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All Journal Medical Journal of Indonesia Oto Rhino Laryngologica Indonesiana Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Indonesian Journal of Cancer Jurnal Penyakit Dalam Indonesia
Rahmat Cahyanur
Faculty of Medicine Universitas Indonesia Cipto Mangunkusumo General Hospital, Jakarta
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Non-psychogenic polydipsia in 45-year-old man with primary hyperparathyroidism and recurrent bilateral nephrolithiasis Cahyanur, Rahmat; Sarwono, Johannes; Armelia, Linda; Marbun, Maruhum B.H.; Soewondo, Pradana
Medical Journal of Indonesia Vol 21, No 4 (2012): November
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (446.727 KB) | DOI: 10.13181/mji.v21i4.506

Abstract

Non-psychogenic polydipsia with hyponatremia is a rare clinical presentation. Primary hyperparathyroidism is a disorder of calcium, phosphate, and bone metabolism caused by increased level of parathyroid hormone (PTH). It is estimated the incidence of primary hyperparathyroidism are 21.6 per 100,000 person a year. This case report describe a 45-year-old man presented with non-psychogenic polydipsia. This patient drank a lot of water out of the fear of recurrent kidney stones. He had history of recurrent nephrolithiasis with hypercalcemia. We investigate further the cause of hypercalcemia and we diagnosed primary hyperparathryoidism as the cause. (Med J Indones. 2012;21:230-4)Keywords: Hyponatremia, non-psychogenic polydipsia, primary hyperparathyroidism
GAMBARAN KLINIS DAN PROPORSI HIPOTIROIDISME SEKUNDER PADA PASIEN ADENOMA HIPOFISIS DI RUMAH SAKIT CIPTO MANGUNKUSUMO Cahyanur, Rahmat; Soewondo, Pradana; Darmowidjojo, Budiman; Aman, Renindra Ananda; Dewiasty, Esthika
Majalah Kedokteran Indonesia Vol 68 No 6 (2018): Journal of the Indonesian Medical Association Majalah Kedokteran Indonesia Volum
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

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Abstract

Pendahuluan: Adenoma hipofisis merupakan tumor yang berasal dari jaringan hipofisis anterior. Manifestasi klinis timbul akibat pendesakan massa dan gangguan sekresi hormon. Salah satu gangguan hormonal yang ditimbulkan adalah hipotiroidisme sekunder. Hipotiroidisme sekunder terkait dengan penurunan kualitas hidup serta peningkatan risiko kardiovaskular. Tujuan: Mengetahui proporsi hipotiroidisme sekunder dan gambaran klinis pasien adenoma hipofisis. Metode: Penelitian ini adalah studi potong lintang. Data diambil dari rekam medis pasien di Rumah Sakit Cipto Mangunkusumo antara tahun 2007-2012. Data demografis (usia, jenis kelamin), karakteristik klinis, jenis adenoma, data radiologis, pemeriksaan hormon (T4 bebas dan TSH) dievaluasi pada peneltian ini. Hasil: Terdapat 45 pasien yang memenuhi kriteria penelitian ini. Sebagian besar subyek adalah wanita (62,2%). Keluhan utama subyek adalah gangguan penglihatan (55,6%). Gejala yang sering ditemukan adalah sakit kepala (86,7%), gangguan penglihatan (77,8%). Pada subyek wanita manifestasi yang pertama kali muncul adalah gangguan penglihatan dan gangguan fungsi seksual (39,3% dan 32,1%). Pada Usia muda, gejala pertama kali muncul lebih pada kelompok adenoma fungsional dibandingkan non fungsional (32,9 vs. 40,6). Hampir seluruh kasus yang ditemukan adalah makroadenoma (97,8%). Proporsi subyek yang mengalami hipotiroidisme sekunder adalah 40%. Subyek dengan hipotiroidisme sekunder lebih banyak mengeluhkan gangguan penglihatan dan gangguan ereksi. Kesimpulan: Gangguan penglihatan adalah keluhan utama yang sering ditemukan. Pada subyek wanita, keluhan gangguan fungsi seksual bersama dengan gangguan penglihatan adalah manifestasi yang pertama kali muncul. Proporsi hipotiroidisme sekunder pada penelitian ini adalah 40,0%. Subyek dengan hipotiroidisme sekunder lebih banyak mengeluhkan gangguan penglihatan, gangguan ereksi.
Neutrophil Lymphocyte Ratio, Three Year Survival of Locally Advanced and Advanced Nasopharyngeal Carcinoma Cahyanur, Rahmat; Nufus, Hayatun; Irawan, Cosphiadi
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 3
Publisher : UI Scholars Hub

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Abstract

Introduction. Nasopharyngeal carcinoma (NPC) is the most prevalent head and neck malignancy in Indonesia, as NPC-related mortality in Indonesia is the second-highest in Asia after China. Inflammation has been studied to be associated with cancer progression. Neutrophil lymphocyte ratio describes the balance between the unfavorable suppression of immune response against cancer by neutrophils and the beneficial effect of adaptive immunity by lymphocytes. This study aimed to determine the relationship between NLR and the survival of locally advanced and advanced NPC patients.Methods. A retrospective cohort study was conducted using the medical records of NPC patients treated at the hematology clinic RSCM from 2015 to 2018. The difference in 3-year survival between NPC patients with and without metastasis, also high and low NLR, was analyzed with the Kaplan-Meier method. At the same time, multivariate Cox regression analysis was used to obtain adjusted hazard ratios (HR) after comparing with patients’ age, gender, T stage, N stage, NLR level, and metastasis status.Results. There were 143 patients included in this study; a total of 49 (34.3%) had metastasis. There was a significant difference in survival between those with and without metastasis (p=0.001), with 3-year survival of 24.5% in patients with metastasis. The AUC of NLR was 0.600 (CI 95% 0.502—0.698; p=0.049). The optimal cut-off value determined for NLR was 4.7 with a sensitivity of 56.00%, specificity of 62.37%, PPV of 59.81%, and NPV of 58.64% in predicting survival. Based on that value (≥4,7), there was a significant difference in proportion between those with and without metastasis (63.3% vs. 33.0%, p=0.001). Multivariateanalysis showed that metastasis (HR 3.349, CI 95% 1.909—5.874, p<0.001) was associated with poorer survival.Conclusions. There was no association between NLR and 3-year survival in NPC patients. The proportion of subjects with high NLR was found higher in those with metastasis. Metastasis status was associated with 3-year survival.
Effectivity of Acupuncture Therapy in Reduction of Pain Intensity in Cancer Pain Affadhia, Hanna Lianti; Cahyanur, Rahmat; Wahdini, Sri; Rachman, Andhika
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 3
Publisher : UI Scholars Hub

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Pain is one of the most common complaints and interferes with the quality of life of cancer patients. Several studies recommend multimodal interventions that combine pharmacological and non-pharmacological therapies. Acupuncture therapy is one of the non-pharmacological treatment options that could be considered. This evidence-based case report aimed to examine the effectiveness of acupuncture therapy in reducing pain intensity in patients with cancer pain. Literature searching was performed on three databases (PubMed, Scopus, and Embase). The keywords used are cancer pain, malignant pain, acupuncture, acupuncture therapy, pain intensity, pain assessment, pain scale. The critical review was carried out using guidelines from the University of Oxford Center for Evidence-based Medicine. Four articles relevant to the clinical question were included in the study. Acupuncture therapy has been consistently shown to reduce pain intensity, shorter pain onset time, reduced dose and number of analgesics used, and better quality of life with minimal side effects, compared to drug therapy alone. Acupuncture therapy should be considered as a complementary therapy in the management of cancer pain, but not to replace standard regiment of pain protocols. Clinical decisions in applying acupuncture therapy need to assess patient preferences, accessibility, and cost-effectiveness.
Polycythemia: A Clinical Approach Cahyanur, Rahmat; Rinaldi, Ikhwan
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
Publisher : UI Scholars Hub

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Polycythemia or erythrocytosis is an increase in the number of red blood cells in circulation marked by the increase in hematocrit. Polycythemia is a case that still raises questions and dilemma for doctors. In this paper, it will be discussed about the diagnostic approach and management of polycythemia. The initial complaints of polycythemia are generally nonspecific, such as weakness and dizziness due to blood hyperviscosity. It is also essential to know accompanying diseases, routine medications, habits, and family histories of the patients. Patients with polycythemia commonly exhibit plethora. In vital sign examination, hypertension can be found in polycythemia vera. In general examination, we should look for signs that lead to secondary polycythemia, such as low oxygen saturation that can be found in secondary polycythemia. Initial workup that should be done is a complete blood count. Ferritin and transferrin saturation are evaluated to assess the iron status that can disguise the incidence of polycythemia, especially when the image of the blood smear indicates a microcytic hyperchromic. Advanced work up that can be done is genetic examination. In the case of polycythemia vera, the primary purpose of treatment is to prevent thrombotic events. In the case of secondary polycythemia, the aim of management is to identify the underlying disease and treat it, which one of them is phlebotomy.
Efektivitas dan Keamanan Beraprost untuk Pengobatan Klaudikasio Intermiten pada Critical Limb Threatening Ischemia (CLTI) Pangestu, Andhika; Asicha, Nur; Cahyanur, Rahmat; Resultanti, Resultanti
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 2
Publisher : UI Scholars Hub

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Critical limb threatening ischemia (CLTI) is the most advanced stage of peripheral arterial diseases. Alternative treatment for claudication in CLTI patients is beraprost. We aim to review effectiveness and safety beraprost for relieve symptoms in CLTI. We conducted systematic literature searching using PubMed/MEDLINE, Embase, ProQuest, and Cochrane databases. Selected articles were examined for duplication and screened by abstract and title. Then, we appraised the articles based on the critical appraisal sheet from Centre for Evidence-Based Medicine (CEBM) University of Oxford. We found one systematic review-meta analysis (SR-MA) which involved 4,477 randomized participants. The results from this study are moderate quality evidence that prostanoids reduced rest pain (RR 1.30; 95%CI 1.06 – 1.59) and promoted ulcer healing (RR 1.24; 95%CI 1.04 – 1.48). In adult patients with CLTI and intermittent claudication as the primary complaint, vasodilator agents such as beraprost have a beneficial effect and a favorable therapeutic response. Numerous effects, including cardiovascular benefit, adverse events, resting pain relief, ulcer healing, outcome maximum walking distance (MWD), and pain-free walking distance, demonstrate the benefit (PFWD). The benefits of beraprost differ depending on the mechanism of action and pharmacokinetics of the drugs.
Survei Kebutuhan Edukasi Pasien Lupus Eritematosus Sistemik Josephine, Jennifer; Widhani, Alvina; Cahyanur, Rahmat; Karjadi, Teguh Harjono
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
Publisher : UI Scholars Hub

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Introduction. Patients with systemic lupus erythematosus (SLE) who suffer from chronic illness, need tailored education to better manage their condition. As nowadays education through internet and social media contributes significantly. This study aimed to assess internet usage related to lupus, educational needs, and education sources preferences among patients. Methods. This study was a cross-sectional study conducted on adult SLE patients at Allergy and Clinical Immunology Clinic, Internal Medicine Department, Cipto Mangunkusumo Hospital, Jakarta, between July-August 2023. Respondents completed a set of questionnaires regarding their internet usage related to lupus, education platform preferences, and educational needs assessment tool (ENAT). Results. Sixty-five female subjects participated, with a median (range) age of 32 (19-56) years. Respondents who used the internet and social media for lupus-related matters were 92.3%. The ENAT domains prioritized by patients were knowledge about the disease (score 89%) and emotional management (score 85%). The primary sources of education desired by patients were direct education from doctors/nurses (87.7%), Instagram (55.4%), and YouTube (55.4%). Conclusions. SLE patients expressed a strong need for knowledge about the disease and emotional management, with doctors/nurses as the preferred sources of education. The widespread use of the internet for lupus-related information indicates a great opportunity for providing education through online platforms, particularly through Instagram, and YouTube.
Penyakit Sel Sabit pada Pasien Laki-laki Berusia 27 Tahun yang Sebelumnya Didiagnosis sebagai Talasemia: Sebuah Laporan Kasus Cahyanur, Rahmat; Kurniawan, Andree; Sharfina, Ratuafni; Mulansari, Nadia Ayu
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
Publisher : UI Scholars Hub

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Sickle cell disease (SCD) is a hemoglobinopathy inherited in an autosomal recessive pattern arising from a mutation causing substitution of valine for glutamic acid in the sixth amino acid of the β-globin chain. The clinical manifestation of SCD varies from acute pain, chronic anemia, to multi-organ infarct and failure. SCD is known to be rare in Indonesia. However, we recently encountered a SCD patient presenting with recurrent pain and hypesthesia since a year ago. The diagnosis of SCD in this patient was established based on the results of peripheral blood smear and hemoglobin electrophoresis. The patient had previously been diagnosed with thalassemia at the age of 19 years old due to a history of icterus, thus delaying prompt treatment. This further emphasizes the challenges in distinguishing SCD, which is relatively rare in Indonesia compared to thalassemia, especially considering the complexity and the variability in the phenotypic presentation of SCD. The patient was then given supportive therapy consisting of blood transfusion and symptomatic treatment, as well as consideration to administer hydroxyurea if the patient’s clinical condition worsens.
Two-point Compression POCUS sebagai Metode Diagnosis Dini Trombosis Vena Dalam Proksimal Ramadan, Edwin Ti; Maharani, Sausan Hana; Cahyanur, Rahmat; Priantono, Dimas; Rajabto, Wulyo
Jurnal Penyakit Dalam Indonesia Vol. 11, No. 2
Publisher : UI Scholars Hub

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Deep vein thrombosis (DVT), especially in the proximal part of the lower extremity, might progress to pulmonary embolism and be fatal. Therefore, it is crucial to prompt the diagnosis of DVT in the emergency room (ER). Due to its efficiency and patient convenience, duplex ultrasound has become the preferred diagnostic method for DVT. Point-of-care ultrasonography (POCUS) was known as a simpler and faster way to use ultrasonography at the bedside. The two-point compression method has become frequently used due to its ability to take less time for examination, yet there are still concerns about its accuracy. This study was conducted to find out whether two-point compression POCUS can be used as an early diagnostic method for proximal DVT. The literature search was carried out in the databases PUBMED, EMBASE, and SCOPUS on March 29, 2023, using keywords “Deep Vein Thrombosis”, “two-point compression POCUS”, and “diagnosis”. Four publications were chosen from the search results. One cross-sectional study was found to have a low validity value because POCUS and Doppler ultrasound operators were not blinded, and the reference test was only performed on positive DVT results on POCUS. All studies had high sensitivity and specificity (>90%) compared to the reference test, except for one cross-sectional study in critical patients in ICU, which had a 63% sensitivity value. In conclusion, the two-point compression POCUS method can be utilized as an early diagnostic method for proximal DVT, with the disclaimer that POCUS operators should get curriculum-based training before doing the examination.
The Role of Biphosphonate and Denosumab in Bone Metastasis Cahyanur, Rahmat; Pravita, Aravinda
Indonesian Journal of Cancer Vol 18, No 3 (2024): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i3.1177

Abstract

Metastasis is a major contributor to cancer-related morbidity and mortality. Bone metastasis is prevalent and associated with pain and fractures, particularly in breast cancer where up to 80% of patients may be affected. Bisphosphonates, traditional anti-resorptive drugs, have been crucial in managing bone metastatic cancers. This article reviews the pathophysiology of bone metastasis, focusing on the invasion-metastasis cascade and the role of matrix metalloproteinases (MMPs). The formation of metastatic tissue in bones involves disrupting the balance of the bone remodeling process. The study delves into the three generations of bisphosphonates, elucidating their structural differences and mechanisms of action. First-generation bisphosphonates, such as etidronate and clodronate, lack nitrogen and interfere with cellular processes. Second-generation bisphosphonates, including alendronate and pamidronate, bind to nitrogen and inhibit farnesyl pyrophosphate synthase (FPPS) in the mevalonate pathway. Third-generation bisphosphonates like risedronate and zoledronate have a heterogeneous nitrogenous chain, enhancing anti-resorptive activity. Denosumab's distinct pharmacokinetics and potential risks upon discontinuation are discussed. The article emphasizes the need for clinicians to be vigilant about potential adverse effects, especially kidney toxicity with bisphosphonates, and to tailor treatment based on individual patient characteristics.
Co-Authors Affadhia, Hanna Lianti Alvina Widhani, Alvina Aman, Renindra Ananda Andhika Rachman Andree Kurniawan Asicha, Nur Budiman Darmowidjojo, Budiman Cosphiadi Irawan Dimas Priantono, Dimas Esthika Dewiasty, Esthika Gurmeet Singh Hasan Maulahela, Hasan Hayatun Nufus Ikhwan Rinaldi Johannes Sarwono Josephine, Jennifer Linda Armelia Maharani, Sausan Hana Marlinda Adham Maruhum B.H. Marbun Mayangsari, Ika Dewi Nadia Ayu Mulansari, Nadia Ayu Nur Atikah Pangestu, Andhika Pradana Soewondo Prajogi, Gregorius Ben Pravita, Aravinda Rahman, Muhammad Ade Ramadan, Edwin Ti Resultanti, Resultanti Safitri, Eka Dian Sharfina, Ratuafni Sri Wahdini Teguh Harjono Karjadi, Teguh Harjono Wulyo Rajabto