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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
 1   2   3   4   5 
THE ENDOTHELIN-1 LEVEL OF FEMALE TYPE 2 DIABETIC PATIENTS WITH AND WITHOUT MICROANGIOPATHY COMPLICATIONS Mazayyanah, Siti
Acta Interna The Journal of Internal Medicine Vol 3, No 1 (2013): Acta Interna The Journal of Internal Medicine
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Background. Chronic complications of diabetes mellitus (DM) include microangiopathy and macroangiopathy. Microangiopathy includes retinopathy, nephropathy and neuropathy, while macroangiopathy includes coronary heart disease, stroke and peripheral arterial disease. When the diagnosis is established in Type 2 Diabetes Mellitus (DM), approximately 25% had suffered non‐proliferative diabetic retinopathy. Within one to three years of non-proliferative retinopathy progresses to proliferative diabetic retinopathy can eventually be leading to retinal detachment, glaucoma and blindness. Diabetic nephropathy occurs in 20‐40% of patients with diabetes mellitus. Diabetic nephropathy is the leading cause of End Stage Renal Disease (ESRD) and is a high risk of Cardiovascular Disease (CVD). Endothelial dysfunction underlies all of this. Markers of endothelial dysfunction endothelin‐1 are assessed in patients with type 2 diabetes with retinopathy or nephropathy and without retinopathy and nephropathy.Aim of the study. The aim of the study is to show the differences between the level of Endothelin-1 on    female patients Type-2 Diabetes Mellitus with retinopathy or nephropathy compared to those without retinopathy and nephropathy.Method and subjects.  This study uses a cross sectional design which was conducted on subjects from outpatient type 2 diabetes mellitus women with retinopathy or nephropathy compared without retinopathy and nephropathy at endocrinology clinic, Dr. Sardjito General Hospital, Yogyakarta. ELISA sandwich’s method was used to measure plasma levels of endothelin‐1 from veins blood. Differences between groups were compared by student’s unpaired t‐test and Mann‐Whitney test (significant when p<0.05). Diabetic retinopathy is enforced through inspection fundoscopy. Diabetic nephropathy is diagnosed by albumin creatinine ratio (ACR) ≥ 30ug/mg.Result. The results showed that there were 52 female subjects with type 2 DM is composed of them 26 (50%) subjects with retinopathy or nephropathy and 26 (50%) subjects without retinopathy and nephropathy. Median age was 54 (44‐59) years. The mean level(s) of endothelin‐1 obtained (was higher) in women with type‐2 diabetes mellitus with retinopathy or nephropathy (was) 19,47 ± 9,94 ng / ml (and) (compared) with no retinopathy and nephropathy (was) 17,64 ± 11,63 ng / ml (with) (although the difference was not statistically significant) p = 0,944.Conclusion. (Endothelin‐1 levels were higher in women with type‐2 diabetes mellitus with retinopathy or nephropathy than without retinopathy and nephropathy, but the difference was not statistically significant.) No significant difference in endothelin-1 level between type 2 diabetic female patients with and without microangiopathy complications). Key words: endothelin‐1, diabetic retinopathy, diabetic nephropathy, type 2 diabetes mellitus. 
Correlation Between C-Reactive Protein And Left Ventricular Ejection Fraction InN Anterior ST Elevation Myocardial Infarction Priambodo, Rosa
Acta Interna The Journal of Internal Medicine Vol 2, No 1 (2012): Acta Interna The Journal of Internal Medicine
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ABSTRACTBackground:  C-Reactive  Protein (CRP)  levels  were  found  increase  in  ST  elevation myocardial  infarction (STEMI) patients, before and after STEMI. Increase of CRP levels were able to activate complement pathway to induce inflammation by attracting neutrophil and macrophage to enter to infarcted myocardial.  Infarct expansion followed by remodeling process, led to left ventricular dysfunction and decrease of ejection fraction.Aim: This study aimed to investigate a correlation between CRP plasma levels and left ventricular ejection fraction (LVEF) in anterior STEMI patients.Subject and method: This study was conducted cross-sectionally. Subjects were new anterior STEMI patients, with maximum onset of 48 hours. Exclusion criteria included  evidence of infection, inflammation, history of surgery or stroke in last three months, malignancy, congestive heart failure and inferior STEMI. There were 30 subjects who met  the eligible criteria. CRP blood samples were collected at least 48 hours after onset.  LVEF measurement was done during   hospitalization. The correlation between CRP levels and LVEF was analyzed by Spearman rank correlation test.Result: CRP levels in female subjects were higher than males [CRP median 23.4 mg/l (5.73 – 61.4 mg/l) vs. 12. 2 mg/l (5.6 – 66.5 mg/l)], but with no significance (P= 0.297). The thrombolytic therapy group had lower CRP levels than non thrombolytic therapy group [10. 7 mg/l (5.6 – 44.5 mg/l) vs. 14.7 mg/l (8.7 – 66.5 mg/l), also with no significance (P= 0.178). There was a non-significantly negative correlation between CRP level and LVEF (r = - 0.100, P= 0.597).Conclusion: There was no correlation between CRP level and LVEF in anterior STEMI.
EFFECTS OF LATIHAN PASRAH DIRI ON THE IMPROVEMENT OF DEPRESSIVE SYMPTOMS Hamra, Muhammad Yusuf; Sumardi, Sumardi; Siswanto, Agus; Sofia, Noor Asyiqah
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
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ABSTRACTBackground. Depression is more common in persons with chronic illnesses such as diabetes, epilepsy and infection of Human Immunodeficiency Virus (HIV). Depression can make HIV worse. Antidepressant may need, but there can be interaction and side effect when use Antiretroviral (ARV) and antidepressant in combination. Complementary and alternative medicine (CAM) include Latihan Pasrah Diri(LPD) may seem safe to treat depression in HIV patient.Methods. This is a quasi experimental study, participant include outpatient dan inpatient at RSUP Dr. Sardjito, Yogyakarta. They were aged >18 years. After scoring with Zung Self Rating Scale for depression, participants allocated into two groups, with dan without Latihan Pasrah Diri program. Zung Self Rating Scale for depression was evaluated after 1 cycle of program.Result. The means of Zung Self-Rating Depression Scale score before and after LPD were 42,21 ± 9,3 and 35 ± 10,73 (p 0,003). While in control group (without LPD / brief psychotherapy) the means of Zung Self-Rating Depression Scale score before and 3 weeks after brief psychotherapy were 42,93 ± 7.45 and 39,36 ± 7,69 (p 0,019). Statistically there was no significancy in the means of delta Zung Self-Rating Depression Scale in LPD group and control group.Conclusion. It was concluded from this study that there is an influence on the improvement of depressive symptoms post- Latihan Pasrah Diri program to people with HIV / AIDS. Key words: depression, HIV, Latihan Pasrah Diri, Zung Self-Rating Scale
LEPTIN LEVEL IN NON DIABETIC POPULATION WITH AND WITHOUT NON ALCOHOLIC FATTY LIVER (NAFL) Sofia, Noor Asyiqah
Acta Interna The Journal of Internal Medicine Vol 2, No 2 (2012): Acta Interna The Journal of Internal Medicine
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ABSTRACTBackground. Non alcoholic fatty liver disease (NAFLD) is a prevalent condition associated with obesity and insulin resistance. Leptin is an adipokine which plays role in decreasing food intake and controlling energy utilization. The role of leptin pathogenesis of NAFLD remains unclear. Former studies associated with the role of leptin in NAFL were never conducted in diabetic patients. Therefore we aimed to analyze the difference of leptin level in non diabetic population between subjects with and without non alcoholic fatty liver disease.Method. This was a non matching case control study in general check up polyclinic Dr.Sardjito Hospital Yogyakarta. The inclusion criteria were aged 30-60 years old, no history of alcohol consumption > 20 gr/day, no diabetes mellitus. The exclusion criteria were viral hepatitis (B and C), rapid weight loss, steroid therapy, and pregnancy.  Diagnosis of NAFL was based on bright liver imaging from ultrasonography.Result. There were 48 subjects consist of 23 subjects with NAFL and 25 subjects without NAFL. Mean of leptin level in NAFL group was higher than non NAFL group and this difference was statistically significant (20.29 + 15.73 ng/ml and 12.27 + 10.1 ng/ml; p=0.040).Conclusion. The conclusion of this study was leptin level significantly higher in non diabetic population with NAFL compared with non NAFL. Keywords:  leptin, non diabetic, non alcoholic fatty liver    
PROGNOSTIC FACTORS OF LEPTOSPIROSIS PATIENTS IN DR. SARDJITO GENERAL HOSPITAL, YOGYAKARTA, INDONESIA Kurniaatmaja, E.R, Kurniaatmaja, E.R; Priambodo, Doni; Humardewayanti, Rizka; Loeheri, Soebagjo
Acta Interna The Journal of Internal Medicine Vol 1, No 2 (2011): Acta Interna The Journal of Internal Medicine
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Background: Leptospirosis, an infectious disease that affects humans and animals, is a common zoonosis with a variety of clinical manifestations. Yogyakarta is one of the cities with a high incidence of leptospirosis. It is important to recognize the clinical features and prognostic factors of this disease. Severe disease can be fatal, although majority of cases are mild and self-limited. Objective: To determine the prognostic factors for leptospirosis that associated with mortality in patients with leptospirosis in Dr. Sardjito General Hospital, Yogyakarta. Methods: We conducted a retrospective study of data collected in our hospital between Jan 2010 until May 2011, from whom the diagnosis of leptospirosis was confirmed based on pertinent clinical and epidemiological data and positive serology. Result: Thirty two patients were included in this study, including 29 survivors (90.62%) and 3 non-survivors (9.38%). Of these 32 patients, 26 patients (81.25%) were admitted to the medical ward and 6 patients (18.75 %) were admitted to the ICU.  Multivariate logistic regression demonstrated that three factors were independently associated with mortality: oliguria (OR 0.75; CI 0.541–1.04; p<0.05); urea nitrogen > 74.7 mmol/L (OR 0.813; CI 0.642-1.028; p<0.05), and neurological symptoms (altered mentation or seizure) (OR 30; CI 4.367–206.07; p<0.05) Conclusion: The mortality of leptospirosis remains high despite improvements in patients care. In order to improve the early treatment of high-risk patients, these 2 clinical and 1 laboratory criteria which are associated with mortality, can be used at the time of admission as prognostic factors.  Keywords : Leptospirosis, prognostic factors, mortality
ANTI-INFLAMMATORY ACTIVITIES OF TEMULAWAK, GINGER, SOYBEAN AND SHRIMP SHELL EXTRACTS IN COMBINATION COMPARED TO DICLOFENAC SODIUM Kertia, Nyoman; Akhadiono, Deddy Nur Wachid; Paramaiswari, Ayu; Fadlilah, Arina Syarifa; Harinawantara, Hangga
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
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ABSTRACT Background: The prevalence of osteoarthritis (OA) in the community is high. This disease is the second most common cause of physical disability worldwide. Pain in OA is caused by several factors, such as inflammation. Non steroidal anti-inflammatory drugs (NSAIDs) were the most common drugs given worldwide to reduce pain in OA. NSAIDs were also associated with a high incidence of gastrointestinal side effects. An alternative to manage this problem is by using the combination of Curcuma xantorrhyza Roxb. (commonly known as temulawak) extract, ginger (Zingiber officinale) extract, soybean (Glycine max), and shrimp shell. Curcuma xantorrhyza contains curcumin which has anti-inflammatory effect by suppressing cyclo-oxygenase (COX-2) enzyme activity, suppressing lipo-oxygenase enzyme activity, and play a role as a free radical scavenger. Ginger can inhibit COX-2 activity in PGE-2 production. Shrimps shell contains glucosamine and chondroitin which can increase proteoglycan in articular chondrocytes and inhibit COX-2 synthesis. Isoflavone in soybean can inhibit articular cartilage degradation and COX-2 synthesis.Study Aims: The purpose of this study is to compare the effect of the combination to diclofenac sodium in reducing synovial fluid leukocyte count and joint pain in patients with osteoarthritis.Study Method:This study was a prospective randomized open end blinded evaluation (PROBE). Twenty one patients with knee osteoarthritis diagnosed by American College of Rheumatology criteria were included in this study. Patients were randomized into two groups to receive either diclofenac sodium 25 mg (control group) or the combination of Curcuma xantorrhyza extract 50 mg, ginger extract 100 mg, shrimp shell 100 mg, and soy bean flour 50 mg (treatment group) three times daily for 14 days. Independent t-tests and Mann-Whitney-Wilcoxon tests were used to evaluate changes between prior and post intervention.Results:  There were significantly reduction of synovial fluid leukocyte count in both control group (p=0.017) and treatment group (p=0.008) respectively.  The reduction of synovial fluid leukocyte count was not significantly different between control group and treatment group (p=0.929).  There were significant improvement of joint pain (VAS score) in both control group (p=0.012) and treatment group (p<0.001).  The reduction of VAS score was not significantly different between diclofenac group and treatment group (p=0.607).Conclution: These results indicate that the evicacy of this combiation was not significantly different with diclofenac sodium in reducing the synovial fluid leukocyte count and joint pain in patients with osteoarthritis.Keywords: osteoarthritis, Synovial fluid leukocyte count, Pain, VAS, Diclofenac sodium,Combinaion of curcuma, ginger, shrimp shell and soybean.
TREATMENT PATTERNS OF PATIENTS WITH RHEUMATOID ARTHRITIS ACCORDING TO THE PRESENCE OF RHEUMATOID FACTOR Rajendran, Puvaneswary
Acta Interna The Journal of Internal Medicine Vol 3, No 1 (2013): Acta Interna The Journal of Internal Medicine
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ABSTRACTBackground: High titer of rheumatoid factor (RF) in the serum of patients with rheumatoid arthritis (RA) is mostly associated with more severe disease and presence of extra-articular features. To choose the best treatment of RA need the combination of science and art. Objective: the aim of the study was to find the comparison of pharmacological treatment patterns in rheumatoid arthritis patients according to the presence of rheumatoid factor in the serum.Method: This study was a retrospective quantitative observational. The data was collected from medical records of new patients with rheumatoid arthritis who came to the appointment at Rheumatology Clinic Dr. Sardjito Hospital, Yogyakarta in 2010.Results: The total of 39 new patients was eligible in this study. A corticosteroid was the most commonly prescribed (93% of the sero-positive and 84% of the sero-negative patients). Disease modifying anti rheumatic drugs (DMARDs) were used in 92% sero-positive and 84% sero-negative patients (p=0.827; df=6). In choosing the DMARDs, Chloroquine was the most commonly prescribed (29% of sero-positive and 44% of sero-negative patients), followed by methotrexate (21% of sero-positive and 24% of sero-negative) and suphasalazine (21% of sero-positive and 0% of sero-negative). Leflunomide, doxycycline and combined DMARDs were some time prescribed. Non steroidal anti-inflammatory drugs (NSAIDs) were used in 64% sero-positive and 68% sero-negative patients. Conclusion: Corticosteroid was the most commonly prescribed drug. There was no difference between the sero-positive and sero-negative of total patients using DMARDs.  Keywords: Rheumatoid arthritis, rheumatoid factor, corticosteroid, diseases modifying anti-rheumatic drugs, non-steroidal anti-inflammatory drugs.
Plasma Angiotensin II Levels In Women With Type 2 Diabetes With Or Without Hypertension Ariadno, Etra
Acta Interna The Journal of Internal Medicine Vol 2, No 1 (2012): Acta Interna The Journal of Internal Medicine
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ABSTRACT Background. Hypertension is a major risk for the development and progressivity complication of macro and microvascular of diabetes mellitus. Renin-angiotensin-aldosteron system (RAAS), insulin resistance, endothelial dysfunction and autonomic nervous dysfunction play an important part in the pathogenesis of hypertension and type 2 diabetes mellitus. In RAAS, increased angiotensin II constricts arterioles, raises total peripheral resistance and blood volume. The rise in intravascular volume increases risk of hypertension. Glucotoxicity or hyperglycemia in type 2 diabetes mellitus can increases angiotensin II levels.Aim. To evaluate plasma angiotensin II levels in type 2 diabetes mellitus women with or without hypertension.Methods. Cross sectional design was conducted on subjects from outpatients’ women with type 2 diabetes mellitus at endocrinology clinic, Dr. Sardjito General Hospital, Yogyakarta. Hypertension was assessed using criteria from Seventh Joint National Committee (2003). ELISA sandwich method was used to measure plasma angiotensin II levels from blood vein. Differences between groups were compared by student’s unpaired t-test and Mann-Whitney test.Results. Among 60 subjects, there are 30 with hypertension (50%) and 30 without hypertension (50%). Mean age were 54.11 ± 3.36 years old. Plasma angiotensin II levels was higher in women with type 2 diabetes mellitus with hypertension than without hypertension although significance was not reached (0.30 ± 0.15 ng/mL vs. 0.28 ± 0.18 ng/mL, p= 0.93).Conclusion. The plasma angiotensin II levels are not significantly different between type 2 diabetes mellitus women with or without hypertension. Key words: hypertension, plasma angiotensin II, type 2 diabetes mellitus, women
ACUTE PULMONARY EMBOLISMS Hariadi, Kartika Widayati Taroeno
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
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ABSTRACTAcute pulmonary embolisms is a major cause of complications and death associated in surgery, medical illnesses, injury, and also may occurs after  a long-distance air travel. It is often originating from deep-vein thrombosis and has a wide spectrum of clinical manifestation ranging from asymptomatic, incidentally discovered emboli, to massive embolism causing immediate death. Incidence of pulmonary embolism ranges from 23-69 cases per 100,000 populations. Case fatality rates vary widely depending on the severity of the cases; at an average case fatality rate within 2 week of diagnosis of approximately 11%. It may have chronic sequele as post thrombotic syndrome and chronic thromboembolism pulmonary hypertension.            Acute pulmonary embolism is often difficult to diagnose. The predisposing factors for pulmonary embolisms consist of hereditary factors, acquired factors, and probable factors. Patients with symptoms of dyspnea, chest apnea, tachypnea or tachycardia arise suspiciousness of pulmonary embolisms therefore should be screened their probability for developing the disease. Low risk patients will then be evaluated for d-dimer test. Treatment should be initiated promptly in high risk patients, followed by imaging procedure evaluation. Chest radiographs, CT scan arteriography, VQ scan are performed to either include or exclude diagnosis of pulmonary embolisms.            Treatments consist of thrombolysis for acute and unstable massive pulmonary embolisms, and anticoagulation with heparin for stable acute pulmonary embolism. A meta-analysis of several major trials showed that low molecular weight heparin is at least as effective as unfractionated heparin in preventing the recurrence of venous thromboembolism events and at least as safe with respect to the rate of major bleeding.            This review will further describe in detail the pathomechanisms, diagnosis, and management of acute pulmonary embolisms. 
ACETAMINOPHEN AND DIPHENHYDRAMINE AS MEDICATION PRETRANSFUSION THE INCIDENCE OF FEBRILE NON-HAEMOLYTIC TRANSFUSION REACTION PLATELET RECIPIENTS Arshanti, Pudya Lestari
Acta Interna The Journal of Internal Medicine Vol 2, No 2 (2012): Acta Interna The Journal of Internal Medicine
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ABSTRACTBackground. Blood transfusion can save lives, patients get the benefit but also the risk of transfusion-related. Febrile non-haemolytic transfusion reaction (FNHTR) most frequently found and have similar symptoms of other transfusion reactions, causing delays in transfusion and decrease the quality of life. Platelet recipients have a higher incidence risk FNHTR than recipients of other blood products. Medications pre-transfusion acetaminophen and diphenhydramine reduce the incidence FNHTR.Methods. The study was conducted from May to November 2010 Internal Medicine Wards, Dr. Sardjito Hospital, Yogyakarta using the method of double-blind randomized controlled trial. Inclusion criteria were first recipient of random donor non leucodepleted platelets in thrombocytopenia malignant patients and willing to participate. Exclusion criteria were fever is when will transfusions or in 2x24 hours, allergies of acetaminophen and diphenhydramine, acetaminophen and diphenhydramine consumption in the last 6 hours, the consumption of continuous corticosteroids, history of transfusion reactions and critical conditions/sepsis. Assessment of the incidence FNHTR 15 minutes before transfusion to 4 hours after transfusion. Medication group will receive a capsule containing 650 mg acetaminophen and 25 mg diphenhydramine dissolved in 5 ml 0.9% NaCl intravenously. The control group received a placebo. Drugs are given 30 minutes before the first transfusion bag. Data were analyzed using Chi-square test and p <0.05 was considered statistically significant.Results. Thirty-two patients met the criteria, 15 patients (46.87%), medication group and 17 (53.13%) patients of control group. Eleven (31.43%) patients had FNHTR, 8 (47.06%) patients of control group and 3 (20%) patients. There are differences in the proportion of incident FNHTR in both groups although not statistically significant (P = 0.04). Every patient has different risk factors on parity, history of transfusion, history of FNHTR and the long of platelet storage. Conclusion. As pre-transfusion medications, Acetaminophen 650 mg and diphenhydramine 25 mg reduced the incidence of FNHTR compared to placebo in the first platelet recipients in malignancy Key words: Acetaminophen, diphenhydramine, medication pretransfusion, FNHTR. 

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