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<![CDATA[ASOSIASI CARA PEMBERIAN OBAT DENGAN ONSET DAN DERAJAT KLINIS REAKSI HIPERSENSITIFITAS AKUT/ANAFILAKSIS PADA PENDERITA YANG DIRAWAT DI RSUP SANGLAH DENPASAR BALI ]]>
<![CDATA[Eka Imbawan, I GN]]>;
<![CDATA[Suryana, Ketut]]>;
<![CDATA[Suardamana, Ketut]]>
<![CDATA[ journal of internal medicine Vol. 11, No. 3 September 2010 ]]>
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<![CDATA[Acute hypersensitivity reaction/anaphylaxis is a post exposure acute reaction involving dermatologic system/mucosal and subcutaneous tissue; while anaphylaxis is an acute systemic reaction involving two or more organ systems (the skin/mucosa and subcutaneous tissue, respiratory system, cardiovascular system, gastrointestinal system). Drugs as allergens can trigger these reactions orally, parenteral, or topically (contact). Different modes of drug administration are known to relate with onset and degree of the resulting clinical features. We conduct a cross sectional study to determine the association between modes of drugs administration with onset and clinical degree in patients hospitalized at Sanglah General Hospital Denpasar. This study involved 205 patients with acute hypersensitivity reactions/anaphylaxis (105 male and 100 female). Mean age was 33.12 (12 ! 80) years, 131 persons (63.9%) were triggered by drugs, while 57 patients (27.8%) were triggered by food, 13 patients (6.3%) by insect sting, and 3 patients (1.5% ) by other allergens. Of 131 patients with drugs as the trigger, 108 patients (82.4%) were given orally, 22 patients (16.8%) were given parenterally and 1 patient (0.8%) was triggered via contact. The mean onset of an acute hypersensitivity reaction/anaphylaxis triggered by oral and parenteral drugs were 4.2 hours and 0.6 hours respectively (p < 0.01). We conclude that modes of drug administration are associated with the onset of symptoms, but not with the degree of clinical manifestation of acute hypersensitivity reaction/anaphylaxi]]>
<![CDATA[KORELASI ANTARA KONSUMSI ALKOHOL DAN FRACTIONAL URIC ACID CLEARANCE (FUAC) PADA POPULASI SUKU BALI DI DESA PENGLIPURAN, KUBU, BANGLI ]]>
<![CDATA[Rama Putra, I Made]]>;
<![CDATA[Raka Putra, Tjokorda]]>
<![CDATA[ journal of internal medicine Vol. 11, No. 3 September 2010 ]]>
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<![CDATA[Hyperuricemia is a term for serum uric acid (UA) level above normal limit, cause by overproduction or underexcretion.Fractional Uric Acid Clearance (FUAC) can determine both conditions. One of many factors affect to FUAC is alcohol.A cross sectional analytic study perform on Balinesse people in Penglipuran Village, to know correlation between alcoholconsumption and FUAC. We arrange a questionaire with anthropometric data, physical and laboratory examinations, to collectdata on September 2009. Blood and urine examinations perform in Laboratorium Klinik Prodia Denpasar. Data was analyzed bycomputer software, result in charactericstic descriptions, Kolmogorov-Smirnov tests for data normality, Spearman!s correlationto analyze dependent variable and independent variable, and multiple linear analysis, with 95% conÞ dent interval (CI) andsigniÞ cance value p < 0.05.Ninety people fulÞ lled inclusions criteria, consist of 30 (33.3 %) female and 60 (66.7%) male. Mean age was 42.40 ± 13.91years, mean UA serum were 5.19 ± 1.40 mg/dl, with 79 people (88.9 %) normouricemia and 11 people (11.1 %) hyperuricemia.Alcohol consumption prevalence was 47.8%. Mean FUAC were 7.92 ± 2.97%. Spearman!s correlation coeÞ cients (r) were -0.24;p = 0.02 between alcohol consumption and FUAC, while Ancova multivariate result none of variable signiÞ cant to FUAC, butalcohol consumption. In conclusion, there is a signiÞ cant correlation between alcohol consumption and FUAC.]]>
<![CDATA[APLIKASI KLINIS RETIKULOSIT ]]>
<![CDATA[Suega, Ketut]]>
<![CDATA[ journal of internal medicine Vol. 11, No. 3 September 2010 ]]>
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<![CDATA[Reticulocytes are immature nonnucleated erythrocytes that are released from the bone marrow following enucleation ofthe normoblast. Under the in! uence of erythropoietin, committed erythroid progenitor cells divide and differentiate through aseries of stages, giving rise basophilic normoblasts, polychromatophilic normoblasts, and orthochromic normoblastsin sequence.Reticulocytes are similar to mature red blood cells, except that they retain functioning polyribosomes and continue to synthesizehemoglobin. Because the reticulocyte stage of erythroid differentiation only lasts a few days, the number of reticulocytes in theblood is a useful clinical indicator of the rate of erythropoiesis. Reticulocytes exist in the circulation for only 1 ? 2 days and signalthe marrow erythropoietic activity 3 ? 4 days after iron was actively incorporated into haemoglobin. Early changes in reticulocytecount may simply re! ect the release of immature reticulocytes from the marrow rather than the true expansion of erythropoiesis.Reticulocyte counts have once again acquired great interest and importance following the introduction of instruments that usedyes speci" c for RNA. This has resulted in precise and accurate counts even at low reticulocyte concentrations The latestgeneration of automated analyzer provides additional information on reticulocytes, such as the immature reticulocyte fraction(IRF) and other reticulocyt indices, eg, mean reticulocyte volume (MCVr) and mean reticulocyte haemoglobin content (CHr).To date, the most widely studied of the reticulocyte indices is the CHr. The hemoglobin content is considered to be constantthroughout the lifetime of erythrocytes and circulating reticulocytes1 unless structural changes take place that compromise theamount of cytoplasm or cause cellular fragmentation. The normal value for the ! owcytometry method can range from 1% to2% depending on the cut off point used to separate reticulocytes from the normal red blood cell population. Since reticulocyteenumeration provides information about the bone marrow activity and the effectiveness of red blood cell production, it is crucialin the clinical application of reticulocytes parameters to aid the diagnosis of anemic patients, and for monitoring bone marrowtransplantation patients, patients undergoing therapy with marrow toxic drugs, and patients being treated for anemia]]>
<![CDATA[FAKTOR-FAKTOR YANG MEMPENGARUHI TINGKAT KETIDAKPATUHAN PENDERITA TUBERKULOSIS DALAM BEROBAT DI POLIKLINIK DOTS RSUP SANGLAH DENPASAR ]]>
<![CDATA[Bagiada, I Made]]>;
<![CDATA[Putri Primasari, Ni Luh]]>
<![CDATA[ journal of internal medicine Vol. 11, No. 3 September 2010 ]]>
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<![CDATA[Tuberculosis (TB) is a major public health problem in the world, especially in developing countries such as Indonesia. Itremains a major contributor to the global burden of disease and has received considerable attention in recent years, particularlyin developing countries. In our country, there is a little information about factors that can predict the adherence of TB patients.The objective of this study was to know factors contributing in non-adherence TB patients in polyclinic DOTS RSUP SanglahDenpasar. This study was a cross-sectional descriptive study of 15 adult newly diagnosed TB patients. Patients interviewed withquestionnaires consist of demographic and reasons of their non-adherence for TB treatment. About 12 (80%) of TB patients weremale. We didn?t ! nd much different in knowledge, work, educational status, and home distance among TB patients to in" uencethe adherence of the patients. The most important factor in" uencing the adherence of TB patients were drug side effects. Thedrug side effects were gastritis and skin itch (found in 10 and 3 patient respectively). Another reason for non-adherence in TBtreatment were over estimated and cost.Adherence was one of the potential factors to increase cure rate in TB patients. Non- adherence not only decreasing curerate in TB patients, but also as a risk for MDR TB. By determining inhibition factors in the treatment of TB patients, we canimprove the effectiveness of TB treatment.]]>
<![CDATA[SEORANG PENDERITA DENGAN LEUKEMIA MIELOID KRONIK DAN MIELOMA MULTIPEL ]]>
<![CDATA[Suega, Ketut]]>
<![CDATA[ journal of internal medicine Vol. 11, No. 3 September 2010 ]]>
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<![CDATA[Chronic Myeloid Leukemia (CML) and Multiple Myeloma (MM) are two chronic progressive diseases characterizedby neoplastic proliferation of myeloid cell and monoclonal plasma cell. Chronic myeloid leukemia was recognized as a distinctentity, associated with massive splenomegaly and as ! rst malignant disease found to be constitutively associated with spesi! ccytogenetic abnormality the Philadelphia oncogene. Whereas MM is frequently recognized by monoclonal protein productionand either difuse osteoporosis or lytic bone lesion. Clinical manifestation are consequence of marrow in! ltration of plasma cells,production of M protein in blood or urine and immune de! ciency. Coincidence of these two diseases in one particular patient is avery rare occasion. Herewith we reported a woman 42 years old Balinese presented of abdominal enlargement without symptomof bone pain, anemic syndrome. After complete examination supporting by ! nding on bone marrow examination this patient! nally diagnosed of having chronic phase of CML and MM stage IIIB as well. Treatment was given with hydroxy urea andother supported measures and we planned to continue with melphalan and prednisone. There were no clear explanation for thiscondition whether it occur concomitantly or one disease follow with the other. Several reports found that in quite similar occasionMelphalan was the agent of suspected with induced secondary malignancy. Others also found twenty MDS patient togetherwith lymphoid malignancy and plasma cell. Tanaka et.al., noted that a more satisfactory explanation is that both disorders arefrom malignant transformation of a precursor cell capable of differentiating into both lymphoid and myeloid lines. In our casemore likely that CML concomitantly found with MM because there were no previous history of having chemotherapy norradiotherapy.]]>
<![CDATA[PAJANAN OKUPASI DARI PASIEN TERINFEKSI HIV DI RSUP SANGLAH DENPASAR ]]>
<![CDATA[Somia, Agus]]>;
<![CDATA[Utama IM, Susila]]>;
<![CDATA[Parwati Merati, Tuti]]>
<![CDATA[ journal of internal medicine Vol. 11, No. 3 September 2010 ]]>
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<![CDATA[Health care personnel who have occupational exposure to blood and some body ! uids or tissues are at risk for HIVinfection. Aim of this study to know about characteristics of occupational exposure to HIV who cares in VCT-CST OutpatientClinic Sanglah Hospital Denpasar. A retrospective descriptive study was done among exposed persons who care in VCT-CSTOutpatient Clinic Sanglah Hospital Denpasar during 1 January 2006 ? 31 December 2007.Total 11 cases occupational exposure occurred in health care places, 9 cases occurrence in Sanglah Hospital and 2 casesoutside Sanglah Hospital. The profession of exposed persons were doctor (45%), medical student (18.2%) and nurse (18.2%).The type of exposure were percutaneous injury (72.7%). Severity of exposures included, 36.4% KP1 (small volume in shorttime), 45.5 % KP2 (large volume and/or long time or percutaneous injury with solid needle, or superfesial laceration), and18.18% KP3 (percutaneous injury with hollow needle, deep injury, visible blood on the device which caused the injury, injurywith needle which had been placed in a source patients artery or vein). HIV-positive class I patients (asymptomatic HIV or alow viral load) was 27.3 % and HIV-positive class II (symptomatic HIV or AIDS, acute seroconversion, or high viral load) was27.3%. about 72% exposed person taken postexposure prophylaxis with combination zidovudine and lamivudine for 4 weeks.Anti HIV status exposed persons at " rst time exposure, 3 month after exposure and 6 month after exposure were negative.We conclude that the most type of exposure were percutaneous with source of exposure each included HIV positive classI dan HIV positive class II. About two third of exposed person taken postexposure prophylaxis with zidovudine and lamivudinecombination. Anti HIV status exposed person a " rst time exposure, 3 month after exposure and 6 month after exposure werenegative.]]>
<![CDATA[PENALAKSANAAN SINDROMA RENJATAN DENGUE DENGAN EDEMA PARU ]]>
<![CDATA[Somia, Agus]]>;
<![CDATA[Parwati, Tuti]]>
<![CDATA[ journal of internal medicine Vol. 11, No. 3 September 2010 ]]>
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<![CDATA[Dengue Hemorrhagic Fever (DHF) is a systemic disease caused by one of the four types Dengue Viruses. DHF transmittedby a mosquito called Aedes aegyptii. Clinical spectrums of dengue infection widely vary from asymptomatic, undifferentiatedfever, dengue fever, dengue hemorrhagic fever, and dengue shock syndrome grade III and IV. Dengue infections remain on thetop list of infectious disease found in our country and several South-East Asia Nations. Pathognomonic clue differing denguehemorrhagic fever with dengue fever is the presence of plasma leakage due to the increasing of vascular permeability. Dengueshock syndrome is a medical emergency needing direct and correct ß uid resuscitation to deal with hemodynamic disturbance andplasma leakages without causing ß uid overload or further complication. We report an 18 years old male with chief complain offever for 6 days and newly lung edema after 12 hours of admission. Patient diagnosed with 3rd grade of dengue hemorrhagic feverwith lung edema. Patient then undergone ß uid resuscitation with crystalloid and colloid ß uid and given furosemide as diureticagent simultaneously. Finally getting better after Þ ve days of treatment in hospital]]>
<![CDATA[HUBUNGAN ANTARA BEBERAPA PARAMETER ANEMIA DAN LAJU FILTRASI GLOMERULUS PADA PENYAKIT GINJAL KRONIK PRADIALISIS ]]>
<![CDATA[Paramita Ayu, Nyoman]]>;
<![CDATA[Suega, Ketut]]>;
<![CDATA[Raka Widiana, Gede]]>
<![CDATA[ journal of internal medicine Vol. 11, No. 3 September 2010 ]]>
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<![CDATA[Anemia is one of chronic kidney disease (CKD) complication and it affects many organs including cardiovascular. Earlydetection and evaluation are important to prevent more serious complications. There is scarce data with regard about correlationbetween anemia and glomerulus ltration rate (GFR) in pradialysis CKD.Aim of this study is to determine correlation between anemia parameters and GFR, also prevalence of anemia in pradialysisCKD in Sanglah Hospital, Denpasar-Bali. An analytical cross sectional study was carried out in Sanglah Hospital. Samples wereselected through simple random sampling.Eighty samples (58 males and 22 females, aged 54 ± 10 years) were included. Prevalence of anemia, serum iron belowthan 50 ug/dl, transferrin saturation below than 20% and erythropoietin below than 5 mIU/ml was 41.3%, 25%, 20%, and 25%respectively. Using Pearson?s analysis, there were signicant correlation between haemoglobin (r = 0.76, p = 0.00) and serumiron (r = 0.29, p = 0.01) with LFG. Using linier regression entering those variables into model, it found formula haemoglobin= 7.63 + 0.13GFR (R-square = 0.58, p = 0.00) and serum iron = 54.71 + 0.48GFR (R-square = 0.08, p = 0.01). There wassignicant correlation between haemoglobin and serum iron with LFG. Forty one percent pradialysis CKD patients had anemiacomplication.]]>
<![CDATA[HUBUNGAN PENYAKIT GINJAL KRONIS PREDIALISIS DENGAN BEBERAPA PARAMETER PENYAKIT ATEROSKLEROSIS ARTERI KAROTIS ]]>
<![CDATA[Sutarka, Nyoma]]>;
<![CDATA[Suwitra, Ketut]]>;
<![CDATA[Loekman, Jodi S]]>;
<![CDATA[Sudhana, Wayan]]>;
<![CDATA[Kandarini, Yenny]]>;
<![CDATA[Martadiani, Elysanti Dwi]]>;
<![CDATA[Margian, Nyoman]]>
<![CDATA[ journal of internal medicine Vol. 11, No. 3 September 2010 ]]>
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<![CDATA[Carotid artery intima media thickness (cIMT) is valid marker of subclinical atherosclerosis because it gives sign of earlyatherosclerosis process. We conduct this study to know the relationship between predialysis chronic kidney disease (CKD) withseveral parameters of carotid arterial atherosclerosis.A cross sectional study was done in patients with predialysis CKD who came to outpatient Clinic of Nephrology inSanglah General Hospital from May 2009. CKD criteria is based on KDQQI 2003. Estimated Glomerular Filtration Rate (eGFR)was calculated with Cockroft-Gault formula. Measurement of cIMT is done by USG B-Mode with USG Logig-5.There were 30 patients (20 with eGFR < 60 ml/mnt and 10 with eGFR 60 ml/mnt). Mean of cIMT in eGFR < 60ml/mnt: right/left cIMT1 0.24445 ± 0.3096/0.3210 ± 0.4006 mm; IMT2 0.2405 ± 0.3138/0.2825 ± 0.3971 mm; IMT3 0.2315 ±0.3026/0.2820 ± 0.3672 mm; bifurkatio IMT 0.3115 ± 0.4069/0.3515 ± 0.4991 mm; total IMT 0.6350 ± 0.1738/0.6938 ± 0.1912mm. For eGFR > 60 ml/mnt: right/left IMT1 0.1120 ± 0.1722/0.1030 ± 0.1398 mm; IMT2 0.0880 ± 0.1103/0.1130 ± 0.1718mm; IMT3 0.1010 ± 0.1408/0.1170 ± 0.1700 mm; bifurcatio IMT 0.1920 ± 0.3545/0.1980 ± 0.3527 mm, total IMT 0.6250 ±0.1269/0.6750 ± 0.1124 mm. There was signiÞ cant difference in eGFR < 60 ml/mnt the left IMT1 (MD: 0.21 CI95% 0.01 ! 0.42;p = 0.038). Five out of 20 patients with eGFR < 60 ml/mnt and 6 among 10 patients of eGFR 60 ml/mnt were found plaques.There are no signiÞ cant difference of plaque location, plaque width, and lumen diameter between carotid arterial with andwithout plaque. As a conclusion we found there is no signiÞ cant difference between predialysis CKD with several parameters ofcarotid arterial atherosclerosis but cIMT tends to be thicker on predialysis CKD patients with eGFR < 60 ml/mnt.]]>
