Neutrophil-lymphocyte ratio (NLR) may predict prognosis in acute coronary syndrome (ACS) patients... more Neutrophil-lymphocyte ratio (NLR) may predict prognosis in acute coronary syndrome (ACS) patients. Psychological conditions play a role before, during and after infarction that can be treated with brief supportive psychotherapy (BSP). This study aimed to analyze effect of BSP on NLR and psychological symptoms (PS) in ACS patients. This double opened clinical randomized study included ACS patients who were treated in Intensive Cardiac Care Unit (ICCU) Cipto Mangunkusumo Hospital, Jakarta in April to July 2019. The BSP was planned for 5 sessions as long as the patients were in ICCU. NLR and PS that was evaluated using hospital anxiety depression scale were measured at baseline and after last BSP or right before discharged from ICCU. Data were analyzed with independent t-test or Mann-Whitney test.
Background Anxiety and depression are psychosomatic disorders that are frequently observed in chr... more Background Anxiety and depression are psychosomatic disorders that are frequently observed in chronic conditions such as systemic lupus erythematosus (SLE). Anxiety and depression can be induced by immunological and neurotransmitter dysregulation, which is characterized by hypothalamic–pituitary–adrenal (HPA) axis dysfunction, production of proinflammatory cytokines, and activation of complement in the blood, such as C3 and C4. The causes of anxiety and depression in SLE are complex, ranging from neuropsychiatric involvement to drug adverse effects. Detecting anxiety and depression symptoms in SLE patients is critical to preventing disability from impacting quality of life. Objective To assess the relationship between anxiety and depression symptomatology, SLE disease activity with levels of C3 and C4 in Cipto Mangunkusumo National Hospital. Methods This study used a cross-sectional design. The study included 120 SLE patients from Cipto Mangunkusumo National Hospital, aged 18 to 60 ...
BACKGROUND The prevalence of type 2 diabetes mellitus (T2DM) is increasing and commonly accompani... more BACKGROUND The prevalence of type 2 diabetes mellitus (T2DM) is increasing and commonly accompanied by comorbidities, such as depression. Vitamin D levels have been associated with T2DM and depression although the mechanism is uncertain. This study aimed to compare vitamin D levels between patients with T2DM with and without depression in the Indonesian community, where such research is rare. METHODS This cross-sectional study was conducted at Cipto Mangunkusumo Hospital. The participants who met the inclusion criteria on an outpatient basis were screened for depression using the Beck Depression Inventory-II (BDI-II) questionnaire and then divided into 2 groups: patients with T2DM with (BDI-II ≥14) and without (BDI-II <14) depression. Both groups were examined for vitamin D levels using the ELISA method, and an analysis of the mean difference between both groups was performed. RESULTS Of 60 patients, 23 (38%) experienced depression. The median vitamin D levels were 21.8 ng/ml (IQR 14.9-26.6) in the depression group and 26.5 ng/ml (IQR 23.96-34.08) in the non-depression group (p = 0.001). After performing multivariate analysis with confounding variables, the adjusted OR of variables (sex, sun exposure score, and body mass index) was 1.123 (95% CI: 1.003-1.259; p = 0.045). CONCLUSIONS Vitamin D levels were significantly lower in patients with T2DM with depression. Future studies should be carried out to determine the benefits of vitamin D supplementation in patients with T2DM with depression and their pathophysiology.
Background: The prevalence of hypovitaminosis D (hypoD) in patients with type 2 diabetes mellitus... more Background: The prevalence of hypovitaminosis D (hypoD) in patients with type 2 diabetes mellitus (T2DM) and depression has not been documented. In addition, the risk factors are unknown. This study aimed to identify the prevalence of and risk factors for hypoD in patients with T2DM who also have depression. Methods: 118 patients with T2DM who visited the outpatient endocrinology clinics at Cipto Mangunkusumo National Hospital between December 2019-September 2022 provided the clinical and demographic data for this cross- sectional study, including body mass index, blood pressure, glycosylated haemoglobin (HbA1c), lipid profiles, therapy, gender, age, marital status, and educational background. We used The Beck Depression Inventory II (BDI II) to evaluate depression. We used enzyme-linked immunosorbent assay kit to assess the dependent variable: serum vitamin D. We characterized serum vitamin D levels into three groups (normal, 30 ng/mL; insufficient, 20-29 ng/mL; deficient, 20 ng/mL). We also used analyses of variance to examine the anthropometric, clinical, and biochemical factors between the three groups. Results: 118 subjects with T2DM. Their median age was 56 years old (48, 75-60 years old), with a BDI II score of 17 (15-19), and a serum concentration of vitamin D. The D level was 18.3 ng/mL (9.17-29.46 ng/mL). Only 21.8% of patients with T2DM and depression had sufficient levels of vitamin D. We used multivariable analysis of variance model to examine the associations between age, BDI II score, HbA1c, and systolic and diastolic blood pressure with vitamin D level. Age and BDI II score both had a statistically significant effect on vitamin D levels. Conclusion: This cross-sectional study discovered that patients with T2DM and depression had a high prevalence (77.7%) of hypoD. Age and BDI II score both affected differences in vitamin D levels with statistical significance.
Background: Increase in the prevalence and survival rates has led to the assessment of disease ac... more Background: Increase in the prevalence and survival rates has led to the assessment of disease activity and quality of life of SLE patients as targets in treatment. Cholecalciferol was considered as having a role in reducing disease activity and improving quality of life. Methods: A double blind, randomized, controlled trial was conducted on female outpatients aged 18-60 years with SLE, consecutively recruited from September to December 2021 at Cipto Mangunkusumo Hospital. Sixty subjects who met the research criteria were randomized and equally assigned into the cholecalciferol and placebo groups. The study outcomes were measured at baseline and after 12 weeks of intervention. Results: Out of 60 subjects, 27 subjects in cholecalciferol group and 25 subjects in placebo group completed the intervention. There was a significant improvement on the level of vitamin D (ng/ml) after intervention in the cholecalciferol group, from an average of 15,69 ng/ml (8.1-28.2) to 49,90 ng/ml (26-72.1), and for the placebo group from 15,0 ng/ml (8.1-25,0) to 17.35 ng/ml (8.1-48.3) (p<0,000). Results of the MEX-SLEDAI score showed significant differences in both groups after the intervention, with a significant decrease in the cholecalciferol group from 2,67 (0-11) to 1,37 (0-6), compared to the placebo group from 2,6 (0-6) to 2,48 (0-6) (p<0,001). There were no significant differences on the quality of life in both groups. Conclusion: Supplementation of cholecalciferol 5000 IU/day for 12 weeks was statistically significant in increasing vitamin D levels and improving disease activity, but did not significantly improve the quality of life of SLE patients.
Background: COVID-19 is a global health problem that affects both physical and psychological aspe... more Background: COVID-19 is a global health problem that affects both physical and psychological aspect of patients. Sleep problems were experienced by many patients during the acute phase of after COVID-19 recovery. It affects patient's quality of life and required comprehensive management. This evidence-based case report aims to study the effect of sleep disturbance on quality of life and what is the appropriate management in post COVID-19 patients. Methods: searching were conducted in Pubmed, Cohcrane, EBSCO according to clinical questions. Study was selected based on inclusion and exclusion criteria, then it was critically appraised. Results: high score on the insomnia severity index and the Pittsburgh sleep quality index were found to be associated with quality of life. Cognitive Behavioural Therapy is currently the best evidence-based treatment in patient during and after COVID-19. Conclusion: sleep disturbance is a problem that many post COVID-19 patient face and CBT can improve their quality of life.
PURPOSE To understand the experiences and preferences of Indonesian cancer survivors regarding me... more PURPOSE To understand the experiences and preferences of Indonesian cancer survivors regarding medical information disclosure and advance care planning. METHODS On the basis of systematic reviews of the scientific literature, qualitative studies, and expert-panel input, we developed an online survey that was distributed to nine cancer survivor support groups in Indonesia. RESULTS A total of 1,030 valid responses were received. Most participants were younger than 60 years (92%), female (91%), married (78%), Muslim (75%), diagnosed with breast cancer (68%), highly educated (64%), and more than one year beyond diagnosis of their cancer. If diagnosed with a life-limiting illness, participants wished to be informed about their diagnosis (74%), disease severity (61%), estimated curability (81%), expected disease trajectory (66%), and estimated life expectancy (37%). Between 46%-69% of the participants wished to discuss four topics of advance care planning (end-of-life treatments, resuscit...
Nyeri adalah gejala utama pada pasien kanker yang perlu diatasi segera karena dapat menurunkan ku... more Nyeri adalah gejala utama pada pasien kanker yang perlu diatasi segera karena dapat menurunkan kualitas hidup. Kekhawatiran atau tidak efektifnya penggunaan satu jenis opioid membuat klinisi perlu memahami bagaimana rotasi opioid. Untuk itu, studi kasus berbasis bukti ini disusun untuk mengetahui tentang efektivitas rotasi opioid dan kombinasi opioid untuk tata laksana nyeri kanker melalui penelusuran literatur pada tiga database. Pencarian dilakukan di Pubmed, Cochrane library, dan EBSCO sesuai dengan pertanyaan klinis. Dari 24 studi yang didapat, hanya satu yang memenuhi kriteria dan kemudian dinilai secara kritis. Studi tersebut mendapati bahwa pasien baik pada kelompok rotasi (fentanyl transdermal) maupun kombinasi (oral oxycodone dan fentanyl transdermal) masing-masing mengalami penurunan skor nyeri secara berturut dari 2,9 menjadi 2,0 (p=0,22) dan 3,0 menjadi 1,8 (p<0,06). Selain itu, kesuksesan terapi tercapai pada 11 pasien di kelompok rotasi dan 12 pasien di kelompok kombinasi (p=0,98). Berdasarkan studi tersebut, dapat disimpulkan bahwa rotasi opioid sama efektifnya dengan kombinasi opioid dalam mengatasi nyeri pada pasien kanker.
Background: The effect of vitamin D supplementation on depressive symptoms in people with type 2 ... more Background: The effect of vitamin D supplementation on depressive symptoms in people with type 2 diabetes is still up for debate. The aim of this paper was to investigate the effect of vitamin D supplementation on symptoms of depression in type 2 diabetic patients. Methods: The protocol for this review has been registered in PROSPERO:CRD42021231713. Searching for literature was conducted using Pubmed, EBSCOhost, and EMBASE. Randomised controlled trials (RCTs) regarding vitamin D supplementation in type 2 diabetic patients with depression were retrieved through a systematic search. The outcome measured was a change in depressive symptoms evaluated with any validated rating scale. Independent data extraction was conducted, and the study quality was assessed. A meta-analysis was carried out to calculate the improvement in depressive symptoms in the group receiving vitamin D and the control group. The available evidence in RCTs was analysed using the PRISMA approach, and clinical significance was determined using the GRADE system. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Results: Four RCTs were reviewed and three RCTs were meta-analysed. In two studies, vitamin D was statistically effective in improving depressive symptoms in type 2 diabetic patients. Three randomised controlled trials were included in the meta-analysis with 161 subjects using depression score as an outcome assessment. Vitamin D is significantly more effective than placebo (95% CI: -0.70 to - 0.08, p = 0.01). Conclusion: Vitamin D supplementation is effective in improving depressive symptoms in type 2 diabetic patients. Future research with different geographical areas and larger samples should be done to further assess the benefits.
INTRODUCTION : Lung cancer accounts for 13% of malignancies in the world and the most common type... more INTRODUCTION : Lung cancer accounts for 13% of malignancies in the world and the most common type of cancer suffered by men in Indonesia. The 5-year survival rate for patients with lung cancer is only 18.1%. About 25-30% will develop brain metastases. Overall palliative care is needed including biologically targeted therapy, chemotherapy, stereotactic radiosurgery (SRS), surgery in selected cases, and whole brain radiotherapy treatment (WBRT). Rare studies that take into account surgical palliation in advanced NSCLC. It has been demonstrated that metastaticectomy generally improves survival and, in some patients, even long-term survival. CASE REPORT : A 65-year-old male patient with Non-Small Cell Carcinoma favor Lung Adenocarcinoma and cerebellum metastases. The patient underwent surgery to remove a brain tumor. The patient received 8 radiotherapies and Erlotinib chemotherapy for 4 cycles for 6 months. The dose of Erlotinib 150g/24 hours was used in the first month. The dose was re...
Background: Health workers are vulnerable to experiencing psychological and physiological stress,... more Background: Health workers are vulnerable to experiencing psychological and physiological stress, including burnout syndrome (BOS). BOS can be measured using the Maslach Burnout Inventory (MBI) assessment. BOS can also affect heart rate variability (HRV). Music therapy is one of the BOS therapies in the recovery phase. This study aims to evaluate the effects of virtual music therapy on "Burnout Syndrome" in health workers in Tertiary Hospitals Methods: Â This research is a qualitative study and a randomized control trial using a pre-and post-test control group study design on healthcare workers at Dr. Kariadi Hospital and Dr. Cipto Mangunkusumo Hospital for three months. Subjects were divided into two groups, namely the intervention group and the control group, each consisting of 20 people. The instruments used were the MBI-HSS questionnaire and heart rate variability measuring devices for the pretest and posttest. Depending on the data distribution analysis performed using...
Despite the numerous benefits of palliative care for cancer patients, there have been few studies... more Despite the numerous benefits of palliative care for cancer patients, there have been few studies on palliative care services for terminal cancer patients, particularly near the end of life. This study aimed to evaluate whether there were differences in length of stay and cost of care associated with how early or late a patient received palliative care intervention. Another objective was to compare the length of stay and cost of care of those who received palliative care intervention and those who did not. This study used a cohort retrospective design at Hospital A, Jakarta, Indonesia, from January to December 2019. The diagnosis of terminal cancer was based on medical records. Data on length of stay and costs of care were based on medical records and finance billing. The hospitalized terminal cancer patients (392) were recruited by consecutive sampling. The length of stay and costs of care for patients with advanced cancer who received palliative care consultations were longer and ...
Background Most studies on advance care planning in Asia originate in high-income Asian countries... more Background Most studies on advance care planning in Asia originate in high-income Asian countries. Indonesia is a middle-income Asian country characterized by its religious devoutness and strong family ties. This study aims to explore the perspectives and experiences of Indonesian healthcare professionals on advance care planning for cancer patients. Methods Focus-group discussions were conducted in July and August 2019 and were analysed using thematic content analysis enhanced by dual coding and exploration of divergent views. Purposive sampling of physicians and nurses actively engaged in cancer care in a national cancer centre and a national general hospital. Results We included 16 physicians and 16 nurses. These participants were open to the idea of advance care planning. We further identified four aspects of this planning that the participants considered to be important: 1) the family’s role in medical decision-making; 2) sensitivity to communication norms; 3) patients’ and fam...
Hemangioma adalah tumor hati kongenital jinak yang paling sering ditemukan dan paling banyak dite... more Hemangioma adalah tumor hati kongenital jinak yang paling sering ditemukan dan paling banyak ditemukan pada wanita dengan angka insiden antara 0,4-20%. Adanya hemangioma hati yang sangat besar dapat menyebabkan timbulnya sindrom Kasabach-Merritt (SKM), suatu gangguan koagulasi yang mengancam nyawa, akibat adanya koagulopati konsumtif dari penumpukan trombosit dan agregasi dalam hemangioma. Angka mortalitas SKM tinggi, dengan penyebab kematian adalah komplikasi ke organ lainnya maupun sepsis. Prinsip tata laksana adalah dekompresi hemangioma yang ada dengan tindakan pembedahan. Namun, seringkali tindakan tersebut sangat sulit dilakukan dikarenakan risiko perdarahan yang sangat tinggi. Sehingga, tata laksana konservatif menjadi pilihan utama pada pasien ini. Penting untuk memikirkan adanya SKM pada pasien dengan keluhan pembesaran abdomen, dikarenakan akan sangat bermanfaat untuk perencanaan tindakan dini dan edukasi prognosis kepada pasien dan keluarga.
Pendahuluan. Pendidikan kedokteran memiliki masa studi yang panjang dan terdapat berbagai macam t... more Pendahuluan. Pendidikan kedokteran memiliki masa studi yang panjang dan terdapat berbagai macam tugas serta ujian. Mahasiswa kedokteran yang menjalani pendidikan kedokteran dapat menghadapi masalah kesehatan sindrom kolon iritabel selama masa pendidikan. Penelitian ini bertujuan untuk mengetahui prevalensi sindrom kolon iritabel (SKI) pada mahasiswa kedokteran dengan menggunakan kriteria Roma IV dan faktor-faktor yang berhubungan. Metode. Studi potong lintang dilakukan terhadap 350 mahasiswa kedokteran Universitas Indonesia tingkat I hingga tingkat V pada bulan November-Desember 2016. Pemilihan subjek dilakukan berdasarkan stratified random sampling. Pengumpulan data dilakukan melalui wawancara menggunakan kuesioner. Kriteria diagnosis yang digunakan adalah kriteria Roma IV. Dilakukan analisis bivariat untuk mengetahui hubungan antara faktor-faktor dengan kejadian SKI pada mahasiswa kedokteran menggunakan uji chi square, uji T tidak berpasangan, dan alternatifnya. Analisis multivariat dilakukan dengan menggunakan regresi logistik. Hasil. Proporsi sindrom kolon iritabel pada mahasiswa kedokteran perempuan dengan menggunakan kriteria Roma IV sebesar 18,3% dan pada mahasiswa kedokteran laki-laki sebesar 9,7% (IK 95% 1,11-3,91). Subtipe SKI terbanyak adalah subtipe diare (53,1%). Skor student-life stress inventory, baik stressor maupun respons terhadap stressor, pada mahasiswa dengan SKI lebih tinggi dibandingkan tanpa SKI, untuk skor stressor (66,4 (SB 11,4) vs. 60,0 (SB 12,2), p=0,001), dan skor respons terhadap stressor (64,0 (41-97) vs. 55,0 (35-88), p<0,001). Faktor-faktor yang berhubungan dengan kejadian SKI di antaranya adalah jenis kelamin perempuan (aOR 2,14; IK 95% 1,12-4,08) dan ansietas (aOR 2,89; IK 95% 1,43-5,83). Simpulan. Proporsi SKI pada mahasiswa kedokteran perempuan dengan menggunakan kriteria Roma IV 18,3% dan pada mahasiswa kedokteran laki-laki 9,7% (1,11-3,91 IK 95%), didominasi subtipe diare (53,1%). Ansietas dan jenis kelamin perempuan berhubungan dengan kejadian SKI.
Karsinoma hepatoselular (KHS) merupakan tumor primer hepar yang paling sering terjadi dari seluru... more Karsinoma hepatoselular (KHS) merupakan tumor primer hepar yang paling sering terjadi dari seluruh tipe kanker hati, serta menduduki peringkat ke-5 kanker tersering di dunia dan ke-3 kanker penyebab kematian terbanyak di dunia. Nyeri merupakan masalah yang seringkali dialami pasien dengan KHS yang mana dapat memberikan pengaruh terhadap penurunan kualitas hidup pasien. Selanjutnya, pasien dengan KHS sering muncul dengan keadaaan sirosis, sehingga penatalaksanaan terkait nyeri menjadi suatu tantangan klinis bagi klinisi. Artikel ini membahas mengenai kasus seorang laki-laki berusia 26 tahun dengan keluhan nyeri perut bagian kanan atas sejak empat bulan lalu disertai dengan penurunan berat badan. Hasil pemeriksaan menunjukkan serologis hepatits B positif dengan peningkatan alfa feto protein (AFP). Computed tomography (CT) scan abdomen dan biopsi hati menyokong karsinoma hepatoseluler, disertai penyebaran ke paru. Pasien kemudian didiagnosis dengan karsinoma hepatoseluler stadium lanjut. Pasien masuk rumah sakit dengan penurunan kesadaran akibat hipoglikemia. Namun, dikarenakan keluhan nyeri perutnya, pasien kemudian mendapatkan terapi analgesik opioid berupa morphine intermediate release (MIR). Dengan pemberian opioid yang hati-hati serta terukur dan terkendali baik, keluhan pasien akibat nyeri keganasan dapat dikontrol dengan memadai, sehingga mampu meningkatkan kualitas hidup pasien.
Neutrophil-lymphocyte ratio (NLR) may predict prognosis in acute coronary syndrome (ACS) patients... more Neutrophil-lymphocyte ratio (NLR) may predict prognosis in acute coronary syndrome (ACS) patients. Psychological conditions play a role before, during and after infarction that can be treated with brief supportive psychotherapy (BSP). This study aimed to analyze effect of BSP on NLR and psychological symptoms (PS) in ACS patients. This double opened clinical randomized study included ACS patients who were treated in Intensive Cardiac Care Unit (ICCU) Cipto Mangunkusumo Hospital, Jakarta in April to July 2019. The BSP was planned for 5 sessions as long as the patients were in ICCU. NLR and PS that was evaluated using hospital anxiety depression scale were measured at baseline and after last BSP or right before discharged from ICCU. Data were analyzed with independent t-test or Mann-Whitney test.
Background Anxiety and depression are psychosomatic disorders that are frequently observed in chr... more Background Anxiety and depression are psychosomatic disorders that are frequently observed in chronic conditions such as systemic lupus erythematosus (SLE). Anxiety and depression can be induced by immunological and neurotransmitter dysregulation, which is characterized by hypothalamic–pituitary–adrenal (HPA) axis dysfunction, production of proinflammatory cytokines, and activation of complement in the blood, such as C3 and C4. The causes of anxiety and depression in SLE are complex, ranging from neuropsychiatric involvement to drug adverse effects. Detecting anxiety and depression symptoms in SLE patients is critical to preventing disability from impacting quality of life. Objective To assess the relationship between anxiety and depression symptomatology, SLE disease activity with levels of C3 and C4 in Cipto Mangunkusumo National Hospital. Methods This study used a cross-sectional design. The study included 120 SLE patients from Cipto Mangunkusumo National Hospital, aged 18 to 60 ...
BACKGROUND The prevalence of type 2 diabetes mellitus (T2DM) is increasing and commonly accompani... more BACKGROUND The prevalence of type 2 diabetes mellitus (T2DM) is increasing and commonly accompanied by comorbidities, such as depression. Vitamin D levels have been associated with T2DM and depression although the mechanism is uncertain. This study aimed to compare vitamin D levels between patients with T2DM with and without depression in the Indonesian community, where such research is rare. METHODS This cross-sectional study was conducted at Cipto Mangunkusumo Hospital. The participants who met the inclusion criteria on an outpatient basis were screened for depression using the Beck Depression Inventory-II (BDI-II) questionnaire and then divided into 2 groups: patients with T2DM with (BDI-II ≥14) and without (BDI-II <14) depression. Both groups were examined for vitamin D levels using the ELISA method, and an analysis of the mean difference between both groups was performed. RESULTS Of 60 patients, 23 (38%) experienced depression. The median vitamin D levels were 21.8 ng/ml (IQR 14.9-26.6) in the depression group and 26.5 ng/ml (IQR 23.96-34.08) in the non-depression group (p = 0.001). After performing multivariate analysis with confounding variables, the adjusted OR of variables (sex, sun exposure score, and body mass index) was 1.123 (95% CI: 1.003-1.259; p = 0.045). CONCLUSIONS Vitamin D levels were significantly lower in patients with T2DM with depression. Future studies should be carried out to determine the benefits of vitamin D supplementation in patients with T2DM with depression and their pathophysiology.
Background: The prevalence of hypovitaminosis D (hypoD) in patients with type 2 diabetes mellitus... more Background: The prevalence of hypovitaminosis D (hypoD) in patients with type 2 diabetes mellitus (T2DM) and depression has not been documented. In addition, the risk factors are unknown. This study aimed to identify the prevalence of and risk factors for hypoD in patients with T2DM who also have depression. Methods: 118 patients with T2DM who visited the outpatient endocrinology clinics at Cipto Mangunkusumo National Hospital between December 2019-September 2022 provided the clinical and demographic data for this cross- sectional study, including body mass index, blood pressure, glycosylated haemoglobin (HbA1c), lipid profiles, therapy, gender, age, marital status, and educational background. We used The Beck Depression Inventory II (BDI II) to evaluate depression. We used enzyme-linked immunosorbent assay kit to assess the dependent variable: serum vitamin D. We characterized serum vitamin D levels into three groups (normal, 30 ng/mL; insufficient, 20-29 ng/mL; deficient, 20 ng/mL). We also used analyses of variance to examine the anthropometric, clinical, and biochemical factors between the three groups. Results: 118 subjects with T2DM. Their median age was 56 years old (48, 75-60 years old), with a BDI II score of 17 (15-19), and a serum concentration of vitamin D. The D level was 18.3 ng/mL (9.17-29.46 ng/mL). Only 21.8% of patients with T2DM and depression had sufficient levels of vitamin D. We used multivariable analysis of variance model to examine the associations between age, BDI II score, HbA1c, and systolic and diastolic blood pressure with vitamin D level. Age and BDI II score both had a statistically significant effect on vitamin D levels. Conclusion: This cross-sectional study discovered that patients with T2DM and depression had a high prevalence (77.7%) of hypoD. Age and BDI II score both affected differences in vitamin D levels with statistical significance.
Background: Increase in the prevalence and survival rates has led to the assessment of disease ac... more Background: Increase in the prevalence and survival rates has led to the assessment of disease activity and quality of life of SLE patients as targets in treatment. Cholecalciferol was considered as having a role in reducing disease activity and improving quality of life. Methods: A double blind, randomized, controlled trial was conducted on female outpatients aged 18-60 years with SLE, consecutively recruited from September to December 2021 at Cipto Mangunkusumo Hospital. Sixty subjects who met the research criteria were randomized and equally assigned into the cholecalciferol and placebo groups. The study outcomes were measured at baseline and after 12 weeks of intervention. Results: Out of 60 subjects, 27 subjects in cholecalciferol group and 25 subjects in placebo group completed the intervention. There was a significant improvement on the level of vitamin D (ng/ml) after intervention in the cholecalciferol group, from an average of 15,69 ng/ml (8.1-28.2) to 49,90 ng/ml (26-72.1), and for the placebo group from 15,0 ng/ml (8.1-25,0) to 17.35 ng/ml (8.1-48.3) (p<0,000). Results of the MEX-SLEDAI score showed significant differences in both groups after the intervention, with a significant decrease in the cholecalciferol group from 2,67 (0-11) to 1,37 (0-6), compared to the placebo group from 2,6 (0-6) to 2,48 (0-6) (p<0,001). There were no significant differences on the quality of life in both groups. Conclusion: Supplementation of cholecalciferol 5000 IU/day for 12 weeks was statistically significant in increasing vitamin D levels and improving disease activity, but did not significantly improve the quality of life of SLE patients.
Background: COVID-19 is a global health problem that affects both physical and psychological aspe... more Background: COVID-19 is a global health problem that affects both physical and psychological aspect of patients. Sleep problems were experienced by many patients during the acute phase of after COVID-19 recovery. It affects patient's quality of life and required comprehensive management. This evidence-based case report aims to study the effect of sleep disturbance on quality of life and what is the appropriate management in post COVID-19 patients. Methods: searching were conducted in Pubmed, Cohcrane, EBSCO according to clinical questions. Study was selected based on inclusion and exclusion criteria, then it was critically appraised. Results: high score on the insomnia severity index and the Pittsburgh sleep quality index were found to be associated with quality of life. Cognitive Behavioural Therapy is currently the best evidence-based treatment in patient during and after COVID-19. Conclusion: sleep disturbance is a problem that many post COVID-19 patient face and CBT can improve their quality of life.
PURPOSE To understand the experiences and preferences of Indonesian cancer survivors regarding me... more PURPOSE To understand the experiences and preferences of Indonesian cancer survivors regarding medical information disclosure and advance care planning. METHODS On the basis of systematic reviews of the scientific literature, qualitative studies, and expert-panel input, we developed an online survey that was distributed to nine cancer survivor support groups in Indonesia. RESULTS A total of 1,030 valid responses were received. Most participants were younger than 60 years (92%), female (91%), married (78%), Muslim (75%), diagnosed with breast cancer (68%), highly educated (64%), and more than one year beyond diagnosis of their cancer. If diagnosed with a life-limiting illness, participants wished to be informed about their diagnosis (74%), disease severity (61%), estimated curability (81%), expected disease trajectory (66%), and estimated life expectancy (37%). Between 46%-69% of the participants wished to discuss four topics of advance care planning (end-of-life treatments, resuscit...
Nyeri adalah gejala utama pada pasien kanker yang perlu diatasi segera karena dapat menurunkan ku... more Nyeri adalah gejala utama pada pasien kanker yang perlu diatasi segera karena dapat menurunkan kualitas hidup. Kekhawatiran atau tidak efektifnya penggunaan satu jenis opioid membuat klinisi perlu memahami bagaimana rotasi opioid. Untuk itu, studi kasus berbasis bukti ini disusun untuk mengetahui tentang efektivitas rotasi opioid dan kombinasi opioid untuk tata laksana nyeri kanker melalui penelusuran literatur pada tiga database. Pencarian dilakukan di Pubmed, Cochrane library, dan EBSCO sesuai dengan pertanyaan klinis. Dari 24 studi yang didapat, hanya satu yang memenuhi kriteria dan kemudian dinilai secara kritis. Studi tersebut mendapati bahwa pasien baik pada kelompok rotasi (fentanyl transdermal) maupun kombinasi (oral oxycodone dan fentanyl transdermal) masing-masing mengalami penurunan skor nyeri secara berturut dari 2,9 menjadi 2,0 (p=0,22) dan 3,0 menjadi 1,8 (p<0,06). Selain itu, kesuksesan terapi tercapai pada 11 pasien di kelompok rotasi dan 12 pasien di kelompok kombinasi (p=0,98). Berdasarkan studi tersebut, dapat disimpulkan bahwa rotasi opioid sama efektifnya dengan kombinasi opioid dalam mengatasi nyeri pada pasien kanker.
Background: The effect of vitamin D supplementation on depressive symptoms in people with type 2 ... more Background: The effect of vitamin D supplementation on depressive symptoms in people with type 2 diabetes is still up for debate. The aim of this paper was to investigate the effect of vitamin D supplementation on symptoms of depression in type 2 diabetic patients. Methods: The protocol for this review has been registered in PROSPERO:CRD42021231713. Searching for literature was conducted using Pubmed, EBSCOhost, and EMBASE. Randomised controlled trials (RCTs) regarding vitamin D supplementation in type 2 diabetic patients with depression were retrieved through a systematic search. The outcome measured was a change in depressive symptoms evaluated with any validated rating scale. Independent data extraction was conducted, and the study quality was assessed. A meta-analysis was carried out to calculate the improvement in depressive symptoms in the group receiving vitamin D and the control group. The available evidence in RCTs was analysed using the PRISMA approach, and clinical significance was determined using the GRADE system. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Results: Four RCTs were reviewed and three RCTs were meta-analysed. In two studies, vitamin D was statistically effective in improving depressive symptoms in type 2 diabetic patients. Three randomised controlled trials were included in the meta-analysis with 161 subjects using depression score as an outcome assessment. Vitamin D is significantly more effective than placebo (95% CI: -0.70 to - 0.08, p = 0.01). Conclusion: Vitamin D supplementation is effective in improving depressive symptoms in type 2 diabetic patients. Future research with different geographical areas and larger samples should be done to further assess the benefits.
INTRODUCTION : Lung cancer accounts for 13% of malignancies in the world and the most common type... more INTRODUCTION : Lung cancer accounts for 13% of malignancies in the world and the most common type of cancer suffered by men in Indonesia. The 5-year survival rate for patients with lung cancer is only 18.1%. About 25-30% will develop brain metastases. Overall palliative care is needed including biologically targeted therapy, chemotherapy, stereotactic radiosurgery (SRS), surgery in selected cases, and whole brain radiotherapy treatment (WBRT). Rare studies that take into account surgical palliation in advanced NSCLC. It has been demonstrated that metastaticectomy generally improves survival and, in some patients, even long-term survival. CASE REPORT : A 65-year-old male patient with Non-Small Cell Carcinoma favor Lung Adenocarcinoma and cerebellum metastases. The patient underwent surgery to remove a brain tumor. The patient received 8 radiotherapies and Erlotinib chemotherapy for 4 cycles for 6 months. The dose of Erlotinib 150g/24 hours was used in the first month. The dose was re...
Background: Health workers are vulnerable to experiencing psychological and physiological stress,... more Background: Health workers are vulnerable to experiencing psychological and physiological stress, including burnout syndrome (BOS). BOS can be measured using the Maslach Burnout Inventory (MBI) assessment. BOS can also affect heart rate variability (HRV). Music therapy is one of the BOS therapies in the recovery phase. This study aims to evaluate the effects of virtual music therapy on "Burnout Syndrome" in health workers in Tertiary Hospitals Methods: Â This research is a qualitative study and a randomized control trial using a pre-and post-test control group study design on healthcare workers at Dr. Kariadi Hospital and Dr. Cipto Mangunkusumo Hospital for three months. Subjects were divided into two groups, namely the intervention group and the control group, each consisting of 20 people. The instruments used were the MBI-HSS questionnaire and heart rate variability measuring devices for the pretest and posttest. Depending on the data distribution analysis performed using...
Despite the numerous benefits of palliative care for cancer patients, there have been few studies... more Despite the numerous benefits of palliative care for cancer patients, there have been few studies on palliative care services for terminal cancer patients, particularly near the end of life. This study aimed to evaluate whether there were differences in length of stay and cost of care associated with how early or late a patient received palliative care intervention. Another objective was to compare the length of stay and cost of care of those who received palliative care intervention and those who did not. This study used a cohort retrospective design at Hospital A, Jakarta, Indonesia, from January to December 2019. The diagnosis of terminal cancer was based on medical records. Data on length of stay and costs of care were based on medical records and finance billing. The hospitalized terminal cancer patients (392) were recruited by consecutive sampling. The length of stay and costs of care for patients with advanced cancer who received palliative care consultations were longer and ...
Background Most studies on advance care planning in Asia originate in high-income Asian countries... more Background Most studies on advance care planning in Asia originate in high-income Asian countries. Indonesia is a middle-income Asian country characterized by its religious devoutness and strong family ties. This study aims to explore the perspectives and experiences of Indonesian healthcare professionals on advance care planning for cancer patients. Methods Focus-group discussions were conducted in July and August 2019 and were analysed using thematic content analysis enhanced by dual coding and exploration of divergent views. Purposive sampling of physicians and nurses actively engaged in cancer care in a national cancer centre and a national general hospital. Results We included 16 physicians and 16 nurses. These participants were open to the idea of advance care planning. We further identified four aspects of this planning that the participants considered to be important: 1) the family’s role in medical decision-making; 2) sensitivity to communication norms; 3) patients’ and fam...
Hemangioma adalah tumor hati kongenital jinak yang paling sering ditemukan dan paling banyak dite... more Hemangioma adalah tumor hati kongenital jinak yang paling sering ditemukan dan paling banyak ditemukan pada wanita dengan angka insiden antara 0,4-20%. Adanya hemangioma hati yang sangat besar dapat menyebabkan timbulnya sindrom Kasabach-Merritt (SKM), suatu gangguan koagulasi yang mengancam nyawa, akibat adanya koagulopati konsumtif dari penumpukan trombosit dan agregasi dalam hemangioma. Angka mortalitas SKM tinggi, dengan penyebab kematian adalah komplikasi ke organ lainnya maupun sepsis. Prinsip tata laksana adalah dekompresi hemangioma yang ada dengan tindakan pembedahan. Namun, seringkali tindakan tersebut sangat sulit dilakukan dikarenakan risiko perdarahan yang sangat tinggi. Sehingga, tata laksana konservatif menjadi pilihan utama pada pasien ini. Penting untuk memikirkan adanya SKM pada pasien dengan keluhan pembesaran abdomen, dikarenakan akan sangat bermanfaat untuk perencanaan tindakan dini dan edukasi prognosis kepada pasien dan keluarga.
Pendahuluan. Pendidikan kedokteran memiliki masa studi yang panjang dan terdapat berbagai macam t... more Pendahuluan. Pendidikan kedokteran memiliki masa studi yang panjang dan terdapat berbagai macam tugas serta ujian. Mahasiswa kedokteran yang menjalani pendidikan kedokteran dapat menghadapi masalah kesehatan sindrom kolon iritabel selama masa pendidikan. Penelitian ini bertujuan untuk mengetahui prevalensi sindrom kolon iritabel (SKI) pada mahasiswa kedokteran dengan menggunakan kriteria Roma IV dan faktor-faktor yang berhubungan. Metode. Studi potong lintang dilakukan terhadap 350 mahasiswa kedokteran Universitas Indonesia tingkat I hingga tingkat V pada bulan November-Desember 2016. Pemilihan subjek dilakukan berdasarkan stratified random sampling. Pengumpulan data dilakukan melalui wawancara menggunakan kuesioner. Kriteria diagnosis yang digunakan adalah kriteria Roma IV. Dilakukan analisis bivariat untuk mengetahui hubungan antara faktor-faktor dengan kejadian SKI pada mahasiswa kedokteran menggunakan uji chi square, uji T tidak berpasangan, dan alternatifnya. Analisis multivariat dilakukan dengan menggunakan regresi logistik. Hasil. Proporsi sindrom kolon iritabel pada mahasiswa kedokteran perempuan dengan menggunakan kriteria Roma IV sebesar 18,3% dan pada mahasiswa kedokteran laki-laki sebesar 9,7% (IK 95% 1,11-3,91). Subtipe SKI terbanyak adalah subtipe diare (53,1%). Skor student-life stress inventory, baik stressor maupun respons terhadap stressor, pada mahasiswa dengan SKI lebih tinggi dibandingkan tanpa SKI, untuk skor stressor (66,4 (SB 11,4) vs. 60,0 (SB 12,2), p=0,001), dan skor respons terhadap stressor (64,0 (41-97) vs. 55,0 (35-88), p<0,001). Faktor-faktor yang berhubungan dengan kejadian SKI di antaranya adalah jenis kelamin perempuan (aOR 2,14; IK 95% 1,12-4,08) dan ansietas (aOR 2,89; IK 95% 1,43-5,83). Simpulan. Proporsi SKI pada mahasiswa kedokteran perempuan dengan menggunakan kriteria Roma IV 18,3% dan pada mahasiswa kedokteran laki-laki 9,7% (1,11-3,91 IK 95%), didominasi subtipe diare (53,1%). Ansietas dan jenis kelamin perempuan berhubungan dengan kejadian SKI.
Karsinoma hepatoselular (KHS) merupakan tumor primer hepar yang paling sering terjadi dari seluru... more Karsinoma hepatoselular (KHS) merupakan tumor primer hepar yang paling sering terjadi dari seluruh tipe kanker hati, serta menduduki peringkat ke-5 kanker tersering di dunia dan ke-3 kanker penyebab kematian terbanyak di dunia. Nyeri merupakan masalah yang seringkali dialami pasien dengan KHS yang mana dapat memberikan pengaruh terhadap penurunan kualitas hidup pasien. Selanjutnya, pasien dengan KHS sering muncul dengan keadaaan sirosis, sehingga penatalaksanaan terkait nyeri menjadi suatu tantangan klinis bagi klinisi. Artikel ini membahas mengenai kasus seorang laki-laki berusia 26 tahun dengan keluhan nyeri perut bagian kanan atas sejak empat bulan lalu disertai dengan penurunan berat badan. Hasil pemeriksaan menunjukkan serologis hepatits B positif dengan peningkatan alfa feto protein (AFP). Computed tomography (CT) scan abdomen dan biopsi hati menyokong karsinoma hepatoseluler, disertai penyebaran ke paru. Pasien kemudian didiagnosis dengan karsinoma hepatoseluler stadium lanjut. Pasien masuk rumah sakit dengan penurunan kesadaran akibat hipoglikemia. Namun, dikarenakan keluhan nyeri perutnya, pasien kemudian mendapatkan terapi analgesik opioid berupa morphine intermediate release (MIR). Dengan pemberian opioid yang hati-hati serta terukur dan terkendali baik, keluhan pasien akibat nyeri keganasan dapat dikontrol dengan memadai, sehingga mampu meningkatkan kualitas hidup pasien.
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