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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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The Relationship between 12MWD and Quality of Life in Tuberculosis Sequelae Patients Heni Retnowulan; Deddy Nur Wachid Achadiono; Andika Ilham Rahmatullah
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

Background: The incidence of TB cases in Indonesia is very high. Although it was undergoing treatment and was declared cured the infection, but it does not mean that the infection does not leave sequelae.Patients TB sequelae decreased functional capacity and quality of life.Aim: The purpose of this study is to determine the relationship between functional capacity (12MWD) and quality of life (SGRQ) in tuberculosis sequelae patients.Method: Patients with TB sequelae aged 18-59 years without comorbid examined functional capacity with a 12-minute walking distance test and assessment of quality of life using the SGRQ questionnaires. Statistical analysis is using correlation and regression.Result: There were significant negative correlation (p<0.05) between the 12 minute walking distance and activity domain (r -.336). In other domains, there is a negative relationship but not significant at the totaldomain (r -.152), impacts (-.124), and symptoms (-.043).Conclusion: There is a significant negative relationship between the 12 minute walking distance and quality of life as assessed by questionnaire SGRQ in activity domain, in other domains there is also a negative correlation but was not statistically significant. The higher of functional capacity patients with tuberculosis sequelae, the quality of life also become higher.

Type of Psychosocial Stressor as Risk Factor of Depressive Symptom in Metabolic Syndrome Ana Fauziati; Agus Siswanto; Luthfan Budi Purnomo
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

Background: Metabolic syndrome and depression are two major diseases over the world, which are increasing in prevalence over time. Depression is major mental health burden over the world. In long time, depression can lead to metabolic syndrome, while metabolic syndrome is risk factor for developing depression. Chronic stress that induced by psychosocialstressor lead to the development of both metabolic syndrome and depression. Further research is important to identify which type of psychosocial stressor is the risk factor for depression symptom in patient with metabolic syndrome.Aims: This study is to identify the type of psychosocial stressor which could be the risk factor for depressive symptom.Method: The study design was case control. The case group consisted of metabolic syndrome patients with depressive symptom, while the control group consisted of metabolic syndrome patients without depressive symptom. Metabolic syndrome was diagnosed based on International Diabetes Federation (IDF) criteria. Depressive symptom was measured by Beck Depression Inventory (BDI). Psychosocial stressors were measured by Stressful Life Events (SLE) questionnaire. Dependent variable was depressive symptom, while independent variables were type of psychosocial stressors (finance, work, social relationship, health and housing). Analysis methods that used in this study were independent t test, Pearson/Spearman correlation analysis, chi square and logistic regression.Result: There were 54 patients in this study, consisted of 24 in case group and 30 incontrol group. There was no significant difference in most basic characteristics between two groups. There was significant difference of SLE score between two groups. Chi square analysis showed that housing, finance, health, social relationship, and work stressors were risk factors fordeveloping depressive symptom in metabolic syndrome (OR 24.5; 9.7; 8.4; 5.4; 3.9 respectively, significant). Demographic factor which also influenced depressive symptoms was salary less than 1 million per month (OR 45, significant). According to logistic regression analysis, psychosocial stressors which most influenced the depressive symptom were finance and housing.Conclusion: The study showed that housing, finance, health, social relationship and work stressors were risk factors for developing depressive symptomp in metabolic syndrome.

Correlation Between Neutrophil To Lymphocyte Ratio With Child Turcotte Pugh In Liver Cirrhosis Patients Wiwiek Probowati; Putut Bayupurnama; Neneng Ratnasari
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

Background: Neutrophil to lymphocyte ratio (NLR) is an index that iswidely used these days. RNL has been widely studied as a predictor of poor survival and outcome in patients with liver cirrhosis, hepatocellular carcinoma, coronary heart disease, rheumatoid arthritis, sepsis and malignancy.Objective: To determine whether there is a correlation between NLR with a score of Child turcotte pugh (CTP) in patients with liver cirrhosis in Dr. Sardjitogeneral Hospital.Methods :The study design was cross-sectional study. The study began in December 2014 until the number of samples are met. The subjects of this study were patients with liver cirrhosis at affordable populations undergoing inpatient and outpatient care in the Dr. Sardjito Hospital that meet the inclusion and exclusion criteria. Venous blood test to measure neutrophils,lymphocytes, albumin, total bilirubin, INR (Internationale normalized ratio). Data presented in the form of descriptive analysis of the characteristics of the study subjects such as the mean and standard deviation values of lymphocyte and neutrophil ratio scores CTP. For analyze the correlation between NLR with CTP scores Spearman nonparametric analysis p <0.05.Results : There are 33 subjects in the study. Based on the results of this study found a positive significant correlation between the ratio of neutrophils to lymphocytes CTP with r = 0.749 andp= <0.0001 and obtained the formula Y = 7.797 + 0,067x. Thus increasing of neutrophils to lymphocytes ratio positive correlated with the severity of liver cirrhosis.Conclusion. There are positive correlation between the neutrophil to lymphocyte ratio with CTP scores in patients with liver cirrhosis.

Prognostic Value Of Chemotherapy-Induced Neutropenia In Metastatic Colorectal Cancer At Rsup Dr Sardjito Yogyakarta Muhammad Ihsan Qomaruzzaman; Johan Kurnianda; Mardiah Suci Hardianti
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

Background: Colorectal cancer is the third largest incidence of cancer in the world and is the third most common cause of death in women and men . Five-year overall survival (OS) in colorectal cancer who have undergone metastasis was 10 % . Hematologic toxicity may be a marker of biological activity of cytotoxic drug on various types of cancer . Neutropeniaafter chemotherapy known to be associated with increased patient survival .Objective : To establish whether chemotherapy-induced neutropenia is predictive of better outcome in patients with metastatic colorectal cancer (mCRC).Methods: This research was a case-control study. Subjects were patients with metastatic colorectal cancer in the Cancer Instalation Center Tulip RSUP dr. Sardjito who meet the inclusion and exclusion criteria. Data were analyzed by bivariate analysis using chi square test and multivariate analysis with logistic regression.Results: Neutropenia present in 26 patients (32.5%) of the total 80 patients of the study. Neutropenia were significantly affect OS ( p = 0.001 and OR 7.73, 95% CI: 2.51-23.80). Multivariate logistic regression analysis showed neutropenia and the number of metastases affect OS with p <0.001 and p <0.003.Conclusion: Neutropenia occurring during the two first lines of chemotherapy for metastases colorectal cancer is associated with better survival. Variables that affect OS is the number of metastases and incidence of neutropenia after chemotherapy.

Treating depression in diabetic patients: Latihan pasrah diri (LPD) revisited Agus Siswanto; Arief Kurniawan Siregar; Ahmad Husain Asdie
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

The condition accompanying depression will always be progressing into poor prognosis if the depression itself is not recognized and treated properly. Among diabetic patients, depression was associated with increased mortality and poor quality of life . It was observed that diabetes and depression has a bidirectional relationship, where the clinical course of both conditions are affecting each other. Despite the effectiveness of psychological and psychopharmacological interventions in treating depressive symptoms in diabetic patients, the effect of such interventions on glycemic control is still inconsistent. Complementary alternative medicine (CAM) alone or in combination with standard medical treatment, targeting both depression and diabetes, appears to be promising. Latihan Pasrah Diri (LPD) has been recognized as a type of relaxation technique under CAM. It is initially directed to provide adequate relieve of depression using both religious and relaxative approach. Among patients with comorbid diabetes and depression, this approach has long been known and utilized over the counter, but its formal practice is seldom advocated, whereas, many clinical trials has been conducted locally to reveal its potential use. Combined with standard therapy, LPD is expected to show its beneficial effects.

Relationship between the MELD score with severity erectile dysfunction in cirrhotic patients Doddy Afprianto; Siti Nurdjanah; Muhammad Robikhul Ikhsan
Acta Interna The Journal of Internal Medicine Vol 7, No 1 (2017): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Background. Liver cirrhosis is a pathological condition that describes the end stage of hepatic fibrotic which progressively ongoing that signed by distortion from hepar architecture and the formation of the regenerative modulus. Liver cirrhosis causes impairment in most of the liver function including the hormonal balance and metabolism of steroids. In the male patients, liver cirrhosis causes hypogonadism and feminization. Sexual dysfunction in cirrhotic patients is still underestimated and underdiagnosed. The most common sexual dysfunction in male cirrhotic patients is impotence or erectile dysfunction. Erectile dysfunction (ED) is define as a persistence inability to reach and/ or maintain enough erection to satisfy the sexual activity. International Index of Erectile Function 5/IIEF-5 could mark erectile dysfunction. Despite the prevalence of erectile dysfunction is high in patients with liver cirrhosis, only a few studies revealing the relationship between severity of liver cirrhosis and severity of erectile dysfunction.Objective. The purpose of this study is to determine the correlation between MELD score and severity of erectile dysfunction (IIEF-5 score) in cirrhosis patients.Methods. This study is observational with a cross-sectional method. Subjects were patients with liver cirrhosis, male, age 18 to 65 years old, married, have a partner, and agreed participated to this study. We used Pearson the correlation to assess correlation between severity of liver cirrhosis (Child Pugh score) and severity of erectile dysfunction (IIEF-5 score) if the data were distributed normally and Spearman correlation if the distribution is abnormal.Conclusion. There is negative correlation with the moderate strength degree between MELD score (the degreee of severity in liver cirrhosis) with the IIEF-5 score (the degree of erectile dysfunction). Keywords: liver cirrhosis, MELD score, erectile dysfunction, IIEF-5, correlation.

Interleukin-8 expression differences in chronic and active chronic inflammation gastric mucosa biopsy with helicobacter pylori infection Muhammad Arif; Siti Nurdjanah; Neneng Ratnasari
Acta Interna The Journal of Internal Medicine Vol 7, No 1 (2017): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Background: Infection with Helicobacter pylori (HP) estimated to occur in 50% of the population in the world. Helicobacter pylori infection causes inflammation of the gastric mucosa and gastric epithelial release of interleukin-1β, interleukin-6, interleukin-8 and tumor necrosis factor α. Interleukin-8 plays a role in the degree of chronic inflammation of the gastric mucosa and gastric cancer risk. There has been no research on differences in the expression of interleukin-8 is based on chronic and chronic active inflammation on biopsy of the gastric mucosa with Helicobacter pylori infection in Hospital Dr. Sardjito.Objective: To prove the differences in the expression of interleukin-8 of chronic inflammation and gastric mucosal biopsy active chronic infection with Helicobacter pylori.Methods: This study used a cross-sectional design. Examined the expression of interleukin-8 on the rest of the biopsy sample HP (+) in August 2009 to March 2014. Classification of chronic inflammatory and chronic active obtained through histopathology report. Categorical numerical data from the two groups, unpaired, the distribution is not normal: Mann-Whitney test. Differences were considered significant if it was obtained p <0.05 with a confidence interval of 95%.Results: There were 41 samples of gastric mucosa biopsy preparations, comprising 9 samples of chronic inflammation and 32 samples of chronic inflammatory active of the gastric mucosa. The median value of the expression of IL-8 eptitel surface on chronic inflammation by 83 (40-94)% and the active chronic inflammation by 82 (19-94). Comparison test with Mann Whitney U test. From the statistical calculations p value = 0.887 with p> 0.05Conclusion: There is no difference in the expression of interleukin-8 in inflammatory chronic active and chronic inflammation of the gastric mucosa with Helicobacter pylori infection.Keywords: Helicobacter pylori, interleukin-8, chronic inflammation and chronic inflammatory active.

Effect Of Latihan Pasrah Diri (Lpd) Plus Fluoxetin Compared With Fluoxetin Alone To Improve Fructosamine Level In Tipe 2 Diabetes Mellitus Patients With Depression Symptoms Natsir Muin; Agus Siswanto; Ahmad Husain Asdie
Acta Interna The Journal of Internal Medicine Vol 7, No 1 (2017): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground. Depression is a risk factor for diabetes and diabetes increase the risk for depression. Depression contributes to progression of diabetes mellitus. Examination of fructosamine is used to monitor blood sugar control for 2-3 weeks (according to age albumin). LPD evoke the relaxation response, which expected to improve symptoms of stress or depression.Objective. To determine the decrease in fructosamine levels in the group of patients with diabetes mellitus with depression symptoms after administration of fluoxetine alone compared with a combination of fluoxetine and LPD.Methods. This research conducted in Dr.Soeradji Tirtonegoro General Hospital, in May to August 2014. Distribution of data tested using the Shapiro-Wilk test. The differences between fructosamine and BDI (Beck Depression Inventory) before and after treatment tested with a pair t-test if normally distributed or Wilcoxon test if it was not normally distributed. The decrease in fructosamine and BDI both groups compared by independent t-test if normally distributed or Mann Whitney U test if not normally distributed. Differences were considered significant if p <0.05 with a confidence interval of 95%.Result. There was a significant decrease in fructosamine levels in treatment group from 293.90±140.042 to 239.01±133.13 after treatment with p value 0.017 (p <0.05). Control group from 263.13±163.65 to 219.01±149.33 with p value 0.001 (p<0.05). The decrease of fructosamine levels not differ in the treatment group 67.24±102.71 than the control group 71.14 ± 72.77 with p value = 0.902 (p> 0.05).Conclusion. LPD had no effect on fructosamine levels of type 2 diabetes mellitus patients with depression symptoms.Keywords: LPD, symptoms of depression, fructosamine, BDI (Beck Depression Inventory)

Effect of Metformin and Valsartan Toward Homa-IR in Metabolic Syndrome Patient with Non-Alcoholic Fatty Liver Disease (NAFLD) Prasetio Kirmawanto; Siti Nurdjanah; Muhammad Robikhul Ikhsan
Acta Interna The Journal of Internal Medicine Vol 7, No 1 (2017): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: Insulin sensitizer drugs such as metformin has suggested giving in metabolic syndrome patient and NAFLD, which both pathogeneses were insulin resistance. Angiotensin II receptor blocker (ARB), anti-hypertension drugs, has the similar properties to improve regulation of Proliferator-Activated Receptor Gama (PPARɤ). This aim of the study is to prove the improvement of insulin resistance which examined by HOMA-IR method on metabolic syndrome patient with NAFLD after receiving metformin and valsartan medication.Method: This study was conducted to the patient in Endocrinology Clinic Sardjito General Hospital aged 35-36 years who meet diagnostic criteria for metabolic syndrome based on the IDF in 2006 and NAFLD. Convenience sampling method is done for 11 months (May 2012 – March 2013) and was expected sample size 35. HOMA-IR examination made before and after administration of metformin and valsartan for 12 weeks. Cut off value for HOMA –IR on pathological metabolic syndrome and NAFLD was ≥ 2. Medical and Health Research Ethics Committee (MHREC) Faculty of Medicine Universitas Gadjah Mada approved this study protocol.Result: Subject of study retrieved 15 (43%), six males (40%) and nine females (60%) aged 43-63 years old. Median HOMA-IR baseline was 2.8 (0.6-14.5) and at the end of therapy was 3.8 (1.72-14.1). Eleven (74%) have increased HOMA-IR value and four (26%) experience declined but none of them reach the value below 2. In general clinical improvement occurs in the form of AST and ALT reduction but not statistically significant.Conclusion: This study does not prove that administration of metformin and valsartan in-patient with metabolic syndrome with NAFLD would improve insulin resistance assessed by the HOMA-IR method.Keywords: Metformin, valsartan, metabolic syndrome, NAFLD, HOMA-IR

Effectiveness Combination of Ginger Extract (Zingiber officinale) and Ranitidine Compared with Combination of Ranitidine and Placebo against Severity of Functional Dyspepsia Dite Ari Prapti; Neneng Ratnasari; Siti Nurdjanah
Acta Interna The Journal of Internal Medicine Vol 7, No 1 (2017): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: Efficacy ranitidine as dyspepsia functional treatment was 8-35 % and ginger extracts as a traditional recipe in various countries for generations could be used as a therapy dyspepsia, antinausea, spasm, colic, and other stomach complaints. Ginger therapeutic effectiveness could reach 68-77% in vivo studies (animal models).Objective: To determined how much influence combination of ginger extract and ranitidine could improve severity of dyspepsia compared with combination of ranitidine and placebo in patients with functional dyspepsia.Method: This study was a quasi experimental. The research was conducted from December 2015 until April 2016 with 26 participants.Results: After getting therapy for 2 weeks in group I, mean SODA score in the pain scale decreased (8.4 %) of 29.07 ± 7.29 to 25.08 ± 8.22, statistically significant (p <0.046). Mean SODA score in the pain scale group II decreased (7.2%) of 25.38 ± 6.19 to 24 ± 6.01 (p=0.302). Mean SODA score in the non pain scale in group I decreased (7.7%) of 16.84 ± 2.44 to 15.15 ± 2.64 (p=0.074), while in the group II decreased (1.6%) of 15.77 ± 2.71 to 15.23 ± 2.94 (p=0.470). Mean SODA score in the satisfaction scale in group I increased (19.9%) of 7.77 ± 3.63 to 10.08 ± 3.59 (p=0.053) while in the group II increased (8.4%) of 9.62 ± 2.72 to 10.92 ± 2.46 (p=0.072). Comparison decline of SODA score in the pain scale between group I was 4.31 ± 6.3 and in group II is 1.23 ± 4.91, greater in group I but not significantly (p=0.178) at baseline to week 2nd. Comparison decline of SODA score in the non pain scale between group I was 1.69 ± 3.11 and in group II was 0.54 ± 2.6, greater in group I but not significantly (p=0.316) at baseline to week 2nd. Comparison increasing of SODA score in the satisfaction scale between group I was – 2.31 ± 3.88 and in group II was -1.31 ± 2.39, greater in group I but not significantly (p=0.437). Conclusion: Combination of ginger extract and ranitidine could decrease pain scale, non pain scale and increase satisfaction scale more effective clinically than plasebo and ranitidine for functional dyspepsia patient, but not statistic significantlyKeywords: ginger extract, severity of dyspepsia, and functional dyspepsia

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