Clinical and Research Journal in Internal Medicine <p><a title="Clinical and Research Journal in Internal Medicine" href="/index.php/crjim/index" target="_self"><strong>Clinical and Research Journal in Internal Medicine ( CRJIM )</strong></a> is the official open access journal of Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia. It publishes articles two times per year. It is a peer reviewed publication of Indonesian Internal Medicine's journals and accepting articles for publication from around the world. <strong>CRJIM</strong> only publishes articles in English version.</p><p>The objective of this journal is to publish the selected clinical and basic research relevant to Internal Medicine. It covers the following topics: nephrology and hypertension, cardiology, pulmonology,endocrine-metabolic-diabetes, rheumatology, geriatrics, tropic-infection, hematology-oncology, allergy-imunology, gastro-entero-hepatology, psychosomatic. CRJIM publishes original researches, reviews, brief reports, editorial, case series, case reports, and commentary. Additionally, it also considers to publish animal, and in-silico studies relevant to Internal Medicine topic. It is an international journal dedicated to provide new information that could giving a new insight for alternative solutions, diagnosis, therapy and prevention for researchers and practitioners in Internal Medicine.</p> Universitas Brawijaya en-US Clinical and Research Journal in Internal Medicine 2723-5130 The copyright of the received article shall be assigned to the journal as the publisher of the journal. The intended copyright includes the right to publish the article in various forms (including reprints). The journal maintains the publishing rights to the published articles. Cardiac Rehabilitation to Prevent Rehospitalization in Myocardial Infarction Patients <p><strong>Introduction</strong>. There is mounting evidence that cardiac rehabilitation (CR) based on physical activity has a positive influence on the degree of disability and level of quality of life, in addition to playing an important and beneficial role in modifying morbidity and mortality.</p> <p><strong>Discussion</strong>. Patients who have experienced an acute myocardial infarction, are candidates for cardiac rehabilitation as an essential component of their care. Clinical evaluation, optimization of pharmacotherapy, physical training, psychological rehabilitation, evaluation and reduction of coronary disease risk factors, lifestyle modification, and patient education are the components that should be included in comprehensive cardiac rehabilitation. Immediately following the acute phase of a myocardial infarction, the designated team (consisting of a physician, physiotherapist, nurse, psychologist, dietician, and social worker) should begin comprehensive cardiac rehabilitation. This rehabilitation should contain individualized programs that are designed to optimize the patient's physical, psychological, social, and emotional status. It is recommended that the modern model of comprehensive cardiac rehabilitation be started as soon as possible, continued for the required amount of time, properly staged, and individualized depending on the clinical status of the patients.</p> <p><strong>Conclusion</strong>. Cardiac rehabilitation after myocardial infarction is an exercise method that could improve the post myocardial infarct patient’s living quality, includes increasing cardiac ejection fraction, exercise tolerance, and physical status. Therefore, it can decrease rate of rehospitalization in patient post myocardial infarct.</p> Diah Ivana Cholid Tri Tjahjono Copyright (c) 2022 Clinical and Research Journal in Internal Medicine 2022-11-25 2022-11-25 3 2 324 331 10.21776/ub.crjim.2022.003.02.6 Cardiovascular Rehabilitation in Patients with Diabetes Mellitus <p>A hazard to global health is being posed by diabetes mellitus (DM). Macrovascular and microvascular abnormalities in blood vessels are one type of DM complication that might happen. In most cases, blood arteries, the brain, and the heart are affected by macrovascular problems. Obesity is well-known to have a substantial significant risk factor for coronary heart disease on its own (CHD). As a result, many persons with DM have a 2 to 4 times higher risk of dying from CHD than those without DM. In fact, different goal parameters (such glucose management, blood pressure, cholesterol status, or body composition) can improve with exercise training to varying degrees in each patient; here is where cardiovascular rehabilitation can help. To attain the best results, the type and intensity of exercise training must be tailored to the unique characteristics of each patient. The clinician's challenge is to teach the patient the skills necessary to maintain lifestyle modifications and to explain the relationship between exercise and blood sugar, BG goal ranges, and the types and amounts of activity that can be done safely.</p> Novita Lavi Cholid Tjahjono Laksmi Sasiarini Copyright (c) 2022 Clinical and Research Journal in Internal Medicine 2022-11-25 2022-11-25 3 2 332 339 10.21776/ub.crjim.2022.003.02.7 The Association of COVID-19 Degree on Transamination and Bilirubin Levels of COVID-19 Patients in RSUD Dr. Saiful Anwar Malang <p><strong>Background : </strong>Corona virus 2019 (COVID-19) is an infectious viral disease caused by SARS-CoV-2 that has infected the world. COVID-19 can cause abnormalities which are characterized by increased levels of the enzyme transaminase and bilirubin. Research on the association between transaminase enzymes and bilirubin is still limited, further research is needed on the association between the degree of COVID-19 and levels of the transaminases and bilirubin enzymes.</p> <p><strong>Aim: </strong>To determine the association between liver function on the degree of severity and outcome of COVID-19 patients.</p> <p><strong>Method:</strong> This was the cross-sectional study. Sampling method was using consecutive sampling at RSUD Dr. Saiful Anwar Malangwho was treated from June 1st 2021 until November 31st 2021 by the Department of Internal Medicine. Statistical analysis used the Kruskal Walllis and Mann Whitney test with a significance level of p&lt;0.5% and correlation analysis using Spearman.</p> <p><strong>Result: </strong>Among 90 patients included in this study there was a strong positive correlation between the degree of COVID-19 and levels of SGOT (r=0.954, p &lt;0.001) and SGPT (r=0.727, p &lt;0.001) and according to regression test, SGOT has the positive correlation towards degree of COVID-19 severity (p=0.026 CI95%: 0.002-0.028). There was a correlation between the degree of COVID-19 and the total bilirubin level (r=0.586, p=0.011). There was no correlation between levels of transaminase enzymes, total bilirubin, direct and indirect bilirubin on the patient's outcome (p&gt;0.050).</p> <p><strong>Conclusion: </strong>There is a positive correlation between the degree of COVID-19 with levels of the enzyme transaminases, indirect and total bilirubin.</p> Ade Rahmawati Syifa Mustika Copyright (c) 2022 Clinical and Research Journal in Internal Medicine 2022-11-25 2022-11-25 3 2 292 300 10.21776/ub.crjim.2022.003.02.2 Transaminase Level of Severity and Mortality of COVID-19 Patients at RSUD Dr. Saiful Anwar Malang <p><strong>Background: </strong>Extend of lung injury, inflammation due to SARS COV-2 can also cause liver injury. Liver injury in COVID-19 patients can be caused by the direct effect on the liver, cholangiocyte role, activation of the immune system, drug-induced liver injury, and hypoxic injury. Hepatocyte necrosis could increase the transaminase. Therefore, transaminase increase may reveal the inflammation severity.</p> <p><strong>Aim: </strong>This study aims to know the relationship of transaminase to the severity and mortality of COVID-19 patients.</p> <p><strong>Method: </strong>A retrospective study of 177 COVID-19 patients hospitalized at Saiful Anwar Hospital Malang. The data were taken from the medical record of COVID-19 patients. The level of transaminase was taken on admission. The severity criteria of COVID-19 were taken from the Indonesian COVID-19 Guidelines. Chi-Square Test and Pearson Correlation Test were used as the statistical analysis with a significance of 0.05 (p=0.05) and a confidence interval of 95% (CI=95%).</p> <p><strong>Results: </strong>From the correlation test, the AST had R=0.42 (p &lt; 0.001) for severity and R=0.17 (p &lt; 0.001) for mortality. The ALT had R=0.33 (p &lt; 0.001) of severity and R=0.28 (p &lt; 0.001) of mortality.</p> <p><strong>Conclusion: </strong>There was a significant relationship between AST and ALT in the severity and mortality.</p> Fiqih Faruz Supriono Supriono Bogi Pratomo Syifa Mustika Copyright (c) 2022 Clinical and Research Journal in Internal Medicine 2022-11-25 2022-11-25 3 2 301 306 10.21776/ub.crjim.2022.003.02.3 Knowledge of General Practitioner’s toward Spondyloarthritis (SpA): A Qualitative Study <p><strong>Background: </strong>Low back pain (LBP) is one of major health problems experienced by 80-85% of patients in their lifetime. Spondyloarthritis (SpA) has become one of the leading causes of chronic LBP but is often undiagnosed. General practitioners (GP) have an essential role in the early diagnosis of SpA.</p> <p><strong>Aim: </strong>To explore the knowledge of GP about SpA from clinical diagnosis and early management and elaborate on each GP’s clinical perspective and practice performance.</p> <p><strong>Methods: </strong>A qualitative study that involved 12 GP. All was consented to participate in an in-depth interview with the experts by online meeting with 15-20 minutes duration. Analysis was focused on the definition, classification, clinical manifestation, diagnosis, and early management of SpA in primary care.</p> <p><strong>Results: </strong> All GP were interviewed (12 GP, 9 men, and 3 women; mean age 29.42) with average years in clinical practice was 3.8 years. All GP could describe the definition of SpA. Only a few subjects are aware of the subtype of SpA. Most of the GP could mention chronic back pain as the main SpA symptom, some GP mentioned extra-articular manifestation, but incomplete. All GP understood the current treatment in clinical practice.</p> <p><strong>Conclusion: </strong> GP is aware of SpA, but not all could completely mention the type and clinical entities. In addition, a limited resource for investigation makes a diagnosis of SpA difficult. Current early treatment has been acceptable in clinical practice. A comprehensive understanding of diagnosis and effective early treatment may reduce delayed diagnosis and improve patients' quality of life.</p> Mirza Zaka Pratama Cesarius Wahono Nabila Mukti Perdana Rahman Copyright (c) 2022 Clinical and Research Journal in Internal Medicine 2022-11-25 2022-11-25 3 2 307 312 10.21776/ub.crjim.2022.003.02.4 COVID-19 Mortality Characteristics During First to Third Pandemic Wave in Malang <p><strong>Background: </strong>The epidemic of SARS-CoV-2 has spread worldwide for about one and half years, including in Indonesia, with several peaks in cases and mortality rates. A descriptive pattern of Covid 19 inpatients in Saiful Anwar General Hospital Malang needed to improve health service quality and reduce mortality rates.<strong>&nbsp; </strong></p> <p><strong>Aim: </strong>Determine the descriptive pattern of inpatients Covid 19 in the internal medicine ward in Saiful Anwar General Hospital from March 2020 until February 2022.</p> <p><strong>Methods: </strong>This descriptive study was conducted from March 2020 to July 2021 and used convenience sampling due to sample availability. A total of 137 hospitalized patients in December 2020, 387 in July 2021, and 113 in February 2022 patients were included with information about age, sex, medical diagnosis, comorbid, and outcome, which was obtained from medical records. Descriptive analysis was used to explore frequency distribution and analysis.</p> <p><strong>Results: </strong>We found several factors associated with the frequency of SARS-CoV-2 cases. Overall, these results emphasize the role of comorbidity as a possible driver of the COVID‑19 case fatality rate.</p> <p><strong>Conclusion: </strong>&nbsp;In the three waves of Covid 19 in Indonesia, the highest case fatality rate was during the Delta variant in July 2021, where more factors significantly affected case mortality.</p> Dewi Indiastari Nur Samsu Didi Candradikusuma Niniek Budiarti Heri Sutanto Siti Fatma Copyright (c) 2022 Clinical and Research Journal in Internal Medicine 2022-11-25 2022-11-25 3 2 313 323 10.21776/ub.crjim.2022.003.02.5 A Case Report Improving Quality of Life in Pulmonary Hypertension with Exercise Training Therapy <p>Pulmonary hypertension is an increase in pulmonary artery pressure &gt;25 mmHg. This causes some disturbing clinical complaints. The most common causes of pulmonary hypertension are idiopathic and congenital heart disease. ASD (Arterial Septal Defect) is a congenital heart disease that occurs in 1.6 per 1000 live births, with a fairly high life expectancy. However, most people with ASD are not aware of a heart problem before the appearance of a clinically significant disorder. Most patients with ASD with complications of pulmonary hypertension will complain of being easily tired, fainting easily and having difficulty carrying out daily activities, even light activities. Most ASD cases apply shunt closure therapy as the main therapy, but not a few ASD cases cannot be shunted closure because it is a contraindication that can lead to more severe complications, especially with complications of chronic pulmonary hypertension. One of the non-medical therapies used to improve the quality of life of patients with pulmonary hypertension is exercise therapy. This therapy provides a variety of physical exercises that aim to increase the strength of respiratory muscles and extremities.</p> <p>From this case, exercise therapy is able to provide a significant improvement in the quality of life of the patient with an increase in the patient's ability to perform physical activities, as evidenced by the increase in distance traveled when doing the six-minute walk test (SMWT).</p> Ni Putu Frida Baskarani Cholid Tri Tjahjono Copyright (c) 2022 Clinical and Research Journal in Internal Medicine 2022-11-25 2022-11-25 3 2 340 346 10.21776/ub.crjim.2022.003.02.8 Treatment Challenge in COVID-19 Patients with Acute Kidney Injury in Hospital <p style="text-align: justify; page-break-after: avoid; vertical-align: baseline; margin: 12.0pt 0in .0001pt 0in;"><span style="font-size: 9.0pt; font-family: 'Source Sans Pro',sans-serif;">Renal, the main characteristic of COVID-19 infection. Acute kidney injury (AKI) has been documented in 20-50% of the hospitalized COVID-19 patients. Renal involvement among COVID-19 patients might be multifactorial. COVID-19 Patients with AKI significantly had higher mortality than patients without AKI. This case series reported severe COVID-19 with respiratory failure and AKI during admission to the hospital. All patients were admitted to the intensive care unit (ICU) and obtained the standard therapeutic protocols according to the COVID-19 severities. The first patient developed AKI in the three days of admission, while the second and third patients had AKI from the first day of admission. The patients had similar complications, including type 1 or 2 respiratory failures, secondary infection with sepsis, hyperpotassemia, and metabolic acidosis. The first and second patients underwent hemodialysis as indicated on these patients. However, the evaluation of their renal functions did not improve after that. The third patient did not receive the hemodialysis therapy and only obtained supportive treatment with adequate fluid therapy. The third patient was getting better on the 16th day of admission. In addition, the renal function test was getting normal after the 16th day of admission. The patient was discharged on the 19th day of admission in stable condition. Early recognition of renal involvement in COVID-19 infection, preventive measures, renal function monitoring, and therapeutic intervention were essential to reduce the morbidity and mortality of COVID-19 patients. Hospitalized patients should be monitored closely for their renal function to prevent renal function deterioration in the future.</span></p> Mirza Zaka Pratama Achmad Rifa'i Duma Sianturi Copyright (c) 2022 Clinical and Research Journal in Internal Medicine 2022-11-25 2022-11-25 3 2 347 354 10.21776/ub.crjim.2022.003.02.9 The “After Effect” Challenges of COVID-19 <p>-</p> Perdana Aditya Rahman Copyright (c) 2022 Clinical and Research Journal in Internal Medicine 2022-11-25 2022-11-25 3 2 290 291 10.21776/ub.crjim.2022.003.02.1