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Acta Interna : The Journal of Internal Medicine

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Published by Universitas Gadjah Mada

ISSN : 2303131X EISSN : 25415441 DOI : -

Core Subject : Health,

Health Professions Medicine & Pharmacology

The Journal considers any original research that advocates change in, or illuminates, clinical practice. The journal also publishes interesting and informative reviews and opinions pieces on any topics connected with clinical practice. Manuscripts must be solely the work of the author(s) stated, not have been published previously elsewhere, and not be under consideration by another journal. all papers should be written to be clearly understandable to the journal`s readers in a wide range of specialities and countries. Diagrams, figures, and photographs should be used to supplement and enhance the text.

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Articles 152 Documents

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Acute Coronary Syndrome in Young Patients at Dr. Sardjito General Hospital Budi Yuli Setianto; Julia Sari; Anggoro Budi Hartopo; Putrika Prastuti Ra Gharini
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: The incidence of acute coronary syndrome in the young patients is increased recently. Several studies reported that young patients have distinct clinical characteristics as compare with older patients.Objective: To assess the prevalence, risk factors and clinical presentation of acute coronary syndrome(ACS) in young patients at Dr. Sardjito Hospital, Yogyakarta.Methods: We conducted a cross sectional study between September 2008-May 2009 at intensive cardiovascular care unit (ICCU) of Dr. Sardjito Hospital. We enrolled consecutive patients admitted with acute coronary syndrome. We divided the patients as young ACS (age ≤ 45 years) and older ACS (age >45 years). We compared cardiovascular risk factors, clinical presentation and clinical spectrums from both groups. Statistics analysis was performing using chi-square test, p value < 0.05 was considered significantly different.Results: In our study there were 20 (13.5%) young ACS and 128 (86.5%) older ACS patients. Most young ACS patients are male (90%). Proportion of diabetes mellitus in young ACS was not different from that in older ACS patients (20% vs. 18.8%; p=0.55). Hypertension was not different either (50% vs. 53.1%; p=0.49). Sixty percent of young ACS patients were smoker, however its proportion did not differ from older ACS patients (p=0.84). There were no signifi cant differences of dyslipidemia. The young ACS patients mostly experienced STEMI than NSTEMI and unstable angina (55% vs. 15% vs. 30%), but there were no signifi cant differences when compared to older ACS patients (p=0.65). Thirty percent of young ACS patients presented with Killip class II or higher, however there were no significant differences between groups (p=0.40).Conclusion: In this study we found that there were no signifi cant differences in risk factors, clinical presentation and spectrums between young ACS and older ACS patients. The need for prevention program in both groups should not be difference.Keywords: ACS– young– older– clinical presentation.

Relationship Between Systemic Lupus Activity Measurement (SLAM) Score and Mortality in Systemic Lupus Erytemathosus (SLE) Inpatients Ayu Paramaiswari; Nyoman Kertia; Deddy Wachid Achadiyono
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder that can be severe and life threatening. Mortality in SLE may due to lupus activity or long-term sequel. Systemic Lupus Activity Measurement (SLAM) score is a tool that can count lupus disease activity inpatients.Aims: To analyze the relationship between SLAM score and mortality in lupus inpatients.Methods: Retrospective cohort study used for reaching objective of the study. Lupus inpatients was used as research population. Medical record was used as study data collection over periods of 2006 until 2011. Independent variable was a SLAM score. The cut point of SLAM score was made based on the mean of SLAM score (16.7 point score). Dependent variable was mortality.Results: There were differences between number of ACR criteria fi ndings, pneumonia, heart rate with SLAM score (p value 0.001; 0.001; 0.002 respectively).There was a difference of median survival between less and more than 16.7 point score, 45 and 28 respectively (p 0.034). There was a relationship between SLAM score (more than 16.7 point score) and mortality HR 2.78 (96% CI 1.01-7.53). There was a difference of mortality incidence between more and less than 16.7 point score, 0.35 and 0.10 respectively. There was a relationship between SLAM score (more than 16.7 point score) and mortality RR 3.5 (95% CI). Mortality in lupus inpatients was 23%.Conclusion: There was a relationship between SLAM score and mortality on lupus inpatients.Keywords: SLE, SLAM, Mortality

The Effect of Telmisartan and Metformin on Insulin Resistance in Metabolic Syndrome Patients with Insulin Therapy Siswi Oktariani; Raden Bowo Pramono; Hemi Sinorita
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: Recommendations for therapy insulin resistance are metformin and thiazolidindion. Side effects of thiazolidindion due to peripheral edema occurs to 2-5% and increased 5-15% when combined with insulin therapy. Telmisartan, an angiotensin receptor blocker, has anti-hypertensive effects and improve insulin resistance. Telmisartan effect on peroxisome proliferator activated receptor γ agonist and has the same structure of the group thiazolidindion, pioglitazone. The research objective was to determine the effects of telmisartan and metformin on insulin resistance in metabolic syndrome patients with insulin therapy.Methods: This study used a before-after design. The study was conducted in the internal medicine clinic of the endocrinology department of Dr. Sardjito Hospital Yogyakarta. Subjects were patients who met the diagnosis of metabolic syndrome based on the IDF 2005, hypertension and receive insulin therapy. Subjects given metformin and telmisartan therapy for 12 weeks. Subjects examined HOMA IR before and after treatment. The average decrease in HOMA IR was tested by paired t test or Wilcoxon test. P value <0.05 was considered signifi cant.Result: The total sample were 27 subjects. Data analysis was performed on 11 subjects. Fasting blood glucose before and after treatment was signifi cantly decreased (p<0.001) whereas the fasting insulin levels increased. HOMA IR was signifi cantly decreased after treatment {p = 0.004 (5.79 – 20.26), CI 95%}.Conclusion: this study found insulin resistance decreased signifi cantly in patients with the metabolic syndrome of insulin therapy who received metformin and telmisartan.Keywords : metabolic syndrome, insulin therapy, metformin, telmisartan, HOMA IR

The Differences of Average Level Serum N Terminal Prob-Type Natriuretic Peptide (NTPROBNP) in Hypertension Patients with and without Left Ventricular Hypertrophy At Cardiology Outpatients Dr. Sardjito General Hospital Yogyakarta Gusti Hariadi Maulana; Lucia Krisdinarti; Hariadi Hariawan
Acta Interna The Journal of Internal Medicine Vol 5, No 1 (2015): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Introduction. Hypertension cause changes in the structure and function of cardial as triggers neurohormonal and vascular changes that concentric cardiac hypertrophy. Myocyte volume expansion or increased pressure will trigger the synthesis of pre-proBrain Natriuretic Peptide (BNP) in the ventricular myocardium. Pre-proBNP will be converted into proBNP and proBNP will be converted into the form of BNP and N-terminal proBNP (NT proBNP).Aim. This study aimed to determine differences in BT pro BNP in hypertensive patients without LVH and hypertensive patients with LVH. The study design was cross-sectional in cardiology polyclinic`s outpatient at Dr. Sardjito General Hospital Yogyakarta from August 2009 until the sample number is fulfi lled.Method. To analyze the difference between the two groups of hypertensive patients using the t-test for normal distribution, while for abnormal distribution were analyzed with the Mann-Whitney U test. To analyze the normality of data conducted by Kolmogorov-Smirnov. The differences of two groups of hypertensive patients considered as signifi cant if p < 0.005 with confi dence interval of 95%.Results. The results showed 73 study subjects grouped subjects into 2 groups: hypertensive subjects without LVH (31 subjects) and with LVH (42 subjects) based on echocardiography parameters (IVSD, LVPWd, LVIDd, LVM, and LVMI) consisting of 24 males and 49 females. The baseline characteristics between the study groups of hypertensive subjects with and without LVH did not differ signifi cantly either in age, BMI, blood pressure, duration of hypertention therapeutic characteristics of the use of drugs such as ACEI, ARB, β-blocker, CCB, spironolactone and furosemide. Mean NT proBNP levels in hypertensive group without LVH (46.60 ± 45.51) and hypertention with LVH group (201.60 ±192.30 ng/ml). From the results of the Kolmogrov-Smirnov test result that the data distribution was not normal then used Mann-Whitney U test, obtained a statistically significant differences.Conclusion. There were significant differences in the mean levels of serum NT proBNP in hypertensive patients without LVH and hypertensive patients with LVH.

The Difference Plasma Levels of Endotelin-1 in Type 2 Diabetes Mellitus Women with and without Hypertension Enita Rahmawati Kurniatmaja; Hemi Sinorita; Lutfan Budi Purnomo
Acta Interna The Journal of Internal Medicine Vol 5, No 1 (2015): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Background. Diabetes and hypertension are related to each other and have a strong pre-disposition on the incidence of atherosclerosis. The incidence of hypertension 2 times greater in patients with DM than non DM. Endothelial dysfunction underlies these events. Endothelial markers, endothelin-1 is known to affect blood pressure.Aim. The aim of this study is to determine the difference plasma levels of endothelin-1 in type 2 diabetes mellitus in women with and without hypertension.Methods. The cross sectional design was conducted on women with type 2 diabetes mellitus with and without hypertension at metabolic and endocrinology clinic, Dr. Sardjito General Hospital Yogyakarta from July 2010 until the sample met the criterias. Subjects were divided into two groups, type 2 DM woman with hypertension groups and without hypertension. ELISA sandwich’s method was used to measure plasma levels of endothelin-1. Characteristics of the study are presented in the form of mean Kurniaatmaja et al.Results. In this research, the plasma levels of endothelin-1 in in type 2 diabetes mellitus in women with hypertension (n=32) and without hypertension (n=32) respectively 19.17±7.53 ng/ml and 13.75±6.19 ng/dl, and this difference was stastistically signifi cant with p= 0.003 CI 95% -8.87 to -1.97.Conclusion. Plasma levels of endothelin-1 in type 2 diabetes woman with hypertension higher than without hypertension.

Maximum Tolerated Volume in Nutrient Drinking Test for Diagnosis of Functional Dyspepsia Suharjo Broto Cahyono; Neneng Ratnasari; Putut Bayupurnama; Siti Nurdjanah
Acta Interna The Journal of Internal Medicine Vol 5, No 1 (2015): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Background. Methods to evaluate pathophysiology of functional dyspepsia (FD) such as barostat are invasive, expensive and not readily available. Nutrient drink test was developed as noninvasive, safe and low cost means to assess impaired gastric accommodation in FD patients. The aim of this study is to evaluate whether this test could be used for diagnostic tool for FD patients.Method. A cross sectional study was conducted from July 2014 to December 2014, at Sardjito General Hospital, Yogyakarta, Indonesia. Twenty FD patients (according Rome III criteria with normal gastroscopy) were matched by age, gender and body mass index with 20 healthy controls. All of FD patient and healthy controls ingested nutrient drink tests (UltraMilk contain 0.6 kcal /mL). Maximum tolerated volume (MTV) of each subject was recorded. Sensitivity, specifi city, positive predictive value (PPV) and negative predictive value (NPV) were analyzed.Results. Using ≤ 950 mL of maximum tolerated volume as cut off point, sensitivity, specificity, PPV and NPV were 95%, 100%, 100% and 95%.Conclusions. A nutrient drinking test can discriminate between FD patients and healthy controls with high sensitivity and specifi city. This test could be used as objective, safe and non-invasive diagnostic tool for FD patients.

Characteristic Patients with Multiple Myeloma at Dr. Kariadi Hospital Semarang Santosa Iva; Catharina Soeharti; Mika Lumban Tobing; Suyono Suyono; Eko Adhi Pangarsa
Acta Interna The Journal of Internal Medicine Vol 5, No 1 (2015): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Background. Multiple myeloma (MM) is a malignancy of differentiated B-lymphocytes characterized by accumulation of clonal plasma cells in the bone marrow (BM), the presence of a monoclonal immunoglobulin (Ig) in the serum and/or urine, and osteolytic bone lesions. Complications of this disease consist of recurrent bacterial infection, anemia, osteolytic lesion and decreased renal function. 2-5 MM is the cause of death in 1% of cancer death in Western countries. MM incidence is 1% of all malignancies and 10% of hematologic malignancies in Caucasian race and 20% in the Afro American race.Aim. The aim of the study is to know the descriptive data of characteristic of patients with MM at dr. Kariadi Hospital Semarang.Method. Despite of development in patient management, MM is still an incurable disease, with 5-year survival rates lower than 40%. There are many differences in myeloma and its clinical manifestations. Some patients can survive in the months until over than 10 years.5, 6, 7 The median survival was 33 months, this number is similar in Asian studies.Results. There are several prognostic factors in myeloma management, such as β2-Microglobulin (β2m), serum albumin, serum creatinine, plasma cell percentage in marrow, bone lytic lesion, anemia.10-13 β2m is a prognostic factor used by the International Staging System (ISS)11 to determine stadium and prognosis in MM. β2m correlates with other prognostic factors, such as serum creatinine, anemia, mechanism of bone destruction in MM patients.11,13Conclusion. MM in Indonesia has not been studied comprehensively and the β2m measurement is expensive and not widely available.

The Difference of Average Mean Platelet Volume (MPV) Values in Stable Angina Pectoris Patients with Symptoms of Depression and without Symptoms of Depression Arief Wibawa; Agus Siswanto; Hariadi Hariawan
Acta Interna The Journal of Internal Medicine Vol 5, No 1 (2015): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Background: Depression is an independent predictor of cardiovascular events. Increased platelet reactivity is one of several possible mechanisms proposed to explain the relationship between psychosocial factors to coronary heart disease. Mean platelet volume (MPV) is an indicator of platelet activation. MPV associated with major cardiovascular events in coronary heart disease.Objective: This study aimed to determine the average difference of mean platelet volume (MPV) in stable angina pectoris patients with symptoms of depression and without symptoms of depression.Methods: The study design was a cross-sectional study. Sampling was carried out in sequence from Stable Angina Pectoris patients who were treated in the internal medicine department of Dr. Sardjito hospital Yogyakarta. MPV and HAD score were measured once on admission. Data presented as a descriptive analysis of the subjects' characteristics on average and standard deviation. The difference average of MPVbetween Stable Angina Pectoris patients with symptoms, depression and without symptoms depression assessed with Pearson's correlation. The results were considered at the signifi cance level of p <0.05.Results: There were 40 subjects, consisting of 20 Stable Angina Pectoris patients with symptoms, depression and 20 Stable Angina Pectoris without symptoms depression. The difference average of MPV in this study was 7.56 ± 0.95 fl . Average MPV in Stable Angina Pectoris patients with symptoms depression was 8.45 ± 0.82 fl and without symptoms depression was 7.68 ± 0.99 fl with p = 0.009.Conclusion: In this study, there was a statistically signifi cant difference of average MPV values in stable angina pectoris patients with symptoms of depression and patients without symptoms of depression.

Prolonged Survival in a Non-Small Cell Lung Cancer with Brain Metastasis Treated with a Brain Mass Evacuation and Gefi tinib Mardiah Suci Hardianti; Johan Kurnianda
Acta Interna The Journal of Internal Medicine Vol 5, No 1 (2015): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

The incidence of brain metastasis (BM) is reported to be increase about 20-40% over the last few years in patients with non-small-cell lung cancer (NSCLC).1 The use of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) in NSCLC patients with BM, especially those harboring EGFR mutations have been reported.

Relationship between the Degrees of Severity Sequelae after Treatment with Quality of Life in Patients of Pulmonary Tuberculosis Patients Deddy Nur Wachid Achadiono; Heni Retnowulan; Tiara Putri Utami
Acta Interna The Journal of Internal Medicine Vol 6, No 1 (2016): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: Tuberculosis remains a global health problem, especially for developing countries.Tuberculosis can cause permanent deformity of the lung parenchyma, airways, pleura, mediastinum,chest wall, and vascular. This deformity is residual symptoms or sequelae. Tuberculosis sequelae mayoccur in most patients although has completed treatment. These sequelae can affect lung functionand will ultimately influence patient’s quality of life.Objective: This study aims to determine the relationship between the severities of sequelae aftertuberculosis based index Willcox with patient’s quality of life.Methods: The study design was cross-sectional at patients of outpatient clinic BP4Yogyakarta from September 2013 until the samples are met. The relationship between theseverities of the degree of sequelae after treatment with the quality of life in patients with pulmonarytuberculosis will be analyzed using t test. Relationship is significant if p <0.05 with 95% confidenceintervals.Results: The total of the subjects are 37 consist of 24 patients (64.9%) males and 13 (35.1%) women.Subjects who met the criteria will be examined the thoracic x-ray poster anterior (PA). Severity of tuberculosis sequelae will be assessed according to the index Willcox. Subjects also completed a SGRQ questionnaire as a tool for assessing their quality of life. There is a significant correlationbetween the severity of tuberculosis sequelae with the quality of life in the activity (ρ = 0.031) and total (ρ = 0.037) domain.Conclusions: There is a relationship between the severities of the quality of life in patients with pulmonary tuberculosis sequelae.

Page 10 of 16 | Total Record : 152

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