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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 8 Documents
 1 
Search results for , issue "Vol. 9, No. 3 September 2008" : 8 Documents clear
PENGARUH VITAMIN C TERHADAP C-REACTIVE PROTEIN SEBAGAI PETANDA INFLAMASI PADA GAGAL GINJAL KRONIK DENGAN HEMODIALISIS REGULER Wulandari, Diah Catur; Suwitra, Ketut
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

One of possible treatment to diminish the inflammation in regularly hemodialysis chronic kidney disease (RHCKD) isantioxidant. Ascorbic acid can inhibit nuclear factor B (NF-B) activation, decrease C-reactive protein (CRP) levels. The objectiveis to determine whether ascorbic acid 1000 mg intravenously can decrease CRP levels in RHCKD. In this randomized singleblind controlled clinical trial, thirty two patients were recruited. CRP was examined at baseline and 4 weeks. Permutted blockrandomization was done to receive vitamin C 1000 mg or NaCL 0.9%. CRP levels were compared between the two groups asprimary outcome. During study 16 patients were received i.v. ascorbic acid 1000 mg and 16 patients were received NaCl 0.9%.One of patient in vitamin C 1000 mg group was dropped out due to infection. During follow-up, both groups showed increased ofCRP among ascorbic acid 1000 mg groups (from 1.77 ± 1.41 mg/L before to 1.83 ± 1.78 mg/L after study; increase by 0.06 ± 1.38mg/L; 95% CI -0.20 ? 0.28 P = 0.72) and among NaCl 0.9% group (from 2.83 ± 2.86 mg/L before to 2.98 ± 3.29 mg/L afterstudy increase by 0.15 ± 1.38 mg/L 95% CI -0.14 ? 0.11 P = 0.82 ). Although CRP levels were increased, no statistically differentof CRP increament in both groups. The conclusion of this study is ascorbic acid 1000 mg during 4 weeks can not decrease CRPlevels in RHCKD.
ASPEK PULMONOLOGIS INFEKSI OPORTUNISTIK PADA INFEKSI HIV/AIDS Agustriadi, Ommy; Sutha, Ida Bagus
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

Human Immunodeficiency Virus (HIV) known as etiologic agent for AIDS (Acquired Immunodeficiency Syndrome), inwhich followed or accompanied by certain opportunistic infections and malignancies. Perhaps the most important reason for thefrequent development of diverse pulmonary complications in HIV/AIDS relates to the fact that the lung is chronically exposed toboth infectious or non-infectious airborne agents (exogenously) and hematogenously spread agents (endogenously) through anexpansive surface area consisting of millions of units called alveoli, that infected alveolar macrophages and lymphocytes.The mechanisms that may play role of defected lung defend mechanisms were direct effect of HIV that infected and killcells cause damaged to the effector cells and shifted cells function from immunostimulative to immunosupressive, then impairedmigration capacity of lymphocytes, monocytes or netrophils to lung. In turn, the opportunistic infections easily developed.In almost 65% AIDS patients also accompanied with oppportunistic infections in the lung. Pneumocystis cariniipneumoniae was the most often, followed by M. tuberculosis infection, bacterial and fungal pneumoniae respectively. Whereas,viral pneumoniae was rare
HUBUNGAN ANTARA INTERLEUKIN- 6 DAN C-REACTIVE PROTEIN PADA SIROSIS HATI DENGAN PERDARAHAN SALURAN MAKANAN BAGIAN ATAS Mariadi, I Ketut; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

Variceal bleeding is a frequent complication of liver cirrhosis. Upper gastrointestinal (GI) bleeding is a risk factor forinfection. The severity of liver cirrhosis was correlated with infection and GI bleeding. Bacterial infection and endotoxin promotecytokine proinflammation (IL-6) release from monocyte. IL-6 stimulates the liver to produce CRP. Does liver cirrhosisaffect the CRP production? Recently, there are no data about the correlation of IL-6 and CRP in liver cirrhosis with uppergastrointestinal bleeding. A cross-sectional analytic study was performed to describe the correlation between IL-6 and CRP inliver cirrhosis patient with upper gastrointestinal bleeding.We performed a cross-sectional analytic study in 52 liver cirrhosis patients. The liver cirrhosis patients with uppergastrointestinal bleeding in last 14 days, absence of steroid and statin treatment, without hepatoma, and GFR 15 ml/mnt/1.73m2, were collected consecutively. The correlation of IL-6 and CRP was analyzed with Pearson correlation test, mean differenceof CRP between Child Turcotte Pugh (CTP) group was analyzed by Ancova test continued with post hoc Tamhane test, the effectof CTP on CRP production was analyzed with Ancova test.Seventy-five percent out of 52 samples were male and the rest were female. Two of them (3.8%) with CTP score A, 20(38.5%) CTP score B and 30 (57.7%) CTP score C. Mean of IL-6 was 28.29 ± 34.60. Mean of CRP was 17.17 ± 28.80 mg/L. Wefound strong positive correlation between IL-6 and CRP (r = 0.610; p<0.001). CTP score didnt have significant independenteffect on correlation of IL-6 and CRP level (F=2.33; p=0.108). Significant mean difference of CRP was found between CTP scoregroup (F=4.27; p=0.02).In conclusion, Interleukin-6 has a strong correlation with CRP in liver cirrhosis with upper GI bleeding. CRP level issignificantly higher in severe liver cirrhosis. And the degree of liver damage doesnt have significant independent effect oncorrelation of IL-6 and CRP level. These results show us that hepatocyte in liver cirrhosis still adequately produce CRP.
HUBUNGAN ADIPONEKTIN DENGAN GAGAL JANTUNG KONGESTIF Agung Budiyasa, Dewa Gde; Santoso, Anwar
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

Adipose tissue synthesis several protein involved in the regulation of insulin action and lipid metabolism. Among theprotein adipocytokines, adiponectin is the most abundant and exerts profound anti-diabetic, anti-atherogenic, and anti-inflammatoryroles. Adiponectin may contribute to the regulation of vascular hemostasis by its ability to affect several signaling pathwaysin the vessel wall and modulate excess inflammatory responses. In the heart, adiponectin serve as a regulator of cardiacinjury through modulation of pro-survival reaction, cardiac energy metabolism, and inhibition of hypertropic remodelling. Manyeffect of adiponectin in the cardiovascular system correlate with the activation of both AMPK and Cox-2.Adiponectin levels may influence the development of CHF, but the epidemiological data are somewhat complex. This isdue in part to the fact that while higher body mass indices are a risk factor for heart failure, obesity is a predictor of improveprognosis in patients with establish CHF because wasting is strongly associated with the increased risk of death in the final stageof this disease. In this regard, high adiponectin levels are a predictor of mortality in patients with heart failure. Presumably, thisparadoxical relationship exist because high body mass, hence low protein, favors survival in endstage heart failure. Therefore,further studies should examine adiponectin levels in patients with stable heart failure
HUBUNGAN KENDALI GLIKEMIK DENGAN ASYMMETRIC DIMETHYLARGININE PENDERITA DIABETES MELITUS TIPE 2 LANJUT USIA Ngurah Hariawa, Kadek; Suastika, Ketut
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

Increasing life expectacy is usually in line with increasing prevalence of matabolic diseases, especially diabetes mellitus(DM). Old age and DM are risk factors for cardiovascular disease. Endothelial dysfunction is the early process of atherosclerosis.Asymmetric dimethylarginine (ADMA) is a marker for endothelial dysfunction. Until recently however, there is a lack of studyon the correlation of diabetes control and ADMA in elderly with DM.The objective of this study was to assess the correlation of diabetes control with ADMA in diabetes elderly. The designof the study was cross sectional analytic study. The study subects were diabetic patients aged 60 years or above without smokingand existance of end stage renal disease.The 80 study subjects consisted of 57 males and 43 females, ages ranging from 60 to 80 years. The majority of thesubjects were with other diseases i.e. hipertension 62 (77.5%), dyslipidemia 51 (63.8%), overweight 59 (73.9%), decreased renalfunction with creatinin clearence below 60 ml/mnt 58 (72.5%), hyperhomocysteinemia 35 (43.8%). The subjects with goodglicemic control were 25 (32%), moderate 31 (38.8%), and bad glicemic control 24 (30%). Pearson correlation showed there wasno correlation between glicemic control (fasting blood glucose, 2 hour after meal blood glucose, HbA1c) and ADMA. Analysis onother factors showed a correlation of ADMA with sistolic blood pressure (r=-0.222; p=0.024) and homocystein (r=0.333; p=0.001).Multiple liniar regression analysis constanly showed a correlation between homocystein and ADMA (B=0.473; p=0.003). Thenew construction model of this study was the formula ADMA (µmol/L)= 0.213+0.473 log homocystein µmol/L. Based on thecriteria used diabetes control, we found mean difference of ADMA at systolic blood pressure (p=0.031). There was no meandiffrence of ADMA found based on the treatment regimens given i.e. those given insulin or not (p=0.547) and those givenmetformin or not (p=0.219).In conclusion, blood glucose control has no correlation with ADMA in the elderly with DM, however homocystein haspositve correlation with ADMA in elderly with DM. The elderly with DM have several accompanying of diseases.
INSUFFISIENSI KATUP MITRAL PADA SEORANG PENDERITA LUPUS ERITEMATOSUS SISTEMIK Sanjaya, Surya; Kambayana, Gede; Rina, I K; Raka Putra, Tjokorda
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

Systemic lupus erythematosus (SLE) is a multisystem inflammatory disease that is often difficult to diagnose and theetiology still unclear. Before the diagnosis can be established, four of eleven clinical and laboratory criteria must be met. Theprogression of SLE is acute fulminant, chronic remision and exacerbation. Prevalens of SLE in the many countries is variouslybetween 2.9 ? 400 per 100.000. SLE usually occur in reproduction period of human (15 ? 40 years old) and female is morecommon than male 5.5 ? 9.0 : 1. Cardiovascular manifestation of SLE is an serious case and increasing of mortality. Pericarditis,miocarditis and fibrinous Libmann-Sacks endocarditis are a common cardiovascular manifestation. Insufficiency of mitral andaorta valve is a rare complication of SLE and usually combination with pulmonal vein congestion and lung edema. We reporteda systemic lupus erythematosus with insufficiency mitral valve in Sanglah hospital because this case is very rare in populationand complicated. Accurate diagnosis of SLE is important because prompt treatment can reduce morbidity and mortality.
PENGARUH SPIRONOLAKTON SEBAGAI TERAPI TAMBAHAN ACE INHIBITOR DAN/ATAU ANGIOTENSIN RECEPTOR BLOCKERS TERHADAP ALBUMINURIA PADA PENYAKIT GINJAL KRONIK PRADIALITIK STUDI KLINIS ACAK TERKONTROL BUTA GANDA -, Yuriawantini; Suwitra, Ketu; Raka Widiana, I Gde; Sidharta Loekman, Jodi; Sudhan, Wayan; Kandarini, Yenny
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

Recently studies suggest that aldosterone contributes to progressive kidney disease. This has raised the possibility ofusing aldosterone antagonist in CKD. To evaluate effects of spironolactone 25 mg/day on albuminuria in CKD patients, thirtyCKD patients were enrolled in randomized double blind placebo controlled study. Permutted block randomization was done toreceive spironolactone 25 mg/day or placebo as control in addition to ACE inhibitors and/or ARBs. Albuminuria and bloodpressure were examined at baseline and 12 weeks. Albuminuria was measured as urinary albumin:creatinine ration and comparedas primary out come. During this study 15 patient were received conventional therapy and spironolactone 25 mg/day and 15patient were received placebo. One of patient dropped-out after 4 weeks due to hiperkalemia in spironolactone group and one ofpatient in the control group lost to follow-up. After 12 weeks of therapy, in spironolactone group albuminuria was decreased from510 (180.0 ? 798.0) to 254.0 (40.3 ? 491.8) mg/g, MD, 187.0 (29.0 ? 332.3) mg/g, p= 0.035 and in control group from 804.0 (52.0? 1126.0) to 637.0 (99.0 ? 1098.8) mg/g MD -10.5 (-186.5-86.0) mg/g, p= 0.490. There was significant difference of decreamentof albuminuria in both groups (Z=-0.69, p=0.046). There were no statistically different of serum potassium levels and bloodpressure in both groups after treatment. Baseline aldosterone levels were not significantly correlated with albuminuria (r = -0.128,p = 0.499). As Conclusion in this study is spironolactone reduces albuminuria in pradialytic CKD patients
DIAGNOSIS DAN PENATALAKSANAAN PNEUMONITIS HIPERSENSITIVITAS Dary, I Wayan; Ngurah Rai, Ida Bagus
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

Hypersensitivity pneumonitis (HP), or extrinsic allergic alveolitis, is a group of immunologically mediated lung diseasesin which the repeated inhalation of certain finely dispersed antigens of a wide variety, mainly including organic particles or lowmolecular weight chemicals, provokes a hypersensitivity reaction with granulomatous inflammation in the distal bronchioles andalveoli of susceptible subjects. HP can be classified as acute, subacute, and chronic form. Clinically its presented as fever, fatique,myalgia, cough and shortness of breath after exposured and physical finding with fever, takipneu, diffuse rhales bibasal. Chestradiograph showed diffuse micronodular pattern or ground-glass appearance on lower and mid field lung only found on tenperse10%n of cases. HRCT can show more specific abnormalities of the lung. Lung function test describe restrictive type.Hystopathologic features are noncaseating granulomas, giant cells with a lot of nucleus, and mononuclear cells infiltration. Themost diagnostic criteria used is made by Richerson et al. the history and physical findings and pulmonary function tests indicatean interstitial lung disease, the X-ray film is consistent, there is exposure to a recognized cause, and there is antibody to thatantigen. Being an immune reaction in the lung, the most obvious treatment of HP is avoidance of contact with the offendingantigen. Systemic corticosteroids represent the only reliable pharmacologic treatment of HP but do not alter the long-term outcome.On the acute HP, prednisone administrate 1 mg/kgBW/day or its equivalent dose for 7 ? 14 days than tapering off foe 2 ? 6 weeks.

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