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"Depression is a significant problem that is common among elderly patients. The prevalence is quite high, effecting approximately 15% of the population of over 65 years.1 Among patients with chronic diseases and those with a longer care the prevalence of depression is even higher, which is 10% to 60%. Several studies demonstrate that the comorbidity of depression and physical diseases a patient suffers creates a worse prognosis and increases mortality.2'3 Disease management becomes more difficult and not optimal because depression could cause the patient to eat less and become less cooperative in following the treatment, thus resulting in a poorer medical condition.Depression is generally commonly found in the elderly. Nevertheless, diagnosing depression in the elderly is not easy. Approximately 60% of depression patients have a co-morbid physical disease.2Detection of depression among geriatric patients is often delayed due to unspecific symptoms. Delayed detection results in delayed management, which has a bad impact on the patient's medical condition and response to treatment. This is also why co-morbidity of diseases and depression has a higher mortality rate. The following are several cases of hospitalized patients suffering from depression and a co-morbid illness"

"HIV merupakan penyakit yang sering terjadi bersamaan dengan penyakit lain. Keberadaan penyakit penyerta memerlukan terapi bersama dengan obat ARV. Hal ini memungkinkan terjadinya interaksi antar obat yang berpotensi menyebabkan penurunan atau peningkatan kadar obat dalam darah, yang bisa menimbulkan kegagalan terapi atau efek samping berupa toksisitas. Penelitian ini bertujuan melihat potensi interaksi yang penting secara klinis dari terapi ARV dengan obat komorbidnya. Penelitian ini adalah penelitian non eksperimental, pengambilan data dilakukan secara potong lintang pada pasien HIV dengan komorbid yang dirawat di rumah sakit Cipto Mangunkusumo dalam periode Januari 2016 sampai dengan Juli 2017. Data diambil dari electronic health record dan pusat rekam medis RSCM. Dari 224 pasien HIV yang masuk kedalam kriteria inklusi, terdapat 121 pasien yang memenuhi persyaratan dan diambil menjadi subjek penelitian. Potensi interaksi yang penting secara klinis didefinisikan sama dengan potensi interaksi mayor memerlukan modifikasi dosis, jangan diberikan bersamaan, kontraindikasi atau hindari . Hasil penelitian menunjukkan dari 121 pasien, potensi interaksi mayor terjadi pada 18 pasien 14,99 dengan potensi interaksi yang menurunkan kadar ARV pada 14 pasien 11,57 . Kejadian potensi interaksi mayor yang paling banyak terjadi yaitu antara nevirapin dan rifampisin 3,53 . Komorbid terbanyak adalah Tuberkulosis Paru 12,92 . Diperlukan penelitian prospektif pengukuran kadar obat dan efek terapi akibat interaksi obat ARV dengan obat komorbidnya.

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HIV is a disease commonly presents with other comorbidities which need concomitant treatments with ARV. Drug-drug interaction is an unavoidable consequence which may potentially lead to an increase or a decrease of affected drug and ultimately resulted in therapeutic failure or otherwise, toxicity.This study was aimed to look at the potential of clinically significant drug-drug interactions between ARV and other treatments. This was a non experimental cross sectional study conducted on HIV patients with comorbids treated at the Cipto Mangunkusumo hospital from January 2016 to Juli 2017. Data were taken from the electronic health record and Cipto Mangunkusumo hospital medical record. From 224 HIV patients who meet the criteria of inclusion, there are 121 patients that rsquo;s fulfilled the conditions and was taken to be the subjects of research. The potential of clinically significant drug-drug interactions are definitioned as potential for major interaction requiring dose modification, do not coadminister, contraindicated or avoid . The results showed that potential for mayor interactions occurred in 18 out of 121 patients 14.99 . Potential decrease of blood ARV level was found in 14 patients 11.57 . The occurance of potential for major interaction mostly happened between nevirapin and rifampisin 3,35 . The most comorbid is pneumonia tuberculosis 12.92 . Prospective study is required to measure drugs level and the effect of therapy consequence ARV drugs interaction with comorbid drugs"

"Long COVID (disebut juga post acute COVID, Post-COVID-19, Post-COVID-19 syndrome) adalah tanda dan gejala yang masih dialami setelah melewati fase akut COVID-19. Long COVID muncul pada banyak penyintas COVID. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan kejadian Long COVID pada penyintas COVID-19 di Kelurahan Jatisampurna Kota Bekasi. Penelitian ini menggunakan desain penelitia cross-sectional. Penelitian ini diikuti oleh 308 responden, dengan proporsi perempuan 64% dan laki-laki 36%. Hasil penelitian ini menunjukan proporsi kejadian Long COVID sebesar 80,2%. Gejala yang paling banyak dilaporkan adalah kelelahan (64%), brain fog (30.5%), dan batuk kering (21.8%). Analisis bivariat menunjukan bahwa tidak ada hubungan yang signifikan antara umur dan pekerjaan dengan kejadian Long COVID. Namun terdapat hubungan yang signifikan antara jenis kelamin dengan kejadian Long COVID (p= 0,011 OR=2,157) dan komorbid dengan kejadian Long COVID (p=0,006 OR= 2,652).

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Long COVID (also known as post acute COVD, Post-COVID-19, Post-COVID-19 syndroem) are signs and symptoms that are still experienced after passing thorugh the acute phase of COVID-19. Long COVID appears in mancy COVID-19 survivors. This trudy aims to determine the factors associated with the incidence of Long COVID in COVID-19 survivors in Urban Village of Jatisampurna, Bekasi City. This study used a cross sectional research design. This study was followed by 308 respondents, with proportion of female 64% and male 36%. The results of this sstudy show the proportion of the incidence of Long COVID is 80,2%. The most common symptom reported was fatigue (72.8%), brain fog (30.5%), and dry cough (21.8%). Bivariate analysis showed that there is no significant relationship between age and occupation with incidencen of Long COVID. However, there is a significant relationship between gender and the incidence of Long COVID (p=0,011, OR= 2,157) and comorbidity with incidence of Long COVID (p= 0,006, OR= 2,652)."

"Narkotika yang disalahgunakan dapat menimbulkan ketergantungan. Semakin lama mengalami ketergantungan narkotika akan semakin memperburuk kualitas kesehatan. Pada pengguna narkoba suntik, komplikasi komorbiditas seperti hepatitis, tuberkulosis paru, dan HIV/AIDs juga semakin tinggi.Tujuan penelitian ini adalah mengetahui komorbiditas pada penyalah guna narkoba dan determinannya. Metode penelitian adalah potong lintang dengan menggunakan data sekunder catatan medis (medical-record) di Rumah Sakit Ketergantungan Obat (RSKO) Jakarta tahun 2013.Populasi dalam penelitian ini adalah seluruh pasien ketergantungan narkoba yang dirawat inap, yang menjalani rehabilitasi dan rawat jalan, dan sampel penelitian ini adalah seluruh populasi sebesar 303 orang. Analisis data yang digunakan adalah analisis secara univariat, bivariat, dan multivariat.Hasil penelitian menunjukkan bahwa pasien yang dirawat jalan dan lama menggunakan narkoba berhubungan dengan komorbiditas pada pecandu narkoba. Model akhir analisis multivariat menunjukkan bahwa lama menggunakan narkoba merupakan variabel yang paling berpengaruh terhadap komorbiditas pecandu narkoba.

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Narcotics are abused can lead to dependence. The longer experiencing drug dependence will worsen the quality of health care. In injecting drug users, complications such ashepatic, comorbidities, pulmonary TB, and HIV/AIDs also higher.

The purpose of this study was to determine the co-morbidity of drug abusers and its determinant. The method is a cross sectional study using secondary data, medical records at the Drug Dependence Hospital Jakarta in 2013.

The study population were all drug dependent patients who are hospitalized, undergoing rehabilitation and outpatient care, and sample is total population of 303 people. Data were analyzed using univariate, bivariate and multivariate analyzes.

The results showed that patients treated in outpatients and comorbidities associated with drug addicts. The final model of multivariate analysis showed that longer using drugs is the most influential variable on the comorbidity of drug addicts."

"Obesity is a common comorbidity of type-2 diabetes and one of the most modifiable risk factors for preventing other comorbid conditions, such as diabeticnephropathy and cardiovascular disease. Using a cross-sectional design, this study aimed to determine eating behavior, factors related with obesity and thedominant factor of obesity in patients with type-2 diabetes. Data were collected from 133 members of the Chronic Disease Countermeasure Program inJatinegara Primary Health Care, East Jakarta, that were selected using purposive sampling. Food intake was assessed by 1 × 24-hour food recall and theFood Frequency Questionnaire, Physical activity was assessed by the Global Physical Activity Questionnaire. Results showed that 63.9% of the surveyedtype-2 diabetics were obese (body mass index ≥ 25 kg/m2) and that the respondents consumed more fat than the recommended value (30.77% ± 9.06%)but less energy than the required value (62.06% ± 23.67%). The prevalence of obesity among adults with type-2 diabetes could be associated with nutritional knowledge, education level, and the length of suffering from the disease. Nutritional knowledge was found to be a dominant factor associated with obesity."

"Pendahuluan: Pada traumatic brain injury (TBI) dapat terjadi peningkatan metabolisme sehingga pasien rentan mengalami malnutrisi. Tatalaksana nutrisi yang adekuat sesuai dengan kondisi klinis dan komorbiditas berperan dalam mencegah terjadinya malnutrisi, menurunkan morbiditas dan mortalitas, serta mengoptimalkan outcome neurologis. Presentasi Kasus: Keempat pasien dalam serial kasus ini adalah laki-laki berusia antara 31-60 tahun dengan TBI dan berbagai faktor penyulit. Pasien pertama dengan obesitas dan mengalami hiponatremia berulang selama perawatan, pasien kedua memiliki status gizi malnutrisi, pasien ketiga dengan riwayat kemoradiasi pada astrositoma, amiloid angiopati dan disfagia, sementara pasien keempat dengan hipertensi dan fibrilasi atrium. Skrining gizi dengan MST pada keempat pasien menunjukkan skor dua. Pemberian energi pada keempat pasien adalah sebesar 140-150% dari kebutuhan energi basal yang dihitung dengan Harris-Benedict, dengan target pemberian protein sebesar 1,5-1,9 g/kg BB/hari atau setara dengan 20% energi. Selama pemantauan asupan protein pada keempat pasien adalah sebesar 0,55-1,67 g/kg BB/hari atau setara dengan 13,1-19,5% energi. Restriksi cairan dilakukan pada pasien pertama sebagai tatalaksana hiponatremia yang diperkirakan terjadi akibat SIADH. Pemberian natrium pada pasien keempat tidak direstriksi meskipun pasien mengalami hipertensi karena hipertensi adalah salah satu mekanisme kompensasi pada TBI. Pasien ketiga mengalami disfagia jika mengasup air putih sehingga dilakukan latihan menelan. Asupan per oral dimulai pada hari ke 6-15 pasca trauma. Hasil: Keempat pasien menunjukkan perbaikan outcome neurologis yang tampak berdasarkan peningkatan skor GCS disertai peningkatan kapasitas fungsional. Kesimpulan: Tatalaksana nutrisi yang adekuat pada pasien TBI dengan mempertimbangkan komorbiditas pasien diperlukan untuk menunjang penyembuhan dan memperbaiki outcome pasien.

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Background: Hypermetabolism in traumatic brain injury (TBI) increase the risk of malnutrition. Adequate nutritional management based on clinical status and comorbidity reduces the risk of malnutrition, therefore reduces morbidity and mortality rate and improves neurological outcomes.

Case Presentation: The four patients included in this serial case were male, 31-60 years old. All patients were diagnosed with TBI complicated by various comorbidities.The first patient was obese with reccurrent episode of hyponatremia during hospitalization, the second patient was malnourished, the third patient had history of chemoradiation due to astrocytoma and was diagnosed with angiopathy amyloid and dysphagia, while the fourth patient was diagnosed with hypertension and atrial fibrilation. The MST scores in all four patients were two. Target of energy provision were between 140-150% of predicted basal energy requirement and target of protein provision were 1,5-1,9 g/kg BW/day or equal to 20% of energy. The protein intake during monitoring were 0,55-1,67 g/kg BW/day or equal to 13,1-19,5% energy. The fluid intake was restricted in first patient due to SIADH- related hyponatremia. Sodium intake was not restricted for the forth patient eventhough the patient was diagnosed with hypertension. In TBI, hypertension could occur due to compensational mechanism. The third patient was having difficulties consuming water due to dysphagia, and was conducted to multiple swallowing therapy exercises. Oral intake in four patients were initiated in day 6-15 post trauma.

Result: There were improvement of neurological outcome shown by the higher GCS score and improvement of the functional capacity in all four patients

Conclusion: Adequate nutritional management in TBI patient can support the recovery and improve patient's outcome. Nutritional management should consider patient's comorbidities."

"Gangguan Pemusatan Perhatian dan Hiperaktivitas (GPPH) adalah gangguan neuropsikiatri yang dapat terjadi pada anak-anak serta dapat memberikan beban dan hambatan dalam menjalankan fungsi sehari-hari. Komorbiditas psikiatrik pada GPPH dapat menambah morbiditas dan memperburuk prognosis dari GPPH. Perbaikan klinis GPPH berhubungan dengan kualitas hidup yang lebih baik, namun belum ada penelitian mengenai hubungan komorbiditas terhadap lama perbaikan klinis GPPH yang menggunakan alat ukur Abbreviated Conners Parent/Teacher Rating Scale (ACP/TRS), alat ukur yang digunakan di Indonesia. Penelitian ini bertujuan untuk mengetahui hubungan komorbiditas gangguan jiwa terhadap lama perbaikan klinis GPPH dengan menggunakan ACP/TRS. Dengan menggunakaan metode cross-sectional, penelitian ini menggunakan rekam medis pasien GPPH yang datang ke RSUPN Cipto Mangunkusumo (RSCM) dalam periode 1 Januari 2014-1 Januari 2018 sehingga didapatkan 94 sampel. Angka perbaikan klinis pasien GPPH dalam 7 minggu secara keseluruhan adalah 56,4% (n = 53), dengan komorbiditas yang paling sering adalah retardasi mental (40%, n = 16). Penelitian ini tidak menemukan hubungan komorbiditas gangguan jiwa terhadap perbaikan klinis GPPH (P = 0,85), kemungkinan karena variabel lain yang memengaruhi perbaikan klinis pasien tidak dieksklusi. Penelitian lebih lanjut perlu mempertimbangkan kepatuhan pasien dalam berobat dan kecukupan dosis obat yang diberikan.

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Attention-Deficit/Hyperactivity Disorder (ADHD) is a neuropsychiatric disorder that can occur in children, which could add burden to their daily functions. Psychiatric comorbidities in ADHD may increase morbidity and worsen the prognosis of ADHD. Clinical improvement of ADHD is associated with better quality of life. However, there has not been a study of ADHD using Abbreviated Conners Parent/Teacher Rating Scale (ACP/TRS), the instrument used in Indonesia. This cross-sectional study used the medical record of ADHD patients in RSUPN Cipto Mangunkusumo (RSCM) that were in the Medical Records Unit within the period of 1 January 2014-1 January 2018. A total of 94 medical records were obtained. Within 7 weeks, 56,4% of all ADHD patients (n = 53) has improved, with the most prevalent comorbidity being mental retardation (40%, n = 16). This study found no significant relationship between psychiatric comorbidity and the clinical improvement of ADHD (P = 0,85), probably because some variables that affect clinical improvement are not excluded. Further studies that consider patients adherence to medication dan adequacy of the dosage of the drug administered are required."

"ABSTRACTTransplantasi ginjal masih menjadi terapi pilihan pada penyakit gagal ginjal stadium akhir. Lama rawat inap (Length of Stay/LOS) adalah penanda alternatif dari morbiditas perioperatif pasien yang berkaitan dengan hasil pembedahan jangka panjang. Penilaian prabedah dapat digunakan untuk memaksimalkan kualitas pemulihan. Salah satu penilaian prabedah adalah Charlson Comorbidity Index (CCI) yang secara umum dinilai baik dalam memprediksi mortalitas, disabilitas, readmisi, dan LOS. CCI belum menjadi standar alat penilaian prabedah di RSUPN dr. Cipto Mangunkusumo. Penelitian dilakukan dengan metode kohort retrospektif menggunakan rekam medik resipien transplantasi ginjal antara Januari 2015-Desember 2017. Analisis bivariat dilakukan antara LOS dengan skor total CCI dan antara LOS dengan kondisi-kondisi komorbid dalam CCI. Variabel yang signifikan dimasukan ke dalam analisis multivariat. Berdasarkan hasil analisis bivariat dan multivariat, skor total CCI dan kondisi-kondisi komorbid dalam CCI tidak memengaruhi LOS secara signifikan. Kesimpulannya, sistem skor CCI tidak dapat digunakan dalam menentukan kejadian LOS berkepanjangan pascatransplantasi ginjal.

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ABSTRACTKidney transplantation is still the treatment of choice in end-stage renal failure. Length of stay (LOS) is an alternative marker of the patient's perioperative morbidity associated with long-term surgical results. Preoperative assessment can be used to maximize the quality of recovery. One of the preoperative assessments is the Charlson Comorbidity Index (CCI) which is generally considered good in predicting mortality, disability, readmission, and LOS. CCI has not become a standard pre-assessment assessment tool at RSUPN Dr. Cipto Mangunkusumo. The study was conducted using a retrospective cohort method using a kidney transplant recipient medical record between January 2015-December 2017. Bivariate analysis was performed between LOS with a total CCI score and between LOS with comorbid conditions in CCI. Significant variables were included in the multivariate analysis. Based on the results of bivariate and multivariate analyzes, total CCI scores and comorbid conditions in CCI did not significantly affect LOS. In conclusion, the CCI scoring system cannot be used to determine the incidence of prolonged LOS after kidney transplantation."

"PURPOSES: The purpose of this study was to evaluate the influence of comorbidities on the surgical outcomes of early cholecystectomy for acute cholecystitis.METHODS: Data were retrospectively collected for patients with acute cholecystitis who underwent early cholecystectomy. Patients were separated into three groups based on the cholecystitis severity grade, and the surgical outcomes of early cholecystectomy were analyzed. Patients with mild and moderate cholecystitis were subdivided into a comorbidity group (n = 10) and a non-comorbidity group (n = 83).RESULTS: There were 57 (55.3%) patients with mild cholecystitis, 36 (35.0%) with moderate cholecystitis, and 10 (9.7%) with severe cholecystitis. The surgical outcomes were significantly worse for patients with severe cholecystitis than for patients with mild or moderate cholecystitis. There were no postoperative deaths after cholecystectomy. There were no significant differences in the complication rate (P = 0.629), conversion rate (P = 0.114), or intraoperative blood loss (P = 0.147) between the comorbidity and non-comorbidity groups.CONCLUSION: Our findings suggest that early cholecystectomy can be performed safely for patients with mild and moderate cholecystitis even if comorbidities are present. Early cholecystectomy may be an alternative treatment strategy for patients with severe cholecystitis who are candidates for anesthesia and surgery."

"Background : The treatment of lung tuberculosis in patient with diabetes mellitus comorbidity is still a major problem because of high incidence rate, unfavourable outcome and failure. In indonesia, there is no specific study about outcome, characteristics and profile patient with this unfavourable outcome.Objectives : To identify the treatment outcome, patient characteristic and patient profile for unfavourable outcome.Methods : This is a retrospective cohort study, analyzing medical record of lung tuberculosis patient with diabetes mellitus comorbidity that treated in Cipto Mangunkusumo Hospital from January 2013 to December 2018. Unfavourable outcome as defined by Tb-DOTS national program consist of subject with failure to treat, death, loss to follow up and transferred out without known of final results. Result : A total of 141 subject enrolled in this study, with median age of subject was 57 years (range 28 to 79 years) and majority subject is male (56.03%), Tb relapse found in 24.11% subject. Outcome of Tb treatment based on National Program was treatment complete in 51.77%, Cure in 1.42%, loss to follow up in 31.91%, transferred out in 14%, and died in 7% subjects. Unfavourable outcome found in 46.81% subject, with majority found in male subject, married, working subject, actively smoking, subject with previous Tb treatment, non-adherence, previously known diabetes, underweight or normoweight subject, reduce eGFR below 60 ml/min/1.73m2, subject with insulin therapy on intensive phase, and poorly controlled diabetes.Conclusion : Unfavourable outcome found in 46,81% subject, will loss to follow up was the highest composition (31.91%)."