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Ade Yonata
Bagian Ilmu Penyakit Dalam, Fakultas Kedokteran, Universitas Lampung

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CRITICAL LIMB ISCHEMIA IN 27 YEARS OLD HIV PATIENT: A CASE REPORT Ade Yonata; Hayatun Nufus; Teguh Harjono Karjadi
JUKE Unila Vol 4, No 8 (2014)
Publisher : Fakultas Kedokteran Universitas Lampung

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Abstract

The prevalence of peripheral arterial disease (PAD) is high in the HIV-infected population and is much higher than expected in the general population. A 27 years old male patient came to Cipto Mangunkusumo General Hospital (RSCM) with chief complaint of pain on right leg which worsened since 2 days prior admission. Patient was diagnosed HIV positive 8 months prior admission and had already on ARV treatment Duviral (AZT/3TC) and Alluvia (lopinavir/ritonavir) since then. CT angiography showed stenosis of femoral communis artery with total stenosis of right posterior tibialis artery. Patient was diagnosed with criticl limb ischemia and got amputation. Some theories of PAD mechanism in HIV patient have been proposed. Highly ac tive antiretroviral therapy (HAART) has decreased the mortality and illnesses related to HIV infection. However, a variety of atherogenic metabolic abnormalities, including dyslipidemia, lipodystrophy, and also thickened intima-media thickness have been observed after the introduction of HAART, especially using Protease Inhibitors. Human Imunodeficiency Virus itself is also thought to have role in injury to the arterial wall such as via chemokine CCL2/MCP-1, a critical mediator  of  atherosclerosis. All HIV-infected patients candidate to antiretroviral therapy and patients already under treatment should undergo an assessment that includes the evaluation of the cardiovascular risk. [JuKe Unila 2014; 4(8):218-224]
HEART VALVE DISEASE IN HYPERTHYROIDISM Ade Yonata; Elza Febria Sari; Ika Prasetya
JUKE Unila Vol 4, No 8 (2014)
Publisher : Fakultas Kedokteran Universitas Lampung

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Abstract

The incidence of heart valve disease, especially mitral valve prolapse was first reported in hyperthyroid heart disease in 1981. Incidence of heart valve disease in the form of mitral regurgitation (MR) or tricuspid regurgitation (TR) reached 23% in patients with hyperthyroidism. 45 years old male with a chief complaint tightness, worsened since 1 week before entering the hospital. Since 2 years ago patient often feels palpitations and breathless if activity. About 5 months ago, patient was sweating a lot and tremble, increase in appetite but weight going down. Defecation 5-6 times a day. Visible and palpable lump in the neck diameter ±5 cm, soft, ned, part moves while swallowing. Laboratory showed free T4: 7.550, sensitive TSH: 0.010. Thoracic X-ray showed cardiomegaly with cardiac waist disappeared. ECG showed atrial fibrillation. Echocardiography showed LA + LV dilatation TAPSE 1.91, AR Moderate, Severe MR, AML prolapse in A2 and PML with EF: 62.7%. Ultrasonography showed Throid hyperthyroidism and thyroid scan results with the impression difusa bilateral goitre within crease of total thyroid uptake. Patients received digoxin, furosemide, PTU. Patients then performed MV Repair and AV Repair. The mechanism of valvular heart disease relationship in hyperthyroidism has not been completely understood. In patients with MPV, some studies have shown a high prevalence of HLA-Bw35. Increased production and secretion of acid polymukosakarida in Graves can accumulate all the heart valves, especially the mitral valve, causing the valve to thicken (myxomatous). MR in hyperthyroidism is said to be a consequence of mitral annulus dilatation due to the left ventricle is dilated. It has been reported also a gernline mutations of thyrotropin receptor gene in Chinese families with thyrotoxicosis and MVP. In hyperthyroid patients is important to explore the patient's cardiovascular condition, including the possibility of valve disorders. [JuKe Unila 2014; 4(8):225-232]