Kidney transplant recipients require the use of immunosuppressive agents to prevent multiple organ rejection. Administration of immunosuppressive agents triggers an increased risk of impaired immunity and microbial infections, one of which is cytomegalovirus (CMV). Prevention of cytomegalovirus infection can be given as a prophylaxis or preemptive therapy. However, the efficacy of choosing prophylaxis or preemptive therapy is still under debate, thus we conducted this study to identify current approach in preventing CMV disease in clinical practice. A literature search was carried out using the PubMed, Cochrane Library, Embase and Scopus databases with the keywords “high risk kidney transplant”, “prophylaxis”, “preemptive” and “CMV infection disease”. Inclusion criteria were only studies in adult kidney transplant patients as a population. , prophylaxis as intervention, preemptive therapy as comparison, and cytomegalovirus infection as outcome. The exclusion criteria of this study were the study articles that were not in Bahasa Indonesia or English, case reports and studies with subjects <18 years old. Critical review using Oxford Center for Evidence Based Medicine (CEBM) Critical Appraisal Tools for Prognostic Study And Systematic Review. The total number of articles identified based on the keywords used is 115 articles. Eliminating duplication with EndNote resulted in 92 articles. Furthermore, exclusion was carried out based on title and abstract so that 29 articles were filtered for which the full text was available. Of these, 23 articles did not have appropriate research questions, 3 studies did not have appropriate patient populations, and 3 articles with types that did not meet the inclusion criteria of this study. As a result, there were 4 articles that can be used in this report. Based on those four articles, it can be concluded that prophylaxis is more effective in preventing CMV disease but had more side effects, when compared to preemptive therapy. However, there was no difference in long term outcome between kidney transplant patients with CMV prophylactic or preemptive therapy.
{"title":"Profilaksis vs. Terapi Preemtif Penyakit Cytomegalovirus (CMV) pada Pasien Transplantasi Ginjal Risiko Tinggi: Suatu Laporan Kasus Berbasis Bukti","authors":"Maruhum Bonar Marbun","doi":"10.7454/jpdi.v10i3.1475","DOIUrl":"https://doi.org/10.7454/jpdi.v10i3.1475","url":null,"abstract":"Kidney transplant recipients require the use of immunosuppressive agents to prevent multiple organ rejection. Administration of immunosuppressive agents triggers an increased risk of impaired immunity and microbial infections, one of which is cytomegalovirus (CMV). Prevention of cytomegalovirus infection can be given as a prophylaxis or preemptive therapy. However, the efficacy of choosing prophylaxis or preemptive therapy is still under debate, thus we conducted this study to identify current approach in preventing CMV disease in clinical practice. A literature search was carried out using the PubMed, Cochrane Library, Embase and Scopus databases with the keywords “high risk kidney transplant”, “prophylaxis”, “preemptive” and “CMV infection disease”. Inclusion criteria were only studies in adult kidney transplant patients as a population. , prophylaxis as intervention, preemptive therapy as comparison, and cytomegalovirus infection as outcome. The exclusion criteria of this study were the study articles that were not in Bahasa Indonesia or English, case reports and studies with subjects <18 years old. Critical review using Oxford Center for Evidence Based Medicine (CEBM) Critical Appraisal Tools for Prognostic Study And Systematic Review. The total number of articles identified based on the keywords used is 115 articles. Eliminating duplication with EndNote resulted in 92 articles. Furthermore, exclusion was carried out based on title and abstract so that 29 articles were filtered for which the full text was available. Of these, 23 articles did not have appropriate research questions, 3 studies did not have appropriate patient populations, and 3 articles with types that did not meet the inclusion criteria of this study. As a result, there were 4 articles that can be used in this report. Based on those four articles, it can be concluded that prophylaxis is more effective in preventing CMV disease but had more side effects, when compared to preemptive therapy. However, there was no difference in long term outcome between kidney transplant patients with CMV prophylactic or preemptive therapy.","PeriodicalId":32700,"journal":{"name":"Jurnal Penyakit Dalam Indonesia","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135039459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Penyakit kardiovaskular masih menjadi penyebab mortalitas dan morbiditas di dunia, diikuti stroke dan penyakit keganasan. Penyakit kardiovaskular telah menyebabkan kematian pada 15,2 juta orang di seluruh dunia pada tahun 2016. Di Indonesia, pada tahun 2016 dilaporkan sebanyak 50.448 kasus rawat inap di rumah sakit akibat penyakit jantung iskemik atau ischemic heart disease (IHD), dengan kelompok usia tertinggi adalah 45–69 tahun. Kondisi tersebut disebabkan semakin meningkatnya prevalensi semua faktor risiko kardiovaskular seperti diabetes, hipertensi, dislipidemia, dan merokok.
{"title":"Faktor-Faktor yang Memengaruhi Kesintasan Pasien yang Dilakukan Intervensi Koroner Perkutan Primer","authors":"Birry Karim","doi":"10.7454/jpdi.v10i3.1492","DOIUrl":"https://doi.org/10.7454/jpdi.v10i3.1492","url":null,"abstract":"Penyakit kardiovaskular masih menjadi penyebab mortalitas dan morbiditas di dunia, diikuti stroke dan penyakit keganasan. Penyakit kardiovaskular telah menyebabkan kematian pada 15,2 juta orang di seluruh dunia pada tahun 2016. Di Indonesia, pada tahun 2016 dilaporkan sebanyak 50.448 kasus rawat inap di rumah sakit akibat penyakit jantung iskemik atau ischemic heart disease (IHD), dengan kelompok usia tertinggi adalah 45–69 tahun. Kondisi tersebut disebabkan semakin meningkatnya prevalensi semua faktor risiko kardiovaskular seperti diabetes, hipertensi, dislipidemia, dan merokok.","PeriodicalId":32700,"journal":{"name":"Jurnal Penyakit Dalam Indonesia","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135039479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
‘Sarcopenia’ involves a progressive age-related loss of muscle mass and associated muscle weakness that renders frail elders susceptible to serious injury from sudden falls and fractures and losing their functional independence. This disease has a complex multifactorial pathogenesis, which involves not only age-related changes in neuromuscular function, muscle protein turnover, and hormone levels and sensitivity, but also a chronic pro-inflammatory state, oxidative stress, and behavioral factors – in particular, nutritional status and degree of physical activity. In the previous definition by the European Working Group on Sarcopenia in Older People (EWGSOP) in 2010, the diagnosis of sarcopenia requires the presence of both low muscle mass and low muscle function. Since the 2010 definition is difficult to be translated to clinical practice, the EWGSOP uses low muscle strength as the primary parameter of sarcopenia in the 2018 definition; sarcopenia is probable when low muscle strength is detected. A sarcopenia diagnosis is confirmed by the presence of low muscle quantity or quality. When low muscle strength, low muscle quantity/quality and low physical performance are all detected, sarcopenia is considered severe. According to the pathophysiological factors involved in the pathogenesis of sarcopenia, different treatment strategies against sarcopenia are resistance exercise training, increase essential amino acids intake, vitamin D supplementation for those with vitamin D deficiency, polyunsaturated fatty acids (PUFAs) supplementation, testosterone supplementation, angiotensin-converting enzyme inhibitor administration.
{"title":"Sarkopenia pada Lanjut Usia: Patogenesis, Diagnosis dan Tata Laksana","authors":"Edwin Nugroho Njoto","doi":"10.7454/jpdi.v10i3.1444","DOIUrl":"https://doi.org/10.7454/jpdi.v10i3.1444","url":null,"abstract":"‘Sarcopenia’ involves a progressive age-related loss of muscle mass and associated muscle weakness that renders frail elders susceptible to serious injury from sudden falls and fractures and losing their functional independence. This disease has a complex multifactorial pathogenesis, which involves not only age-related changes in neuromuscular function, muscle protein turnover, and hormone levels and sensitivity, but also a chronic pro-inflammatory state, oxidative stress, and behavioral factors – in particular, nutritional status and degree of physical activity. In the previous definition by the European Working Group on Sarcopenia in Older People (EWGSOP) in 2010, the diagnosis of sarcopenia requires the presence of both low muscle mass and low muscle function. Since the 2010 definition is difficult to be translated to clinical practice, the EWGSOP uses low muscle strength as the primary parameter of sarcopenia in the 2018 definition; sarcopenia is probable when low muscle strength is detected. A sarcopenia diagnosis is confirmed by the presence of low muscle quantity or quality. When low muscle strength, low muscle quantity/quality and low physical performance are all detected, sarcopenia is considered severe. According to the pathophysiological factors involved in the pathogenesis of sarcopenia, different treatment strategies against sarcopenia are resistance exercise training, increase essential amino acids intake, vitamin D supplementation for those with vitamin D deficiency, polyunsaturated fatty acids (PUFAs) supplementation, testosterone supplementation, angiotensin-converting enzyme inhibitor administration.","PeriodicalId":32700,"journal":{"name":"Jurnal Penyakit Dalam Indonesia","volume":"170 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135039481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. Prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing throughout the world due to sedentary lifestyle and dietary habit, including in patients with chronic hepatitis B (CHB). In several studies, advanced of liver disease were more likely observed among those CHB patients with NAFLD. NAFLD might increase the risk of liver disease progression in CHB patients, but prior investigations were still limited. This study aimed to determine the association between NAFLD and risk of liver fibrosis in CHB patients. Methods. All patients with positive serum hepatitis B surface antigen in the Hepatobilier Data Registry, Cipto Mangunkusumo Hospital, were included in this study. Based on abdominal ultrasonography, patients were divided into two group (group I: non-NAFLD – hepatitis B patients vs. group II: NAFLD – hepatitis B patients). Data demographic and clinical examination were collected. Significant liver fibrosis was defined as stage liver fibrosis above 7 kPa (≥ F2). Logistic regression was used to identify NAFLD as risk factor for significant fibrosis. Variables were expressed as prevalence odd ratio (POR) with 95% CI. P values <0.05 were considered statistically significant. Results. Among 130 hepatitis B patients, 45 patients (34.6%) were diagnosed with NAFLD. Of 45 patients in group II, 36 patients (80%) had significant liver fibrosis. It was observed that a higher percentage of patients in group II were HBeAg negative compared to those in group I (66.7% vs. 35.9%; p=0.038). Furthermore, group II also displayed higher levels of liver stiffness compared to group I (12.22 (8.6 kPa) vs. 8.57 (7.8 kPa); p 0.016). In multivariate analysis, NAFLD was significantly associated with significant liver fibrosis (POR: 5.87; CI95%: 2.48 – 13.86; p < 0.001) after adjusted with HBeAg status. Conclusion. NAFLD associated with the higher risk of liver fibrosis in patients with hepatitis B. Modification of lifestyle and potential therapeutic intervention may help in reducing the progression of liver fibrosis.
{"title":"Perlemakan Hati Non-Alkoholik dan Risiko Fibrosis Hati pada Pasien Hepatitis B Kronik","authors":"Andri Sanityoso Sulaiman","doi":"10.7454/jpdi.v10i3.1456","DOIUrl":"https://doi.org/10.7454/jpdi.v10i3.1456","url":null,"abstract":"Introduction. Prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing throughout the world due to sedentary lifestyle and dietary habit, including in patients with chronic hepatitis B (CHB). In several studies, advanced of liver disease were more likely observed among those CHB patients with NAFLD. NAFLD might increase the risk of liver disease progression in CHB patients, but prior investigations were still limited. This study aimed to determine the association between NAFLD and risk of liver fibrosis in CHB patients. Methods. All patients with positive serum hepatitis B surface antigen in the Hepatobilier Data Registry, Cipto Mangunkusumo Hospital, were included in this study. Based on abdominal ultrasonography, patients were divided into two group (group I: non-NAFLD – hepatitis B patients vs. group II: NAFLD – hepatitis B patients). Data demographic and clinical examination were collected. Significant liver fibrosis was defined as stage liver fibrosis above 7 kPa (≥ F2). Logistic regression was used to identify NAFLD as risk factor for significant fibrosis. Variables were expressed as prevalence odd ratio (POR) with 95% CI. P values <0.05 were considered statistically significant. Results. Among 130 hepatitis B patients, 45 patients (34.6%) were diagnosed with NAFLD. Of 45 patients in group II, 36 patients (80%) had significant liver fibrosis. It was observed that a higher percentage of patients in group II were HBeAg negative compared to those in group I (66.7% vs. 35.9%; p=0.038). Furthermore, group II also displayed higher levels of liver stiffness compared to group I (12.22 (8.6 kPa) vs. 8.57 (7.8 kPa); p 0.016). In multivariate analysis, NAFLD was significantly associated with significant liver fibrosis (POR: 5.87; CI95%: 2.48 – 13.86; p < 0.001) after adjusted with HBeAg status. Conclusion. NAFLD associated with the higher risk of liver fibrosis in patients with hepatitis B. Modification of lifestyle and potential therapeutic intervention may help in reducing the progression of liver fibrosis.","PeriodicalId":32700,"journal":{"name":"Jurnal Penyakit Dalam Indonesia","volume":"220 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135039323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Severe malaria is a serious infectious disease that required immediate diagnosis and prompt treatment. Severe malaria may result several organ failures which is similar with other infectious diseases like SARS-CoV-2, sepsis, dengue, and HIV infection. Most of those infection have similar symptoms such as fever, myalgia, and headache, therefore physician should have high suspicion regarding co-infection with other infectious agents. The overlapping symptoms of co-infections may become a challenge for physician in diagnosing and delivering prompt therapy. Failure to deliver prompt treatment may lead to fatal outcome such as in severe malaria case. Stigmatization of all patients with fever and cough for COVID-19, may lead to misdiagnosis, moreover in some facilities which SARS-COV-2 PCR testing may not readily available to rule out infection. Therefore, it is importance to have broad differential diagnosis of fever during COVID-19 pandemic era, including the possibility of malaria infection in immunocompromised patients This can be achieved by comprehensive history taking and physical examination in evaluating patients with fever. We report antiretroviral naïve HIV infected patient with severe malaria indicated by several multi organ damage that successfully treated.
{"title":"Manajemen Koinfeksi Malaria Berat dengan HIV Belum Mendapat Terapi Antiretrovirus di Era Pandemi COVID-19: Sebuah Laporan Kasus","authors":"Paul Harijanto","doi":"10.7454/jpdi.v10i3.1480","DOIUrl":"https://doi.org/10.7454/jpdi.v10i3.1480","url":null,"abstract":"Severe malaria is a serious infectious disease that required immediate diagnosis and prompt treatment. Severe malaria may result several organ failures which is similar with other infectious diseases like SARS-CoV-2, sepsis, dengue, and HIV infection. Most of those infection have similar symptoms such as fever, myalgia, and headache, therefore physician should have high suspicion regarding co-infection with other infectious agents. The overlapping symptoms of co-infections may become a challenge for physician in diagnosing and delivering prompt therapy. Failure to deliver prompt treatment may lead to fatal outcome such as in severe malaria case. Stigmatization of all patients with fever and cough for COVID-19, may lead to misdiagnosis, moreover in some facilities which SARS-COV-2 PCR testing may not readily available to rule out infection. Therefore, it is importance to have broad differential diagnosis of fever during COVID-19 pandemic era, including the possibility of malaria infection in immunocompromised patients This can be achieved by comprehensive history taking and physical examination in evaluating patients with fever. We report antiretroviral naïve HIV infected patient with severe malaria indicated by several multi organ damage that successfully treated.","PeriodicalId":32700,"journal":{"name":"Jurnal Penyakit Dalam Indonesia","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135039458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. Psychological disorders are closely associated with hormonal factors, including cortisol and serotonin. In patients with acute coronary syndrome (ACS), autonomic dysfunction and dysregulation of the hypothalamic-pituitaryadrenal (HPA) axis can occur, leading to an increase in cortisol levels that may worsen the prognosis of ACS patients. Therefore, it is important to understand the hormonal impact, namely cortisol and serotonin levels, on depressive symptoms, which will be examined in this study. Methods. This was a cross-sectional study to determine the impact of cortisol and serotonin in the incidence of depression in post-treatment ACS patients at the ICCU RSUPN dr. Cipto Mangunkusumo, Jakarta. Data collection from patients meeting the inclusion criteria was carried out 10-14 days post-treatment through interviews, HADS questionnaire completion, physical examinations, and laboratory tests. The Mann-Whitney test was used to examine the differences between serotonin and salivary cortisol levels in patients with and without depression. Results. Among the 73 ACS patients included in this study, the average age was 57.53 (9.97) years, with 68.5% was male. Posttreatment depression was observed in 15.1% of subjects. The median serotonin levels were lower in patients with depression [175 (147 – 227.64) ng/mL vs. 189.31 (152.87-235.44) ng/mL], while cortisol levels were higher in patients with depression [3.09 (1.46-6.26) ng/mL vs. 2.15 (0.92-3.91) ng/mL]. However, the statistical analysis showed no significant differences between plasma serotonin and depression (p=0.482) or saliva cortisol and depression (p=0.275). Conclusions. There were no significant differences in cortisol and serotonin levels concerning depressive symptoms among post-acute coronary syndrome patients. Nevertheless, this study holds clinical importance due to the observed lower plasma serotonin levels and higher saliva cortisol levels in ACS patients with depression.
{"title":"Perbedaan Serotonin Plasma dan Kortisol Saliva terhadap Gejala Depresi pada Pasien Pasca Sindrom Koroner Akut","authors":"Hamzah Shatri","doi":"10.7454/jpdi.v10i3.1479","DOIUrl":"https://doi.org/10.7454/jpdi.v10i3.1479","url":null,"abstract":"Introduction. Psychological disorders are closely associated with hormonal factors, including cortisol and serotonin. In patients with acute coronary syndrome (ACS), autonomic dysfunction and dysregulation of the hypothalamic-pituitaryadrenal (HPA) axis can occur, leading to an increase in cortisol levels that may worsen the prognosis of ACS patients. Therefore, it is important to understand the hormonal impact, namely cortisol and serotonin levels, on depressive symptoms, which will be examined in this study. Methods. This was a cross-sectional study to determine the impact of cortisol and serotonin in the incidence of depression in post-treatment ACS patients at the ICCU RSUPN dr. Cipto Mangunkusumo, Jakarta. Data collection from patients meeting the inclusion criteria was carried out 10-14 days post-treatment through interviews, HADS questionnaire completion, physical examinations, and laboratory tests. The Mann-Whitney test was used to examine the differences between serotonin and salivary cortisol levels in patients with and without depression. Results. Among the 73 ACS patients included in this study, the average age was 57.53 (9.97) years, with 68.5% was male. Posttreatment depression was observed in 15.1% of subjects. The median serotonin levels were lower in patients with depression [175 (147 – 227.64) ng/mL vs. 189.31 (152.87-235.44) ng/mL], while cortisol levels were higher in patients with depression [3.09 (1.46-6.26) ng/mL vs. 2.15 (0.92-3.91) ng/mL]. However, the statistical analysis showed no significant differences between plasma serotonin and depression (p=0.482) or saliva cortisol and depression (p=0.275). Conclusions. There were no significant differences in cortisol and serotonin levels concerning depressive symptoms among post-acute coronary syndrome patients. Nevertheless, this study holds clinical importance due to the observed lower plasma serotonin levels and higher saliva cortisol levels in ACS patients with depression.","PeriodicalId":32700,"journal":{"name":"Jurnal Penyakit Dalam Indonesia","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135039461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. Diabetic ketoacidosis (DKA) is one of life-threatening acute complication of diabetes mellitus (DM) characterized by hyperglycemia, ketosis, and acidosis. The prevalence of DM is increasing, therefore the incidence of DKA is predicted to continue to increase. The aim of this study was to obtain the profile of DKA patients in RSUP Prof. Dr. IGNG. Ngoerah (RSPN), Denpasar, Bali as a tertiary refferal hospital of Bali and Nusa Tenggara region. Methods. This study was a cohort retrospective study. All patients aged 18 years or older with a diagnosis of DKA during Januari 2022 to February 2023 at RSPN, were included in this study. Data were obtained from medical records then analyzed using the SPSS version 26 program. Results. There were a total of 41 patients with DKA with mean of age was 50,59 (SD 16,87) years, most of them were female (51,2%) and came alone without referral (58,5%). Based on the clinical profile, most patients presented with decreased consciousness (36,5%), infection (90,2%) mostly urinary tract infection (UTI) (40,5%), have a history of insulin use (34,1%), and impaired of renal function (85,4%). The mean of blood glucose was 468,95 (SD 207,78) mg/dL, potassium level 4,19 (SD 1,17) mmol/L, bicarbonate level 12,85 (SD 6,27) mmol/L, and HbA1c 11,5% (7,1-14). The median duration of hospitalization was 7 (1-30) days and 19,5% of them were passed away during treatment, mostly within the first 72 hours. Conclusions. Most patients in this study are female with age less than 60 years. The most common precipitating factor of DKA are UTI and poor glycemic control. A total of 19,5% of patients with DKA were passed away in this study. Thus, clinicians should be more aggressive in the management of DKA, particularly in the first 72 hours.
{"title":"Profil Pasien Ketoasidosis Diabetikum di Rumah Sakit Rujukan Tersier di Bali, Indonesia","authors":"Noviana Joenputri","doi":"10.7454/jpdi.v10i3.1484","DOIUrl":"https://doi.org/10.7454/jpdi.v10i3.1484","url":null,"abstract":"Introduction. Diabetic ketoacidosis (DKA) is one of life-threatening acute complication of diabetes mellitus (DM) characterized by hyperglycemia, ketosis, and acidosis. The prevalence of DM is increasing, therefore the incidence of DKA is predicted to continue to increase. The aim of this study was to obtain the profile of DKA patients in RSUP Prof. Dr. IGNG. Ngoerah (RSPN), Denpasar, Bali as a tertiary refferal hospital of Bali and Nusa Tenggara region. Methods. This study was a cohort retrospective study. All patients aged 18 years or older with a diagnosis of DKA during Januari 2022 to February 2023 at RSPN, were included in this study. Data were obtained from medical records then analyzed using the SPSS version 26 program. Results. There were a total of 41 patients with DKA with mean of age was 50,59 (SD 16,87) years, most of them were female (51,2%) and came alone without referral (58,5%). Based on the clinical profile, most patients presented with decreased consciousness (36,5%), infection (90,2%) mostly urinary tract infection (UTI) (40,5%), have a history of insulin use (34,1%), and impaired of renal function (85,4%). The mean of blood glucose was 468,95 (SD 207,78) mg/dL, potassium level 4,19 (SD 1,17) mmol/L, bicarbonate level 12,85 (SD 6,27) mmol/L, and HbA1c 11,5% (7,1-14). The median duration of hospitalization was 7 (1-30) days and 19,5% of them were passed away during treatment, mostly within the first 72 hours. Conclusions. Most patients in this study are female with age less than 60 years. The most common precipitating factor of DKA are UTI and poor glycemic control. A total of 19,5% of patients with DKA were passed away in this study. Thus, clinicians should be more aggressive in the management of DKA, particularly in the first 72 hours.","PeriodicalId":32700,"journal":{"name":"Jurnal Penyakit Dalam Indonesia","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135039482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. Sarcopenia is a phenomenon of progressive decline in muscle function that occurs due to the aging process. Insulin-like growth factor-1 (IGF-1) and tumor necrosis factor-α (TNF-α) have an important role in the occurrence of sarcopenia as a positive and negative regulator of muscle mass. Research shows differences in IGF-1 and TNF-α levels between sarcopenia and non-sarcopenia groups, but research on differences in severity of sarcopenia remains unclear. The purpose of this study was to determine the difference in levels of IGF-1 and TNF-α in various degrees of sarcopenia in elderly patients. Methods. This was an analytical observational study with a cross-sectional approach involving 45 subjects of elderly patients who came to the internal outpatient clinic of RSUP dr. M. Djamil Padang and met the criteria for inclusion and exclusion. Subjects were grouped into possible sarcopenia, sarcopenia, and severe sarcopenia. Then, serum IGF-1 and TNF-α examinations were performed using the enzyme linked immunosorbent assay (ELISA) method. Data was analyzed using SPSS 26.0. Results. Median of serum IGF-1 levels in the total sample were 41.36 ng/mL. The highest levels of IGF-1 were found in the possible sarcopenia group (55.28 ng/mL), while the lowest level was in the severe sarcopenia group (31 ng/mL). Median of serum TNF-α levels in the total sample were 157.63 ng/L with the lowest was found in the possible sarcopenia group (111.41 ng/L) and the highest was in the severe sarcopenia group (241.1 ng/L). There was a significant difference in serum levels of IGF-1 and TNF-α in the three sarcopenia groups (p= 0.001). IGF-1 levels decreased according to the severity of sarcopenia, while TNF-α levels increased according to the severity of sarcopenia. Conclusions. There are differences in serum levels of IGF-1 and TNF-α between possible sarcopenia, sarcopenia, and severe elderly sarcopenia.
{"title":"Perbedaan Kadar Insulin-Like Growth Factor-1 dan Tumor Necrosis Factor-α Serum pada Berbagai Derajat Sarkopenia Pasien Lanjut Usia: Studi Potong Lintang","authors":"Roza Mulyana","doi":"10.7454/jpdi.v10i3.1482","DOIUrl":"https://doi.org/10.7454/jpdi.v10i3.1482","url":null,"abstract":"Introduction. Sarcopenia is a phenomenon of progressive decline in muscle function that occurs due to the aging process. Insulin-like growth factor-1 (IGF-1) and tumor necrosis factor-α (TNF-α) have an important role in the occurrence of sarcopenia as a positive and negative regulator of muscle mass. Research shows differences in IGF-1 and TNF-α levels between sarcopenia and non-sarcopenia groups, but research on differences in severity of sarcopenia remains unclear. The purpose of this study was to determine the difference in levels of IGF-1 and TNF-α in various degrees of sarcopenia in elderly patients. Methods. This was an analytical observational study with a cross-sectional approach involving 45 subjects of elderly patients who came to the internal outpatient clinic of RSUP dr. M. Djamil Padang and met the criteria for inclusion and exclusion. Subjects were grouped into possible sarcopenia, sarcopenia, and severe sarcopenia. Then, serum IGF-1 and TNF-α examinations were performed using the enzyme linked immunosorbent assay (ELISA) method. Data was analyzed using SPSS 26.0. Results. Median of serum IGF-1 levels in the total sample were 41.36 ng/mL. The highest levels of IGF-1 were found in the possible sarcopenia group (55.28 ng/mL), while the lowest level was in the severe sarcopenia group (31 ng/mL). Median of serum TNF-α levels in the total sample were 157.63 ng/L with the lowest was found in the possible sarcopenia group (111.41 ng/L) and the highest was in the severe sarcopenia group (241.1 ng/L). There was a significant difference in serum levels of IGF-1 and TNF-α in the three sarcopenia groups (p= 0.001). IGF-1 levels decreased according to the severity of sarcopenia, while TNF-α levels increased according to the severity of sarcopenia. Conclusions. There are differences in serum levels of IGF-1 and TNF-α between possible sarcopenia, sarcopenia, and severe elderly sarcopenia.","PeriodicalId":32700,"journal":{"name":"Jurnal Penyakit Dalam Indonesia","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135039488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. Primary percutaneous coronary intervention (PPCI) is an angioplasty (with or without a stent) performed immediately on the infarct-related artery without prior administration of fibrinolytics. Although PPCI is the reperfusion therapy of choice in ST-segment Elevation Myocardial Infarction (STEMI) patients, survival in post-PPCI patients still varied and research on its determinant factors still showed inconsistent results. This study aimed to determine the predictors of oneyear survival in patients undergoing PPCI at Dr Cipto Mangunkusumo General Hospital. Methods. This retrospective cohort study evaluated the medical records of patients who underwent PPCI at Dr. Cipto Mangunkusumo General Hospital from January 2014 to December 2019. The data collected included clinical parameters and demographic data from the PPCI registry. Patients’ outcomes were cardiovascular mortality, determined based on medical records or by contacting patients or their families by phone. Survival curves were created using the Kaplan Meier method and significance using the log-rank test. Multivariate analysis was performed using the Cox Proportional Hazard model. Results. A total of 220 patients who underwent PPCI were included in this study. The mortality rate was 11.82% and the one-year survival post-PPCI was 88.2%, with a mean survival of 10.7 (10.2-11.2) months. The highest mortality rate occurred in the first month post of PPCI, then mortality trend decresed in the 2nd month to one year. In multivariate analysis, age >60 years [p<0.001; HR 4.25 (1.93-9.37)], high serum creatinine [P=0.031; HR 2.41 (1.08-5.33)], and Killip score III-IV [p<0.001; HR 4.06 (1.83-9.00)] were significant prognostic factors. Conclusion. The predictors of one years survival patients post of PPCI are age, serum creatinine level, and Killip score.
{"title":"Kesintasan Satu Tahun Pasien yang Menjalani Intervensi Koroner Perkutan Primer di Rumah Sakit Dr. Cipto Mangukusumo","authors":"Muhammad Yamin","doi":"10.7454/jpdi.v10i3.1488","DOIUrl":"https://doi.org/10.7454/jpdi.v10i3.1488","url":null,"abstract":"Introduction. Primary percutaneous coronary intervention (PPCI) is an angioplasty (with or without a stent) performed immediately on the infarct-related artery without prior administration of fibrinolytics. Although PPCI is the reperfusion therapy of choice in ST-segment Elevation Myocardial Infarction (STEMI) patients, survival in post-PPCI patients still varied and research on its determinant factors still showed inconsistent results. This study aimed to determine the predictors of oneyear survival in patients undergoing PPCI at Dr Cipto Mangunkusumo General Hospital. Methods. This retrospective cohort study evaluated the medical records of patients who underwent PPCI at Dr. Cipto Mangunkusumo General Hospital from January 2014 to December 2019. The data collected included clinical parameters and demographic data from the PPCI registry. Patients’ outcomes were cardiovascular mortality, determined based on medical records or by contacting patients or their families by phone. Survival curves were created using the Kaplan Meier method and significance using the log-rank test. Multivariate analysis was performed using the Cox Proportional Hazard model. Results. A total of 220 patients who underwent PPCI were included in this study. The mortality rate was 11.82% and the one-year survival post-PPCI was 88.2%, with a mean survival of 10.7 (10.2-11.2) months. The highest mortality rate occurred in the first month post of PPCI, then mortality trend decresed in the 2nd month to one year. In multivariate analysis, age >60 years [p<0.001; HR 4.25 (1.93-9.37)], high serum creatinine [P=0.031; HR 2.41 (1.08-5.33)], and Killip score III-IV [p<0.001; HR 4.06 (1.83-9.00)] were significant prognostic factors. Conclusion. The predictors of one years survival patients post of PPCI are age, serum creatinine level, and Killip score.","PeriodicalId":32700,"journal":{"name":"Jurnal Penyakit Dalam Indonesia","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135039659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. Fall is one of the main causes of hospitalization in the elderly, which is caused by several factors including gait disturbances, balance disorders, visual disturbances, chronic kidney disease (CKD), vitamin D deficiency, and so on. Chronic kidney disease can cause disruption of vitamin D metabolism, especially in the elderly population. This study aimed to assess the relationship between vitamin D status and the risk of falling in elderly patients with CKD who receive regular hemodialysis programs. Methods. We conducted a cross-sectional study by assessing the relationship between vitamin D status and the risk of fall in elderly patients undergoing regular hemodialysis at H. Adam Malik General Hospital and Rasyida Kidney Special Hospital Medan. Fall risk assessment was carried out using the Morse fall scale (MFS) and vitamin D status was examined in the Clinical Pathology Laboratory of H. Adam Malik General Hospital, Medan. The data was analyzed statistically with the chi square test. Results. This study involved 92 subjects with a median vitamin D level of 20.15 (3.9-52.1) mg/dL and a median MFS value of 65 (25-95). As many as 87% of subjects had insufficient vitamin D levels, 11% of subjects had inadequate levels, and 1% of subjects had adequate levels of vitamin D. High fall risk was found in 56% of subjects, 43% had moderate fall risk, and 1% had low fall risk. The chi square test found a significant relationship between vitamin D status and risk of falling with p value = 0.001 and an odds ratio 0.056 (95%CI 0.007-0.454). Conclusion. Reduction of vitamin D level has a significant relationship with the risk of falling in elderly patients with CKD undergoing regular hemodialysis.
{"title":"Hubungan Status Vitamin D dengan Risiko Jatuh pada Pasien Lansia dengan Penyakit Ginjal Kronik yang Menjalani Hemodialisis Reguler","authors":"","doi":"10.7454/jpdi.v10i2.1423","DOIUrl":"https://doi.org/10.7454/jpdi.v10i2.1423","url":null,"abstract":"Introduction. Fall is one of the main causes of hospitalization in the elderly, which is caused by several factors including gait disturbances, balance disorders, visual disturbances, chronic kidney disease (CKD), vitamin D deficiency, and so on. Chronic kidney disease can cause disruption of vitamin D metabolism, especially in the elderly population. This study aimed to assess the relationship between vitamin D status and the risk of falling in elderly patients with CKD who receive regular hemodialysis programs. Methods. We conducted a cross-sectional study by assessing the relationship between vitamin D status and the risk of fall in elderly patients undergoing regular hemodialysis at H. Adam Malik General Hospital and Rasyida Kidney Special Hospital Medan. Fall risk assessment was carried out using the Morse fall scale (MFS) and vitamin D status was examined in the Clinical Pathology Laboratory of H. Adam Malik General Hospital, Medan. The data was analyzed statistically with the chi square test. Results. This study involved 92 subjects with a median vitamin D level of 20.15 (3.9-52.1) mg/dL and a median MFS value of 65 (25-95). As many as 87% of subjects had insufficient vitamin D levels, 11% of subjects had inadequate levels, and 1% of subjects had adequate levels of vitamin D. High fall risk was found in 56% of subjects, 43% had moderate fall risk, and 1% had low fall risk. The chi square test found a significant relationship between vitamin D status and risk of falling with p value = 0.001 and an odds ratio 0.056 (95%CI 0.007-0.454). Conclusion. Reduction of vitamin D level has a significant relationship with the risk of falling in elderly patients with CKD undergoing regular hemodialysis.","PeriodicalId":32700,"journal":{"name":"Jurnal Penyakit Dalam Indonesia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45296113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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