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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 423 Documents
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Pengaruh Ivabradin terhadap Variabilitas Detak Jantung pada Gagal Jantung dengan Fraksi Ejeksi Rendah Akibat Penyakit Jantung Koroner Kurnia, Handy; Limantoro, Charles; Silitonga, Friska Anggraini Helena; Setiawan, Andreas Arie
Jurnal Penyakit Dalam Indonesia Vol. 12, No. 4
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Introduction. Heart failure is one of the major challenges in global health due to its significant contribution to morbidity and mortality. One of the pathophysiological aspects is autonomic nervous system dysfunction which can be monitored through heart rate variability (HRV) parameters. Ivabradine is a pharmacological agent that potentially improves the balance of sympathetic and parasympathetic tone. This study was designed to evaluate the impact of ivabradine administration on HRV parameters in heart failure with reduced ejection fraction (≤40%) due to coronary heart disease in Indonesian population. Methods. This study used a quasi-experimental research type with a pretest and posttest method without control which was conducted at Dr. Kariadi Hospital from October 2024 to February 2025. Sixteen patients diagnosed with heart failure with reduced ejection fraction due to coronary heart disease underwent intervention in the form of ivabradine administration at a fixed dose of 5 mg twice a day for 30 days. Evaluation of HRV was carried out through 24 hours holter recording before and after therapy. The HRV parameters analyzed included SDNN, SDANN, RMSSD, pNN50, and LF/HF ratio. Data processing was carried out using a paired t-test for normal distribution and the Wilcoxon Signed-Rank test for non-normal data. P value <0.05 was considered statistically significant. Results. A total of 16 subjects participated in this study, consisting of 14 men (87.5%) and 2 women (12.5%), with a mean age of 57 years. There was a significant increase in SDNN of 14.71 (SD 24.15) milliseconds (p = 0.028), SDANN of 56.99 (SD 26.94) milliseconds (p < 0.001), RMSSD of 18.39 (SD 27.05) milliseconds (p = 0.007), and pNN50 of 6.96% (SD 7.87) (p < 0.001), as well as a decrease in the LF/HF ratio of 1.42 (SD 0.85) (p < 0.001) after 30 days of ivabradine therapy. Conclusions. The administration of ivabradine had a significant effect on improving heart rate variability parameters in both the time and frequency domains in patients with heart failure with reduced ejection fraction due to coronary heart disease. These findings indicate enhanced parasympathetic dominance and reduced sympathetic nervous system activity.
Perbandingan Ablasi Radiofrekuensi dengan Transplantasi Hati sebagai Terapi Kuratif pada Karsinoma Hepatoseluler Stadium Awal: Laporan Kasus Berbasis Bukti Gunawan, Mikhael Fabian; Safira, Ranindita Amaida; Singh, Gurmeet; Kalista, Kemal Fariz
Jurnal Penyakit Dalam Indonesia Vol. 12, No. 4
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Hepatocellular carcinoma (HCC) is the most common type of liver cancer and the second leading cause of cancer-related mortality worldwide. Liver transplantation is considered the definitive treatment for HCC; however, in Indonesia, adult liver transplantation is still rarely performed due to donor limitations and high costs. Radiofrequency ablation (RFA) has therefore become a preferred therapeutic option in the management of HCC. This report discuss about the survival and recurrence rates of HCC in patients treated with RFA compared with those undergoing liver transplantation. A literature search was conducted using the PubMed, Cochrane, Embase, and Scopus databases. Selected articles were screened according to the predefined clinical question as well as inclusion and exclusion criteria. Critical appraisal was performed based on the 2011 Oxford Centre for Evidence-Based Medicine framework, assessing validity, importance, and applicability. Critical appraisal was conducted on two selected articles. One study reported comparable survival rates between the two groups. However, overall, both articles demonstrated that liver transplantation was associated with higher survival rates and lower recurrence rates compared with RFA. In conclusion, survival outcomes are superior with liver transplantation compared with RFA. Nevertheless, RFA may be considered in the management of hepatocellular carcinoma as a bridging therapy to liver transplantation or in situations where liver transplantation is not available.
Polisitemia Sekunder pada Pasien Laki-Laki Muda dengan Sindrom Nefrotik Wardhani, Ariani Intan; Nugroho, Pringgodigdo; Rinaldi, Ikhwan; Sarasawati, Meilania; Miranda, Monik Ediana; Harahap, Agnes Stephanie
Jurnal Penyakit Dalam Indonesia Vol. 12, No. 4
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Polycythemia is a condition characterized by an abnormal increase in the total red blood cell mass and is classified into primary and secondary polycythemia. Secondary polycythemia occurs as a physiological response to tissue hypoxia or increased erythropoietin production, without intrinsic abnormalities in erythroid progenitor cells. This condition is rare, particularly when associated with nephrotic syndrome. This report aims to describe a case of secondary polycythemia associated with focal segmental glomerulosclerosis (FSGS). A 20-year-old man presented with generalized edema for five months prior to admission, accompanied by foamy urine. Physical examination revealed peripheral edema and minimal ascites. Laboratory investigations demonstrated massive proteinuria and elevated hemoglobin levels. Renal biopsy confirmed the diagnosis of FSGS, while bone marrow biopsy showed normocellular findings without evidence of malignancy or fibrosis. The patient was treated with methylprednisolone, ramipril, and simvastatin, and underwent four sessions of phlebotomy along with antiplatelet therapy. Following treatment, there was improvement in hemoglobin levels, proteinuria, and blood pressure control. Secondary polycythemia has been reported to be associated with various parenchymal kidney diseases, including FSGS. The proposed mechanisms include increased erythropoietin production due to renal ischemia or dysregulation of erythropoiesis feedback mechanisms. Phlebotomy is an important therapeutic intervention to prevent complications related to hyperviscosity and thromboembolism and has been shown to result in clinical improvement. This case illustrates a rare occurrence of secondary polycythemia in a patient with nephrotic syndrome due to FSGS. Accurate diagnosis and comprehensive management, including phlebotomy, can lead to meaningful clinical improvement. This report is expected to contribute to the literature on the diagnosis and management of secondary polycythemia in kidney disease.
Optimalisasi Rekam Medis Elektronik Berbasis Artificial Intelligence Rinaldi, Ikhwan; Sulistiadi, Wahyu
Jurnal Penyakit Dalam Indonesia Vol. 12, No. 4
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Electronic medical records (EMRs) are essential to modern healthcare systems, yet their implementation continues to face challenges such as disruption of doctor–patient communication, administrative burden, and documentation structures misaligned with clinicians’ clinical reasoning processes. This narrative review aims to assess the limitations of conventional EMRs and examine the potential of artificial intelligence (AI) to improve documentation efficiency, accuracy, and overall clinical performance. The literature indicates that AI technologies, including machine learning, deep learning, and natural language processing, can automate documentation, streamline workflows, enhance decision support, and reduce physician burnout, thereby allowing clinicians to devote more attention to patient care. Nevertheless, the integration of AI into EMRs must address ethical concerns such as algorithmic bias, data privacy, and accountability for AI-assisted decisions. In conclusion, AI-driven EMR optimization has the potential to create a more human-centered, efficient, and data-driven documentation ecosystem when supported by strong regulatory and ethical frameworks.
Faktor Risiko Perdarahan Gastrointestinal pada Pasien dengan Sindrom Koroner Akut: Sebuah Tinjauan Sistematis setyobudi, Assyadilla Kirana; Vidyani, Amie; Sutadji, Jonathan Christianto; Kurniawati, Lady Aqnes; Suhardi, Kevin Fernando
Jurnal Penyakit Dalam Indonesia Vol. 13, No. 1
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Introduction. Gastrointestinal bleeding (GIB) is a serious but potentially preventable condition. Its symptoms include hematemesis, hematochezia, and melena. Risk factors for GIB include medications such as antiplatelets and anticoagulants, which are standard treatments for acute coronary syndrome (ACS). GIB is strongly associated with ACS and represents the most common bleeding complication in these patients. This study aimed to systematically review the factors contributing to GIB in patients with ACS. Methods. Relevant articles were retrieved from PubMed, ScienceDirect, Springer, and EBSCO databases, covering studies on GIB risk factors in ACS patients published between March 31, 2003, and March 31, 2025. The search was conducted using specific keywords and Boolean operators. Data were then extracted and comprehensively evaluated. Results. A total of 17 studies were included, with varied patient populations, including general ACS patients, as well as those specifically diagnosed with acute myocardial infarction (AMI), ST-elevation myocardial infarction (STEMI), or non-ST-elevation myocardial infarction (NSTEMI). The follow-up periods ranged widely, from 15 days to 4 years. Based on the initial evaluation, 23 potential risk factors were identified. GIB was more likely to occur in older individuals, females, and those with a history of smoking and alcohol consumption. Comorbidities, including anemia, diabetes, peptic ulcer disease, cirrhosis, and chronic kidney disease, were also more frequently observed among ACS patients with GIB events. The use of proton pump inhibitors (PPIs) was identified as the only protective factor. Conclusion. This systematic review identified several risk factors associated with GIB in ACS patients. Careful monitoring and appropriate management should be implemented in patients with these risk factors to prevent bleeding events, which may be fatal.
Campak: Refleksi Keberhasilan Program Vaksinasi Nelwan, Erni Juwita
Jurnal Penyakit Dalam Indonesia Vol. 13, No. 1
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Kesintasan Hidup Satu Tahun Pasien Sirosis Hati yang Dirawat di Rumah Sakit Cipto Mangunkusumo pada Periode COVID-19 Aprilicia, Gita; Baihaki, Ichwan; Banjarnahor, Riri Oktavani; Kalista, Kemal Fariz; Gani, Rino Alvani
Jurnal Penyakit Dalam Indonesia Vol. 13, No. 1
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Introduction. Liver cirrhosis represents the terminal stage of chronic liver disease and is characterized by a markedly reduced survival rate. Understanding the characteristics and laboratory parameters of patients with liver cirrhosis can provide valuable insights into their prognosis and potential interventions. This study was conducted during the COVID-19 pandemic period, which may have influenced patient outcomes due to potential impact of COVID-19 infection on patients with chronic liver disease. This study aimed to evaluate the one-year survival rate of hospitalized liver cirrhosis patients at Cipto Mangunkusumo Hospital during the COVID-19 and to identify clinical and laboratory factors associated with patient survival. Methods. This retrospective study analyzed data from 73 in-hospital liver cirrhosis patients during January to December 2020. Demographic characteristics, comorbidities, diagnosis upon admission, and laboratory parameters were collected. Patients were categorized into two groups: those who survived and those who died within one year of hospitalization. Survival analysis was performed using the Kaplan–Meier method to estimate 1 year survival probability of cirrhosis patients. Results. The analysis revealed significant differences in several characteristics and laboratory parameters between the survival and death groups during COVID-19 period. The etiology of liver cirrhosis was predominantly related to HBV (41.1%) and HCV (23.3%), which constituted the most common causes. Diagnosis upon admission showed a significant association with survival, with bleeding esophageal varices (53.4%) being the most prevalent. Laboratory parameters such as SGOT, SGPT, albumin, bilirubin, prothrombin time, INR, and Child Pugh score demonstrated significant differences between the two groups. The 1-year survival rate for the Child Pugh class A, B and C was approximately 100%, 61.2% (CI 95% 42.2 - 80.2%) and 0%, respectively. The overall 1-year survival rate of in-hospital liver cirrhosis patients was 52.6% (CI 95% 38.7 - 66.5%). Conclusions. This study found the overall survival of in-hospital liver cirrhosis patients during COVID-19 period was low. It’s essential to develop a comprehensive and personalized treatment plan for optimal patient outcomes.
Prevalensi COVID-19 Derajat Berat dan Kritis saat Admisi pada Pasien Penyakit Reumatik Autoimun dan Faktor-Faktor yang Berhubungan Destini, Mulia; Ariane, Anna; Yulianti, Mira; Rizka, Aulia; Rinaldi, Ikhwan; Mansjoer, Arif; Maulahela, Hasan; Wafa, Syahidatul
Jurnal Penyakit Dalam Indonesia Vol. 13, No. 1
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Introduction. Patients with autoimmune rheumatic diseases are known to be more vulnerable to severe and critical infections, including COVID-19. Although it is no longer classified as a pandemic, SARS- CoV-2 infection still persists, and several surges of cases have been reported, including in Indonesia. To date, no data are available regarding the prevalence of severe and critical COVID-19 at admission in patients with autoimmune rheumatic diseases in Indonesia and the associated factors. This study aimed to determine the prevalence of severe and critical COVID-19 at admission in patients with autoimmune rheumatic diseases at Dr. Cipto Mangunkusumo National General Hospital, and to identify the associated factors. Methods. This was a cross-sectional study using secondary data from the medical records of patients with autoimmune rheumatic diseases confirmed with COVID-19 and hospitalized at Dr. Cipto Mangunkusumo National General Hospital between July 2020 and August 2024. Analyses were performed up to multivariate logistic regression to evaluate the association between predictor variables and severe and critical COVID-19 at admission. Results. Among 171 subjects, the majority were female (n=158). The median age was 31 years, ranging from 18 to 74 years. The prevalence of severe and critical COVID-19 at admission in patients with autoimmune rheumatic diseases was 41.5%. Routine corticosteroid use (adjusted prevalence ratio (aPR) 2.58; 95% CI 1.40–5.17; p=0.004), the presence of comorbidities (aPR 2.24; 95% CI 1.19–4.59; p=0.018), moderate–high disease activity (aPR 5.12; 95% CI 1.74–21.96; p=0.009), and combination immune-modifying therapy (aPR 1.79; 95% CI 1.06–3.17; p=0.034) were independently associated with severe and critical COVID-19 at admission in the final multivariate analysis. Conclusions. The prevalence of severe and critical COVID-19 at admission in patients with autoimmune rheumatic diseases was 41,5%. The associated factors were routine corticosteroid use, the presence of comorbidities, moderate–high disease activity, and combination immune-modifying therapy.
Waktu Pemulihan Saturasi Oksigen pada Pasien COVID-19 di RSND Semarang: Pengaruh Usia, Derajat Keparahan, dan Komorbiditas Hapsari, Hererapratita Aysha; Purwoko, Yosef; Basyar, Edwin; Ngestiningsih, Dwi
Jurnal Penyakit Dalam Indonesia Vol. 13, No. 1
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Introduction. COVID-19 may cause impaired oxygenation that affects the recovery process, making oxygen saturation an important parameter in clinical monitoring. Age, disease severity, and comorbidities are suspected to influence the duration of oxygen saturation recovery. This study aimed to analyze differences in oxygen saturation recovery time based on age, disease severity, and comorbidity status in hospitalized COVID-19 patients. Methods. This was an observational analytic study with a retrospective cohort design using a survival analysis approach. The study was conducted at Diponegoro National Hospital (RSND) Semarang from October to November 2021 using medical records of hospitalized COVID-19 patients from March 2020 to February 2021. A total of 82 patients were selected using consecutive sampling based on inclusion and exclusion criteria. The variables analyzed included age, disease severity, and comorbidity status, with oxygen saturation recovery time as the outcome. Recovery time was defined as the duration (in days) from hospital admission until oxygen saturation (SpO2) ≥95% was achieved in stable condition. Data were analyzed using Kaplan–Meier, log-rank test, and Cox regression. Results. Bivariate analysis showed significant differences in oxygen saturation recovery time based on age (p < 0.001), severity (p < 0.001), and comorbidity status (p = 0.006). Median recovery time was longer in the elderly, those with severe cases, and those with comorbidities. Multivariate analysis showed that only severity was significantly associated with recovery time (HR = 1.98; 95% CI: 1.12–3.48; p = 0.018). Conclusion. There was a significant association between severity and oxygen saturation recovery time.
Skoring Risiko Mortalitas pada Pneumonia Komunitas Sedang-Berat Kusuma, Ni Nyoman Indirawati; Singh, Gurmeet; Wulani, Vally; Rumende, Cleopas Martin Martin; Fauzar, Fauzar; Kamelia, Telly; Koesnoe, Sukamto; Susilo, Adityo; Shatri, Hamzah
Jurnal Penyakit Dalam Indonesia Vol. 13, No. 1
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Introduction. Community Acquired Pneumonia (CAP) is a lung parenchyma infection acquired outside of the hospital and is significantly associated with morbidity and mortality rates. Identifying patients with moderate-severe CAP at high risk of mortality through a combination of these variables is expected to serve as a basis for prompt and appropriate intervention, ultimately improving clinical outcomes for CAP patients. This study aimed to develop a scoring system using clinical characteristics, radiological findings, and serum biomarkers to assess the mortality risk in patients with moderate-severe CAP. Methods. This study employs a retrospective cohort design with moderate-severe CAP patients treated at Dr. Ciptomangunkusumo Hospital, Jakarta. The sample data were secondary, derived from medical records of patients diagnosed with moderate-severe CAP between January 2022 and December 2023. Predictor variables for mortality risk were obtained through multivariate analysis using Cox regression. Results. The study included 277 subjects, with 124 (44.77%) deaths and 153 (55.23%) survivors. Predictor variables consistently influencing mortality risk in moderate-severe CAP patients were low BMI (HR 1.609, 95% CI 1.047 – 2.472), procalcitonin (HR 1.778, 95% CI 1.200 – 2.634), and lactate levels (HR 1.451, 95% CI 0.994 – 2.119). The prediction model’s performance, based on the ROC curve analysis, showed moderate predictive ability (AUC = 0.641), and calibration performance, as assessed by the Hosmer-Lemeshow test, showed good validation (p = 0.082). Conclusions. There is an association between BMI, procalcitonin, and lactate levels with the mortality risk in moderate-severe CAP patients. A mortality risk scoring model for moderate-to-severe CAP patients has been established.

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