Bogi Pratomo
Division of Gastroentero-hepatology, Department of Internal Medicine, Faculty of Medicine, University of Brawijaya/Dr. Saiful Anwar General Hospital, Malang

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Journal : Jurnal Penyakit Dalam Indonesia

PERBANDINGAN MORTALITAS ANTARA PEMBERIAN ALBUMIN INTRAVENA DAN TIDAK DIBERIKAN ALBUMIN INTRAVENA PADA PASIEN SEPSIS DENGAN KONDISI HIPOALBUMINEMIA DAN FAKTOR YANG BERPENGARUH TERHADAP MORTALITAS PASIEN SEPSIS Marzuki, Mochammad Jalalul; Supriono, Supriono; Pratomo, Bogi; Mustika, Syifa
Jurnal Penyakit Dalam Indonesia Vol 6, No 4 (2019)
Publisher : Internal Medicine Department, Faculty of Medicine Universitas Indonesia-RSCM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.7454/jpdi.v6i4.361

Abstract

Pendahuluan. Hipoalbuminemia merupakan prediktor kuat terhadap mortalitas pada pasien non operatif maupun operatif. Albumin berperan mempertahankan tekanan onkotik pada kondisi kritis seperti sepsis. Pemberian human serum albumin (HSA) eksogen pada sepsis dengan kondisi hipoalbuminemia masih kontroversial dengan hasil luaran yang bervariasi. Penelitian ini dilakukan untuk mengetahui perbandingan mortalitas antara pasien sepsis dengan kondisi hipoalbuminemia yang diberikan albumin intravena dan tanpa pemberian albumin intravena serta mengetahui faktor yang berpengaruh terhadap mortalitas pasien sepsis.Metode. Penelitian observasional dengan pendekatan prospektif melibatkan 75 subjek penelitian usia >18 tahun dengan sepsis disertai hipoalbuminemia (<2,5 g/dL) yang dirawat di ruangan high care unit RSUD dr. Saiful Anwar Malang selama periode 1 September 2018-31 Agustus 2019 yang terbagi menjadi dua kelompok, yaitu kelompok  albumin dan nonalbumin. Kedua kelompok diikuti selama hospitalisasi sampai pulang atau meninggal dunia. Perbedaan mortalitas antara kedua kelompok dianalisis dengan uji bivariat chi square. Faktor yang paling berpengaruh terhadap mortalitas dianalisis dengan uji multivariat regresi logistik berganda.Hasil. Didapatkan 39 orang (52%) dari kelompok albumin dan 36 orang (48%) dari kelompok non albumin. Perbedaan jumlah mortalitas antara kelompok albumin dan nonalbumin {25 (64,1%) vs. 16 (44,4%) yang mana perbedaan tersebut tidak bermakna secara statistik dengan nilai OR 2 (p=0,138}. Faktor yang berpengaruh terhadap mortalitas  antara lain: skor SOFA (OR 34,27, p<0,001), nilai MAP (OR 8, p<0,001), kondisi syok septik (OR 4,31, p=0,03), diabetes melitus (OR 0,28, p=0,009), kondisi gagal nafas (OR 8,02, p<0,001), penurunan kesadaran (OR 64,75, p<0,001), gagal kardiovaskular (OR 6, p<0,001), dan kondisi gagal hematologi (OR 3,05, p=0,027). Faktor yang paling dominan berpengaruh terhadap mortalitas pasien sepsis adalah penurunan kesadaran (OR 2,67, p=0,001).Simpulan. Pemberian transfusi albumin tidak memberikan perbedaan bermakna terhadap kejadian mortalitas pada pasien sepsis dengan kondisi hipoalbuminemia. Faktor yang paling berpengaruh terhadap mortalitas pasien sepsis adalah kondisi penurunan kesadaran.Kata Kunci:  Hipoalbuminemia, mortalitas, sepsis, transfusi albumin Comparison of Mortality between Intravenous Albumin and No Intravenous Albumin in Sepsis Patients with Hypoalbuminemia Conditions and Factors that Influence the Mortality of Sepsis Patients Introduction. Hypoalbuminemia is a strong predictor of mortality in nonoperative and operative patients. Albumin plays a role in maintaining oncotic pressure in critical conditions such as sepsis. The administration of exogenous Human Serum Albumin (HSA) in sepsis with hypoalbuminemia conditions is still controversial with varying outcomes.This study aimed to know the mortality ratio between intravenous albumin administration and no intravenous albumin administration in sepsis patients with hypoalbuminemia conditions and also to know the factors that influence the mortality of sepsis patients.Methods. An observational study with a prospective approach involving 75 research subjects aged >18 years with sepsis accompanied by hypoalbuminemia (<2.5 g/dL) treated in the high care unit of RSUD dr. Saiful Anwar Malang during the period 1 September 2018-31 August 2019. Subjects were divided into two groups namely albumin and nonalbumin groups. Both groups were followed during hospitalization until they discharged or died. Differences in mortality between the two groups were analyzed by chi square bivariate test. The most influential factors on mortality were analyzed by multivariate binary logistic regression tests.Results. There were 39 people (52%) from the albumin group and 36 people (48%) from the non-albumin group. Difference in mortality between albumin and nonalbumin groups {25 (64.1%) vs 16 (44.4%) with OR 2, p=0.138} means there was no statistically significant difference. Factors that influence mortality included: SOFA score (OR 34.27, p <0.001), MAP value (OR 8, p<0.001), septic shock (OR 4.31, p=0.03), diabetes mellitus (OR 0.28, p=0.009), respiratory failure (OR 8.02, p <0.001), decreased of consciousness (OR 64.75, p <0.001), cardiovascular failure (OR 6, p <0.001), hematological failure (OR 3.05, p=0.027). The most dominant factor affecting mortality in sepsis patients is decreased of consciousness (OR 2.67, p=0.001).Conclusion. The administration of albumin transfusion did not make a significant difference in the incidence of mortality in sepsis patients with hypoalbuminemia. The most influential factor on mortality of sepsis patients is decreased of consciousness.
Pengaruh Kurkumin Terhadap Kadar NF-κB dan Derajat Fibrosis Hati pada Tikus Fibrosis Hati Supriono, Supriono; Pratomo, Bogi; Praja, Dedy Indra
Jurnal Penyakit Dalam Indonesia Vol 5, No 4 (2018)
Publisher : Internal Medicine Department, Faculty of Medicine Universitas Indonesia-RSCM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (713.64 KB) | DOI: 10.7454/jpdi.v5i4.271

Abstract

Pendahuluan. Inflamasi kronik merupakan mekanisme utama penyebab fibrosis hati. NF-κB  berfungsi mengatur inflamasi, penyembuhan luka, serta kematian sel. Kurkumin berperan sebagai antiinflamasi, antifibrotik, dan induksi apoptosis, salah satunya melalui hambatan terhadap NF-κB. Penelitian ini bertujuan untuk mengetahui pengaruh pemberian kurkumin terhadap perubahan kadar NF-κB dan korelasi antara lama pemberian kurkumin terhadap kadar NF-κB dan derajat fibrosis hati.Metode. Penelitian ini merupakan penelitian eksperimental in vivo menggunakan 32 ekor tikus wistar yang dibagi dalam 8 kelompok perlakuan, tiap kelompok terdiri dari 4 ekor tikus. Perlakuan terhadap tikus berupa induksi CCl4 dan pemberian kurkumin. Pengukuran kadar NF-κB dengan metode ELISA. Derajat fibrosis hati menggunakan Metavir scoring system. Analisis data menggunakan uji korelasi, one-way Anova, unpair T-test, Mann-Whitney, Chi-square, Kruskal-Wallis dan analisis jalur model struktural dengan nilai p signifikan yaitu p<0,05. Hasil. Terdapat perbedaan yang signifikan kadar NF-κB dan derajat fibrosis hati antara kelompok kontrol positif dengan kelompok kontrol negatif. Terdapat pengaruh yang signifikan pemberian kurkumin dan lama pemberian kurkumin terhadap perubahan derajat fibrosis hati dan kadar NF-κB jaringan hati. Terdapat korelasi negatif antara lama pemberian kurkumin dengan perubahan kadar NF-κB dan korelasi positif antara perubahan kadar NF-κB dengan derajat fibrosis hati.Simpulan. Pemberian kurkumin dapat menurunkan kadar NF-κB dan derajat fibrosis hati. Lama pemberian kurkumin berkorelasi dengan penurunan kadar NF-κB dan penurunan kadar NF-κB berkorelasi dengan penurunan derajat fibrosis hati. Kata Kunci: Derajat fibrosis hati, Kurkumin, NF-κB, Tikus model fibrosis hati The Effects of Curcumin on NF-κB Level and Degree of Liver Fibrosis in Rat Liver Fibrosis Introduction. Chronic inflammation is the main mechanism responsible for liver fibrosis. NF-κB regulates inflammation, wound healing, and cell death. Curcumin acts as an antiinflammatory, antifibrotic and induced apoptosis, one of them through resistance to NF-κB. This study aimed to determine the effect of curcumin on NF-κB levels and the correlation between the duration of curcumin on NF-κB and degree of liver fibrosis. Methods. This study was an experimental in rats using a completely randomized design. The treatment of rats was induced with CCl4 and given curcumin. Measurement of NF-κB levels by ELISA method. Degree of liver fibrosis using metavir scoring system. The data were analyzed using correlation test, one-way anova, unpair T-test, mann-whitney, chi-square, kruskal-wallis, structural model with significant p value p < 0,05. Results. There were significant differences in NF-κB level and degree of liver fibrosis between the positive control group and the negative control group. There was a significant effect of curcumin administration on the level of NF-κB and degree of liver fibrosis. There was a negative correlation between duration of curcumin and NF-κB level and positive correlationbetween NF-κB levels and degree of liver fibrosis. Conclusions. Curcumin can decrease NF-κB levels and decrease the degree of liver fibrosis. The duration of the curcumin administration correlated with decreased levels of NF-κB and decreased NF-κB levels correlated with decreased degree of liver fibrosis in rat liver fibrosis. 
Analisis Faktor Risiko Gastroesofageal Refluks di RSUD Saiful Anwar Malang Tarigan, Ricky; Pratomo, Bogi
Jurnal Penyakit Dalam Indonesia Vol 6, No 2 (2019)
Publisher : Internal Medicine Department, Faculty of Medicine Universitas Indonesia-RSCM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (419.281 KB) | DOI: 10.7454/jpdi.v6i2.306

Abstract

Pendahuluan. Gastroesophageal reflux disease (GERD) adalah suatu keadaan patologis sebagai akibat refluks kandungan lambung ke dalam esofagus dengan berbagai gejala yang timbul akibat keterlibatan esofagus, laring, dan saluran nafas. Prevalensi GERD meningkat akhir-akhir ini. Di Indonesia, ditemukan kasus esofagitis sebanyak 22,8%. Analisis faktor risiko terjadinya GERD sangatlah penting diketahui di dalam mengurangi prevalensi GERD. Tujuan dari penelitian ini yaitu untuk mengetahui faktor risiko yang paling berpengaruh pada pasien GERD sehingga diharapkan menjadi acuan referensi untuk mengurangi prevalensi GERD di tahun berikutnya.Metode. Penelitian ini merupakan penelitian cross-sectional. Data yang diambil berdasarkan rekam medis pasien yang menjalani pemeriksaan endoskopi di Divisi Gastroenterologi Hepatologi di Rumah Sakit Dr. Saiful Anwar Malang selama tahun 2016. Diagnosis didapatkan dari anamnesis, pemeriksaan fisik, dan kriteria diagnostik GERD dari endoskopi menurut kriteria Los Angeles.Hasil. Didapatkan 57 pasien dengan wanita 20 orang (32,5%) dan laki-laki 37 orang (67,5%). Pasien berusia >40 tahun ada sebanyak 36 pasien (63,16%). Didapatkan sebanyak 28 pasien (49,12%) mengonsumsi jamu, 31 pasien (54,38%) merokok, dan 18 pasien (31,48%) mengonsumsi alkohol. Hasil analisis faktor risiko GERD menunjukkan bahwa faktor yang berpengaruh terhadap kejadian GERD pada yaitu faktor konsumsi jamu (p=0,007 dengan nilai OR=4,586 (interval kepercayaan [IK] 95%: 1,386-15,177)) dan alkohol (p=0,027 dengan nilai OR=4,846 (IK 95%: 1,024-22,929)).Simpulan. Faktor yang berpengaruh terhadap kejadian GERD pada penelitian ini yaitu faktor konsumsi jamu dan alkohol.Kata Kunci: Endoskopi, Gastroesofageal refluks, GERD, Kriteria Los Angeles  Gastroesophageal Reflux Risk Factor Analysis at Saiful Anwar Hospital in MalangIntroduction. Gastroesophageal reflux disease (GERD) is a pathological condition as a result of reflux of stomach contents into the esophagus with various symptoms that arise due to the involvement of the esophagus, larynx, and airways. The prevalence of GERD has increased lately. In Indonesia, 22.8% cases of esophagitis were reported. Analysis of the risk factors for GERD is very important in reducing the prevalence of GERD. This study aimed to identify the most influential risk factors for GERD patients so that it could become a reference to reduce the prevalence of GERD in the following year.Methods. This study was a cross-sectional study where data was taken based on data from medical records of patients undergoing the endoscopic procedure in the division of Hepatology Gastroenterology at Saiful Anwar Hospital Malang during 2016. The diagnosis was obtained from history, physical examination, and GERD diagnostic criteria from endoscopy according to the Los Angeles criteria.Results. Among 57 patients, there were 20 female (32.5%) and 37 male (67.5%), 63.16% of them are >40 years old. This study found that 28 patients (49.12%) consumed herbs, 31 patients (54.38%) found smoking, and those who consumed alcohol were 18 patients (31.48%). The analysis showed that factors related to the incidence of GERD were herbal consumption (p=0.007; OR 4.586 (95% CI: 95%: 1.386-15.177)) and alcohol consumption (p 0.027; OR 4.846 (95% CI: 1.024-22.929)). Conclusion. Consumption of herbal and alcohol appear to be risk factors of the incidence of GERD in this study.
ARTRITIS PADA INFEKSI HEPATITIS C KRONIS: RHEUMATOID LIKE ARHTRITIS ATAU TRUE RHEUMATOID ARTHRITIS? Susanto, Jefri Pratama; Mustika, Syifa; Pratomo, Bogi
Jurnal Penyakit Dalam Indonesia Vol 7, No 1 (2020)
Publisher : Internal Medicine Department, Faculty of Medicine Universitas Indonesia-RSCM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.7454/jpdi.v7i1.244

Abstract

Infeksi hepatitis C sering ditemukan pada pasien asimptomatis, yaitu pada saat skrining ditemukan peningkatan kadar transaminase. Gejala infeksi hepatitis C antara lain seperti lemas, gangguan tidur, mual dan sebagainya. Namun, tidak jarang juga disertai gejala ekstrahepatik seperti artritis dan myalgia. Artritis ditemukan pada 2-20% pasien hepatitis C. Sebanyak 2/3 pasien hepatitis C memiliki artritis menyerupai artritis rheumatoid dan sisanya merupakan oligoartritis.Sebuah studi menunjukkan bahwa pasien dengan infeksi hepatitis C kronis memiliki resiko dua kali lipat untuk terkena artritis rheumatoid. Studi tersebut menemukan bahwa pasien hepatitis C dengan manifestasi artritis ini sering misdiagnosis dengan artritis rheumatoid. Karena artritis pada pasien hepatitis C juga memenuhi kriteria diagnosis artritis rheumatoid menurut ACR dan EULAR 2010. Dengan demikian, perlu untuk membedakan penyebab artritis pada pasien hepatitis C kronis, karena tata laksana pada kedua penyakit tersebut sangatlah berbeda.Laporan kasus ini memberikan gambaran tentang seorang wanita 61 tahun dengan infeksi hepatitis C kronis dengan sirosis hepatis yang sudah mendapatkan pengobatan hepatitisnya yang datang dengan keluhan nyeri sendi pada jari-jari tangan kiri. Melalui pemeriksaan fisik dan pemeriksaan penunjang anti-CCP, rheumatoid factor, dan CRP didapatkan bahwa pasien menderita artritis rheumatoid. Pasien mendapatkan pengobatan klorokuin 1 x 250 mg dan mengalami perbaikan klinis. Kata Kunci: Artritis, artritis rheumatoid, hepatitis C, sirosis hepatisArthritis in Chronic Hepatitis C Infection: Is It Rheumatoid Like Arthritis or True Rheumatoid Arthritis?Hepatitis C infection is often found in asymptomatic patients accidentaly during general check up, where there is increment levels of transaminases. Symptoms of hepatitis C infection include weakness, sleep disorders, nausea and so on. However, extrahepatic symptoms such as arthritis and myalgia are common. Arthritis is found in 2-20% of hepatitis C patients. As many as 2/3 of hepatitis C patients have arthritis resembling rheumatoid arthritis and the rest are oligoarthritis.Studies showed that patients with chronic hepatitis C infection had twice the risk of developing rheumatoid arthritis. Hepatitis C patients with manifestations of arthritis are often misdiagnosed with rheumatoid arthritis. Because arthritis in hepatitis C patients also meets the criteria for diagnosis of rheumatoid arthritis according to ACR and EULAR 2010. Therefore, it is necessary to differentiate the causes of arthritis in patients with chronic hepatitis C, because the management of both diseases is very different.This case report describes a 61-year-old woman with chronic hepatitis C infection and cirrhosis hepatis who had received hepatitis treatment and felt joint pain in the fingers of the left hand. Through physical examinations and anti-CCP investigations, rheumatoid factor, and CRP, it was found that patients suffered from rheumatoid arthritis. Patients get 1 x 250 mg chloroquine treatment and showed clinical improvement.