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INDONESIA
Jurnal Penyakit Dalam Indonesia
Published by Universitas Indonesia
ISSN : 24068969     EISSN : 25490621     DOI : https://doi.org/10.7454/
Core Subject : Health,
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.
Articles 414 Documents
Kesintasan Satu Tahun Pasien yang Menjalani Intervensi Koroner Perkutan Primer di Rumah Sakit Dr. Cipto Mangukusumo Hamdan, Muhammad Afriadi; Wijaya, Ika Prasetya; Widhani, Alvina; Yamin, Muhammad
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
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Introduction. Primary percutaneous coronary intervention (PPCI) is an angioplasty (with or without a stent) performed immediately on the infarct-related artery without prior administration of fibrinolytics. Although PPCI is the reperfusion therapy of choice in ST-segment Elevation Myocardial Infarction (STEMI) patients, survival in post-PPCI patients still varied and research on its determinant factors still showed inconsistent results. This study aimed to determine the predictors of oneyear survival in patients undergoing PPCI at Dr Cipto Mangunkusumo General Hospital. Methods. This retrospective cohort study evaluated the medical records of patients who underwent PPCI at Dr. Cipto Mangunkusumo General Hospital from January 2014 to December 2019. The data collected included clinical parameters and demographic data from the PPCI registry. Patients’ outcomes were cardiovascular mortality, determined based on medical records or by contacting patients or their families by phone. Survival curves were created using the Kaplan Meier method and significance using the log-rank test. Multivariate analysis was performed using the Cox Proportional Hazard model. Results. A total of 220 patients who underwent PPCI were included in this study. The mortality rate was 11.82% and the one-year survival post-PPCI was 88.2%, with a mean survival of 10.7 (10.2-11.2) months. The highest mortality rate occurred in the first month post of PPCI, then mortality trend decresed in the 2nd month to one year. In multivariate analysis, age >60 years [p<0.001; HR 4.25 (1.93-9.37)], high serum creatinine [P=0.031; HR 2.41 (1.08-5.33)], and Killip score III-IV [p<0.001; HR 4.06 (1.83-9.00)] were significant prognostic factors. Conclusion. The predictors of one years survival patients post of PPCI are age, serum creatinine level, and Killip score.
Perbedaan Kadar Insulin-Like Growth Factor-1 dan Tumor Necrosis Factor-α Serum pada Berbagai Derajat Sarkopenia Pasien Lanjut Usia: Studi Potong Lintang Tamayo, Auliangi; Mulyana, Roza; Martini, Rose Dinda
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
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Introduction. Sarcopenia is a phenomenon of progressive decline in muscle function that occurs due to the aging process. Insulin-like growth factor-1 (IGF-1) and tumor necrosis factor-α (TNF-α) have an important role in the occurrence of sarcopenia as a positive and negative regulator of muscle mass. Research shows differences in IGF-1 and TNF-α levels between sarcopenia and non-sarcopenia groups, but research on differences in severity of sarcopenia remains unclear. The purpose of this study was to determine the difference in levels of IGF-1 and TNF-α in various degrees of sarcopenia in elderly patients. Methods. This was an analytical observational study with a cross-sectional approach involving 45 subjects of elderly patients who came to the internal outpatient clinic of RSUP dr. M. Djamil Padang and met the criteria for inclusion and exclusion. Subjects were grouped into possible sarcopenia, sarcopenia, and severe sarcopenia. Then, serum IGF-1 and TNF-α examinations were performed using the enzyme linked immunosorbent assay (ELISA) method. Data was analyzed using SPSS 26.0. Results. Median of serum IGF-1 levels in the total sample were 41.36 ng/mL. The highest levels of IGF-1 were found in the possible sarcopenia group (55.28 ng/mL), while the lowest level was in the severe sarcopenia group (31 ng/mL). Median of serum TNF-α levels in the total sample were 157.63 ng/L with the lowest was found in the possible sarcopenia group (111.41 ng/L) and the highest was in the severe sarcopenia group (241.1 ng/L). There was a significant difference in serum levels of IGF-1 and TNF-α in the three sarcopenia groups (p= 0.001). IGF-1 levels decreased according to the severity of sarcopenia, while TNF-α levels increased according to the severity of sarcopenia. Conclusions. There are differences in serum levels of IGF-1 and TNF-α between possible sarcopenia, sarcopenia, and severe elderly sarcopenia.
Sarkopenia pada Lanjut Usia: Patogenesis, Diagnosis dan Tata Laksana Njoto, Edwin Nugroho; Suka Aryana, I Gusti Putu
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
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‘Sarcopenia’ involves a progressive age-related loss of muscle mass and associated muscle weakness that renders frail elders susceptible to serious injury from sudden falls and fractures and losing their functional independence. This disease has a complex multifactorial pathogenesis, which involves not only age-related changes in neuromuscular function, muscle protein turnover, and hormone levels and sensitivity, but also a chronic pro-inflammatory state, oxidative stress, and behavioral factors – in particular, nutritional status and degree of physical activity. In the previous definition by the European Working Group on Sarcopenia in Older People (EWGSOP) in 2010, the diagnosis of sarcopenia requires the presence of both low muscle mass and low muscle function. Since the 2010 definition is difficult to be translated to clinical practice, the EWGSOP uses low muscle strength as the primary parameter of sarcopenia in the 2018 definition; sarcopenia is probable when low muscle strength is detected. A sarcopenia diagnosis is confirmed by the presence of low muscle quantity or quality. When low muscle strength, low muscle quantity/quality and low physical performance are all detected, sarcopenia is considered severe. According to the pathophysiological factors involved in the pathogenesis of sarcopenia, different treatment strategies against sarcopenia are resistance exercise training, increase essential amino acids intake, vitamin D supplementation for those with vitamin D deficiency, polyunsaturated fatty acids (PUFAs) supplementation, testosterone supplementation, angiotensin-converting enzyme inhibitor administration.
Pentingnya Edukasi Pasien Lupus Eritematosus Sistemik Yunihastuti, Evy; Harinda, Fadlika
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
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Lupus eritematosus sistemik (LES) merupakan penyakit kronik yang dapat mengenai berbagai macam organ dengan manifestasi ringan hingga serius. Karakteristik LES adalah sangat dinamis, bervariasi, dengan perjalanan penyakit yang kadang tidak dapat diprediksi. Walau saat ini semakin tinggi pengetahuan tentang patofisiologi, optimalisasi penanganan, dan banyak ditemukan obat yang lebih baik untuk terapi LES, masih banyak ODAPUS (orang dengan lupus) mengalami morbiditas, mortalitas, dan kualitas hidup yang kurang baik. Tanpa penanganan yang baik, pemantauan dan pengobatan yang teratur, tentu luaran yang baik akan lebih sulit didapatkan.
Uji Coba Pemberian Snack Bars Berbahan Dasar Tape Ketan Hitam sebagai Sumber Serat terhadap Penurunan Kadar Glukosa Darah Puasa Pasien Diabetes Melitus Tipe 2 Billah, Muhammad Muayyad; Wiboworini, Budiyanti; Prayitno, Adi
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
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Introduction. Managing dietary pattern, including snack schedule, is one of the most important factors in maintaining blood glucose levels in patients with type 2 diabetes mellitus (T2DM). Black glutinous rice tape is one of the foods that contains bioactive nutrient and fiber beneficial to health. This study aimed to determine the effect of snack bars made from black glutinous rice tape on fasting blood glucose levels in T2DM patients. Methods. The study employed a quasi-experimental pre and post-test design with a control group which was conducted among T2DM patients undergoing treatment at Bhayangkara Tk. II Sartika Asih Hospital, Bandung. The study was conducted from October 2022 to January 2023 and involved a total of 22 subjects divided into two groups (treatment and control), selected through the accidental sampling method. The treatment group received a daily intake of 3 x 30 grams sticky rice tape snack bar for 7 days along with nutritional counseling, while the control group did not received the snack bar but received nutritional counseling. Fasting blood glucose (FBG) levels were measured both before and after treatment, then analyzed using a paired sample T-test. The difference in the treatment’s impact between the two groups was assessed using the Wilcoxon test. Results. Statistical analysis showed a reduction in the mean levels of FBG in the control group by 21.36 mg/dL (p=0.111) and in the treatment group by 61.46 mg/dL (p=0.021). There was an impact of consuming black glutinous rice tape snack bars on the reduction of FBG levels in DMT2 patients, with a difference in FBG reduction between the control and treatment groups of 40.10 mg/dL (p=0.018). Conclusion. Administering 3 x 30 grams of black sticky rice tape snack bars for 7 days was effective in reducing the FBG levels in T2DM patients.
Kombinasi Sofosbuvir-Ledipasvir dan Sofosbuvir- Daclatasvir pada Pengobatan Pasien Hepatitis C di Indonesia Sulaiman, Andri Sanityoso, Dr; Hasan, Irsan, Dr; Lesmana, Cosmas Rinaldi Adithya, Dr; Kurniawan, Juferdy, Dr; Aprilicia, Gita; Nugroho, Yayah, Dr; Wahyuni, Nunuk Tri, Dr; Sulaiman, Budiman Sujatmika
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
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Introduction. Direct-acting antivirals (DAAs) has been developed for treatment hepatitis C virus (HCV). Therapy of HCV using DAA has shown high sustained virologic response (SVR) and shortening duration of therapy. Sofosbuvir-ledipasvir (SOF/LDV) is fixed dose combination tablet of DAAs which recommended for genotype 1, 4, 5, and 6 infected patients. In developing countries, SOF/LDV still can be used as cost-effective regimen in all genotype compared with sofosbuvir-daclatasvir (SOF/ DCV). This study aimed to evaluate the efficacy of combination sofosbuvir-ledipasvir in all genotypes of HCV patients compared with available DAA in Indonesia (sofosbuvir- daclatasvir). Methods. A retrospective study was conducted among patients who received HCV therapy in Klinik Hati and Cipto Mangunkusumo Hospital during January until December 2017. Demographic data, baseline characteristics virus, and baseline characteristics laboratory were collected from medical record. Quantitative polymerase chain reaction (PCR) for HCV RNA were assessed at the end point of study. The efficacy of SOF/LDV and SOF/DCV were carried out by sustained virological response at 12 weeks (SVR-12). Results. A total of 214 HCV patients were include in this study. Sixty-nine patients treated with SOF/LDV, whereas 145 patients treated with SOF/DCV. In group of SOF/LDV, 20 (29%) patients had an experience therapy, 9 (13%) received 24-week therapy, 26 (37.7%) patients observed with cirrhosis. In group of SOF/DCV, 24 (16.6%) patients had an experience therapy, 38 (26.2%) received 24-week therapy, 41 (28.3%) patients observed with cirrhosis. The patients were dominated by HCV genotype 1 in both of group SOF/LDV and SOF/DCV (63.7% vs. 67.6%). All patients had undetected HCV RNA virus after the combination therapy of SOF/LDV, with the SVR-12 rate was 69 (100%) patients. Meanwhile, SVR-12 rate was achieved in 142 (97.9%) patients in group SOF/DCV. Conclusion. SOF/LDV is effective in all genotypes of HCV patients and the cost fix dose combination of SOF/LDV more affordable to patients in developing countries compared with SOF/DCV regimen.
Survei Kebutuhan Edukasi Pasien Lupus Eritematosus Sistemik Josephine, Jennifer; Widhani, Alvina; Cahyanur, Rahmat; Karjadi, Teguh Harjono
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
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Introduction. Patients with systemic lupus erythematosus (SLE) who suffer from chronic illness, need tailored education to better manage their condition. As nowadays education through internet and social media contributes significantly. This study aimed to assess internet usage related to lupus, educational needs, and education sources preferences among patients. Methods. This study was a cross-sectional study conducted on adult SLE patients at Allergy and Clinical Immunology Clinic, Internal Medicine Department, Cipto Mangunkusumo Hospital, Jakarta, between July-August 2023. Respondents completed a set of questionnaires regarding their internet usage related to lupus, education platform preferences, and educational needs assessment tool (ENAT). Results. Sixty-five female subjects participated, with a median (range) age of 32 (19-56) years. Respondents who used the internet and social media for lupus-related matters were 92.3%. The ENAT domains prioritized by patients were knowledge about the disease (score 89%) and emotional management (score 85%). The primary sources of education desired by patients were direct education from doctors/nurses (87.7%), Instagram (55.4%), and YouTube (55.4%). Conclusions. SLE patients expressed a strong need for knowledge about the disease and emotional management, with doctors/nurses as the preferred sources of education. The widespread use of the internet for lupus-related information indicates a great opportunity for providing education through online platforms, particularly through Instagram, and YouTube.
Angka Kejadian dan Karakteristik Klinis Pasien Infeksi Jamur Invasif di RSUP Dr. Hasan Sadikin Tahun 2020 – 2022 Alessandro, Ariella; Fauziah, Nisa; Megantara, Imam; Wisaksana, Rudi; Dewi, Intan Mauli Warma
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
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Introduction. Invasive fungal infection (IFI) is increasingly common in patients at risk, especially those with impaired immune response. In Indonesia, there is currently a low prevalence of IFI which may be influenced by challenges in diagnosis. This study aimed to determine the prevalence and clinical characteristics of IFI patients in Dr. Hasan Sadikin Hospital in Bandung, Indonesia. Methods. This cross-sectional study was conducted at Dr. Hasan Sadikin Hospital. Data were collected using medical records of IFI patients diagnosed between 2020 and 2022 which were selected using total sampling method. Demographic data, clinical symptoms, radiological appearance, and laboratory results were recorded. Results. The prevalence of IFI in Dr. Hasan Sadikin Hospital between 2020 and 2022 was 0,04% (40 per 100,000 patients). The most common cause of invasive fungal infection was Cryptococcus spp. and Candida spp. Fever and loss of consciousness were the two most common signs and symptoms found in this study. HIV/AIDS was present in 51,4% of cases. The diagnostic test was mostly done with cryptococcal antigen (CrAg) examination. Lung involvement was common, appearing as consolidation, infiltration, and ground glass opacity in the lungs. The mortality rate of IFI patients was 51,4%. Conclusions. The prevalence of IFI in Dr. Hasan Sadikin Hospital was quite low, with HIV/AIDS as the most common risk factor. However, there was a high mortality rate found this study is high. Thus, timely diagnosis and antifungal treatment induction should be considered to improve the outcome of invasive fungal infection patients.
Modifikasi Skor TIMI sebagai Model Prediksi Mortalitas 30 Hari Pasien STEMI Muda Mansur, M. Tasrif; Yamin, Muhammad; Rusdi, Lusiani; Abdullah, Murdani; Karim, Birry; Rumende, Cleopas Martin; Marbun, Maruhum Bonar H.; Shatri, Hamzah
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
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Introduction. Cardiovascular disease is a leading cause of death worldwide. Three-quarters of these deaths occur in lowand middle-income countries among individuals in their productive years. ST-segment elevation myocardial infarction (STEMI) is a dangerous manifestation of coronary artery disease (CAD) and can lead to sudden death. Smoking and a family history of early CAD are major risk factors for STEMI cases. However, their role in any risk stratification system for patients has not been clearly established. The most widely used score in assessing the prognosis of STEMI patients is the TIMI score, but its accuracy in the young patient population is still unknown. The objectives of this study were to determine the proportion of mortality in young STEMI patients at RSCM, validate the TIMI score in young patients, and develop a risk stratification system for young STEMI patients. Methods. This research is a retrospective cohort study using medical record data from the Dr. Cipto Mangunkusumo National General Hospital (RSCM) on patients aged ≤50 years who were treated for ST-elevation myocardial infarction (STEMI) from 2018 to 2022. Univariate analysis was conducted to obtain subject characteristics and the 30-day mortality proportion of young STEMI patients. Bivariate Cox regression analysis was performed to examine the relationship between smoking and a family history of early coronary artery disease (CAD) with 30-day mortality. The TIMI score was validated in the study subjects of young patients. Multivariate analysis was conducted to obtain a new prediction model, and the model’s discriminatory performance was assessed using the area under the ROC curve (AUC), and model calibration was modified using the Hosmer-Lemeshow test. Results. A total of 164 study subjects were included. There were 107 patients (65.2%) with a smoking risk factor, while 39 patients (23.9%) had a family history of early CAD. The proportion of 30-day mortality among young patients was 7.9% (13 individuals). Statistical analysis showed that there was no correlation between 30-day mortality in young STEMI patients and a history of smoking (HR 0.0441 (95% CI 0.148-1.312)) or a family history of early CAD (HR 0.567 (95% CI 0.126- 2.559)). The TIMI score showed good predictive ability for 30-day mortality in young STEMI patients, with an AUC value of 0.836 (95% CI 0.717- 0.956). The combination of the TIMI score with the smoking history variable demonstrated good discriminatory performance in predicting 30-day mortality among young STEMI patients, with an AUC value of 0.875. However, when comparing the AUC values between the TIMI score and the TIMI score with the addition of the smoking history factor, no significant increase in accuracy was observed (p-value=0.215). Conclusions. The TIMI score demonstrates good discrimination and calibration in predicting 30-day mortality among young STEMI patients. The TIMI score, when combined with the smoking history factor, shows improved discriminatory performance and calibration in predicting 30-day mortality among young STEMI patients compared to the pure TIMI score but does not significantly enhance the accuracy.
Penyakit Sel Sabit pada Pasien Laki-laki Berusia 27 Tahun yang Sebelumnya Didiagnosis sebagai Talasemia: Sebuah Laporan Kasus Cahyanur, Rahmat; Kurniawan, Andree; Sharfina, Ratuafni; Mulansari, Nadia Ayu
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
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Sickle cell disease (SCD) is a hemoglobinopathy inherited in an autosomal recessive pattern arising from a mutation causing substitution of valine for glutamic acid in the sixth amino acid of the β-globin chain. The clinical manifestation of SCD varies from acute pain, chronic anemia, to multi-organ infarct and failure. SCD is known to be rare in Indonesia. However, we recently encountered a SCD patient presenting with recurrent pain and hypesthesia since a year ago. The diagnosis of SCD in this patient was established based on the results of peripheral blood smear and hemoglobin electrophoresis. The patient had previously been diagnosed with thalassemia at the age of 19 years old due to a history of icterus, thus delaying prompt treatment. This further emphasizes the challenges in distinguishing SCD, which is relatively rare in Indonesia compared to thalassemia, especially considering the complexity and the variability in the phenotypic presentation of SCD. The patient was then given supportive therapy consisting of blood transfusion and symptomatic treatment, as well as consideration to administer hydroxyurea if the patient’s clinical condition worsens.