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Aulia Rizka, Aulia
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Medicine & Pharmacology

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Prevalence of Geriatric Syndromes in Elderly Undergoing Chemotherapy Rizka, Aulia; Helda, Helda; Prasetyawaty, Findy; Hanjani, Arcita
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 3
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Introduction. Geriatric syndromes is associated with poor survival, poor quality of life and increased chemotoxicity risk in elderly receiving chemotherapy. Geriatric syndromes is currently not routinely evaluated in pre-chemotherapy clinical setting. This study aimed to identify the prevalence of some geriatric syndromes in elderly patients undergoing chemotherapy.Methods. This study is part of primary study investigating geriatric syndromes in elderly with cancer. A descriptive cross sectional study during March 2020 – March 2021 was conducted to elderly patients before chemotherapy administration in Cipto Mangunkusumo Hospital, a national referral hospital in Jakarta. Patients were recruited consecutively. Patients underwent Comprehensive Geriatric Assesment (CGA), including nutritional, depression, sarcopenia risk assessment, frailty, cognitive assessment, as well as medication review.Results. Total of140 elderly subjects were recruited with mean age of 66 years old. 52% subjects were women and 67% with solid tumor. As many as 80% subjects were having malnutrition, 40,6% were frailt, 40,3% were at high risk of sarcopenia, 14,1% with depression, and 19,1% were having cognitive impairment. Of all subjects, 24,1% have more than 3 diagnosis of geriatric syndromes.Conclusion. As geriatric syndromes are prevalent among elderly subjects receiving chemotherapy, routine identification would be useful to improve cancer treatment result.
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
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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.
Rino-orbital-cerebral Mucormicosys in A Patient Type 1Diabetic: A Case Report Marpaung, Hamka Gunawan; Baso, Gery Dala Prima; Rizka, Aulia; Nelwan, Erni Juwita; Wardani, Retno S; Wahyuningsih, Retno
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 1
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Mucormycosis is an opportunistic andfrequently fulminating fungal infection causedby members of the family Mucoraceae, orderMucorales and class Zygomycetes which highly invasive and high mortality. Mucormycosis occurs in diabetic patients with poor blood glucose control. We reported a case of rhinocerebral mucormycosis in 20-year-old female patient with type 1 diabetes. The patient was treated for diabetic ketoacidosis and swollen symptoms in the left eye and out secretions from the left nose containing blackish spots. The probable diagnosis of rhinocerebral mucormycosis is made based on the results of direct examination and culture of nasal and palate tissue biopcywhich result suitable for Mucor sp. She was given systemic antifungal therapy with amphotericin B and symptoms of swelling of the left eye and secretions of the left nose with patches of blackness improved.
Perbedaan Serotonin Plasma dan Kortisol Saliva terhadap Gejala Depresi pada Pasien Pasca Sindrom Koroner Akut Firmansyah, Irman; Shatri, Hamzah; Putranto, Rudi; Ardani, Yanuar; Ginanjar, Eka; koesnoe, sukamto; Rizka, Aulia; Isbagio, Harry; Yunir, Em
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
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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.
Efektivitas Sacubitril/Valsartan dalam Mencegah Gagal Jantung pada STEMI Pasca Percutaneous Coronary Intervention Andre, Nobian; Adila, Lana; Rizka, Aulia; Rusdi, Lusiani
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
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Heart failure is a possible complication following ST-elevation myocardial infarction (STEMI) even after revascularization. Neuroendocrine activation in the process of ventricular remodeling can be regulated by angiotensin receptor-neprilysin inhibitor (ARNI) as well as angiotensin-converting enzyme (ACE) inhibitor. The use of ARNI in heart failure with reduced ejection fraction has been found to be superior to ACE inhibitor. The role of ARNI on cardiac function in STEMI has not been established. A clinician treating a patient with STEMI considered giving sacubitril/valsartan to reduce the risk of developing heart failure. Literature search was performed in three electronic databases: PubMed, Embase, and Cochrane. Keywords in the form of text words and MeSH terms were arranged using Boolean operator technique. Critical appraisal of selected articles was carried out according to the guideline from Oxford Centre for Evidence-Based Medicine. Four relevant randomized clinical trials were obtained. There was a reduced risk of heart failure events at 6 months following STEMI who underwent percutaneous coronary intervention (PCI) in the sacubitril/valsartan group compared to ACE inhibitor group, with a relative risk (RR) of 0.35 (95%CI 0.15 – 0.84; p=0.037); RR 0.5 (95%CI 0.31 – 0.82; p=0.004); and number needed to treat (NNT) of 6. Similar results were also found in STEMI patients complicated by cardiogenic shock: RR 0.47 (95%CI 0.24 – 0.94; p=0.044). Sacubitril/valsartan is more effective than ACE inhibitor in reducing the risk of heart failure at 6 months following STEMI post-PCI.
Evaluasi Pengukuran Kekakuan Limpa dalam Memprediksi Perdarahan Varises Esofagus Berulang pada Pasien Sirosis Hati Tahir, Andi Cahaya; Kurniawan, Juferdy; Simadibrata, Marcellus; Rizka, Aulia; Shatri, Hamzah; Lesmana, Cosmas Rinaldi A.; Mulansari, Nadia Ayu
Jurnal Penyakit Dalam Indonesia Vol. 11, No. 1
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Introduction. Esophageal variceal bleeding is one of the complications caused by an increase in pressure within the portal vein blood vessels. The gold standard examination for portal pressure is the hepatic venous pressure gradient (HVPG), but HVPG examination is invasive, involving transjugular catheterization of the hepatic vein. Currently, non-invasive methods for measuring portal hypertension are being developed to predict esophageal varices and esophageal variceal bleeding using spleen stiffness measurements. This study aimed to evaluate the accuracy of spleen stiffness measurement in predicting recurrent esophageal variceal bleeding in patients with liver cirrhosis. Methods. This study used a retrospective cohort design with secondary data sourced from medical records at Cipto Mangunkusumo Hospital. Spleen stiffness assessment was conducted using the vibration controlled transient elastography (VCTE) spleen-dedicated stiffness measurement (FibroScan®, Echosens, France) with a frequency of 100Hz. After six weeks post-first esophageal variceal bleeding in liver cirrhosis patients, an evaluation of recurrent esophageal variceal bleeding was performed. The collected data were analyzed using SPSS 26. The ability of spleen stiffness measurement to predict recurrent esophageal variceal bleeding was assessed by evaluating the AUROC (area under the curve of receiver operating characteristic) curve. Results. A total of 102 liver cirrhosis patients who experienced first-time esophageal variceal bleeding were included in the study. Recurrent esophageal variceal bleeding was found in 23/102 (22.5%) liver cirrhosis patients. There was a significant difference in spleen stiffness values between the two groups, with higher values in the group of patients with recurrent esophageal variceal bleeding (90.9 kPa (IQR: 86.5 – 96.2) vs. 59.3 kPa (IQR: 45.2 – 74.3), p < 0.001). The AUC value of spleen stiffness for predicting recurrent esophageal variceal bleeding provided good predictability, with an AUC value of 0.898 (95% CI 0.808 – 0.988), p < 0.001. The cut-off value of spleen stiffness at 70 kPa yielded a sensitivity of 87% and specificity of 65% in predicting recurrent esophageal variceal bleeding. Conclusion. Spleen stiffness measurement can be beneficial as an evaluation method to assess the likelihood of recurrent esophageal variceal bleeding in patients with liver cirrhosis at the 6th week after the first bleeding episode.
Peningkatan Leukosit, Neutrofil, dan Prokalsitonin Persisten Tanpa Bukti Infeksi pada Kanker Stadium Akhir: Sebuah Laporan Kasus Yanuar, Santosa; Ahani, Ardhi Rahman; Setiabakti, Andrian; Rizka, Aulia; Sinto, Robert
Jurnal Penyakit Dalam Indonesia Vol. 11, No. 2
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Elevation of leukocyte, neutrophil, and procalcitonin (PCT) has been known as a marker of bacterial infection independent of the underlying disease. This article will describe a case of end-stage cancer with persistent elevation of leukocyte, neutrophil, and procalcitonin with no evidence of infection. A 45-year-old female presented with abdominal distension for three months prior to hospital admission. The patient was suspected to have breast cancer with hepatic metastasis based on diagnostic tests. Throughout treatment, the patient experienced persistent elevation of leukocytes, neutrophils, and PCT despite no signs or symptoms of infection from history, physical examination, and diagnostic tests. The patient received antibiotic therapy including ciprofloxacin escalated to meropenem, but leukocytes, neutrophils, and PCT did not decrease. A breast tumor biopsy was performed. The result of biopsy revealed after the patient had passed away. The histopathology was invasive carcinoma, No Special Type (NST) of right breast. The immunohistochemistry showed luminal B type, HER2 positive. The persistent increase in leukocytes and neutrophils in this patient indicates poor prognosis, disease progression, metastasis, and pro-cancer activity of neutrophils. The elevated PCT in this patient may be due to systemic inflammation and/or aberrant secretion from the cancer itself.
Co-Authors Adila, Lana Ahani, Ardhi Rahman Aida Lydia, Aida Andre, Nobian Arcita Hanjani, Arcita Ardani, Yanuar Baso, Gery Dala Prima Ceva W Pitoyo Eka Ginanjar Em Yunir, Em Erni Juwita Nelwan, Erni Juwita Esthika Dewiasty, Esthika Findy Prasetyawaty, Findy Hamzah Shatri Harry Isbagio Helda Helda Indra G Mansur, Indra G Irman Firmansyah Juferdy Kurniawan Koesno, Soekamto Kuntjoro Harimurti Lesmana, Cosmas Rinaldi A. Lusiani Rusdi, Lusiani M Sadikin Marcellus Simadibrata Marpaung, Hamka Gunawan Nadia Ayu Mulansari, Nadia Ayu Retno S Wardani Retno Wahyuningsih Robert Sinto Rudi Putranto Setiabakti, Andrian Siti Setiati Sukamto Koesnoe Tahir, Andi Cahaya Yanuar, Santosa