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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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CORRELATION BETWEEN CYSTATIN C TO SEVERITY DISEASE OF CIRRHOSIS BASED ON MODEL OF END STAGE LIVER DISEASE SCORE Heribertus Gunadi; Putut Bayupurnama; Siti Nurdjanah
Acta Interna The Journal of Internal Medicine Vol 1, No 2 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: Cirrhosis patients with renal failure are at high risk for death and reduced survival as compared with those without renal failure, and have poor prognosis. Some studies have suggested that cystatin C did more accurate than creatinine /0 detect glomerulusfiltration rate (GFR) in patients with cirrhosis. Model of End Stage Liver Disease (MELD) score can be used in patients with cirrhosis with variously Widely severity disease and etiologies. Until nmv, there is no study about correlation between levels of cystatin C to disease severity in cirrhosis based on MELD score.Objective: This present study was to investigate the correlation between levels of cyst at ill C with disease severity in cirrhosis based on MELD score.Method: Study design was cross sectional s t u d y, This study was conducted at Gastoenterohepatology outpatient clinic and Internal Medicine ward of Dr Sardjito General Hospital, Yogyakarta. Inclusion criteria were patients with cirrhosis diagnosed by clinical criteria, laboratory and USG.findillg, age > 18 years, had complete medical record and obtained informed consent. Exclusion criteria were chronic kidney disease, sepsis, hepatocellutare carcinoma, used high doses of steroid, had thyroid dysfunction. hypertension and diabetes mellitus.Result: The mean of cystatin C based on categorical MELD score were MELD <10 = 0.93±0.19 mgll; MELD IO-19=1.08±0.26 mg/l; MELD 20-29 = 1.25±O.27 mgll; MELD 30-39 = 2.49 mg/l and MELD >40 = 2.43 mgll; 0)=0.013; 95% CI 0.000-0.061). There was a significant correlation between cystatin C to MELD score as demonstrated byp=O.OOOand r=0.485.Conclusion: Our data suggested a significant correlation with medium strength between cystatin C to severity disease of cirrhosis based 011 MELD score. Keywords: cirrhosis, cystatin C, MELD score

CORRELATIONS BETWEEN SERUM LEVEL OF MATRIX METALLOPROTEINASE-9 (MMP-9) AND SERUM LEVEL OF TROPONIN-I IN PATIENT WITH ACUTE CORONARY SYNDROME (ACS) Ruchanihadi Ruchanihadi; Budi Yuli Setianto; Hariadi Hariawan
Acta Interna The Journal of Internal Medicine Vol 1, No 2 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground. The pathophysiology of acute coronary syndromes (ACS) is now accepted as the rupture or erosion of an atherosclerotic plaque, initially occurs at the shoulder of the plaque and is followed by intra-plaque thrombosis then spread to the vascular lumen and cause total partial vascular occlusion. MMP-9 is an extracellular matrix degrading enzyme that plays a crucial role in the breakdown of the fibrous cap of plaque and subsequent rupture in the pathogenesis of ACS. Cardiac troponins are currently the most sensitive and specific biochemical markers of myocytes necrosis.Objective. To know the correlation between serum level MMP-9 and serum level of Troponin-I in patients with ACSMethod. Study design was cross sectional. Data were collected by consecutive sampling from patients in ICCU board of RSUP Dr. Sardjito Yogyakarta, in June 2008-August 2010. A questionnaire was used to collect information from patient. After admission, peripheral venous blood was drawn once and measuring concentration of serum level of MMP-9 and Troponin-I before definitive thrombolysis. Data are expressed as means ± standard deviation (SD). Correlation between serum level of MMP-9 and serum level of Troponin-I were assessed using Spearman’s rank correlations test. A value of p<0.05 was considered statistically significant.Result. There were 139 patients with ACS and comprising 63 patients with STEMI, 27 patients with NSTEMI, and 49 patients with UAP. Means±SD of Troponin-I from all of samples was 9.49±10.47 ng/dL. Mean±SD of MMP-9 from all of samples was 1296.06±729.97 ng/dL. There were significant correlations between MMP-9 and Troponin-I in patients with ACS (r=0.34, p=0.000).Conclusion. There were significant correlations between MMP-9 and Troponin-I in ACS patients in ICCU RSUP Dr. Sardjito Yogyakarta. Keywords: ACS, MMP-9, Troponin-I

CORRELATION BETWEEN MAGNESIUM SERUM LEVELS AND PEAK EXPIRATORY FLOW IN CHRONIC ASTHMA PATIENTS Grendi Faneri Yonarko; Suhardi Darmo Atmojo; Barmawi Hisyam
Acta Interna The Journal of Internal Medicine Vol 1, No 2 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACT Background: Magnesium Serum in some previous studies had been related to asthma events and severity levels. Correlation between magnesium serum levels and severity of asthma was controversies. It might be influenced by race, genetic pattern, diet and demography factor.Objective: The objective of this study was to know relationship between magnesium serum levels and predictive PEF (Peak Expiratory Flow) in chronic asthma patients in Yogyakarta.Method: This was a cross-sectional study; subjects were asthma patients who visited Pulmonology Outpatient Department in Dr. Sardjito General Hospital Yogyakarta, from September 2004 - March 2005. We performed clinical evaluation, magnesium serum levels (normal 0.65 mmol/L-1.04 mmol/L), predictive PEF and medications. Correlation between magnesium serum levels and PEF were analyzed by Pearson correlation test. This study used analysis of variance (anova) to analyze mean difference among more than 2 groups and multiple regressions to know the variables which influenced serum magnesium levels.Result: There were 62 asthma patients in this study. There was no hypomagnesaemia. The mean of magnesium was 0.89 ± 0.08 mmol/L. Results showed that serum magnesium levels and predictive PEF had weak correlation (r= 0.281; p=0.027). There was no significant correlation between admission rate to Emergency Room due to asthma by magnesium levels (r=0.029 p= 0.8).Conclusion: Results showed weak relationship serum magnesium levels and PEF in chronic asthma patients. Keywords: bronchial asthma; serum magnesium levels, Peak Expiratory Flow rate

PROGNOSTIC FACTORS OF LEPTOSPIROSIS PATIENTS IN DR. SARDJITO GENERAL HOSPITAL, YOGYAKARTA, INDONESIA Kurniaatmaja, E.R Kurniaatmaja, E.R; Doni Priambodo; Rizka Humardewayanti; Soebagjo Loeheri
Acta Interna The Journal of Internal Medicine Vol 1, No 2 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

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

THE COGNITIVE FUNCTION OF ANTHRACYCLINE-BASED ADJUVANT CHEMOTHERAPY IN WOMEN WITH BREAST CARCINOMA Sukendro Sendjaja; Ibnu Purwanto; Johan Kurnianda
Acta Interna The Journal of Internal Medicine Vol 1, No 2 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACT Objective. The objective of this study was to determine the changes cognitive function of anthracycline-based adjuvant chemotherapy in women with breast carcinoma.Method. The study design was prospective longitudinal study. The breast cancer patients who received anthracycline-based adjuvant chemotherapy were recruited from internal medicine wards and TULIP outpatient department Dr. Sardjito General Hospital Yogyakarta. Subjects eligible with inclusion and exclusion criteria were examined for cognitive function by mini-mental state examination (MMSE) before chemotherapy (T0), 3 weeks after 2nd adjuvant chemotherapy (T1), 3 weeks after 4th adjuvant chemotherapy (T2), and 3 months after 4th adjuvant chemotherapy (T3). The mean difference of MMSE scores were analyzed with Wilcoxon-signed rank test and P<0.05 was considered statistically significant.Result. There were 47 subjects eligible to study criteria in October 1st 2008 – October 31st 2009. Forty subjects finished this study and were analyzed. The mean age was 47.08±6.65 with age ranged from 27 to 61 years old. The mean MMSE scores before chemotherapy (T0), 3 weeks after 2nd adjuvant chemotherapy (T1), 3 weeks after 4th adjuvant chemotherapy (T2), and 3 months after 4th adjuvant chemotherapy (T3) were 29.28±1.20, 28.60±1.69, 28.18±1.89, and 27.85±2.03, respectively. The mean MMSE score changes (ΔT0-T1), (ΔT0-T2), and (ΔT0-T3) were 0.68±0.80, 1.10±1.06, and 1.43±1.36, respectively and P<0,001. The incidence of cognitive impairment with MMSE scores < 24 was 2.5% and P=1.0.Conclusion. There was a significant decline of MMSE score in women with breast carcinoma who received anthracycline-based adjuvant chemotherapy at 3 weeks after 2nd adjuvant chemotherapy, 3 weeks after 4th adjuvant chemotherapy, and 3 months after 4th adjuvant chemotherapy compared with before chemotherapy. Key Words: Cognitive Function, Breast Cancer, Adjuvant Chemotherapy, Anthracycline

Association between Zinc Serum Level And CD4+ Count In Healthy Elderly Women At AISYIAH Elderly Club Kota Gede Yogyakarta Niko Adhi Husni; Wasilah Rochmah; Suhardi Darmo Atmodjo
Acta Interna The Journal of Internal Medicine Vol 2, No 1 (2012): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTIntroduction. Old ages are associated with physiologic deteriorations of all organs and tissues, such as involution of thymus and decreased function of gastrointestinal tract which lead to malnutrition. Involution of thymus will caused reduction of T cell subset for instance T cell CD4+. Prevalence of nutrient deficiency in old age was high, according to a survey that 35% of subjects with age above 50 years old showed deficiency for one or more vitamins and trace-elements. Zinc as one of trace-elements has vital role for immune system.Aim. Aims of this study are to know the mean of zinc serum level, proportions of zinc deficiency in elderly and correlation between zinc and CD4+ count.Methods and Subjects. Design of this study is cross sectional, with study subjects including healthy elderly women from Aisyiah elderly club at Kota Gede Yogyakarta. Elderly who were eligible with study criteria were measured height, weight, zinc serum level, and CD4+ count. Correlation test was performed to know correlation between ages, weight, body mass index (BMI), and zinc serum level with CD4+ count. Significant variables will be tested with multiple linier regressions. Level of significance is p < 0.05.Results. A total healthy elderly women subjects were 60 persons with median of age 63.5 years old. Median zinc serum level was 5.47 umol/L with range between 3.25- 7.95 umol/L. Zinc deficiency (zinc serum level < 7.65 umol/L) occured in 95% of subjects. Mean of CD4+ count was 767.22±232.95 count/mm3. There were correlations between age, weight, and zinc serum level with CD4+ count (r= -0.296; 0.345; 0.324; 0.792, respectively). Results from linear regression model showed zinc serum level was the only variable that affect to CD4+ count (adjusted R2 = 0.622).Conclusion. Ninety five percent of healthy elderly women at elderly club Aisyiah Kota Gede Yogyakarta suffer from zinc deficiencies, and there is strong correlation between zinc serum level and CD4+ count. Keyword: zinc serum, CD4+ count, elderly

Correlation between the Symptoms of Depression and Sexual Function in Breast Cancer Patients Receiving Chemotherapy Dwi Rohmawati; Agus Siswanto; Johan Kurnianda; Noor Asyiqah Sofia
Acta Interna The Journal of Internal Medicine Vol 2, No 1 (2012): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACT Symptoms of depression and sexual problems that occur among breast cancer patients are a rarely detected and get good handling. Therefore, an early detection for any psychological problems that may affect the sexual life of patients with breast cancer is needed so that the patients can have better life. This study aims to assess the correlation between symptoms of depression and sexual function in women with breast cancer who undergo chemotherapy at Dr. Sardjito Hospital. Research design was cross sectional. The study necquited 38 breast cancer patients in Tulip outpatients Cancer Clinic in Dr. Sardjito Hospital. Assessment of depressive symptoms used Beck Depression Inventory questionnaire and Female Sexual Function Index to assess sexual function. The results showed that the proportion of subjects aged 46-55 years at 55.2% followed by 36-45 years of age at 39.5% and aged 26-35 years by 5.3%. The mean age of subjects was 45.4 + 6.5 years. Correlation between symptoms of depression with sexual function among participants was r=- 0.30 with significance p=0.068. Correlation between symptoms of depression with the domains of sexual function domain of desire (r=-0.296, p=0.072), stimulation (r = -0.470, p = 0.003), lubrication (r=-0.353, p=0.030), orgasm (r=-0.223, p=0.179), satisfaction (r=-0.233, p=0.158), pain (r=-0.186, p=0.262). The conclusion is that there is no correlation between symptoms of depression with sexual function. Keywords: Depression symptoms, Breast Cancer, Sexual Dysfunction

Correlation Between C-Reactive Protein And Left Ventricular Ejection Fraction InN Anterior ST Elevation Myocardial Infarction Rosa Priambodo
Acta Interna The Journal of Internal Medicine Vol 2, No 1 (2012): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

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.

Plasma Angiotensin II Levels In Women With Type 2 Diabetes With Or Without Hypertension Etra Ariadno
Acta Interna The Journal of Internal Medicine Vol 2, No 1 (2012): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

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

Effect of Curcuminoid versus Diclofenac Sodium on Monocytes Secretion of Tumor Necrosis Factor–α in Knee Osteoarthritis Vivin Hudiyanti
Acta Interna The Journal of Internal Medicine Vol 2, No 1 (2012): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground. Tumor Necrosis Factor-α (TNF-α), a pro-inflammatory cytokine produced by monocyte is increased in osteoarthritis synovial fluid. Curcuminoid from Curcuma domestica Val. suppresses the secretion of TNF-α.Objective. The purpose of this study was to investigate the suppression effect of curcuminoid from Curcuma domestica Val on synovial fluid monocyte’s TNF-α secretion compared to diclofenac sodium in knee osteoarthritisMethods. A prospective randomized open end blinded evaluation (PROBE) method was applied. Subjects were patients with knee osteoarthritis visiting Rheumatology Clinic Dr. Sardjito Hospital and Wirosaban Hospital Yogyakarta. Curcuminoid 30 mg three times daily or diclofenac sodium 25 mg three times daily were administered for 4 weeks. The level of TNF-α secreted by synovial fluid’s monocytes were measured by ELISA before and after treatment.Results. A total of 80 subjects were enrolled, 39 subjects on curcuminoid treatment groups and 41 subjects on diclofenac sodium group. Seven subjects were dropped out, 5 from the curcuminoid group and 2 from the diclofenac sodium group. There was a significant decrement of TNF-α level during 4 weeks treatment in both groups (p< 0.001 respectively). There was no significant difference on TNF-α levels between groups (p= 0,237), neither in 50% decrement of TNF-α levels (p= 518).Conclusion. The effect of curcuminoid in decreasing TNF- α level on patients with osteoarthritis is similar with sodium diclofenac. Keywords: osteoarthritis-monocyte-TNF-α-curcuminoid-diclofenac sodium

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