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INDONESIA
journal of internal medicine
Published by Universitas Udayana
ISSN : -     EISSN : -     DOI : -
Core Subject : Health,
Medicine & Pharmacology
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Articles 10 Documents
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Search results for , issue "Vol. 7, No. 2 Mei 2006" : 10 Documents clear
HUBUNGAN ANTARA OBESITAS SENTRAL DENGAN ADIPONEKTIN PADA PASIEN GERITARI DENGAN PENYAKIT JANTUNG KORONER Gotera, Wira; Suastika, Ketut; Santoso, Anwar; Kuswardhani, Tuty
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

Obesity is rapidly becoming a global problem not only in developed countries but also in developing countries such asIndonesia. Visceral obesity (central obesity) is an importance risk for cardiovascular disease and recognition that adipose tissuecan be regarded as a large endocrine organ that secreted inflammatory and anti inflammatory molecules (adiponectin). This studyaims to know the correlation between central obesity and adiponectin in geriatric coronary heart disease (CHD) patients. Thisstudy was cross sectional analytic study of geriatric CHD at out and in patients in Sanglah hospital. Data are presented as groupmean ± SD and analyzed by t-test, chi-square, and Pearson correlation with SPSS 12 software. Forty five patients (35 males and10 females), 23 patient unstable angina pectoris, 14 patient acute myocardial infarction, and 8 patient stable angina pectoris wererecruited and examined. There was high prevalence of central obesity 51.1% (23 patients). Mean of log adiponectin weresignificantly difference between central obese and non central obese (1.80 ± 0.61 vs 1.09 ± 0.41 with p). Central obesity increasedrisk of hypoadiponectinemia 5 times than non central obesity (p=0.011, CI 95% 1.4-17.8). Waist circumference has negativecorrelation with log plasma adiponectin (R=-0.663, p<0.001). There was high prevalence of central obesity in geriatric coronaryheart disease patients. Central obesity increased risk of hypoadiponectinemia 5 times than non central obesity. Waistcircumference has negative correlation with plasma adiponectin. Increased of waist circumference will decrease of adiponectin(cardioprotective protein) and will increase risk of acute coronary syndrome in geriatric patients.
PENATALAKSANAAN HIPERTENSI PADA LANJUT USIA Kuswardhani, RA Tuty
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

The more increasing of life expectancy is more complex disease in elderly. One of cause disease in elderly is hypertension Theisolated systolic hypertension (ISH) the most risk factor in stroke, coronary failure, and coronary heart disease, their role ispredicted more their in the youth. The definition of hypertension is not change in the age : systolic blood pressure (SBP) 140mmHg, and or diastolic blood pressure (DBP) 90 mmHg. The Joint National Committee on Prevention, Detection, Evaluationand Treatment of high blood pressure (JNC VI) and WHO or International society of hypertension guidelines sub committeesagree that SBP and DBP, both are used to classify the hypertension. Patophysiology of blood pressure is not clear. The most effectof the mortal aging in the cardio vascular system includes the changing of compliance aorta and systemic vessels. The thickeningof aorta wall are major vessels are increasing while the elasticity of vessel is decreasing in aging. This changing brings thecompliance of aorta is decreasing and the major vessel, it causes the increasing of peripheral vascular resistance. Baroreceptorsensitivity is also changing in aging. The changing in the metabolism of baroreceptor reflex possibly can explain the existence thevariability pressure. The changing of vasodilatation adrenergic and vasoconstriction of adrenergic a in balance will tendvasoconstriction are will bring the increasing of peripheral vessel resistance and blood pressure. The management of hypertensionin the elderly includes behavior, exercise, and pharmacology therapy.
KORELASI ANTARA BRACHIAL-ANKLE PULSE WAVE VELOCITY DAN PROFIL LIPID PADA PASIEN DIABETES GERIATRIK Ratna Saraswati, Made; Suka Aryana, IGP; Astika, Nym; Kuswardani, Tuty; Suastika, K
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

Brachial-ankle pulse wave velocity (baPWV) is an indicator of limb arterial stiffness. Dislipidemia is a major risk factorof atherosclerosis and may worsen baPWV by increasing the blood viscosity. This study aims to know the correlation betweenbaPWV and the lipid profile in diabetic geriatric patients. Cross sectional analytic study has conducted in geriatric polyclinic,Sanglah hospital. Pulse wave velocity was measured using an automatic device (Fukuda VS 1000). Lipid profile were taken beforetest was done. Data was expressed in mean + SD, analyzed by t-test compare mean and Pearson correlation by using SPSS 11.0.There were 61 patients involved, 40 (65.6%) male and 21 (34.4%) female, age between 60-82 (mean 67.23 + 5.79) years old.Cholesterol total level, LDL-C, HDL-C, and triglyceride were vary among subject, range (means + SD) as 96-312 (198.7 + 42.3)mg/dL, 54-314 (133.2 + 40.4) mg/dL, 27-67 (45,5 + 9.0) mg/dL, and 51-438 (138.6 + 80.0) mg/dL, respectively. BaPWV on theright limbs were between 920-2260 (1605.4 + 228.5) cm/sec, on the left limbs were 870-2240 (1628.0 + 274.8) cm/sec, and meanright/left limbs baPWV were 895-2240 (1616.7 + 241.8) cm/sec. A significant correlation were found between triglyceride leveland the left baPWV (r = 0.3, p = 0.019), while no significant correlation were found on the right side and mean r/l. There weresignificant difference of left limb baPWV among high (>150 mg/dL) and normal triglyceride level group (<150 mg/dL, accordingATP-III). Brachial-ankle pulse wave velocity correlated positively with triglyceride level in diabetic geriatric patients.
HEPCIDIN PADA ANEMIA OF CHRONIC DISEASE Agustriadi, Ommy; Suega, Ketut
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

Anemia of chronic disease (ACD) induce dysregulation of iron homeostasis. A hallmark of anemia of chronic disease is thedevelopment of disturbances of iron homeostasis, with increased uptake and retention of iron within cells of thereticuloendothelial system (RES), that leads to a diversion of iron from the circulation into storage sites of RES, and decreasedintestinal iron absorption, subsequent limitation of the availability of iron for erythroid progenitor cells, and iron-restrictederythropoiesis. A new small peptide called hepcidin was found. It is strongly suggest that hepcidin play role on the pathogenesisof ACD. Hepcidin expression is induced by inflammation/infection (by lipopolysaccharide and interleukin-6) and iron overloadcondition, it is strongly suggest that hepcidin induced dysregulation of iron homeostasis by inhibit iron efflux from macrophagedan RES (causing iron retention in turn) and decrease intestinal iron absorption. In the aggregate, the increase of hepcidinproduction suppress erythropoiesis by iron starvation strongly suggest that hepcidin is the key mediator of ACD. If hepcidinfollows the pattern of other peptide hormones or cytokines, its actions will be mediated by cell surface receptors. Elucidation ofthe receptor and its transduction pathways should lead to the development of hepcidin antagonists, some of which could be usefulin treatment of ACD, along with it's underlying disease.
SEORANG PENDERITA HEMOFILIA RINGAN DENGAN PERDARAHAN MASIF Renny A.R, Ni Made; Suega, Ketut
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

Haemophilia A is the most common of the hereditary clotting factor deficiencies, which have defect of absence or lowlevel factor VIII in the plasma. It is a X-linked recessive inheritance disease, with incidence approximately 1 per 10.000 malebirth. In the middle of the year 2001,it were reported 314 cases in Indonesia. The clinical features of the bleeding may be shownmany various severity, and classified into mild, moderate and severe disease. The clinical severity of the disease correlates withthe extent of the factor VIII deficiencies. Diagnostic confirm by specific clinical features, there is a history of the bleeding in thefamily, and laboratorium examination to measure the factor VIII level in the plasma. We reported a case, male, 46 years old,Balinese, reffered from private hospital with complaining profuse bloody vomiting and blackish stool and has been done bloodtransfusion for 15 bags, with history of haemophilia confirmed. The history of bleeding before classified patients into a milddisease, but in the present the patient suffered from chronic liver disease and erosive gastritis, that can lead patients has moreprofuse bleeding. A good respons shown by giving the transfusion of the cryopresipitate and packed red cell.
HUBUNGAN BESI DAN PRODUKSI SITOKIN Suega, Ketut
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

Iron deficiency is a widespread nutritional disorder in infant, children and women of reproductive age especially indeveloping countries where almost 2 billion individuals are concerned, particularly infant and children. The absorption ofintestinal iron as regulated in several ways such as dietary regulator, stores regulator and erythropoietic regulator. The negativeconsequence iron deficiency anemia on behavior, psychomotor development and growth rate are well established and underlinedthe need to control iron deficiency anemia. Iron supplementation has proven to be useful, particularly in infant and children,when iron deficiency is important and has to be corrected rapidly. However several studies have indicated that iron deficiencyprotects against infection and other studies show the opposite where morbidity is higher in iron deficient children. Iron deficiencywould decrease the resistance to infection through impairment of immune competence of the individual especially cell-mediatedimmunity. The mechanisms of impairment are very likely multifactorial and may include but not be limited to a reduction in theactivity of certain iron-dependent enzymes such as ribonucleated reductase. Other mechanism may include a defect in one orseveral of the early events of lymphocyte activation and cytokine productions such as IL-2. The main cellular source of IL-2 isactivated lymphocyte and TCR/CD3 actvation leads to autocrine IL-2/high affinity receptor signal transduction, resulting in cellproliferation. Iron deficiency may inactivated T cell proliferation and decreasing IL-2 production.
PERITONITIS BAKTERIAL SPONTAN PADA SIROSIS HATI DAN HUBUNGANNYA DENGAN BEBERAPA FAKTOR RISIKO Ayu Yuli Gayatri, Anak Agung; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

Spontaneous Bacterial Peritonitis (SBP) is a frequent and severe complication in cirrhotic patients with ascites. It occursin 10-30% of cases and assosiated mortality rate is 20-40%. Spontaneous Bacterial Peritonitis is diagnosed base on the presence ofa Polymorphonuclear leucocyte count greater than 250/mm3 or positive monomicrobial ascitic fluid culture. The key to successfultreatment of SBP is knowledge of appropriate antibiotic regimen and an understanding of the setting in wich infection develops,particularly those individuals at high risk of infection. This study was conducted to know prevalence of SBP and to evaluatepossible risk faktors for this complication such as: severe cirrhosis (Child C), upper gastrointestinal bleeding, low protein ascites(<1g/dL) and low platelet count (<98.000/mm3). Sixty two consecutive hospitalized patients with cirrhotic and ascites were followup for manifestations of SBP. Prevalence of SBP was 30.6%. Multivariate analysis and Logistic regression showed that onlysevere cirrhosis (Child C) is the risk faktor of SBP. (OR= 5.297; 95% CI=1.036-27.079).
BEBERAPA KASUS ABSES HATI AMUBA Junita, Arini; Widita, Haris; Soemohardjo, Soewignjo
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

Amoebiasis is an infection caused by Entamoeba hystolitica intestinal protozoa. Extraintestinal complication is liverabscess (amoebeic liver abscess). The highest prevalence is in tropical and developing country, which have poor sanitation, badsosioeconomic condition, not well nutrition status, and in area which strain E. Hvstotistica is high. About 10% from all people inthe world had this infection, but only 10% became clinically. Amoeboic liver abscess is handled with chemotherapy usingnitromidazole derivate, aspiration or drainage with surgery. In case which needed operation, mortality is 12%. And if there is aamoeboic peritonitis, the mortality approximately 40% - 45%, High mortality rate is caused by severe condition. Malnutrition,icteric or shock. Patient died ussually caused by septic condition or hepatorenal syndrome. In this moment, we will report threecase of liver abscess with variable size, which made differential decisiton treatment. One case is liver abscess which contain 4.5 Lafter done surgery drainage.
PERBANDINGAN EFEKTIFITAS ASAM FOLAT DOSIS STANDAR DENGAN DOSIS TINGGI TERHADAP HIPERHOMOSISTEINEMIA PADA GAGAL GINJAL DENGAN HEMODIALISIS REGULER Darmaja, I Made Gede; Suwitra, Ketut
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

Prevalence of hyperhomocysteinemia(HHcy) in regularly hemodialysis chronic kidney disease (RHDCKD) is high.HHcy in RHD CKD related to atherosclerosis an increase risk of cardiovascular disease. Increasing 5 ?mol/L of Hcy level from10?mol/L correlate with increasing 60% cardiovascular risk in male and 80% in female and also increasing 50% risk of strokeboth in male and female. Folic acid, vitamin B 12 and vitamin B 6 is needed to decrease Hcy level according homocysteine trialystlowering collaboration (HTLC), folic acid may decrease the Hcy level by 25%, vitamin B 12 7% but no significance effect ofvitamin B 6. Standard dose of folic acid 2-5 mg/day may normalized HHcy in predialysis CKD but most of RHDCKD fail toreach normal level. Treatment result of RHDCKD before is varied and inconsistent. This study was randomized double blindcontrolled clinical trial aimed to know whether higher dose of folic acid decreased Hcy greater than standard dose, that using 15mg/day compare to 5 mg/day of folic acid treatment for 4 weeks RHDCKD with hyperhomocysteinemia. Thirty patients wererecruited base on exclusion and inclusion criteria and two weeks standardization using 1 mg/day folic acid was performed.Complete blood count, lipid profile, blood sugar, albumin and globulin, BUN, creatinine serum, SGPT/SGOT and Hcy wereexamined in the beginning of the study and after 4 weeks. Permuted block randomization was done among participant in order togrouping them into 15 mg/day and 5 mg/day folic acid group. Compare means of decreased Hcy in each group as primaryoutcome was analyzed using student t test, 95% confidence interval (CI) , p<0,05. During study, 15 patients were treated with 15mg/day folic acid and 13 patients with 5 mg/day folic acid. Increased of Hcy was 1,00±4,11 ?Mol/L among 15 mg/day folic acidgroup (20,67 ±6,69 ?Mol/L increased to 21,68±4,59 ?Mol/L ) and 1,93±3,40 ?Mol/L (18,77±5,38 increased to21,00±5,24?Mol/L) among 5 mg /day folic acid group, CI 95% -2,03 to 3,88, p = 0,53. ANCOVA analyzed of other variableseffect such as BMI, blood sugar, age and sex on Hcy level was not found. We conclude that 15 mg/day comparing to 5 mg/dayfolic acid is not more effective in decreasing Hcy level of regularly hemodialysed patient with hyperhomocysteinemia.
SEORANG WANITA DENGAN URTIKARIA KRONIK IDIOPATIK Suryana, Ketut; Suastika Adiguna, Made
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

Urticaria is characterized by red edematous plaques surrounded by a clear or red halo. The lesions are round or oval andmay become polycyclic when confluent. They usually multiple and vary from 1 mm to several centimeters in diameter. They canoccur at any site of the body and are typically associated with itching and sometimes burning. Skin returns to its normalappearances usually within 1-24 hours. Urticaria is sometimes accompanied by angioedema, in which the edematous processextends into the deep dermis and / or subcutaneous tissues. While patient with urticaria usually have symptoms confined to theskin they may have concomitant systemic manifestations. Urticaria is termed acute when episode less than 6 weeks, it’s termedchronic when episode persist longer. Chronic urticaria / angioedema, the syndrome last and average of 3-5 years, with 20%patients still symptomatic at 40 years. The syndrome is frustrating to patient and clinician alike in death a search for an exogenouscause is futile in the majority of patients. However in recent year its has been demonstrated that many patients involved idiopathicchronic urticaria (80% of the chronic type urticaria). The incidence of idiopathic chronic urticaria was 3% population. Thediagnosis, there is no the specific approach. Mostly based on clinical history and several laboratory procedure and in certaincondition need skin biopsy. The management; allergen avoidance, medicamentosa symptomatically. The first line; non sedatingsecond-generation AH-1 and in a several case add by antihistamine AH-2. in severe case sometimes need the corticosteroids oranother immunosuppressive.

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