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All Journal Cermin Dunia Kedokteran The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia Cermin Dunia Kedokteran
Edy Rizal Wahyudi
Divisi Geriatri, Departemen Ilmu Penyakit Dalam, Rumah Sakit Pusat Nasional Cipto Mangunkusumo, Fakultas Kedokteran Universitas Indonesia, Jakarta, Indonesia
Health Professions Medicine & Pharmacology Public Health

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Hubungan Kadar Vitamin D dengan Derajat Keparahan Pasien COVID-19 Dewasa dan Usia Lanjut Stella Andriana Putri; Edy Rizal Wahyudi
Cermin Dunia Kedokteran Vol 49, No 7 (2022): Vitamin D
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v49i7.1941

Abstract

Latar Belakang: Populasi usia lanjut berisiko defisiensi vitamin D akibat beragam faktor seperti kurangnya suplementasi dan gaya hidup, serta obesitas. COVID-19 merupakan penyakit infeksi dengan morbiditas dan mortalitas global. Beberapa studi terkait COVID-19, salah satunya meneliti potensi vitamin D sebagai proteksi terhadap COVID-19. Tujuan: Studi ini bertujuan untuk mengetahui hubungan kadar vitamin D dengan derajat keparahan pasien COVID-19 dewasa dan lanjut usia. Metode: Kami menelusuri database PubMed, Cochrane, EBSCOhost, dan Scopus untuk mencari dan menyaring studi dalam bentuk kohort. Selanjutnya beberapa artikel dengan isu serupa dianalisis menggunakan instrumen prognosis dari Oxford Centre for Evidence Based Medicine. Hasil: Didapatkan dua studi kohort prospektif yang lolos seleksi yakni studi Baktash, dkk (2020) dan Campi, dkk (2021). Keduanya menunjukkan kadar vitamin D rendah berhubungan dengan prognosis klinis dan marka inflamasi yang lebih buruk pada kasus COVID-19 dewasa dan lanjut usia(p<0.05). Simpulan: Kadar vitamin D rendah berisiko marka inflamasi maupun prognosis klinis lebih buruk pada pasien COVID-19 dewasa maupun usia lanjut.Background: Elderlies as well as adults are high-risk populations for vitamin D deficiency, caused by lack of supplementation, lifestyle, or obesity. COVID-19 is an infectious disease with global morbidity and mortality. Some studies showed vitamin D’s potential for protection against COVID-19. Objective: This evidence-based case report was to investigate the association between vitamin D levels with COVID-19 severity in adult and elderly patients. Method: Database such as PubMed, Cochrane, EBSCOHost, and Scopus were explored to search and filter relevant cohort studies. Articles with similar issue were analyzed with prognosis instrument from Oxford Centre for Evidence Based Medicine. Result: Two prospective cohort studies from Baktash, et al (2020) and from Campi, et al (2021) fulfilled the requirements. Both studies showed that low vitamin D levels was related to worse clinical prognosis and inflammation markers in COVID-19 cases (p<0.05). Conclusion: Low vitamin D levels was related to poorer clinical prognosis or COVID-19 inflammation markers in adult and elderly COVID-19 patients.
Papilla Vaterƒs Tumor in Elderly: an Interdisciplinary Issue Eric Daniel Tenda; Murdani Abdullah; Kuntjoro Harimurti; Edy Rizal Wahyudi; Czeresna Heriawan Soejono
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 3, December 2010
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/1132010155-159

Abstract

Tumors of the papilla Vater are very rare. Papilla Vater’s tumors are benign or malignant tumors in the ampulla of Vater and periampullary region. Blockage of ampulla leads to the development of obstructive jaundice; intermittent cholangitis, epigastric discomfort and weight loss. Treatment possibilities include endoscopic ampulectomy, surgical transduodenal excision of tumors of the ampulla and pancreatoduodenectomy (PDE). Prognosis depends on histological typing of the tumor and their clinical stage. We report a case of papilla Vater’s tumor in elderly with comorbidities based on literature review. A 68-year-old female patient was referred for evaluation of intra and extra hepatic bile duct dilatation noted on abdominal ultrasonography. She complained of intermittent epigastric and right upper abdominal pain, with yellowish skin for two months. The laboratory findings showed leukocytosis, hyperbilirubinemia, abnormal liver function test, and high Ca 19-9. An endoscopic retrograde cholangiopancreatography (ERCP) revealed a distal obstruction caused by papilla Vater’s tumor. Abdominal computed tomography (CT) with contrast, revealed a dilated common bile duct and pancreatic duct. The histologic evaluation was highly suggestive for dysplasia. She is now on a schedule for a Whipple procedure. To make a true diagnosis and optimal treatment of papilla Vater’s tumor is multimodal. By doing a comprehensive geriatric assessment, with a careful modality selection, a Whipple procedure can be performed in elderly (65 years) safely. The post operative morbidity and mortality depends on their multi morbidity. Surgical, endoscopic, or radiologic biliary decompression; relief of gastric outlet obstruction; and adequate pain control may improve the quality of life but do not affect overall survival rate. By building a great interdisciplinary teamwork, the quality of life increased as follows.Keywords: papilla Vater tumor, elderly, Whipple procedure
Prediction Model of 30-Day Mortality in Elderly Patients Admitted to Geriatric Acute Ward Using Comprehensive Geriatric Assessment Domain Dwimartutie, Noto; Setiati, Slti; Wahyudi, Edy Rizal; Harimurti, Kuntjoro
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 2
Publisher : UI Scholars Hub

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Predictor Factors Affecting Seroconversion Post-InfluenzaVaccination in the Elderly Nursyirwan, Saskia Aziza; Koesnoe, Sukamto; Wahyudi, Edy Rizal
Jurnal Penyakit Dalam Indonesia Vol. 4, No. 4
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Introduction. The influenza vaccine as the most effective method for preventing influenza virus infection currently has lower efficacy in the elderly than younger adults due to change of immune response as well as other risk factors. This study aims to identify predictor factors affecting seroconversion post-influenza vaccination in elderly. Methods. retrospective cohort study in the elderly population in East Jakarta Posyandu who got the influenza vaccine. A total of 277 subjects with antibody titre pre and one month post-vaccination influenza were examined. Risk factors such as age, gender, exercise status, smoking status, type 2 diabetes, pulmonary, and cardiovascular disease, nutritional status of MNA (Mini Nutritional Assessment), GDS (Geriatric Depression Scale), and pre-vaccination antibodi titre were assessed in each subject. Results. The proportion of elderly people who seroconverted (fourfold rise or more in antibody titer post-vaccination) was 50.9% (141/277). On multivariate analysis, the predictor factors that affect seroconversion of one month post- influenza vaccination in the elderly on the community is a no depression state (p = 0.048, OR = 2.1, CI = 1.01 to 4.30), exercise status ≥5 times per week minimal 30 minutes (p = 0.013, OR 4.0, CI 1.34 to 11.76), and not seroprotective pre-vaccination (p=0.000, OR 6.4, CI 3.40 to 11.99). Conclusion. Predictor factors affecting seroconversion post-influenza vaccination in the elderly on the community is depression status, exercise status and pre-vaccination antibody titre.
Correlation of Frailty Status with Influenza Vaccine Seroconversion and Seroprotection among Elderly Population Koesnoe, Sukamto; Habibah, Ummu; Wahyudi, Edy Rizal; Abdullah, Murdani
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 4
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Penilaian Domain Pengkajian Paripurna Pasien Geriatri (P3G) sebagai Faktor yang Berpengaruh terhadap Kejadian Pneumonia Nosokomial pada Pasien Usia Lanjut yang Dirawat di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo Victor, Hildebrand Hanoch; Wahyudi, Edy Rizal; Rumende, C. Martin; Soejono, C. H.; Rooshoeroe, A. G.; Shatri, Hamzah; Nainggolan, Leonard; Irawan, Cosphiadi
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 1
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Introduction. Nosocomial pneumonia is a lung infection that occurs after the patient is hospitalized for more than 48 hours, without any signs of pulmonary infection at the time of treatment. When compared with young individuals, elderly individuals are more likely to have community-sourced and nosocomial infections with worse outcomes. Comprehensive Geriatric Assessment (CGA) domains are expected to explain the factors that contribute to nosocomial pneumonia in elderly patients. This study aimed to determine the proportion of elderly treated at Dr. Cipto Mangunkusumo National Central General Hospital who experienced nosocomial pneumonia and whether the CGA domains influence the occurrence of nosocomial pneumonia. Methods. A retrospective cohort study was conducted by analyzing the medical records of patients aged 60 years or older who were hospitalized in the medical ward of Geriatric Internal Medicine at Dr. Cipto Mangunkusomo National Central General Hospital in January – September 2019. We also collected secondary data from the geriatric division’s research. The sample consisted of inpatients aged ≥60 years who were hospitalized for more than 48 hours. Those who died within the first 48 hours of hospitalization and subjects with incomplete CGA domain data were excluded from the study. The criteria for nosocomial pneumonia used in this study followed the CDC’s pneumonia criteria for geriatric patients. Data processing was conducted using the application of Statistical Product and Service Solutions (SPSS) 16. Results. Of 228 subjects, the proportion of nosocomial pneumonia in elderly patients hospitalized was 31,14%. The mean age was 69 years with the subject’s age range between 60-89 years. Nutritional status (OR 2.226; CI95% 1.027-4.827) and functional status (OR 3.578; 95%CI 1.398-9.161) are factors that influence the incidence of nosocomial pneumonia in elderly patients who are hospitalized at Dr. Cipto Mangunkusumo National Central General Hospital. Conclusions. The proportion of elderly patients with nosocomial pneumonia was 31.14%. Nutritional status and functional status are factors that influence the incidence of nosocomial pneumonia in elderly patients who are hospitalized at Dr. Cipto Mangunkusumo National Central General Hospital. Keywords: Comprehensive geriatric assessment, elderly, nosocomial pneumonia
Pengaruh Status Nutrisi terhadap Kesintasan 30 Hari Pasien Geriatri yang Dirawat di Rumah Sakit Lugito, Nata Pratama Hardjo; Soejono, Czeresna Heriawan; Wahyudi, Edy Rizal; Dewiasty, Esthika
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 3
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Pendahuluan: Dengan meningkatnya jumlah populasi usia lanjut, masalah kesehatan yang dialami juga semakin banyak, salah satunya malnutrisi. Studi di luar negeri menunjukkan malnutrisi pada pasien geriatri yang dirawat di rumah sakit menurunkan kesintasan. Pasien usia lanjut di Indonesia mempunyai karakteristik yang berbeda dengan pasien usia lanjut di luar negeri. Di Indonesia belum ada studi tentang status nutrisi pasien usia lanjut yang dirawat di rumah sakit dan pengaruhnya terhadap kesintasan. Penelitian ini bertujuan mengetahui pengaruh status nutrisi terhadap kesintasan 30 hari pasien usia lanjut yang dirawat di ruang rawat akut geriatri dan ruang rawat penyakit dalam rumah sakit. Metode: Penelitian kohort retrospektif, dengan pendekatan analisis kesintasan, dilakukan terhadap 177 pasien geriatri yang dirawat di ruang rawat akut geriatri dan ruang rawat penyakit dalam Rumah Sakit Cipto Mangunkusumo selama bulan April–September 2011. Data demografis, diagnosis medis, kadar albumin, indeks ADL Barthel, geriatric depression scale, status nutrisi dengan mini nutritional assessment (MNA) dikumpulkan, dan diamati selama 30 hari sejak mulai dirawat untuk melihat ada tidaknya mortalitas. Perbedaan kesintasan kelompok pasien dengan status nutrisi baik, berisiko malnutrisi dan malnutrisi ditampilkan dalam kurva Kaplan-Meier, diuji dengan uji Log-rank, serta analisis multivariat dengan Cox proportional hazard regression model untuk menghitung adjusted Hazard Ratio dan interval kepercayaan 95% terjadinya mortalitas 30 hari dengan memasukkan variabel-variabel perancu sebagai kovariat. Hasil: Kesintasan antara subyek yang status nutrisinya baik, berisiko malnutrisi dan malnutrisi ialah 94,7% dengan 89,0% dan 80,7%, namun perbedaan kesintasan 30 hari tak bermakna dengan uji Log-rank (p=0,106). Pada analisis multivariat didapatkan adjusted HR setelah penambahan variabel perancu sebesar 1,49 (IK 95% 0,29 – 7,77) untuk kelompok berisiko malnutrisi dan 2,65 (IK 95% 0,47 – 14,99) untuk kelompok malnutrisi dibandingkan dengan pasien nutrisi baik. Simpulan: Perbedaan kesintasan 30 hari pasien geriatri yang dirawat di rumah sakit yang menderita malnutrisi dan berisiko malnutrisi dibandingkan dengan status nutrisi baik pada awal perawatan belum dapat dibuktikan.
Proporsi dan Faktor-Faktor yang Berhubungan dengan Kejadian Hipotensi Postprandial pada Usia Lanjut Hamonangan, Rachmat; Alwi, Idrus; Wahyudi, Edy Rizal; Setiati, Siti
Jurnal Penyakit Dalam Indonesia Vol. 1, No. 1
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Pendahuluan: Hipotensi postprandial sebenarnya sering terjadi dan saat ini dikenal sebagai masalah klinis yang penting. Studi-studi yang ada menunjukkan bahwa prevalensi hipotensi postprandial pada usia lanjut cukup tinggi. Hipotensi postprandial merupakan prediktor mortalitas pada orang usia lanjut dan menyebabkan banyak sekuele yang signifikan pada subyek yang terkena. Hingga saat ini, penelitian-penelitian yang berkaitan dengan hipotensi postprandial lebih banyak dilakukan pada kelompok usia lanjut di negara-negara maju yang definisi usia lanjut, proporsi penyakit, proporsi obat-obatan yang digunakan serta proporsi asupan yang berbeda dengan kelompok usia lanjut di negara berkembang khususnya Indonesia. Tujuan. Mengetahui proporsi dan faktor-faktor yang berhubungan dengan kejadian hipotensi postprandial pada kelompok usia lanjut. Metode: Penelitian studi potong-lintang dilakukan pada subjek usia lanjut di RSCM. Dilakukan pengisian kuesioner dan pengukuran tekanan darah sebelum makan dan setiap 15 menit sampai 2 jam setelah makan. Makanan yang dimakan dicatat untuk dianalisis. Hasil: Selama periode Januari – Maret 2010 terkumpul 119 subjek usia lanjut dengan rerata umur 67,50 ± 5,92 tahun. Sebanyak 53,8% memiliki hipertensi dan menggunakan obat anti hipertensi, 36.1% memiliki riwayat diabetes mellitus dan menggunakan obat pengontrol gula darah, 9,2% pernah mengalami stroke, 7.6% menggunakan terapi digoksin, 29.4% menggunakan terapi nitrat dan 3.4% menjalani hemodialisis rutin. Hipotensi postprandial didapatkan pada 55% subjek. Penggunaan obat diuretik loop dan insulin berhubungan dengan kejadian hipotensi postprandial. Selain itu diketahui pula bahwa penurunan tekanan darah postprandial lebih besar pada subjek dengan hipertensi, menggunakan obat ACE inhibitor, menggunakan obat diuretik loop/furosemid, menggunakan diuretik HCT, menggunakan insulin dan menggunakan obat nitrat. Simpulan: Penelitian ini menyimpulkan bahwa proporsi hipotensi postprandial pada subjek usia lanjut adalah 55%. Penggunaan obat diuretik loop dan insulin berhubungan dengan kejadian hipotensi postprandial. Penurunan tekanan darah postprandial lebih besar pada subjek dengan hipertensi, menggunakan obat ACE inhibitor, menggunakan obat diuretik loop/furosemid, menggunakan diuretik HCT, menggunakan insulin dan menggunakan obat nitrat.
Hubungan Kadar Vitamin D dengan Derajat Keparahan Pasien COVID-19 Dewasa dan Lanjut Usia Stella Andriana Putri; Edy Rizal Wahyudi
Cermin Dunia Kedokteran Vol 49 No 7 (2022): Nutrisi - Vitamin D
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v49i7.265

Abstract

Latar Belakang: Populasi lanjut usia berisiko mengalami defisiensi vitamin D akibat beragam faktor, seperti kurangnya suplementasi dan gaya hidup, serta obesitas. COVID-19 merupakan penyakit infeksi dengan morbiditas dan mortalitas global. Beberapa studi terkait COVID-19, salah satunya meneliti potensi vitamin D sebagai proteksi terhadap COVID-19. Tujuan: Studi ini bertujuan untuk mengetahui hubungan kadar vitamin D dengan derajat keparahan pasien COVID-19 pada dewasa dan lanjut usia. Metode: Kami menelusuri database PubMed, Cochrane, EBSCOhost, dan Scopus untuk mencari dan menyaring studi dalam bentuk kohort. Selanjutnya beberapa artikel dengan isu serupa dianalisis menggunakan instrumen prognosis dari Oxford Centre for Evidence Based Medicine. Hasil: Didapatkan dua studi kohort prospektif yang lolos seleksi, yakni studi Baktash, dkk. (2020) dan Campi, dkk. (2021). Keduanya menunjukkan kadar vitamin D rendah berhubungan dengan prognosis klinis dan marka inflamasi yang lebih buruk pada kasus COVID-19 dewasa dan lanjut usia (p<0,05). Simpulan: Kadar vitamin D rendah berisiko marka inflamasi ataupun prognosis klinis lebih buruk pada pasien COVID-19 dewasa dan lanjut usia. Background: Elderlies as well as adults are high-risk populations for vitamin D deficiency, caused by lack of supplementation, lifestyle, or obesity. COVID-19 is an infectious disease with global morbidity and mortality. Some studies showed vitamin D’s potential for protection against COVID-19. Objective: This evidencebased case report was to investigate the association between vitamin D levels with COVID-19 severity in adult and elderly patients. Method: Database such as PubMed, Cochrane, EBSCOHost, and Scopus were explored to search and filter relevant cohort studies. Articles with similar issue were analyzed with prognosis instrument from Oxford Centre for Evidence Based Medicine. Result: Two prospective cohort studies from Baktash, et al, (2020) and from Campi, et al, (2021) fulfilled the requirements. Both studies showed that low vitamin D levels was related to worse clinical prognosis and inflammation markers in COVID-19 cases (p<0.05). Conclusion: Low vitamin D levels were related to poorer clinical prognosis or COVID-19 inflammation markers in adult and elderly COVID-19 patients.
Faktor-Faktor yang Berhubungan dengan Gejala Depresi pada Pasien Insomnia Usia Lanjut di Rawat Jalan Pratiwi, Amalia Nur; Wahyudi, Edy Rizal; Kusumaningrum, Profitasari; Shatri, Hamzah; Rinaldi, Ikhwan; Gani, Rino Alvani; Wijaya, Ika Prasetya; Susilo, Adityo; Renaldi, Kaka
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Introduction. The elderly population is increasing globally, including in Indonesia, where 10.7% of the population in 2020 were elderly. Insomnia is a common health issue among older adults and has been identified as a predictor of depression. This study aims to identify factors associated with depressive symptoms in elderly outpatients with insomnia. Methods. This cross-sectional study was conducted in 2024 on patients aged ≥60 years at the outpatient unit of Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia, using consecutive sampling to select participants. Elderly patients were screened using the Pittsburgh sleep quality index (PSQI), and those with a score >5 (indicating insomnia) were included as study subjects. Data were collected through interviews, covering sociodemographic characteristics, level of loneliness, duration of insomnia, depressive symptoms [Geriatric Depression Scale–15 (GDS-15) items], functional status [Barthel Activities of Daily Living (B-ADL)], cognitive status [Mini-Mental State Examination (MMSE)], nutritional status [Mini Nutritional Assessment (MNA)], and chronic diseases [Cumulative Illness Rating Scale for Geriatrics (CIRSG) score]. Results. The study included 209 elderly subjects with insomnia, with a mean age of 72.88 (SD 6.98) years, and a depression prevalence of 6.7%. Bivariate analysis showed significant associations between dependency (PR 5.24; 95% CI 1.50 – 18.29), malnutrition (PR 11.54; 95% CI 4.77 – 27.92), and chronic disease with a CIRSG score ≥9 (PR 4.15; 95% CI 1.18 – 14.50) and depressive symptoms in elderly patients with insomnia. No significant associations were found between sociodemographic factors, loneliness, duration of insomnia, or cognitive status and depression. Multivariate logistic regression analysis revealed a statistically significant association between malnutrition and depressive symptoms (p < 0.001). Conclusions. There is a significant association between malnutrition and depressive symptoms in elderly outpatients with insomnia. Further cohort studies are recommended to explore the causal relationship between malnutrition and depression in elderly patients with insomnia.
Co-Authors Aditama, Humala Prika Adityo Susilo, Adityo Arif Mansjoer Aulia Rizka, Aulia C Rinaldi A Lesmana C. Martin Rumende, C. Martin Cosphiadi Irawan Czeresna Heriawan Soejono Czeresna Heriawan Soejono E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Eric Daniel Tenda Esthika Dewiasty Esthika Dewiasty, Esthika Hendra Koncoro Idrus Alwi Idrus Alwi Ika Prasetya Wijaya Ikhwan Rinaldi Irsan Hasan Kaka Renaldi Kuntjoro Harimurti Kusumaningrum, Profitasari Leonard Nainggolan Murdani Abdullah Murdani Abdullah Murdani Abdullah Nata Pratama Hardjo Lugito Noto Dwimartutie Pratiwi, Amalia Nur Rachmat Hamonangan Rachmat Hamonangan, Rachmat Rino Alvani Gani Rooshoeroe, A. G. Saskia Aziza Nursyirwan Saskia Aziza Nursyirwan, Saskia Aziza Setiati, Slti Siti Setiati Siti Setiati Siti Setiati Soejono, C. H. Stella Andriana Putri Stella Andriana Putri Sukamto Koesnoe Sukamto Koesnoe Sukamto Koesnoe THARIQAH SALAMAH, THARIQAH Ummu Habibah Ummu Habibah, Ummu Victor, Hildebrand Hanoch