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INDONESIA
Medical Journal of Indonesia
Published by Universitas Indonesia
ISSN : 08531773     EISSN : 22528083     DOI : 10.13181
Core Subject : Health,
Medicine & Pharmacology
This quarterly medical journal is an official scientific journal of the Faculty of Medicine Universitas Indonesia in collaboration with German-Indonesian Medical Association (DIGM) Indexed in: IMSEAR; CAB Abstracts; Global Health; HINARI; DOAJ; DRJI; Google Scholar; JournalTOCs; Ulrichsweb Global Serial Directory; WorldCat; New Jour; Electronic Journals Library; ISJD Accredited (2013-2018) by DIKTI Kemendikbud Republik Indonesia (No:58/DIKTI/Kep/2013)
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Articles 1,648 Documents
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Assessment of antibiotics use after introducing a hospital formulary by ATC/DDD methodology
Medical Journal of Indonesia Vol. 13 No. 3 (2004): July-September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v13i3.149

Abstract

The objective of this study is to compare the use of antibiotics at the Metropolitan Medical Center Hospital in Jakarta, Indonesia (MMCH), before and after the implementation of a hospital formulary. All antibiotic data under J01 Anatomical Therapeutic Chemical (ATC) classification were collected from pharmacy inpatient and outpatient records. Quantitative antibiotic use was expressed in Defined Daily Doses/100 bed-days (DDDs/hbd) for inpatients and DDDs/1000 patients/day (DDDs/tpd) for outpatients. The general quality of drug use was assessed in number of drugs that account for 90% of the use (DU90%) and the adherence to hospital formulary by substance and brand name within the DU90% segment. Quantitative and qualitative antibiotic use were compared before and after implementation of the formulary (1999 to 2000). The Wilcoxon rank sign test was used to compare overall antibiotic use. Inpatient antibiotic usage decreased significantly by 23.1%, 124.96 DDDs/hbd in 1999 to 96.13 DDDs/hbd during 2000 (p= 0.03) and outpatient antibiotic usage decreased insignificantly by 4.9%, 3.49 DDDs/tpd during 1999 to 3.32 DDDs/tpd during 2000 (p=0.58).The most commonly antibiotic use was ciprofloxacin in inpatient setting during the study and in out-patient setting was amoxicillin in 1999 and ciprofloxacin in 2000. The adherence to the formulary by substance and by brand name in inpatient department was 100% and 90.5% and in outpatient department was 100% and 94.3% during the study. DU 90% by substance name and by brand name was considerably not improved in both settings. The conclusion is that the effectiveness of one year formulary implementation at MMCH was only revealed in inpatient setting. (Med J Indones 2004; 13: 173-9) Keywords: antibiotic use, hospital formulary
The prevalence of orthostatic hypotension and its risk factors among 40 years and above adult population in Indonesia
Medical Journal of Indonesia Vol. 13 No. 3 (2004): July-September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v13i3.150

Abstract

Factors associated with orthostatic hypotension such as age, drug induced hypotension, hypertension and diabetes mellitus have still been debatable. Most of previous studies were conducted in subjects 65 years or older, only a few were done in subjects from younger to older adults. The purpose of this study is to find the prevalence and predictor factors of orthostatic hypotension among adult population aged 40 years and above in Indonesia. This study is a part of Indonesian Hypertension Epidemiologic Survey. A random sample of 4436 subjects aged 40–94 years was obtained from various municipalities in every big island in Indonesia. Orthostatic testing, assesment of history of medical conditions (diabetes mellitus, stroke, and hypertension), blood pressure measurement and use of anti-hypertensive medications were performed. A stepwise logistic regression was used to determine the significant predictor of orthostatic hypotension. A total of 561 persons (12.6%) experienced orthostatic hypotension. Central α2-agonist and other centrally acting drug is the only anti hypertension medicine which influences orthostatic hypotension. Multivariate analysis showed that high systolic and diastolic blood pressures were predictor factors of orthostatic hypotension. The use of anti-hypertensive medicine was a protective factor for orthostatic hypotension. This study confirms the conclusion that age is not a predictor factor for orthostatic hypotension. In fact, the existence of comorbidities in the subjects such as hypertension (high systolic and diastolic blood pressure) is a predictor factor, while the use of anti-hypertensive medication is a protective factor. (Med J Indones 2004; 13: 180-9) Keywords: adult, orthostatic hypotension, prevalence, risk factor
Genetic variation among dengue virus that possibly correlate with pathogenesis
Medical Journal of Indonesia Vol. 13 No. 3 (2004): July-September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v13i3.151

Abstract

Dengue disease are reemerging disease and major health concern in tropical and subtropical regions because of the increasing number of patients, expanding endemic areas and increased occurrence of severe clinical manifestation (DHF/DSS) in the last two decades. Despite extensive studies, it is not fully elucidated mechanism by which dengue infection progress to DHF/DSS. Information obtained so far indicates that both host-related factor and virus virulence are involved. Recent studies have shown several structural differences of dengue virus genome between those associated with DF only and those with the potential to cause DHF. That genome differences might be correlated with pathogenesis. (Med J Indones 2004; 13: 190-4) Keywords: dengue virus, virulence factor, pathogenesis
Immunophenotyping in leukemia and its diagnostic significance
Medical Journal of Indonesia Vol. 13 No. 3 (2004): July-September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v13i3.152

Abstract

The identification of cell surface markers, defined as clusters of differentiation antigens (CD’s) could be used to classify and sub-classify leukemia. Although the same antigens are expressed on normal cells, the phenotype on malignant cells are aberrantly and frequently asynchronously expressed and may be present in combinations not observed in normal blood or bone marrow. Aberrant expression of surface antigens corresponds with poor therapeutic response and short survival. Additional surface marker analysis complementary to morphologic evaluation and cytochemical staining has greatly improved our ability to characterize hematologic malignancies. A review and illustration on the diagnostic significance of immunophenotyping in leukemia will be presented. Data from 225 patients having complete assessments including morphology, cytochemistry and immunophenotyping in the period of 1994-2001 were collected and analyzed. Based on morphologic evaluation and cytochemistry, the diagnosis of acute myeloid leukemia and acute lymphoblastic leukemia were established in 51.1% and 48.9% of cases, respectively. Based on immunophenotyping AML was found in 49.0% of the cases. ALL could be classified into 4.9% pre-B-ALL, 18.7% B-ALL, and 14.7% T-ALL. Cases expressing cross-lineage antigens were found in 12.7%. The prognostic significance of these aberrant expression of antigens for those cases has yet to be established but some of the cases responded poorly to therapy. Immunophenotyping provides the tool to: 1) distinguish normal from clonal populations of leukemic cells; 2) define lineage and reveal the stage of maturation; 3) identify inappropriate expression of lineage associated antigens; 4) provides more informations to establish diagnosis and prognosis compared to standard methods. (Med J Indones 2004; 13: 195-202) Keywords: Immunophenotyping, clusters of differentiation antigens, lineage associated antigens
Single nucleotide polymorphisms of follicle-stimulating hormone receptor promoter and their impacts to the promoter activities
Medical Journal of Indonesia Vol. 13 No. 4 (2004): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v13i4.153

Abstract

Women of reproductive ages are varies in their responses to exogenous FSH stimulations. The difference of FSHR genotype due to the polymorphisms in exon 10 is one of its significant factors. To know further whether the core promoter of FSHR is also polymorphic and to know whether those polymorphisms influence the promoter activity, we did polymorphism screening of FSHR promoter to 262 women undergoing IVF/ICSI, followed by functional study to know the impact of polymorphisms to the promoter activity. This study indicated that the core promoter of human FSHR is polymorphic. We found five SNPs at positions –29, –37, –114, –123 and –138 in addition to the variety number of adenines. Polymorphism at position –123 significantly decreased the promoter activity, in contrast, polymorphism at position –37 and –138 significantly increased the promoter activity, whereas polymorphism at position –29, –114 and short adenines stretch did not significantly influence the promoter activity. The differences of the promoter activities due to polymorphisms might change the ovarian sensitivity to FSH. (Med J Indones 2004; 13: 205-14)
The association of CAG repeat length polymorphisms of androgen receptor gene and spermatogenesis impairment in several Indonesian men
Medical Journal of Indonesia Vol. 13 No. 4 (2004): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v13i4.154

Abstract

Spermatogenesis impairment is the main cause of infertility in men. Androgen is believed to play a critical role in regulating spermatogenesis. Androgen acts by binding to the androgen receptor (AR) which is a protein regulator of DNA transcription. Exon 1 of AR gene contains a CAG repeat length polymorphism and it is believed to interfere AR function. This study includes DNA isolation from peripheral blood and amplification of CAG repeat fragments by PCR method. CAG repeat lengths were determined by electrophoresis on 6% denaturing gel polyacrylamide. We found that the mean CAG repeat lengths were 24,3 ± 3,4 in oligozoospermic/azoospermic men and 22,7 ± 2,7 in normozoospermic men. The difference in CAG repeat length between the two groups was statistically significant (p = 0,031, t-test). Nevertheless, there was no correlation between CAG repeat lengths and sperms concentration (rs = -0,038; p = 0,775). This result suggest that the expansion of CAG repeat length was not the main cause of spermatogenesis impairment. (Med J Indones 2004; 13: 215-20)
Coronary to pulmonary fistula as the primary source of pulmonary blood supply in pulmonary atresia with ventricular septal defect
Medical Journal of Indonesia Vol. 13 No. 4 (2004): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v13i4.155

Abstract

A communication between the coronary and pulmonary arteries, so called coronary to pulmonary fistula, is a rare source of pulmonary supply in pulmonary atresia (PA) with ventricular septal defect (VSD). A 4 year old girl referred to National Cardiovascular Center Harapan Kita, Jakarta with symptoms and signs of increased pulmonary blood flow since infancy and was confirmed by the chest x-rays. Heart examination revealed normal first heart sound with single loud second heart sound and an ejection systolic murmur at the pulmonary area. ECG demonstrated sinus rhythm with normal axis and biventricular hypertrophy. Echocardiography was performed and truncus arteriosus (TA) type I was suspected with perimembranus VSD, overriding of the aorta, and dilated main pulmonary artery. But on cardiac catheterization studies, a non obstructive fistula was found between the left coronary and main pulmonary artery coexisted with PA and VSD. A successful surgery was performed subsequently and confirmed the above diagnosis. Although there were episodes of pulmonary hypertension crisis during early post operative course, she was then discharge from the hospital in a good condition. Since irreversible pulmonary vascular disease may develop in a non restrictive coronary to pulmonary fistula, early recognition of this anomaly is very important for better surgical result. (Med J Indones 2004; 13: 237-40)
Clinical manifestation of HIV/AIDS patients: differences between public and private hospitals in Jakarta
Medical Journal of Indonesia Vol. 13 No. 4 (2004): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v13i4.156

Abstract

The aims of this study is to determine the demographic data, risk factors, clinical presentations, opportunistic/co-infections and its difference between public and private hospitals. A retrospective -descriptive study was conducted in Dr. Cipto Mangunkusumo National General Hospital (public hospital) and Medistra Hospital (private hospital), Jakarta. The inclusion criteria were new HIV/AIDS cases admitted in year 2002-2003 and positive HIV serology (Elisa method). Secondary data were collected form medical record. Sixty-six subjects were enrolled in this study (public hospital 30 subjects and private hospital 36 subjects), consist of 59 male (89.4%) and 7 female (10.6%). Thirty-seven percent subjects were defined as HIV and 62% AIDS. Risk factors obtained include drug user (59.1%), homosexual (13.6%), heterosexual (21.1%), transfusion (1.5%) and maternal-child (perinatal) (1.5%). The clinical symptoms mainly present as acute fever (56.2%), weight loss (39.4%), cough (38.8%), shortness of breath (27.2%), chronic diarrhea (22.8%), prolong fever (19.7%), loss of conciousness (15.3%), anorexia (15.3%). Significant differences between public and private hospitals were seen in fever and cough symptoms. Clinical presentation of HIV/AIDS patients during admission were : pneumonia (56%), oral trush (22.6%), anemia (56.5%), leucopenia (32.3%), lymphopenia (55.9%), elevated AST/ALT (66.1%), hypoalbuminemia (46.9%), limphadenopathy (10.6%), brain space occuping lesion (7.6%), encephalopathy (6.0%), pulmonary tb and pleural effusion (10.6%). The opportunistic and co-infections present were candidiasis (25.8%), chronic hepatitis C (24.2%), chronic hepatitis B and C (4.5%), pulmonary tb, lymphadenitis and miliary tb. Candidiasis and pulmonary tb were frequently found in public hospital. In conclusion from this study that clinical manifestation of HIV/AIDS were young man or woman, with one or more possible risk factor, had fever, respiratory complain, loss of body weight, chronic diarrhea, fatique, oral trush, anemia, leucopenia, lymphopenia. Patients admitted in private hospital had varied complain; and patients that admitted in public hospital had more severe and advance condition. (Med J Indones 2004; 13: 232-6)
Use of anti-citrullinated peptide (Anti–CCP) antibodies in distinguishing patients with systemic lupus erythematosus and rheumatoid arthritis
Medical Journal of Indonesia Vol. 13 No. 4 (2004): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v13i4.157

Abstract

Diagnosis of Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) can be confused in their initial stages. The joints, especially the hands, are commonly affected in both disorders, many patients with SLE are initially misdiagnosed as having RA Given that the outcome for the two diseases is diverse, it would be helpful to have serological marker to distinguish between them at onset. Anti-citrullinated peptide antibodies (anti-CCP) have recently been described as highly specific for RA. The objective of this study is to confirm the specificity of anti-CCP antibodies and to determine whether they might distinguish patients with RA from those with SLE. This study is a cross sectional study on a group of patients with RA (n=27), SLE with arthritis (n=20), other autoimmune diseases (non-rheumatic diseases, n = 8), and healthy adults (n=20). Anti-CCP was determined by a commercial Elisa test and Rheumatoid factor (RF) was determined by the standard slide latex test. The sensitivity and specificity of anti-CCP for the diagnosis of RA was 63.0% and 97.9% respectively, comparing with RF for RA that was 40.7 % and 85.4 %. Only 1 healthy adult was anti-CCP+, no anti-CCP was detected from SLE and other autoimmune disease. The mean of titer anti CCP in normal healthy adult, other autoimmune diseases, SLE and RA was 1.35 ± 2.04, 0.63 ± 0.59, 0.75 ± 0.59, and 38.17 ± 44.22 RU/ml, respectively. There was a highly significant difference between the mean of titer anti CCP for RA with others diseases (p <0.001). We conclude that detection of anti-CCP is very useful for the diagnosis of RA and distinguishing RA from SLE. (Med J Indones 2004; 13: 227-31)
Using homeopathica drugs combination at peripartal phase in preventing bovine subclinical mastitis
Medical Journal of Indonesia Vol. 13 No. 4 (2004): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v13i4.158

Abstract

A total of 33 dairy lactating cows suffering from subclinical mastitis were classified into group A (10 cows), group B (12 cows) and group C (11 cows). They were treated with the combination of homeopathic drugs and placebo, applied at the 4th and 3rd week antepartum (a.p), and continuing every week postpartum (p.p), for four times. Group A received Coenzyme comp® (in the 4th and 3rd week a.p), Lachesis comp® combined with Traumeel®(1st and 2nd week p.p) and Coenzyme comp® combined with Carduus comp® (3rd and 4th week p.p). Group B received Traumeel®+ Mucosa comp® (4th and 3rd week a.p), Lachesis comp®+ Traumeel® (1st and 2nd week p.p) and Coenzyme comp®+ Carduus comp® (3rd and 4th week p.p) and group C as a placebo. The incidence of subclinical mastitis in group A and C appeared irregular. In contrast, group B showed a constant percentage (33.3%). Group A and B showed significant response to the homeopathic drugs, expressed as an increasing of the somatic cell count value. At peripartal phase, haptoglobin increased in group B 0.80 mg/ml and group A as well as placebo 1.40 mg/ml. After calving, group B expressed a constant value (0.05 mg/ml), while group A and placebo rose significantly. The milk yield in normal lactation period (the 3rd - 7th month) increased significantly, with an increasing 14.1% for group B and 4.9% A respectively. (Med J Indones 2004; 13: 221-6)

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