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Patricia Wulandari
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Sriwijaya Journal of Internal Medicine
Published by Phlox Institute: Indonesian Medical Research Organization
ISSN : 29883237     EISSN : 29883237     DOI : https://doi.org/10.59345/sjim
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Nursing
Focus Sriwijaya Journal of Internal Medicine (SJIM) focused on the development of medical sciences especially internal medicine for human well-being. Scope Sriwijaya Journal of Internal Medicine (SJIM) publishes articles which encompass all aspects of basic research/clinical studies related to the field of internal medicine and allied science fields, especially all type of original articles, case reports, review articles, narrative review, meta-analysis, systematic review, mini-reviews and book review.
Arjuna Subject : Kedokteran - Kedokteran Internal
Articles 44 Documents
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Efficacy and Safety of Endoscopic Anti-Reflux Therapy versus Sham or Proton Pump Inhibitor Control in Gastro-oesophageal Reflux Disease: A Meta-Analysis of Randomised Controlled Trials Tiffano Taufan Firdaus; Vesri Yoga
Sriwijaya Journal of Internal Medicine Vol. 4 No. 2 (2026): Sriwijaya Journal of Internal Medicine
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjim.v4i2.296

Abstract

Background: Gastro-oesophageal reflux disease (GERD) is among the most prevalent chronic disorders, and lifelong proton pump inhibitor (PPI) dependence is common. Endoscopic anti-reflux therapies are minimally invasive alternatives between medical and surgical management, but individual device trials are small and the randomised evidence has largely been synthesised device by device. Objective: To pool the randomised evidence across all endoscopic anti-reflux modalities against a common control and provide a single, class-level estimate of benefit in adults with GERD. Methods: Four databases were searched for randomised controlled trials comparing endoscopic anti-reflux therapy (radiofrequency, suturing/plication, injection/implant, transoral incisionless fundoplication) with a sham procedure and/or continued PPI in adults with GERD. Risk ratios (RR) for treatment success were pooled with a DerSimonian–Laird random-effects model; heterogeneity was quantified with I² and a prediction interval; bias was appraised with Cochrane RoB 2.0. Results: Twelve trials were eligible; seven were pooled (536 participants; follow-up 3–6 months). Endoscopic anti-reflux therapy approximately doubled treatment success versus sham or PPI control (pooled RR 1.89, 95% CI 1.51–2.37; p<0.001; I² 23.6%; prediction interval 1.17–3.05) — about 28 percentage points absolute, NNT ≈4. The effect persisted across subgroup, low-risk-of-bias, current-device and leave-one-out analyses; a secondary PPI reduction/cessation analysis confirmed benefit (RR 1.82, 95% CI 1.43–2.30; I² 0%). Serious adverse events were infrequent, concentrated among injection/implant devices. Conclusion: In adults with GERD, endoscopic anti-reflux therapy produced a clinically meaningful, robust improvement in short-to-intermediate-term treatment success versus sham or continued PPI, consistently across device classes; durability and device-specific safety require ongoing evaluation.
Monocyte Distribution Width as a Prognostic Biomarker of Mortality in Adult Patients with Sepsis or Severe Infection: A Systematic Review and Meta-Analysis I Gusti Agung Made Risma Ari Pertiwi; I Komang Parwata
Sriwijaya Journal of Internal Medicine Vol. 4 No. 2 (2026): Sriwijaya Journal of Internal Medicine
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjim.v4i2.310

Abstract

Background: Monocyte distribution width (MDW) is reported automatically with a routine complete blood count. Its diagnostic accuracy for sepsis has been meta-analysed repeatedly, but no synthesis has asked whether it predicts death once sepsis is present. Objective: To determine whether admission MDW predicts all-cause mortality in hospitalised adults with sepsis or severe infection. Methods: Three databases were searched for cohorts of hospitalised adults with sepsis or severe infection reporting admission MDW against all-cause mortality. The standardised mean difference (Hedges' g) was derived through three tiers (group means, mortality-AUC conversion, and 2 × 2 tables) and pooled with a DerSimonian–Laird random-effects model; risk of bias used the QUIPS tool. Results: Twelve cohorts from eight countries were included (2,289 patients; 475 non-survivors). MDW was higher in non-survivors (pooled Hedges' g = 0.60, 95% CI 0.39 to 0.80; p < 0.001; I² = 50.8%), robust across all twelve leave-one-out models (0.56 to 0.64). Elevated MDW carried roughly five-fold higher odds of death (OR 4.68; k = 9), but discrimination was modest (pooled AUC 0.676; k = 8). The pooled OR fell from a crude 3.99 to 2.68 after severity adjustment. No small-study effects were detected (Egger p = 0.846); certainty was low. Conclusion: Admission MDW was consistently higher in adults with sepsis or severe infection who died. The association was moderate, not confined to COVID-19 and survived severity adjustment, but discrimination was insufficient for individual prognostication and no threshold is recommended; MDW is best regarded as an adjunct to established severity scores.
Relapsing Superwarfarin Coagulopathy in an Unrecognised Early Pregnancy: An Eight-Month Vitamin K₁ Course Ending in Second-Trimester Pregnancy Loss Arya Baruna Purwa Sunu; Ni Made Renny Anggreni Rena
Sriwijaya Journal of Internal Medicine Vol. 4 No. 2 (2026): Sriwijaya Journal of Internal Medicine
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjim.v4i2.311

Abstract

Background: Superwarfarins are anticoagulant rodenticides whose hepatic sequestration and enterohepatic recirculation produce a vitamin K–dependent coagulopathy lasting months. Exposure during pregnancy is rarely reported. Objective: To describe relapsing superwarfarin coagulopathy in a woman whose pregnancy was unrecognised at exposure, and to define the endpoint of antidotal therapy. Case presentation: An 18-year-old woman presented with two weeks of spontaneous ecchymoses, gum bleeding and haematuria. Haemoglobin was 6.0 g/dL with normal platelets and hepatic and renal function; prothrombin time (PT; >90 s) and international normalised ratio (INR; >6) exceeded the analytical ceiling and activated partial thromboplastin time (APTT) was 133.4 s. She later disclosed ingesting a rodenticide three days before onset. After 28 days of plasma, red cells and intramuscular vitamin K₁ she was discharged (INR 5.32) but relapsed 20 days later (haemoglobin 9.4→4.0 g/dL). Ultrasonography for suspected intraperitoneal bleeding instead disclosed an unsuspected live intrauterine pregnancy of 11 weeks, conceived around the time of ingestion. Despite parenteral vitamin K₁ the INR rebounded to 21.6 on day 10 before responding to high-dose infusion. Oral vitamin K₁ was titrated across 16 visits and withdrawn after eight months; the pregnancy was lost as an incomplete abortion at 18 weeks. Conclusion: Superwarfarin poisoning should be considered in any unexplained vitamin K–dependent coagulopathy; treatment must target the hepatic toxicant reservoir rather than symptom resolution, and maternal biochemical rescue does not guarantee fetal survival.
Simultaneous Lymphatic and Alveolar Leak: High-Output Non-Traumatic Chylothorax with Bilateral Fluidopneumothorax and Pneumomediastinum in a 27-Year-Old Woman Treated by Thoracoscopic Duct Ligation and Mechanical Pleurodesis Tjokorda Istri Anom Saturti; I Gusti Agung Dwi Putri Anjani; Gede Vivekananda Rusdi; I G Mahapraja Divasta; I Wayan Tegar Raharja Ariawan
Sriwijaya Journal of Internal Medicine Vol. 4 No. 2 (2026): Sriwijaya Journal of Internal Medicine
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjim.v4i2.315

Abstract

Background: Chylothorax accounts for a small minority of pleural effusions, and the non-traumatic form is rarer still, usually indolent and usually low output. The simultaneous occurrence of high-output chylothorax and a spontaneous air-leak syndrome in an immunocompetent young adult has not been described. Objective: To report such a case, to quantify the metabolic and immunological cost of the leak, and to argue that a single mechanical trigger can breach the alveolar and the lymphatic conduits together. Case presentation: A 27-year-old woman with no trauma, thoracic surgery or malignancy developed progressive dyspnoea and recurrent massive pleural effusion requiring three thoracenteses, approximately 5,000 mL in 11 days. Tube thoracostomy then drained about 2,500 mL of serosanguineous, milky-pink fluid on the first day. Pleural fluid triglycerides were 1,774 mg/dL with cholesterol 130 mg/dL, a ratio of 13.6, lymphocyte predominance and a positive Rivalta test. Computed tomography showed bilateral fluidopneumothorax, pneumomediastinum, extensive subcutaneous emphysema and bilateral pneumonia, although lung sliding had been preserved bilaterally on admission ultrasonography. Lymphopenia of 0.63 ×109/L, albumin of 2.20 g/dL, rising haemoglobin and deterioration to pH 7.33 with PaO2 52 mmHg accompanied a daily loss of approximately 44 g of triglyceride. Thoracoscopic duct ligation with mechanical pleurodesis reduced drainage to 180–250 mL/day and the patient was discharged on day 28. Conclusion: High output does not imply trauma, and a non-traumatic cause does not imply an indolent course. Failure of conservative treatment is better defined by the metabolic and immunological ledger than by drainage volume alone.

Page 5 of 5 | Total Record : 44

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