JURNAL PENYAKIT DALAM UDAYANA (UDAYANA JOURNAL OF INTERNAL MEDICINE) Published by Indonesian Society of Internal Medicine Bali branch (PAPDI cabang Bali) in association with Udayana University. Udayana Journal of Internal Medicine is an open access, peer-reviewed journal aiming to communicate high quality research articles, reviews and general articles in the field of internal medicine. Udayana Journal of Internal Medicine publishes articles which encompass all aspects of basic research/clinical studies related to the field of internal medical sciences. The Journal aims to bridge and integrate the intellectual, methodological, and substantive diversity of medical scholarship, and to encourage a vigorous dialogue between medical scholars and practitioners. We welcome authors for original articles (research), review articles, interesting case reports, special articles, clinical practices, and medical illustrations that focus on the clinical area of internal medicine.
The page kidney phenomenon: Rarely found causes of secondary hypertension subcapsular hematoma renal in post-trauma cases
Page Kidney Phenomenon is a rare condition caused by extra-renal processes that cause the kidney parenchyma to compress, thus activating the renin-angiotensin-aldosterone system (RAAS). The manifestation that occurs is secondary hypertension. The etiology of Page Kidney can be caused by trauma and non-trauma. Initial management to treat secondary hypertension can be divided between antihypertensive treatment and combined with surgical approaches to drainage of hematoma subcapsular and in extreme cases nephrectomy total. An 18-year-old man was taken to the emergency room after a motorbike accident. The patient's blood pressure continued to increase to 178/91 mmHg. Abdominal ultrasonography revealed a subcapsular hematoma of the right kidney measuring 0.9 x 2.9 x 4.6 cm. The patient was diagnosed with Page Kidney. This patient was given antihypertensive therapy with a single pill combination (SPC) which is a combination of valsartan 80 mg and amlodipine 5 mg 1 x 1, with this antihypertensive therapy, secondary hypertension is controlled.
Copyright (c) 2024 Jurnal Penyakit Dalam Udayana https://creativecommons.org/licenses/by/4.0
The comparison of fecal occult blood test screening and flexible sigmoidoscopy in reducing mortality risk in colorectal cancer patients: Systematic review and meta-analysis
Introduction: Colorectal cancer is a malignancy originating from the colon and is the second most common new case in women. Most patients come for treatment at an advanced stage so they have a low life expectancy. Screening in colorectal cancer patients is expected to be used for early detection so as to speed up the management of colorectal cancer patients. Fecal occult blood test (FOBT) and flexible sigmoidoscopy (FS) are colorectal cancer screening that has been applied. However, the effectiveness of the two is still contradictory, so a systematic review and meta-analysis is needed to evaluate their effectiveness. Objective: To explore the use of FOBT and FS in colorectal cancer screening. Methods: A literature search was performed on Pubmed, Google scholars, and Cocraine, CINAHL. Selection of titles and abstracts based on inclusion and exclusion criteria, double filter, journal read in full. This study obtained was assessed for its validity. Result: There are 10 journals analyzed. The use of FS is more effective than FOBT in reducing colorectal cancer mortality. The use of FOBT has an effect on colorectal cancer mortality 0.86 (95% CI 0.79, 0.94 p = 0.001). The use of FS had a significant effect on colorectal cancer 0.82 (95% CI 0.88, 0.98 p = 0.03). Both of these screenings cannot reduce the incidence of colorectal cancer. Conclusion: FS more effective to reducing mortality than FOBT on colorectal cancer.
The severity of anemia and type of erythrocyte index in patients with chronic kidney disease undergoing regular hemodialysis in Prof. Dr. I.G.N.G Ngoerah General Hospital
Introduction: Chronic kidney disease (CKD) is a clinical condition characterized by an irreversible decline in kidney function and requires renal function replacement therapy in the form of dialysis or kidney transplantation. Anemia is a complication that occurs in 80-90% of CKD patients. This study aimed to observe the severity of anemia and type of erythrocyte index in patients with CKD undergoing regular hemodialysis. Methods: This is a descriptive observational study with retrospective method to analyze data by describing the data that has been analyzed as it is. This study was performed in Prof. Dr. I.G.N.G Ngoerah General Hospital, Bali within the month of May 2022. The population of this study was 100 CKD patients who underwent routine hemodialysis according to inclusion and exclusion criteria using medical record data. The sample collection technique was purposive sampling method and this study design has been approved by the institutional ethical board. Results: Out of 100 CKD patients who underwent regular hemodialysis that were observed, most of them are male patients (52%) and mostly at the age of 55-64 years old (31%). Anemia was found in 84 out of 100 CKD patients that were observed with the severity of anemia mostly is moderate anemia. Erythrocyte index was mostly in the normal range with the type of anemia generally is normocytic normochromic anemia. Conclusion: The majority of MCV, MCHC, MCH values of CKD patients undergoing hemodialysis are normal.
Edukasi daring untuk meningkatkan pengetahuan tenaga medis terhadap monkeypox sebagai new emerging disease
Introduction: Monkeypox is a new emerging infectious disease and is just beginning to be recognized in Indonesia. This study aimed to know the increase in healthcare workers' knowledge about Monkeypox through an online seminar. Method: This research is an experimental study with a quasi-experimental design. The research sample consists of all healthcare workers at health posts affiliated with the Jakarta Archdiocese (KAJ) in 45 regions who attended an online education session about Monkeypox (n=64). The healthcare workers' knowledge before and after the education was assessed by analyzing data using the SPSS program. Initially, normality tests were conducted, followed by non-parametric tests using the Wilcoxon test. Results: The data analysis showed that the mean values of pretest and post-test scores on Monkeypox were 6.33±1.69 and 7.86±1.51, respectively. The statistical test indicated a significant increase in participants' knowledge about Monkeypox (p=0.000). Conclusion: Providing education through online seminars has been proven to enhance healthcare workers' knowledge about Monkeypox. Online seminars held on weekends with appropriate duration and clear content are effective in improving participants' knowledge.
The effect of probiotics on inflammatory bowel disease Remission and relaps rate: A systematic review and meta-analysis
Introduction: Dysbiosis is believed to play a role in the pathogenesis of Inflammatory Bowel Disease (IBD). Therefore, there is a hope that giving probiotics can be an addition to standard IBD treatment. This study aims to examine the efficacy of probiotics on the remission and relapse rates of IBD and its safety profile. Methods: The authors collected studies from PubMed, Scopus, Embase, Cochrane, and Google Scholar. Inclusion criteria included all randomized controlled trials that compared groups of adult IBD patients (>18 years) who received probiotics and placebo on their standard treatment. Results: Twenty-four studies met the inclusion criteria with a total sample of 2,233. The mean age of the sample was 39.1 ± 12.4 years in the probiotic group and 38.2 ± 12.3 years in the placebo group. The remission rate in the probiotic group was higher than placebo (OR 1.58, 95% CI 1.28-1.95, p<0.0001). Moreover, the relapse rate in the probiotic group was significantly lower than in the placebo group (OR 0.70 CI 95% 0.53-0.93, p=0.01). There was no significant difference in the incidence of adverse events in the probiotic group compared to placebo (RR 1.04, CI 95% 0.85-1.29, p=0.68). Multistrain probiotics increased the remission rate(OR 2.68, CI 95% 1.88 -3.83, p=<0.00001). Meanwhile, only Bifidobacterium sp. significantly reduced the relapse rate (OR 0.07, p=0.002). Conclusion: Probiotics can significantly ameliorate the remission rate and reduce the relapse rate in IBD patients. Giving probiotics that contain particular strains can increase the remission rate and reduce the relapse rate in IBD.
Korelasi kadar antibodi anti-SARS-COV-2 paska-vaksinasi COVID-19 dan tekanan darah pada obesitas dan non-obesitas
Background: Obesity tends to lead to ineffective antibody production after COVID-19 vaccination. One of the widely studied antibody parameters currently is the quantitative anti-SARS-CoV-2, which is an in vitro examination to measure quantitative antibodies (including IgG) against the receptor binding domain (RBD) of the SARS-CoV-2 Spike (S) protein. There are reports that COVID-19 vaccination also causes an increase in blood pressure, especially mRNA-based vaccines. Objective: The aim of this study is to determine the correlation between post-COVID-19 vaccination anti-SARS-CoV-2 antibody levels and blood pressure in obese and non-obese individuals. Methods: This study is an analytical cross-sectional study. The sample consisted of 96 healthcare workers at Prof. I.G.N.G. Ngoerah Hospital, aged 18-59 years, who have undergone a COVID-19 vaccination program with 4 doses (two boosters and the last booster using the mRNA-1273 or Moderna vaccine). Result: Systolic and diastolic blood pressure correlated with anti-SARS-CoV-2 levels (r=0.265, p=0.009 and r=0.245, p=0.016). In the obese group, systolic and diastolic blood pressure showed a positive and significant correlation with anti-SARS-CoV-2 levels (r=0.373; p=0.011 and r=0.351; p=0.017). Conclusion: Systolic and diastolic blood pressure have a positive and significant correlation with anti-SARS-CoV-2 levels, especially in the obese group.
Comparison of high sensitive c reactive protein levels between metabolically healthy and unhealthy obese
Introduction: Overweight and obesity are associated with risks of several comorbidities, yet not all individuals with obesity condition having equal metabolic risks, suggesting the presence of a subgroup known as metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO). Obesity is characterized by chronic low-grade inflammation, with C-reactive Protein (CRP) serving as a key inflammatory marker. Research on high-sensitivity CRP (hs-CRP) levels across different obesity categories, especially MHO and MUHO, remains limited. Aim: This study aims to compare hs-CRP levels across various levels of obesity, particularly in MHO and MUHO individuals. Methods: This analytical cross-sectional study included subjects aged 18-60 from Denpasar with a BMI over 25 kg/m2. Subjects with chronic or acute inflammatory conditions were excluded. Comparative tests were utilized for analysis. Results: The study comprised 40 men and 20 women with an average age of 35.6 years. Of these, 35% were classified as MHO and 65% as MUHO. The analysis revealed no significant difference in hs-CRP levels between the MHO and MUHO groups (p = 0.108), likely due to similar age and BMI distributions resulting in comparable levels of inflammation. Conclusion: The analysis demonstrated no significant variation in hs-CRP levels between MHO and MUHO groups.
Characteristics and quality of life of chronic kidney disease patients undergoing hemodialysis in Surabaya
Background: Quality of life is a complex concept that includes an individual's physical, mental, social, and environmental health. Chronic Kidney Disease (CKD), a degenerative condition affecting kidney function, can greatly influence the quality of life of patients. Objective: To characterize the quality of life among CKD patients receiving hemodialysis in Surabaya. Methods: The study sample consisted of 96 participants meeting the inclusion criteria in Surabaya. This research employed a descriptive observational approach utilizing a multistage random sampling method. Public health centers were selected using a cluster sampling technique, and respondents were sampled through a simple random sampling method. The quality of life questionnaire from WHOQOL-BREF was used as the data collection instrument. Results: Findings indicate that CKD patients undergoing hemodialysis in Surabaya predominantly fall within the 55-64 age group (31 respondents, 32.3%), with 50 female respondents (52.1%), 52 respondents having completed senior high school (54.2%), and 56 respondents not currently employed (58.7%). The majority of CKD patients undergoing hemodialysis reported a good quality of life (62 respondents, 64.6%). However, in the physical domain, 20 respondents (20.8%) experienced a decline in quality of life, reaching the moderate category. Conclusion: This study concludes that CKD patients undergoing hemodialysis in Surabaya generally exhibit a good quality of life, particularly among individuals aged 55-64, predominantly women, with a senior high school education level, and not currently employed.
The efficacy of administering elbasvir/grazoprevir as hepatitis C therapy in hemodialysis patients with comorbid of hypertension and diabetes mellitus
Background: Hepatitis C and chronic kidney disease (CKD) are significant global health burdens. Hemodialysis therapy can pose a risk of hepatitis C infection. Conditions related to Hepatitis C, such as hypertension and diabetes, have morbidity and mortality rates and can impact the outcomes of hepatitis C treatment. Objective: This study aimed to assess the efficacy of Elbasvir/Grazoprevir as hepatitis C therapy in hemodialysis patients with comorbid hypertension and diabetes mellitus. Methods: The target population for this study consists of hepatitis C-infected patients undergoing routine hemodialysis with comorbid hypertension and diabetes mellitus who were treated with Elbasvir/Grazoprevir. The data collected included demographic characteristics, comorbid conditions (hypertension and diabetes mellitus), cirrhosis status, and whether patients achieved Sustained Virologic Response (SVR). Multinomial logistic regression was used to calculate the odds ratio (OR). Results: From the population profile of the study, a total of 164 individuals were included, with the majority being under 60 years old. Patients with comorbid hypertension or diabetes mellitus achieved SVR rates of 95% and 83.3%, respectively, while patients with both comorbid conditions, hypertension, and diabetes mellitus, had an SVR rate of 74.07%. The multinomial logistic regression analysis showed that patients with both comorbid conditions (HT and DM) had a higher risk of failing to achieve SVR compared to patients without comorbid conditions, with an OR of 22.4, p = 0.005. Conclusion: Administering Elbasvir/Grazoprevir for hepatitis C therapy in hemodialysis patients with comorbid hypertension and/or diabetes mellitus carries a higher risk of SVR failure compared to those without comorbid conditions.
Copyright (c) 2023 Jurnal Penyakit Dalam Udayana https://creativecommons.org/licenses/by/4.0
Tuberkulosis pankreas pada pasien human immunodeficiency virus (HIV): laporan kasus
Tuberkulosis (TB) merupakan penyakit yang disebabkan oleh Mycobacterium Tuberculosis. TB umumnya ditemukan pada paru-paru. Sekitar 20% kasus TB terjadi di luar paru, dengan 5-12% kasus terjadi pada perut. TB pada perut dapat melibatkan berbagai organ intra-abdominal salah satunya adalah pankreas. Pasien perempuan 40 tahun datang ke poliklinik penyakit dalam dengan keluhan nyeri pada ulu hati hingga tembus ke punggung yang memberat sejak 3 hari sebelum masuk rumah sakit. Nyeri dirasakan seperti tertusuk-tusuk yang diperberat saat makan. Pasien juga mengalami demam, mual dan muntah. Pasien memiliki riwayat HIV dan TB. Pada pemeriksaan fisik ditemukan ikterus pada sklera, jaundis pada kulit, kandidiasis pada lidah dan nyeri tekan pada epigastrium tanpa teraba adanya massa. Pemeriksaan USG abdomen ditemukan adanya pembesaran pada pankreas disertai dilatasi pada saluran empedu intra hepatic. Pemeriksaan CT scan abdomen dengan kontras menunjukkan adanya dilatasi duktus pankreatikus dengani pembesaran fokal pada caput pankreas berukuran 4,0 cm x 4,5 cm x 5,1 cm dan pembesaran beberapa kelenjar, serta sentral nekrotik pada mesenterik, peripankreas, paraaorta dan periportal dengan diameter terbesar 1,9 cm. Pemeriksaan gold standar berupa biopsi melalui laparotomi atau endoscopic ultrasound-fine needle aspiration (EUS-FNA) sulit dilakukan karena invasif, keterbatasan alat dan sumber daya tenaga kesehatan.
Characteristic of hospitalized COVID 19 patients with gastrointestinal manifestation and liver injury
Background: COVID-19 is known to affect the digestive and liver systems. These can occur during the disease, and the prevalence was varied widely. Objective: This study aimed to investigate the prevalence and characteristics of hospitalized COVID-19 patients with gastrointestinal symptoms and liver injury. Methods: The data collected from the first 3 months of COVID-19 hospitalized patients (April – June 2020). We analyzed patients with gastrointestinal symptoms (nausea or vomiting, abdominal discomfort or pain, diarrhea, and anorexia) and patients with liver injury (alanine aminotransferase (ALT) (> 45 U/L for men and > 34 U/L for women) or aspartate aminotransferase (AST) level (> 35 U/L for men and > 31 U/L for women) at admission), then compared their clinical features with those who did not show gastrointestinal symptoms and liver injury. Results: A total of 232 hospitalized COVID-19 patients were included. Gastrointestinal symptoms were found in 16.4% of patients. The symptoms were diarrhea (3.01%), anorexia (1.72%), nausea or vomiting (12.06%), and abdominal pain or discomfort (1.72%). The patients with gastrointestinal symptoms were more likely than those without to be admitted to the intensive ward (13.15% vs. 2.5%; p= 0.012). The elevation of liver aminotransferase levels on admission was found in 40.9% of patients. Longer hospitalization (15 days vs 11 days; p= 0.007) more likely to have liver injury. Conclusion: Patients with liver injury had a longer hospital stay than patients without liver injury, while gastrointestinal symptoms have no significance on the duration of hospitalization.
Cokorde Istri Yuliandari Krisnawardani Kumbara
Predictor of death in elderly patients with Covid-19 : a retrospective cohort study at RSUP Prof Dr. I.G.N.G Ngoerah
Background: COVID-19 in elderly has poor prognosis as well as patients with comorbidities. However, evidence that showed comorbidities in COVID-19 cause death, regardless of age, has not been obtained Methods: A retrospective cohort study in patients aged 60 years and over with COVID-19 who were hospitalized in Prof. dr. I. G. N. G. Ngoerah Hospital was conducted by taking data from medical record Results: The highest proportion of deaths were 130 men and 36 with hypertension comorbidities. Age was not significantly associated with death (p=0.60), male gender was significantly associated with death (p=0.005), smoking had significant effect on death (p=0.047). Based on the symptoms, there was no relationship between death and fever (p = 1.00), cough (p = 0.054), nausea and vomiting (p = 0.s35). However, there is significant relationship with shortness of breath (p = 0.00) and delirium (p = 0.00). Based on previous medical history, there was no significant association between death and diabetes (P=0.78), hypertension (p=0.26), COPD (p=1.0), ischemic stroke (p=0.11), heart disease (p=0.11)), congestive heart disease (p=0.65), kidney disease (0.81), and tumors (p=0.31). High D-dimer levels also were not associated with death (p=0.37). Treatment with antibiotics (p=0.04), anticoagulants (p=0.002) and corticosteroids (p=0.00) were significantly associated with death. The use of antiviral was not significantly associated with death (p=1.00). Conclusion: Factors associated with the death of elderly patients with COVID-19 were male gender, smoking, treated with antibiotics, anticoagulants and corticosteroids.
Avascular necrosis of femoral head (AVNFH): Kasus yang jarang ditemui sebagai gejala fase kronik pada pasien chronic myelogenous leukemia dewasa dengan terapi nilotinib
Chronic myelogenous leukemia (CML) adalah kelainan klonal malignan dari stem cell hematopoetic yang ditandai dengan kelainan proliferasi dan akumulasi imatur granulosit. Avascular necrosis (AVN) sangat jarang ditemui pada pasien CML dimana sebuah systematic review melaporkan hanya terdapat 21 kasus dari tahun 1984 hingga 2021 dengan 17 kasus merupakan avascular necrosis of the femoral head (AVNFH) dan 3 kasus diantaranya dihubungkan dengan pemberian terapi tyrosine kinase inhibitors yaitu imatinib, desatinib serta nilotinib. Kami melaporkan pasien laki-laki berusia 51 tahun dengan keluhan nyeri sendi pinggul. Pasien didiagnosis menderita CML dari pemeriksan sumsum tulang dengan hasil hiperseluler dan pemeriksaan PCR yang mendeteksi adanya transkripsi BCR-ABL dalam bentuk fusi b2a2. Pasien mendapat terapi nilotinib 200 mg setiap 12 jam. Diagnosis avascular nekrosis ditegakkan dari gejala klinis dan pemeriksaan radiologi. Pasien direncanakan menjalani total hip replacement.
The effect of acupuncture on improvement of Pittsburgh Sleep Quality Index Scores in geriatric patients with insomnia: A randomized, sham-controlled, single-blind clinical trial
Background: Life expectancy continues to grow gradually in developed countries up to 120. The elderly often complain of insomnia which is influenced by mental health, physical illness, comorbid diseases, and life satisfaction. Moreover, multi-pathological conditions can occur in geriatric patients over the age of 60 with insomnia. In this case, the drugs used can have unwanted side effects. Objective: This study aimed to compare the effect of acupuncture with sham on the difference in Pittsburgh Sleep Quality Index (PSQI) scores after the 8th session in geriatric patients with insomnia. Methods: This single center, randomized, controlled, single-blind clinical trial on geriatric patients who experienced insomnia at the geriatric and acupuncture polyclinic of RSUPN dr. Cipto Mangunkusumo. Thirty-six (36) eligible subjects with consecutive sampling methods were randomly assigned 1:1 into acupuncture and sham groups. PSQI test was conducted at the beginning and end of treatment which will result scores that will be analyzed using the T-Test if they are normally distributed. Otherwise, the Mann-Whitney Test is used. Result: Thirty-four (34) participants completed the trial and two dropped out. Based on the data analysis result, the average of initial PSQI scores between the acupuncture and sham acupuncture groups were not significantly different (p=0,488). Meanwhile, the difference in PSQI scores after 8th session in the acupuncture group was greater than sham acupuncture (p=0,013). Conclusion: Based on the study results, it was concluded that acupuncture had a greater PSQI score reduction effect than sham acupuncture in geriatric patients with insomnia.
Korelasi lemak viseral sebagai penanda obesitas sentral pada pemeriksaan body impendance analysis dengan serum profil lipid dan kadar gula puasa
Background: Several health problems have been found due to high levels of visceral fat, including disorders of glucose and fat metabolism and insulin resistance. Visceral fat is associated with central obesity because visceral fat produces abnormal amounts of hormones, such as high insulin secretion. Objective: This study aimed to describe the metabolic condition and examine its correlation with visceral fat levels in the body. Method: The study used an analytic cross-sectional design, with consecutive sampling. The study was conducted on Internal Medicine residents at Prof. IGNG Ngoerah Hospital, Denpasar, Bali, Indonesia from September 1st – 14th 2022. Visceral fat was measured using Body Impendance Analysis (BIA). Fasting blood sugar and lipid levels were measured using flow cytometry Results: From 114 samples of Internal Medicine residents, it was found that visceral fat levels had a positive correlation with fasting blood sugar (r = 0.326) (p 0.0005), LDL (r = 0.251) (p 0.007), and triglycerides (r = 0.47) (p = 0.0005). HDL levels had a negative correlation with visceral fat levels (r = -0.446) (p = 0.0005). Conclusion: This study shows a positive correlation between visceral fat levels and triglycerides, fasting blood sugar, and LDL levels and a negative correlation between visceral fat levels and HDL levels.
A rare case of primary tuberculosis complex in the abdomen
Cutaneous tuberculosis (CTB) is the rarest form of tuberculosis (TB). CTB cases account for less than 1% of all TB cases and about 15% of all extrapulmonary tuberculosis (EPTB) cases. CTB is rare even in communities where it is endemic. CTB has a variety of manifestations and can appear similar to other disease processes. Therefore, many clinicians have difficulty recognizing CTB because CTB is known to be a great imitator. We present an unusual case of CTB which happened to be a primary tuberculous complex (PTC) manifested as an ulcerated abdomen in a 33-year-old woman. Previous medications received showed no improvement and referred to the hospital for further treatment. Histopathology of the skin lesion showed fibrous connective tissue that contained granulomas composed by epithelioid histiocytes, lymphocytes, plasma cells, and multinucleated giant cells. Patients were given therapy in the form of a fixed-dose combination of antituberculosis drugs (fixed-dose combination/FDC) and vitamin B6. Despite being rare, PTC is important to consider in patients with suggestive clinical pictures of the infection.
Pankreatitis pasca endoscopic retrograde choalangiopancreatography dan hubungannya dengan beberapa faktor risiko: studi potong lintang pada pasien endoscopic retrograde choalangio pancreatography
Latar Belakang: Endoscopic Retrograde Cholangiopancreatography (ERCP) adalah tindakan endoskopi untuk diagnostik dan terapi kelainan-kelainan di sistim pankreatobilier. Komplikasi yang paling sering ditemukan pasca tindakan adalah pankreatitis akut atau post-ERCP pancreatitis (PEP), dengan spektrum klinis dari ringan sampai berat, dan memerlukan biaya perawatan yang besar. Tujuan: Studi ini bertujuan untuk mengetahui faktor-faktor risiko yang berhubungan dengan kejadian PEP pada pasien-pasien yang telah menjalani tindakan ERCP di Rumah Sakit Umum Pusat Sanglah Denpasar. Metode: Studi ini adalah studi retrospektif yang melibatkan 118 pasien dari Januari 2015 sampai dengan Juni 2019. Sebanyak 12 faktor risiko yang berhubungan dengan pasien dan 6 faktor risiko yang berkaitan dengan prosedur ERCP dikumpulkan. Enzim amilase dan lipase diperiksa 24 jam setelah tindakan ERCP. Data kemudian dianalisis secara bivariat dan multivariat. Hasil: Tingkat keberhasilan kanulasi didapatkan sebesar 77,1% dan kejadian PEP didapatkan sebesar 31,4%. Dari analisis bivariat terhadap 18 faktor-faktor risiko didapatkan 4 faktor risiko yang memiliki hubungan signifikan dengan PEP, yaitu batu CBD, keganasan, jumlah upaya kanulasi dan waktu kanulasi (p < 0,05). Hasil analisis multivariat dari keempat faktor risiko tersebut menunjukkan terdapat dua faktor risiko yang hasilnya signifikan yaitu keganasan (OR 4,001, p = 0,040, IK95%: 1,062-15,073) dan waktu kanulasi (OR 6,516, p = 0,045, IK95%: 1,039-40,874). Simpulan: Adanya faktor keganasan dan waktu kanulasi yang melebihi 25 menit merupakan prediktor PEP.
Korelasi antara oxidized-low density lipoprotein dan densitas mineral tulang pada pasien wanita penderita systemic lupus erythematosus
Latar Belakang: Systemic Lupus Erythematosus (SLE) adalah suatu penyakit autoimun. Kondisi inflamasi kronis dan adanya modifikasi lipoprotein pada SLE (partikel LDL), dimediasi oleh ROS menyebabkan terbentuknya LDL proinflamasi yaitu LDL teroksidasi (Ox-LDL). Pada pasien dengan SLE sering ditemukan kondisi rendahnya densitas mineral tulang (BMD). Tujuan: Penelitian ini bertujuan untuk mengetahui adanya hubungan antara kadar Ox-LDL dan BMD pada pasien SLE di RSUP Sanglah Denpasar. Metode: Dalam penelitian ini menggunakan model observasional potong lintang dengan jumlah sampel 66 wanita penderita SLE dengan rentang 18-50 tahun, data didapat melalui wawancara dan telaah rekam medis. Kadar Ox-LDL serum diukur dengan uji ELISA dan skor BMD diukur menggunakan alat densitometer DXA (Dual Energy X-ray Absorptiometry) yang digambarkan dengan T-Score. Hasil: Total 66 subjek rerata usia 30,68 tahun dengan jenis kelamin seluruh sampel adalah perempuan. Rerata Ox-LDL yaitu 536,49 mg/L, rerata yaitu -1,21. Hasil signifikan dengan nilai p=0,000 dengan koefisien korelasi r=-0,829 untuk menilai hubungan antara variabel Ox-LDL dan BMD. Simpulan: Peningkatan kadar Ox-LDL serum akan berdampak pada penurunan skor BMD pada pasien SLE. Terdapat korelasi negatif signifikan antara kadar Ox-LDL dan BMD.
Does end stage renal disease increase severity of COVID-19?
Background: End stage renal disease (ESRD) patients are vulnerable to contract corona virus disease-19 (COVID-19), and they have higher risk of deterioration and mortality rate compared to general population. There are studies on COVID-19 in end stage renal disease (ESRD) patients showing the low rates of deterioration, most of which did not develop into severe pneumonia. Objective: Compare the clinical, laboratory, and radiological findings in COVID-19 patients with and without ESRD and to identify the mortality risk factors in those with ESRD. Methods: We conducted a cross-sectional study involving 87 COVID-19 patients, consisted of 43 ESRD and 44 non-ESRD. Data taken included age, gender, the amount of co-morbid, oxygen saturation when they first arrived, COVID 19 symptoms (mild/moderate/severe-critical), and the data of patients who died. Result: Severe-critical clinical manifestations of COVID-19 were more common in those with ESRD vs those without (p=0.012). However, the mortality was not significantly different. Absolute neutrophil count and neutrophil-lymphocyte ratio (NLR) were significantly higher in those with ESRD. As many as 24% COVID patients died, in which 11% are ESRD patients, and 13% non-ESRD. Multivariate analysis showed that NLR ≥1 had 1.3 times higher death risk compared to NLR<1. Conclusion: Severe-critical clinical manifestations of COVID-19 were more commonly found in ESRD patients. The mortality rate was not significantly different between the ESRD and non-ESRD. In COVID-19 patients with ESRD, NLR ≥1 had 1.3 times higher death risk compared to NLR<1. High NLR is a risk factor for higher mortality in ESRD patients.
Sequential organ failure assessment (SOFA) score as a predictor of acute kidney injury in COVID-19 patients: a systematic review and meta-analysis
Background: The sequential organ failure assessment (SOFA) score is a tool used to describe organ failure in critically ill patients. Studies have showed that coronavirus disease 2019 (COVID-19) patients who develop predictor of acute kidney injury (AKI) often have an increased SOFA. Objective: This study aimed to evaluate the potential of SOFA score as a predictor AKI in COVID-19 patients. Methods: A systematic search was conducted on PubMed, Google Scholar, EBSCO-Host, and ProQuest. The risk of bias was assessed using the Newcastle-Ottawa Scale . Result: Out of the 9 studies reviewed, 7 showed a significant association between SOFA score and AKI. The meta-analysis of 3 studies gave mean differences of 1.66 in favor of the AKI group (95% CI 1.12 - 2.21). The heterogeneity was low (Tau2 result = 0.06, I2 result = 22% with p = 0.28) and the significant results for the overall effect showed a value of p < 0.00001. Conclusion: The SOFA score has the potential to be a good predictor of AKI development in COVID-19 patients, with a significant mean difference.
Hubungan antara red cell distribution width (RDW) dengan HbA1c pada pasien diabetes melitus tipe 2 dengan gagal jantung di RSUP Prof. Dr. I.G.N.G. Ngoerah Denpasar
Latar Belakang: Penyakit kardiovaskular merupakan salah satu penyebab kematian tertinggi pada pasien-pasien dengan diabetes dan pasien-pasien dengan diabetes melitus memiliki risiko dua kali lebih tinggi mengalami gagal jantung. Dalam beberapa tahun terakhir, red cell distribution width (RDW) telah diteliti sebagai alternatif hemoglobin terglikasi (HbA1c) untuk mengukur kontrol glikemik pada diabetes melitus dan sebagai prediktor keparahan penyakit kardiovaskular. Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui korelasi RDW dengan HbA1c pada pasien diabetes melitus dengan gagal jantung. Metode: Penelitian ini merupakan studi potong lintang menggunakan data rekam medis pasien dengan DM dan gagal jantung yang dirawat di RSUP Prof. Dr. I.G.N.G. Ngoerah, Denpasar, Bali antara Agustus 2020 hingga Agustus 2021. Data yang dikumpulkan meliputi umur, indeks massa tubuh (BMI), durasi penyakit, HbA1c, dan RDW. Uji korelasi Spearman digunakan untuk menentukan hubungan bivariat dan uji korelasi parsial digunakan untuk mengontrol variabel pengganggu (usia, IMT, dan lama sakit). Hasil: Sebanyak 68 subjek didapatkan, terdiri dari 57,6% laki-laki dan 42,4% perempuan. Dalam analisis bivariat RDW didapatkan memiliki korelasi negatif yang signifikan dengan HbA1c (r=-0,301, p=0,013) tetapi menjadi tidak signifikan setelah uji korelasi parsial untuk variabel pengganggu korelasi (r=-0,223, p=0,074). Simpulan: RDW memiliki korelasi negatif dengan HbA1c pada pasien diabetes melitus dengan gagal jantung. Kami menduga korelasi negatif terjadi karena penurunan efek umur eritrosit pada HbA1c dari gagal jantung dan kondisi terkait usia. Studi lebih lanjut diperlukan untuk lebih menjelaskan temuan ini.
Copyright (c) 2022 Jurnal Penyakit Dalam Udayana https://creativecommons.org/licenses/by/4.0
Statins and cardiovascular disease outcomes: before and during the COVID-19 pandemic (SCOBAC): meta-analysis and systematic review of large populations
Background: Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide, both due to heart and vascular disease. In Indonesia alone, 470,000 deaths are estimated each year due to CVD. Based on the latest guideline, statins are highly recommended in the prevention of CVD. Objective: To assess the role of statins in reducing CVD rates, and all-cause mortality, before and during the COVID-19 pandemic respectively. Methods: Literature search was performed from 1994 – 2021. Data extraction was in the form of Major Adverse Cardiac Events (MACEs) before the pandemic, and all-cause mortality, before and during the COVID-19 pandemic. Literature of medical database extracted based on inclusion and exclusion criteria. The research analyzed two study designs: clinical trials for pre-pandemic and observational studies for pandemics. Results: After critical appraisal, 23 clinical trials and 9 observational studies were included in the data analysis. Statins played a role in reducing MACEs before the pandemic (OR: 0.62, p < 0.05, 95% CI 0.60 – 0.74, I2 = 91%). However, there was no significance between the groups receiving statins and those without statins in reducing mortality during the pandemic (RR: 0.97, p > 0.05, 95% CI 0.90 – 1.04). Conclusion: Statins have been shown to statistically reduce mortality before the COVID-19 pandemic and further studies are needed during the pandemic. Government policies need to consider the lack of screening for dyslipidemia and appropriate statin treatment in the primary care setting, especially during the pandemic.
Gambaran profil systemic lupus erythematosus (SLE) dan lupus nefritis di Rumah Sakit Umum Pusat Sanglah
Latar Belakang: Systemic Lupus Erythematosus (SLE) adalah penyakit autoimun sistemik yang menyerang berbagai sistem tubuh. Manifestasi SLE sangat beragam dan bergantung pada organ yang terlibat. Nefritis lupus merupakan salah satu komplikasi SLE yang berujung pada end-stage-renal-disease. Tujuan: Penelitian ini bertujuan untuk mengetahui profil klinis pasien SLE, kejadian nefritis lupus, dan respon ginjal di klinik reumatologi RSUP Sanglah pada Januari-Februari 2022. Metode: Penelitian ini merupakan penelitian deskriptif observasional dengan 152 peserta di klinik reumatologi RSUP Sanglah. Data penelitian dikumpulkan melalui anamnesa dan data laboratorium. Hasil: Berdasarkan hasil penelitian, 93,5% pasien SLE adalah wanita. Terdapat 36,1% young-adult (17-30 tahun), 11,2% middle-aged-adult (31-44 tahun), dan 52,7% old-aged-adult (>45 tahun). Gejala yang paling sering dikeluhkan pasien adalah artritis (88%). Keluhan mukokutan dialami oleh 86% pasien. Demam merupakan keluhan terbanyak ketiga (71%). Keterlibatan ginjal atau nefritis lupus dialami 47% pasien. Sebanyak 34,9% pasien nefritis lupus wanita mencapai respon komplet ginjal dan 11,2% mencapai respon parsial ginjal. Pasien yang diterapi lebih dari 5 tahun dan mencapai respon komplet ginjal berjumlah sebanyak 20,4%. Terdapat 10,5% pasien yang diterapi kurang dari 2 tahun dan mencapai respon parsial ginjal sebanyak 10,5%. Simpulan: Nefritis lupus merupakan gejala ke-4 tersering. Maka dari itu, pasien yang dicurigai SLE harus mendapat terapi secepatnya untuk mencegah keterlibatan ginjal. Pasien yang sudah mengalami nefritis lupus harus mendapat terapi yang adekuat agar respon komplet ginjal dapat tercapai.
Aspek diagnosis dan tatalaksana pasien koinfeksi human immunodeficiency virus (HIV) dengan tuberkulosis (TB): Tantangan bagi klinisi di daerah perifer
Koinfeksi pasien human immunodeficiency virus (HIV) dengan tuberkulosis (TB) akan mempercepat perburukan kondisi klinis penderita. Infeksi HIV menurunkan kekebalan tubuh penderita, sehingga mempermudah terjadinya infeksi TB. Pasien HIV dengan TB juga akan lebih mudah jatuh pada kondisi yang berat. Seorang pasien laki-laki usia 45 tahun datang ke Instalasi Gawat Darurat (IGD) dengan keluhan lemas seluruh tubuh, disertai dengan riwayat demam naik turun selama kurang lebih tiga bulan serta batuk. Pasien juga disertai dengan penurunan berat badan drastis dan diare selama dua minggu yang hilang timbul. Konjungtiva tampak anemis, mukosa mata kering dan mata cowong. Pemeriksaan fisik dada didapatkan ronki basah kasar pada kedua lapang paru. Hasil laboratorium didapatkan leukositosis dengan rapid test antibody HIV positif. Pemeriksaan rontgen thoraks didapatkan perselubungan bentuk bulat, batas relative tegas pada parakardial paru kanan. Tes cepat molekular sputum didapatkan MTB positif, Sensitif RIF. Pasien didiagnosis dengan HIV stadium 4, TBC paru aktif, gastroenteritis dengan dehidrasi sedang berat, oroesofageal kandidiasis, dan anemia ringan. Pasien diberikan obat anti TB (OAT) kategori 1 sebanyak 4 tablet tiap 24 jam oral. Pasien juga direncakan mendapat obat antiretroviral (ARV) dua minggu setelah pemberian OAT. Pasien dipulangkan dalam kondisi membaik dan delapan bulan setelah masuk rumah sakit, pasien mengalami perbaikan dengan peningkatan berat badan dan tidak ditemukan infeksi oportunistik. Koinfeksi HIV dengan TB perlu menjadi perhatian dalam penanganan yang menyeluruh sehingga efek merugikan dari pemberian obat dan penyakit dapat ditangani dengan baik.
Hubungan antara kadar interleukin 1 serum dan laju filtrasi glomerulus pada lupus eritematosus sistemik
Latar Belakang: Gejala klinis lupus eritematosus sistemik (LES) menunjukkan variabilitas yang besar, dengan proses autoimun yang mendasarinya. Interleukin-1 (IL-1) adalah sitokin pleiotropik yang telah dikaitkan dengan imunopatogenesis SLE dan tingkat keparahan penyakitnya. Selain itu, telah ditunjukkan bahwa IL-1 memainkan peran penting dalam nefritis lupus. Tujuan: Untuk mengetahui hubungan antara laju filtrasi glomerulus (LFG) dan interleukin 1 (IL-1) serum pada pasien SLE. Metode : Dari Januari hingga Maret 2018, sebuah studi potong lintang analitik observasional dilakukan di poliklinik penyakit dalam dan bangsal rawat inap di Rumah Sakit Sanglah Denpasar di Bali, Indonesia. Pasien SLE perempuan yang berusia di atas 18 tahun, tidak dalam masa menopause, dan bersedia berpartisipasi dilibatkan dalam penelitian ini. Tes imunosorben terkait-enzim (ELISA) dengan sensitivitas tinggi digunakan untuk mengukur kadar IL-1 darah. Usia, Indeks Massa Tubuh (BMI), skor MEX-SLEDAI, kreatinin serum, dan Glomerular Filtration Rate (GFR) data diperoleh dari wawancara dan tinjauan catatan medis. Hasil: Studi ini melibatkan 54 peserta, dengan usia rata-rata 28,43+6,58. Kadar IL-1 serum ditentukan rata-rata 0,16 (0,06-0,95) pg/ml. IL-1 dan GFR terbukti berkorelasi secara signifikan (r=0,338; P=0,012). Simpulan: Penelitian ini menunjukkan hubungan antara IL-1 serum dan laju filtrasi glomerulus pada LSE yang tidak aktif.
The association between body mass index, hypertension, and lifestyle on cardiovascular disease in Indonesian elderly
Background : Cardiovascular disease is one of the non-communicable diseases that causes most deaths in Indonesia. According to data from the Ministry of Health, coronary heart disease is the leading cause of all deaths at 26.4%. The rate of heart disease increases at a concerning pace every year, affecting at least 15 in 1000 Indonesians. Objective: This study aimed to determine the relationship between BMI, hypertension, and lifestyle to heart disease in the elderly communities in Indonesia. Methods: This study is a cross-sectional descriptive-analytic study that uses secondary data from a questionnaire in the Indonesian Family Life Survey (IFLS) 5 IIIB book. The sample includes elderly people in Indonesia who met both the inclusion and exclusion criteria and are registered as respondents in IFLS-5. The bivariate analysis used the Chi-Square test and the multivariate analysis used the multivariate logistic regression test. Result: The result shows that there is a significant relationship between gender (p= 0.000; OR = 0.492; 95% CI= 0.351-0.691), education (p= 0.003; OR= 0.584; 95% CI= 0.409-0.833), BMI (p= 0.041; OR=1.748; 95% CI= 1.023-2.987), and smoking habits (p= 0.000; OR= 0.202; 95% CI= 0.125-0.327) with cardiovascular disease. The most significant factor is BMI (p= 0.041; OR=1.748; 95% CI= 1.023-2.987). Conclusion: Gender, education, BMI, and smoking habits have a significant relationship with heart disease. BMI is the most significant factor and act as a risk factor of cardiovascular disease.
Profile of chronic obstructive pulmonary disease (COPD) patients in Oksibil Regional Public Hospital at 2020
Background: Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by persistent respiratory symptoms and airflow limitation due to blocked airways and/or alveolar abnormalities caused by harmful particles or gases. COPD is the third leading cause of death in the world. Objective: To determine the profile of COPD patients at Oksibil Regional Public Hospital. Methods: This study implemented a descriptive study design. Sample acquisition was done with total sampling. All COPD patients from January until December 2020 were included in this study. Result: This study obtained a total of 50 patients with COPD, with dominant of men aged > 60 years and worked as farmers. Most of patients have history of smoking, and those who use furnace or firewood. Most of patients with CAT score ≥ 10, with mMRC grades of 2-4. Based on the history of exacerbations, it was obtained that most with ≥ 2 times per year or minimum of one time with hospitalization. Based on the GOLD category, patients with the GOLD D category were the most numerous and the main symptom that made the patients come for treatment was shortness of breath. Conclusion: Most COPD patients were more than 60 years old with smoking risk factors and GOLD D category.
Benefit of probiotics in preventing hepatic encephalopathy among patients with liver cirrhosis: an evidence-based case report
Background: Hepatic encephalopathy (HE) is a serious complication in patients with liver cirrhosis. Its pathogenesis involved the mechanism of HE including endotoxins, ammonia production and other neurotoxins by gut microflora. Probiotic exert potential benefit for gastrointestinal microflora. The use of probiotics may provide substantial benefit for the treatment of HE. Objective: This report aimed to evaluate the benefit of probiotics in preventing HE among liver cirrhosis patients. Methods: Literature searching with keywords of ‘liver cirrhosis’, ‘probiotics’, ‘hepatic encephalopathy’ along with its synonyms and related terms was implemented in Pubmed. Additional hand-search was implemented to obtain the relevant articles Result: Three meta-analyses showed that probiotics are effective to prevent HE development. All meta-analyses obtained similar results, in which the odds ratio (OR) obtained was ranging from 0.22 to 0.42. One randomized controlled trial (RCT) by Dhiman et al showed that probiotics treatment reduces the relative risk of overt HE by 33% compared to placebo. Conclusion: Probiotics administration exert potential to prevent the development of HE in the liver cirrhotic patients. The patient may benefit with the given of probiotics.
Hubungan antara kadar serum hepatitis B PreS1 antigen (PreS1-Ag) dengan HBV DNA pada pasien hepatitis B kronis
Latar Belakang: Prevalensi hepatitis B kronis (HBK) di Indonesia masih cukup tinggi, sebagian diantaranya berpotensi mengalami komplikasi sirosis dan HCC dengan angka kematian yang tinggi. HBV DNA merupakan pemeriksaan baku emas untuk diagnosis dan inisiasi terapi, namun tidak semua laboratorium memiliki pemeriksaan PCR. Marker pemeriksaan serologi dapat menjadi pilihan alternatif dalam penegakan diagnosis pasien HBK di tempat-tempat dengan keterbatasan PCR. PreS1-Ag merupakan salah satu biomarker yang dipercaya menggambarkan infektivitas HBV dengan baik karena berfungsi mengawali masuknya HBV ke dalam hepatosit. Tujuan: Tujuan penelitian ini untuk mengetahui korelasi antara kadar PreS1-Ag dan HBV DNA pada pasien HBK. Metode: Desain penelitian adalah studi cross-sectional dengan metode consecutive sampling pada pasien HBK di RSUD Dr. Saiful Anwar Malang. Subjek penelitian dibedakan menjadi kelompok HBV DNA positif dan negatif. Pengukuran PreS1-Ag menggunakan metode ELISA dan HBV DNA menggunakan metode real-time PCR. Uji beda dengan Mann-Whitney test. Uji korelasi antara kadar PreS1-Ag dan HBV DNA menggunakan Spearman test, dimana p<0,05 dianggap signifikan. Hasil: Tujuh puluh sampel terkumpul, 47 (67,1%) HBV positif dan 23 (32,9%) HBV negatif. Tidak didapatkan perbedaan signifikan usia dan jenis kelamin antara kedua kelompok. Median kadar PreS1-Ag (8,68ng/mL dibanding 3,67ng/mL)dan HBV DNA (19.600 IU/mL dibanding 0,22 IU/mL) didapatkan lebih tinggi pada kelompok HBV DNA positif. Hasil Spearman test menunjukkan korelasi positif antara kadar PreS1-Ag dan HBV DNA dengan kekuatan sedang (r = 0,629; p < 0,05). Simpulan: Terdapat korelasi positif antara kadar PreS1-Ag dan HBV DNA pada pasien HBK, semakin tinggi kadar HBV DNA semakin tinggi pula kadar PreS1-Ag.
Copyright (c) 2021 Jurnal Penyakit Dalam Udayana https://creativecommons.org/licenses/by/4.0
Hubungan kerapuhan dan status activity of daily living pada penduduk usia lanjut di Desa Pedawa, Buleleng, Bali
Background: Frailty is a process of decreasing physical, psychological, and/or social functions related to the aging process. The process before frail often shows no signs and symptoms. At this stage the individual will experience a decline in functional status which can lead to severe clinical consequences. Objective: To determine the relationship of frailty and frailty parameters with functional status based on the assessment of Activity of Daily Living (ADL). Methods: A cross-sectional analytic study was conducted in Pedawa Village, Buleleng, Bali. Subjects underwent interviews and physical examinations to determine frailty and questionnaires to assess activity of daily living. The Spearman correlation test was used to determine the correlation between frailty and ADL scores, Mann Whitney U test to determine the correlation between weight loss, fatigue, and decreased physical activity with ADL. Result: A total of 80 samples were included in this study, consisting of elderly men (50%) and women (50%). A significant negative correlation obtained between frailty scores and ADL scores (r = -0.47, p < 0.001). There were also significant results between the frailty parameters, that is weight loss, fatigue, decreased walking speed, and decreased physical activity with ADL (p <0.05), while the relationship between hand grip strength and ADL was found to be not significant (p = 0.269). Conclusion:This study showed a negative correlation between frailty and ADL scores, with the higher the frailty score associated with lower ADL scores. There is a significant relationship between weight loss, fatigue, decreased walking speed and decreased physical activity with ADL.