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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,
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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Korelasi Skor Get with The Guidelines-Heart Failure dan Rasio Platelet Limfosit pada Pasien Rawat Inap dengan Gagal Jantung Panjaitan, Samuel Hendryk; Dalimunthe, Naomi Niari; Supriatmo, Supriatmo; Pradana, Andika
Jurnal Penyakit Dalam Indonesia
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Introduction. The Get with the Guidelines-Heart Failure (GWTG-HF) risk score is a widely utilized and validated tool for assessing prognosis in patients with heart failure. Inflammation significantly contributes to the pathophysiology of heart failure, evidenced by platelet activation and a reduction in lymphocyte counts. Consequently, the platelet-to-lymphocyte ratio (PLR) may function as a prognostic biomarker in this population. This study aims to investigate the correlation between the GWTG-HF risk score and PLR as an inflammatory marker in patients hospitalized with heart failure. Methods. This cross-sectional study utilized medical records of heart failure patients admitted to Adam Malik Hospital in Medan from January 2022 to July 2023. Total GWTG-HF scores and PLR values were recorded at the time of patient admission. Correlation analyses were conducted to assess the relationship between the two variables. Results. The study evaluated 106 patient records, with male patients comprising 72.64% and a mean age of 55.84 (SD 14.09) years. The median GWTG-HF score was 37.5, while the median PLR was 137.14. Correlation analysis yielded a coefficient of r = 0.249 (p < 0.05), indicating a statistically significant association.Conclusion. A weak positive correlation exists between the GWTG-HF score and PLR in patients with heart failure, suggesting that PLR may serve as a supplementary inflammatory marker in prognostic assessments.
Sarkopenia sebagai Faktor Risiko Varises Esofagus Risiko Tinggi berdasarkan Stratifikasi Child-Pugh Pasien Sirosis Hati Sepmeitutu, Iwandheny; Kurniawan, Juferdy; Maulahela, Hasan; Rinaldi, Ikhwan; Shatri, Hamzah; Pramana, Triyanta Yuli; Makmun, Dadang; Lesmana, Cosmas Rinaldi A; Hidayat, Rudy; Laksmi, Purwita Wijaya; Sunardi, Diana
Jurnal Penyakit Dalam Indonesia
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Background The high prevalence of sarcopenia in chronic liver disease negatively impacts the quality of life and increases the risk of various complications of cirrhosis, one of which is the development of esophageal varices. The aim of this study was to determine the prevalence of sarcopenia in cirrhosis patients based on the severity of liver cirrhosis and to explore the association of sarcopenia with high-risk esophageal varices stratified by Child-Pugh. Methods This observational cross-sectional study involved patients with liver cirrhosis at Cipto Mangunkusumo Hospital between January and September 2023. Sarcopenia was defined as a reduction in muscle mass accompanied by decreased grip strength or walking speed, according to the AWGS 2019 criteria (Asian Working Group for Sarcopenia). Multivariate logistic regression analysis was conducted to evaluate the association between sarcopenia and high-risk esophageal varices. Results A total of 155 patients with liver cirrhosis were included in this study. The majority of liver cirrhosis patients were males, with hepatitis B being the most commonly found etiology. The prevalence of sarcopenia was found in 40.0% of Child-Pugh A patients, 53.8% of Child-Pugh B patients, and 50.0% of Child-Pugh C patients with a p-value of 0.411. The high-risk of esophageal varices was found more frequently in Child-Pugh B (53.8%) and Child-Pugh C (50.0%) compared to Child-Pugh A (25.6%) with a p-value of 0.013. Bivariate analysis showed that the presence of sarcopenia in liver cirrhosis patients has a statistically significant association with an increased risk of high-risk esophageal varices, especially in the Child-Pugh B and C subgroups of liver cirrhosis patients (OR = 7.50 (95% CI: 1.48 – 37.91, p<0.030)). However, no association was found between sarcopenia and high-risk esophageal varices in the Child-Pugh A subgroup (OR = 1.46 (95% CI: 0.65 – 3.29, p<0.477)). Conclusion Sarcopenia significantly increases the risk of high-risk esophageal varices in liver cirrhosis, especially in those with Child-Pugh B and C classification.
Nilai Diagnostik Italian Score untuk Memprediksi Infeksi Bakteri Extended Spectrum Beta-Lactamase (ESBL) pada Pasien Sepsis di RSUP Dr. M. Djamil Padang Fadrian, Fadrian; Ahmad, Armen; Khairat, Khairat
Jurnal Penyakit Dalam Indonesia
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Introduction. Infections caused by Extended-Spectrum Beta-Lactamase (ESBL) bacteria, especially in septic patients, require adequate management. Giving definitive antibiotics according to culture results takes a long time. Therefore, a clinical scoring system is needed to predict ESBL bacterial infection, one of which is the Italian score. Methods. This research used a cross-sectional design and was conducted in the inpatient room of RSUP Dr. M. Djamil Padang for 6 months. The samples in this study were septic patients who underwent culture examination at RSUP Dr. M. Djamil Padang who met the research inclusion and exclusion criteria. Sampling was carried out using consecutive sampling, and the total sample obtained was 34 samples. Selected samples will have an Italian score calculated, and specimens will be taken for clinical culture examination. Data analysis and processing will involve 2x2 tables and ROC curves. Results. Among a total of 34 participants with an equal distribution of male and female subjects (50% each), the average age was 59 years (standard deviation [SD] 14.15). Microbiological culture results revealed that 26 subjects (76.47%) were identified as positive for ESBL, while 8 subjects (23.53%) were classified as non-ESBL. Based on the Italian score, 22 patients were found to be ESBL-positive, and 12 were non-ESBL. The diagnostic performance of the Italian score yielded a sensitivity of 80.77%, specificity of 87.5%, positive predictive value (PPV) of 95.45%, and negative predictive value (NPV) of 58.33%. The accuracy of the Italian score in predicting ESBL bacterial infections among septic patients at RSUP Dr. M. Djamil Padang was demonstrated by an area under the curve (AUC) of 0.820 (95% confidence interval [CI] 0.75-1.00; p=0.002). Conclusion. The Italian score demonstrated significant performance as a tool in predicting the risk of ESBL bacterial infection.
Peran Pemeriksaan Penanda Tumor Cairan Pleura dalam Diagnosis Efusi Pleura Maligna Akibat Kanker Paru Primer Rumende, Cleopas M; Sutandyo, Noorwati; Hanafi, Arif R; Rumende, Samuel K; Susanto, Erwin C; Sitorus, Truely P
Jurnal Penyakit Dalam Indonesia
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Introduction. Pleural effusion is a frequently acquired lung disorder and based on the type of cause it is divided into malignant and non-malignant pleural effusion. Cytological examination of pleural fluid to differentiate between malignant and non-malignant pleural effusion shows varying sensitivity. Research regarding the benefits of CEA and Cyfra 21-1 pleural fluid examination to detect malignant pleural effusion due to primary lung cancer in Indonesia is still very limited. The aims of this study is to determine the sensitivity and specificity of CEA and Cyfra 21-1 pleural fluid in diagnosing malignant pleural effusion due to primary lung camcer. Methods. A cross-sectional diagnostic study was conducted on patients with exudative pleural effusion at Dr. Cipto Mangunkusumo National Hospital (RSCM) and Darmais Cancer Hospital between September 2015 and May 2016. Patients underwent examinations for carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (Cyfra 21-1) in their pleural fluid. The ROC curves were generated to determine the optimal cut-off values for CEA and Cyfra 21-1 concentrations in pleural effusion, considering the area under the curve (AUC) obtained. Chi-square tests were performed to assess sensitivity and specificity, as well as to calculate positive predictive value, negative predictive value, and accuracy for each cut-off value for both CEA and Cyfra 21-1. Results. A total of 122 patients with exudative pleural effusion, positive cytology results were obtained in 80 patients. By using the CEA cut-off value of 4.23 ng/ml, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 87.50%, 80.95%, 89.74%, 77.27% and 85.25% with an AUC value of 0.878 (0.814 - 0.942). By using the Cyfra 21-1 cut-off value of 26.9 ng/ml, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 78.75%, 71.43%, 84.00%, 63.82% and 76.23% with an AUC value of 0.817 (0.739 - 0.896). Conclusion. Examination of CEA and Cyfra 21-1 level in pleural fluid can be used to support the diagnose of malignant pleural effusion due to primary lung cancer.
Kesintasan Pasien Karsinoma Hepatoselular: Sebuah Studi Komprehensif tentang Pengaruh Awitan Dini versus Lambat dan Faktor Determinannya Achmad, Ibrahim; Jasirwan, Chyntia Olivia Maurine; Rajabto, Wulyo; Abdullah, Murdani; Nababan, Saut Horas H.; Nasution, Sally Aman; Koesnoe, Sukamto; Sari, Nina Kemala
Jurnal Penyakit Dalam Indonesia
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Introduction. The prognosis for patients with Hepatocellular Carcinoma (HCC) is generally poor because most cases are diagnosed at an advanced stage. Several studies indicate that HCC is more prevalent and has a worse prognosis among younger individuals. This study aims to identify and compare the variations in survival rates between early and late-onset HCC patients at Cipto Mangunkusumo Hospital and investigate the factors that impact survival outcomes in both groups. Methods. Retrospective cohort study of HCC patients registered in HCC registry 2015-2022. Survival was visualized using Kaplan-Meier curves. Prognostic factor variables in the Cox Proportional Hazard Regression analysis by backward method in the final model became independent prognostic factors for overall survival. Results. There were 896 subjects. Patients with early onset had a median survival of 2.0 months (95% CI 1.0-2.9), while late-onset patients had a median survival of 4.0 months (95% CI 3.4-4.5) (p=0.021). During the observation period, the incidence of death in early onset was found to be higher compared to late onset (92.9% vs. 87.7%, p 0.032). In the multivariate analysis for early onset, hypertension comorbidity and lack of hepatitis treatment were prognostic factors increasing the risk of death with [HR 3.7 (95% CI: 1.0-12.7)] and [HR 2.4 (95% CI: 0.9-6.2)] (p=0.053). In the multivariate analysis for late onset, prognostic factors increasing the risk of death include AFP levels ≥200 ng/mL [HR 1.2 (95% CI: 1.0-1.5)], liver cirrhosis [HR 1.2 (95% CI: 1.0-1.3)], AJCC stage 4 as the most advanced stage [HR 4.5 (95% CI: 2.2-8.9)], supportive therapy [HR 5.2 (95% CI: 3.9-6.8)], and palliative therapy [HR 1.6 [95% CI: 1.2-2.2)]. Conclusion. The median survival of early-onset HCC patients is lower compared to late-onset ones because the majority are not given curative treatment. Independent prognostic factors in early-onset are hypertension and hepatitis treatment, while in late-onset AFP levels, liver cirrhosis, AJCC stage, and therapy are given.
Potassium-Competitive Acid Blocker sebagai Alternatif Penghambat Pompa Proton untuk Mengatasi Gejala Gastroesophageal Reflux Disease: Sebuah Laporan Kasus Berbasis Bukti Prabata, Adam; Prahasary, Adelia Nova; Govinda, Arya
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Gastric acid suppression is one of the main pillars of gastroesophageal reflux disease (GERD) treatment. Proton pump inhibitor (PPI) is the most used drug for suppressing gastric acid in GERD patients currently. Potassium- acid competitive acid blocker (PCAB) is a new class of drug which can be used as an alternative drug for suppressing gastric acid, so hypothetically, this drug could be an alternative of PPI for relieving GERD symptoms. However, the ability of PCAB for relieving GERD symptoms was not established, so this study was aimed to elucidate the ability of PCAB as an alternative drug of PPI for relieving GERD symptoms. Comprehensive literature searching was conducted in several databases such as PubMed, Embase, Cochrane, EBSCO, and Proquest with keywords “GERD”, “PCAB”, “PPI” dan “symptoms” on September 16-20, 2023. Early literature searching comprised 229 articles then selected based on clinical question and eligibility criteria to get 3 articles to be appraised critically. Vonoprazan, one of PCAB, was using as the main therapy in all of selected studies. Two randomized control trial (RCT) studies showed the non-inferiority of vonoprazan compared to PPI for relieving GERD symptoms. On the other hand, one systematic review and meta-analysis study showed that vonoprazan was superior than PPI for relieving GERD symptoms. This evidence-based case report (EBCR) shows that vonoprazan is non-inferior, even superior, compared to PPI for relieving GERD symptoms. Further, extensive, and larger researches is still needed to support this evidence and the using of PCAB as main and routine treatment for GERD patients.
Abses Iliopsoas Akibat Tuberkulosis: Sebuah Laporan Kasus Sari, Desty Gusti; Imanuela, Rosatya; Resultanti, Resultanti
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Psoas abscess is a rare condition with an unclear clinical presentation where there is a collection of pus in the iliopsoas compartment. The most common cause of an iliopsoas abscess is infection with Staphylococcus aureus. Mycobacterium tuberculosis rarely causes psoas abscesses, with an incidence of about 10–30% of extrapulmonary tuberculosis and only 3% of tuberculosis in general. Psoas abscesses due to tuberculosis is quite rare and has non-specific symptoms, so it sometimes causes a late diagnosis. This case study reports on male aged 43-year-old patient who had previously been diagnosed with spondylitis tuberculosis (TBC) and complained of pain accompanied by swelling in both legs and scrotum. A diagnostic examination was performed. Computed tomography (CT) scan abdomen contrast found an abscess on the iliopsoas, so the patient was treated with anti-TBC drugs and percutaneous drainage for abscess evacuation. Clinical and laboratory improvements were obtained after the therapeutic action was carried out.
Ventilasi Noninvasif pada Obstructive Sleep Apnea dan Obesity Hypoventilation Syndrome Herikurniawan, Herikurniawan; Audrey, Joanna; Adelya, Firina
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Chronic respiratory disease such as obstructive sleep apnea (OSA) and obesity-hypoventilation syndrome (OHS) remain are respiratory sleeping disorder that gradually affect quality of life. Comprehensive treatment such as the use of non-invasive ventilation (NIV) is a method adopted to improve the patient’s quality of life. The correct choice of NIV mode, mask and titration methods will provide optimal therapeutic effects to the patient. This article review lays out an update on the use of non-invasive ventilation as the treatment of OSA and OHS.
Penggunaan Antibiotik Empiris yang Rasional pada Era Infeksi oleh Organisme Multi Drug Resistant Sinto, Robert
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Resistensi antimikroba (antimicrobial resistance, AMR), secara khusus antibiotik, telah menjadi masalah dunia saat ini. Masalah resistensi antibiotik terjadi pada seluruh jenis antibiotik yang ada, dan terjadi di seluruh negara, termasuk Indonesia. Dalam skala global, Perserikatan Bangsa-Bangsa mengeluarkan World Health Assembly Resolution WHA 68.7 dengan judul Global Action Plan on Antimicrobial Resistance sebagai wujud perhatian yang mendalam terhadap masalah global ini.
Hubungan Abnormalitas Ekokardiografi terhadap Mortalitas Pasien Terkonfirmasi COVID-19 Derajat Berat dan Kritis di RSUPN Dr. Cipto Mangunkusumo Santoso, Fidiaji Hiltono; Alwi, Idrus; Nasution, Sally A.; Rumende, Cleopas Martin
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Introduction. The mortality rate of COVID-19 patients in Indonesia is high with manifestations of cardiac complications. Echocardiographic evaluation can help identify cardiac functional and structural disorders associated with patient mortality. Therefore, this study aims to determine the relationship between echocardiographic abnormalities and mortality in severe and critical COVID-19 patients. Methods. A retrospective cohort study was conducted using medical record data of severe and critical COVID-19 patients at Dr. Cipto Mangunkusumo Hospital Jakarta during March 2020 to April 2021. Subjects were selected using total sampling. Descriptive analysis was performed, presenting descriptive tables, and bivariate analysis was conducted using the chi-square test. Results. Of the total 83 patients, 30 (36.1%) were classified as severe and 53 (63.9%) as critical. Most of the subjects were male, with 21 (70%) in the severe group and 33 (62.2%) in the critical group, with a median age of 55.5 (23-95) years for the severe group and 59 (23-83) years for the critical group. A total of 48 patients (57.8%) in this study died. The most common functional abnormality found on echocardiography was mPAP in 51 or 68%, and the most structural disturbance was left ventricular concentric remodelling in 48 or 58%. The chi-square analysis results of echocardiographic variables namely TAPSE with RR = 7.292, Right Ventricular Systolic Pressure (RVSP) 10.208, mean Pulmonary Artery Pressure (mPAP) 1.440, Pulmonary Acceleration Time (PAT) 2.357, and Right Atrial Pressure (RAP) 3.403 had a significant relationship with mortality. Meanwhile, LVEF, E/e’ and CO have no significant relationship. Based on the multivariate analysis, variables independently associated with mortality were RVSP and RAP. Conclusion. Echocardiographic abnormalities associated with mortality in severe and critical COVID-19 patients were TAPSE, RVSP, mPAP, PAT and RAP estimation.

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