV DNA load significantly decline (1.31 x 107 (2.0x106 – 1.0x108) copies/mL to 0 (0 – 1.7 x 107) copies/mL, p = 0.001), alanine aminotransferase (ALT) levels significantly decline (58 (11– 404) U/L to 27 (8-291) U/L, p = 0.001). Nevertheless, there were five patients (8%) who still had F3 liver disease, and 20 patients (32.3%) had F4 liver disease, 21 (34%) had detectable HBV-DNA, 17 (27%) had not achieved ALT normalization. From 52 patients with positive HBeAg 140| Jurnal Penyakit Dalam Indonesia | Vol. 8, No. 3 | September 2021Andri S. Sulaiman, Irsan Hasan, C.R.A. Lesmana, Chyntia O.M. Jasirwan, Saut Horas H. Nababan, Kemal F. Kalista, Gita Aprilicia, Rino A. Ganibaseline, there were 20 patients (39%) who had seroconversion to negative HBeAg after three year period.Conclusion. NA therapy resulted in a reduction level of fibrosis in CHB induced liver disease.
Neutrophil Lymphocyte Ratio, Three Year Survival of Locally Advanced and Advanced Nasopharyngeal Carcinoma Cahyanur, Rahmat; Nufus, Hayatun; Irawan, Cosphiadi
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 3
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Introduction. Nasopharyngeal carcinoma (NPC) is the most prevalent head and neck malignancy in Indonesia, as NPC-related mortality in Indonesia is the second-highest in Asia after China. Inflammation has been studied to be associated with cancer progression. Neutrophil lymphocyte ratio describes the balance between the unfavorable suppression of immune response against cancer by neutrophils and the beneficial effect of adaptive immunity by lymphocytes. This study aimed to determine the relationship between NLR and the survival of locally advanced and advanced NPC patients.Methods. A retrospective cohort study was conducted using the medical records of NPC patients treated at the hematology clinic RSCM from 2015 to 2018. The difference in 3-year survival between NPC patients with and without metastasis, also high and low NLR, was analyzed with the Kaplan-Meier method. At the same time, multivariate Cox regression analysis was used to obtain adjusted hazard ratios (HR) after comparing with patients’ age, gender, T stage, N stage, NLR level, and metastasis status.Results. There were 143 patients included in this study; a total of 49 (34.3%) had metastasis. There was a significant difference in survival between those with and without metastasis (p=0.001), with 3-year survival of 24.5% in patients with metastasis. The AUC of NLR was 0.600 (CI 95% 0.502—0.698; p=0.049). The optimal cut-off value determined for NLR was 4.7 with a sensitivity of 56.00%, specificity of 62.37%, PPV of 59.81%, and NPV of 58.64% in predicting survival. Based on that value (≥4,7), there was a significant difference in proportion between those with and without metastasis (63.3% vs. 33.0%, p=0.001). Multivariateanalysis showed that metastasis (HR 3.349, CI 95% 1.909—5.874, p<0.001) was associated with poorer survival.Conclusions. There was no association between NLR and 3-year survival in NPC patients. The proportion of subjects with high NLR was found higher in those with metastasis. Metastasis status was associated with 3-year survival.
Comparison of Red Cell Distribution Width Values towardsMortality in Adult and Elderly Hospital-Acquired PneumoniaPatients in Dr. Sardjito Hospital Sari, Desty Gusti; Asdie, Rizka Humardewayanti; Retnowulan, Heni
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 2
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Introduction. Hospital-acquired pneumonia (HAP) is a major cause of morbidity and mortality. Red cell distribution width (RDW) is associated with mortality in patients with septic shock and community-acquired pneumonia (CAP). However, little is known about the effect of elevation of RDW value on mortality in HAP patients, especially in the elderly population who have a worse prognosis. This study aimed to determine the proportion of adult and elderly HAP patients who have an increase in RDW value and the relation between the increase in RDW value to the risk of mortality in HAP patients during hospitalization. Methods. A cross-sectional and retrospective cohort study was performed using medical records of inpatients diagnosed with HAP in RSUP Dr. Sardjito Yogyakarta from March 2014 until March 2015. The study’s sample was chosen by a consecutive sampling method. The data were analyzed with chi-square and logistic regression. Results. During the study period, a total of 106 patients were diagnosed with HAP with fulfilled the inclusion and exclusion criteria. Sixty-eight subjects (64.15%) survived, and 38 subjects (35.84%) died. The median RDW value was 15.3% (range 11.4 – 29.8%). The proportion of adult and elderly HAP patients toward the increase in RDW value was not statistically significant (p=0.331). Factor contributing to the increase of RDW value was haemoglobin (p<0.001; RR 5.617 (95% CI 2.294 – 13.756) and thrombocyte (p=0.002; RR 4.471 (95% CI 1.720 – 11.625). There was a proportion difference between RDW value and HAP mortality (p=0.043), but it was not statistically significant. Factor contributing to the increase of HAP mortality was sepsis (p<0.001; RR 7.121 (95% CI 2.599-19.509)) and leucocyte (p=0.031; RR=3.077 (95% CI 1.108 – 8.546)). Conclusions. There is no proportion difference in increasing RDW value between adult and elderly HAP patients. We also found that RDW value was not contributing to make the increase in mortality among HAP patients. However, this study found other factors, including haemoglobin and platelet level which correlated with the increase of RDW. We also found that sepsis and high leukocyte levels are significantly correlated with the incidence of mortality among HAP patients.
Proportion of Pre-dialysis Prolonged QT Dispersion in TwiceWeekly Chronic Hemodialysis Patients and Its Associated Factors Pattiiha, Arief; Yamin, Muhammad; Lydia, Aida; Abdullah, Murdani
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 2
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Introduction. Cardiovascular disease (CVD) is the common cause of mortality in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Causes of CVD in ESRD patients are multifactorial. Ventricular arrhythmia is known as the leading cause of sudden death in dialysis patients. QT dispersion, which is measured from electrocardiography (ECG), is known as one of the parameters to assess the risk of arrhythmia in HD patients. This study aimed to determine the proportion of pre-dialysis prolonged QT dispersion in chronic twice-weekly HD patients and the associated factors. Methods. A cross-sectional study was conducted among HD patients age ≥18 years with dialysis duration of at least three months in Cipto Mangunkusumo Hospital during May–June 2019. Electrocardiography, echocardiography, and blood samples were taken before the dialysis session. Bivariate analysis using Chi-square and Fisher’s exact test was performed on each variable. Significant results were further analysed using logistic regression. Results. A total of 142 subjects were included in this study. The mean age of subjects was 49 (standard deviation (SD) 15) years. Prolonged QT dispersion was found in 51 subjects (35.9%). Multivariate analysis showed prolonged QT dispersion was significantly correlated with systolic dysfunction (PR=1.875 (CI 95% 1.234-2.848); p=0.006) and left ventricle hypertrophy (PR=2.361 (CI 95% 1.032-5.403); p=0.019). Age, diabetes mellitus, hypokalemia, hypomagnesemia, and diastolic dysfunction were not significantly correlated with QT dispersion (p>0.05). Conclusion. The proportion of pre-dialysis prolonged QT dispersion in twice-weekly chronic hemodialysis patients in RSCM is 35.9% and associated with systolic dysfunction and left ventricle hypertrophy
Puasa Ramadan dan Diabetes Melitus: Risiko, Manfaat dan Peluang Penelitian Tahapary, Dicky L; Wafa, Syahidatul; Harbuwono, Dante S.
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 1
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The Pattern of Microorganism on Adult Acute Leukemia PatientsDuring Bacterial Surveillance and Febrile Neutropenia at CiptoMangunkusumo Hospital Sukrisman, Lugyanti
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 1
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Introduction. The standard intensive chemotherapy in acute leukemia patients will cause severe neutropenia and infection (febrile neutropenia) with high fatality rate. The availability of accurate data on causative pathogens is essential to the appropriate selection of empirical therapy and usually obtained from bacterial surveillance. This study was intended to evaluate bacterial pathogens found on surveillance and during febrile neutropenia in acute leukemia patients undergoing chemotherapy at Cipto Mangunkusumo Hospital and to provide information for antimicrobial policy in the hospital. Methods. A retrospective study from data of bacterial surveillance of acute leukemia patients undergoing chemotherapy during 2008-2010 in isolation room for acute leukemia patients at 8th floor of ‘Gedung A’ Cipto Mangunkusumo Hospital, Jakarta. The isolates for surveillance data were obtained from cultures from feces culture, nasal and throat swab, preputium swab and other sites (urine, sputum, skin infection - as indicated) from acute leukemia patients before and during intensive chemotherapy. Blood sample for blood culture was collected from central venous catheter and peripheral veins using Bactec during febrile neutropenia, and the other specimens (swab, urine, feces cultures) were collected according to the standard laboratory procedure. All specimens were collected by nurses in isolation room and bacterial cultures were performed at microbiology division of Clinical Pathology Department Cipto Mangunkusumo Hospital. Results. There were 1,127 isolates of acute leukemia patients (acute myeloid leukemia - AML or acute lymphocytic leukemia - ALL) that could be analyzed. Gram positive bacteria was significantly higher than gram negative bacteria from all cultures, from respiratory tract (514 out of 675 isolates; 76.1%) and blood culture (Staphylococcus epidermidis and Streptococcus anhemolyticus – 81 out of 103 isolates; 78.7%). Regarding bacterial surveillance in colon, only 8 out of 45 E. coli isolates from feces can be analyzed for sensitivity to ciprofloxacin/cotrimoxazole and the other 37 isolates were sensitive to other antimicrobials that not commonly used for gut decontamination in acute leukemia. The sensitivity pattern of the other isolates could not be analyzed to the antibiotics recommended for the management of febrile neutropenia due to wide range of antibiotics tested. Conclusion. From 1,127 isolates found among acute leukemia patients undergoing intensive chemotherapy at Cipto Mangunkusumo Hospital, it was found that gram positive was the most common bacteria found on upper respiratory tract from bacterial surveillance and from blood culture during febrile neutropenia
Management of Diabetic Ketoacidosis in Patient with HeartFailure Febrianto, Dicky; Hindariati, Est
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 1
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Diabetic ketoacidosis (DKA) is diabetes mellitus emergency which is defined by the biochemical triad of hyperglycemia, ketonemia, and acidemia. Diabetic ketoacidosis continues to have high rates of morbidity and mortality despite advances in the treatment of diabetes. Crucial aspects of DKA management involve adequate replacement of fluids and electrolytes, particularly potassium, and the continuous administration of insulin. Hydration status in patients with DKA and heart failure can be assessed by physical examination, such as consciousness, vital signs, capillary refill time, skin turgor, jugular venous pressure, and signs of pulmonary edema. Invasive and non-invasive methods can also assess fluid adequacy in rehydration of patients with DKA and heart failure. Invasive methods include central venous pressure (CVP) and pulmonary artery pressure, while non-invasive methods include echocardiography, bioimpedance vector analysis (BIVA), and brain natriuretic peptide (BNP). By assessing hemodinamic status properly in an intensive care setting, a patient with heart failure who develops DKA can be administered adequate quantities of fluid to avoid dehydration or overhydration.
Peran Penting Pengendalian Resistensi Antibiotik pada Pandemi COVID-19 Sinto, Robert
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 4
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