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

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (177.968 KB)

ABSTRACTBackground: Recommendations for therapy insulin resistance are metformin and thiazolidindion. Side effects of thiazolidindion due to peripheral edema occurs to 2-5% and increased 5-15% when combined with insulin therapy. Telmisartan, an angiotensin receptor blocker, has anti-hypertensive effects and improve insulin resistance. Telmisartan effect on peroxisome proliferator activated receptor Î³ agonist and has the same structure of the group thiazolidindion, pioglitazone. The research objective was to determine the effects of telmisartan and metformin on insulin resistance in metabolic syndrome patients with insulin therapy.Methods: This study used a before-after design. The study was conducted in the internal medicine clinic of the endocrinology department of Dr. Sardjito Hospital Yogyakarta. Subjects were patients who met the diagnosis of metabolic syndrome based on the IDF 2005, hypertension and receive insulin therapy. Subjects given metformin and telmisartan therapy for 12 weeks. Subjects examined HOMA IR before and after treatment. The average decrease in HOMA IR was tested by paired t test or Wilcoxon test. P value <0.05 was considered signifi cant.Result: The total sample were 27 subjects. Data analysis was performed on 11 subjects. Fasting blood glucose before and after treatment was signifi cantly decreased (p<0.001) whereas the fasting insulin levels increased. HOMA IR was signifi cantly decreased after treatment {p = 0.004 (5.79 â 20.26), CI 95%}.Conclusion: this study found insulin resistance decreased signifi cantly in patients with the metabolic syndrome of insulin therapy who received metformin and telmisartan.Keywords : metabolic syndrome, insulin therapy, metformin, telmisartan, HOMA IR

The Effects of Aerobic Exercise on Functional Capacity of Geriatric Chronic Heart Failure Patients Muhammad Khalimur Rouf; Irsad Andi Arso; I Dewa Putu Pramantara
Acta Interna The Journal of Internal Medicine Vol 6, No 2 (2016): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Background: Chronic heart failure, a condition predominantly affecting the elderly, is a major clinical burden and cause death in admission patients especially the elderly population. The focus of cardiac rehabilitation recently is exercise used as one of the modality of therapy designed for stable heart failure patients. Exercise is recommended as one of modality in management of heart failure to improve prognosis, increase physical activity tolerance and quality of life of heart failure patients. Aim: The objective of this study is to understand is aerobic exercise program can improve functional capacity in geriatric heart failure patients. Methods: The design of this study is randomized controlled trial. Twenty subjects were cardiology outpatient clinic at Dr Sardjito hospital men and women with chronic heart failure functional class I-II of NYHA age > 60 years and agreed to be included to the study. Subjects were divided into two group randomly, which were the exercise group (10 subjects) and the control group (10 subjects). To compare the functional capacity of both groups, t-test independent is used with condition of normal data range and Mann Whitney test is used if abnormal data range is found. The level of significance was set at p<0,05 with confidence interval 95% Result : Comparison of the mean increase in the six minute walk test distance between aerobic exercise group 107.9 ± 22.153 meters compared with the control group 21.3 ± 16.166 was significantly better in the aerobic exercise group (p <0.001) Conclusion : Aerobic exercise can improve the functional capacity of patients with chronic heart failure in the elderly. Keyword: chronic heart failure, elderly, aerobic exercise, functional capacity.

Correlation of Ferritin Level to The Quality of Life Ariyanto Nugroho; Iri Kuswadi; Bambang Djarwoto
Acta Interna The Journal of Internal Medicine Vol 4, No 2 (2014): The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: Chronic kidney disease is a worldwide health problem. Circumstances that caused the condition of end-stage renal failure causes a decrease in quality of life with a high mortality rate ranging from 22% per year. Many ways to assess the quality of life, form-36 (SF-36) has undergone several revisions refi nement. Serum ferritin continues to be the focus of attention. Nearly half of all hemodialysis patients had serum ferritin > 500 ng/ml. Serum ferritin is a marker of infl ammation that is a good, low levels correlated with iron defi ciency and high levels correlated with infl ammation.Objective: To determine the correlation of high levels of serum ferritin to decline in the quality of life in patients with CRF who had been undergoing hemodialysisMethods: This study was a cross sectional study to determine whether high levels of serum ferritin may have an impact on the decline in the quality of life in patients with chronic renal failure (CRF) who had undergone regular hemodialysis. The study was conducted at Hospital Hemodialysis Unit Dr. Sardjito,Yogyakarta. Result: A total of 61 patients who met the inclusion criteria to undergo research. Score KDQOL-SF in this study, negative correlations (weak) significant in sleep (sleep disorders) 58.79 ± 1.95 (r = -0.306) and (p = 0.017). On the Role Physical scores (physical activity) 24.59 ± 3.21 obtained a negative correlation (weak) signifi cant (r = -0.268) and (p = 0.037). For Emotional Well Being scores (emotional condition) 70.85 ± 1.39 (r = -0.374) and (p = 0.003). On the score of Energy Fatigue (physical fatigue) 62.29 ± 1.61 (r = -0.261) and (p = 0.043).Conclusion: Overall, this study shows the lack of statistically signifi cant results showed a high correlation ferritin directly on quality of life.Keywords: chronic renal failure, hemodialysis, ferritin, KDQOL-SF

The relationship between six minutes walking distance and quality of life in pulmonary tuberculosis sequelae patients Heni Retnowulan; Deddy Nur Wachid Achadiono; Anggraeni Ayu Rengganis
Acta Interna The Journal of Internal Medicine Vol 6, No 2 (2016): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: Tuberculosis is an infectious disease that affects the lung and has high incidence. It could leave sequelae in the patient that has been declared cured. Tuberculosis sequelae results in changes of lung function that could lead to deteriorating of functional capacity and quality of life.Aim: The study aim to determine the relationship between functional capacity (6MWD) and quality of life (SGRQ) within pulmonary tuberculosis sequelae patients.Method: This study used cross sectional design and performed on pulmonary tuberculosis sequelae patient in pulmonary clinic of Dr. Sardjito General Hospital and BP4 Yogyakarta. Functional capacity was assessed with six minutes walking distance and assessment of quality of life using SGRQ questionnaire. Distribution of data was tested using the Shapiro-Wilk statistical test. Spearman correlation test and regression test was used to analyze the correlation between 6-minute walking distance test and assessment of quality of life using the SGRQ questionnaire.Result: The 6 minutes walking distance was 257.02±64.56 m. There were significant negative correlation between 6 minutes walking distance and SGRQ score activity domain (r=-.333, p<0.05). The others domains in SGRQ, there were no significant negative correlation at domain symptoms (r-.062), impacts (-.114), and total (-.135).Conclusion: There were negative correlation between the 6 minutes walking distance (6MWD) and SGRQ score. There was significant negative correlation between 6 minutes walking distance (6MWD) and activity domain in the SGRQ score.Keywords: tuberculosis sequelae, functional capacity, 6MWD, quality of life, SGRQ.

Telomere and telomerase in hematological disorders Focusing on bone marrow failure syndromes and hematological malignancies Mardiah Suci Hardianti; Ibnu Purwanto; Johan Kurnianda
Acta Interna The Journal of Internal Medicine Vol 4, No 2 (2014): The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTWe review the present knowledge of telomeres and telomerase with special attention to their role in hematological disorders especially bone marrow failure syndromes including acquired aplastic anemia and myelodysplastic syndromes, as well as acute and chronic myeloid leukemia. The current understanding on the role of telomere and telomeres dysfunctions in hematological disorders leads us to a better understanding on the pathology of the diseases as well as considering some possibilities to employ the measurement of telomere length and telomere activity in disease prognostication. Several treatment options targeting telomere and telomerase being developed are also reviewed.Keywords: telomere- telomerase- bone marrow failure syndromes- hematological malignancies

Overlap in Patient with Functional Dyspepsia and Unspecified Functional Anorectal Pain Suharjo B Cahyono; Neneng Ratnasari; Siti Nurdjanah
Acta Interna The Journal of Internal Medicine Vol 6, No 2 (2016): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Functional gastrointestinal disorders (FIGD) represent a common and important class of disorders within gastroenterology. FIGD are a cause of great anxiety, distress and morbidity. FIGD disorders maybe manifest as overlapping syndrome. Patients with functional dyspepsia (FD) show frequent overlapping of other gastrointestinal disease, such as functional anorectal pain. These overlap patients have more frequent or more severe symptoms, poor health related quality of life and higher somatization scores, and they are more likely to experience anxiety, depression or insomnia compared to non-overlap patients. These disorders were diagnosed according Rome III criteria and excluded structural diseases. Multimodalities approach should be used during treatment patient with FGID. It was reported a male patient with functional dyspepsia and unspecified functional anorectal pain overlap. Keywords: Functional gastrointestinal disorders, functional dyspepsia, functional anorectal pain

Evaluating Indications and Diagnostic Yield of Colonoscopy in Sardjito General Hospital Suharjo Broto Cahyono; Putut Bayupurnama; Neneng Ratnasari; Catharina Triwikatmani; Fahmi Indrarti; Sutanto Maduseno; Siti Nurdjanah
Acta Interna The Journal of Internal Medicine Vol 4, No 2 (2014): The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: Colonoscopy is the gold standard procedure which is widely used in the diagnosis and treatment of colonic mucosal disorder. Inappropriate colonoscopy indications increase rate of complications.Aim: The main aims of our study were to evaluate indications, fi ndings and diagnostic yield at colonoscopy.Methods: A retrospective study of all colonoscopy was conducted from January 2012 through August 2013, at Dr. Sardjito General Hospital, Yogyakarta and there were 688 colonoscopy reports. Seven colonoscopy indications were documented and presented: rectal bleeding or hematochezia, chronic diarrhea, abdominal pain, constipation, screening and surveillance for colonic neoplasia, change in bowel habit and anemia. Diagnostic yield was defi ned as the ratio between signifi cant fi ndings detected on colonoscopy and the total number of procedures performed for the indication. In our study, diagnostic yield was established by colonoscopy, not confirmed by biopsy.Results: Overall diagnostic yield was 72.53%. The leading indication for colonoscopies was rectal bleeding or hematochezia (36.19%), followed by chronic diarrhea (23.11%), abdominal pain (14.09%), constipation (13.37%), screening and surveillance (5.66%), change in bowel habit (5.52%) and anemia (2.02%). Diagnostic yields according colonoscopies examination were normal (37.14%), colorectal cancer (19.33%), proctitis (14.24%), infl ammatory bowel disease (12.50%), polyps (11.19%),hemorrhoid (10.03%), and diverticel(3.78%). Colorectal cancers were found in patients with hematochezia (74 patients, 29.71%), chronic diarrhea (34 patients, 21.38%), constipation (13 patients, 14.13%). Of 249 patients presenting with hematochezia were found colorectal cancer (74 patients), hemorrhoid (50 patients), proctitis (30 patients), normal (30 patients). Our study showed that diagnostic yield was far lower in patients below 50 years (38.48%) compared > 50 years (61.52%), especially for colorectal cancer (p < 0.001), polyps (p = 0.004) and diverticular (p < 0.001).Conclusions: Hematochezia was the leading indication for colonoscopy and the diagnostic yield was 72.53%. The leading of colonoscopy fi ndings were normal colonoscopies, followed by colorectal cancer, proctitis,infl ammatory bowel disease, polyps and diverticel. Colonoscopy indications should be based on the available guidelines to minimize as much as possible the number inappropriate procedures and complications.Keywords: Colonoscopy, diagnostic yield, colonic indications, appropriateness of colonoscopy

Relationship between Degrees of Dyspnea with Functional Capacity in Pulmonary Tuberculosis Sequelae Patients Deddy Nur Wachid Achadiono; Heni Retnowulan; Eko Nugroho
Acta Interna The Journal of Internal Medicine Vol 6, No 2 (2016): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACT Background: TB disease is still a serious health problem. Due to the changes that occur because of TB infection, appears sequelae in patients with pulmonary tuberculosis. TB sequelae will have an impact on the patient’s life, especially to do with the degree of dyspnea and functional capacity.Objective: To know the relationship between degree of dyspnea with functional capacity in pulmonary tuberculosis sequelae patients.Method: The design of this study is cross-sectional observational study. Subjects were patients with TB who have had at least 6 months of therapy that has been declared cured by leaving sequelae in Dr. Sardjito Hospital and BP4 Yogyakarta in September 2013. The sample was selected based on the selection criteria. Statistical analysis is using One-Way ANOVA.Results: From the 42 patients, there were 78.6% of patients with MRC scale 0, 11.9% of patients with MRC scale 1, and 4.8% respectively of patients with MRC scale 2 and 3. The mean of 6-minute walk test distance is 257.02±64.56 meters. There is a significant relationship on comparison of the mean of 6-minute walk test distance on each MRC scale (p = 0.028).Conclusion: There is a relationship between degrees of dyspnea with functional capacity in pulmonary tuberculosis sequelae patients. Keywords: tuberculosis sequelae, degrees of dyspnea, functional capacity

Correlation of thirst with ejection fraction and plasma sodium level in elderly with chronic heart failure Sri Lestari; I Dewa Putu Pramantara; Hasanah Mumpuni
Acta Interna The Journal of Internal Medicine Vol 4, No 2 (2014): 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/acta interna.16572

ABSTRAKLatar Belakang: Haus merupakan simptom yang umum dan mengganggu bagi pasien gagal jantung.Banyak pasien gagal jantung usia lanjut mengeluh rasa haus berlebihan. Perjalanan alamiah gagal jantung,terapi farmakologi dan non farmakologi dapat meningkatkan rasa haus. Cardiac output yang rendah danpeningkatan aktivasi sistem neurohormonal seperti sistem renin-angiotensin aldosteron akan merangsangpusat haus di hipotalamus. Hubungan antara rasa haus dengan fraksi ejeksi dan kadar natrium plasma padapasien gagal jantung kronis usia lanjut belum diketahui.Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui hubungan antara derajat rasa haus denganfraksi ejeksi dan kadar natrium plasma pada gagal jantung kronis usia lanjut.Metode: Penelitian menggunakan metode potong lintang, dilakukan di Bagian Penyakit Dalam dan BagianKardiologi RSUP Dr. Sardjito Yogyakarta. Subyek penelitian adalah pasien usia lanjut penderita gagal jantungkelas fungsional III-IV sesuai dengan kriteria NYHA, usia ≥60 tahun. Pengukuran rasa haus dilakukandengan menggunakan skor VAS. Pemeriksaan fraksi ejeksi dilakukan dengan ekokardiografi . Karakteristiksubyek penelitian disajikan dalam bentuk rerata dan simpangan baku. Hubungan antara derajat rasa hausdengan fraksi ejeksi dan kadar natrim plasma dianalisis dengan menggunakan uji korelasi Pearson. Nilai p<0.05 dianggap signifi kan.Hasil: Didapatkan 30 subyek sebanyak 63.3% laki-laki dengan median usia 69.5 tahun. Diperoleh rerata rasahaus 63.67±17.5 mm dan rerata fraksi ejeksi sebesar 41.93±15.5%. Rerata hasil pemeriksaan kadar natriumadalah 139.7±4.1 mmol/l sedangkan rerata osmolalitas plasma 296.4±10.1 mOsm/kg.Kesimpulan: Pada uji korelasi Pearson didapatkan korelasi antara rasa haus dengan fraksi ejeksi adalahkorelasi negatif lemah namun tidak signifi kan secara statistic (r=-0.314, p=0.091). Tidak didapatkan korelasiantara rasa haus dengan kadar natrium plasma (r=-0.04 p=0.833).Kata kunci: usia lanjut, rasa haus, gagal jantung kronis, fraksi ejeksi, natrium plasmaABSTRACTBackground: Thirst is a common symptom that disturbs patient with heart failure. Many elderly patients withheart failure get severe thirst. Natural history of heart failure, pharmacological and non-pharmacological therapiescould increase the thirst level. Low cardiac output and activation of neuro-hormonal system e.g. renin angiotensinaldosteronesystem, would stimulate the thirst center in hypothalamus. Correlations of thirst with ejection fractionand plasma sodium level in elderly with chronic heart failure have not been known yet.Aims: The aims of this study are to investigate the correlations of thirst with ejection fraction and plasmasodium level in elderly with chronic heart failure. Cross sectional design has been conducted on elderly patients(age of ≥60 years) with heart failure of functional class of III-IV (based on NYHA criteria) in Departmentof Internal Medicine and Department of Cardiology, Dr. Sardjito General Hospital, Yogyakarta.Method: Measurement of thirst was done using VAS score, while the investigation of ejection fraction wasperformed using echocardiography. Characteristics of subjects were presented in the average and standarddeviation values. Correlations between thirst with ejection fraction and plasma sodium level were analyzedby using Pearson correlation test with p < 0.05 considered to be signifi cant.Result: There were 30 subjects, 63.3% male, median of age of 69.5 years. The average of thirst value was63.67} 17.5 mm and the ejection fraction was 41.93} 15.5%. The averages of plasma sodium level andplasma osmolality were respectively 139.7} 4.1 mmole/l and 296.4} 10.1 mOsm/kg.Conclusion: Pearson correlation test has revealed a weak negative correlation of thirst and ejection fraction(r= -0.314, p=0.091). On the other hand, there was no correlation between thirst and plasma sodium level(r=-0.04 p=0.833).Keywords: thirst, elderly, chronic heart failure, ejection fraction, plasma sodium level

EFFECT OF NARROW BAND ULTRA VIOLET B (NBUVB) PHOTOTHERAPY TO DECREASE SERUM FERRITIN LEVELS IN URAEMIC PRURITUS PATIENTS WHOSE UNDERGOING REGULAR HEMODIALYSIS IN DR. SARDJITO HOSPITAL YOGYAKARTA Muhammad Himawan Nugroho; Muhammad Robikhul Ikhsan; Iri Kuswadi
Acta Interna The Journal of Internal Medicine Vol 6, No 2 (2016): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground. Uraemic pruritus is the complaint most often found in patients with terminal renal failure (15-49 %) and hemodialysis patients (50-90%). Mikroinflamasi role as ferritin be one cause. Phototherapy NBUVB theoretically can lower serum ferritin, thereby reducing the intensity of pruritus in patients .Objective. The main objective to determine the effect of phototherapy NBUVB to decrease serum ferritin levels of uremic pruritus patients undergoing regular hemodialysis. The next goal NBUVB know the influence of phototherapy to decrease the intensity of itch (VAS).Methods. Quasi experimental with pre-post comparison design, comparing the reduction in serum ferritin levels before and after phototherapy NBUVB, here p < 0.05 is said to be significant.Results. A total of 29 subjects who underwent the study protocol, 18 were male, the average age was 55.7 years, the largest cause of kidney disease is hypertension (48.3%), average 4.2 years old undergoing hemodialysis. There was a decrease which signifkan where median serum ferritin levels before phototherapy 1693 ng/mL (12.05 to 6000) and after phototherapy 275 ng/mL (12.55-6000) with p 0.001. The degree of intensity of pruritus also decreased significantly where the median VAS before phototherapy 7 (4-10) and after phototherapy 4 (2-8) with p 0.001.Conclusions. Phototherapy NBUVB lowering serum ferritin levels and degrees of intensity of pruritus (VAS) of uraemic pruritus in patients undergoing regular hemodialysis.Keywords : CRF (Chronic Renal Failure), Hemodialysis, Uraemia pruritus, Serum Ferritin, Phototherapy NBUVB

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