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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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ACETAMINOPHEN AND DIPHENHYDRAMINE AS MEDICATION PRETRANSFUSION THE INCIDENCE OF FEBRILE NON-HAEMOLYTIC TRANSFUSION REACTION PLATELET RECIPIENTS Pudya Lestari Arshanti
Acta Interna The Journal of Internal Medicine Vol 2, No 2 (2012): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

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.

A CROSS SECTIONAL STUDY QUALITY OF LIFE PEOPLE LIVING WITH HIV&AIDS: EMPHASIZE IN ANTHROPOMETRIC VALUE Olivia Cicilia Walewangko
Acta Interna The Journal of Internal Medicine Vol 2, No 2 (2012): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground. The nutritional problem is a significant role factor in determine of health, mortality and quality of life of people with HIV&AIDS. Therefore, it is very important to provide the nutritional assessment, nutritional management, counseling and education which are very useful to upgrade the quality of life of people with HIV&AIDS.Objective. This study was designed to analyze the correlation between anthropometric measurement with quality of life of people with HIV&AIDS.Method. The study design was a cross sectional study. The subjects were HIV&AIDS patients who came to outpatient clinic in Dr. Sardjito General Hospital Yogyakarta, from November 2009 – January 2010. Subjects eligible with inclusion criteria were examined for anthropometric measurement and fill the WHOQOL-bref questioner.Result. There were 53 subjects eligible to the study criteria from November 2009 to January 2010. Majority of the subjects were man (73.6%), single (62.3%) and live alone (58.5%), last education was high school (41.5%) and employed (73.6%). Mean of ages was 33 years old, weight 53.67±10.3kg, height 161.28±7.68cm, BMI 20.57± 3.48 Kg/m2, MUAC 24.40 ± 3.23 cm, waist circumference 76.17 ± 8.10 cm, hip circumference 87.04 ± 8.03 cm , ST 11.17 ± 8.10 mm. Mean score of total WHOQOL-bref was 75.68 ± 10.3, Domain 1 (physics) 21.32 ± 3.07, Domain 2 (psychology) 19.75 ± 3.62 , Domain 3 (social) 10.04 ± 1.87, Domain 4 (environment) 24.75 ± 4.58. There was a very weak correlation between anthropometric measurements with quality of life; with the p value was statistically insignificant.Conclusion. There was no significant correlation between nutritional statuses which is measured by the anthropometric value with the quality of life in people with HIV&AIDS. Keywords: HIV, nutrition, anthropometric, QOL

LEPTIN LEVEL IN NON DIABETIC POPULATION WITH AND WITHOUT NON ALCOHOLIC FATTY LIVER (NAFL) Noor Asyiqah Sofia
Acta Interna The Journal of Internal Medicine Vol 2, No 2 (2012): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

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

CORRELATION BETWEEN CARDIOMEGALY AND PULMONAL DYSFUNCTION IN CHRONIC HEART FAILURE Isbianto Sutedjo
Acta Interna The Journal of Internal Medicine Vol 2, No 2 (2012): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: Cardiac enlargement or cardiomegaly always found in chronic heart failure (CHF). Progressivity of cardiac enlargement relates with pulmonal function changes in CHF. This study examined the influence of increased cardiac enlargement on pulmonal function.Methods: This is a cross sectional study on 63 CHF patient of New York heart Association (NYHA) class I and II that fulfilled inclusion criteria. Definitions of CHF based on Framingham criteria. Cardiac enlargement measured by Danzer’s methods through postero anterior chest radiography. Spirometry used to evaluate FVC and FEV1.Results: Male subjects have an equal proportion (49.21%) with female subjects (50.79%) with mean of CTR 59.47 ± 5.57%. Spirometry test showed mean predicted FVC (%) 61.83 ± 9.62, predicted FEV1 (%) 75.27 ± 12.55, and FEV1/FVC mean ratio 95.53 ± 2.19%. Coefficient correlations between cardiomegaly and FVC (%) and FEV1 (%) predicted are -0.537 (p <0.001) and -0.460 (p <0.001). duration of diseased has a negative correlation with FVC (%) and FEV1 (%) predicted (-0.329; p= 0.008 and -0.341; p=0.006).Conclusions: Cardiomegaly on CHF showed a restriction type and has a negative correlation with pulmonal function. Keywords: cardiomegaly, pulmonal dysfunction, chronic heart failure

ANTI-INFLAMMATORY ACTIVITIES OF TEMULAWAK, GINGER, SOYBEAN AND SHRIMP SHELL EXTRACTS IN COMBINATION COMPARED TO DICLOFENAC SODIUM Nyoman Kertia; Deddy Nur Wachid Akhadiono; Ayu Paramaiswari; Arina Syarifa Fadlilah; Hangga Harinawantara
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

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.

ANEMIA AS RISK FACTOR OF HANDGRIP STRENGTH DECREASED ON ELDERLY IN YOGYAKARTA PROVINCE’S PANTI WERDHA Ganda Hidayat; Johan Kurnianda; I Dewa Putu Pramantara
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Background: According to the WHO, by the end of 20 th century, the more the world population grow, the more the elderly population will be. Yogyakarta province has a 13.72% of Indonesian elderly. The anemia prevalence increased as the age added. Aging process resulted in strength muscle reduced. Handgrip strength test is a valid and consistent as well as simple alternative to value the muscle strength decreased advanced age. Purpose of this study is to know whether anemia is a risk factor against muscle strength decreased measured by handgrip strength test on elderly population in nursing house. Method: This study used cross sectional study design. The study time was in August 2010. The advance ages fullfilling the inclusion and exclusion criteria followed physical examination, routine blood test and handgrip strength measurement. Result: This study involved 118 elderly participants. There was difference of mean handgrip strenght in: age (14.52 kg vs 19.64 kg; p=0.001), gender (13.39 kg vs 22.47 kg; p=0.001), activity level (7.94 kg vs 16.75 kg; p=0.001) and anemia status (13.60 kg vs 17.84 kg; p=0.001); for women even in mild anemia group, there was difference with non anemia group (12.36 kg vs 14.68 kg ; p=0.027). Conclusion: According to multivariable analysis,. There are 3 factors affecting handgrip strength in elderly, namely; Age, activity levels, and anemia which are statistically significant. In this study, it was concluded that anemia is a risk factor of handgrip strength decreased in elderly, for women even in mild anemia, there was statistically significant different with non anemia group. Keywords : Elderly, anemia, handgrip strength

CORRELATION BETWEEN CHILD PUGH SCORE AND CYSTATIN C IN LIVER CIRRHOSIS PATIENTS Deshinta Putri Mulya; Siti Nurdjanah; Neneng Ratnasari
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground. Renal dysfunction is a serious problem and it provides a poor prognosis for patients with advanced liver cirrhosis, where this condition can progress to kidney failure. This condition is known as hepatorenal syndrome. Cystatin C utilization as a marker of decreased kidney function in patients with liver cirrhosis has been widely proven. Data on how far the severity of liver cirrhosis can affect the decline in renal function has not been widely known. Objective. This study aimed is to verify correlation between the severity degree of the liver (Child Pugh/CP score) with levels of Cystatin C serum. Methods. This study was a cross sectional study. Population studied were patients with liver cirrhosis who visited the clinic of Gastroentero-hepatology and treated in the department of Internal Medicine ward Dr. Sardjito Hospital - Yogyakarta during October 2009 - March 2010. Data were analyzed with a computer; the analyzed of the CP score correlation with increased levels of Cystatin C using Spearman correlation for data not normally distributed. Result. We found 48 research subjects during the month of October 2009 - March 2010. The subjects were 35 male (72.9%) and 13 female (27.1%) with average age 53.1 ± 11.9 years old. Subjects with CP-A were 9 patients (18.8%), CP-B were 14 patients (29.2%) and CP-C were 25 patients (52.1%). The range value of Cystatin C between CP class shows CP-A 0.7 - 0.97 mg/L, CP-B 0.7 - 0.49 mg/L, and CP-C 0.7 – 2.49 mg/L (statistically significant difference with p <0.05). Liver cirrhosis patients who had Cystatin C levels <0.96 mg/L were 22 patients (45.83%) and 26 patients (54.1%), had higher levels of Cystatin C> 0.96 mg/L. Child score was positively correlated to increased levels of Cystatin C (p= 0.000; r= 0.566) linear regression equation with Cystatin was = 0.37 + 0.08 * Child score (r square 0.32). Conclusion. This study concluded that the Child score had a moderate positive correlation with Cystatin C serum level. Key words: Liver Cirrhosis – Child Pugh score - Cystatin C

LEVEL OF INTERLEUKIN-6 IN OBESE PEOPLE WITH AND WITHOUT INSULIN RESISTANCE Nedya Safitri; Bambang Sigit Riyanto; H. Ahmad Husain Asdie
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground. Obesity is one of the risk factor for type 2 diabetes mellitus characterized by insulin resistance, decrease insulin secretion and hyperglycemia. Chronic inflammation has been proposed to have an important role in the pathogenesis of obesity related insulin resistance. A number of studies have indicated that several humoral markers of inflammation are elevated in people with obesity and type 2 diabetes mellitus, because adipose tissue secretes a number of proinflammatory cytokines, including interleukin-6. The level of plasma IL-6 is increase in obese people.Objective. To investigate the mean of difference in the level of IL-6 in obese people with and without insulin resistance.Subjects and Method. The study design was cross-sectional. It was conducted in obese people with BMI ≥ 25 kg/m2. Insulin resistance were measured with HOMA-IR methode, calculated using the following formula: fasting serum glucose X fasting plasma insulin/22,5. Insulin resistance was defined when HOMA-IR > 2,77. Interlukin-6 was measured with Quantikine High Sensitivity human IL-6 ELISA. Difference of mean of IL-6 level was analyzed by student’s t-test for normal distribution and Mann- Whitney U-test if distribution was not normal.Results. There were 56 subjects, 24 (42,9%) subjects with insulin resistance and 32 (57,1%) subjects without insulin resistance. Obese people with insulin resistance had higher mean level of IL-6 than obese people without insulin resistance, although the difference was not significant (20,05±8,59 vs 18,98±8,15 pg/ml; p=0,639; 95% CI -5,58-3,46).Conclusion. There was no difference in the mean of IL-6 level in obese people with and without insulin resistance. Keywords. IL-6, obese, insulin resistance

EFFECTS OF LATIHAN PASRAH DIRI ON THE IMPROVEMENT OF DEPRESSIVE SYMPTOMS Muhammad Yusuf Hamra; Sumardi Sumardi; Agus Siswanto; Noor Asyiqah Sofia
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

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

ACUTE PULMONARY EMBOLISMS Kartika Widayati Taroeno Hariadi
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

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.

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