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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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Faktor-Faktor yang Berhubungan dengan Gejala Depresi pada Pasien Insomnia Usia Lanjut di Rawat Jalan Pratiwi, Amalia Nur; Wahyudi, Edy Rizal; Kusumaningrum, Profitasari; Shatri, Hamzah; Rinaldi, Ikhwan; Gani, Rino Alvani; Wijaya, Ika Prasetya; Susilo, Adityo; Renaldi, Kaka
Jurnal Penyakit Dalam Indonesia
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Introduction. The elderly population is increasing globally, including in Indonesia, where 10.7% of the population in 2020 were elderly. Insomnia is a common health issue among older adults and has been identified as a predictor of depression. This study aims to identify factors associated with depressive symptoms in elderly outpatients with insomnia. Methods. This cross-sectional study was conducted in 2024 on patients aged ≥60 years at the outpatient unit of Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia, using consecutive sampling to select participants. Elderly patients were screened using the Pittsburgh sleep quality index (PSQI), and those with a score >5 (indicating insomnia) were included as study subjects. Data were collected through interviews, covering sociodemographic characteristics, level of loneliness, duration of insomnia, depressive symptoms [Geriatric Depression Scale–15 (GDS-15) items], functional status [Barthel Activities of Daily Living (B-ADL)], cognitive status [Mini-Mental State Examination (MMSE)], nutritional status [Mini Nutritional Assessment (MNA)], and chronic diseases [Cumulative Illness Rating Scale for Geriatrics (CIRSG) score]. Results. The study included 209 elderly subjects with insomnia, with a mean age of 72.88 (SD 6.98) years, and a depression prevalence of 6.7%. Bivariate analysis showed significant associations between dependency (PR 5.24; 95% CI 1.50 – 18.29), malnutrition (PR 11.54; 95% CI 4.77 – 27.92), and chronic disease with a CIRSG score ≥9 (PR 4.15; 95% CI 1.18 – 14.50) and depressive symptoms in elderly patients with insomnia. No significant associations were found between sociodemographic factors, loneliness, duration of insomnia, or cognitive status and depression. Multivariate logistic regression analysis revealed a statistically significant association between malnutrition and depressive symptoms (p < 0.001). Conclusions. There is a significant association between malnutrition and depressive symptoms in elderly outpatients with insomnia. Further cohort studies are recommended to explore the causal relationship between malnutrition and depression in elderly patients with insomnia.
Pengaruh Heart Rate Variability terhadap Kesintasan Pasien dengan Kanker: Laporan Kasus Berbasis Bukti Kosasih, Kartika Anastasia; Raniah, Nida; Putranto, Rudi; Rajabto, Wulyo; Shatri, Hamzah; Faisal, Edward; Poespitasari, Vinandya Irvianita
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Depression, anxiety, and poor outcomes in cancer are possibly mediated by autonomic dysfunction. Autonomic disfunction found in cancer patients can cause increase in sympathetic tone and decrease in cardiac muscle vagal tone. Heart rate variability (HRV) is a non-invasive index for measuring vagal response and a potential stress response in autonomic dysfunction. In patients with cancer, high vagal tone measured by HRV is significantly correlated with increased overall survival. This evidence-based case report aims to investigate the role of HRV as a prognostic factor in cancer patients. Literature search was done by two authors on five databases: Pubmed, Cochrane Library, EMBASE, ProQuest dan MEDLINE (EbscoHost) in accordance with clinical question. Articles were selected using inclusion and exclusion criteria, then critical review was performed. Quality of the studies was evaluated using the Center of Evidence-Based Medicine, University of Oxford guideline. Two systematic review and four cohort study was included. Increased HRV index is consistently correlated with increased overall survival (OS) in cancer patients. One meta-analysis study found that OS is significantly longer in group with higher HRV (Hazard ratio, HR = 0.70, IK95% 0.60 – 0.82, p < 0.001, I2 = 27%). In conclusion, HRV can be used as a prognostic factor in advanced stage cancer patients. Increased HRV is associated with better OS.
Hubungan Faktor Psikologis dengan Atrium Fibrilasi: Suatu Tinjauan Kepustakaan Murni, Arina Widya; Fadella, Annesa
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Psychological factors influence the onset of cardiac rhythm and dysrhythmia disorders, including atrial fibrillation (AF), which is defined as uncoordinated atrial activation resulting in ineffective contractions. Psychological factors have a bidirectional relationship with AF, as AF symptoms can lead to a decline in mental health, which in turn negatively affects the clinical course. One explanation for how psychological stress impacts the heart and contributes to AF involves the autonomic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. Anxiety and depression are common comorbidities in AF. These conditions can be assessed using standardized instruments, such as the Hospital Anxiety and Depression Scale (HADS), which includes subscales for anxiety (HADS-A) and depression (HADS-D). Additionally, the Beck Depression Inventory (BDI) can be used to assess depression, while the State-Trait Anxiety Inventory (STAI) is useful for evaluating anxiety. Management of psychosomatic disorders requires a bio-psycho-socio-spiritual approach, involving both non-pharmacological and pharmacological therapies. Key components include somatic or symptomatic therapy, psychotherapy or sociotherapy, and psychopharmacotherapy, with the choice of method depending on various factors. In AF patients, treatment of psychological stress, anxiety, and depression generally prioritizes non-pharmacological approaches, such as supportive psychotherapy. If necessary, short-term use of benzodiazepines as anti-anxiety medication can be considered. In cases requiring antidepressants, newer agents such as selective serotonin reuptake inhibitors (SSRIs) are preferred, with close monitoring of heart rhythm due to the potential arrhythmogenic effects of certain medications, especially non-selective antidepressants.
Kerentanan dan Kanker pada Usia Lanjut: Sebuah Tantangan Cahyanur, Rahmat
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Penggunaan Continous Glucose Monitoring pada Pasien DM Tipe 2 dengan Insulin Dosis Tinggi Hardigaloeh, Amanda Trixie; Tahapary, Dicky; Yunir, Em; Juli Edi Tarigan, Tri
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Type 2 diabetes mellitus (T2DM) is a chronic disease with a high risk of complications, requiring optimal glycemic control. This case report aims to describe the use of continuous glucose monitoring (CGM) in the evaluation of a patient with T2DM and obesity whose glycemic levels remained uncontrolled despite high-dose insulin therapy. A 58-year-old woman with an 18-year history of T2DM presented to the Endocrinology Clinic of Cipto Mangunkusumo Hospital with uncontrolled blood glucose accompanied by classic diabetic symptoms. CGM revealed that the majority of glucose levels were within the time above range (TAR) at 83% without hypoglycemia, while the time in range (TIR) was only 17%. Contributing factors included a high-carbohydrate diet, limited physical activity, and technical difficulties with insulin injection. Interventions consisted of dietary re-education, gradual physical activity, optimization of injection technique, and insulin dose adjustment. CGM provided a comprehensive glycemic profile and helped identify non-pharmacological factors hindering glycemic control. This case highlights the role of CGM as an essential tool for individualized therapy in patients with T2DM requiring high-dose insulin.
Faktor-Faktor yang Berhubungan dengan Kualitas Hidup Pasien Geriatri yang Menjalani Hemodialisis Mohammad, Nurhidayat; Soejono, Czeresna Heriawan; Lydia, Aida; Rinaldi, Ikhwan; Syafiq, Muhammad; Wardoyo, Elizabeth Yasmine
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Introduction. The decline in quality of life among geriatric patients undergoing hemodialysis has a negative impact on treatment adherence, physical functioning, dietary patterns, and mortality. This study was conducted to assess the quality of life of geriatric hemodialysis patients and its association with comorbidities, functional status, frailty, sarcopenia, nutritional status, depression, hemoglobin levels, hemodialysis vintage, vascular access, and hemodialysis adequacy. Methods. This study employed a cross-sectional design with primary data collection. Consecutive sampling was used to recruit participants. The study was conducted at the hemodialysis units of Cipto Mangunkusumo National General Hospital (RSCM), Persahabatan National General Hospital (RSP), and Fatmawati National General Hospital (RSF) from June 2024 to August 2024. The inclusion criteria were patients aged ≥60 years undergoing maintenance hemodialysis. Exclusion criteria were unstable clinical condition, cognitive or mental impairment, and refusal to participate. Quality of life was assessed using the EQ-5D-5L instrument. Data on medical history and laboratory findings were obtained from hospital medical records. Bivariate analysis was performed using the Mann–Whitney U test for comorbidities, sarcopenia, depression, hemoglobin level, vascular access, and dialysis adequacy; the Kruskal–Wallis test for frailty, functional status, and nutritional status; and Spearman’s correlation for hemodialysis vintage. Multivariate analysis was conducted using linear regression to identify factors associated with reduced quality of life. Results. A total of 124 subjects (mean age 67 years) were included in this study. The mean EQ-5D-5L index score was 0.76 (IQR 0.63–1.00), while the mean VAS score was 70. The majority of subjects (75%) reported no difficulties in self-care or daily activities. Functional status (p < 0.0001) and depression (p < 0.002) were significantly associated with the quality of life in geriatric patients undergoing hemodialysis, with an adjusted R² value of 0.642. Conclusions. Geriatric patients undergoing HD at RSCM, RSP, and RSF had an average EQ-5D-5L index score of 0.76 (out of 1.000), and 75% of the patients reported no issues with self-care and daily activities. Functional status and depression have been proven to play a significant role in determining their quality of life.
Rekam Medis Elektronik Berbasis Artificial Intelligence: Sudahkan Saatnya Digunakan? Koesnoe, Sukamto
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Korelasi Kadar Serum VEGF-A dengan Rasio Albumin-Kreatinin Urin pada Pasien Penyakit Ginjal Diabetik Syaiful, Hannie Q; Priyono, Drajad; Harun, Harnavi; Murni, Arina W; Hanif, Akmal M; Faheri, Eifel; Arnelis, Arnelis; Yoga, Vesri
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Introduction. Diabetic kidney disease (DKD) is a major microvascular complication of diabetes mellitus, characterized by persistent albuminuria and a progressive decline in glomerular filtration rate (GFR), making it a leading cause of chronic kidney disease (CKD) and end-stage renal disease. Vascular endothelial growth factor-A (VEGF-A) is implicated in the pathogenesis of DKD, being overexpressed in the kidneys and contributing to increased vascular permeability, inflammation, and fibrosis. Albuminuria, an early indicator of renal damage in DKD, is a strong predictor of CKD progression and cardiovascular events. The urine albumin-to-creatinine ratio (UACR) is the recommended test for detecting and monitoring albuminuria. This study aimed to investigate the correlation between serum VEGF-A levels and UACR in patients with DKD. Methods. This cross-sectional analytical observational study involving DKD patients at the Outpatient Clinic of Dr. M. Djamil General Hospital Padang from May to October 2024. Demographic and clinical data were collected. Blood samples were taken for serum VEGF-A measurement using ELISA, and morning spot urine samples were collected for UACR measurement using immunoturbidimetry. Correlation analysis was performed using the Spearman test. Ethical approval was obtained from the Health Research Ethics Committee of Dr. M. Djamil General Hospital Padang. Results. A total of 30 PGD patients were included in the study. The mean age was 61.9 years (SD 9.75), and 53.3% of the participants were male.The mean serum VEGF-A level in DKD patients was 131.34 (SD 83.9) pg/ml, and the mean UACR was 403.90 (SD 53.1) mg/g creatinine. There was a very strong positive correlation between serum VEGF-A levels and UACR (r = 0.993, p < 0.05). Conclusions. Serum VEGF-A levels are very strongly and positively correlated with UACR in DKD patients. Serum VEGF-A may serve as a potential marker for assessing DKD progression and risk of complications, as well as a potential therapeutic target.
Kadar Transthyretin Plasma pada Lanjut Usia Sarkopenia dan Non-Sarkopenia Fahrurozi, R. Ifan A.; Martini, Rose D; Mulyana, Roza; Murni, Arina W; Decroli, Eva; Miro, Saptino; Viotra, Deka; Yoga, Vesri
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Introduction. Sarcopenia is a geriatric syndrome marked by an age-related decline in muscle mass, which is affected by protein intake. Transthyretin is a visceral protein used to evaluate nutritional status and acts as a positive regulator of muscle mass. This study aimed to assess the difference in plasma transthyretin levels between elderly groups with and without sarcopenia. Methods. This was an analytical observational study with a cross-sectional approach. Subjects were elderly patients who visited the Internal Medicine Polyclinic of Dr. M. Djamil Hospital Padang and met the inclusion and exclusion criteria from August to September 2024. Subjects were classified into sarcopenic and non-sarcopenic groups, followed by an examination of plasma transthyretin levels. Sarcopenia was diagnosed using bio-impedance analysis (BIA) measurement, handgrip strength with a Jamar hydraulic hand dynamometer, and physical performance with a walking speed test. Plasma transthyretin levels were measured using the enzyme-linked immunosorbent assay (ELISA) method. Comparative analysis was performed using the unpaired T-test using SPSS 29.0. Results. Among total of 46 subjects who participated in this study, the majority of elderly individuals with sarcopenia were predominantly female. The mean plasma transthyretin level in the sarcopenic elderly group was 10.9 (3.3) mg/dL, while in the non-sarcopenic elderly group was 20.3 (2.5) mg/dL. Comparative analysis demonstrated a significant difference in plasma transthyretin levels between sarcopenic and non-sarcopenic elderly individuals (p < 0.001). Plasma transthyretin levels in the sarcopenic elderly group were lower compared to the non-sarcopenic elderly group. Conclusion. There is a significant difference in plasma transthyretin levels between sarcopenic and non-sarcopenic elderly individuals.
Faktor Prediktif Post Dialysis Fatigue Sedang pada Pasien yang Menjalani Hemodialisis Reguler Amu, Ivan Virnanda; Marbun, Maruhum Bonar H; Nugroho, Pringgodigdo; Rinaldi, Ikhwan; Shatri, Hamzah; Mardiana, Nunuk; Hidayat, Rudy; Susalit, Endang; Yunihastuti, Evy; Purnamasari, Dyah; Wardoyo, Elizabeth Y
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Introduction. Fatigue is often found in patients with CKD-HD. Fatigue serves as an indicator of mortality and may be a viable target in a treatment strategy. Current research has not established the determinants of moderate PDF in individuals with CKD who are undergoing HD. Therefore, this study was conducted to prove the predictor factors of moderate PDF. Methods. A retrospective cohort study in CKD-HD patients at Fatmawati Central General Hospital during the period of November-December 2024. The independent variables of this study are comorbidities, MIS, depression, intradialytic SBPV, dialysis vintage, UFG, IDWG, and anemia status. Primary data from the PDF Scale, MIS, and BDI II questionnaire were collected through patient interviews during the eighth hemodialysis session. Demographic and clinical information of the patients was obtained from medical records. Intradialytic SBPV was determined by the ARV. All variables were examined using the chi-square test, except for the depression variable, which failed to fulfil the requirements and was assessed using the Fisher exact test. A logistic regression analysis was performed to identify the most significant association among the predictor variables of moderate PDF. Results. A total of 135 research subjects were included in the study. Based on the results of the bivariate analysis, MIS, depression, and the type of dialysis were significantly linked to moderate post dialysis fatigue (p < 0.05). From the results of the multivariate analysis, inflammatory malnutrition (RR 1.580; 95% CI 1.017–2.455; p = 0.042), dialysis vintage (RR 1.850; 95% CI 1.208–2.834; p = 0.005), and depression (RR 2.165; 95% CI 1.542–3.039; p < 0.001) were obtained. The logistic regression model shows a significant relationship between moderate PDF and severe malnutrition inflammation score, mild to moderate depression, and dialysis vintage exceeding 12 months. Conclusion. Our findings underscore a significant association between depression, dialysis vintage, and malnutrition inflammation score (MIS) with moderate PDF in CKD-HD patients.

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