Laurentius A. Pramono
Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta

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Prevalence, characteristics, and predictors of pre-diabetes in Indonesia Soewondo, Pradana; Pramono, Laurentius A.
Medical Journal of Indonesia Vol 20, No 4 (2011): November
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1041.548 KB) | DOI: 10.13181/mji.v20i4.465

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Background: Pre-diabetes is a state where glucose level higher than normal, but not satisfy the criteria for diabetes. This condition is very critical, so that if subject don’t do lifestyle modification and pharmacology therapy, they could fall to diabetes. This research objective is to describe the prevalence and predictors of pre-diabetes in Indonesia.Methods: A cross-sectional study was conducted by Metabolic Endocrinology Division, Department of Internal Medicine FMUI/RSCM and Jakarta Diabetes and Lipid Center using secondary data from National Health Survey 2007. Total  respondents are 24417 subjects from 33 provinces in Indonesia. We analyze characteristics, correlation, predictors, and  attributable risks for some predictors of pre-diabetes and diabetes.Results: Prevalence of pre-diabetes (based on impaired glucose tolerance data) in Indonesia is 10%. Predictors of pre-diabetes are male, old-age, high socio-economic status, low education level, hypertension, obesity, central obesity, and smoking. Priority for pre-diabetes and diabetes prevention in Indonesia directed to decrease blood pressure (Attributable Risk/AR  56.5%), reduce waist circumference (AR 47.3%), and stop smoking (AR 44.4%).Conclusion: Prevalence of pre-diabetes in Indonesia is high so that we need a prevention strategy for pre-diabetes and the development from pre-diabetes to diabetes. The implementation of those strategies is compiled in the Indonesian Diabetes Prevention Program.(Med J Indones 2011; 20:283-94)Keywords: diabetes, Indonesian diabetes prevention program, pre-diabetes
Tokyo Declaration: one step ahead to research and publication integrity in Asia Pacific region Pramono, Laurentius A.
Medical Journal of Indonesia Vol 22, No 3 (2013): August
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (263.969 KB) | DOI: 10.13181/mji.v22i3.579

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[no abstract available]
Mycophenolate mofetil versus cyclophosphamide for therapy of lupus nephritis: an evidence-based case report from systematic reviews and meta-analyses Pramono, Laurentius A.; Karim, Birry; Rajabto, Wulyo; Siregar, Parlindungan; Sukmana, Nanang; Setyohadi, Bambang
Medical Journal of Indonesia Vol 21, No 1 (2012): February
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (402.305 KB) | DOI: 10.13181/mji.v21i1.474

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Background: The aim of this case study is to compare the effectiveness between cyclophosphamide and mycophenolate mofetil to achieve remission of lupus nephritis in an evidence-based case report from meta-analyses.Methods: Method in this case study is evidence-based case report using meta-analyses. Clinical question used in this paper is; which immunosuppressant gives better result in achieving remission in lupus nephritis patient: cyclophosphamide or mycophenolate mofetil? To answer this question, we search the evidence from PubMed with the keywords: “lupus nephritis AND mycophenolate mofetil AND cyclophosphamide” with inclusion criteria of meta-analysis, written in English, and focused comparing cyclophosphamide and mycophenolate mofetil.Results: From the searching method, we found 11 articles which is relevant. One has been excluded since it written in Hebrew, 4 articles excluded since are not focus answering the clinical question. At the end, 6 studies were included to the critical appraisal step.Conclusion: Based on the evidences, mycophenolate mofetil is non-inferior to cyclophosphamide in achieving remission in lupus nephritis patients, but with the better safety profile. Patient in our case study get mycophenolate mofetil and shows better clinical condition towards remission as she are evaluated in the outpatient clinic. (Med J Indones 2012;21:44-51)Keywords: Cyclophosphamide, evidence-based case report, lupus nephritis, meta-analysis, mycophenolate mofetil, remission, systematic review
Plants and herbs for therapy of diabetes Pramono, Laurentius A.
Medical Journal of Indonesia Vol 24, No 2 (2015): June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (332.809 KB) | DOI: 10.13181/mji.v24i2.1260

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[No abstract available]
Profile and analysis of diabetes chronic complications in Outpatient Diabetes Clinic of Cipto Mangunkusumo Hospital, Jakarta Tarigan, Tri J.E.; Yunir, Em; Subekti, Imam; Pramono, Laurentius A.; Martina, Diah
Medical Journal of Indonesia Vol 24, No 3 (2015): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (344.752 KB) | DOI: 10.13181/mji.v24i3.1249

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Background: Chronic complications of diabetes mellitus have a significant role in increasing morbidity, mortality, disability, and health cost. In the outpatient setting, the availability of data regarding to the chronic complications of type 2 diabetes is useful for evaluation of prevention, education, and patient’s treatment. This study aimed to describe the characteristic of type 2 diabetes chronic complications in outpatient diabetes clinic.Methods: A cross-sectional study was done using 155 patients in Outpatient Diabetes Clinic of Cipto Mangunkusumo Hospital (RSCM), Jakarta in 2010. Secondary data were used from medical record based on history taking, physical examination, diabetic foot assessment, laboratory, neurologic, cardiology, opthalmology, ankle brachial index, and electrography of the patients. Characteristic profiles of the subjects, prevalence of the chronic complications, and its association with diabetes risk factors, such as glycemic control using HbA1c, fasting blood glucose, duration of diabetes, and LDL cholesterol were analyzed using chi square test.Results: Among 155 subjects participated in the study, most of them were women (59%) and elderly (46%). The prevalence of diabetes chronic complications was 69% from all subjects. These chronic complications included microangiopathy, macroangiopathy and mixed complications, with prevalence of 56%, 7% and 27% respectively. Microangiopathy included nephropathy (2%), retinopathy (7%), neuropathy (38%) and mixed complications (53%). Macroangiopathy included coronary heart disease (46%), peripheral arterial disease (19%), stroke (18%), and mixed complication (17%). From the analysis, we found significant association between duration of diabetes and diabetic neuropathy (p = 0.003).Conclusion: Prevalence of diabetes chronic complications in Outpatient Diabetes Clinic of Cipto Mangunkusumo Hospital, mainly dominated by microvascular-related complications including nephropathy, retinopathy, neuropathy and mixed complications. There was statistical significance between diabetes duration and diabetic neuropathy.
Kolangiokarsinoma dan Infeksi Virus Hepatitis PRAMONO, LAURENTIUS A.
Indonesian Journal of Cancer Vol 9, No 1 (2015): Jan - Mar 2015
Publisher : "Dharmais" Cancer Center Hospital

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ABSTRACTCholangiocarcinoma is a cancer which derived from biliary epithelial. This malignancy is rare, but have poor prognosis. Manifestation of liver flukes, primary sklerosing cholangitis, hepatolithiasis, and malformation of the biliary tree all this time are known to be risk factors for cholangiocarcinoma. In recent years, it has been shown that infection of hepatitis B and hepatitis C viral are also cholangiocarcinogenic, so it is known to become ‘new’ risk factor for cholangiocarcinoma. A literature study was conducted to search for pathogenesis theory and evidence in clinical and community study. Most basic, epigenetic, pathologic, clinical, and community studies revealed that there is a link between hepatitis viral infection and intrahepatic cholangiocarcinoma. Unfortunately, the link between the infection and extrahepatic cholangiocarcinoma remain unclear. Look at the analysis, in the future, we must take more attention to chronic hepatitis patients for the risk of getting cholangiocarcinoma, while in cholangiocarcinoma, we must also consider about the risk factors such as hepatitis viral infection in the patients. Keywords: cholangiocarcinoma, hepatitis B, hepatitis C, cholangiocarcinogenic ABSTRAKKolangiokarsinoma adalah kanker yang berasal dari epitel bilier. Keganasan ini termasuk jarang, namun memiliki prognosis yang buruk. Manifestasi cacing hati, kolangitis sklerosis primer, hepatolitiasis, dan malformasi bilier selama ini diketahui merupakan faktor risiko kejadian kolangiokarsinoma. Beberapa tahun terakhir diketahui bahwa infeksi virus hepatitis B dan hepatitis C juga memiliki sifat kolangiokarsinogenik sehingga menjadi faktor risiko ‘baru’ bagi kejadian kolangiokarsinoma. Penelusuran literatur mengenai patogenesis dan bukti ilmiah dalam studi klinis dan epidemiologi dilakukan untuk mengkaji hubungan antara infeksi virus hepatitis B dan C dengan kolangiokarsinoma. Sebagian besar riset dasar, epigenetik, patologi, klinis, dan komunitas (populasi) menyiratkan adanya hubungan antara infeksi virus hepatitis B dan C dengan kolangiokarsinoma intrahepatik. Sayangnya, hubungan infeksi kedua virus dengan kolangiokarsinoma ekstrahepatik masih belum jelas. Melihat kajian ini, ke depan perlu perhatian lebih kepada pasien hepatitis kronis terhadap risiko kolangiokarsinoma. Sementara, bagi pasien kolangiokarsinoma, perlu pencarian faktor risiko, yang salah satunya adalah infeksi virus hepatitis kronis.Kata Kunci: kolangiokarsinoma, hepatitis B, hepatitis C, kolangiokarsinogenik
Obesity and central obesity in Indonesia: evidence from a national health survey Harbuwono, Dante S.; Pramono, Laurentius A.; Yunir, Em; Subekti, Imam
Medical Journal of Indonesia Vol 27, No 2 (2018): June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (282.289 KB) | DOI: 10.13181/mji.v27i2.1512

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Background: Obesity and central obesity have become serious public health problems in developing countries such as Indonesia. Although 10 years have passed since the largest national health survey was conducted in 2007, no further analysis and publication concerning obesity and central obesity in Indonesia have been conducted based on the survey. The aim of this study is to determine the prevalence of obesity and central obesity, and its association with sociodemographic characteristics and comorbidities in Indonesia.Methods: A cross-sectional study was conducted based on the National Basic Health Survey 2007 using total sampling method from 33 provinces. Obesity is defined as body mass index ≥25 according to the Asia-Pacific standard for obesity. Central obesity is defined as waist circumference >90 cm for men and > 80 cm for women according to the Asia-Pacific standard for central obesity.Results: The prevalence of obesity and central obesity in the Indonesian adult population are 23.1% and 28%, respectively. Both rates are higher in females than in males. Obesity and central obesity are associated with the risk of diabetes and hypertension.Conclusion: Prevalence of obesity and central obesity is high in the Indonesian adult population. Interventional programs are important to promote awareness of obesity and healthy lifestyle changes in the community.
Comparison of Effects of The Hypoglycemia Management Protocol with 40% Dextrose Concentrated Solution to the Post-Correction Blood Sugar Response through Intravenous Infusion and Intravenous Bolus Yuriani, Yuriani; Andrajati, Retnosari; Pramono, Laurentius A.
Indonesian Journal of Clinical Pharmacy Vol 8, No 2 (2019)
Publisher : Universitas Padjadjaran

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Abstract

Hypoglycemic patients who receive 40% dextrose (D40%) concentrated solution in the correction process need to avoid excessive blood glucose spikes. Administration of D40% was found in two different ways, through intravenous infusion (iv infusion) and intravenous bolus (iv bolus) and the effects of both types of administration were unknown. The purpose of this study was to compare the effect of a hypoglycemia treatment protocol using D40% concentrated solution to the post-correction blood sugar response through iv infusion and iv bolus at two different hospitals with two distinct protocols. This comparative analytical cross-sectional study was conducted retrospectively at St. Carolus Hospital (D40% iv infusion group) and Bella Hospital (D40% iv bolus group). Blood glucose response, in form of coefficient of variation and degree of overcorrection, were compared between groups. The overall median blood glucose response was 69.5 (3-195) mg/dl for iv infusion group (n=60) and 77 (15-249) mg/dl for iv bolus group (n=62) (p=0.259). The coefficient of variation with iv infusion and iv bolus group were 47.18% and 52.75%, respectively. The median of degree of overcorrection in iv infusion group was lower compared with iv bolus group, 10% (0-138%) versus 23% (0-195%), respectively. Both D40% protocols did not have a significant correlation with the degree of overcorrection (Mann-Whitney test; p=0.099). D40% iv infusion and bolus administration had no effect to the post-correction blood sugar response.Keywords: Blood glucose, dextrose 40%, hypoglycemia, intravenous bolus, intravenous infusionPerbandingan Efek Protokol Manajemen Hipoglikemia dengan Larutan Pekat Dekstrosa 40% secara Intravena Infus dan Intravena Bolus terhadap Respon Gula Darah PascakoreksiAbstrakPasien hipoglikemia yang menerima larutan pekat dekstrosa 40% (D40%) dalam proses koreksinya perlu menghindari lonjakan gula darah yang berlebih. Cara pemberian D40% ditemukan diberikan dengan dua cara yang berbeda, melalui intravena infus (iv infus) dan intravena bolus (iv bolus), dan efek dari kedua jenis pemberian tersebut belum diketahui. Tujuan dari penelitian ini adalah membandingkan efek protokol manajemen hipoglikemia dengan larutan pekat D40% secara iv infus dan iv bolus terhadap respon gula darah pascakoreksi di dua rumah sakit dengan protokol yang berbeda. Penelitian analitik komparatif secara potong lintang ini dilakukan secara retrospektif di RS St. Carolus (kelompok iv infus D40%) dan RS Bella (kelompok iv bolus D40%). Respon gula darah, dalam bentuk koefisien variasi dan derajat overkoreksi, dibandingkan antara kedua kelompok. Median kenaikan gula darah pada kelompok iv infus D40% 69,5 (3-195) mg/dl (n=60 pasien) dan kelompok iv bolus D40% 77 (15-249) mg/dl (n=62 pasien) (p=0,259). Koefisien variasi dengan iv infus adalah 47,18% dan iv bolus 52,75%. Median derajat overkoreksi iv infus D40% lebih rendah dibandingkan dengan iv bolus D40%, dengan masing-masing 10% (0-138%) dan 23% (0-195%). Kedua cara pemberian D40% tidak memiliki hubungan yang bermakna dengan derajat overkoreksi (Uji Mann-whitney; p=0,099). Pemberian iv infus dan bolus D40% tidak memiliki pengaruh terhadap respon gula darah pascakoreksi.Kata kunci: Dekstrosa 40%, gula darah, hipoglikemia, intravena bolus, intravena infus
Ende Diabetes Study: diabetes and its characteristics in rural area of East Nusa Tenggara Waspadji, Sarwono; Soewondo, Pradana; Subekti, Imam; Soebardi, Suharko; Harbuwono, Dante S.; Pramono, Laurentius A.; Supali, Taniawati
Medical Journal of Indonesia Vol 22, No 1 (2013): February
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (575.721 KB) | DOI: 10.13181/mji.v22i1.517

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Background: There are only few studies about diabetes in rural area in Indonesia. Epidemiological study are needed to formulate health policy of disease management in specific area. The aim of this study was to find the prevalence of diabetes and knowledge of diabetes among the community in Nangapanda Village, Ende District, East Nusa Tenggara.Methods: A cross-sectional study “Ende Diabetes Study” was conducted in Nangapanda Village. This study use cluster random sampling method to a total number of 19756 residents in Nangapanda village. From the sampling frame of 1800 adult subjects who underwent screening with glucometer in 2008 and 2009, 125 subjects have been diagnosed as diabetes or impaired fasting glucose (IFG). All of the subjects who were diagnosed as diabetes or IFG from the previous screening and 218 subjects from control (normal subjects in the 2008 and 2009 screening) were included in the present study. Each subject underwent general anamnesis, nutritional interview, complete physical examinations, and laboratory test (blood and urine). The data were analyzed using SPSS 13.0.Ressult: There were 343 subjects in this study. The prevalence of diabetes in Nangapanda using blood glucose criteria (using fasting and post-glucose load values) was 2%; using post glucose load criteria, the prevalence of DM was 1.56%; while with HbA1c criteria, the prevalence was 2.83%. The prevalence of impaired glucose tolerance (IGT) was 2.2%, and IFG was 6.2%. A number of 71.1% Nangapanda residents have sufficient knowledge about diabetes.Conclusion: Prevalence of diabetes in Nangapanda (using fasting and post-glucose load criteria) was 2% and 1.56% (using post-glucose load values). As much as 71.1% of Nangapanda residents have sufficient knowledge about diabetes. (Med J Indones. 2013;22:30-8)Keywords: Diabetes mellitus, Ende Diabetes Study, prevalence, rural Indonesia