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Kota denpasar,
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INDONESIA
journal of internal medicine
Published by Universitas Udayana
ISSN : -     EISSN : -     DOI : -
Core Subject : Health,
Medicine & Pharmacology
Arjuna Subject : -
Articles 9 Documents
 1 
Search results for , issue "Vol. 9, No. 1 Januari 2008" : 9 Documents clear
EFEKTIFITAS OBAT PENURUN KOLESTEROL 'STATIN' DALAM MENURUNKAN KEJADIAN KARDIOVASKULER PADA SINDROM KORONER AKUT -, Sajinadiyasa; Santoso, Anwar
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Acute coronary syndromes (ACS) is usually caused by atherosclerotic process in coronary artery. Clinical manifestation of ACS is unstable angina pectoris, acute miocard infarc ( non-Q-wave and Q-wave) and sudden death. ACS develop have various degrees of coronary artery occlusion. ACS is caused by rupture of plaque with a thin cap. Inflammation is also plays the pathogenesis these syndromes. Stable plaque is imfortance condition in prevent cardiac event and statin drug lowering cholesterol can made stable plaque and as antiimplammation.
KORELASI ANTARA DERAJAT PENYAKIT SIROSIS HATI BERDASARKAN KLASIFIKASI CHILD-TURCOTTE-PUGH DENGAN KONSENTRASI TROMBOPOIETIN SERUM Juliana, I Made; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Thrombocytopenia is one of the most frequent haematological abnormalities in patients with livercirrhosis. It is generally considered to be due to pooling and destruction of the platelets in enlarged spleenwhich was defined as hypersplenism. Portal decompression procedures, either by surgical shunts ortransjugular intrahepatic portosystemic shunt (TIPS) have not led to a consistent rise in thrombocytes count.With the discovery of the lineage specific cytokine thrombopoietin (TPO) in 1994, the missing link betweenhepatocelular function and thrombopoiesis was found. TPO is predominantly produced by the liver andconstitutively expressed by the hepatocytes. In liver cirrhosis, the damaged of liver cells reduced TPOproduction. This leads to reduce thrombopoiesis in the bone marrow and consquently causesthrombocytopenia. However, these two pathogeneses were still remained controversial results in previousstudy abroad.The aim of this study was to determine the correlation between disease severity of liver cirrhosisbased on Child-Turcotte-Pugh classification and serum thrombopoietin concentration. An analytic crosssectional study had been conducted among liver cirrhotic patients in Sanglah Hospital Denpasar. The subjectwere adult liver cirrhotic patients that were not on upper or lower gastro-intestinal tract bleeding, septiccodition/septic shock, without history of taking antithrombocytic drugs or received platelets transfusion inlast two weeks, and no history of thrombocytopenia due to primary haematologic disorders. Statisticalanalysis was done by Spearman’s test and multivariate linier regression model, with significant level p <0,05.The number of subjects were 39 liver cirrhotic patients consist of 28 (71.8%) men and 11 (28.2%)women. The median of age was 53 (25 – 68) years. We found subjetcs with Child-Turcotte-Pugh class A 3(7.7%), B 18 (46.2%) and C 18 (46.2%) respectively with the median of Child-Turcotte-Pugh score was 9 (6– 14). The range of serum TPO concentration was 1.10 – 224.60 pg/ml, median of serum TPO was 40.60pg/ml. The median of thrombocyte was 103 x 103/L with range of 30 – 729 x 103/L. Liver cirrhoticpatients with thrombocytopenia were 29 (74.4%), 41.0% of them with moderate thromboytopenia. We foundnegative correlation between Child-Turcotte-Pugh score and serum TPO concentration ( r = - 0.319; p = 0.048) but there was no correlation between Child-Turcotte-Pugh class and TPO concentration. (r = -0.303;p = 0.061). We found significant positif correlation between thrombocyte count and serum TPOconcentration also (r = 0.354; p = 0.027). Based on multivariate linier regression model, we did not findsignificant association between TPO concentration and Child-Turcotte-Pugh score (p = 0.153) orthrombocyte count (p = 0.208), respectively. Conclusion: there was no correlation between disease severityof liver cirrhosis based on Child-Turcotte-Pugh classification and serum thrombopoietin concentration.
PERAN HIPOKSIA PADA PATOGENESIS PENYAKIT GINJAL Sastrawan, I Gede Pande; Suwitra, Ketut
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Chronic kidney disease is a current major worldwide health problem with an increasing prevalency.Kidney is a sensitive organ with hypoxic condition relate to its high tubular epithelial cells and vascular oxygenconsumption. Chronic peritubular ischemia may occur through several interrelating mechanisms. The activationof local renin-angiotensin system, angiotensin II, could induce hypoxia by means of hemodinamic and nonhemodinamicmechanisms.Anemia in renal disease could accelerate the decline of renal function through the induction oftubulointerstitial hypoxia. Non Steroidal Anti Inflamatory Drugs (NSAID) could evoke renal medullar hypoxiaby its regional hypoperfusion mechanism and the escalation of tubular transport. The Outer region of renalmedulla and tubulus are main target of hypoxic renal damage. The mechanism of hypoxia induced AcuteKidney Disease involves renal vascular and tubulus through the reduction of blood flow and the increasing oftubular oxygen demands. The Patofisiology of hypoxia induced chronic kidney disease occurs bytubulointerstitial damage which induce fibrogenesis, causing interference of peritubular blood flow and oxygenconsumption.
HUBUNGAN KADAR INTERLEUKIN 6 DENGAN KADAR BESI SERUM PENDERITA ANEMIA PADA PENYAKIT KRONIK Wibawa, I Putu Budi; Bakta, I Made
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Anaemia of chronic disease is the second most prevalence after iron deficiency anaemia. It is a commonproblem faced because it decreasing the life quality. The pathofisiology of anaemia of chronic disease is same inmalignancy, chronic infection and chronic inflammation. There is immune driven pathway. Releasedproinflammation cytokine cause hypoferemia and hyperferitinaemia which the result is anaemia. The Objectiveis to determine the correlation of IL-6 with serum iron and haemoglobin in anaemia of chronic disease patien atSanglah General Hospital, Denpasar – Bali. The Cross sectional analytic study performed to search thecorrelation of IL-6 with serum iron and haemoglobin. Descriptive statistical test performed to descript thesample characteristic and the distribution frequency of many variable. Spearman correlation used with p < 0.05is significant. From 25 samples, there are 12 man (48%) and 13 woman (52%). The mean of samples age is49.20 ± 17.95 years old. The most prevalence diagnosis is lung TB, 8 samples (32%). The mean of IL-6 is 39.32± 48.66 pg/mL. The mean of serum iron is 42.48 ± 22.09 ug/mL. The mean of hemoglobin is 10.49 ± 1.47 g/dL.The mean of feritin is 607.62 ± 841,01 ng/mL. The mean of monocyte count is 0,91 ± 0,95 cell/mm3. Thecorrelation of IL-6 with serum iron is not significant (r -0.05, p 0325). The correlation of IL-6 withhaemoglobin is not significant too (r -0.027, p=0.898). There are possibility cause, first, the gradation ofmalignancy, chronic infection, chronic inflammation is not performed. Second, other inflammation cytokine isnot checked. Comorbid disease also may take a place. We conclude the correlation of IL-6 with serum iron andhaemoglobin is not significant.
GAGAL JANTUNG Mariyono, Harbanu H; Santoso, Anwar
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Heart failure were the end stage of all heart disease and the cause of the increasing morbidity andmortality among patient. Almost five percent from all inhospital patient were heart failure. Heart failure hasbeen defined as the failure of the heart to pump blood to systemic. It can be classify into acute, acutedecompensated and chronic heart failure. New York Heart Association, Stevenson, Forrester have madeclassification based on the clinical symptoms. All cardiac problems can ended into heart failure, thepathogenesis was very complex including renin-angiotensin-aldosteron system, neurohormonal, sympatic nervesystem, nattriuretic peptide, and others. Twelve leads ECGs, echocardiography, chest x-rays, blood chemistries,catheterisation can help us diagnose patient with heart failure. Management of heart failure consist ofmanagement of acute and chronic heart failure, non drugs management, drugs and even an invasive treament.
PREVALENSI ASMA BRONKIAL ATOPI PADA PELAJAR DI DESA TENGANAN Sastrawan, I Gede Pande; Suryana, Ketut; Ngurah Rai, I B
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Asthma as one of the allergic diseases continuos to be a major public health problem in developed anddeveloping countries. We carried out a population-based survey to search the prevalence of atopic asthma inschool children of Tenganan, Manggis-Karangasem. Asthma was diagnose by quisioner and bronchodilator test.Atopic asthma define as asthma patients with total IgE > 100 IU/ml and or skin prick test 3 mm. Five hundredfourteen (91.5%) students out of of 562 students were were invited, participated the study. Thirty six (7%)students were diagnosed asthma based on peak expiratory flow variability after brochodilator test, stratified bysex there were 13 (36.1%) boys and 23 (63.9%) girls and 9 (25.0%) primary school children, 14 (38.9%) juniorhigh, 13 (36.1%) high school, respectively. Mean of age, serum IgE total and wheal diameter was 13.42 ± 3.26year, 1551.83 ± 2008.19 IU/ml, 22.9±3.4% and 3.58 ± 0.99 mm, respectively. Out of 36 asthma patients, 35(97.2%) diagnosed atopic asthma consist of 12 (34.3%) boys and 23 (65.7%) girls, and 1 (2.8%) diagnosednonatopic asthma.
SARIPATIPenelitian ini bertujuan untuk mengetahui efek dari monitoring gula darah sendiri pada glycaemic control dan indikator psikologis pada pasien yang baru terdiagnosis diabetes mellitus (DM) tipe 2. Rancangan penelitian ini adalah prospective randomi Study, Esmon
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Penelitian ini bertujuan untuk mengetahui efek dari monitoring gula darah sendiri pada glycaemic control dan indikator psikologis pada pasien yang baru terdiagnosis diabetes mellitus (DM) tipe 2. Rancangan penelitian ini adalah prospective randomised controlled trial dari monitoring gula darah sendiri. Penelitian ini mengikutsertakan 184 orang pasien (111 lakilaki) yang berusia <70 yang baru terdiagnosis DM tipe 2. Kriteria eksklusi mayor meliputi diabetes sekunder, pengobatan dengan insulin dan adanya pemantauan gula darah sendiri sebelumnya. Intervensi dilakukan dengan melakukan randomisasi terhadap subjek menjadi kelompok yang melakukan monitoring gula darah dan yang tidak melakukan monitoring gula darah (kontrol). Penelitian dilakukan selama 1 tahun dengan follow up dilakukan selama 3 bulan. Hasil akhir yang dinilai adalah kadar HbA1c, indikator psikologis, penggunaan obat hipoglikemik oral, indeks massa tubuh (IMT), dan jumlah insiden hipoglikemia yang dilaporkan. Hasil penelitian: 96 pasien (55 laki-laki) dirandomisasi menjadi kelompok monitoring dan 88 (56 kali-laki) sebagai kontrol. Pada awal penelitian tidak terdapat perbedaan antara mean (SD) umur (57,7 (11,0) pada kelompok monitoring dengan 60,9 (11,5) pada kelompok kontrol) atau HbA1c masing-masing(8,8 (2,1)% dan 8,6 (2,3)%). Pada kelompok monitoring terdapat IMT yang lebih besar pada awal penelitian (34 (7) dengan 32 (6,2)). Tidak terdapat perbedaan yang bermakna antara kedua kelompok pada waktu yang ditentukan (12 bulan) pada HbA1c (6,9 (0,8)% dengan 6,9 (1,2)%, P=0,69; 95% dengan konfiden interval untuk perbedaan -0,25% to 0,38%), IMT (33,1 (6,4) dengan 31,8 (6,0); penambahan untuk IMT awal, P=0,32), penggunaan obat hipoglikemik oral, atau insiden hipoglikemia. Monitoring berhubungan dengan skor untuk depresi yang 6% lebih besar pada well-being questionnaire (P=0,01). Kesimpulan: pada pasien yang baru terdiagnosis dm tipe 2, monitoring gula darah sendiri tidak memiliki efek terhadap glycaemic control tapi berhubungan dengan skor depresi yang lebih besar. Maurice JK et al. Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial. BMJ 2008;336;1174-7.
KESULITAN DIAGNOSIS DAN TERAPI PADA LIMFOMA PANKREAS DISERTAI SINDROMA KAUDA EQUINA Ridwan, Muhammad; Dharmayuda, Tjokorda Gde
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Lymphoma, part of non-Hodgkin’s lymphoma, is a rare malignancy in pancreas. Its clinicalpresentations and supporting laboratory and imaging results are similar to those of pancreas adenocarcinoma.Apart from pancreas, extranodal type of non-Hodgkin can involve many other organs including bone marrows,nervous system, and kidneys. Treatment should be focused on emergency priority and the underlying cause. Inthis case report, we have documented a 44 year-old man who initially presented jaundice and abdominal massand then diagnosed with pancreas tumor. However, pathology anatomy and histochemistry examinations ofperipancreas tissue biopsy and indicated a non-hodgkin lymphoma of pancreas, in form of diffuse large B celllymphoma, intermediate grade. The patient was developing cauda equina syndrome a week after laparotomy.Discussion among team suggested that both conditions may have the same root: lymphoma. The patient wasthen put on CHOP regiments of chemotherapy program and later, also underwent a spinal decompressionprocedure. Overall, jaundice, abdominal mass and other related symptoms subsided, and quality of lifeimproved, although some cauda equina symptoms remained.
AKURASI PULSE OKSIMETRI UNTUK MENDETEKSI DILATASI VASKULAR INTRAPULMONER (DVIP) PADA PASIEN SIROSIS HATI Sujana, I Ketut; Wibawa, I Dewa Nyoman; Santoso, Anwar
journal of internal medicine Vol. 9, No. 1 Januari 2008
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Abstract

Hepatopulmonary syndrome (HPS) is a complication of liver cirrhotic in the lung. This clinicalsyndrome has three components; liver disease, intrapulmonary vascular dilatation (IPVD), and a defect inoxygenation. Transthoraxic echocardiography with contras enhancement (CE-TTE) is a gold standart methodbut still expensive and difficult to detect IPVD because it needs expertise. Therefore, a simple non-invasivemethod to detect IPVD would be desirable. In this study pulse oximetry was evaluated as predictor foridentification of IPVD in patient with liver cirrhotic.Objective of ythis study is to determine the diagnostic accuracy of pulse oxymetry in detection IPVDcompared with CE-TTE as a gold standart. The diagnostic test was perfomed with pulse oxyimetry in 49consecutive patient with liver cirrhotic of >17 years old without primary cardiopulmonary diseases. Oxygensaturation (SO2) was determined using a pulse oximeter in supine and upright position. The IVPD measured byCE-TTE as gold standard. Measurement of predictor and effect variables were singgle blinded which mean thedifferent examiner, each of them does not know the result of others. Sensitivity, specificity, positif predictivevalue, negative predictive value, accuracy, and likelihood ratio was calculated with computer programmed.Eight patients (16.3%) had IPVD and fourty (83.7%) without IPVD. The cut off SO2 95.5 % in supineposition can predict IPVD with sensitivity 97.6% (CI 95% 72.8;100.0), specificity 87.5% (CI95% 93.2;100.0),positif predictive value 87. 0% (CI95% 78.2;96.7) negative predictive value 100% (CI95% 72.8;100.0),accuracy 95% (CI95% 75.8;100.0), positif likelihood ratio 7.8, and negatif likelhood ratio 0.3. The cut off SO293.0 % in upright position can predict IPVD with sensitivity 100% (CI95% 94.2;100.0), specificity 87.5%(CI95% 78.2;96.7), positif predictive value 100% (CI95% 94.2;102.2), negative predictive value 97.6 %(CI95% 93.4;100.0), accuracy 97.5%(94.1;100.0), positif likelihood ratio 8, and negatif likelhood ratio 0. Thecut off slope oxygen saturation from supine to upright position ( SO2) 2.5% can predict IPVD with sensitivity100% (CI95% 97.2;100.1), specificity 95.1% (CI95% 89.1;100.0), positif predictive value 80% (CI95% 52.0;100.0), negative predictive value 100 %, accuracy 100% (97.1;100.0), positif likelihood ratio 20.4, andnegatif likelhood ratio 0. Pulse oxymetry is accurate predictor to detect of IPVD in liver cirrhotic patientwithout primary cardiopulmonary disease.

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