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Acta Interna : The Journal of Internal Medicine
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.
Arjuna Subject : -
Articles 152 Documents
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Comparison of the Effectiveness of Subcutaneous Insulin Injection between Upper Arm and Abdominal Sites in Type II Diabetes Mellitus Patients with Normal and Above Normal Body Mass Index Khairina, Ana; Ihsan, Mohammad Robikhul; Susanti, Vina Yanti
Acta Interna The Journal of Internal Medicine Vol 11, No 1 (2021): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.94630

Abstract

Background. Type II Diabetes Mellitus (DM) has high morbidity and mortality. One of DM therapy is insulin. Insulin effectiveness is affected by the injection site and the thickness of the fat in the injection site. Several studies on the effectiveness of insulin injection sites have been conducted, but the results still vary.Objective. To determine the difference in the effectiveness of subcutaneous insulin injections between the upper arm and abdominal sites on changes in capillary glucose levels in type II diabetes mellitus patients with normal and above-normal body mass index (BMI).Methods. The research design used a quasi-experimental repeated measure design. The research subjects were patients diagnosed with type II DM, age ≥ 40 years, hospitalized in the ward of Dr. Sardjito Hospital Yogyakarta. The effectiveness of insulin injection is described by the difference between 2-hours postprandial glucose (2hPPG) minus fasting blood glucose (FBG) (Δ2hPPG-FBG). Δ2hPPG-FBG was taken on the site of the upper arm and abdomen. Patients were classified based on normal and above normal BMI. Statistical analysis was performed using paired T-tests.Result. There were 14 patients with normal BMI and 11 patients with above normal BMI. Paired T-test showed a significant difference in Δ2hPPG-FBG between the upper arm and abdominal sites in normal BMI patients (p=0.028) with a mean of Δ2hPPG-FBG for the upper arm site of 26,14±38.18 mg/dL, and a mean of Δ2hPPG-FBG of the abdominal site -0.64±50,62 mg/dL. Paired T-test showed no significant difference in Δ2hPPG-FBG between the upper arm and abdominal sites in patients with an above-normal BMI (p = 0.239).Conclusion. The effectiveness of subcutaneous insulin injection in the abdominal site was better than in the upper arm site in patients with normal BMI. There was no difference in the effectiveness of subcutaneous insulin injection between the upper arm and abdominal sites in patients with an above-normal BMI.
HALP Score as a Prognostic Factor of Mortality in Septic Patients at Dr. Sardjito General Hospital Anjani, Alindina; Asdie, Rizka Humardewayanti; Wijisaksono, Doni Priambodo
Acta Interna The Journal of Internal Medicine Vol 11, No 1 (2021): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.94631

Abstract

Background. Sepsis is still an important health problem with a high mortality rate, an average of 44.5% in Asian countries. An easy and early biomarker is needed to determine the prognosis of sepsis. The HALP inflammation index can be used to predict mortality in malignancy conditions, yet has not been studied for sepsis.Objective. This study aimed to determine whether HALP score has a prognostic value for mortality in non malignant septic patients at Dr. Sardjito General Hospital.Methods. This was a retrospective cohort study of septic patients admitted to Internal Medicine wards between January 1, 2016 and December 31, 2018. The prognostic accuracy was evaluated by assessing the area under the receiver operating characteristic (AUC) curve. The primary outcome was mortality at the end of hospitalization. Results:. There were 125 adult patients, 104 with high HALP score (≥54,34), 21 low HALP score (<54,34), 45 patients died (36%). Patients with low HALP score were significantly at risk of death (p=0.007, OR 3.66, 95% CI 1.38-9.68) than high HALP score. Logistic regression was used to account for potential confounding factors. Low HALP score (p = 0.004, OR 4.74, 95% CI 1.63-13.76), sepsis diagnosed with quick SOFA (p = 0.006, OR 0.25, 95% CI 0.09-0.68), and multiple infections (p = 0.011, OR 2.93, 95% CI 1.28-6.73) were significantly associated with mortality in sepsis patients at Dr. Sardjito General Hospital.Conclusion. HALP score has a prognostic value of mortality in adult patients with sepsis at Dr. Sardjito General Hospital
Association Between Irregular Eating Behavior, High Fat Intake, and Dyspepsia Syndrome of Male Adolescents at Selected Senior High School in Yogyakarta Nugraha, Adityansyah Irendra; Maduseno, Sutanto; Ratnasari, Neneng
Acta Interna The Journal of Internal Medicine Vol 11, No 1 (2021): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.94632

Abstract

Background. Dyspepsia syndrome is a group of symptoms consisting of epigastric discomfort, nausea, vomiting, bloating, early satiety, abdominal fullness, and belching. Dyspepsia syndrome is common in male adolescents. The causes of dyspepsia are multifactorial, one of the most common is diet and lifestyle changes. Objective. The aim of this study is to determine the association between irregular eating behavior, high fat intake, and dyspepsia syndrome of male adolescents in Yogyakarta senior high school.Methods. A cross-sectional study was performed among 255 male adolescents aged 15-19 years in Yogyakarta senior high school. The data were obtained using Gastrointestinal Symptoms (GIS) questionnaire, irregular eating behavior questionnaire, and Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ). Nominal variables were analyzed statistically by chi-square test and logistic regression test, numerical variables were analyzed by Mann-Whitney test and linear regression test. Result.  Dyspepsia syndrome is positive in 54.9% of the subject. Seventy-four percent of subjects with irregular eating behavior had dyspepsia, p<0.001, OR 3.58 (CI 95%, 2.05-6.26). Seventy-five percent of subjects with high fat intake had dyspepsia, p= 0.005, OR 2.86 (CI 95%, 1.33-6.15). The median GIS score of the high fat and normal fat intake group are two to one (p=0.005). Median GIS scores of irregular and regular eating behavior groups are two to zero (p<0.001). The coefficient of determination (R2) from multivariate analysis is 0.065.Conclusion. There is a significant association between eating irregularities and high fat consumption patterns with the incidence of dyspepsia syndrome in male adolescents in Yogyakarta high school.
The Effect of Weight Gain on Recurrence During Hormonal Therapy in Breast Cancer with Positive Estrogen Receptor and Negative Her2 Subtype Nugraha, Doddy Rizqi; Taroeno-Hariadi, Kartika Widayati; Hardianti, Mardiah Suci
Acta Interna The Journal of Internal Medicine Vol 11, No 1 (2021): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.94634

Abstract

Background. Weight gain is found in patients with positive estrogen subtype breast cancer. The effect of weight gain on breast cancer recurrence is still being debated and associated with a poor prognosis. Being overweight is associated with an increase in estrogen production by adipose tissue.Methods. A retrospective and prospective cohort study with data collection was conducted from July 2018 - June 2019 at the outpatient unit of Dr. Sardjito Hospital. We reviewed medical records of patients who came from January 2013 - July 2018.  Three categories of weight gain:  weight loss, increase 0 - 5%, and increase > 5% from baseline will be evaluated.Statistical Analysis. The relationship between weight gain and some risk factors of recurrence was analyzed with cox regression and multivariate logistic regression tests. The Kaplan Meier method is used to show lifetime data.Result. Weight gain in breast cancer patients with positive Her2-negative estrogen receptor subtypes was not associated with recurrence (p = 0.264; HR 0.637; 95% CI 0.289 - 1.405). Patients with body mass index ≥ 25 kg / m2 at diagnosis had a lower risk of relapse than patients with body mass index < 25 kg / m2 (p = 0.026; HR 0.461; 95% CI, 0.234 - 0.912).Conclusions Weight gain after diagnosis in breast cancer patients with positive estrogen receptor-negative Her2 subtypes receiving hormonal therapy is not associated with recurrence.
Anti-Tuberculosis Therapy after DRESS: Case Report Wahyuni, Dwi; Mulya, Deshinta Putri; Retnowulan, Heni
Acta Interna The Journal of Internal Medicine Vol 11, No 1 (2021): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.94635

Abstract

Introduction.Anti-tuberculosis-induced DRESS (drug reaction with eosinophilia and systemic symptoms) is uncommon, and usually delayed in diagnosis. The patient has minor complain and the clinical presentation involves the side effect on their heart and skin. Antituberculosis-related DRESS may have been present, but it has been underdiagnosed and underreported for several years. Management including discontinuation of the suspected drugs and changing it with second line treatment become less effective. Identifying the causative drug in DRESS is very difficult, especially in antituberculosis drugs.Case. A 34-year-old woman complains of having itch and redness throughout the body and fever. Two months before hospitalization, the patient was diagnosed with tuberculosis based on GeneXpert examination. Patients were given anti-tuberculosis drug therapy (OAT) which was 4 fixed drug combinations (FDC). Two weeks after taking the drugs, complains appeared. After 3 weeks the drug was stopped and in the next 1 week the patient's condition got worse, with itching and redness of the whole body accompanied by fever. Patients received treatment for 13 days with 125 mg/24-hour methylprednisolone therapy gradually reduced with OAT therapy levofloxacin 500 mg/24 hours and streptomycin 1 gram/24-hour IM (intramuscular).Conclusion. DRESS triggered by OAT was very rare and underreported. The choice of therapy after DRESS needed to be well considered, because it increased the risk for a DRESS to return with more severe manifestations when re-administering the same drug. The management in tuberculosis patients with a history of DRESS was given with second-line OAT with treatment options based on the clinician's experience.
Thyrotropin Receptor Antibody as a Risk Factor for the Occurrence and Severity of Graves' Ophthalmopathy Ikhsan, Mohammad Robikhul; Kertia, Nyoman; Supanji, Supanji; Rianto, Bambang Udji Djoko
Acta Interna The Journal of Internal Medicine Vol 12, No 1 (2023): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.98158

Abstract

Background. Graves' disease (GD) is an autoimmune disorder known to be the most common cause of hyperthyroidism. Thyrotropin receptor antibody (TRAb) might be involved in the occurrence and the disease process of Graves’ ophthalmopathy (GO).Objectives. This study aimed to evaluate whether TRAb levels are associated with the occurrence and severity of GO based on the clinical severity of The European Group on Graves' Orbitopathy (EUGOGO).Methods. A case-control study of 44 patients with newly diagnosed Graves’ disease (22 with GO compared to 22 without GO). Diagnosis of GO was made according to Bartley and Gorman’s criteria. Level of thyrotropin receptor antibody was tested with electrochemiluminescence immunoassay (ECLIA) method. Assessment of the clinical severity of GO was documented with EUGOGO scores.Results. Baseline characteristics were similar between 22 patients with GO compared to 22 patients non-GO group. Thyrotropin receptor antibody (TRAb) significantly increased in the GO group (11.223±7.116 IU/L) when compared to non-GO (6.720±3.442 IU/L; P=0.035). Multiple logistic regression analysis shows that 1 IU/L increase of TRAb has a 1.610-fold higher risk for developing GO. In the GO group, there is correlation between TRAb and the severity of GO-based on EUGOGO (r =0.794, P<0.001).Conclusion. Thyrotropin receptors antibody is a risk factor for the occurrence and severity of GO-based on EUGOGO.
Absolute Eosinophil Counts and Colonic Mucosal Eosinophils Based on Inflammatory Bowel Disease Severity Aulia, Nisma; Mulya, Deshinta Putri; Bayupurnama, Putut
Acta Interna The Journal of Internal Medicine Vol 12, No 1 (2023): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.98159

Abstract

Background. The inflammatory process in Inflammatory Bowel Disease (IBD) involves various types of inflammatory cells, including eosinophils. Eosinophils are not only associated with the severity of IBD but are also associated with clinical improvement. In contrast to the confirmed role of neutrophils, the role of eosinophils either in the blood or in the colonic mucosa of IBD patients have not been fully understood and confirmed.Objectives. To determine the difference in absolute eosinophil counts in the blood based on the severity of IBD and to determine the differences in the density of colonic mucosal eosinophil based on the severity of IBD.Methods. This is a cross-sectional study with consecutive sampling in the period August 2020 - July 2021. The research subjects were IBD inpatient or outpatient at Dr. Sardjito Hospital who met the inclusion and exclusion criteria. Researcher assessed data on absolute eosinophil counts in peripheral blood and eosinophil density in the colonic mucosa. The number of biopsies and the location of the biopsy were determined based on a colonoscopy performed by a Gastroentero-Hepatology Consultant. The calculation of eosinophils in the colonic mucosal tissue was carried out by an Anatomical Pathologist Specialist. IBD severity was assessed using the Truelove Witts score for Ulcerative Colitis (UC) and Crohn's Disease Activity Index (CDAI) for Crohn's Disease (CD) patients. Analysis using a computer program with a p value <0.05 was considered statistically significant.Results. There were 50 research subjects with a median age of 55 years (24-77 years). There was not a big difference between the number of male and female patients, namely 26 people (52%) vs 24 people (48%). The number of UC patients were dominant, namely 48 people (96%). The severity of IBD were divided into three groups with the number of patients with mild IBD were 22 (44%), moderate were 11 (20%), and severe IBD were 18 (36%). The number of patients with eosinophilia were 7 patients (14%) and colonic mucosal eosinophilia were 5 patients (10%). Kruskal Wallis test found that the mean absolute eosinophil blood in mild IBD was 21.45 cells/µL, moderate IBD was 25.50 cells/µL, and severe IBD was 30.44 cells/µL (p = 0.152). The mean of colonic mucosal eosinophils in mild IBD was 19.48 cells/hpf, in moderate IBD was 27.00 cells/hpf, in severe IBD was 32.03 cells/hpf (p = 0.023) and there was a statistically significant moderate correlation (r = 0.392; p = 0.005).Conclusion. There is no significant difference in absolute eosinophil counts in the blood based on the severity of IBD and there is a significant difference in the density of colonic mucosal eosinophil based on the severity of IBD.
Plateletcrit as Risk Factor of Major Adverse Cardiac Event in Elderly Patient with Acute Coronary Syndrome Kathrine, Anita Septiana Maria; Pramantara, I Dewa Putu; Hartopo, Anggoro Budi
Acta Interna The Journal of Internal Medicine Vol 12, No 1 (2023): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.98161

Abstract

Background. The morbidity and mortality of patients with acute coronary syndrome (ACS) are very high so it is important to do risk factor stratification. Several studies found that plateletcrit plays an important role in predicting mortality in STEMI patients and that it had a significant correlation as a predictor of a coronary slow flow phenomenon correlated with a worse cardiovascular outcome. The aging process is associated with altered platelet activity and a higher rate of vascular disease. The effect of aging on thrombotic function is not fully understood yet, so further research is needed. It is hypothesized that high plateletcrit increases the risk of major cardiovascular events (MACE) in elderly acute coronary syndrome (ACS) patients treated in intensive cardiac care unit (ICCU).Objective. To determine the role of plateletcrit as a risk factor for major cardiovascular events in elderly acute coronary syndrome patients.Method. We collected samples of elderly patients who experienced ACS in the period January 2016 - December 2019, recorded plateletcrit data and whether there were MACE incidents or not. The data were processed in SPSS to find a cut off of plateletcrit values which are a risk factor for the occurrence of MACE in elderly patients at Dr. Sardjito Hospital.Result. A total of 174 study subjects consisted of 58 MACE and 116 non-MACE groups, the results showed that platelecrit ≥0.35 increased the risk of MACE with a p value of 0.046 and OR 5.49.Conclusion. Plateletcrit is statistically significant to the incidence of MACE in elderly coronary syndrome patients who are treated in intensive cardiac are units.
Change in Serum Cystatin C Level as Predictor for Length of Hospital Stay in Patients Undergoing Primary Percutaneous Coronary Intervention Putra, Andika; Prasanto, Raden Heru; Puspitasari, Metalia
Acta Interna The Journal of Internal Medicine Vol 12, No 1 (2023): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.98162

Abstract

Background. Percutaneous Coronary Intervention (PCI) is one of the most frequently performed medical procedures. Length of stay for patients after undergoing PCI should be standardized to achieve the best quality of health services. The existence of complications is one of the main factors considering the length of stay after PCI. Cystatin C has the ability as a predictor of complications in patients with acute coronary syndrome, especially those undergoing PCI, as well as the increase in length of stay associated with complications after the PCI procedure.Objectives. To determine the average changes in serum cystatin C levels, the correlation between serum cystatin C levels and length of treatment, and changes in serum cystatin C levels as predictors of length of stay in patients undergoing primary PCI at Dr. Sardjito Hospital.Methods. Analytical observational study with a prospective cohort method conducted on patients with a STEMI diagnosis who underwent primary PCI procedures in Emergency Room, Cardiovascular Care Unit (CVCU) of Dr. Sardjito Hospital, treated from November 2020 to April 2021. The data was then analyzed for normality, multicollinearity, bivariate, and multivariate tests to see the effect of changes in cystatin C and other variables on the length of stay for patients after primary PCI (p <0.05 is significant).Results. Of the 111 patients, 92 patients were subjected to further analysis. Patients included in the study had an average age of 59.55 (+10.80) years, majority of men, reduced LVEF, using trans-radial PCI access, Killip I, average eGFR of 64 ml / 1.73m2, length of stay in hospital is 5 days, delta cystatin C and creatinine 0.10 and 0.04 U / L, respectively. The increase in cystatin C had a moderate positive correlation (0.502) with the length of hospital stay (p<0.001), in multivariate analysis serum cystatin C does not correlate with length of hospital stay (p=0.590). Other variables including LVEF, eGFR, infection, and contrast-induced acute kidney injury had a significant correlation with length of stay (p<0.001). The multivariate test showed that LVEF, eGFR, and infection had the most significant correlation (p = 0.034; 0.001; 0.005 respectively) to the length of hospital stay with a regression coefficient of 0.72; -0.04; and 1.93.Conclusion. An increase of cystatin C serum does not correlate significantly with the length of hospitalization in STEMI patients undergoing PCI procedure in Dr. Sardjito Hospital.
The Relationship between the Number of Major Organ Involvement and Therapeutic Response of Pulse Dose Methylprednisolone in Systemic Lupus Erythematosus Patients Kartyanto, Adhita; Paramaiswari, Ayu; Kertia, Nyoman
Acta Interna The Journal of Internal Medicine Vol 12, No 1 (2023): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.98165

Abstract

Background. Systemic Lupus Erythematosus (SLE) requires comprehensive and integrated treatment because it can manifest in various organ systems, both non-major and major organs. Pulse doses Methylprednisolone used as induction therapy, it provides dramatic improvement in prognosis in severe lupus through its nongenomic effects. Not all SLE patients who received pulse dose methylprednisolone therapy gives complete response, several factors may influence the therapeutic response, one of which is thought to influence the difference in therapeutic response is the number of major organ involvement.Objectives. To determine the relationship between the number of major organ involvement and therapeutic response of pulse dose methylprednisolone therapy in SLE patients at Dr. Sardjito Hospital Yogyakarta.Methods. This study used a retrospective cross-sectional study. The subjects of this study were adult patients with SLE treated in the internal medicine ward at Dr. Sardjito Hospital Yogyakarta and met the inclusion and exclusion criteria from January 1, 2016 to December 31, 2019. The data on the characteristics of the research subjects were taken from the patient's medical records and laboratory data before giving pulse methylprednisolone.Results. A total of 88 research subjects were taken from medical records. Patients with major organ involvement 1 experienced more complete response (53.8%), major organ involvement 2 mostly partial response (66.7%), major organ involvement 3 (48.6%) and major organ involvement 4 (53.8%) no response, and major organ involvement 5 (75%) partial response. There is a significant relationship with the number of major organ involvement with therapeutic response p<0.001. The correlation coefficient r=0.382 means that the more major organ involvement the less therapeutic response. The results of multivariate analysis showed that only the number of major organ involvement had a dominant effect on the therapeutic response, p=0.001. Regression coefficient 0.797.Conclusion. The number of major organ involvement significantly affects the success of pulse dose methylprednisolone therapy in SLE patients.

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