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All Journal Medical Journal of Indonesia Jurnal Penyakit Dalam Indonesia
Em Yunir, Em
Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta
Medicine & Pharmacology

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Profile and analysis of diabetes chronic complications in Outpatient Diabetes Clinic of Cipto Mangunkusumo Hospital, Jakarta Tarigan, Tri J.E.; Yunir, Em; Subekti, Imam; Pramono, Laurentius A.; Martina, Diah
Medical Journal of Indonesia Vol 24, No 3 (2015): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (344.752 KB) | DOI: 10.13181/mji.v24i3.1249

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Background: Chronic complications of diabetes mellitus have a significant role in increasing morbidity, mortality, disability, and health cost. In the outpatient setting, the availability of data regarding to the chronic complications of type 2 diabetes is useful for evaluation of prevention, education, and patient’s treatment. This study aimed to describe the characteristic of type 2 diabetes chronic complications in outpatient diabetes clinic.Methods: A cross-sectional study was done using 155 patients in Outpatient Diabetes Clinic of Cipto Mangunkusumo Hospital (RSCM), Jakarta in 2010. Secondary data were used from medical record based on history taking, physical examination, diabetic foot assessment, laboratory, neurologic, cardiology, opthalmology, ankle brachial index, and electrography of the patients. Characteristic profiles of the subjects, prevalence of the chronic complications, and its association with diabetes risk factors, such as glycemic control using HbA1c, fasting blood glucose, duration of diabetes, and LDL cholesterol were analyzed using chi square test.Results: Among 155 subjects participated in the study, most of them were women (59%) and elderly (46%). The prevalence of diabetes chronic complications was 69% from all subjects. These chronic complications included microangiopathy, macroangiopathy and mixed complications, with prevalence of 56%, 7% and 27% respectively. Microangiopathy included nephropathy (2%), retinopathy (7%), neuropathy (38%) and mixed complications (53%). Macroangiopathy included coronary heart disease (46%), peripheral arterial disease (19%), stroke (18%), and mixed complication (17%). From the analysis, we found significant association between duration of diabetes and diabetic neuropathy (p = 0.003).Conclusion: Prevalence of diabetes chronic complications in Outpatient Diabetes Clinic of Cipto Mangunkusumo Hospital, mainly dominated by microvascular-related complications including nephropathy, retinopathy, neuropathy and mixed complications. There was statistical significance between diabetes duration and diabetic neuropathy.
Obesity and central obesity in Indonesia: evidence from a national health survey Harbuwono, Dante S.; Pramono, Laurentius A.; Yunir, Em; Subekti, Imam
Medical Journal of Indonesia Vol 27, No 2 (2018): June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (282.289 KB) | DOI: 10.13181/mji.v27i2.1512

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Background: Obesity and central obesity have become serious public health problems in developing countries such as Indonesia. Although 10 years have passed since the largest national health survey was conducted in 2007, no further analysis and publication concerning obesity and central obesity in Indonesia have been conducted based on the survey. The aim of this study is to determine the prevalence of obesity and central obesity, and its association with sociodemographic characteristics and comorbidities in Indonesia.Methods: A cross-sectional study was conducted based on the National Basic Health Survey 2007 using total sampling method from 33 provinces. Obesity is defined as body mass index ≥25 according to the Asia-Pacific standard for obesity. Central obesity is defined as waist circumference >90 cm for men and > 80 cm for women according to the Asia-Pacific standard for central obesity.Results: The prevalence of obesity and central obesity in the Indonesian adult population are 23.1% and 28%, respectively. Both rates are higher in females than in males. Obesity and central obesity are associated with the risk of diabetes and hypertension.Conclusion: Prevalence of obesity and central obesity is high in the Indonesian adult population. Interventional programs are important to promote awareness of obesity and healthy lifestyle changes in the community.
Peripheral Arterial disease and Cardiovascular Mortality in Type-2 Diabetes Mellitus Esa, Dekta Filantropi; Prahasary, Adelia Nova; Tahapary, Dicky L.; Yunir, Em
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 2
Publisher : UI Scholars Hub

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Peripheral arterial disease (PAD) is one of the macrovascular complications of type 2 diabetes mellitus (T2DM), which increases the risk of cardiovascular mortality. Ankle-brachial index (ABI) is one of the simple and widely available tool to diagnose PAD. The authors aim to find out the cardiovascular mortality in T2DM patient with PAD. Bundo et al. study found HR 2.45 (95% CI: 0.84 to 7.17). Mostaza et al. study reported HR 1.64 (95% CI: 0.64 to 4.49). Aboyans et al. study declared HR 2.21 (95% CI: 1.16 to 4.22). Mohammedi K et al. claimed HR 1.35 (95% CI: 1.15 to 1.60). Quiles et al. found HR 6.61 (95% CI: 2.47 to 17.72). Mueller et al. study reported RR 3,53 (95% CI: 1.80 to 6.91). Mueller et al. study reported RR 4,06 ( 95% CI: 2.67 to 6.18). In conclusion, the mortality risk in T2DM patients with PAD is higher compared to those without PAD. Moreover, an ankle-brachial index can be used as an independent stratification tool to predict the risk of cardiovascular mortality
The Role of Clinical Sign and The Added Value of Procalcitonin in Determining The Existance of Infection in The Treated Diabetic Foot Ulcer Aswar, Andra; Yunir, Em; Karuniawati, Anis; Harimurti, Kuntjoro
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 2
Publisher : UI Scholars Hub

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Determinant Factors and Added Value of Osteoprotegerin (OPG) to Detect Carotid Intima-Media Thickness (CIMT) in Type 2 Diabetes Mellitus Patient Tedjasaputra, Shirly Elisa; Yunir, Em; Wijaya, Ika Prasetya; Setiati, Siti
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 2
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Hubungan Albumin Serum Awal Perawatan dengan Perbaikan Klinis Infeksi Ulkus Kaki Diabetik di Rumah Sakit di Jakarta Kurniawan, Hendra Dwi; Yunir, Em; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 1
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Latar Belakang: Ulkus kaki diabetik terinfeksi merupakan kasus DM yang paling banyak dirawat di RS, berhubungan dengan morbiditas, mortalitas, biaya yang tinggi dan bersifat multifaktorial. Salah satu faktor yang berpengaruh adalah albumin. Belum ada penelitian yang secara langsung menghubungkan konsentrasi albumin serum awal perawatan dengan perbaikan klinis infeksi ulkus kaki diabetik. Belum ada batasan mengenai konsentrasi albumin yang dapat mempengaruhi perbaikan klinis infeksi ulkus kaki diabetik. Penelitian ini bertujuan Mendapatkan data mengenai konsentrasi albumin serum awal perawatan dan hubungannya dengan perbaikan klinis infeksi ulkus kaki diabetik. Metode: Penelitian dengan desain kohort prospektif terhadap 71 pasien diabetes dengan ulkus kaki terinfeksi yang dirawat inap di RSUPNCM, RSPADGS atau RSP pada kurun waktu April-Agustus 2014. Diagnosis dan klasifikasi ulkus kaki diabetik terinfeksi menggunakan kriteria IDSA. Data klinis dan albumin serum diambil dalam 24 jam pertama perawatan dan diikuti dalam 21 hari perawatan dengan terapi standar untuk dilihat perbaikan klinis infeksi ulkus kaki diabetik. Perbedaan rerata konsentrasi albumin antara subjek yang mengalami perbaikan klinis infeksi dan yang tidak, diuji dengan uji t tidak berpasangan dengan batas kemaknaan p
Non-Operative Management of Diabetic Foot Osteomyelitis: ACase Report Yunir, Em; Aziza, Yully Astika Nugrahayning
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 2
Publisher : UI Scholars Hub

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Diabetic foot osteomyelitis is an advanced complication of diabetic foot infection which can increase the risk of amputation. This report discusses a case of a 50-year-old female with a wound on the thumb of her left foot that became more swollen with a bluish red color within one month. The patient delayed her treatment due to the COVID-19 pandemic. She has had diabetes and hypertension for 20 years which is uncontrolled. Physical examination showed a sausage toe digiti 1 left pedis with wound 4 x 2 cm with purulent discharge, Probe to Bone (PTB) positive. Laboratory and x-ray examination showed leukocytosis, increased erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP), glucose level 415 mg/dL, and HbA1c 13.1%, with destruction and fragmentation in first toe bone of the left foot. Because she refused minor surgery, the wound was treated regularly by removing infected bone fragments and giving intravenous (IV) antibiotics for four weeks. For glucose level control, continuous IV insulin was given with subcutaneous basal-bolus insulin, then continued by outpatient care with oral antibiotics. After seven weeks, manifestations of infection improved, the wound area was reduced, and antibiotics were discontinued, but wound care was continued. Metabolic control along with long-term antibiotics and wound care for diabetic foot osteomyelitis can be used as an alternative to surgery
Diagnosis and Treatment of Acquired Hemophilia A (AHA) with Bullous Pemphigoid Sihombing, Rasco Sandy; Silalahi, Henry Ratno Diono; Shatri, Hamzah; Sukrisman, Lugyanti; Rinaldi, Ikhwan; Prasetyawati, Findy; Novianto, Endy; Yunir, Em
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 4
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The Association between Degree of Diabetic Peripheral Neuropathy with Ankle Brachial Index, Toe Brachial Index, and Transcutaneus Partial Oxygen Pressure in Patients with Type 2 Diabetes Mellitus Asir, Taufik Rizkian; Antono, Dono; Yunir, Em; Shatri, Hamzah
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 3
Publisher : UI Scholars Hub

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Introduction. Diabetic peripheral neuropathy (DPN) in the lower extremity caused by complications of diabetes in the microvascular which can damage nerve in the lower extremity. Then, it is necessary to be aware of the process of aterosclerosis elsewhere, both in the macro and microvascular arteries in the lower extremity. This study was conducted to assess the association of the degree of diabetic peripheral neuropathy assessed by Toronto clinical scoring system (TCSS) with the process of atherosclerosis in the blood vessels of the lower extremity, both macrovascular with ankle brachial index (ABI) and toe brachial index (TBI), as well as microvascular with transcutaneus partial oxygen pressure (TcPO2 ) in patients with type 2 diabetes mellitus. Methods. Cross-sectional study was carried out in patients with type 2 DM with DPN with TCSS values> 5 in the Integrated Cardiac Polyclinic, Endocrine and Metabolic Polyclinic, and Internal Medicine Polyclinics at Cipto Mangunkusumo Hospital. Data were obtained from interviews, medical records, as well as ABI, TBI and, TcPO2 examinations. Bivariate analysis of each variable was performed using Spearman test. Results. Total of 36 subjects who met the selection criteria were included in the study, the average age was 62 years (SD 9.2) with 20 (55.6%) of whom were women and the median duration of diabetes was 12 years. Based on bivariate analysis with the Spearman test, there was a statistically significant negative correlation with moderate correlation coefficient between the degree of diabetic peripheral neuropathy assessed by TCSS with ABI (r = -0.475, p = 0.003) and TBI (r = -0.421, p = 0.010). The TcPO2 examination also found a statistically significant negative correlation with moderate correlation coefficient (r = -0.399, p = 0.016). Conclusion. There is a statistically significant negative correlation between the degree of diabetic peripheral neuropaty with ABI, TBI, and TcPO2 examinations.
Pengaruh Depresi Terhadap Perbaikan Infeksi Ulkus Kaki Diabetik Auliana, Arshita; Yunir, Em; Putranto, Rudi; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 4
Publisher : UI Scholars Hub

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Pendahuluan. Pasien Diabetes Melitus (DM) dengan ulkus kaki lebih banyak yang mengalami depresi dan memiliki kualitas hidup yang buruk. Dalam tatalaksana ulkus kaki diabetik perlu diperhatikan faktor psikososial karena diperkirakan dapat mempengaruhi penyembuhan luka melalui induksi gangguan keseimbangan neuroendokrin-imun. Penelitian ini bertujuan untuk mengetahui pengaruh depresi terhadap proses perbaikan infeksi ulkus kaki diabetik, serta tingkat depresi pada pasien ulkus kaki diabetik yang dirawat inap. Metode. Studi kohort prospektif dilakukan pada 95 pasien ulkus kaki diabetik terinfeksi yang dirawat di RSCM dan RS jejaring pada Maret-Oktober 2014. Subjek dibagi ke dalam dua kelompok yaitu kelompok depresi dan kelompok tidak depresi. Data klinis, penilaian depresi, dan data laboratorium diambil saat pasien masuk rumah sakit kemudian dinilai perbaikan infeksi ulkus kaki diabetik dalam 21 hari masa perawatan. Hasil. Dari 95 subyek penelitian, 57 orang (60%) masuk dalam kelompok depresi, yang didominasi oleh kelompok perempuan (70%). Penyakit komorbid terbanyak adalah hipertensi, dengan angka komorbiditas dan penyakit kardivaskular lebih tinggi pada kelompok depresi. Malnutrisi dan obesitas juga lebih banyak pada kelompok depresi (64,9% dan 31,6%), demikian pula dengan kontrol glikemik yang buruk (73,7%). Sebagian besar pasien (73,7%) yang masuk dalam kelompok depresi memiliki depresi ringan. Pada kelompok depresi 40,4% mengalami perbaikan infeksi dalam 21 hari masa perawatan, sedangkan 68,4% pada kelompok tidak depresi. Depresi cenderung meningkatkan risiko atau kemungkinan tidak terjadinya perbaikan infeksi ulkus kaki diabetik, walaupun setelah dilakukan penyesuaian terhadap variabel perancu, hasil tersebut tidak bermakna secara statistik (p = 0,07, adjusted OR 2,429 dengan IK 95% 0,890-6,632). Lebih banyak subjek dengan depresi sedang yang tidak mengalami perbaikan infeksi ulkus kaki diabetik dibandingkan dengan subjek dengan depresi ringan (93,3% dan 47,6%). Simpulan. Depresi cenderung meningkatkan risiko atau kemungkinan tidak terjadinya perbaikan infeksi ulkus kaki diabetik.
Co-Authors A.A. Ketut Agung Cahyawan W Achmad Rudijanto Andra Aswar, Andra Anis Karuniawati Ardani, Yanuar Arshita Auliana Asir, Taufik Rizkian Aulia Rizka, Aulia Aziza, Yully Astika Nugrahayning Dante S Harbuwono, Dante S Dante S. Harbuwono Dharmeizar Dharmeizar Diah Martina, Diah Dono Antono Eka Ginanjar Endy Novianto, Endy Esa, Dekta Filantropi Findy Prasetyawati, Findy Hamzah Shatri Hari Hendarto, Hari Harry Isbagio Hendra Dwi Kurniawan, Hendra Dwi Henry Ratno Diono Silalahi, Henry Ratno Diono Ika Prasetya Wijaya Ikhwan Rinaldi Imam Subekti Irman Firmansyah Khomimah Khomimah, Khomimah Kumala, Poppy Kuntjoro Harimurti Laurentius A Pramono, Laurentius A Laurentius A. Pramono Lugyanti Sukrisman Mandang, Veny VV Murdani Abdullah Prahasary, Adelia Nova Pringgodigdo Nugroho, Pringgodigdo Puteri, Happy HS Rasco Sandy Sihombing, Rasco Sandy Rudi Putranto Saraswati, Made R Sarwono Waspadji Siti Setiati Sukamto Koesnoe Tahapary, Dicky L. Tedjasaputra, Shirly Elisa Tri J.E. Tarigan Wijaya, Indra