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INDONESIA
journal of internal medicine
Published by Universitas Udayana
ISSN : -     EISSN : -     DOI : -
Core Subject : Health,
Medicine & Pharmacology
Arjuna Subject : -
Articles 8 Documents
 1 
Search results for , issue "Vol. 9, No. 2 Mei 2008" : 8 Documents clear
MANAJEMEN PERIOPERATIF PADA HIPERTENSI Wiryana, Made
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Abstract

Hypertension is a leading cause of death and the most frequent preoperative abnormality in surgical patients, and becomemajor risk factor for cardiac, cerebral, renal and vascular disease during intraoperative or post-operative periode. Agressivecontrolled hypertension will decrease complications due to the damage of end organs. Consequences by taking anti-hypertensiveagents is the interaction with other medications that being used during surgery. Consideration must be taken especially due to thehalf life and adjustment dose of this medications. The National Committee 7 (JNC 7) on prevention, detection, evaluation andtreatment of high blood pressure 2003, degree of hypertension can be classified into pre-hypertension (120-139/80-89), hypertensionstage 1 (140-159/90-99 mmHg) and hypertension stage 2 (systolic pressure 160 mmHg or diastolic pressure 100 mmHg).According to the etiology, hypertension can be classified into primary hypertension (80-95%) and secondary hypertension (10-15%) due to the causes. Usually hypertension always has association with abnormality of sympathetic activity, increasing thepheripheral vascular resistance (SVR) or increasing both of them. But the most common cause of hypertension is increasing thepheripheral vascular resistance. Management perioperative of hypertension includes evaluation and optimalised patients conditionpreoperative, management patients who under influenced of anesthetic agents and treatment post operative. Patient withhypertension incline to have instability haemodinamic and more sensitive to anesthesia and surgery procedures, so carefull mustbe taken at the beginning of anesthesia and surgery until post operatively, especially to control hemodynamic. The best monitoringfor patient with hypertension is by using suitable anesthetic techniques, anesthetic agents and antihypertensive agents. Postoperative hypertension can be happened due to several factors such as, inadequate antihypertensive agents, respiratory disturbance,pain, fluid overload, or distended of the bladder. Excellent perioperative management of hypertension patients beforesurgery will decrease morbidity and mortality rate
PERANAN TERAPI INSULIN INTENSIF TERHADAP INTERLEUKIN-6 (IL-6) DAN LUARAN KLINIK PADA PENDERITA KRITIS DENGAN HIPERGLIKEMIA Wiryana, Made
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Abstract

Hiperglycemia and insulin resistance are common in critically ill patients, even that have not previously had diabetes.Though it has been reported that pronounced hyperglycemia may lead to complications in such patients and cause of reactiveoxygen species (ROS) production, although data from controlled trial are still lacking. The debatable issue focused on whetherintensive insulin therapy to normalized blood glucose improves prognosis. The debate is mainly about the time to start therapy,and target of blood glucose level. The main purpose of this research is to know the different between intensive insulin therapy andconventional insulin therapy on decreases of cytokine production (IL-6), increase of albumin level and event of systemic inflammatoryrespons syndrome (SIRS). The design of this study is randomized pre and post control group design involving 40 adultpatients that admitted to the ICU Sanglah hospital Denpasar. They were randomly assigned to receive intensive insulin therapy inwhich blood glucose at the level between 80 ? 110 mg/dL or conventionl insulin therapy in which insulin therapy start if the bloodglucose level exceed 215 mg/dL and blood glucose maintained at the level between 180 ? 200 mg/dL. The results of this studyshowed that: (1) Significant decrease of IL-6 level (10.25 vs 2.02; p=0.023); (2) Significant increase of albumin level (0.62 vs0.22); (3) Significant decrease of SIRS (10 % vs 45%, p=0.000) on intensive insulin therapy group compare to the conventionalinsulin therapy group. Conclusions of this study is that the increase insulin dose as well as intensive insulin therapy can maintainblood glucose level at the level normoglycaemia between 80-110 mg/dL faster compare to the conventional insulin therapy. Onthe otherhand, interleukin-6 decreases cause of decreases ROS production and anti inflammatory effect of insulin. Intensiveinsulin therapy can increase albumin level and decrease of SIRS event on hyperglycemia in critically ill ICU patients compare tothe conventional insulin therapy.
TERAPI 2-ADRENERGIK KERJA PANJANG PADA TATALAKSANA PENYAKIT PARU OBSTRUKTIF KRONIK Putrawan, Ida Bagus; Ngurah Rai, Ida Bagus
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Abstract

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease, characterized by airflow limitationthat is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory responseof the lung to noxious particle or gases. There is a chronic inflammation that leads to fixed narrowing of small airways andalveolar wall destruction (emphysema). This characterized by increased number of alveolar macrophages, neutrophils and cytotoxicT-lymphocytes, and the release of multiple inflammatory mediators. A high level of oxidative stress may amplify thisinflammation. There is also increased elastolysis and evidence for involvement of several elastolytic enzymes, including serineproteases, cathepsins and matrix metalloproteinasses. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelinesrecommend a stepwise approach to disease management, with bronchodilators being the mainstay of treatment. 2-Adrenergicagonists induce bronchodilatation through stimulation of 2-receptors, leading to an increase in cyclic adenosine monophosphate.In addition to prolonged bronchodilatation, long-acting 2-agonists (LABAs) exert other effects that may be of clinicalrelevance. These include inhibition of airway smooth-muscle cell proliferation and inflammatory mediator release, as well asnonsmooth-muscle effects, such as stimulation of mucociliary transport, cytoprotection of the respiratory mucosa, and attenuationof neutrophil recruitment and activation.
HUBUNGAN ANTARA KADAR LEPTIN DAN ADIPONEKTIN PLASMA PADA PASIEN DENGAN DIALISIS RUTIN Raka Widiana, I Gde; Kandarini, Yenny; Suwitra, Ketut
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Abstract

Leptin and adiponectin (ADPN) are adipokines with respective pro-atherogenic and anti atherogenic properties. In nonrenalpatients, both hyperleptinemia and hypoadiponectinemia are associated with cardiovascular complication. Relationshipsbetween serum leptin and ADPN in patients with dialysis is not consistently reported.Objective of this study is evaluate relationships between serum ADPN and leptin in patients with dialysis. A cross sectionalstudy was performed in and 54 HD and 22 CAPD patients.Seventy six patients were enrolled this study, M/F 41/76, aged 48.4±11.4 year, BMI 21.4±2.7 kg/m2, haemoglobin (Hb)7.9±1.5 mg/dL, blood sugar 94.8±33.5 mg/dL, albumin 4.1±0.4 g/dL, total-cholesterol 177.9±46.3 mg/dL, triglyserida 164.4±104.8mg/dL, SC 14.3±3.8 mg/dL, TNF 14.40±7.43 pg/mL, ADPN 17.6±7.6 µg/mL, leptin 13068±23589 µg/mL (log leptin 3.7±0.59µg/ml). Using Spearmans rho analysis there were negative correlation between log-leptin and ADPN (r= -0.39, p= 0.00), andpositive correlation between log leptin and Hb (r= 0.25, p= 0.04), insulin(r= 0.44, p = 0.00), total-cholesterol (r= 0.34, p = 0.003),triglyserida (r= 0.41, p= 0.00), and BMI (r= 0.41, p= 0.00), but there was no correlation between log-leptin and albumin, bloodsugar, SC and TNF alfa. Using multiple regression to analyze relationship between ADPN and leptin, insulin, Hb, and dialysismodality, we found log leptin independently correlated with ADPN (B= -0.402, p= 0.01, 95%CI B: -1.24 to -0.32). Using multipleregression to analized relationship between ADPN with log-leptin, BMI, total cholesterol, and triglyserida, we found log leptin(beta= -0.3, p= 0.01, 95%CI B: -0.98 to -0.13) and triglyserida independently correlated with ADPN (beta= -0.5, p= 0.00, 95%CIB: -0.008 to -0.003).Serum leptin and triglyseride relate with ADPN. Some metabolic parameters such as insulin resistance, anemia, dialysismodality, nutritional status (BMI and total cholesterol) have indirect relationship with ADPN may be through leptin secretion.
ADVERSE DRUG REACTION Mariyono, Harbanu H; Suryana, Ketut
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Abstract

There are lots of new drugs that made for therapy, prevent and even as a diagnostic tools. Beside the desired effect therewere also undesired effect that can occur when managing patient with drugs which then we call adverse drugs reaction. Anadverse reaction to a drug has been defined as any noxious or unintended reaction to a drug that is administered in standard dosesby the proper route for the purpose of prophylaxis, diagnosis, or treatment. Adverse drug reaction can be devided in two groups,which is reactions than can occur on everyone and the ones that can only occur on susceptible ones. One of the adverse drugreaction is drug allergy. History taking is the most important thing on diagnosing drug allergy, one that can help was Naranjosscore. We can run few more test to defined the type of Adverse Drug Reaction. For managing patient with adverse drug reaction,we have to avoid drugs that induce the reaction, premedication and also desensitisation.
PREDIKTOR DISFUNGSI EREKSI PADA PENDERITA DIABETES TIPE 2 DI POLIKLINIK PENYAKIT DALAM RS SANGLAH DENPASAR Ratna Saraswat, Made; Sanjaya, Dwija; Suastika, Ketut
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Abstract

Erectile dysfunction (ED) is a commonly reported condition among men with diabetes, however little is known aboutthe predictive factors associated with diabetic ED. To examine the predictors related to ED among type 2 diabetes outpatient, aconsecutive cross sectional study at Internal Medicine Outpatient Clinic, Sanglah Hospital was conducted, enrolled 137 type 2diabetes men aged between 35 ? 77 years old. We found 79.5% of type 2 diabetics with ED. Erectile function score was significantlycorrelated with other component of International Index of Erectile Function 15 (IIEF 15) including orgasmic function(r=0.622, p<0.001), sexual desire (r=0.782, p<0.001), intercourse satisfaction (r=0.911, p<0.001), and overall satisfaction (r=0.842,p<0.001). Erectile function was also correlated with age (r=0.315, p<0.001). Chi square analysis among diabetic complication,ED were significantly higher among patient with albuminuria/proteinuria (p=0.025, prevalence ratio 7.43 (95% IC 0.95 ? 58.15).Other factors such as duration of diabetes, central obesity, cigarette smoking, alcoholism, diabetic control (HbA1C and lipidprofile), diabetic complications, and hypertension were not significantly correlated with ED. ED were high among type 2 diabeticsand erectile function were correlated with orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction.ED also correlated with age and albuminuri/proteinuria but not with other predictors.
SEORANG PENDERITA HIPOKALSEMIA BERAT OLEH KARENA HIPOPARATIROIDISME DIDAPAT Dharmawan Harjanto, David; Ratna Saraswati, Made; Suastika, Ketut
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Abstract

Albeit rare, hypocalcemia might present an acute severe symptom as hypocalcemic seizure, which is documented in ourpatients. Failure in its diagnosis and management will lead to significant morbidity and mortality. Establishing the PTH status,anorganic-phosphate and magnesium level will enable investigation on possible etiology of hypocalcemia. The overall incidenceof post thyroidectomy hypoparathyroidism and hypocalcemia is about 0.5-3 % worldwide. The pathophysiology are multifactorial,it is not simply the glands extirpations, as well as its multiple risk factors although operator technique skill is still theprominent one. We have presented a case of 24 year old female with an acute generalized seizure (hypocalcemic seizure) andprolonged corrected QT interval due to a severe hypocalcemia secondary to hypoparathyroidism from a total thyroidectomy,accompanied by acquired hyperthyroidism and a cerebral cortex calcification. Clinical symptoms and total calcium were improvedafter intravenous calcium gluconate, followed by oral calcium and calcitriol administrations. However, the ideal therapyfor hypoparathyroidism is still the hormone substitution, either by auto/xeno-transplantations or injections, pending further studies.PTH level determinations immediately or several hours after surgery and thus oral calcium supplementations might predictand reduce the incidence of post thyroidectomy hypocalcemia and hypoparathyroidism.
EFFECT OF POLYETHERSULFONE COMPARED TO CELULLOSE DIACETATE DIALYZER MEMBRANE ON SERUM INTERLEUKIN-6 AND C-REACTIVE PROTEIN LEVES IN HEMODIALYSIS Raka Widiana, I Gde
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Abstract

Synthetic dialyzer membrane is considered to have greater biocompatibility properties than cellulose based dialyzermembrane. This study is aiming to determine whether the use of polyethersulfone synthetic dialyzer (PES) membrane producelower inflammatory (IL-6 and CRP) response compared to celullose diacetate (CDA).Study samples were selected consecutively from all kidney failure patients who were undergoing routine HD at HDcenters in Denpasar Mayoralty. Thirty HD patients consisted of 15 with PES (11 males and 4 females, aged 45 ±10 years) and 15patients with CDA (8 males and 7 females, aged 48 ±13 years) were included in this study.A significant increase of plasma IL-6 per 1000 monocytes (Z=-4.103, p=0.003), from18.56±21.00 pg/dl before HD to56.00±105.41 pg/dl after HD among two groups was found. When the increase of plasma IL-6 per 1000 monocytes duringhemodialysis was compared bewteen the two groups, a significant higher increase of plasma IL-6 per 1000 monocytes in CDAgroup compared to PES group (71.47±142.51 pg/dl versus 3.38±4.46 pg/dl, Z=-2.883, p=0.003). There was no significant increaseof plasma hs-CRP levels before-after HD among both groups. Also, there was no significant difference of plasma hs-CRPchanges during HD between the two groups. Using multivariate ANCOVA, a consistent effect between the two membrane (F=18.401,p=0.000) on logistic transformed of plasma IL-6 per 1000 monocytes changes. However, this effect was not significant (F=1.937,p=0.176) on logistic transformed of plasma hs-CRP changes. It was found that plasma levels of pre HD albumin related to logistictransformed of plasma IL-6 per1000 monocytes (F=5.610, p=0.026), however, there were no relationship between HD factor(KT/V) and HD age (months), with logistic transformed of plasma IL-6 per 1000 monocytes changes.Increament of plasma IL-6 levels per 1000 monocytes during HD is smaller, however, changes of plasma hs-CRP levelsduring HD is similar among HD patients with PES than CDA membrane. In addition, plasma levels of pre HD albumin may affectplasma IL-6 changes during HD.

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