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OSTEOPOROSIS PADA HIPERTIROIDISME Desi Salwani
Jurnal Kedokteran Syiah Kuala Vol 13, No 3 (2013): Volume 13 Nomor 3 Desember 2013
Publisher : Universitas Syiah Kuala

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Abstract. Osteoporosis didefenisikan sebagai pengurangan masa dan kekuatan tulang sehingga meningkatakan risiko fraktur. Di Amerika serikat, terjadi pada 1 dari 2 wanita usia lebih dari 50 tahun dan meningkat sejalan dengan bertambahnya usia, mengakibatkan fraktur, meningkatkan morbiditas serta mortalitas.Hipertiroidisme mencetuskan bone turnover dan mempersingkat siklus remodelling tulang normal dan lebih sering merusak tulang kortikal (hip dan forearm) dibanding tulang trabekular (spine).Hypertiroidisme berkaitan dengan remodelling tulang, menurunnya densitas tulang, osteoporosis dan meningkatnya kejadian fraktur. Konsentrasi hormon tiroid yang tinggi dalam jangka waktu lama meningkatkan risiko osteoporosis dan risiko fraktur. Perubahan metabolisme tulang berkaitan dengan keseimbangan kalsium negatif, hiperkalsiuria dan kadang-kadang hiperkalsemia. Penanganan terhadap hipertiroidisme akan mengembalikan densitas tulang.Abstract. Osteoporosis is defined as low bone mass density that increase fractur risk. In US, 0steoporosis affecting approximately 1 of 2 old women and increase fractur risk, morbidity and mortality.Hipertiroidisme causes bone turnover and stimullates bone remodelling cycle, cortikal (hip and forearm) than trabecular (spine).Hypertiroidisme was associated with bone remodelling, reduced bone density, osteoporosis and could increase fracture risk. High concentration of thyroid hormone causes osteoporosis and increase fracture risk. Changes in bone metabolism are associated with negative calcium balance, hypercalciuria and, rarely, hypercalcemia Management of hypertiroidisme affects bone density.

PUASA RAMADHAN DAN PENGARUHNYA TERHADAP PROGRESIFITAS PENYAKIT GINJAL KRONIK Abdullah Abdullah; Desi Salwani; Muhsin Muhsin; Andri Baftahul Khairi; Maimun Syukri
Jurnal Kedokteran Syiah Kuala Vol 21, No 3 (2021): Volume 21 Nomor 3 Desember 2021
Publisher : Universitas Syiah Kuala

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24815/jks.v21i3.23754

Bulan Ramadhan merupakan bulan suci umat Islam dimana pada bulan ini seluruh umat Islam diwajibkan untuk berpuasa selama satu bulan penuh, mulai dari terbit fajar hingga tenggelam matahari. Pengaruh puasa Ramadhan terhadap fisiologis dan biokimia tubuh telah banyak dipelajari dengan hasil yang berbeda-beda. Banyak penelitian menunjukkan puasa Ramadhan dapat ditoleransi dengan aman pada orang sehat dan memberikan efek yang menguntungkan dalam hal regulasi tekanan darah, kadar lipid darah, stres oksidatif, sensitivitas insulin, dan penyakit jantung kronis jika dilakukan dengan benar. Ada banyak kontroversi mengenai puasa Ramadhan untuk penderita Penyakit Ginjal Kronik (PGK) terutama apakah puasa tersebut memperbaiki indikator fungsi ginjal atau malah sebaliknya. Terdapat juga banyak kekhawatiran tentang dampak dehidrasi dan efek hipoperfusi ginjal selama puasa Ramadhan terhadap penderita PGK. Tinjauan kepustakaan ini memberikan bukti-bukti terbaru tentang pengaruh puasa Ramadhan terhadap progresifitas PGK, baik pada penderita predialisis, yang sedang menjalani dialisis, maupun yang telah menjalani transplantasi ginjal.

OSTEOPOROSIS PADA HIPERTIROIDISME Desi Salwani
Jurnal Kedokteran Syiah Kuala Vol 13, No 3 (2013): Volume 13 Nomor 3 Desember 2013
Publisher : Universitas Syiah Kuala

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24815/jks.v13i3.3423

Abstract. Osteoporosis didefenisikan sebagai pengurangan masa dan kekuatan tulang sehingga meningkatakan risiko fraktur. Di Amerika serikat, terjadi pada 1 dari 2 wanita usia lebih dari 50 tahun dan meningkat sejalan dengan bertambahnya usia, mengakibatkan fraktur, meningkatkan morbiditas serta mortalitas.Hipertiroidisme mencetuskan bone turnover dan mempersingkat siklus remodelling tulang normal dan lebih sering merusak tulang kortikal (hip dan forearm) dibanding tulang trabekular (spine).Hypertiroidisme berkaitan dengan remodelling tulang, menurunnya densitas tulang, osteoporosis dan meningkatnya kejadian fraktur. Konsentrasi hormon tiroid yang tinggi dalam jangka waktu lama meningkatkan risiko osteoporosis dan risiko fraktur. Perubahan metabolisme tulang berkaitan dengan keseimbangan kalsium negatif, hiperkalsiuria dan kadang-kadang hiperkalsemia. Penanganan terhadap hipertiroidisme akan mengembalikan densitas tulang.Abstract. Osteoporosis is defined as low bone mass density that increase fractur risk. In US, 0steoporosis affecting approximately 1 of 2 old women and increase fractur risk, morbidity and mortality.Hipertiroidisme causes bone turnover and stimullates bone remodelling cycle, cortikal (hip and forearm) than trabecular (spine).Hypertiroidisme was associated with bone remodelling, reduced bone density, osteoporosis and could increase fracture risk. High concentration of thyroid hormone causes osteoporosis and increase fracture risk. Changes in bone metabolism are associated with negative calcium balance, hypercalciuria and, rarely, hypercalcemia Management of hypertiroidisme affects bone density.

Thalassemia Beta Mayor dengan Osteoporosis Desi Salwani
Jurnal Kedokteran Syiah Kuala Vol 14, No 2 (2014): Volume 14 Nomor 2 Agustus 2014
Publisher : Universitas Syiah Kuala

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Thalassemia Beta Mayor dengan Osteoporosis

HUBUNGAN LAMA HEMODIALISIS DENGAN KEJADIAN AMENORE SEKUNDER PADA PASIEN GAGAL GINJAL KRONIK DI RSUD dr. ZAINOEL ABIDIN BANDA ACEH DAN RSUD TGK.CHIK DITIRO SIGLI Dewi Yulianti Prastiwi; Desi Salwani; Saminan .
Jurnal Ilmiah Mahasiswa Kedokteran Medisia Vol 2, No 1: Februari 2017
Publisher : Jurnal Ilmiah Mahasiswa Kedokteran Medisia

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Gagal ginjal kronik (GGK) ialah kerusakan pada struktur dan fungsi ginjal 3 bulan dengan atau tanpa penurunan laju filtrasi glomerulus (LFG) 60 ml/menit/1,73 m2 yang bersifat progresif danireversible. Salah satu terapi bagi penderita GGK ialah hemodialisis (HD). Namun, lama hemodialisis dapat berpengaruh pada perubahan siklus menstruasi yaitu menjadi berkurang bahkan berhenti atau amenore sekunder pada pasien GGK yang berjenis kelamin perempuan sebab hemodialisis akan mempengaruhi hormon estrogen. Tujuan dari penelitian ini untuk mengetahui hubungan lama hemodialisis dengan kejadian amenore sekunder pada pasien GGK di Ruang Hemodialisis RSUD dr. Zainoel Abidin Banda Aceh, Klinik Ginjal Nadhira Banda Aceh dan RSUD Chik Ditiro Sigli. Penelitian ini merupakan penelitian analitik observasional dengan pendekatan cross-sectional dan telah dilakukan pada bulan Mei-Juni 2016 dengan jumlah responden 33 orang, 14 responden mengalami amenore sekunder dan 19 responden tidak mengalami amenore sekunder. Hasil analisis komparatif dengan uji Chi-Squaremenunjukkan tidak terdapat hubungan yang signifikan antara lama HD dengan kejadian amenore sekunder (p = 1,000) pada pasien GGK. Maka, persentasi angka kejadian amenore sekunder pada pasien gagal ginjal kronik yang menjalani HD 42,4 % dan salah satu faktor risiko kejadian amenore sekunder ialah hemodialisis (HD).

Rhabdomyolysis and Acute Kidney Injury Requiring Dialysis Desi Salwani; Farissa Farissa; Aida Lydia
Indonesian Journal of Kidney and Hypertension Vol 3 No 1 (2020): January - April 2020
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Background : Acute kidney injury (AKI) with myoglobinuria is the most serious complication of rhabdomyolysis, and it may be life threatening. Acute kidney injury as a complication of rhabdomyolysis represents about 7 to 10% of all cases of acute kidney injury in the United State. Case Ilustration : A 42-year-old man presented with altered mental status after being found strangulated 3 hours before admission. Five day prior to admission he had ingested detergent with the intention of suicide. He had a history of paranoid schizophrenia that had been medicated with risperidone for 2 years. He denied history of trauma or injury. History of hypertension. On initial examination, he was unresponsive with a glasgow coma score of 3, attention and orientation was not adequate, hemodynamic were stable. Vulnus Excoriatum and circular hematom were on cervical area . In the patient’s initial laboratory, evaluation showed leukocyte 19690/ul, low potassium 2,8 mEq/L, high ALT and AST, ureum 13 mg/dl, creatinine was 1,639 mg/dl and creatinine increased 6,8 mg/dL on 3th and 9,7 mg/dL on 4th day, high serum uric acid and low serum calsium. Blood gas analysis showed bicarbonate 20,5. HCV serology was positive. Cervical x rays showed swelling on retrofaring soft tissue. Chest x ray showed cardiomegaly, infilltrate on right lung and kidney ultrasonography showed no abnormality. Diagnosed were acute kidney injury, rhabdomyolysis, schizophrenia paranoid, pneumonia, hypertension, vulnus ekscoriasis regio collie caused by strangulated, hipocalcemia and reactif leukositosis. He was started on intravenous hydration with KN2 at 1000 mL daily. He also got haloperidol 5 mg daily, risperidone 2 mg daily, 2 times daily, KSR 600 mg 3 times daily and antibiotic ceftriaxone 2 gram daily and Ramipril. The intra venous fluid rate was increased to 1500 mL daily, he remained oliguria with persistent hyperkalemia. He was started intermittent conventional hemodialysis on 4 of the hospitalization. He was dialyzed for 2 sessions. Urine output started to improve on Day 6 when his 24 hours’ urine output was 1000 mL. His last dialysis was on day 6th of hospitalization after which creatinine and CK continued to improve without dialysis. After 24 days of hospitalization he was discharged, his creatinine was 1.6 mg/dL and CK was 299 IU/L. Discussion : The earlier patients receive supportive therapy. Initiate volume repletion with normal saline promptly, target urine output of approximately 3 ml per kilogram of body weight per hour. In patients who develop oliguria, administration of intravenous fluids is limited due volume expansion and pulmonary edema. In these cases, RRT is indicated. Intermittent hemodialysis, has the added benefit of correcting volume overload and pulmonary edema. Bicarbonates to induce urinary alkalinisation. Conclusion : Acute kidney injury is the most serious complication of rhabdomyolysis. Fluid overload and imbalance electrolyte need renal replacement therapy.

Dialysis Vintage, Vitamin D, and Bone Mineral Density of CKD Patients on Chronic Hemodialysis Maimun Syukri; Desi Salwani; Khairunnisa Khairunnisa; Abdullah Abdullah
Indonesian Journal of Kidney and Hypertension Vol 3 No 1 (2020): January - April 2020
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Background: Bone mineral disorders in chronic kidney disease (CKD-MBD) is one of the complications that occurs due to systemic disorders of minerals and bones in chronic kidney disease (CKD). This syndrome is one or a combination of laboratory abnormalities (phosphate, parathyroid hormone, and vitamin D), bone disorders (turnover, mineralization, volume, linear growth, and strength), and/or vascular calcification or other soft tissue. It is associated with high mortality and morbidity in CKD patients. To determine the relationship of vitamin D levels and bone mineral density (BMD) examination with the hemodialysis vintage in CKD patients undergoing hemodialysis at RSUD Dr. ZainoelAbidin. Methods: This study is a cross-sectional study held in Zainoel Abidin Hospital, Banda Aceh, Indonesia, from January until May 2017. We include all patients who received twice-weekly hemodialysis for at least 3 months. Patients who received corticosteroids in the past 2 weeks, pregnancy, suffering from endocrine disorders, malignancy, menopausal women, autoimmune diseases, and thalassemia were excluded. Laboratory examination and Bone Densitometry were performed before a single hemodialysis session. Data were analyzed using the Spearman Rank Correlation test. Results: Thirty patients were analyzed from 196 hemodialysis patients. The proportion of patients that have vitamin D insufficiency was 56.6%. The proportion of patients that have with normal vitamin D was 43.3%. The proportion of patients that have osteoporosis was 30% and 56.6% were osteopenia based on bone densitometry examination. The magnitude of the Spearman Rank Correlation coefficient between vitamin D levels and the duration of hemodialysis in CKD patients is -0.552 with a p-value 0.002. The magnitude of the Spearman Rank Correlation coefficient between BMD and hemodialysis time in CKD patients is -0,397 with a p-value of less than 0.030. Conclusion: There was a correlation between dialysis vintage with vitamin D levels and bone densitometry.

Hemoglobin dan Adekuasi Berkorelasi dengan Kualitas Hidup dan Kinerja Jantung Pada Pasien Hemodialisis Hardi Yanis; Abdullah Abdullah; Desi Salwani; Muhammad Diah; Muhsin Muhsin; Maimun Syukri
Jurnal Kedokteran Syiah Kuala Vol 22, No 1 (2022): Volume 22 Nomor 1 Maret 2022
Publisher : Universitas Syiah Kuala

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24815/jks.v22i1.24769

Pendahuluan. Penyait Ginjal Stadium Akhir (end stage renal disease, ESRD) merupakan stadium Penyakit Ginjal Kronis (PGK) yang memerlukan terapi pengganti ginjal termasuk hemodialisis (HD). Indikator keberhasilan HD termasuk kinerja jantung dan kualitas hidup pasien diyakini tergantung pada indikator proses yang meliputi kecukupan (adekuasi) HD, kejadian anemia serta malfungsi akses vaskular dan infeksi. Tujuan. Penelitian ini bertujuan untuk menilai hubungan antara indikator proses dan indikator hasil pasien HD. Metode. Penelitian ini merupakan penelitian observasional analitik dengan pendekatan kohort yang melibatkan 350 pasien dari 5 unit HD di Provinsi Aceh. Data diperoleh dari rekam medis pasien, sedangkan kualitas hidup pasien HD dinilai dengan kuesioner Kidney Disease Quality of Life (KDQoL). Kinerja jantung dinilai dengan menggunakan ekokardiografi. Hasil. Hasil penelitian menunjukkan adanya hubungan positif yang signifikan antara hemoglobin (Hb) dan adekuasi HD dengan fraksi ejeksi pasien yang menjalani HD. Selain itu, penelitian ini juga menemukan hubungan positif yang signifikan antara Hb dan adekuasi dengan kualitas hidup pasien HD, terutama fungsi fisik dan kesejahteraan emosional. Kesimpulan. Adanya korelasi positif antara Hb dan adekuasi HD dengan kinerja jantung dan kualitas hidup menunjukkan pentingnya indikator proses dalam meningkatkan kualitas pelayanan HD serta pasien HD.

Cutaneous Adverse Drug Reaction Among HIV-Infected Patients Starting Antituberculosis Treatment Widhani, Alvina; Karjadi, Teguh Harjono; Yunihastuti, Evy; Salwani, Desi; Pramudita, Angga; Nababan, Saut Horas; Praptini, Mirna Nurasri; Mondrowinduro, Prionggo
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 4
Publisher : UI Scholars Hub

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Introduction. Treatment of tuberculosis (TB) in HIV patients is complicated due to numerous comorbidities and possible adverse effects. One of which is cutaneous adverse drug reaction (CADR). This adverse event is often difficult to manage because of multiple medications the patients get. The objective of this study was to know the prevalence and risk factors of CADR among HIV-infected patients starting anti-TB treatment. Methods. This retrospective study reviewed data from medical records of new patients at Working Group on AIDS outpatient clinic at Cipto Mangunkusumo Hospital, Indonesia in January 2008-December 2010 that had started anti-TB treatment. Risk factors of CADR among HIV patients treated with antituberculosis drugs evaluated were sex, age, route of HIV transmission, TB manifestation, and baseline CD4+ cell count. Numeric data were analyzed using independent T-test if normally distributed, otherwise Mann Whitney U test were used. Chi-square or Fisher’s exact test were used for categorical data. p-value was considered significant if below 0.05. Results. Of 454 HIV-infected patients that started anti-TB treatment, median age was 30 years. Most patients were male and intravenous drug users/IDU. Median baseline CD4+ cell count was 61 cells/ μL. There were 10.6% subjects that developed CADR. Most common manifestations were maculopapular rashes (66.7%), followed by erythema multiforme (14.6%), and Stevens Johnson Syndrome (8.3%). Anti-TB drugs were stopped and then re-challenge was conducted in 54.2% patients. Anti-TB drugs were continued and only the suspected drug was stopped in 29.2% patients. The offending drugs were cotrimoxazole (41.7%), rifampicine (41.7%), ethambutol (16.7%), pyrazinamide (14.6%), pyrimethamine (12.5%), isoniazide (10.4%), streptomycin (8.3%), efavirenz (8.3%), fixed dose combination of antituberculosis drugs (8.3%), and nevirapine (4.2%). The proportion of CADR was higher in woman than man (12% vs. 10.3%, p=0.66), non-IDU than IDU (13% vs. 9.2%, p=0.20), without extrapulmonary TB than extrapulmonary TB (11.1% vs. 9.4%, p=0.29), but the associations weren’t statistically significant. Median age was higher (31 vs. 30 years, p=0.32) and CD4 cell count (59.5 vs. 62 sel/μL, p=0.96) was lower in CADR group than non CADR group. Conclusion. The prevalence of CADR among HIV-infected patients starting anti-TB treatment was 10.6%. Sex, age, route of HIV transmission, TB manifestation, and baseline CD4+ did not have statistically significant association with CADR.

Performance of Combination of Symptoms, Chest x-rays and MGIT 960 Culture for Diagnosis of Pulmonary Tuberculosis in HIV Patients Salwani, Desi; Nasir, Ujainah Zaini; Yunihastuti, Evy; Harimurti, Kuntjro; Andriansjah, Andriansjah
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 2
Publisher : UI Scholars Hub

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