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All Journal journal of internal medicine E-Jurnal Medika Udayana Media Kesehatan Masyarakat Indonesia Journal of Biomedicine and Translational Research PUBLIKASI PENELITIAN TERAPAN DAN KEBIJAKAN Essential: Essence of Scientific Medical Journal MEDICINUS
I Made Susila Utama
Tropic And Infectious Disease Division, Internal Medicine Dept, Faculty Of Medicine, Universitas Udayana Prof. I.G.N.G.Ngoerah Hospital
Agriculture, Biological Sciences & Forestry Biochemistry, Genetics & Molecular Biology Economics, Econometrics & Finance Environmental Science Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Social Sciences

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Journal : journal of internal medicine

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PENGARUH PEMBERIAN KOMBINASI ANTI RETRO VIRUS LEBIH AWAL TERHADAP MORTALITAS PADA KO-INFEKSI TB-HIV DI RUMAH SAKIT SANGLAH DENPASAR Utama, Susila
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Abstract

TB and HIV are closely interlinked. TB is a leading cause of HIV-related morbidity and mortality. Mortality amongpatients with TB-HIV co-infection is known to be high despite the use of effective TB treatment. Many studies have indicatedthat the initiation of Combination Anti Retro Virus (cARV) during TB treatment improves outcomes. The optimal timing forthe initiation of cARV in patients with TB-HIV co-infections remains unclear. The aims of this study is to know the impact ofearly initiation of cARV during TB treatment on mortality in TB-HIV co-infected patients at Sanglah Hospital Denpasar. Cohortretrospective study was conducted from medical record of TB-HIV co-infected patients from June 2004 until August 2009. Theinclusion criteria was TB-HIV co-infected patients with TB treatment earlier than cARV. The cARV treatment was differentiatedinto 2 category, before 2 months of TB treatment (during intensive phase) and after 2 months (maintenance phase). All of thepatients were followed for mortality after one year of cARV treatment. There were 60 TB-HIV co-infected patients, 50 (83.3%)male and 10 female (16.7%). The CD 4 level less than 50 cell/mm3 were 48 (80%) and CD 4 level more than 50 cell/mm3 were 12(20%). The cARV treatment during intensive phase of TB treatment were 20 (33.3%) and cARV treatment after intensive phasewere 40 (66.7%). Mortality after one year cARV treatment were 28.3%. The mortality on cARV treatment after 2 intensive phasewas 32.5% (13 patients) and mortality on ARV treatment during intensive phase was only 20% (4 patients). The odds ratio was1,926 with confidence interval 0.536 ? 6.926. The mortality on the group of CD 4 level less than 50 cell/mm3 was not different.The mortality on ARV treatment after intensive phase were 34.5% and only 21.1% when cARV during intensive phase. Oddsratio was 1.974 with confidence interval 0.515 ? 7.558. The initiation of cARV during intensive phase of TB treatment on TBHIVco-infected patients will decreased mortality in one year of cARV treatment, but statistically not significance. The sameresult was also found in CD 4 less than 50 cell/mm3.
PENGARUH VIRUS HEPATITIS C PADA RESPON CD4 SETELAH 6 BULAN PEMAKAIAN REGIMEN KOMBINASI ANTIRETROVIRUS LINI PERTAMA PADA PASIEN INFEKSI HIV Somia, Agus; Utama, Susila; Parwati, Tuti; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Abstract

Hepatitis C Viral (HCV) and Human ImmunodeÞ ciency Virus (HIV) infection are global health problems. Co-infectionHIV-HCV in intravenous drug users about 53 99%. Despite very high prevalence of this co-infection, there were controversiesabout impact of hepatitis C virus in CD4 response of HIV patients receiving anti retroviral therapy. We conduct a retrospectivecohort to Þ nd out the impact of hepatitis C virus in CD4 response after 6 months of Þ rst line ART therapy. We collect data fromVCT-CST clinic patient!s record. Inclusion criteria for this study were HIV patients more than 12 years old, receiving Þ rst lineof ART treatment, and with anti HCV result.Sixty two patients enrolled for this study. Twenty eight patients found positive anti HCV and 34 negative anti HCV result.Mean of age was 29 ± 4.44 years old in anti HCV (+) group and 34 ± 7.335 in anti HCV (-) group, male dominant (92.9% and85.3% respectively). There were no signiÞ cant differences in total lymphocyte count, hemoglobine, and transaminases (AST andALT) between the two groups. The increasing of mean CD4 after 6 months ART treatment higher in anti HCV (-) group than inanti HCV (+) group, but statistically not signiÞ cant.
PAJANAN OKUPASI DARI PASIEN TERINFEKSI HIV DI RSUP SANGLAH DENPASAR Somia, Agus; Utama IM, Susila; Parwati Merati, Tuti
journal of internal medicine Vol. 11, No. 3 September 2010
Publisher : journal of internal medicine

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Abstract

Health care personnel who have occupational exposure to blood and some body ! uids or tissues are at risk for HIVinfection. Aim of this study to know about characteristics of occupational exposure to HIV who cares in VCT-CST OutpatientClinic Sanglah Hospital Denpasar. A retrospective descriptive study was done among exposed persons who care in VCT-CSTOutpatient Clinic Sanglah Hospital Denpasar during 1 January 2006 ? 31 December 2007.Total 11 cases occupational exposure occurred in health care places, 9 cases occurrence in Sanglah Hospital and 2 casesoutside Sanglah Hospital. The profession of exposed persons were doctor (45%), medical student (18.2%) and nurse (18.2%).The type of exposure were percutaneous injury (72.7%). Severity of exposures included, 36.4% KP1 (small volume in shorttime), 45.5 % KP2 (large volume and/or long time or percutaneous injury with solid needle, or superfesial laceration), and18.18% KP3 (percutaneous injury with hollow needle, deep injury, visible blood on the device which caused the injury, injurywith needle which had been placed in a source patients artery or vein). HIV-positive class I patients (asymptomatic HIV or alow viral load) was 27.3 % and HIV-positive class II (symptomatic HIV or AIDS, acute seroconversion, or high viral load) was27.3%. about 72% exposed person taken postexposure prophylaxis with combination zidovudine and lamivudine for 4 weeks.Anti HIV status exposed persons at " rst time exposure, 3 month after exposure and 6 month after exposure were negative.We conclude that the most type of exposure were percutaneous with source of exposure each included HIV positive classI dan HIV positive class II. About two third of exposed person taken postexposure prophylaxis with zidovudine and lamivudinecombination. Anti HIV status exposed person a " rst time exposure, 3 month after exposure and 6 month after exposure werenegative.
KELAINAN HEMATOLOGI PADA DEMAM BERDARAH DENGUE 1Ni Made Renny A Rena, 2Susila Utama, 2Tuty Parwati M 1 Divisi Hematologi Onkologi Medik, 2 Divisi Penyakit Tropik dan Infeksi Bagian / SMF Ilmu Penyakit Dalam, FK Unud RSUP Sanglah Denpasar Email: renny_ang@ Renny A Rena, Ni Made; Utama, Susila; Parwati M, Tuty
journal of internal medicine Vol. 10, No. 3 September 2009
Publisher : journal of internal medicine

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Abstract

Dengue infection can cause a unique and complex alteration to the homeostasis mechanism of the body. The underlying of bleeding, as a more frequent clinical manifestation of dengue was based on multiple factors such as thrombocytopenia, thrombopathy, Disseminated Intravascular Coagulation (DIC), prolonged of bleeding time and prothrombin time, decrease of some coagulation factors, hypoÞ brinogenemia and also increasing of Þ brin degradation products. Beside, kinin and bradikinin sytem was also activated. Endothelial dysfunction as one of coagulopathy disorder in dengue infection patients can shown as some clinical manifestation. Antigen antibody complex of dengue, activated the coagulation system, start from Haegeman factor (factor XII become factor XIIa). Therefore, factor XIIa activated the others coagulation factors respectively until Þ brin are produced, Þ brinolysis system are also activated, plasminogen change become plasmin through enzymatic process. Disseminated intravascular coagulation, is an emergency complication of dengue infection, which occur because activation of coagulation system and decreasing of thrombocyte level. Others condition such as shock, hypoxia, and acidosis also thought to be the factors that cause the DIC. Deterioration of all of the hemopoesis system, which are hypoplasia occur on the beginning of the infection and increasing of erythropoesis after Þ fth day of infection. This is caused by direct suppression of the viral and activation of the proinß ammatory cytokines
KARAKTERISTIK PASIEN KO-INFEKSI HIV-HCV DI RSUP SANGLAH DENPASAR Somia, Agus; Utama, Susila; Parwati, Tuti; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Abstract

Human Immunode! ciency Virus (HIV) and Hepatitis C Virus (HCV) are similar in many respects. Both viruses have asingle stranded RNA genome, both share similar routes of transmission and both cause chronic infection. However, HIV andHCV are also different in the pathogenesis, clinical manifestation and treatment. The aim of this study is to know characteristicof HIV-HCV coinfection patients in Sanglah Hospital. This study was descriptive study. Data based on patients medical recordduring from 1 januari 2004 sampai 31 Desember 2007 at VCT-CST. There were 48 cases HIV-HCV coinfected. 81.6% was male,mean of age of the ! rst anti HIV positive was 29.19 ± 4.63 years old. The risk factor was 75% IVDU. Baseline data showed71.4% suffered from HIV infection stage IV (WHO). The mean of body mass index was 18.78 ± 2.965 kg/m2, the mean of CD4was median of CD 4 was 222.56 ± 155.4 cell/ul, mean WBC was 4.38 ± 7.06 K/ul, mean of TLC was 1.134 ± 0.689 k/ul, meanof Hb was 12.53 ± 2.29 g/dl, Mean of PLT was 247.9 ± 90.11 k/ul, mean of SGOT 62.29 ± 71.91 IU, mean of SGPT was 77.34 ±109.83 IU. HbsAg positif 8.3% and 79.6% with HAART. The mortality rate was 10.8%. Most of HIV-HCV coinfected was male,productive age and the risk factor were IVDU.
FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KEJADIAN MAKROSITOSIS PADA PASIEN HIV/AIDS YANG MENDAPAT TERAPI ZIDOVUDIN DI RUMAH SAKIT SANGLAH DENPASAR Ridana Wibawa, Ketut; Parwati Merati, Tuti; Somia, Agus; Utama, Susila
journal of internal medicine Vol. 11, No. 1 Januari 2010
Publisher : journal of internal medicine

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Abstract

Zidovudine is a Þ rst line drug used for treating HIV/AIDS patients in Indonesia and has been associated with prolongedsurvival, a reduction in the frequecy and severity of opportunistic infections, transient increases in the number of CD4 Tlymphocytes, and decreases in serum HIV p24 antigen. However prolong use of zidovudine associated with bone marrowtoxicity manifested by macrocytosis until anemic condition which need the transfusion. Some factors has been identiÞ ed canincreasing the bone marrow toxicity like: age, sex, cotrimoxazole, anemic and neutropenia condition, CD4 count < 200 cells/ L,vit B12 and folic acid level.To determine the risk factors correlated with incident of macrocytosis on HIV/AIDS patients treated with zidovudine,an analytical retrospective cross sectional study was done. The patients were selected using WHO criteria and the antiretoviraltherapy as Depkes guideline which zidovudine base with dose 600 mg/day. The age, sex, cotrimoxazole use and CD4 count wereassesed from all the patients by review medical record when the macrocytosis exist.This study included 140 subyects, age arround 19 ! 65 years old, sex male 72 % and female 28%. Cotrimoxazole use as atreatment or prophylaxis for PCP infection is 90% and the median CD4 count is 24.5 cells/ L. The incidence of macrocytosis is54.3% which is 46.4% without anemia and 7.9% present with anemia. The mean MCV value before zidovudine therapy is 86.27fL and elevated to 110.11 fL after zidovudine therapy. The median time of macrocytosis is 5 month. With bivariat analysis wedidn"t Þ nd correlation betwen age, sex, cotrimoxazol use and CD4 count with incident of macrocytosis (age p = 0.935 95% CIOR = 0.963 sex p = 0.800 95% CI OR = 0.846 cotrimoxazol use p = 0.237 95% CI OR = 0.403 and CD4 count p= 0.646 95%CI = 0.997 respectively).This study concluded no correlation betwen age, sex, cotrimoxazol use and CD4 count with incident of macrocytosis onHIV/AIDS patients whom treated with zidovudine. We suggest to routinely monitoring the MCV value every a month in a year,be cause the incidence of macrocytosis cause by toxicity effect of zidovudine to bone marrow is high.
Co-Authors A.A. Ayu Yuli Gayatri, A.A. Ayu Yuli Agung Bagus S. Satyarsa Agus Somia Agus Somia, Agus Somia Anak Agung Ayu Yuli Gayatri Aries Hasan Basri Cokorda Agung Wahyu Purnamasidhi Elmeizi Arafah Gde Adit Putra Deva Harris Hardian Haruko Akatsu I Dewa Gede Agung Suta Ariwangsa I Dewa Nyoman Wibawa I Ketut Agus Somia I Made Bakta Jessica Santosa Ketut Ridana Wibawa Ketut Tuti Parwati Merati Made Jawi Ni Made Dewi Dian Sukmawati Ni Made Renny A Rena Nur Rizky Amaliah Rinto . Tuti P Merati, Tuti P Tuti Parwati Tuti Parwati Merati Tuty Parwati M