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INDONESIA
Jurnal Penyakit Dalam Indonesia
Published by Universitas Indonesia
ISSN : 24068969     EISSN : 25490621     DOI : https://doi.org/10.7454/
Core Subject : Health,
Medicine & Pharmacology
Jurnal Penyakit Dalam Indonesia contains the publication of scientific papers that can fulfill the purpose of publishing this journal, which is to disseminate original articles, case reports, evidence-based case reports, and literature reviews in the field of internal medicine for internal medicine and general practitioners throughout Indonesia. Articles should provide new information, attract interest and be able to broaden practitioners insights in the field of internal medicine, as well as provide alternative solutions to problems, diagnosis, therapy, and prevention.
Arjuna Subject : Kedokteran - Kedokteran Internal
Articles 360 Documents
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Value of Heart Rate Variability, Neutrophil-Lymphocyte Ratio and Quality of Life of Patients with Depressive Symptoms in Acute Myocardial Infarction Shatri, Hamzah; Adli, Mizanul; Muhadi, Muhadi; Abdullah, Murdani; Irawan, Cosphiadi; Putranto, Rudi; Koesnoe, Sukamto; Wijaya, Ika Prasetya
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 4
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Introduction. Major depression criteria can be found in more than 20% of coronary heart patients and more than 30% acute coronary syndrome patients have significant depressive symptoms. Several studies have shown that reduction of hearth rate variability (HRV) and enhancement of neutrophil lymphocyte ratio (NLR) can cause enhancement of morbidity and mortality in myocardial infarction patients. On the other hand, depression can cause reduction of HRV, enhancement of NLR and reduction of quality of life. This study aimed to determine differences in HRV, NLR and quality of life between acute myocardial infarction (AMI) patients with depressive symptoms and AMI patients without depressive symptoms. Methods. A cross-sectional study was conducted among AMI patients who were treated during the period of March to July 2021 at the Intensive Cardiac Care Unit (ICCU) Cipto Mangunkusumo Hospital Jakarta. Samples were taken consecutively until the amount of sample is met. Data were analyzed using unp aired T test. Results. There was a total of 46 subjects AMI patients in this study, ten subjects with depressive symptoms and 36 subjects without depressive symptoms. From the analysis, it was found that AMI patients with depressive symptoms had lower standard deviation normal to normal (SDNN) average (p=0.447), lower low frequency/high frequency (LF/HF) (p=0.323), and higher NLR average (p=0.438) than AMI patients without depressive symptom, although it was not statistically significant. Analysis showed that the mean value of SF36 total scores (p<0.001), physical function domain scores (p<0.001), energy domain scores (p<0.001), mental health domain scores (p<0.001), social function domain scores (p=0.028), bodily pain domain scores (p=0.002), and general health domain scores (p=0.002) were lower in AMI patients with depressive symptoms. Conclusion. AMI patients with depressive symptoms had lower SDNN, lower LF/HF, and higher NLR than AMI patients without depressive symptoms, although it was not statistically significant. AMI patients with depressive symptoms significantly have lower quality of life than AMI patients without depressive symptoms.
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
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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.
Effect of Advance Care Planning on Heart Failure Patients: An Evidence Based Case Report Shatri, Hamzah; Nurfitria, Nandika; Sinulingga, Dika; Irvianita, Vinandia; Faisal, Edward; Putranto, Rudi; Martina, Diah
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 4
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Despite the advances in medical therapy, heart failure remains a disease that requires attention due to the course of the illness; it can lead to unpredictable, progressive, and fatal conditions. Existing therapy aims to improve the condition and prevent disease progression, with a balanced secondary therapy for various conditions that can trigger acute decompensated heart failure. Advances in technology and therapy may increase the prevalence of patients with heart failure, including prolonging the refractory phase of the disease. There are recommendations for advance care planning to support patient therapy and improve the quality of life of patients with heart failure. This evidence-based case report aims to investigate the benefits of advance care planning in heart failure patients. A heart failure patient is referred to the palliative care team for advance care planning. Literature searches were conducted on ProQuest, PubMed, Scopus, and Cochrane according to the clinical questions. The studies were selected based on the inclusion and exclusion criteria, then a critical review was conducted. One study showed significant results regarding the effectiveness of advance care planning on the quality of life of heart failure patients. Another study showed a significant improvement in depression among patients engaged in advance care planning. However, it showed no difference in the quality of life compared to usual care because the sample size was relatively small, and the quality of evidence was low. Therefore, it can be concluded that advance care planning can improve heart failure patients’ psychological symptoms and quality of life.
Dampak Pandemi COVID-19 terhadap Mahasiswa Kedokteran P. Utari, Amanda
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 3
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Outcome Result of Acute Myeloid Leukemia Undergoing Treatment in Semi-Isolation Chemotherapy Ward Irawan, Cosphiadi; Steven, Ricci; Gunarsa, Ralph Girson; Tenggara, Jeffry Bela
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 3
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Introduction. Standard positive pressure isolation room is not yet widely available in Indonesia. In several private hospitals, current best practice is admitting patients to semi-isolation room with additional protective measures. Despite the limitation, this practice is considered safe and might benefit Acute Myeloid Leukemia (AML) patients. This study aimed to analyze the leukemic profile and survival in AML patients admitted to semi-isolation room. Methods. A retrospective cohort study was conducted using secondary data from medical record of AML patients diagnosed in Mochtar Riady Comprehensive Cancer Center between 2018 – 2020. Patients were divided into semi-isolation room group and not admitted to semi-isolation room group. Semi-isolation room patients who received standard chemotherapy regimen were further analyzed according to complication, outcome, and survival.Results. We included 45 AML patients, 53.3% were females, 42.2% in the 40-59 years age group, and 28.9% were AML-M2. Fifteen patients received standard chemotherapy regimen including D3A7, FLAG, ATRA-Daunorubicin-Cytarabine in semi-isolation room, 60% of them had complete remission after treatment completion. Patients who not admitted to semi-isolation room received conservative treatments including hydroxyurea, mercaptopurine, cytarabine cytoreduction, and decitabine. Among patients in semi-isolation room, 41.2% had sepsis and 29.4 % had septic shock, with most of the sources coming from bloodstream infection (80%), Acinetobacter baumannii remained the most prevalent microorganism. Treatment outcomes showed median Progression Free Survival (PFS) of 11 months, 1-year survival was 47%, and 2-year survival was 27%.Conclusions. In countries with limited standard isolation room, treatment of AML patients in semi-isolation room with infection control protocol could be considered in order to give the standard induction chemotherapy regimen. Although there was an infection risk, strict isolation policy produced good response (60% complete remission).
Threats of COVID-19 Reinfection: A Review of the Evidence from the Literature Adnan, Muhammad Luthfi; Fauziyati, Ana
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 3
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Case of COVID-19 reinfection are related to immune factors in patients who have recovered by the natural course of the infecting pathogen. However, the chance of COVID-19 reinfection are still not well established. This review aimed to discuss about reinfection-related studies, including causes and clinical manifestations, and reinfection management. Reinfection happens when a patient is infected by the SARS-CoV-2 virus, which has a different genome from previous infection. Although the comparison of clinical manifestation between reinfection and the previous infection is not clear, it is believed that vulnerable populations may have worse outcomes. Vaccination is the main option to reduce the severity of reinfection. Further studies are needed to understand the mechanisms and management of COVID-19 reinfection. Thus, the development of COVID-19 treatment and vaccine can be more effective.
Proportion of Depression Symptoms and Its Relationship with ARV Therapy: A Study at the VCT Clinic, Dr. Kariadi General Hospital Sofro, Muchlis Achsan Udji; Raharja, Tommy; Haidati, Titis; Sari, Linda Kartika; Jusup, Innawati
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 2
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Introduction. Indonesia has the second largest HIV burden in Asia. The prevalence of depression in HIV/AIDS is 2-10 times higher than the general population, influenced by biological, environmental, psychological, and demographic factors. Data on the proportion of depression symptoms in HIV/AIDS patients and their relationship to biological factors are still limited, which needed for better treatment of HIV/AIDS. This study aimed to determine the prevalence of depression and its relationship to the biologic factors of ARV therapy (ART) in HIV/AIDS patients.Methods. Cross-sectional study was conducted among 142 HIV/AIDS patients undergoing ARV treatment at RSUP. Dr. Kariadi in January – March 2021. Demographic data, ART, ART type, side effects, ARV use duration, viral load, and CD4 cell count were obtained from medical records. The incidence of depression was assessed by the Beck Depression Inventory II (BDI-II).Results. The proportion of depression symptoms was 48.6%, consisting of mild depression (26.1%), moderate depression (17.6%), and severe depression (4.9%). Multivariate analysis resulted a significant relationship between the incidence of depression and biological factors, consisting of ART side effects, ART use duration, and CD4 cell count. Meanwhile, there was no significant relationship between the incidence of depression with the ART type and viral load. Conclusion. The proportion of depression symptoms in HIV patients undergoing ART is 48.6%. It is concluded that biological factors can affect the proportion of depression in patients with ART.
The Association between Type 2 Diabetes Mellitus and The Outcome of COVID-19 Patients at Sanglah Hospital in 2020-2022 Upadhana, Putu Sayakumara; Sastrawan, I Gede Gita; Rahmautami, I Gita Dewi; Merry, Merry; Daradila, Ni Putu Kostarika Melia; Sutanto, Derian Adiguna; Pertiwi Manuaba, Ida Ayu Santhi; Hartadi, Putu Ardy; Ratna Kinasih, Komang Vika Nariswari; Sudarmika, Putu
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 2
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Introduction.People with type 2 diabetes mellitus (T2DM) are at a higher risk of mortality from COVID-19. This study aimed to identify the relationship between T2DM and the outcome of COVID-19 patients in Sanglah Hospital Denpasar, Bali. Methods. An observational analytic study with a cross-sectional approach was conducted among COVID-19 patients. We used secondary data from the records of confirmed COVID-19 patients who were treated at Sanglah Hospital on 1 August 2020 – 28 February 2022. Sample were selected with total sampling technique. Results. There were 1,056 patients involved in this study. Most of the patients were male (n=571; 54.1%), with a median age of 59 years old. Most of the patients were categorized as severe COVID-19 (n=641; 60.7%). A total of 275 patients had T2DM (26.0%). Chi-square analysis showed a significant association of T2DM with mortality (PR=1.422; 95%CI=1.162-1.742; p=0.001), severe COVID-19 (PR=1.726; 95%CI=1.365-2.184; p<0.001), ventilator usage (PR=1.334; 95%CI=1.093-1.791; p=0.045), and longer hospitalization duration (PR=1.340; 95%CI=1.083-1.658; p=0.006) with T2DM. Logistic regression analysis showed significant association of T2DM with mortality (PR=1.536; 95%CI=1.110-2.125; p=0.010), severe COVID-19 (PR=1.704; 95%CI=1.233-2.356; p<0.001), and longer hospitalization duration (PR=1.615; 95%CI=1.191-2.190; p=0.002).
Atherogenic Index of Plasma is Correlated with Prolonged Length of Stay in COVID-19 Patients with Type 2 Diabetes Mellitus in RSUP Sanglah Denpasar Sastrawan, I Gede Gita; Upadhana, Putu Satyakumara; Handayani, Putu Novi; Laela, Tika Rizki Nur; Dewi, Kadek Aprilia Sukma; Wiguna, I Nyoman Bayu Andika; Trisna, Cindy Gracia; Putri, Komang Anjani; Agrasidi, Komang Adya Data; Sudarmika, Putu
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 2
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Introduction. Atherogenic index of plasma (AIP) is a logarithmic calculation of the ratio of triglycerides to HDL cholesterol as a marker of lipid profile abnormalities. In COVID-19 patients with comorbid type 2 diabetes mellitus (T2DM), higher AIP tend to worsen the patient conditions. This study aims to assess the correlation between AIP and length of stay (LOS) in COVID-19 patients with T2DM.Methods. An analytical observational study with a cross-sectional approach was conducted among COVID-19 patients with comorbid T2DM. Data were collected from online medical records of confirmed COVID-19 patients with comorbid T2DM who were treated at Sanglah Hospital Denpasar during the period August 1-December 31, 2021. Patients who were <18 years old and did not have lipid profile data during>treatment, were excluded from this study.Results. There were 83 data samples that met the study criteria. The median age of the patients was 64 (23- 91) years, the majority were male (59%; n=49), and 30 patients died during treatment (36.1%). The median LOS for all patients was 10 (1-26) days. Patients with prolonged LOS (≥10 days) had higher triglyceride levels (171.8 vs. 120 mg/dL; p<0.001) and AIP values (0.442 vs. 0.286; p=0.02). There was a strong relationship between AIP and LOS values in COVID-19 patients with T2DM (r=0.632; p<0.001). The AIP value can well-discriminated in prolonged LOS conditions (AUC=0.883; 95%CI 0.792-0.974) with the optimal cut-off value of 0.3045 (sensitivity 75.9% and specificity 83.3%).Conclusion. AIP is correlated with prolonged LOS in COVID-19 patients with T2DM. Holistic management of COVID-19 patients with T2DM is urgently needed, including lipid profile control.
Effectivity of Opioid Rotation Compared to Opioid Combination for Cancer Pain: An Evidence Case Report Faisal, Edward; Puspadina, Shafira; Puranto, Rudi; Shatri, Hamzah
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 2
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Pain is the main symptom in cancer patients that needs to be addressed immediately because it can reduce the quality of life. Concern or the ineffectiveness of using one type of opioid makes it necessary for clinicians to understand how to rotate opioids. Therefore, this evidence-based case report was conducted to identify the effectiveness of opioid rotation and combined opioids for the cancer pain management through a literature search on three databases. Literature searching was performed by using Pubmed, Cochrane library, and EBSCO according to clinical inquiries. Of the 24 studies obtained, only one study met the criteria and was then critically assessed. The study found that pain score in both opioid rotation group (fentanyl transdermal) and combined opioids group (oral oxycodone and fentanyl transdermal) was decreased from 2.9 to 2.0 (p=0.22) and 3.0 to 1.8 (p<0.06), respectively. In addition, therapeutic success was achieved in 11 patients in the opioid rotation group and 12 patients in the combined opioids group (p=0.98). Based on the study, it can be concluded that opioid rotation is as effective as combined opioids in managing pain in cancer patients.

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