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SEORANG PENDERITA HAMIL DENGAN LEUKEMIA MIELOID AKUT Sukrawan, Gede; Losen Adnyana, Wayan; Suega, Ketut
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Leukemia during pregnancy is extremely rare, the estimate one per100,000 pregnancies each year. Intrauterine growthdisorders have been reported in pregnant women with untreated AML. A pregnant female patient, 28 years old, Balinese, privateemploy came with chief complain fever, sweaty, nausea and vomiting, body weekly, Physical examination: anemic, pale, bloodpressure; 120/80mmHg, pulse 88 x/minute, respiration 20 x/minute, axillary temperature of 36.7 degrees Celsius, heart andlungarenormal, Abdoment: fundus uteri-high processusxipoideus, distention and bowel sounds normal. Laboratory January 14th 2011:leukocyte 63,2 103/ul, Hb 11.7 g/dl, hematocrite 33.6%, MCV 30.7 pg, trombocite 40 103/ul, anatomicalpathology on November26th 2009 with increasing blast dysplasia eritroid series, allowing a leukemia acute. January 16th 2010 chemotherapyAra-C150 mg in 500 ml NaCl 0.9% 24 hours for 7 days and daunorubicine 60 mg IV bolus for 3 days. January 18th 2010 laboratoryresultleukosit 46.2 x 103/ul, Hb 9.2 g/dl, hematocrite 26.3%, MCV 87.4 fl, MCH 30.4 pg and thrombocyte 10 x 103/ul. The patienthad complite remission after chemoterapy and laboratory results on February 12th 2010 were leucocyte 7.02 x 103/ul, Hb 8.6g/dl, hematocrite 25.5%, MCV 74.5 fl, MCH 25.5 and thrombocyte 125 x 103/ul. The baby was born with normal condition withoperation. Acute leukemia in pregnancy should be managed together hematologist, obstetrics-gynaecology and neonatologists.

PREVALENSI DAN HUBUNGAN SINDROM METABOLIK DENGAN PENYAKIT GINJAL KRONIK PADA POPULASI DESA LEGIAN, KUTA BALI Ayu, Paramita; Kandarini, Yenny; Widiana, G Raka; Sudhana, W; Loekman, Jodhi S; Suwitra, K
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Metabolic syndrome may relate to pathogenesis of chronic kidney disease (CKD). There is scarce data with regard to thatphenomenon in Indonesian general population. We conduct a study to determine the prevalence of metabolic syndrome and itsrelationship with CKD individuals in general population of Legian Village, Bali. An analytical cross sectional study was carriedout in the community of Legian Village, a tourist destination in Bali. Samples were selected through simple random sampling.Two hundred and eighty four samples (117 males and 107 females, aged 46.1 ± 10.02 years) were included. Prevalenceof hypertension, hypertrigliseridemia, hypoHDL-cholesterol, central obesity, impaired fasting glucose (IFG), obese and CKDwas 14.1%, 38.4%, 25%, 18%, 11.6%, 51.8% and 11.6% respectively. Using bivariate analysis, there were strong and significantrelationship between hypertension (OR 2.6, 95%CI 1.12 to 6.19, p = 0.02) and IFG (OR 5.21; 95%CI 2.23 to 12.13, p = 0.00) withCKD. Using multivariate logistic regression entering those components of metabolic syndrome into the model, it was consistentlyfound that hypertension and DM is the associated factors for CKD in the population. There was increasing odds of CKD about1,0-fold every augment of metabolic syndrome components (OR 1.098; 95%CI 0.83 to 1.44). As our conclusion, hypertensionand IFG are associated factor for CKD in general population. Multiple components increased risk factor for CKD.

HUBUNGAN HIPERURISEMIA DAN FRACTION URIC ACID CLEARANCE DI DESA TENGANAN PEGRINGSINGAN KARANGASEM BALI Kurniari, Pande Ketut; Kambayana, Gde; Raka Putra, Tjokorda
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Hyperuricemia is a condition of high consentration of uric acid in the blood. In most epidemiology study hyperuricemiais defined as level uric acid more than 7.0 mg/dl in men and more than 6.0 mg/dl in women. Hyperuricemia can be caused byseveral factors. Regarding the etiology hyperuricemia can be classified as primary, secondary and idiopathic hyperuricemia.Primary hyperuricemia related to genetic factor while secondary hyperuricemia caused by condition or other factors besidesgenetic factor such as high purin consumption, chronic kidney disease, certain drugs, alcohol and hypertension. Hyperuricemiacan be caused by inceased of uric acid metabolism (overproduction), decreased of urine uric acid excretion (underexcretion),or mix of both. Fraction Uric Acid Clearance (FUAC) is one of the method used to differentiate either hyperuricemia caused byoverproduction or underexcretion. The aim of this studi is to determine the prevalence of hyperuricemia, means value of FUACand association between hyperuricemia and FUAC in Tenganan Pegringsingan Karangasem region Bali.A cross sectional analytic study was conducted on Balinesse in Tenganan Pegringsingan Karangasem region. Samplestudy was Balinese at age of 13 years old or above, agree to participate by informed consent. Descriptive statistic analysis onnumeric data presented as mean mean ± SD, nominal and ordinal data in proportion. Pearson?s correlation method is used incomparing the correlation between hyperuricemia and FUAC. Of 100 eligible samples, mean age was 37.20 ± 13.59 y.o, 51(51%) men and 49 (49%) women. Youngest age was 13 y.o and oldest was 69 y.o. Mean of blood uric acid level was 5.69 ± 1.43mg/dl. Prevalence of hyperuricemia on this study was 28%, 21% men and 7% women. Means value of FUAC is 6.41 + 1.99%;6.94 + 2.01% in normal uric acid level and 5.04 ± 1.1% in hyperuricemia. There is close correlation between hyperuricemia andFUAC (r = 0.43; p = 0.00)

DEEP VEIN THROMBOSIS SEBAGAI MANIFESTASI SINDROMA PARANEOPLASTIK DARI KANKER PARU Suega, Ketut
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Thrombotic event in patient with cancer is a common feature in contrary to the presentation of thombotic disordersthat part of para neoplastic syndrome as a solely initial symptom of an occult malignancy. The underlying mechanism thatassociating between cancer and thrombosis as well as between cancer and paraneoplastic syndrome is not clearly understoodyet. One of those cancers that frequently associated with paraneoplastic syndrome is lung cancer. We reported a 46 years oldwoman that presents initially because of a swollen left leg and tenderness along the leg. Other examinations within normalfinding including normal chest x ray. In approximately a year later, the patient experiences disturbing cough with blood streak,accompany with shortness of breath. She was also complaining of sharp chest pain especially when taking a deep breath.After several examinations performed such as bronchoscopy with bronchial washing, transthoracal biopsy, sonographic study,echocardiography, chest CT scan, this patient was finally diagnose of having advanced lung malignancy. Histologic finding wascomfirm with adeno carcinoma poorly differentiated. He was treated under 6 concecutive cycles of gemzitabin combined withcarboplatin. Despite completed chemotherapy treatment, she became worst and died because of respiratory failure

INTERLEUKIN 8 BERHUBUNGAN DENGAN DERAJAT GASTRITIS PADA PASIEN TERINFEKSI HELICOBACTER PYLORI Mariadi, IK; Kurniari, PK; Wibawa, IDN; Purwadi, N; Suryadarma, IGA
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Helicobacter pylori infection induces a local pro-inflammatory cytokine response. The secretion of IL-8 by epithelialcells is probably a key factor in host defenses at mucosal sites, permitting a rapid polymorph response against infectious agents.Interleukin-8 is an important chemotactic and activating factor for neutrophils. If defense mechanisms fail and chronic infectionresults, continued up regulation of IL-8 and neutrophil activation could lead to mucosal damage and increased free radicalformation. Mucosal IL-8 production in Helicobacter pylori infection may be an important factor in the immunopathogenesisof gastritis and peptic ulcer disease. This study aim to investigate correlation between IL-8 and severity of gastritis in ourpopulation. We performed a cross-sectional analytic study in Helicobacter pylori infected patients. Severity of gastritis wasdetermined base on The Updated Sydney System. IL-8 level was analyzed from gastric mucosa biopsy using ELISA method.We included 65 samples. 31 (47.7%) men and the rest was women. Base on Kruskalwallis test we found significant associationbetween IL-8 gastric mucosa and severity of gastritis (x2 = 12.8; p = 0.002). We also found significant association between IL-8gastric mucosa and density of H pylori infection (x2 = 10.6; p = 0.01), severity of atrophy (x2 = 9.4; p = 0.02) and neutrophilscount (x2 = 11.0; p = 0.01). But notmethaplasia (x2 = 3.3; p = 0.18). Base on this study we concluded that IL-8 was associatedwith severity of gastritis in Helicobacter pylori infected patients.

PENGARUH PEMBERIAN KOMBINASI ANTI RETRO VIRUS LEBIH AWAL TERHADAP MORTALITAS PADA KO-INFEKSI TB-HIV DI RUMAH SAKIT SANGLAH DENPASAR Utama, Susila
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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TB and HIV are closely interlinked. TB is a leading cause of HIV-related morbidity and mortality. Mortality amongpatients with TB-HIV co-infection is known to be high despite the use of effective TB treatment. Many studies have indicatedthat the initiation of Combination Anti Retro Virus (cARV) during TB treatment improves outcomes. The optimal timing forthe initiation of cARV in patients with TB-HIV co-infections remains unclear. The aims of this study is to know the impact ofearly initiation of cARV during TB treatment on mortality in TB-HIV co-infected patients at Sanglah Hospital Denpasar. Cohortretrospective study was conducted from medical record of TB-HIV co-infected patients from June 2004 until August 2009. Theinclusion criteria was TB-HIV co-infected patients with TB treatment earlier than cARV. The cARV treatment was differentiatedinto 2 category, before 2 months of TB treatment (during intensive phase) and after 2 months (maintenance phase). All of thepatients were followed for mortality after one year of cARV treatment. There were 60 TB-HIV co-infected patients, 50 (83.3%)male and 10 female (16.7%). The CD 4 level less than 50 cell/mm3 were 48 (80%) and CD 4 level more than 50 cell/mm3 were 12(20%). The cARV treatment during intensive phase of TB treatment were 20 (33.3%) and cARV treatment after intensive phasewere 40 (66.7%). Mortality after one year cARV treatment were 28.3%. The mortality on cARV treatment after 2 intensive phasewas 32.5% (13 patients) and mortality on ARV treatment during intensive phase was only 20% (4 patients). The odds ratio was1,926 with confidence interval 0.536 ? 6.926. The mortality on the group of CD 4 level less than 50 cell/mm3 was not different.The mortality on ARV treatment after intensive phase were 34.5% and only 21.1% when cARV during intensive phase. Oddsratio was 1.974 with confidence interval 0.515 ? 7.558. The initiation of cARV during intensive phase of TB treatment on TBHIVco-infected patients will decreased mortality in one year of cARV treatment, but statistically not significance. The sameresult was also found in CD 4 less than 50 cell/mm3.

DISFUNGSI SEKSUAL PADA WANITA PENDERITA DIABETES MELITUS TIPE 2 Ratna Saraswati, Made; Sanjaya Funistera, Surya
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Female Sexual Dysfunction (FSD) has received less attention from doctors, beside very rare complained from patients.This is a contrast situation compare to male with diabetes, for example in general, erectile dysfunction is a common problemreported and decrease patient?s quality of life. A cross sectional study has done, enrolling 97 type 2 diabetes female at outpatientclinic Sanglah Hospital Denpasar. FSD was assessed using FSFI (the female sexual function index) with 19 items of questions.Based on the score of the answer, FSD cathegorized into four categories, including desire disorders, arousal disorder, orgasmicdisorder, and sexual pain disorder. In this study, mean age was 58.8 years (SD 8.9), age range between 34 ? 80 years; and meanduration of diabetes was 8.6 years (SD 8.0), range between 0 ? 30 years. Sexual function index of type 2 diabetes female werelow, arousal domain was the lowest score: 2.13 or 35.5% of maximum 6 score of this domain. Other domains also have low scoreunder 50%, including desire, lubrication, orgasm, and pain: 41.83%, 42.0%, 39.5%, 48.5%, respectively. Only satisfaction hasmore than 50%. There was significant association between each domain. Significant and strong negative association were foundbetween all domain and total score with age, followed by duration of diabetes, and number of children. While obesity, glycemiccontrol, lipid profile were not associated with female sexual function index in type 2 diabetes.

KORELASI ANTARA GERIATRIC NUTRITIONAL RISK INDEX DENGAN LAMA RAWAT PASIEN GERIATRI DI RUMAH SAKIT SANGLAH, DENPASAR Andriyasa, K; Kuswardhani, RA Tuty; Aryana, IGP Suka; Astika, N; Putrawan, IB
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Patients at risk of malnutrition are associated with a poor outcome. There are several tools that we can use to assess thenutritional status. European Society of Parenteral and Enteral Nutrition (ESPEN) guidelines and the French Program NationalNutrition Sante (PNNS) recommend Mini Nutritional Assessment (MNA) to detect the risk of under nutrition among elderlysubjects. The MNA which based on a Questionnaire does not use biological indicators. It is more adapted to the elderly at homeor nursing home setting than hospitalization. We want to evaluate the new tool Geriatric Nutritional Risk Index (GNRI) that moresimple than MNA to assess nutritional status and predict hospitalization outcomes in geriatric patients.This is a cohort study to evaluated correlation between GNRI score with length of stay in elderly patients. We evaluatednutritional status using Geriatric Nutritional Risk Index (GNRI) and Mini Nutritional Assessment (MNA) for elderly patientsthat admitted in Sanglah Hospital (Internal Department, class III) between February 2010 and April 2010. The patients werenutritionally assessed within 48 hours of hospital admission and studied in correlation to length of stay and in-hospital mortality.Fifty complete assessments were available for analysis. There are 32 male (62%) and 18 female (38%) with mean age are67.2 (60 ? 82) years old. GNRI score and MNA correlated inversely with length of stay in elderly patients (r = -0.67; p < 0.000)and (r = -0.44; p = 0.004) respectively. There are three fatal outcome (death) and all of cases with GNRI score grade 4 (majorrisk, GNRI score < 82) . GNRI score has a significant correlation with MNA score (r = 0.72; p < 0.000).In conclusion: Poor nutritional status as measured by GNRI was associated with a longer length of stay and increased inhospitalmortality. GNRI is a simple tool and has more significant correlation with hospitalization outcomes than MNA.

FAKTOR-FAKTOR YANG MENENTUKAN KEKUATAN GENGGAMAN TANGAN PADA PASIEN LANJUT USIA DI PANTI WREDHA TANGTU DAN POLIKLINIK GERIATRI RSUP SANGLAH - DENPASAR Putrawan, IB Putu; Kuswardhani, RA Tuty
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Handgrip strength is necessary for performing activities of daily living, which, in turn, are required to maintain functionalactivity. The purpose of this study was to determine anthropometric and personal factors that affect handgrip strength in groupsof nursing home and out patients of Sanglah Teaching Hospital Denpasar-Bali. Body weight and height, Waist Circumference(WC), Mid-Upper-Arm Circumference (MUAC) and triceps skinfold, scapula skinfold and supra iliaca skinfold were obtainedusing standard techniques. Body height was estimated from kneeheight. Handgrip was measured using a mechanical handgripdynamometer. A total of 38 male and 53 female aged 60 ? 82 years participated in the study. Both groups were statistically similarregarding all factors studied. Bivariate analyses showed that handgrip strength was associated with sex, age, WC, hemoglobin,albumin and body mass index in both of groups. Multiple linear regression analysis identified sex and WC (r = 0.39; p = 0.00),sex and age (r = 0.71; p = 0.00), as independent determinants of handgrip strength in both of groups. We conclude that womenhave a smaller handgrip strength than men. In addition, handgrip strength decreases with increasing age and decreasing WC.

THE ROLE OF NEOPTERIN AS A NOVEL BIOMARKER FOR REDUCED KIDNEY FUNCTION: A COMMUNITY BASED STUDY Widiana, G Raka; Suwitra, K; Effendi, Imam
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Cardiovascular disease is a major complication for patents with reduced kidney function. Neopterin is well known as abiomarker for cardiovascular disease, however it is not clear whether it is associated with reduced kidney function. Study wascarried out in a Legian Kuta village a tourist town in Bali. Samples were underwent a series of interview, physical examinationand were taken blood samples for neoperin and creatinine tests. Neoptein concentrations were tested for its normal distributionand associated with C-G formula for estimated glomerular filtration rate. Cut-off value for prediction of reduced renal functionwas rested using ROC curve, and calculated for sensitivity, specificity.Seventy nine samples were selected through cluster random sampling from 284 residents (177 males and 107 females)with age 46 ± 10 years, body weight 67 ± 13 kg and height 162 ± 9 cm. It was shown that neopterin concentration was normallydistributed (K-S Z = 1.175, p = 0.126), with mean 6.66 ± 3.35 ng/ml and e-GFR was 89 ± 25 ml/mnt. There was significantnegatively correlation between neopterin concentrations and e-GFR (R = -0.26, Rsq = 0.068, p = 0.021), using regressionequation it was revealed that every 1 unit increased of neopterin concentrations produce 1.42 decrease of e-GFR. Using ROCcurve, neopterin was accurately detect reduced kidney function defined as e-GFR of 60 ml/mnt or less (AUC = 0.88; 95%CI0.74 to 1.00; SE = 0.07; p = 0.02). Using 7.46 ng/ml as cut-off value for normal neopterin concentrations, it was showed thatsensitivity and specificity were 100% and 72% to detect the presence of reduced kidney function, consecutively. Neopterin maybe used as a novel biomarker for reduced kidney function, for its role in the pathogenesis of cardiorenal syndrome in generalpopulation.

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Journal Mail Official
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Kota denpasar,

Bali

INDONESIA