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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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Efektivitas dan Keamanan Beraprost untuk Pengobatan Klaudikasio Intermiten pada Critical Limb Threatening Ischemia (CLTI) Pangestu, Andhika; Asicha, Nur; Cahyanur, Rahmat; Resultanti, Resultanti
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 2
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Critical limb threatening ischemia (CLTI) is the most advanced stage of peripheral arterial diseases. Alternative treatment for claudication in CLTI patients is beraprost. We aim to review effectiveness and safety beraprost for relieve symptoms in CLTI. We conducted systematic literature searching using PubMed/MEDLINE, Embase, ProQuest, and Cochrane databases. Selected articles were examined for duplication and screened by abstract and title. Then, we appraised the articles based on the critical appraisal sheet from Centre for Evidence-Based Medicine (CEBM) University of Oxford. We found one systematic review-meta analysis (SR-MA) which involved 4,477 randomized participants. The results from this study are moderate quality evidence that prostanoids reduced rest pain (RR 1.30; 95%CI 1.06 – 1.59) and promoted ulcer healing (RR 1.24; 95%CI 1.04 – 1.48). In adult patients with CLTI and intermittent claudication as the primary complaint, vasodilator agents such as beraprost have a beneficial effect and a favorable therapeutic response. Numerous effects, including cardiovascular benefit, adverse events, resting pain relief, ulcer healing, outcome maximum walking distance (MWD), and pain-free walking distance, demonstrate the benefit (PFWD). The benefits of beraprost differ depending on the mechanism of action and pharmacokinetics of the drugs.
Pica sebagai Manifestasi Anemia Defisiensi Besi: Suatu Laporan Kasus murwaningrum, artati; Rinaldi, Ikhwan; Mustopa, Inna Intani
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 2
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Prevalence of anemia in Indonesia based on Basic Health Research (2018) was 23.7%. Symptoms of iron deficiency anemia were pallor, malaise, palpitation, shortness of breath, headache, sore tongue. But sometimes can be found abnormal behavior in the form of PICA. This article reports on a-52-year-old man who sought medical treatment and was diagnosed with iron deficiency anemia with pica manifestation. The pica manifestation was characterized by a repeated desire to consume raw rice due to bleeding from hemorrhoids. Patient was given oral iron replacement therapy contain 100 mg of Fe (III) hydroxide polymaltose complex and folic acid 0.35 mg alternating with vitamin C 500 mg daily. Total iron daily dose given were 200 mg, divided in two doses. The patient received dietary education and was advised to consult a Gastroenterohepatology Subspecialist for the management of hemorrhoids, but it has not been done yet. The desire for raw rice consumption disappeared and the hemoglobin level increased to 12.4 g/dL after six weeks of therapy. The patient continued to take iron supplements until January 2023 but did not have follow-up visits to the clinic. In January 2023, the patient underwent hemorrhoid surgery due to bleeding accompanied by and a non-reducible lump that had been present for three days. Iron supplements continued for one month post-operation and then discontinued. The latest hemoglobin level was 15.3 g/dL without iron supplements. The symptoms of pica in this patient disappeared along with an increased hemoglobin level, and the management of severe anemia in this patient showed an adequate response. Bleeding has never occurred again after the surgery. Curative measures for hemorrhoidal bleeding are crucial, while iron supplementation is only a supportive therapy.
Peran Penting Inflamasom NLRP3 pada Aterosklerosis Sukmawati, Dewi
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 2
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Cardiovascular diseases (CVDs) still contribute as the main cause of mortality and premature mortality worldwide. In Indonesia, CVDs contribute to 35% of the main cause of death in non-communicable diseases followed by diabetes at 6%. The ischemic heart disease and acute ischemic stroke is the main cause of death in Indonesia due to atherosclerosis. Atherosclerosis is a multifactorial cause, with chronic inflammation which causes myocardial infarction and acute ischemic stroke. Research demonstrated that one of the underlying mechanisms of atherosclerosis is inflammation. The current research suggested that inflammation could activate a complex of cytosol proteins, namely nucleotide-binding oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3) inflammasome. The NLRP3 inflammasome is known as a protein sensor as a response to danger signals known as pathogen-associated molecular patterns (PAMPs) or damage/danger-associated molecular patterns (DAMPs). The NLRP3 inflammasome will convert the pro-IL1β and pro-IL-18 into their mature forms which initiates the cell death (pyroptosis) through the cleavage of Caspase-1. This NLRP3 inflammasome has a central role in the initiation and progression of atherosclerosis by affecting the sequences of its cellular and molecular targets. To date, several small molecules and drugs have been identified as NLRP3 inflammasome inhibitory pathways and potential therapeutic agents for atherosclerosis. In this review, we will discuss further the structure of NLRP3 inflammasome and its roles in atherosclerosis, and the potential candidates of the small molecules and drugs targeted in the inflammasome pathway.
Profil Klinis dan Kesintasan Pasien Karsinoma Sel Hati di Rumah Sakit Rujukan Tersier Indonesia Tahun 2015-2021 Hasan, Irsan; Gani, Rino Alvani; Sulaiman, Andri Sanityoso; Kurniawan, Juferdy; Lesmana, Cosmas Rinaldi A.; Jasirwan, Chyntia Olivia M; Nababan, Saut Horas H.; Kalista, Kemal Fariz; Aprilicia, Gita; Teressa, Maria
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 2
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Introduction. Hepatocellular carcinoma (HCC) is the most common primary liver cancer in the world and Indonesia. This study aimed to describe the clinical presentation and survival rate of HCC patients in Dr. Cipto Mangunkusumo Hospital (RSCM) as the Indonesian tertiary referral hospital in year 2015-2021 Methods. Cohort study was performed in year 2015-2021. Clinical presentations at the time of diagnosis were recorded from electronical health record. All HCC patients were followed up until death. One-year survival based on staging was assessed using log rank test and presented with Kaplan Meier curve. Results. A total of 799 HCC patients were included. Majority of HCC patients were male, 619 patients (77.5%), and aged 55 (SD 11.9) years. Hepatitis B was the major etiology, found in 500 patients (62.6%). Median of alfa feto-protein (AFP) was 1,109 (0.8-3,462,499) ng/ml. At the time of diagnosis, Barcelona Clinic Liver Cancer (BCLC) stage C (37.7%) was the most commonly found. Portal vein thrombosis was found in 205 patients (25.7%). There were 271 (33.9%) HCC patients received curative and palliative treatment, and others had supportive care. One year survival rate of HCC was 61.2%. One year survival rate of HCC based on staging for BCLC A, BCLC B, BCLC C, and BCLC D were 91.1%, 68.6%, 47.6%, and 13.3%, respectively (log-rank test: p<0.001). Conclusion. The majority of patients diagnosed with HCC were at an advanced stage so that the one-year survival is poor.
Manajemen Koinfeksi Malaria Berat dengan HIV Belum Mendapat Terapi Antiretrovirus di Era Pandemi COVID-19: Sebuah Laporan Kasus Harijanto, Paul; Mawuntu, Rosye; Rusli, Novia; Adiwinata, Randy; Nugroho, Agung
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
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Severe malaria is a serious infectious disease that required immediate diagnosis and prompt treatment. Severe malaria may result several organ failures which is similar with other infectious diseases like SARS-CoV-2, sepsis, dengue, and HIV infection. Most of those infection have similar symptoms such as fever, myalgia, and headache, therefore physician should have high suspicion regarding co-infection with other infectious agents. The overlapping symptoms of co-infections may become a challenge for physician in diagnosing and delivering prompt therapy. Failure to deliver prompt treatment may lead to fatal outcome such as in severe malaria case. Stigmatization of all patients with fever and cough for COVID-19, may lead to misdiagnosis, moreover in some facilities which SARS-COV-2 PCR testing may not readily available to rule out infection. Therefore, it is importance to have broad differential diagnosis of fever during COVID-19 pandemic era, including the possibility of malaria infection in immunocompromised patients This can be achieved by comprehensive history taking and physical examination in evaluating patients with fever. We report antiretroviral naïve HIV infected patient with severe malaria indicated by several multi organ damage that successfully treated.
Perlemakan Hati Non-Alkoholik dan Risiko Fibrosis Hati pada Pasien Hepatitis B Kronik Sulaiman, Andri Sanityoso; Hasan, Irsan; Lesmana, Cosmas Rinaldi A.; Kurniawan, Juferdy; Jasirwan, Chyntia Olivia Maurine; Nababan, Saut Horas H.; Kalista, Kemal Fariz; Aprilicia, Gita; Gani, Rino Alvani
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
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Introduction. Prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing throughout the world due to sedentary lifestyle and dietary habit, including in patients with chronic hepatitis B (CHB). In several studies, advanced of liver disease were more likely observed among those CHB patients with NAFLD. NAFLD might increase the risk of liver disease progression in CHB patients, but prior investigations were still limited. This study aimed to determine the association between NAFLD and risk of liver fibrosis in CHB patients. Methods. All patients with positive serum hepatitis B surface antigen in the Hepatobilier Data Registry, Cipto Mangunkusumo Hospital, were included in this study. Based on abdominal ultrasonography, patients were divided into two group (group I: non-NAFLD – hepatitis B patients vs. group II: NAFLD – hepatitis B patients). Data demographic and clinical examination were collected. Significant liver fibrosis was defined as stage liver fibrosis above 7 kPa (≥ F2). Logistic regression was used to identify NAFLD as risk factor for significant fibrosis. Variables were expressed as prevalence odd ratio (POR) with 95% CI. P values <0.05 were considered statistically significant. Results. Among 130 hepatitis B patients, 45 patients (34.6%) were diagnosed with NAFLD. Of 45 patients in group II, 36 patients (80%) had significant liver fibrosis. It was observed that a higher percentage of patients in group II were HBeAg negative compared to those in group I (66.7% vs. 35.9%; p=0.038). Furthermore, group II also displayed higher levels of liver stiffness compared to group I (12.22 (8.6 kPa) vs. 8.57 (7.8 kPa); p 0.016). In multivariate analysis, NAFLD was significantly associated with significant liver fibrosis (POR: 5.87; CI95%: 2.48 – 13.86; p < 0.001) after adjusted with HBeAg status. Conclusion. NAFLD associated with the higher risk of liver fibrosis in patients with hepatitis B. Modification of lifestyle and potential therapeutic intervention may help in reducing the progression of liver fibrosis.
Faktor-Faktor yang Memengaruhi Kesintasan Pasien yang Dilakukan Intervensi Koroner Perkutan Primer Karim, Birry
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
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Profilaksis vs. Terapi Preemtif Penyakit Cytomegalovirus (CMV) pada Pasien Transplantasi Ginjal Risiko Tinggi: Suatu Laporan Kasus Berbasis Bukti Wardhani, Ariani Intan; Tunjungputri, Rahajeng N.; Tetrasiwi, Erpryta Nurdia; Marbun, Maruhum Bonar
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
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Kidney transplant recipients require the use of immunosuppressive agents to prevent multiple organ rejection. Administration of immunosuppressive agents triggers an increased risk of impaired immunity and microbial infections, one of which is cytomegalovirus (CMV). Prevention of cytomegalovirus infection can be given as a prophylaxis or preemptive therapy. However, the efficacy of choosing prophylaxis or preemptive therapy is still under debate, thus we conducted this study to identify current approach in preventing CMV disease in clinical practice. A literature search was carried out using the PubMed, Cochrane Library, Embase and Scopus databases with the keywords “high risk kidney transplant”, “prophylaxis”, “preemptive” and “CMV infection disease”. Inclusion criteria were only studies in adult kidney transplant patients as a population. , prophylaxis as intervention, preemptive therapy as comparison, and cytomegalovirus infection as outcome. The exclusion criteria of this study were the study articles that were not in Bahasa Indonesia or English, case reports and studies with subjects <18 years old. Critical review using Oxford Center for Evidence Based Medicine (CEBM) Critical Appraisal Tools for Prognostic Study And Systematic Review. The total number of articles identified based on the keywords used is 115 articles. Eliminating duplication with EndNote resulted in 92 articles. Furthermore, exclusion was carried out based on title and abstract so that 29 articles were filtered for which the full text was available. Of these, 23 articles did not have appropriate research questions, 3 studies did not have appropriate patient populations, and 3 articles with types that did not meet the inclusion criteria of this study. As a result, there were 4 articles that can be used in this report. Based on those four articles, it can be concluded that prophylaxis is more effective in preventing CMV disease but had more side effects, when compared to preemptive therapy. However, there was no difference in long term outcome between kidney transplant patients with CMV prophylactic or preemptive therapy.
Perbedaan Serotonin Plasma dan Kortisol Saliva terhadap Gejala Depresi pada Pasien Pasca Sindrom Koroner Akut Firmansyah, Irman; Shatri, Hamzah; Putranto, Rudi; Ardani, Yanuar; Ginanjar, Eka; koesnoe, sukamto; Rizka, Aulia; Isbagio, Harry; Yunir, Em
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
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Introduction. Psychological disorders are closely associated with hormonal factors, including cortisol and serotonin. In patients with acute coronary syndrome (ACS), autonomic dysfunction and dysregulation of the hypothalamic-pituitaryadrenal (HPA) axis can occur, leading to an increase in cortisol levels that may worsen the prognosis of ACS patients. Therefore, it is important to understand the hormonal impact, namely cortisol and serotonin levels, on depressive symptoms, which will be examined in this study. Methods. This was a cross-sectional study to determine the impact of cortisol and serotonin in the incidence of depression in post-treatment ACS patients at the ICCU RSUPN dr. Cipto Mangunkusumo, Jakarta. Data collection from patients meeting the inclusion criteria was carried out 10-14 days post-treatment through interviews, HADS questionnaire completion, physical examinations, and laboratory tests. The Mann-Whitney test was used to examine the differences between serotonin and salivary cortisol levels in patients with and without depression. Results. Among the 73 ACS patients included in this study, the average age was 57.53 (9.97) years, with 68.5% was male. Posttreatment depression was observed in 15.1% of subjects. The median serotonin levels were lower in patients with depression [175 (147 – 227.64) ng/mL vs. 189.31 (152.87-235.44) ng/mL], while cortisol levels were higher in patients with depression [3.09 (1.46-6.26) ng/mL vs. 2.15 (0.92-3.91) ng/mL]. However, the statistical analysis showed no significant differences between plasma serotonin and depression (p=0.482) or saliva cortisol and depression (p=0.275). Conclusions. There were no significant differences in cortisol and serotonin levels concerning depressive symptoms among post-acute coronary syndrome patients. Nevertheless, this study holds clinical importance due to the observed lower plasma serotonin levels and higher saliva cortisol levels in ACS patients with depression.
Profil Pasien Ketoasidosis Diabetikum di Rumah Sakit Rujukan Tersier di Bali, Indonesia Joenputri, Noviana, NJ; Suastika, Ketut, KS; Gotera, Wira, WG; Saraswati, Made Ratna, MRS; Dwipayana, I Made Pande, IMPD; Semadi, I Made Siswadi, IMSS; Nugraha, Ida Bagus Aditya, IBAN
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
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Introduction. Diabetic ketoacidosis (DKA) is one of life-threatening acute complication of diabetes mellitus (DM) characterized by hyperglycemia, ketosis, and acidosis. The prevalence of DM is increasing, therefore the incidence of DKA is predicted to continue to increase. The aim of this study was to obtain the profile of DKA patients in RSUP Prof. Dr. IGNG. Ngoerah (RSPN), Denpasar, Bali as a tertiary refferal hospital of Bali and Nusa Tenggara region. Methods. This study was a cohort retrospective study. All patients aged 18 years or older with a diagnosis of DKA during Januari 2022 to February 2023 at RSPN, were included in this study. Data were obtained from medical records then analyzed using the SPSS version 26 program. Results. There were a total of 41 patients with DKA with mean of age was 50,59 (SD 16,87) years, most of them were female (51,2%) and came alone without referral (58,5%). Based on the clinical profile, most patients presented with decreased consciousness (36,5%), infection (90,2%) mostly urinary tract infection (UTI) (40,5%), have a history of insulin use (34,1%), and impaired of renal function (85,4%). The mean of blood glucose was 468,95 (SD 207,78) mg/dL, potassium level 4,19 (SD 1,17) mmol/L, bicarbonate level 12,85 (SD 6,27) mmol/L, and HbA1c 11,5% (7,1-14). The median duration of hospitalization was 7 (1-30) days and 19,5% of them were passed away during treatment, mostly within the first 72 hours. Conclusions. Most patients in this study are female with age less than 60 years. The most common precipitating factor of DKA are UTI and poor glycemic control. A total of 19,5% of patients with DKA were passed away in this study. Thus, clinicians should be more aggressive in the management of DKA, particularly in the first 72 hours.

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