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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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Prolong QTc Interval in Ethionamide-Induced Hypothyroidism in the Treatment of Multidrug Resistant Tuberculosis (MDR TB) Pratiwi, Dekritiana Dian; Budiono, Eko
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.98166

Abstract

Background. Ethionamide, as part of multidrug resistant tuberculosis (MDR TB) treatment, is an antibiotic classified by WHO as a second-line drug with bactericidal property. Administration of ethionamide therapy is associated with the incidence of hypothyroidism in MDR TB patients. The resulting hypothyroidism can be a factor that triggers QTc interval prolongation on electrocardiogram (ECG) during anti-tuberculosis treatmentCase Presentation. A 77-year-old man with a history of pulmonary TB treatment one year ago, returned to undergo the intensive phase of pulmonary TB treatment for two months. Sputum evaluation at the end of the phase showed positive smear results, and the patient was diagnosed with MDR TB after further examination. Before starting MDR TB treatment, an initial ECG examination (QTc interval 0.41 seconds), TSH, and FT4 level were found to be within normal limits. MDR TB regimen including ethionamide 750 mg/day was given for the treatment. In the third month of treatment, the patient was diagnosed with hypothyroidism suspected to be related to ethionamide. In the seventh month of treatment, the patient complained of sudden weakness and QTc interval prolongation in the ECG (0.48 seconds). Ethionamide was stopped and the ECG was evaluated. No QTc interval prolongation was found after stopping ethionamide.Conclusion. This case emphasizes the importance of monitoring side effects arising from anti-tuberculosis treatment, especially ethionamide. Accuracy in diagnosing and following up the side effects of ethionamide administration in MDR TB patients is necessary to prevent worse cardiac events.
The Role of Neutrophil-Lymphocyte Ratio (NLR) as a Predictor of Successful Thrombolysis in Patients with STEMI at RSUP Dr. Sardjito Rahadiyani, IDA Swasty; Dinarti, Lucia Kris; Hartopo, Anggoro Budi
Acta Interna The Journal of Internal Medicine Vol 12, No 2 (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.98238

Abstract

Background. Coronary atherosclerosis is a major cause of ST-elevation acute myocardial infarction (STEMI). Many factors influence the pathophysiology of atherosclerosis formation, and one of the most important is inflammation. Neutrophils have an important role in the progression and instability of atherosclerotic plaques that lead to acute coronary syndromes, while lymphopenia is caused by an increase in endogenous cortisol that occurs during acute stress in acute coronary syndromes. The neutrophil-lymphocyte ratio (NLR) is a combination of inflammatory markers, integrating the two roles of leukocyte subtypes with their respective pathways into one predictor factor that can be applied to the outcome stratification of patients with STEMI undergoing thrombolytic therapy.Objectives. To identify the role of NLR as a predictor of successful thrombolysis in patients with STEMI and knowing the NLR cut-off point that can act as a predictor of successful thrombolysis in patients with STEMI.Method. This study was a retrospective cohort study. The research subjects were patients who were first diagnosed with STEMI in the ER/ICCU Dr. Sardjito Hospital and who met the inclusion and exclusion criteria, from January 1, 2016, to November 30, 2020. The independent variable in this study was the NLR at admission. The dependent variable in this study was the success of thrombolysis. Characteristic data in this study are presented in the form of categorical data. Bivariate statistical analysis with Chi-Square test. The prognostic value for success of thrombolysis was analyzed using the Receiver Operating Characteristic curve to determine the NLR limit value, followed by calculating the Relative Risk (RR). Variables having p<0.25 were continued in multivariate analysis.Result. A total of 162 subjects met the inclusion and exclusion criteria. Overall, the success of thrombolysis was 81.5%. NLR values are in the range of 6 to 13 with a median value of 6.38. ROC NLR analysis on the success of thrombolysis obtained a cut-off of 10.16 fL. From the bivariate analysis for all possible predictors, 6 predictors had logistical significance (p<0.25) namely NLR, gender, age, BMI, onset, and Killip. From multivariate analysis, statistically significant independent predictors of thrombolysis success were NLR (p=0.007, OR 3.44), onset (p=0.003, OR 4.13), and Killip (p=0.009, OR 6.76).Conclusion. A low NLR can be used as a predictor of successful thrombolysis in STEMI patients at RSUP Dr. Sardjito, with 3.44 times higher compared to the high NLR.
Effect of Pursed-Lips Breathing on Quality-of-Life Chronic Obstructive Pulmonary Disease Patients with The Short Form-36 (SF-36) Widiatmoko, Widiatmoko; Riyanto, Bambang Sigit; Retnowulan, Heni
Acta Interna The Journal of Internal Medicine Vol 12, No 2 (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.98239

Abstract

Background. Chronic obstructive pulmonary disease (COPD) is a disease of high prevalence that is characterized by irreversible airway obstruction. The most frequent symptoms such as tightness during activity and fatigue have a negative impact on the quality of life of patients and limit physical activity in everyday life. One of the goals of COPD therapy is to improve the quality of life of patients. Pursed-Lips Breathing (PLB) as one of the pulmonary rehabilitation options is known to improve breathing patterns, increase tidal volume, and reduce shortness of breath.Objective. To demonstrate the influence of PLB on the quality of life of COPD patients as measured by The Short-Form 36 questionnaire.Methods. A prospective, single-blind, randomized controlled trial study was conducted at RSKP Paru Respira, Bantul, Yogyakarta. The subjects of the study were stable COPD patients who met the inclusion and exclusion criteria. The SF-36 score was assessed in both groups before and after 28 days (4 weeks). The independent variable PLB treatment and the dependent variable SF-36 score were measured before and after treatment. Statistical analysis was carried out by a mean difference test between the treatment group and the control group.Results. Seventy-eight patients (mean age, 63 years) were randomized into the treatment group (n=41 patients) continuing standard therapy and doing 8-minute PLB for 28 days and the control group (n=37 patients) only continuing the previous standard therapy. The PLB treatment group showed an increase in the mean delta of the SF-36 score which was especially significant in aspects of physical function, physical role, and social function. There was a significant difference in the increase of average total SF-36 score in the PLB treatment (8.93 ± 15.85) compared to the control group (2.09 ± 8.15) of the 100 points total score (p=0.033).Conclusion. There was an improvement in the SF-36 score in COPD patients who received standard therapy and pulmonary rehabilitation with a PLB technique for four weeks.
The Relationship of Thyroid Stimulating Hormone Receptor Antibody (TRAb) Levels to Activity and Clinical Severity of Graves' Ophthalmopathy in RSUP Dr. Sardjito Putra, Kharisma Wibawa Nurdin Putra; Ikhsan, M. Robikhul; Susanti, Vina Yanti
Acta Interna The Journal of Internal Medicine Vol 12, No 2 (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.98252

Abstract

Background: Graves' disease (GD) is an autoimmune disease that is the most common cause of hyperthyroidism. Thyroid stimulating hormone receptor antibody (TRAb) is a specific biomarker for diagnosing GD. Graves' ophthalmopathy (GO) is the most common extrathyroid manifestation in Graves'. Each GO was assessed for activity and clinical severity for treatment.Objectives: To determine the relationship between TRAb levels and GO clinical activity in Clinical Activity Score (CAS) classification and clinical severity of The European Group on Graves' Orbitopathy (EUGOGO).Methods:  This is a cross-sectional study, conducted from January to August 2021 at RSUP Dr. Sardjito Yogyakarta. 30 newly diagnosed Graves' patients or previously diagnosed with Graves' presented symptoms of hyperthyroidism were included. The patients had TRAb levels > 1.75 IU/L, and diagnosed with Graves' ophthalmopathy based on clinical criteria according to Bartley and Gorman and has not received steroid injections. Serum TRAb examination by electrochemiluminescence immunoassay (ECLIA) method. Clinical activity are assessed with CAS, while severity are assessed with EUGOGO criteria. The data are analyzed using Spearman correlation, multivariate analysis with linear regression and logistic regression.Results: 30 study subjects mean age 35.43 years, female dominant (80%), median GD duration of 13 months. Median TRAb 8.15 IU/L, median CAS score 2 with 46.3% active. Mild severity 40% and moderate-severe 60%. Correlation of TRAb with CAS (r=0.576, p=0.001), EUGOGO (r=0.535, p=0.002). Multivariate analysis of TRAb with CAS (B= 0.076, p=0.01) while EUGOGO (OR=1.198, p=0.045)Conclusion: TRAb is positively correlated with activity and clinical severity of OG.
Correlation Between the Presences of Ascites with MELD-Na Scoring in Liver Cirrhosis Patients Marcellus, Marcellus; Ratnasari, Neneng; Indrarti, Fahmi
Acta Interna The Journal of Internal Medicine Vol 12, No 2 (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.98482

Abstract

Background. Global prevalence of liver cirrhosis (LC) ranges from 4.5% to 9.5% of the general population amounting to more than fifty million people in the world. The Model for End Stage Liver Disease (MELD-Na) is commonly used to determine the prognosis and survival of liver cirrhosis patient. MELD-Na scoring consists of creatinine, bilirubin, international normalized ratio (INR), and serum sodium. Ascites is one of the clinical signs of decompensated liver cirrhosis, as well as present in Child Turcotte Pugh (CTP). The purpose of this study was to investigate the association between the presence of ascites and MELD-Na scores of LC patients.Methods. This cross-sectional study was performed in LC patients who met the inclusion without exclusion criteria. The study was conducted at RSUP Dr. Sardjito, Yogyakarta, Indonesia during 2017-2018 periods. The MELD-Na value was calculated using the following equation:MELD-Na = 9.57 ln (creatinine mg/dL) + 11.2 ln (INR) + 3.78 ln (bilirubin mg/dL) + 1.59 (135-Na [mEq/L]) + 6.43. Differences of mean MELD-Na scores based on presenting of ascites were tested by independent T-tests. The cut-off value of MELD-Na was determined through the Receiver Operating Characteristic (ROC) curve. The relationship between the presence of ascites and the MELD-Na value was determined by the Fisher exact test; the correlation strength was determined by Phi and Crammer's V test. Prevalence ratio (PR) was calculated for determining the predictor factors. The results were considered statistically significant when the probability value p <0.05 was obtained.Results. There were 59 subjects (41 male and 18 female). The mean age of subjects was 52.05 years old. The 39 patients were found ascites and 20 patients were not. Based on independent T test results there was a significant difference in mean values of MELD-Na (p=0.006). Based on the ROC curve result, a cut-off point of 20.7 (95% specificity, 35% sensitivity) with Area under the Curve (AUC) was 0.662 (p=0.042). Based on the cut-off, Fisher test with 2x2 tables, Phi and Cramer's V test were done with p value 0.022; 0.015; 0.015 respectively. The PR value was 1.607 (95% CI: 1.203-2.145).Conclusion. There was a significant correlation between the presences of ascites with MELD-Na scoring using cut-off point of 20.7 and value of Prevalence Ratio of 1.6.
Prognostic Values of Hemoglobin and Red Blood Cell Distribution Width to Overall Survival in Non-Hodgkin Lymphoma Trisnawati, Lidwina Tika; Hardianti, Mardiah Suci; Purwanto, Ibnu
Acta Interna The Journal of Internal Medicine Vol 12, No 2 (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.98483

Abstract

Background. After the Rituximab era, baseline International Prognostic Index (IPI) is not sufficient for the initial risk stratification of patients with Non-Hodgkin lymphoma (NHL). Low hemoglobin (Hb) levels and high red blood cell distribution width (RDW) baseline are known to be associated with poor outcomes and overall survival in malignancy. This study aimed to evaluate the prognostic value of Hb and RDW to overall survival in NHL patients who undergoing chemotherapy at Dr. Sardjito Hospital.Method. A retrospective cohort study in NHL from patients’ medical records diagnosed from 2014 to 2018 and undergoing chemotherapy at Dr. Sardjito Hospital. The prognostic influence of clinical factors including Hb and RDW on 3 years of overall survival were studied by using Kaplan-Meier curves and univariate Cox regression tests. To evaluate the independent prognostic relevance of basic characteristics data (age, gender, BMI, performance status, Ann Arbor stage, extranodal involvement), Hb, and RDW, multivariate Cox proportional hazards regression was applied. Results. From 292 NHL patients included, the median Hb was 12.7 g/dL and the median RDW was 14.2%. The mean survival time was 31.13 months, 38 patients (13%) died during the 3 years of follow-up. The most common causes of death were sepsis (68.4%) and 12 patients (4.1%) died within <30 days of chemotherapy. Based on Cox regression univariate analysis, patients with lower Hb levels (<10 gr/dL) had a 3-year overall survival lower than Hb>10 gr/dL (71% vs. 87%, CI 95%, p=0.014), with Hazard Ratio 2.49 (p=0.02). Patients with higher RDW>15.5 levels had lower overall survival than patients with RDW<15.5 levels (77.5% vs. 91.1%, CI 95%, p=0.002), and Hazard Ratio 2.78 (p=0.02). Based on multivariate analysis, performance status (OR=2.589, CI 95%, 1.225-5.471, p=0.013) and RDW (OR=2.292, CI 95%, 1.106-4.48, p=0.026) are independent predictor factors of 3-year overall survival.Conclusion. NHL patients with lower Hb and higher RDW levels have lower 3-year overall survival.
Prognostic Factors for Mortality in Patients With HIV/AIDS in Sardjito Hospital Helmi, Hamid; Subronto, Yanri Wijayanti; Wijisaksono, Doni Priambodo
Acta Interna The Journal of Internal Medicine Vol 13, No 1 (2024): 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.101185

Abstract

Background. There are 3.8 million people infected with HIV in the Southeast Asia region. Even though it tends to fluctuate, cases of HIV AIDS infection in Indonesia continue to increase every year. HIV infection in Yogyakarta is also still relatively high. The treatment of HIV infection using ARV drugs is one of the spearheads to extend the life expectancy. The risk factors that influence the outcomes of patients receiving ARV therapy are varied. Slow immune improvement is greatly influenced by the patient's condition at the start of ARV therapy, such as age, long duration of HIV infection before therapy, specific immune activation, low CD4 count, and the period of AIDS at the start of ARV therapy.Objective. To find out the factors that significantly contributed to the mortality of patients with HIV/AIDS on ARV treatment at Sardjito Hospital.Methods. An observational study was conducted using a cohort retrospective method on HIV/AIDS patients who received ARV therapy for the first time in the period January 2008 – December 2021. Data extraction was conducted from December 2021 - February 2022. Multivariable analysis was carried out using multiple logistic regression. Survival analysis was measured by Kaplan-Meier curves.Results. The total number of HIV patients in the study was 1,591 people, with 199 patients having died. Variables associated with mortality in HIV patients in bivariate analysis were age, tuberculosis status, CD4 count, occupation, and clinical stage. Multiple logistic regression showed that occupation, CD4 count, and clinical stage were consistently associated with mortality among HIV patients. One and five-year survival rates for HIV patients were 89% and 87%.Conclusion. The CD4 count, occupation, and clinical stage of HIV are associated with mortality in HIV/AIDS patients receiving ARV treatment. Although variables other than the clinical stage are not independently related, some of these variables must still be considered in the care of HIV patients.
The Association Between Physical Activity and Monocyte-HDL Ratio in Diabetes Mellitus Patients Who Have Exceed Life Expectancy in Yogyakarta Province Setiawan, Gibran Ilham; Probosuseno, Probosuseno; Sinorita, Hemi
Acta Interna The Journal of Internal Medicine Vol 13, No 1 (2024): 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.101284

Abstract

Background: The elderly population is expected to double in the upcoming three decades, due to increase in life expectancy. The province of DIY has the highest life expectancy in Indonesia (73.13 years and 76.67 years for men and women). Physical activity can reduce insulin resistance, improve lipid metabolism and reduce levels of inflammation in diabetes mellitus (DM). Physical activity can increase life expectancy. Many factors affect life expectancy, one of which is physical activity. This study investigated the association between physical activity and monocyte to HDL ratio (MHR) in diabetes mellitus patients who had exceeded their life expectancy in Yogyakarta.Method: This cross-sectional study was conducted in September 2022-April 2023 and using purposive sampling. Participants who meet the criteria and consent were asked to fast at least 8 hours, then be interviewed by a physical activity questionnaire and checked complete blood tests, fasting blood glucose and HDL cholesterol. The association between physical activity and MHR then analyzed using SPSS.Result: There were 50 participants with median age 78 (74-91) years. The mean score of physical activity is 100.28±7.96. Mean MHR is 0.0147±0.005. There is a significant relationship with weak correlation between physical activity and MHR (p 0.034, r -0.301), weak correlation between MHR and body mass index (BMI) (p 0.015, r 0.343), obesity (p 0.019, r 0.331) central obesity (p 0.032, r 0.303) and smoking (p 0.039, r 0.293). Multivariate analysis was performed, there is a significant relationship with weak correlation between physical activity and MHR (p 0.033, r -0.297).Conclusion: There is a negative correlation with weak strength between physical activity and MHR in patients with diabetes mellitus who have reached the life expectancy of province of DIY.
Correlation Between Systemic Immune-Inflammation Index and Depression in Patient with Heart Failure Reduced Ejection Fraction in Sardjito Hospital Yogyakarta Somba, Imanuel Maryo; Sofia, Noor Asyiqah; Anggraeni, Vita Yanti
Acta Interna The Journal of Internal Medicine Vol 13, No 1 (2024): 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.101285

Abstract

Background. Depression is highly prevalent in patients with heart failure reduced ejection fraction (HFrEF). The pathophysiology between these two conditions is related to the inflammation process, therefore some inflammatory markers can be used to assess those conditions. In recent years, the systemic immune-inflammation index (SII) has been developed as a simple and inexpensive indicator of inflammation. Unfortunately, we did not find any study that assessed the correlation between SII and depression in patients with HFrEF.Objective. To investigate the correlation between SII and depression in patients with HFrEF in Sardjito Hospital YogyakartaMethods. This was a cross-sectional study on patients with HFrEF in Sardjito Hospital between February 2023 and May 2023. The normality test was carried out using the Shapiro-Wilk test. Bivariate analysis was carried out using the Spearman correlation test. The result was considered statistically significant when p-value <0.05. Multivariate analysis was carried out using multiple linear regression test.Results. There were 47 HFrEF patients with depression. There was a significant relationship between SII and depression scores from the Spearman Correlation test results of SII with depression scores, with p=0.009. The result showed that the higher the SII, the higher the depression score. The correlation coefficient between the two variables was r=0.375, showing that the correlation was in the weak category.Conclusion. There is a positive correlation between the systemic immune-inflammation index and depression in patients with heart failure reduced ejection fraction.
Effect of Combination Hemodialysis Hemoperfusion on Lowering Leptin Level in Patients with Kidney Failure Receiving Routine Hemodialysis: A Multi-Center Study Naraswari, Ilsya Asti; Puspitasari, Metalia; Wardhani, Yulia
Acta Interna The Journal of Internal Medicine Vol 13, No 1 (2024): 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.101288

Abstract

Background: Leptin clearance during conventional haemodialysis (HD) has been found to be minimal or absent. Some authors reported the possibility of decreasing leptin serum levels with high flux membranes, but limited date are available. Leptin has been reported as a marker of inflammation and long-term complications such as cardiovascular events leading to increased quality of life deterioration. Haemodialysis hemoperfusion (HD+HP) has been reported to effectively decrease middle-sized and macromolecular toxin concentrations. In the present study, we compared the effectiveness of high-flux HD and HD + HP can effectively remove serum leptin levels, and is expected to reduce cardiovascular events in patients with kidney failure.Objective: To assess the influence of HD+HP therapy on serum leptin level in routine haemodialysis patients.Metode: Quasi experimental with pre and post exposure measurements in 26 kidney failure patients who received routine HD at three hospital sites were selected according to inclusion criteria and divided into intervention group (HD twice a week + Hemoperfusion once a week) and control group (HD twice a week). Serum leptin levels were compared before and after 8 weeks of therapy, and differences were then compared from each group.Result: Leptin levels reduced significantly (p = 0.017) in the control group (High-Flux HD). Serum leptin levels decreased in HD+HP group but there was no significant differences (p = 0.784). Significant differences were not observed between two modalities (HD and HD+HP) (p = 0.258).Conclusion: Haemodialysis plus hemoperfusion once a week for 8 weeks was not found effectively lowering leptin level compared high-flux HD alone.

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