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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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Peran Prediktif IL-6, IL-10, dan TNF-α Plasma terhadap Gagal Ginjal Akut pada Pasien dengan COVID-19 Derajat Sedang dan Berat Gathmyr, Dewi; Bonar, Maruhum Bonar H; Susilo, Adityo; Harimurti, Kuntjoro; Nainggolan, Ginova; Tagor, Alvin; Shatri, Hamzah; Lesmana, Cosmas Rinaldi Adithya; Amin, Zulkifli
Jurnal Penyakit Dalam Indonesia
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Introduction. Acute kidney injury (AKI) is associated with higher mortality rate in COVID-19 patients due to inflammation and immune dysregulation. This study aimed to correlate serum levels of IL-6, IL-10, and TNF-α with serum creatinine changes and their roles to predict incidence of acute kidney injury (AKI) in patients with moderate and severe COVID-19. Methods. This prospective cohort study was conducted among patients with moderate to severe COVID-19 in Pertamina Central Hospital Jakarta, Indonesia during November 2020 to January 2021. All serum levels of cytokines (IL-6, IL-10, and TNF-α) and creatinine were collected on the first day and seventh day of hospitalization. They might be collected earlier if the patients died or discharged early. AKI was defined as deterioration in serum creatinine or urine output based on Kidney Disease Improving Global Outcomes (KDIGO) guideline. The correlation between cytokine and creatinine serum level changes were analyzed using Spearman test. Receiver operator characteristic curve was calculated to explore predictive roles of cytokines on AKI incidence. Results. A total of 43 patients were included in the study, with a mean age of 59.3 years (SD 12.59), and the majority were male (74%). The incidence of AKI was 7%. Serum creatinine changes were correlated with serum levels changes IL-10 (r= -0.343; p=0.024), but not for IL-6 (r=-0.198; p=0.202) and TNF-α (r=-0.129, p=0.409). Meanwhile, serum TNF-α level on the first day was able to predict AKI incidence on the seventh day of hospitalization (AUC 85%; p=0.045; 95% CI=0.737 to 0.963). Conclusions. TNF-α on the first day is potential to be predictor on AKI incidence on the seventh day in moderate and severe COVID-19 patients.
Korelasi Stenosis Penyakit Arteri Perifer di Bawah Lutut dengan Kecepatan Hantar Saraf pada Penyandang Neuropati Perifer Diabetes Melitus Tipe 2 Antono, Akbarbudhi; Antono, Dono; Karim, Birry; Hakim, Manfaluthy; Harimurti, Kuntjoro; Sulistianingsih, Dyah Purnamasari; Ginanjar, Eka; Nelwan, Erni Juwita; Nugroho, Pringgodigdo
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Introduction. One consequence of DM is the emergence of peripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN). Diabetic peripheral neuropathy is a complication of diabetes that presents signs and symptoms of motor and sensory disturbances, while PAD is an atherosclerosis condition that gradually develops in the arterial vessels. This study aimed to determine correlation of arterial obstruction assessed using arteriography and the nerve impairment assessed using nerve conduction velocity (NCV) in DM patients with PAD and DPN. Methods. This is a cross-sectional study that takes secondary data from previous research conducted from July 2018 to June 2021 in Cipto Mangunkusumo hospital. Subjects were people with DM type 2 who had NPD and PAP who met the inclusion criteria and did not meet the exclusion criteria. Subjects underwent an arteriography examination to assess the stenosis in the peroneal artery, anterior tibial artery, and posterior tibial artery. Subjects also underwent nerve conduction velocity (NCV) examinations in the peroneal N. communis, N. peroneal superficialis, N. tibialis, and N. suralis. The correlation between the two variables was then tested using the Spearman correlation test. Results. The peroneal artery stenosis had a moderate negative correlation (r = - 0.420) with the sensory NCV of the superficial peroneal nerve which was statistically significant (p = 0.023). Meanwhile, the correlation of stenosis and NCV disorders in the peroneal nerve with the common peroneal nerve, anterior tibial nerve with tibialis nerve and posterior tibial nerve with sural nerve was not statistically significant. This can be explained by the possibility of collaterals appearing in people with PAD, the structure of vasculature on the nerves, and the small number of samples. Conclusions. There is a moderate negative correlation between the stenosis of the peroneal nerve and the sensory NCV of the peroneal superficialis. However, insignificant results were found in the correlation between peroneal artery with common peroneal nerve, anterior tibialis artery with tibial nerve, and posterior tibial artery with sural nerve.
Laporan Kasus Hipokalemi Periodik Paralisis pada Pasien dengan Graves’ Disease Sirait, Anggi Cahaya Millenia S; Buharman, Borries Foresto; Putri, Adinda Zhafira Dyanti; Putri, Derby Ayudhia Utami Iskandar
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Hypokalemia periodic paralysis (HPP) characterized by episodes of flaccid weakness or paralysis that may be associated with abnormalities of the serum potassium level. HPP often associated with hyperthyroidism and Graves’ disease. HPP prevalence is 1 in 100.000. Each individual has different clinical manifestations, so it’s necessary to adjust therapy based on the etiology. This case report was developed to provide more information regarding Graves’ disease, considering lack of information about management and description of HPP with Graves’ disease. A 27-year-old male with sudden weakness in both legs radiating to upper extremity, shortness of breath, palpitations, and sweating. Over the last 2 months, the patient’s weight has dropped drastically even though his appetite was increased. There were no complaints of nausea, vomiting, or increased frequency of defecation and urination. Previously, the patient had the similar experiences and received potassium transfusion twice. The patients revealed tachycardia, diffuse thyroid gland, fine hand tremor, superior motor streght 222/222 and inferior 111/111, hypokalemia (1.40 mmol/L), T4 total 197.80 nmol/L, and fluorescence T4 >320 m/U/mL. Graves’ disease that has become thyrotoxicosis can be accompanied by a picture of HPP or also called thyrotoxicosis periodic paralysis (TPP). Hypokalemia in TPP are not caused by potassium loss but due to intracellular potassium movement, so there’s a high possibility to hyperkalemia rebound. Treatment of TTP due to Grave’s disease is to prevent potassium transfer by administering beta blocker, potassium replacement, and treating hyperthyroidism.
Pemberian Asupan Kalori Terestriksi vs. Asupan Kalori Standar yang Berlanjut pada Pasien Penyakit Kritis dengan Refeeding Syndrome: Laporan Kasus Berbasis Bukti Hapsari, Sukma; Pribadi, Rabbinu Rangga
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Refeeding syndrome is a different clinical symptom and metabolic disorder that occur during the reintroduction of nutrition in chronically malnourished patients. Calorie restriction can increase survival and reduce mortality rates. This evidence-based case report was developed to examine the influence of caloric restriction on mortality, morbidity, and duration of critical illness. A literature search was performed using PubMed, EBSCOHost, ScienceDirect, and Cochrane with the keywords: “critically ill,” “restricted caloric intake,” “standard caloric intake,” “mortality,” “morbidity,” and “duration”. Articles were appraised using the University of Oxford Centre for Evidence-Based Medicine (CEBM) tools. Two studies met the inclusion criteria. The first was a randomized controlled trial, which demonstrated that protocolized caloric restriction significantly improved 60-day survival in ICU patients with refeeding syndrome (91% vs. 78%, p = 0.002), although no significant difference was observed in days alive following ICU discharge (44.8 vs. 39.9 days, p = 0.19). The second was a meta-analysis, which suggested a trend toward reduced hospital mortality with hypocaloric feeding; however, risk ratios varied widely (0.23–5.54), and 30-day mortality differences were not statistically significant (RR: 0.79–3.00). In conclusion, while caloric restriction may not significantly impact overall mortality in chronically ill patients, it appears to improve 60- to 90-day survival in critically ill ICU patients with refeeding syndrome. One study noted a reduced risk of respiratory infection, though evidence on other complications remains inconclusive. A regimen of 20 kcal/hour for at least two days may be suitable for managing refeeding syndrome. Overall, caloric restriction may offer modest clinical benefits in this specific population.
Tata Laksana Fraktur Panggul pada Geriatri: Sudut Pandang Internis Jannah, Laila M; Dwimartutie, Noto
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Hip fracture are a common issue in geriatric patients, associated with increased risk of morbidity and mortality. The complex and multimorbid characteristics of geriatric patients presents significant challenge in their management. Optimal outcomes require a comprehensive interdisciplinary approach to care, aiming to restore functional status and reduce postoperative complications. A holistic strategy, grounded in thorough Comprehensive Geriatric Assessment (CGA), is essential to guide individualized treatment and ensure effective, patient-centered management.
Faktor Risiko yang Berhubungan dengan Kematian Pasien Penyakit Ginjal Kronis pada Usia Dewasa yang Menjalani Hemodialisis Reguler di Provinsi Lampung Latupeirissa, Joue Abraham Trixie; Sudaryo, Mondastri Korib; Hadiaturahman, Muhamad Zulfikar; Sinaga, Steven Sapta Putra
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Introduction. Although mortality among adult chronic kidney disease (CKD) patients on regular hemodialysis remains infrequent within the first three months, it is still a potential outcome. Given that hemodialysis is required for life, identifying risk factors for mortality is critical. This study aims to examine risk factors associated with mortality in adult CKD patients undergoing regular hemodialysis. Methods. A case-control study, without matching, was conducted using medical record data from adult CKD patients (≥18 years) receiving regular hemodialysis between 2022 and 2024 at three hospitals (types A, B, and C) in Lampung Province. The case group consisted of patients who experienced mortality, while the control group consisted of similar patients who survived. Patients with autoimmune-related CKD were excluded. Subjects were selected using convenience sampling with a 1:2 case-to-control ratio. Risk factors assessed included sociodemographics, dialysis duration, comorbidities, and nutritional status. Logistic regression analysis was performed. Results. A total of 114 cases and 228 controls were included, with the longest dialysis duration in both groups being 72 months. The oldest patient starting dialysis was 77 years in the case group and 75 years in the control group. Logistic regression analysis revealed that the following factors were associated with increased mortality: history of heart failure (OR = 2.3; 95% CI = 1.2–4.4; p = 0.009), history of post-renal obstruction (OR = 3.5; 95% CI = 1.6–7.6; p = 0.002), random blood glucose ≥140 mg/dL (OR = 2.1; 95% CI = 1.2–3.6; p = 0.011), acute kidney injury (OR = 6.5; 95% CI = 3.8–11.1; p < 0.001), and BMI Conclusion. History of heart failure, post-renal obstruction, elevated blood glucose, acute kidney injury, and low BMI are significant predictors of mortality in adult CKD patients undergoing regular hemodialysis in Lampung Province.
Hubungan Frailty dengan Kesintasan Satu Tahun pada Pasien Lanjut Usia dengan Tumor Padat Ganas Stadium Lanjut Satrio, Trian; Rizka, Aulia; Prasetyawaty, Findy; Widhani, Alvina; Dwimartutie, Noto; Anggoro, RM Suryo; Yulianti, Mira; Antono, Dono
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Introduction. Frailty is characterized by a multisystem physiological decline that increases the risk of morbidity and mortality, especially in patients with advanced-stage solid malignancies. The association between frailty and one-year survival in older adults with solid malignancies in Indonesia has not yet been established. This study aimed to assess the association between frailty status and one-year survival in elderly patients with advanced-stage solid tumors. Methods. This was a retrospective cohort study conducted at Dr. Cipto Mangunkusumo National General Hospital, Jakarta utilizing patient data from a previous study conducted between November 2020 and 2021. Subjects were cancer patients aged >60 years with advanced-stage solid tumors. Frailty was assessed using the FRAIL scale, and one-year survival was determined through medical records and direct follow-up confirmation. Data analysis included bivariate tests, Kaplan-Meier survival analysis, log-rank test, and multivariate Cox regression. Results. A total of 106 elderly patients with advanced solid tumors were analyzed, with a frailty prevalence of 41.5%. A total of 44.3% of patients died within one year. Multivariate analysis showed that frailty was a significant independent predictor of survival. Frail patients had a 2.131 times higher risk of death. Other factors such as nutritional status, polypharmacy, and comorbidities were not significant. Conclusion. Frailty was identified as a significant independent predictor of reduced one-year survival in elderly patients with advanced-stage cancer.
Hubungan Visceral Adiposity Index dengan Neuropati Diabetik Perifer pada Pasien Diabetes Melitus Tipe 2 Sanusi, Muhammad Arif; Lubis, Dian Anindita; Syafril, Santi
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Introduction. Type 2 diabetes mellitus (T2DM) is the leading metabolic disease in Indonesia. Diabetic peripheral neuropathy (DPN), a major complication of T2DM, was associated with insulin resistance and adipose dysfunction. Visceral adiposity index (VAI) is a tool to measure visceral fat as the indicator of adipose dysfunction and insulin sensitivity. The association between VAI and DPN has not been widely researched, especially in Indonesia. This study aims to assess the association between them. Methods. This was a cross-sectional study conducted on adult patients (aged ≥18 years) with T2DM at H. Adam Malik General Hospital, Medan, from December 2024 to March 2025. DPN was assessed using the Michigan Neuropathy Screening Instrument (MNSI), consisting of a questionnaire (MNSI A) and physical examination (MNSI B). VAI was calculated using waist circumference, body mass index (BMI), triglyceride level, and high-density lipoprotein (HDL) cholesterol level. A bivariate analysis was conducted to compare mean VAI values between patients with and without DPN and to assess correlations between VAI and MNSI scores. Results. From a total of 80 subjects, the average age was 56 years (SD 9), and the majority were female (56.3%). The median VAI value in the DPN group was 2.863 (0.401–11.665), slightly higher than in the non-DPN group, which was 2.549 (0.781–17.414), but the difference was not statistically significant (p=0.34). No statistically significant correlation was found between VAI and MNSI A score (r=0.092; p=0.42) or MNSI B score (r=0.12; p=0.31). Conclusion. There was no significant association between VAI and DPN in patients with T2DM.
Hubungan Hiperurisemia dengan Penurunan LFG pada Pasien Penyakit Ginjal Diabetes di RSCM Jakarta Adna, Rury Maharani; Marbun, Maruhum Bonar Hasiholan; Rinaldi, Ikhwan; Yunir, Em; Koesnoe, Sukamto; Singh, Gurmeet; Sinto, Robert
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Introduction. Elevated serum uric acid levels are associated with the progression of kidney disease in patients with type 2 diabetes mellitus (DM), through mechanisms involving endothelial dysfunction, oxidative stress, and chronic inflammation. Research in Indonesia on the relationship between uric acid levels and the decline of glomerular filtration rate (GFR) in diabetic patients remains limited. This study aimed to determine the association between serum uric acid (SUA) levels and decline in glomerular filtration rate among patients with diabetes mellitus diagnosed with diabetic kidney disease at Cipto Mangunkusumo Hospital, Jakarta, over a one-year period. Methods. This retrospective cohort study analyzed medical records of 192 type 2 diabetes melitus patients attending the Endocrinology and or Kidney Hypertension Clinics at Cipto Mangunkusumo National General Hospital , Jakarta. Inclusion criteria were baseline glomerular filtration rate ≥60 mL/min/1.73 m², available baseline serum uric acid, and follow-up glomerular filtration rate after one year. Bivariate and multivariate analyses were performed, adjusting for confounders including age, sex, hypertension, body mass index (BMI), triglycerides, HDL, LDL, total cholesterol, HbA1c, fasting blood glucose, and albuminuria. Results. Hyperuricemia prevalence was 85.94%. Multivariate analysis revealed that elevated SUA levels (≥6 mg/dL in women, ≥7 mg/dL in men) were associated with a 13.5% higher risk of GFR decline compared to normal serum uric acid (RR 1.135; 95% CI 1.015–1.268) after adjustment. Higher Body mass index was protective against glomerular filtration rate decline, while lipid profile, HbA1c, and fasting blood glucose were not significantly associated with diabetic kidney disease progression. Conclusions. Hiperuricemia is an independent risk factor for diabetic kidney disease progression in type 2 diabetes mellitus. Regular monitoring and management of serum uric acid may be crucial in preventing kidney function decline in this population.
Hubungan Aktivitas Fisik dengan Kualitas Hidup Pasien Hemodialisis Reguler Br Manurung, Shofi 'Ainun Azzahra; Nasution, Bayu Rusfandi; Rey, Imelda
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Introduction. Hemodialysis (HD) is one of the renal replacement therapies commonly used in patients with end-stage renal disease. Patients undergoing hemodialysis typically exhibit lower levels of physical activity compared to inactive yet healthy individuals. A decline in physical function and muscular strength may impair the ability to perform daily activities, ultimately affecting patients’ quality of life (QoL). This study aimed to examine the relationship between physical activity and quality of life among hemodialysis patients at Rumah Sakit Khusus Ginjal Rasyida Medan. Methods. This was an analytical observational study with a cross-sectional design involving 50 respondents undergoing hemodialysis therapy at Rumah Sakit Khusus Ginjal Rasyida Medan between July and November 2022. Participants were selected based on predetermined inclusion and exclusion criteria. The association between variables was analyzed using the Chi-square test. Results. Among the respondents, 72.0% were categorized as having a good quality of life, while 28.0% had a poor quality of life. Regarding physical activity levels, 48.0% of patients had moderate activity, 26.0% had high activity, and 26.0% had low activity. Bivariate analysis revealed significant associations between quality of life and physical activity (p = 0.007), as well as between quality of life and comorbidities (p = 0.024). Multivariate analysis indicated that physical activity was a significant predictor of quality of life, with a prevalence ratio (PR) of 4.429 (95% CI: 1.383–14.191). Conclusion. There is a significant association between physical activity and quality of life among hemodialysis patients at Rumah Sakit Khusus Ginjal Rasyida Medan.

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