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INDONESIA
journal of internal medicine
Published by Universitas Udayana
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Core Subject : Health,
Medicine & Pharmacology
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Articles 9 Documents
 1 
Search results for , issue "Vol. 8, No. 2 Mei 2007" : 9 Documents clear
KORELASI ANTARA BRACHIAL-ANKLE PULSE WAVE VELOCITY DAN PROFIL LIPID PADA KARYAWAN RUMAH SAKIT SANGLAH DENPASAR Arsana, Gede Putu; -, Kambayana; Santoso, Anwar; Suastika, Ketut
journal of internal medicine Vol. 8, No. 2 Mei 2007
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 study the correlations betweenbaPWV and the lipid profile among employees of Sanglah Hospital. Cross sectional analytic study was performed in Sanglahhospital. Pulse wave velocity was measured using an automatic device (Fukuda VS 1000). Lipid profile were taken as well. Datawas expressed in mean + SD, analyzed by t-test compare mean and Pearson correlation by using SPSS 13.0. There were 85patients involved, all subjects were male, age all between 40-56 (mean 47.23 + 5.16) years old. Cholesterol total, LDL-C, HDLC,and triglyceride concentrations varied subject, range (means + SD) as (205.05 + 39.40) mg/dL, (144.26 + 36.85) mg/dL,(45.94 + 8.98) mg/dL, and (151.94 + 64.56) mg/dL, respectively. BaPWV on the right limbs were between (13,31 + 2,14 ) m/sec,on the left limbs were (15,05 + 2,33 ) m/sec. Significant correlations were found between total cholesterol concentration and theleft baPWV (r = 0.222, p = 0.41), while a significant correlation were found on the right side (r = 0.234, p = 0.031). Brachialanklepulse wave velocity is positively correlation with total cholesterol concentration.
LUPUS ERITEMATOSUS SISTEMIK PADA KEHAMILAN Jaya Kusuma, Anak Agung Ngurah
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Abstract

Systemic lupus erythematosus (SLE) is an auto immune disease which is charaterized by the production of antibodiestowards the nucleus of the cell. The mechanism is not well defined, but there seem to be some exacerbating factors like physicaland metal stress, infection, ultraviolet radiation and drugs. The various cell of our body are recognized as antigen thereforeleading to the formation of immune complexes which will be deposited in organs and eventually cause inflammation. The processwhich affects the placenta is known as deciduas vasculitis. The effects of pregnancy towards SLE in unclear, but the risks ofexacerbation increases as pregnancy advances. Complications such as death of the fetus, premaurity and restricted growth mayoccur. Complication of pregnancy with SLE which affects the fetus characterized by congenital heart block, cutaneus lesion,cytopenia, liver disorders and other systemic manifestation. The pathogenesis of fetal heart block is not well understood, but themechanism seems to be transfers of antibody through the placenta on the second trimester which then will lead to immunologicaltrauma of the heart and its conduction system which will manifest upon delivery. There are two major points to be considered inthe management of SLE in pregnancy; pregnancy can affect the course of SLE and the fetus may become the target of autoantibody which will lead to failure of the pregnancy itself. Corticosteroids have a significant effect and is normally tolerable bymay be considered. Contraception becomes an important key in SLE as estrogens concentration of 20-30 urg/day may exacerbateSLE and will increase the risk of thromboemboli, therefore progesterone containing contraceptives are highly recommended.
HUBUNGAN ANTARA PRODUK KALSIUM X FOSFAT SERUM DENGAN PENYAKIT ARTERI PERIFER PADA PASIEN HEMODIALISIS REGULER DI RSUP SANGLAH DENPASAR Wulandari, Dewi Catur; Raka Widiana, I G; SL, Jodi; Sudhana, I W; Suwitra, Ketut
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Abstract

Peripheral Arterial Occlusive Disease (PAOD) is common among patients undergoing hemodialysis (HD). In the generalpopulation, DM, male, cigarette smoking, advanced age, hypertension and dyslipidemia are the most important risk factorsfor PAOD. Recently, some studies in patients with regular HD found evidences that PAOD associated with increase of calciumand phosphate serum level and increase of Ca.P product due to secondary hyperparatiroidism. A cross-sectional study was doneon 46 regular HD patients to evaluate prevalence of PAOD among patients who are undergoing regular HD and their associationbetween Ca.P product. Morning fasting plasma were taken for lipid profile, blood sugar, blood urea nitrogen, serum creatinin,albumin level, Ca, inorganic P. Ankle-brachial index (ABI) of blood pressure as measured after dialysis session using Va-SeraVS-100. Fourty six (26 males, 20 females) regular HD patients, age 50.95 ± 9.90 years, duration of HD 27.7 ± 22 months wereincluded in this study. Using ABI < 0.9 as cut off value for the presence of PAOD, 15.2% had PAOD. Means of Ca serum levelwas 9.04 ± 0.76 mg/dl, phosphate serum level was 56.48 ± 23.90 mg/dl. Using 55 or more as cut off value for abnormal concentrationof Ca.P product, 47.7% patients had abnormal Ca.P product. Three of 21 patients with Ca.P 55 had PAOD and 4 of 23patients with Ca.P < 55 had PAOD ( OR 0.79 with 95% CI : 0.15 ? 4.04 for patients with Ca.P < 55 ). Using logistic regression tocontrol Ca and P levels, Ca.P 55 tend to associate with increased risk of PAOD (OR 6.22 ; 95% CI : 0.23 ? 167.71)More than fifteen percent of patients with regular HD had PAOD. More than fourty seven percent of patients had abnormal Ca.P.Patients with Ca.P 55 tend to associated with increased risk of PAOD (OR 6.22 ; 95% CI : 0.23 ? 167.71)
NUTRISI PADA PENDERITA SAKIT KRITIS Wiryana, Made
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Abstract

Malnutrition is always been being associated with the increase of morbidity and mortality rate due to lack of immunesystem, depending on ventilator, high rate of infection, and delayed healing process, so it will increase the cost and length of stayof the patients. Clinician need to have right information about how to manage nutrition for critical ill patient because it willinfluence the outcome of ICU patient.Objective measurement nutritional status of the patient is difficult because process of illnesses itself will disturb themethod that will be used in the population. Nutritional status is multidimension phenomenon that need several methods formeasurement, including associated factors of nutrition, nutrition intake, and energy expenditure.Nitrogen balance can be used to determine effectiveness of nutritional therapy. Nitrogen balance can be counted by formulathat count nitrogen in 24 hours from patch urine, especially urine urea nitrogen (UUN), minus nitrogen intake from the food.Resting Energy Expenditure (REE) must be determined for nutritional therapy in critical ill patients. Acuracy estimation REE willhelp to reduce complications due to overfeeding, such as infiltration fat to liver and pulmonyary compromise. Several methods areavailable to predict REE such as Calorimetry, and Harris-Benedict equation.The goal in nutritional therapy in critical ill patient is to support metabolic, not to complete their need in that time. Becausein critical ill patient there is no metabolic condition is able to metabolize total amount of calories to fulfill lack of energy expenses.Ideally the route of nutritional therapy is able to supply nutrition with minimal morbidity. Each routes (parenteral andenteral) have advantages and disadvantages, and the choice is depend on patient condition. In critical ill patient care, enteralnutrition is always being the first choice and parenteral nutrition become the next alternative.
SEORANG PENDERITA HEPATITIS KRONIK B DAN C DENGAN MUTASI PADA GEN P53 KODON 249 PADA JARINGAN HATI Eka Saputra, I Wayan; Gunawan, Stephanus; Muttaqin, Zainul; Soemoharjo, Soewignjo
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Abstract

Role of gene P53 as a tumor suppressor gene in generating primary liver cancer is very important primarily in cellgrowth regulation and apoptosis. By using AS-PCR method, the gene mutation can be recognized. It has been reported a chronichepatitis B and C case with experiencing mutation of gene P53 Codone 249 in liver tissue of a 33 years old male with anti HCVpositive, HBsAg positive, on the liver biopsy indicated of chronic hepatitis without cirrhotic features and malignancy signs. OnAS-PCR examination found mutation on gene P53 codone 249. This finding was expected to be an early warning sign foroccurrence of primary liver cancer, so that, early intervention could be performed.
PERANAN KADAR HEMATOKRIT, JUMLAH TROMBOSIT DAN SEROLOGI IgG - IgM ANTIDHF DALAM MEMPREDIKSI TERJADINYA SYOK PADA PASIEN DEMAM BERDARAH DENGUE (DBD) DI RUMAH SAKIT ISLAM SITI HAJAR MATARAM Taufik S, Ahmad; Yudhanto, Didit; Wajdi, Farid; -, Rohad
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Abstract

The mortality rate of Dengue Haemorrhagic Fever is still high. It is still very difficult to predict shock. The commonlaboratory feature to predict shock are low platelet count, high hematocrit level and the positive result of serologic test (IgG andIgM antiDHF), but the validity remains controversial. This researh was determine many factor to predict shock in denguehemoragik fever patient . This research was case-control study. Data was collected from secondary data based on hematologic andserologic findings of patients with DHF who were hospitalized in Siti Hajar Islamic Hospital Mataram in the period of June 1,2005 until June 1, 2006. The samples of this study were patients that diagnosed as DHF based on WHO criteria and performedwith rapid serologic test Pan Blow? made in America, for Ig G and Ig M anti DHF. DHF patients that suffering shock werecatogorized as case group (n=47), and DHF patients without shock were control group (n=94). The total number of control groupwas two times of case group. Risk factor of shock were analyzed using chi-square test and multiple logistic regressions with levelof significance of < 0.05. The number of samples used in this study were 141 patients diagnosed as DHF, there were 47 patienstsDHF with shok and 94 DHF patients without shock. There was 70% patient with thrombositopenia and 44% patient had high rateof hematokrit more than 41.5 %. Shock was more frequent among pasients age more than 25 years, male, hematokrit level lessthan 40% and platelet count 50,000-100,000/ml. Based on univariate analysis, age, gender, high hematocrit value andtrombositopenia were not significantly different to predict shock. On multiple logistic regression methode, primery infection(IgM+ and IgG-) and secondary infection (IgG positif and IgM+/-) were not significantly different to predict shock. The conclusionof this study is high hematocrit value, platelet count and serology IgM or and IgG antiDHF there were no factor that couldpredict shock in DHF patients.
THROMBOSIS DAN USIA LANJUT Bakta, I Made
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Abstract

Thrombosis, venous as well as arterial thrombosis, is the basic pathogenetic mechanism which leads to high morbidityand mortality diseases. The Virchow triad is the basic mehanism of pathogenesis of thrombosis, ie abnormality of vessel wall,disturbances of blood flow, and abnormality of blood coagulation (hypercoagubility state). The risk factors for thrombosis couldbe classified into 3 main categories: situational risk factors, hereditary thrombophilia, and acquired thrombophilia.The incidence of thrombosis is higher in old people, old age is categorised as one of the risk factors of thrombosis. Themechanism of old age in promoting thrombosis is not well understood. It is assumed that in old age there is imbalance betweenprotrombotic and antithrombotic factors, the increase of protrombotic factors are higher than antithrombotic factors.The increaseof coagulation factors (fibrinogen, prothrombin, factor VII, factor VIII, von Willebrand factor, and plasminogen activator inhibitor)were increased in old age population. Recently, the genetic mechanism of age regulation synthesis of factor IX and protein C wasfound.Atherothrombosis is a new concept, in which thrombus deposition occured on an atheromataous plaque. Atherothrombosisgives principal clinical manifestations as coronary artery disease, acute myaocardial infarction and unstable angina, ischaemicstroke, and peripheral arterial disease. Venous thrombosis, especially on deep vein, gives clinical manifestation as deep veinthrombosis (DVT), which is frequently followed by pulmonary emboli (PE). The combination of DVT and PE is known as venousthromboembolism (VTE).The concept of thrombosis management should be based on its pathogenesis. In arterial thrombosis, the main therapy isadministration of antiplatelet drug and anticoagulant to prevent the deposition of thrombus, while thrombolytic or fibrinolyticdrugs are given to dissolve the preformed thrombi. In venous thrombosis antiplatelet drug is not effective.Basically, the treatment of thrombosis in old age is not different from the treatment of thrombosis in general. But in oldpeople the comorbids are more frequent, drug interaction should be taken into special consideration.
PREVALENSI, KARAKTERISTIK DAN FAKTOR-FAKTOR YANG TERKAIT DENGAN INFEKSI SALURAN KEMIH PADA PENDERITA DIABETES MELITUS YANG RAWAT INAP Ariwijaya, Made; Suwitra, Ketut
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Abstract

Diabetes Melitus (DM) is related with the increased risk of Urogenital Tract Infection (UTI). Prevalence and characteristicorganisms from urine suprapubic aspiration in DM patient who admitted to the hospital is rare. The aim of the study wasto now prevalence, characteristic and related factor with UTI in DM patient who admitted. We have done cross sectional analyticstudy in admitted DM patient more than 12 years old, less than 3 days admission. The patients who used antibiotic last 7 daybefore urine culture dan pregnancy were excluded. Urine specimen were taken via suprapubic aspiration. We had 100 respondenwith 53 men (53%), 47 women (47%), age 56 ± 11.9 yo., mean Body massa indeks (BMI) 23.99±2.56 Bw/ m2.SBP 130.7 ± 28.5mmHg. DBP 80 ± 14.65 mmHg. WBC 14.5 ± 11.9 K/ml . Hb 12.5± 3.1 mg/dl. BUN 32.2± 33 mg/dl. SC 2.2± 3.3 mg/dl. HbA1C13.8 ± 6.4 g%. Cholesterol 173.7 ± 61.6 mg/dl. HDL-cholesterol 39.06 ± 28.0 mg/dl. LDL-cholesterol 115.0 ± 55 mg/dl.trigliserida 138.8 ± 71.5 mg/dl, Fasting BS 196.6 ± 94 mg/dl, after meal BS 243.2 ± 110 mg/dl. We found 36 patient UTI (36%)with upper UTI 9 (25%). Lower UTI 27 (75%). Asymptomatic bacteriuria 25 (69.4%). Symptomatic bacteriuria 11 (30.6%).About 2.8% of recurrent UTI. Prevalence of UTI in patients less than 50 yo. were more than patient above 50 yo. UTI in womenwere higher than men. We found E. coli 30.5%, S. epidermidis 27.7% S. aureus 11.1%, E. zakazakii, and S. marcescens, C.albican respectly 5.5%, S. coagulase, S. liquyacians, E. cloaceae, E. hapniae, C. violaleum respectly 2.7%. as cause UTI thisstudy. We found Sensitivity test with antibiotic, imipenem 23%, amoxicillin-clavulamic acid 20%, ceftazidin 19%, gentamisin19%, cefoxitin 17%, piperacillin/ tazobactam 14%, sulphamethoxazol, ofloxasin, ceftriaxon 13% respectly, cefuroxime 12%,cifroploxasin 11%, ampicilin, linezolide 6% respectly. vancomisin 4%, cephazolin, cefoperazone-sulbactam 3% respectedly.meticilin, cefoperazone, erithromisin, amoxillin, oxacilin respectly 1%. We found E. coli 100% sensitive with imepenem,amoxicillin-clavulamic acid, piperasillin-tazobactam. 90.9% Sensitivity for ceftazidin, gentamycin. From six independen variabel(dyslipidemia, BMI catagori, hipertension, sex, age, blood sugar controled, stone in urinary tract, chronic renal disease, lungTB, pneumonia, cancer, user of chateterization) only BMI significant correlation (X2 = 13.8, p= 0.03 OR= 2.14) with prevalenceUTI in patient DM.
HEPATIC ISCHEMIA REPERFUSION INJURY IN SEPSIS: BASIS PATHOGENIC MECHANISMS Suryadarma, I Gusti Agung
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Abstract

Hepatic ischemia reperfusion injury is a complex patho-physiology with a number contributing factors. Ischemia insultcan lead to sublethal cell injury, which is aggravated by the formation of reactive oxygen from various intracellular sources duringreperfusion. In addition, formation of proinflammatory mediators and the recruitment and activation of macrophages, neutrophiland lymphocyte can further enhance the injury. Microcirculatory disturbances lead to underperfused areas in the liver and maycause ischemic injury. Hepatic IR injury involves interaction between different cell types and a variety of cellular and molecularmechanisms including kupffer cells activation, formation of ROS, release of cytokines and chemokines, neutrophil recruitment,mitochondrial permeability transition and pH paradox. There are two distinct phase of liver injury after warm ischemic reperfusion,such as early phases and followed by late phases. Clinical presentation of hepatic ischemic reperfusion injury in sepsis, includingsepsis-associated cholestasis, hepatitis ischemic, cholangitis lenta and progressive sclerosing cholangitis

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