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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 432 Documents
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Manfaat Latihan Kekuatan Otot terhadap Kadar HbA1c pada Orang Dewasa dengan Prediabetes: Laporan Kasus Berbasis Bukti Simanjuntak, Owen Paruhum; Lubis, Anna Mira
Jurnal Penyakit Dalam Indonesia
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Prediabetes is a metabolic condition of impaired glucose homeostasis which results in elevated blood glucose levels. Besides the higher risk of developing diabetes, prediabetes is associated with increased risk of cancer, dementia, heart failures, and coronary artery disease. The common first line treatment regimen given to this group are healthy diet and aerobic exercise. However, some conditions might prevent patients from doing aerobic exercises therefore there is a need for alternatives. This evidence-based case report aims to evaluate the benefit of resistance training on HbA1c levels compared to control group (no exercise) in prediabetic adults. Literature search was conducted across several databases (PubMed, Cochrane, Scopus, and Wiley). Included articles are then critically appraised with the Oxford Center for Evidence-Based Medicine (CEBM) tool. Levels of evidence for each included study are assessed with the Oxford CEBM 2011 levels of evidence table.  Out of 658 studies screened, 15 studies were selected and 2 were included. A systematic review and meta-analysis found that resistance training with low-to-moderate load resulted in a significant reduction of HbA1c compared to the control group. A randomized controlled trial (RCT) also found significant reduction in HbA1c levels after 12 and 24 months of resistance training, compared to the control group. However, study found that resistance training with high load does not significantly reduce HbA1c levels. Current evidence supports the regimen of low-to-moderate resistance training (performed three times per week for 50-60 minutes per session at an intensity of 50-75% of one-repetition maximum) to lower HbA1c levels in adult prediabetic populations.
Koeksistensi Spondiloartritis Perifer dan Fokal Segmental Glomerulosklerosis: Sebuah Laporan Kasus Jarang Zulaifah, Zakiya; Hapsari, Florentina Carolin Puspita; Muzellina, Virly Nanda
Jurnal Penyakit Dalam Indonesia Vol. 13, No. 1
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Spondyloarthritis is a group of inflammatory rheumatic diseases characterized by shared clinical features, genetic predispositions, and pathogenic mechanisms. Without appropriate management, it carries a risk of various complications. We report the case of a young male patient with a one-year history of nephrotic syndrome prior to admission, presenting with chronic polyarthritis. Initially, systemic lupus erythematosus (SLE) with renal and musculoskeletal involvement was suspected, although SLE is relatively uncommon in young males. However, based on the clinical presentation of arthritis, imaging findings of sacroiliitis, and the absence of diagnostic criteria supporting SLE, the patient was subsequently diagnosed with peripheral spondyloarthritis and nephrotic syndrome secondary to focal segmental glomerulosclerosis (FSGS). Patients with spondyloarthritis have approximately a twofold increased risk of renal complications compared with the general population, with IgA nephropathy being the most common abnormality. Although rare, cases of spondyloarthritis occurring in patients with FSGS have been reported. The relationship between these two conditions remains unclear—whether causal or coincidental—and warrants further investigation. A careful diagnostic approach is essential in patients with chronic polyarthritis, particularly when differential diagnoses do not align with demographic characteristics or clinical presentation. This is crucial to improve diagnostic accuracy, guide appropriate therapy, enable earlier prevention of disease progression, and reduce the risk of complications.
Campak dan Vaksinasi Campak pada Orang Dewasa Sinto, Robert; Koesnoe, Sukamto; Nelwan, Erni Juwita; Widhani, Alvina; Shakinah, Sharifah; Pasaribu, Adeline; Duindrahajeng, Bernadine Gracia; Suwarto, Suhendro; Nainggolan, Leonard; Chen, Lie Khie; Susilo, Adityo; Maria, Suzy; Hasibuan, Anshari Saifuddin; Wicaksana, Bramantya
Jurnal Penyakit Dalam Indonesia Vol. 13, No. 1
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Measles is a highly contagious viral infection that remains a significant global health problem despite the availability of an effective vaccine. Measles re-emergence is driven by gaps in immunization coverage, waning post-vaccination immunity, and increased population mobility. In adults, measles infection is associated with greater disease severity compared to children. This literature review was conducted by reviewing recent scientific publications addressing the epidemiology, pathogenesis, clinical manifestations, diagnosis, management, complications, and prevention of measles, with a focus on the adult population.  Measles is caused by an RNA virus of the Paramyxoviridae family and is transmitted through respiratory droplets and aerosols. Typical clinical features include fever, cough, coryza, conjunctivitis, and a maculopapular rash with a centrifugal and cephalocaudal distribution. Diagnosis is based on clinical findings and confirmed by laboratory tests such as RT-PCR and measles-specific IgM serology. Measles infection causes significant immunosuppression, including immune amnesia, which increases susceptibility to secondary infections. Management is primarily supportive and vitamin A supplementation has been shown to reduce mortality in certain populations. In adults, complications tend to be more severe, particularly pneumonia as the leading cause of morbidity and mortality, as well as neurological complications such as encephalitis and subacute sclerosing panencephalitis (SSPE). Measles vaccination with the MMR vaccine remains the main prevention strategy. However, its implementation faces challenges, including gaps in immunization coverage, vaccine hesitancy, and limited adult immunization record system. Measles in adults remains a significant health concern with a high risk of severe complication. Strengthening immunization program, improving public education, and developing integrated surveillance system are essential to reduce disease incidence and burden.
Variabel dan Model Prediktor Perdarahan Varises Esofagus Berulang pada Pasien Sirosis Hati di RSUPN Dr. Cipto Mangunkusumo Sari, Ifani Media; Kurniawan, Juferdy; Kalista, Kemal Fariz; Rizka, Aulia; Ginanjar, Eka; Nasution, Sally Aman; Nainggolan, Leonard, MD. Internal medicine, Tropic-Infection spesialist; Koesnoe, Sukamto
Jurnal Penyakit Dalam Indonesia
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Introduction. Liver cirrhosis is a chronic condition associated with severe complications, including esophageal variceal bleeding, which carries high morbidity and mortality rates. Approximately 60% of patients with cirrhosis experience recurrent bleeding within one year, with a mortality rate of 20–60% within six weeks after the initial bleeding episode. Therefore, identifying predictors of recurrent bleeding is essential for improving preventive strategies. This study aimed to identify predictors of recurrent esophageal variceal bleeding in patients with liver cirrhosis and to develop a predictive model. Methods. This retrospective study included 220 patients with liver cirrhosis and a history of esophageal variceal bleeding based on medical record data. The variables analyzed included age, platelet count, red color sign, spontaneous bacterial peritonitis, splenomegaly, number of endoscopic variceal ligation (EVL) bands, portal hypertensive gastropathy, and Child–Pugh score. Statistical analyses were performed to identify independent predictors and to develop a prediction model. Results. Recurrent esophageal variceal bleeding occurred in 33.6% of patients. Patients with recurrent bleeding were more likely to be male, younger, have hepatitis B as the underlying etiology, a Child–Pugh score ≥7, a platelet count <150,000/µL, and ≥3 EVL bands placed during treatment. Bivariate analysis demonstrated that a Child–Pugh score ≥7, platelet count <150,000/µL, ≥3 EVL bands, the presence of a red color sign, and splenomegaly were significantly associated with recurrent esophageal variceal bleeding in patients with liver cirrhosis. The final prediction model consisted of three variables: Child–Pugh score, platelet count, and number of EVL bands, with a maximum total score of 4 points. The model demonstrated good predictive performance, with an area under the receiver operating characteristic curve (AUC) of 0.81. Conclusions. The predictors of recurrent esophageal variceal bleeding in patients with liver cirrhosis were Child–Pugh score, platelet count, and the number of EVL bands. The resulting prediction model demonstrated good statistical performance and may be useful for risk stratification in clinical practice.
Kontinuitas Terapi Lupus: Kesenjangan antara Evidence-Based Medicine dan Real-World Practice Araminta, Abirianty P.
Jurnal Penyakit Dalam Indonesia
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Hubungan Penggantian Imunosupresan Tidak Terencana dengan Aktivitas Penyakit Lupus Eritematosus Sistemik: Studi Kohort Retrospektif di RSUPN Dr. Cipto Mangunkusumo, Jakarta Amanda, Rosvitha; Koesnoe, Sukamto; Widhani, Alvina; Rinaldi, Ikhwan; Susilo, Adityo; Kurniawan, Juferdy; Putranto, Rudi; Karim, Birry
Jurnal Penyakit Dalam Indonesia
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Introduction. Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease with diverse clinical manifestations. Treatment stabilization is crucial for optimal disease control, but the consistency of immunosuppressive therapy may be affected by non-ideal conditions, including drug unavailability or adverse effects. This study aimed to assess the association between unplanned immunosuppressant switching and increased disease activity in SLE patients. Methods. A retrospective cohort study of SLE patients meeting the inclusion criteria, whose disease activity was evaluated using the MEX-SLEDAI score during immunosuppressant substitution. Participants were grouped into an exposed group undergoing unplanned immunosuppressant switching due to drug unavailability and a comparison group continuing maintenance therapy without switching. Disease activity was assessed using the MEX-SLEDAI score during follow-up. Results. A total of 213 SLE patients were included; 45 patients (21.1%) experienced increased disease activity. Unplanned immunosuppressant substitution was significantly associated with increased disease activity (RR 2.06; 95% CI 1.18–3.60; p=0.011), and remained significant after adjustment for confounders (aRR 1.82; 95% CI 1.05–3.15; p=0.034). Subgroup analysis showed most flares occurred within the first three months after substitution, and mycophenolate-containing replacement regimens were associated with a lower risk of increased disease activity (p=0.025). Conclusions. Unplanned immunosuppressant substitution is associated with increased disease activity in SLE patients. Close monitoring following switching is essential to maintain disease stability.
Efektivitas Penambahan Suplementasi Vitamin C Terhadap Penurunan Malondialdehid dan Perbaikan Derajat Aktivitas Penyakit Lupus Eritematosus Sistemik: Uji Klinis Acak Tersamar Ganda Yuniza, Yuniza; Kurniati, Nova; Theodorus, Theodorus; Salim, Eddy M; Hartanto, Kristian S
Jurnal Penyakit Dalam Indonesia
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Introduction. Vitamin C is an antioxidant that exerts its effects at multiple cellular levels. However, evidence regarding its effects in systemic lupus erythematosus (SLE) remain inconclusive. This study aimed to evaluate the potential of vitamin as an adjunctive antioxidant therapy in patients with SLE by assessing its effects on serum malondialdehyde (MDA) levels and disease activity using the Mexical Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) score. Methods. This pilot double-blind, randomized controlled trial was conducted at Dr. Mohammad Hoesin General Hospital, Palembang. Participants were patients with mild-to-moderate SLE diagnosed according to the 2019 European Alliance of Association for Rheumatology/American College of Rheumatology (EULAR/ACR) classification criteria and assessed using the MEX-SLEDAI score. Subjects were randomly assigned to receive either vitamin C (500 mg twice dailiy for 2 months) or placebo in addition to standard SLE therapy. Serum MDA levels and MEX-SLEDAI scores were measured at baseline and after the intervention. Results. A total of 34 subjects were enrolled in the study. The mean baseline serum MDA concentration was 1.38 (SD 0.31) μmol/L. After 2 months of treatment, the vitamin C group demonstrated a significant reduction in serum MDA levels [1.38 (SD 0.38) μmol/L vs. 1.09 (SD 0.26) μmol/L; p = 0.003] and MEX-SLEDAI scores [median 2 (2–5) vs. 1 (0–2); p = 0.001]. In the placebo group, only the MEX-SLEDAI score decreased significantly [3 (2–7) vs. 2 (0–6); p = 0.016], whereas serum MDA levels showed no significant change [1.37 (SD 0.25) μmol/L vs. 1.32 (SD 0.38) μmol/L; p = 0.518]. Between-group comparisons revealed that both the reduction in MDA (p = 0.047) and MEX-SLEDAI (p=0.048) were significantly greater in the vitamin C group compared to placebo group. Conclusions. Vitamin C supplementation at dose of 500 mg twice daily as an adjuct to standard therapy could reduce disease activity and serum MDA levels in patients with mild-to-moderate SLE.
Profil Biomarker Apolipoprotein B dan Lipid terhadap Skor SYNTAX pada Pasien Sindrom Koroner Kronik Chalik, Muhammad Novran; Sukandi, Erwin; Indrajaya, Taufik; Usnizar, Ferry; Indra, Syamsu; Saleh, Imran; Chodilawati, Rukiah; Irfannuddin, Irfannuddin
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Introduction. Apolipoproteins are structural components of plasma lipoproteins that are involved in lipoprotein metabolism and lipid transport, reflecting the number of circulating atherogenic particles. The degree of coronary artery stenosis can be assessed by calculating the Synergy between PCI with TAXUS/paclitaxel-eluting stent and Cardiac Surgery (SYNTAX) score, which is an angiographic scoring system used to evaluate the complexity of coronary artery lesions. This study aimed to investigate the profile of apolipoprotein B and lipids, as well as their correlation with the SYNTAX score in patients with chronic coronary syndrome. Methods. An observational analytic study with a cross-sectional design was conducted from July to September 2024 in the cardiac catheterization laboratory of the Department of Internal Medicine, Mohammad Hoesin General Hospital, Palembang. A total of 69 samples were obtained using consecutive sampling. Samples that met the inclusion and exclusion criteria were analyzed using SPSS version 22. Data were presented in tables and figures. Data analysis was performed using correlation tests with a significance level of p < 0.05. This study received ethical approval from the Ethics Committee of Dr. Mohammad Hoesin General Hospital, Palembang. Results. Among the 34 analyzed subjects, the mean total cholesterol, LDL cholesterol, and apolipoprotein B levels were 175.88 (SD 36.01) mg/dL, 123.59 (SD 35.54) mg/dL, and 141.41 (SD 25.06) mg/dL, respectively. HDL cholesterol and triglyceride levels were not normally distributed and were therefore expressed as medians (range): 42 (29–80) mg/dL and 89 (40–289) mg/dL, respectively. The mean SYNTAX score was 24.09 (SD 2.69). Overall, 20.59% of subjects had a SYNTAX score Conclusions. Patients with chronic coronary syndrome demonstrated elevated apolipoprotein B levels and high SYNTAX scores. Higher apolipoprotein B levels were independently and positively associated with the SYNTAX score. Further studies are needed to investigate additional factors influencing apolipoprotein B levels, lipid profiles, and the SYNTAX score.
Gagal Jantung Kanan pada Hipertiroid Tidak Terkontrol: Laporan Kasus Lazuardy, Kevin; Nainggolan, Leonard; Tedyanto, Nadim Marchian
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Right heart failure is a clinical syndrome that is influenced by various factors. The incidence of heart failure reaches 5/1,000 population, while the prevalence of heart failure reaches 1-2% of the adult population. Management of the main etiology of heart failure is the main therapy. In some cases, hyperthyroidism is an indirect cause of heart failure, especially in right heart failure. Hyperthyroidism can cause reversible pulmonary hypertension which causes right heart failure, although the underlying mechanism is uncertain at the moment. This study reports a 46-year-old woman who was diagnosed with right heart failure and also had hyperthyroidism. In this case, hyperthyroidism was not detected because there were no typical symptoms in the patient. The patient was given furosemide intravenous, propylthiouracil, and bisoprolol. After clinical improvement, the patient went home with right heart failure in uncontrolled hyperthyroidism as a final diagnosis.
Miopati Atrium, Fibrilasi Atrium, dan Stroke: Mengungkap Hubungan Tersembunyi Yamin, Muhammad; Azizi, Mohamad Syahrir; Putri, Anneira Amanda
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Atrial fibrillation (AF) is the most common arrhythmia and has been long recognized as a cause for atrial thrombus formation leading to cardioembolic stroke. However, recent studies reveal that the relationship between atrial fibrillation and stroke is an association rather than a temporal relationship. Left atrial thrombus formation is associated with vascular risk factor, atrial remodeling, and thrombogenesis. Various atrial electrical and structural markers of atrial myopathy have been linked to ischaemic stroke, even in the absence of AF. In addition to the CHA2DS2-VASc score as a consideration for anticoagulant administration, accurate atrial myopathy markers are needed to allow early identification of patients at risk for cardioembolic stroke. This article describes the current concept of atrial myopathy, including its pathophysiology, diagnostic approach, and stroke prevention.

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