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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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Apoptosis In Sepsis Rizka Humardewayanti
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

INTRODUCTION The word sepsis is derived from the Greek term for rotten or “to make putrid”. Sepsis, defined as the systemic host response to microorganisms in previously sterile tissues, is a syndrome related to severe infections and is characterized by end-organ dysfunction away from the primary site of infection. To meet the definition of sepsis, patients need to satisfy at least two of the Systemic Inflammatory Response Syndrome (SIRS) criteria in association with having a suspected or confirmed infection. The severity and mortality increase when this condition is complicated by predefined organ dysfunction (severe sepsis) and cardiovascular collapse (septic shock). The normal host response to infection is complex, aiming to both identify and control pathogen invasion and start immediate tissue repair. Both the cellular and humoral immune systems are activated, giving rise to anti-inflammatory and proinflammatory responses. Exacerbating these mechanisms can cause a chain of events that leads to sepsis, promoting massive liberation of mediators and the progression of multiple organ dysfunction1.Sepsis remains a critical problem with significant morbidity and mortality even in the modern era of critical care management. Despite intense efforts, sepsis remains a serious clinical problem and still associated with a high mortality rate. Septic shock and sequential multiple organ failure/dysfunction syndrome (MOF/MODS) correlate with poor outcome, and septic shock is the most common cause of death in intensive care units. A recent review by Angus et al estimated the 1995 incidence of sepsis in the United States to be 751,000 cases, resulting in 215,000 deaths. The average cost per case of sepsis was $22,100 with total costs of $16.7 billion nationally. A more recent analysis of hospital records indicates that the total number of patients who are dying is actually increasing. This study also confirmed the work of Angus et al that the incidence of sepsis is increasing and projected to continue to grow as the population ages. These studies concluded that “severe sepsis is a common, expensive, and frequently fatal condition, with as many deaths annually as those from acute myocardial infarction2,3.The immunological cascade resulting in the sepsis response can be initiated by tissue injury, ischemia reperfusion injury, gram-positive organisms, and fungi as well as gram-negative organisms and their constituent endotoxin. The sepsis response may begin with an infectious nidus, which may either invade the bloodstream, leading to dissemination and positive blood cultures, or proliferate locally and release various microbial products into the bloodstream3.Multiple derangements exist in sepsis involving several different organs and systems, although controversies exist over their individual contribution to the disease process. Septic patients have substantial, life-threatening alterations in their coagulation system. Previously, it was believed that sepsis merely represented an exaggerated, hyperinflammatory response with patients dying from inflammation-induced organ injury. More recent data indicate that substantial heterogeneity exists in septic patients’ inflammatory response, with some appearing immuno-stimulated, whereas others appear suppressed. Cellular changes continue the theme of heterogeneity. Some cells work too well such as neutrophils that remain activated for an extended time. Other cellular changes become accelerated in a detrimental fashion including lymphocyte apoptosis2.The role that apoptosis plays in sepsis syndromes and in the development of CARS and MODS has not been adequately explored, but there is rapidly developing evidence to suggest that increased apoptotic processes may play a determining role in the outcome to sepsis syndromes. In particular, increased apoptosis, particularly in lymphoid tissues and potentially in some parenchymal tissues from solid organs, may contribute to the sepsis-associated MODS3

Relationship between plasma fi brinogen levels with model of end stage liver disease score in patients with liver cirrhosis Moch. Abdul Nasir; Neneng Ratnasari; Putut Bayupurnama
Acta Interna The Journal of Internal Medicine Vol 3, No 2 (2013): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTIntroduction. One of the complications which often occur in the liver cirrhosis is bleeding. Closely associated with weighing of bleeding were disturbance haemostatic homeostasis disorders that commonly associated with impaired liver function. Therefore certain biomarkers are needed to objectively measure the severity of liver cirrhosis. Fibrinogen is one of the clotting factors that can be used to determine the severity of liver cirrhosis.The model of end-stage liver disease (MELD) score is most excellent alternative of the Child-Pugh score. It can be used in patients with liver cirrhosis spacious ranges severity of disease and etiology even in patients whose cirrhosis etiology are not clear. Currently, there was not any data showing the correlation between the level of plasmatic fi brinogen and MELD score in patients with liver cirrhosis. Aims. This study aimed to determine the correlation between level of plasmatic fi brinogen and MELD score in patients with liver cirrhosis.Method. This study was cross-sectionally conducted used consecutive sampling. Study population were eligible patients with liver cirrhosis who visited outpatient and inpatient clinic in the Division of Gastroentero-hepatology, Dr. Sardjito general hospital, between November 2011 to October 2012. Correlation between the level of plasmatic fibrinogen and MELD score was statistically assessed using correlation test with fi nal result stated as correlation coefficient (r).Result. There were 40 subjects that met criteria, 28 male and 12 female, with average age of 53 ± 12,51 years. Etiology of cirrhosis was viral hepatitis B in 16 (40,0%) subjects, hepatitis C in 11 (27,5%) subjects and non viral in 13 (32,5%) subjects. Subjects with ascites were 19 (47, 5%) and without ascites were 20 (52.5%). Bleeding was experienced by 30 (80.0%) subjects while 10 (20,0%) subjects did not present with bleeding. Mean of plasma fibrinogen was 198 ± 102, 89 mg/dl, and mean of the MELD score was 17,05 ± 8.79. Spearman correlation coefficients between fi brinogen and MELD score was r = -0,404 (p = 0,010).Conclusion. There was a negative correlation between plasma fi brinogen and the MELD score in liver cirrhosis patients visiting our local setting.Keywords: liver cirrhosis, fi brinogen, MELD score

Effects of latihan pasrah diri in quality of life in chronic kidney disease-dialysis patients with depression symptoms Widyaningrum Widyaningrum; Agus Siswanto; Bambang Djarwoto
Acta Interna The Journal of Internal Medicine Vol 3, No 2 (2013): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: Patients with chronic kidney disease (CKD) suffering from various physical and emotional symptoms show depression and disturbance in quality of life. Patients with chronic kidney disease have a decreased quality of life, and mortality rate about 22% in every year. Depression in patients with CKD must be managed properly because a large effect on HRQOL (Health Related Quality of Life) and the potential side effects on the management of patients with CKD. Latihan pasrah diri (LPD) is a method combining relaxation and remembrance with a focus on breathing exercises and words contained in the dhikr (relaxation and repetitive prayer). The rise of the relaxation response is expected to improve the symptoms of stress or depressive symptoms, which is expected to improve HRQOL.Objective: This study aimed to determine the effect of LPD on quality of life in hemodialysis patients with depressive symptoms that was compared with controls.Methods: The research constituted the study of Randomized Control Trial. The research was measured the KDQOL-SF scores (Kidney Disease Quality of Life-SF) in subjects with LPD treatment during 21 days, compared with controls. The research was conducted at the Hemodialysis Unit of Dr. Sardjito Hospital, Yogyakarta, from May to June 2012. A total of 36 patients who met the inclusion criteria were randomized and divided into LPD group (n = 18) and control group (n = 18).Results: Found a statistically signifi cant decrease in BDI scores in both groups, 23.00 ± 5.34 to 15.00 ± 8.55 (p = 0.001) in the LPD group and 23.00 ± 5.34 to18.33 ± 6, 66 (p = 0.022) in the control group. KDQOL-SF scores after treatment when compared between the LPD and control groups experienced different changes were statistically signifi cant in domains effects of kidney disease 59.65 ±23.52 compared to 39.41 ± 20.03 (p = 0.022), sleep 69 ± 13.17 compared to 46.53. (p = 0.000), overall health 73.89 ± 16.85 compared to 57.22 ± 19.04 (p = 0.009), pain 64.86 ± 20.80 compared to 42.36 ± 24.90 (p = 0.005), general health 53.88 ±16.05 compared to 47.78 ± 20.74 (p = 0.014), and the physical component scale 35.98 ± 6, 83 compared to 29.12 ± 6.46 (p = 0.004). Despite increased KDQOL-SF domain scores, but there were 2 domains that Δ KDQOL-SF score changes were statistically signifi cantly different compared with the control group, which was the domain of sleep and overall health.Conclusion: Latihan pasrah diri twice a day during 21 days (3 weeks) can improved the quality of life of patients with symptoms depression in CKD patients undergoing hemodialysis in domains of sleep and overall health.Keywords: CKD, depression, latihan pasrah diri, KDQOL-SF.

The effects of albumin concentration to outcome of acute respiratory distress syndrome (ARDS) patients in intensive care unit RSUP Dr. Sardjito Yogyakarta Novia Etty Parmawati
Acta Interna The Journal of Internal Medicine Vol 3, No 2 (2013): 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/acta interna.5001

ABSTRACTBackground: Hipoproteinemia mostly happened in critically ill patients, including ARDS, and usually comes toworst clinical appearance. Early ARDS is characterized by a rising of the permeability in the alveolar-capillarybarrier, leading to an infl ux of fl uid into the alveoli, and albumin also has a major role to control the osmolatoryof plasma.Aim: The aim of the study was to know about the effect of the albumin concentration to outcome (survivor/nonsurvivor) of the ARDS patient in the Intensive Care Unit (ICU) RSUP Dr. Sardjito.Methods: This study used cross-sectional method. The samples of this study were the patients at the ICU RSUPDr. Sardjito Yogyakarta, from January 2009 until December 2011. The diagnosed of ARDS based on EACCcriteria. The inclusion criteria were people with age ≥ 18 years old, fulfi ll diagnostic criteria of ARDS, and treatedin ICU. The demography, laboratory result, and curing process, have been tested statistically in SPSS 17. Thevariable was analyzed by chi-square and Mann-Whitney test, signifi cantly considered if p < 0,05.Results: The samples who fulfi ll these criteria were 61 patients. Mostly women (54,1%) with 49 years-old rangeand the result were 34 patients (55,7%) died. The biggest cause of ARDS was pneumonia (60,7 %) and thebiggest Comorbid was malignant (21,6%). The mortality rate of ARDS was 5,75%. The result of univariat analysiswas the increased of transaminase enzyme (p 0,007), COPD Co morbid (p 0, 02) and length of stay in the ICU (p= 0,021) which was signifi cantly given effect to the outcome of the patients. The survivors have higher albuminconcentration (2, 6) than in non survivors (2, 4), although not statistically signifi cant (p = 0,621).Conclusion:The albumin concentration did not have a statistically signifi cant effect to the outcome of the ARDSpatient in ICU RSUP Dr. Sardjito Yogyakarta. The main factor was the increase of transaminase enzyme, Comorbid COPD, and length of stay in the ICU.Keywords: ARDS, albumin concentration, ICU

Impact of irrational antibiotic therapy to hospital cost of care of pneumonia in patients in Dr. Sardjito Hospital Edi Sutrisno
Acta Interna The Journal of Internal Medicine Vol 3, No 2 (2013): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: The mortality rate from pneumonia remains very high, reaching 15% in the United States while inIndonesia pneumonia is the second leading cause of death. Antibiotics improve outcomes in those with bacterialpneumonia. Irrational antibiotic therapy impacts to bacteria resistance, potentially increasing side effects of drugs,prolonged patient’s length of stay and higher total hospital costs.Aim: This study aimed to improve the service quality by calculating the percentage of irrational antibiotic therapybased on Gyssens workfl ow and the additional total of consumables antibiotics costs.Methods: The study design was retrospective, including 57 pneumonia inpatients in internal medicine departmentwards in Dr. Sardjito Hospital, from November 2011 to January 2012. Statistical analyses were conducted byusing Mann-Whitney U test.Results: From 57 pneumonia inpatients, irrational antibiotic therapy reached 68,4% (39 of 57 patients).Azithromycin was misused and overused antibiotic. Total excess cost of daily antibiotic were Rp 294,000.00and consumables antibiotics were Rp 215,000.00Conclusion: Irrational antibiotic therapy in pneumonia is associated with and an overall impacts on healthcarecosts.Keywords: irrational antibiotic therapy, health-care cost, and customer satisfaction.

JAK2 mutation and treatment of JAK2 inhibitors in Philadelphia chromosome-negative myeloproliferative neoplasms Susanna Hilda Hutajulu; Johan Kurnianda
Acta Interna The Journal of Internal Medicine Vol 3, No 2 (2013): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTThe Philadelphia chromosome-negative (Ph-negative) myeloproliferative neoplasms (MPNs) polycythaemia vera (PV), essential thombocythaemia (ET) and primary myelofi brosis (PMF) are clonal disorders of multipotent haematopoietic progenitors. The genetic cause of these disorders was not fully defi ned until a somatic activating mutation in the JAK2 non-receptor tyrosine kinase, JAK2V617F, was identifi ed in most patients with PV and a considerable proportion of patients with ET and PMF. The discovery of JAK2 mutation has changed the molecular reclassification of MPNs and served as a genomic target for therapeutic implication. A number of JAK2 inhibitors have been developed and tested for MPNs. Several JAK2 inhibitors have reached the phases of clinical trial and included patients with intermediate-risk or high-risk MF. This population of MF is the best candidate for trials because currently it has no effective therapy besides patients’ poor survival. Considering all clinical data on Ph negative MPNs, JAK2 inhibitors have shown a clinical benefi t and reduced symptoms in the vast majority of MF cases. The most developed among JAK2 inhibitors is Ruxolitinib, which has demonstrated clinical improvement with well tolerated toxicities. However, JAK2 inhibitor was equally active in patients with and without JAK2 mutation. Other JAK2 inhibitors are less developed, but showed a similar clinical benefi t. Furthermore, its effect on the natural course of MPNs in treating patients needs to be investigated.Keywords: myeloproliferative neoplasms – JAK2 mutation – JAK2 inhibitors.

Differences of lung function in elderly patients with and without hypertension in RSUP Dr. Sardjito Yogyakarta Bungsu Wahyu Sutriningsih; Sumardi Sumardi; I Dewa Putu Pramantara
Acta Interna The Journal of Internal Medicine Vol 3, No 2 (2013): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: In the elderly, there is a decrease in lung vital capacity to 68%. The prevalence of hypertension is at the age above 65 years with 13% of the population. The Incidence of lung function decline in chronic heart failure and hypertension was found mainly in the elderly.Aims: The aim of the study was to know the differences ilung function in elderly patients with and without hypertension.Methods: The Study was cross-sectional, a study in November 2012 until January 2013 of the elderly population over 60 years of research with a sample of 58 people (29 people and 29 groups of hypertensive people without hypertension). Inclusion criteria for the study subjects were elderly patients over 60 years of signing the informed consent, can perform spirometry maneuvers correctly. Data were analyzed by T-test to examine some differences in the mean or median, between the two groups.Results: In this research, there were no signifi cant difference in lung function as measured by FVC and FEV1 in the elderly with hypertension and without hypertension (p = 0.984, 95% CI-0, 13-0,139 for FVC and p = 0.83, 95 IK-0, 14-0,116% for FEV1).Conclusion: There is no signifi cant difference in lung function in the elderly with and without hypertension.Keywords: elderly, hypertension, pulmonary function1Speciality

Correlation between Depressive Symptom Score and Geriatric Handgrip Strength at Nursing Home Province of Yogyakarta Ahmad Syahri; Agus Siswanto; I Dewa Putu Pramantara
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): 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/acta interna.5324

ABSTRACTBackground: By the year of 2020, Indonesia’s elderly population will be expected to the fourth highest number in the world after China, India and USA. Special Region of Yogyakarta has the highest percentage that is equal to 13.72%. Depression may increase the risk of mortality, disability and motivation of physical Low grip strength would increase mortality and morbidity in the elderly.Objective: This study aimed to assess the correlation between depressive symptoms and handgrip strength in the elderly population in nursing homes at province of Yogyakarta.Methods: This study was a cross-sectional study that conducted in October 2010 at the nursing home residents. Depression was assessed by the Geriatric Depression Scale Cronbach’s alpha 0.88. Handgrip strength was measured by a handgrip dynamometer. Data of age, education and gender was collected by questionnaire. The study performed statistical tests to assess the correlation of symptoms depression and grip strength.Results: The mean age of subjects was 73.84 ± 8.36 years with 36 subjects (35.3%) were between 60-69 years and 66 subjects (64.7%) were over 70 years. There were 33 men (32.4%) and 69 women (67.6%). MeanGDS score was 12.76 ± 3.22. Handgrip strength in the depression group 16.94 ± 6.96 kg was higher than the non-depressed group 15.23 ± 6.79. There was correlation between severity of depression symptom byhandgrip strength with r = 0.235 (weak correlation) and statistically signifi cant with p = 0.017.Conclusion: The severity of depressive symptom scores was correlated significantly to the handgrip strength in elderly nursing homes in the province of Yogyakarta.Keywords: elderly, nursing homes, depression, handgrip strength.confi dent interval.

The Accuracy of Wells Clinical Model for Predicting Pretest Probability in Deep Vein Thrombosis (DVT) at Dr. Sardjito Hospital Dwi Wulansih; Johan Kurnianda; Kartika Widayati
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: The diagnosis of deep vein thrombosis (DVT) is an important issue in the medical field because a large number of cases are undiagnosed. The accurate diagnosis of the DVT is essential to prevent complications of acute pulmonary embolism and long-term complications. The complication such as pulmonary hypertension and post phlebitis syndrome. It also to avoid improper anticoagulant therapy associated with a high risk of bleeding. There are several models of clinical suspicion of DVT include Hamilton’s score and Wells’ score. The Wells clinical model for predicting pretest probability for DVT has been widely used and tested its validity in several countries in Europe. The accuracy of a Wells clinical model of pretest probability for DVT has not been done for the races of Asia especially in Indonesia.Objective: This study aimed to test the accuracy and precision (sensitivity, specificity and predictive value) of Wells clinical model for predicting pretest probability for diagnose DVT for patients in the Dr. Sardjito Hospital.Methods: This study was a diagnostic study with cross-sectional design. The subjects were patients with DVT symptoms who visited Tulip clinic, outpatient and inpatient in the department of Dr. Sardjito General Hospital during January 2011-May 2012. In this study, a total of 100 patients were participated the Wells clinical model of pretest probability for DVT examination, Doppler ultrasound and D-dimer examination. The negative results on the fi rst ultrasound examination will be examined again 1 week later.Results: DVT was confi rmed in 56 patients (56%) from 100 patients. The baseline characteristics showed the number of women more than men and the mean age was 52.98 ±1.335 years. The 57% of subjects were women and the median age was ≥60 years. The most frequent risk factors of DVT were cancer 49 patients (49%), bed ridden 42 patients (42%) and elderly 33 patients (33%). The accuracy of the Wells clinical model of pretest probability for DVT was 81%, precision was 77.6%, sensitivity was 92.8%, specifi city was 65.9%, and negative predictive value was 87.9%.Conclusion: The Wells clinical model for predicting pretest probability in DVT has a high accuracy, moderate precision, high sensitivity and poor specifi city to diagnose DVT at Dr. Sardjito Hospital.Keywords: deep vein thrombosis/DVT, the Wells clinical model of pretest probability for DVT, accuracy test, precision

Reactivation and Flare of Chronic Hepatitis B: Natural History, Diagnosis, Therapy and Prevention Suharjo Broto Cahyono; Neneng Rasari Neneng Rasari; Putut Bayupurnama; Sutanto Maduseno; Siti Nurdjanah
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTAlmost 30% of the world population has been exposed to hepatitis B virus (HBV) and 400 millionof these are chronically infected. 20–30% of HBsAg carriers may develop reactivation or fl are (acuteexacerbation) of chronic hepatitis B with elevation of biochemical levels, high serum HBV DNA level with orwithout sero-coversion to HBeAg. In countries with intermediate or high endemicity for HBV, compoundedin use cytotoxic or immunosuppressive therapy for the treatment of a wide variety of clinical disease,reactivation or fl are may be the fi rst presentation of HBV infection. Sometime it is diffi cult to differentiatebetween acute hepatitis B and reactivation (fl are). Accurate diagnosis in these cases is very important fordeciding whether to start treatment or not, because acute hepatitis B does not require treatment, whilereactivation or fl are may take benefi t from it. Effort to early detect, to treat and to prevent the reactivationor fl are of chronic hepatitis B is very crucial to reduce morbidity and mortality.Keywords: Reactivation, fl are (acute exacerbation) of chronic hepatitis B, acute hepatitis B, nucleos(t)ideanalogues

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