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Abdominal Tuberculosis: Diagnostic and Management Problems Dwimartutie, Noto; A, Iskandar; Simadibrata, Marcellus; Syam, Ari F; Pitoyo, Ceva W; Sulaiman, Andri; Loho, Tony
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 1, April 2006
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Abdominal tuberculosis, as one of the manifestations of extrapulmonary tuberculosis, may involve gastrointestinal tract, peritoneum, mesenteric lymph nodes, liver, and also spleen. Most patients have constitutional symptoms of fever, pain, diarrhea, constipation, alternating constipation and diarrhea, weight loss, anorexia and malaise. It also has an insidious course without any specific laboratory, radiological or clinical findings and makes it difficult to diagnosis. Anti tuberculosis treatments with initiation phase for 2 months and continue with continuation phase for 7 months is effective. Steroids may be used to reduce acute inflammation and limit delayed fibrotic complications. We report a male patient with abdominal tuberculosis involving peritoneum, liver, colon, paraaorta lymph nodes, and spleen, which at first suggested as a malignancy. Drug induced hepatitis due to anti tuberculosis drug during treatment was emerged and substituted with other regimen. After given anti tuberculosis treatment and steroid as adjunctive treatment, the clinical condition of patient was improved. Keywords: abdominal tuberculosis, anti tuberculosis treatment, drug induced hepatitis

Abdominal Tuberculosis: Diagnostic and Management Problems Noto Dwimartutie; Iskandar A; Marcellus Simadibrata; Ari F Syam; Ceva W Pitoyo; Andri Sulaiman; Tony Loho
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 1, April 2006
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/71200621-27

Abdominal tuberculosis, as one of the manifestations of extrapulmonary tuberculosis, may involve gastrointestinal tract, peritoneum, mesenteric lymph nodes, liver, and also spleen. Most patients have constitutional symptoms of fever, pain, diarrhea, constipation, alternating constipation and diarrhea, weight loss, anorexia and malaise. It also has an insidious course without any specific laboratory, radiological or clinical findings and makes it difficult to diagnosis. Anti tuberculosis treatments with initiation phase for 2 months and continue with continuation phase for 7 months is effective. Steroids may be used to reduce acute inflammation and limit delayed fibrotic complications. We report a male patient with abdominal tuberculosis involving peritoneum, liver, colon, paraaorta lymph nodes, and spleen, which at first suggested as a malignancy. Drug induced hepatitis due to anti tuberculosis drug during treatment was emerged and substituted with other regimen. After given anti tuberculosis treatment and steroid as adjunctive treatment, the clinical condition of patient was improved. Keywords: abdominal tuberculosis, anti tuberculosis treatment, drug induced hepatitis

Validation of Rapid Emergency Medicine Score (REMS) in Predicting30 days Mortality in Elderly Visiting Emergency Department Rizka, Aulia; Harimurti, Kuntjoro; Pitoyo, Ceva W; Koesno, Soekamto
Jurnal Penyakit Dalam Indonesia Vol. 4, No. 2
Publisher : UI Scholars Hub

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Introduction. Rapid Emergency Medicine Score (REMS) has been known as a useful instrument to stratify patients in emergency department (ED) based on its ability to predict short term mortality. As the clinical characteristics of elderly patients visiting ED are frequently aypical, validation of REMS in this specific population is very important. To measure predictive validity of REMS in elderly patients visiting ED Methods. Prospective cohort study in elderly visiting ED of Cipto Mangunkusumo between September to October 2016. Subjects were followed for 30 days after visiting ED. Calibration (Hosmer Lemeshow test), discrimination (Area Under ROC Curve) and REMS predictive value of 30 days mortality were measured. Result. Of 321 elderly subjects visiting ED during study period, 306 subjects were included in the study. Among them, 163 (53,2%) were men. 30 days mortality incidence was 22,8% (95% CI 22,3-23,3). Median age was 68,3 (6,7) year. As many as 83 (27%) subjects were in red triage. There were 154 (50%) patients with REMS 0-7, 140 (46%) with REMS 8-17 and 12(4%) with REMS more than 17. Calibration plot shows r=0,23 with poor calibration (p=0,00) in Hosmer Lemeshow test. AUC of REMS in predicting 30 days mortality in elderly was 0,45 (95% CI 0,23-0,66). Conclusion. REMS shows poor calibration and discrimination in eldery patients visiting ED.

Factors Related to 30 day Mortality in Critically Ill Patients withInvasive Candidiasis in Cipto Mangunkusumo Hospital Ardian, Ardi; Pitoyo, Ceva W; Adhitianingsih, Dita; Santoso, Widayat Djoko; Setiati, Siti
Jurnal Penyakit Dalam Indonesia Vol. 4, No. 1
Publisher : UI Scholars Hub

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Introduction. Mortality rate of invasive candidiasis is still high, approximately 30-70%. Every study has a variety mortality rate depend on study design and sample. There is no data in Indonesia about profile and mortality factors analysis in critically ill patients with invasive candidiasis. Methods. The Study design was cross sectional. We studied 102 hospitalized critically ill patients with invasive candidiasis. The demographic, clinical and laboratory data, the risk factors for invasive candidiasis and the outcome of each patient in 30 days were recorded. An analysis bivariate with chi square or Fisher’s test was carried out to analyse some factors such as age > 60 years old, severe sepsis, APACHE score > 20, respiratory failure, renal failure, delayed antifungal treatment > 72 hours after positive culture, Charlson index score, and ICU or non ICU patients. The logistic regression of multivariate analysis was carried out to identify the most influence of all mortality factors. Results. Among 102 identified sample, the majority was male (52.9%), the median age was 53 years old and the mortality rate was 68,6%. Laboratory candida findings came from blood sample (candidemia) (98.03%), liquor cerebrospinal (1.5%) and retina exudate (1.5%). The most common candida species were candida non albicans especially Candida tropicalis (34.3%) and Candida parapsilosis (34.3%). The risk factors for invasive candidiasis from this study related to underlying disease were sepsis (78.9%), malignancy (42.15%), diabetes mellitus (29.4%) and related to therapy or treatment were the usage of broad spectrum antibiotic (99%), central vein catheter (77.5%), and parenteral nutrition (70.6%). The result from multivariate analysis, severe sepsis (p 0.001, OR 7.7, IK95% 2.4 – 24.7), Charlson Index ≥3 (p 0.022, OR 3.5, IK95% 1.2–10.2), and respiratory failure (p 0.066, OR 2.7 IK95% 0.9 – 8.0) were independently associated with mortality. Conclusions. In Cipto Mangunkusumo hospital, most critically ill patients with invasive candidiasis was male, median age was 53 years old, and mortality rate was 68,6%. The most species candida caused infection were Candida tropicalis and Candida parapsilosis. The most risk factors of invasive candidiasis from underlying disease was sepsis and from the treatment was the usage of broad spectrum antibiotic. Severe sepsis, and Charlson index ≥3 were associated with a 30 day mortality in critically ill patients with invasive candidiasis.

Coronavirus Disease 2019: Review of Current Literatures Susilo, Adityo; Rumende, C. Martin; Pitoyo, Ceva W; Santoso, Widayat Djoko; Yulianti, Mira; Herikurniawan, Herikurniawan; Sinto, Robert; Singh, Gurmeet; Nainggolan, Leonard; Nelwan, Erni J; Chen, Lie Khie; Widhani, Alvina; Wijaya, Edwin; Wicaksana, Bramantya; Maksum, Maradewi; Annisa, Firda; Jasirwan, Chyntia OM; Yunihastuti, Evy
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 1
Publisher : UI Scholars Hub

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