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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 9 Documents
 1 
Search results for , issue "Vol. 8, No. 3 September 2007" : 9 Documents clear
ASPEK IMUNOLOGI SLE -, Yuriawantini; Suryana, Ketut
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Systemic Lupus Erythematosus (SLE) is autoimmune disease characterised by the production ofautoantibodies to component of the cell nucleus in association with a diverse array of clinical manifestations.The patho-aetiology of systemic Lupus Erythematosus probably involves multifactorial interaction amongvarious genetic and environmental factors. Multiple genes contribute to disease susceptibility, including genesencoding complement and other components of the immune response. The interaction of sex, hormonal millieuand the hypothalamus-pituitary-adrenal axis modifies this susceptibility and the clinical expression of thedisease. Defective immune regulatory mechanism, such as the clearance of apoptotic cells and immunecomplexes, are important contributors to the development of SLE. The loss of immune tolerance, increaseantigenic load, excess T cells helper, defective B cell suppression, and the shifting of T helper 1 (Th1) to Th2immune responses leads to the B cell hyperactivity and the production of pathogenic autoantibodies. ANAs areantibodies against both functional and structural in the cell nucleus. ANA is early detection of autoantibodies forthe patient with clinical features that suggest SLE. Positive test for antinuclear antibodies may support thediagnosis, especially if more spesific autoantibodies are present, such as anti-double-stranded DNA, anti-Sm,anti-RNP or anti-Ro. Understanding the value of autoantibody testing in patient care requires clinical judgmentand experience.
PROFIL ANALISIS BATU SALURAN KENCING DI INSTALASI LABORATORIUM KLINIK RSUP SANGLAH DENPASAR Rasmika Dewi, Dewa Ayu Putu; Ngurah Subawa, Anak Agung
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Urolithiasis is a pathological condition that is caused by the formation of hard mass like stone along theurinary tract. Identification of the urinary stones can be done through chemical analysis or using of infraredspectroscopy. The semiquantitative methods used to analyze are titrimetric and colorimetric. This study wascross sectional whose results were descriptive. The data used in this study was 113 urinary stone analysisrecords taken from Routine Clinic of Laboratory Clinic Installation at Sanglah Hospital in period January untilDecember 2007 (one year). The prevalence of urolithiasis in males were more than females (4:1) and it wasmostly occur in age range 40-60 years old of both sexes. Generally, more than one kind of stone compositionswere found in a patient of urolithiasis, the dominant was calcium oxalate.
PERKEMBANGAN TERKINI DALAM DIAGNOSIS DAN PENATALAKSANAAN IRRITABEL BOWEL SYNDROME Mariadi, I Ketut; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) motility and sensory disorder that ischaracterized by abdominal pain/discomfort, bloating and altered bowel habit. The disease accounts for hugecosts for both patients and health-care systems and worsens significantly patients’ quality of life. Diagnosis isbased on the identification of symptoms according to Manning, Rome I and Rome II criteria and the most recentRome III criteria and exclusion of alarm indicators. The treatment of IBS is centred on an excellent doctor–patient relationship along with drugs targeting the predominant symptom, especially during exacerbations. Thisreview aim to explain new ctriteria to diagnose IBS and to conduct a systematic evidence-based review ofpharmacological therapies currently used, or in clinical development, for the treatment of IBS
HUBUNGAN KADAR ESTROGEN DENGAN KADAR DEOXYPIRIDINOLIN URIN PADA WANITA MENOPAUSE Wardhiana, I Putu Gede
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Women in her life will get two land marks, menarche and menopause. Menopause is that point in timewhen permanent cessation of menstruation occurs following the loss of ovarian activity. Women will loss theprotective effect of estrogen, accelerate bone remodeling and get osteoporotic. This study was conducted toevaluate relationship between estrogen level and bone resorption by deoxypyridinoline ekskretion in urine ofmenopausal women. Cross sectional study was done at Obgyn Department, RS Sanglah Denpasar. Population inthis study were women who got cessation their menstruation for 12 months or more, including our inclusioncriteria and the worked in this hospital. We performed deoxypyridinoline urine by high performance liquidchromatography (HPLC) method at Klinik Prodia and basal estradiol level (E2) at Laboratorium Graha TunjungRS Sanglah Denpasar. 52 menopausal women were evaluated, 21.1% with normal estradiol level, and 78.9%low (< 30 pg/ml). We collected 75% normal deoxyyridinoline urine and 25% with high deoxypyridinoline urinelevel (> 7.5 nmol/L), 1 sample with normal estradiol got high deoxypyridinoline urine level. From 41 sample(78.9%) with low estradiol level, twelve (23.1%) with high deoxypyridinoline have the highest osteoporotic riskin their life. Conclusion: 23,1% sample with low estradiol level and high deoxypyridinoline have the highestosteoporotic risk in their life
VENTILATOR ASSOCIATED PNEUMONIA Wiryana, Made
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Ventilator Associated Pneumonia (VAP) is defined as nosocomial pneumonia that occurred 48 hours afterthe patient had a mechanical ventilation support either from endotracheal tube or tracheostomy tube. VAPussually charactherized by 3 component sign of systemic infection: fever, tachycardia and leukocytosisfollowed by new infiltrate sign or a worsening scheme on the chest x ray and bacteriologic findings of thecausal of lung infection, but acctually we can diagnosed a VAP based on the findings of a number ofcriteria: histopathologic examination of the lung tissue from an open biopsy, a fast cavity formation of alung infiltrate without any sign of tuberculosis or malignancy and a positive pleural fluid culture, in whichthe species that found on the blood culture and airway were the same.The insidens of VAP are high, according to the foreign literature approximately between 9 – 27 % from allIntensive Care Unit population. This condition made VAP as the first causal of a nosocomial infection inthe Intensive Care Unit. The mortality rate of VAP is also high, Chastre and Fagon stated that the crudemortality rate can reach of 76%. Early onset VAP which occurred on the first 4th day after admission in theIntensive Care Unit ussually had a better prognosis because of caused by a still antibiotic sensitivepathogens. The Late onset VAP which occurred after 5 days or more after hospitalization, has worseprognosis because of caused by a multidrug resistance (MDR) pathogens. In order to define the pathogensthat caused VAP, some scientist made a classification of VAP patient based on the degree of disease, riskfactor and the onset, which is the group I with mild-moderate degree, common risk factor and the onset isanytime during hospitalization or a severe degree with an early onset, ussually caused by a gram negativebacteria. The group II, patient with a mild-moderate degree, specific risk factor that happened anytimeduring hospitalization, ussually caused by all bacteria in the group I added with an anaerob bacteria. Thegroup III, patient with a severe degree, early onset with specific risk factor or a late onset, ussually caused by Pseudomonas aeruginosa, Acinetobacter sp and MRSA. Other approach is by classifying the bacteriacausing VAP in a primary endogen, secondary and eksogen type.Prevention of VAP can be done by 2 different ways, first by a non pharmachologic way, routine andstandard things that ussually done in the ICU, but this action still could not enough in lowering the insidensof VAP. Second, by a pharmachologic way, Selective Decontamination of the Digestive Tract (SSD) andOropharyngeal Decontamitation (OD). SSD is proven effective empirically in preventing VAP but the usedof antimicrobial can caused a higher risk on resistention. SDD is not recommended as a routine action inpreventing VAP so that OD with the used of antiseptic is preferred as another alternative.
POLA JUMLAH TROMBOSIT PENDERITA DEMAM BERDARAH DENGUE (DBD) PADA ANAK-ANAK YANG PETANDA SEROLOGINYA POSITIF Ngurah Subawa, Anak Agung; Sutirta Yasa, I Wayan Putu
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Thrombocytopenia represent one of non specific laboratory criterion to uphold diagnosed DHF specifiedby WHO. Existence of trombositopenia on third or fourth days of disease, will be easily diagnosed of DHF. Toknow the pattern of the thrombocyte amount on children suffering from DHF based on IgG and IgM serologicmarker. This Research is retrospective study by seeing medical report of pediatric patient which is taken care byDHF in Sanglah Hospital Denpasar from July 2005 until June 2006. There are 42 pediatric patient sufferingfrom DHF with the positive serologi examination result, as much 17 child (40.5%) by IgG is positive, 9 child(21.4%) IgM positive and 16 child (38.1%) by IgG and IgM positive. At fourth days of disease development,the mean of the thrombocyte amount in serologi IgG are positive is the lowest (99.8 x 103/mm3). At fifth days,the mean of thrombocyte amount in serologic IgG and IgM are positive is the lowest (61.7 x 103/mm3). At sixthdays, the mean thrombocyte amount in serologic IgG are positive is the lowest (61.9 x 103/mm3). At seventhdays, the patient having positive IgG or positive IgG and IgM, the mean of the thrombocyte amount experienceof the improvement from previous day. At eighth days, patient having positive IgG and IgM were more oftenhave the thrombocyte amount more than the other (only IgG or IgM positive). The patient suffering from secondinfection (IgG positive or IgG and IgM positive) at the acute phase more often have the thrombocyte amount islower the than the primary infection (IgM Positive). Expected of continuation research with the sample amountand scope is more than before.
RELATIONSHIP BETWEEN METHYLENE TETRA HYDRO FOLATE REDUCTASE (MTHFR) GENE POLYMORPHISM AND HYPERHOMOCYSTEINEMIA IN STROKE Raka Widiana, I Gde; -, Tianing; Santoso, Anwar; Ketut Budiarsa, Gusti Ngurah
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Cardiovascular disease is a major cause of mortality in Indonesia. Hyperhomocysteinemia (hyper-hcy) isan independent cardiovascular risk factor, which may be due to methylene tetrahydrofolate reductase (MTHFR)deficiency, frequently linked to MTHFR gene mutation. This case-control study examined the relationshipbetween homocysteine (hcy), folate, and vitamin B12 plasma concentrations with C677T mutation of MTHFRgene among 20 haemorrhagic and non-haemorrhagic stroke patients aged 18-55 years, in Sanglah Hospital,Denpasar. 10 age-matched controls were selected via random sampling of 1 of 4 neighbours; all subjects wereBalinese. Hyper-hcy (X2: 5.4; PR: 1.8; 95% CI: 1.0-2.7; p=0.03), hypertension (X2: 13.12; PR 2.66; 95%CI1.41 to 5.02; p=0.00) were associated with increased risk of stroke. There were no significant correlationbetween plasma hcy levels and plasma folate and vitamin B12 levels as co-factors of hcy metabolism. Lowplasma vitamin B12, smoking, alcohol drinking, and hypertension tend to be determinant factors of hyper-hcy.This study found no mutation on 677 from C to T (C677T), however there were substitution in nucleotidesamong stroke and controls, with or without producing chances of amino acids, including: 1) G659A substitutionthat caused changing in amino acid from glutamine to glycine found in 1 stroke patients with hyper-hcy; 2)A660G substitution that cause changing in amino acid from glutamine to glycine found among all controlsubjects and among 3 stroke patients, one of whom had hyper-hcy; and 3) A661G substitution that causechanging in amino acid from lysine to glutamine found in one stroke patients with normo-hcy. Some variationswere also found in nucleotide 659 and 660, however, did not produce changing in amino acid. Whether thissubstitution is a kind of polymorphism that specific to Balinese ethnicity needs a further study to answer.
HIPONATREMIA PADA SEORANG PENDERITA DENGAN KECURIGAAN INSUFISIENSI ADRENAL Sri Yenny, Luh Gede; Gotera, Wira
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Hyponatremia is defined as a decrease in the serum sodium concentration to a level below 135 mmol perliter. Hyponatremia can be associated with low, normal, or high tonicity. One cause of hyponatremia is adrenalinsufficiency. Serum sodium concentration is regulated by stimulation of thirst, secretion of ADH, feedbackmechanisms of the renin-angiotensin-aldosterone system, and variations in renal handling of filtered sodium.Increases in serum osmolarity above the normal range (280-300 mOsm/kg) stimulate hypothalamicosmoreceptors, which, in turn, cause an increase in thirst and in circulating levels of ADH. ADH increases freewater reabsorption from the urine, yielding urine of low volume and relatively high osmolarity and, as a result,returning serum osmolarity to normal. Aldosterone, synthesized by the adrenal cortex, is regulated primarily byserum potassium but also is released in response to hypovolemia through the renin-angiotensin-aldosterone axis.Aldosterone causes absorption of sodium at the distal renal tubule.In this report, patient is male, 64 years old, with probable adrenal insufficiency. Patient have very lowrespond to sodium teraphy. The sodium level increased and have good respond after corticosteroid teraphy.Patient have low level of cortisol serum (18,60 ?/dl) in critically ill condition.The possibility of adrenal insufficiency is of crucial importance in critically ill patients. If the diagnosisis missed, the patient will probably die. In such patients, a blood sample for the measurement of plasma cortisoland corticotropin should be obtained, a short corticotropin test (see below) should be performed, and immediatehigh-dose cortisol therapy should be considered or instituted. A plasma cortisol value in the normal range doesnot rule out adrenal insufficiency in an acutely ill patient. On the basis of a recent study of plasma cortisolconcentrations in patients with sepsis or trauma, a plasma cortisol value of more than 25 ?g per deciliter in apatient requiring intensive care probably rules out adrenal insufficiency, but a safe cutoff value is unknown.
DISTRIBUSI GEOGRAFIS PENYAKIT GINJAL KRONIK DI BALI: KOMPARASI FORMULA COCKCROFT-GAULT DAN FORMULA MODIFICATION OF DIET IN RENAL DISEASE Raka Widiana, I Gde
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Chronic kidney disease (CKD) is related to the increased of cardiovascular morbidity and mortality. Thisstudy is aiming to identify the prevalence of CKD based on demographical distribution in Bali. A communitybased study has been conducted in Bali, 1) height region among indigenous community in a village at northernpart of Bali island using cluster random samples.; 2) in urban area at Denpasar city using stratified randomsampling and 3) in isolated coastal area in Nusa Ceningan island using cluster random sampling. The glomerularfiltration rate was calculated by Cockroft-Gault (C-G) formula and abbriviated Modification of Diet in RenalDisease ringkas with 4 variables (MDRD-4). The results of GFR using both calculation were compared. CKDwas defined based on KDOQI classification, namely GFR less than 60 ml/mnt. During the study 826 sampleswere collected consisted of 219 from height region (males/females 118/101, aged 48±15 years, BW 48.9±10.4kg, creatinine 0.97±0.64 mg/dL), 302 from urban area (males/females 137/165, aged 43±16 years, BW56.1±12.1 kg, creatinine 0.81±0/.19 mg/dL) and 305 isolated coastal area (males/females 150/155, aged 42±16years, BW 53.5±10.3 kg, creatinine 1.00±0.18 mg/dL). Using C-G, mean prevalence of CKD was 56.0%(95%CI 51.2-60.7%) consisted of 69.9% (95%CI 60.6-77.9%) in height region, 61.9% (95%CI54.5-68.8%) inurban and 42.3% (95%CI 33.7-51.4%) in isolated coastal area. Using 4-MDRD formula, mean prevalence ofCKD was 6.0% ( 95%CI 1.4-18.2%) consisted of 4.8% (95%CI 0.00-31.2%) in height region, 2,6% (95%CI50.3-43.1%) in urban and 9.8% (95%CI 2.5-27.4%) in isolated coastal area. In conclusion, there is a significantdifference of CKD prevalence in Bali if calculated by C-G compared with MDRD-4. Prevalence of CKD in Baliwith MDRD-4 (6.0%) is similar to those in other countries such as USA (4.2%) and Thailand (8.8%). Whetherthe calculation of GFR using MDRD-4 is more accurate than C-G in this setting, needs further study.

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