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HUBUNGAN FERITIN SERUM DENGAN KADAR IL-2 PADA PENDERITA ANEMIA DEFISIENSI BESI Losen Adnyan, I Wayan; Bakta, I Made; Suega, Ketut; Darmayuda, Tjok Gde
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Iron deficiency anemia is one of the most common single nutrient deficiency in the world, impairs lymphocyte proliferationin humans and laboratory animals. The mechanisms are not fully understood. Cellular iron availability modulates the differentiationand proliferation of Th-1 and Th-2 subsets. Th-1 clones are very sensitive to treatment with antitransferrin receptor antibodies,resulting in inhibition of their DNA synthesis. Th-1-mediated immune effector function may be much more sensitive to changesin iron homeostasis in vivo. Th-1 produce IFN- and IL-2. The effects of iron deficiency on immunity remain controversial. Crosssectional study was performed to determine the relationship between iron status (serum ferritin) and IL-2 production in patientswith iron deficiency anemia. This relationship was assessed in 33 adult patients. Infection, malnutrition, malignancy, acute bleedingand using immunosuppressive medicines were excluded. Iron deficiency anemia was defined by Kerlin et al criteria. Serumferritin was measured by immunometric assay and IL-2 was measured by immunoassay solid phase ELISA. The mean of Hb was6.27 ± 2.19 g/dL, serum ferritin 30.07 ± 49.41, IL-2 2.26 ± 1.30. The most causes of this anemia were chronic bleeding i.e. pepticulcer, ancylostomiasis, menorrhagia, hemorrhoid and hematuria. There was not correlation between serum ferritin and IL-2 (r =0.118; p = 0.512). There was not correlation between Hb and IL-2 too (r = 0.220; p = 0.219). Lack of the correlation may be causedby some conditions i.e. without activated T cell, inadequately controlled the other trace elements or co-morbid diseases. Our datasupport that there is not correlation between serum ferritin, Hb and IL-2 production by lymphocyte without stimulation. Furtherprospective studies are needed to determine relationship between iron status and immune function.

PAJANAN OKUPASI DARI PASIEN TERINFEKSI HIV DI RSUP SANGLAH DENPASAR Somia, Agus; Utama IM, Susila; Parwati Merati, Tuti
journal of internal medicine Vol. 11, No. 3 September 2010
Publisher : journal of internal medicine

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Health care personnel who have occupational exposure to blood and some body ! uids or tissues are at risk for HIVinfection. Aim of this study to know about characteristics of occupational exposure to HIV who cares in VCT-CST OutpatientClinic Sanglah Hospital Denpasar. A retrospective descriptive study was done among exposed persons who care in VCT-CSTOutpatient Clinic Sanglah Hospital Denpasar during 1 January 2006 ? 31 December 2007.Total 11 cases occupational exposure occurred in health care places, 9 cases occurrence in Sanglah Hospital and 2 casesoutside Sanglah Hospital. The profession of exposed persons were doctor (45%), medical student (18.2%) and nurse (18.2%).The type of exposure were percutaneous injury (72.7%). Severity of exposures included, 36.4% KP1 (small volume in shorttime), 45.5 % KP2 (large volume and/or long time or percutaneous injury with solid needle, or superfesial laceration), and18.18% KP3 (percutaneous injury with hollow needle, deep injury, visible blood on the device which caused the injury, injurywith needle which had been placed in a source patients artery or vein). HIV-positive class I patients (asymptomatic HIV or alow viral load) was 27.3 % and HIV-positive class II (symptomatic HIV or AIDS, acute seroconversion, or high viral load) was27.3%. about 72% exposed person taken postexposure prophylaxis with combination zidovudine and lamivudine for 4 weeks.Anti HIV status exposed persons at " rst time exposure, 3 month after exposure and 6 month after exposure were negative.We conclude that the most type of exposure were percutaneous with source of exposure each included HIV positive classI dan HIV positive class II. About two third of exposed person taken postexposure prophylaxis with zidovudine and lamivudinecombination. Anti HIV status exposed person a " rst time exposure, 3 month after exposure and 6 month after exposure werenegative.

PENATALAKSANAAN PASIEN DIABETES MELITUS DI POLIKLINIK RUMAH SAKIT SANGLAH DENPASAR Adnyana, Losen; -, Hensen; Gde Budhiarta, Anak Agung
journal of internal medicine Vol. 7, No. 3 September 2006
Publisher : journal of internal medicine

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A cross-sectional study was conducted from March until May 2003 among 100 diabetic patients, registered inDiabetic Clinic, Department of Internal Medicine Sanglah Hospital for management of diabetes for more than 12months. Primary objective was to evaluate diabetes control, diabetes management and late complications status in thediabetic population managed by Diabetic Clinic as urban health care clinics. The subjects were 65% men and 35%women with mean of age 59.4 years and known having diabetes since 1-5 years (mean 2.1 years). Samples consist of4% type-1 diabetes; 95% type-2 diabetes and 1% gestational diabetes. Antidiabetic medication were sulfonylurea67%; metformin 55%; insulin 26% and others (glucosidase inhibitors, thiazolidenedione and others) were 0%.According to the level of AIC, lipid profile and blood pressure, 40% (AIC < 6.5%); 50% (HDL-chol >-45 mg/dl);27.0% (LDL-cho! < 100 mg/dl); 67.6% (triglyceride < 150 mg/dl) and 23% (blood pressure < 130/80 mmHg) werecategorized as good diabetic controls. Large proportion of poor diabetic controls partly may be due to low proportionof education days received on diabetes in the past year (57% have only I education day and 32% with zero educationday). This condition also impact on lifestyle modification where 63% not regularly and 14% never follow the diet and50% never . exercise. Also 12% still smoker and 4% sti 11 consume alcohol on a regu lar basis. Micral test to detectmicroalbuminuria as an early I phase of diabetic nephropathy were not commonly used (7%), and dipstick to detectmakroalbuminuria (99%). Blood test for serum creatinin showed 89% with serum creatinin <2 mg/dl and 11% withserum creatinin >2 mg/dl. Another chronic complication were neuropathy (10.1%); cataract (10.4%); backgroundretinopathy (8.6%), healed ulcer (3%), stroke (2%), leg amputation (1%), absence of foot pulse (1%), acuteulcer/gangrene (1%), myocard infard/CABG/angioplasty (1%).

PENGARUH INSULIN TERHADAP FUNGSI KARDIOVASKULAR Ridwan, Muhammad; Gotera, Wira
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

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Insulin is an anabolic hormone responsible for regulation of glucose metabolism and signals for storage and usage ofmany fundamental nutrients such as glucose, amino acids, and fatty acids. Its effects on cardiovascular function, reveal widerearly-known insulin actions, are based on the balance between its NO-dependent vasodilator action and endothelin-1-dependentvasocontriction action regulated by signals through phosphatidylinositole 3-kinase (PI3K) and mitogen-activated protein kinase(MAPK)-dependent pathways on vascular endothelial cells. On insulin resistance setting, signal perturbances of PI3K pathwayand enhanced signals through MAPK pathway are conditions underlying link between metabolic disorders and cardiovasculardiseases. Insulin also has antiinflammatory effects by suppressing expression of ICAM-1, MCP-1, NF-kB, MMP-9 and CRP. Onthe heart, insulin increases contractility and plays important roles in maximazing heart glucose uptake particularly in stress states.In addition, insulin plays a role in physiologic heart growth through Akt pathway. However, chronic exposure of insulin isassociated with ventricular disfunction. In term of cardiovascular function, insulin is known to increase peripheral blood flow danto decrease peripheral resistance, so that results in enhanced cardiac output without significant changes in blood pressure.Not only can improved insulin action repair glucose metabolism, but also improve risks underlying atherosclerosis andcardiovascular complications of diabetes. In 2007, European Cardiac Society (ESC) has recommended intensive insulin usage totightly control blood glucose in order to improve adult critically ill and heart surgery patient mortality and morbidity

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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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.

KELAINAN HEMATOLOGI PADA DEMAM BERDARAH DENGUE 1Ni Made Renny A Rena, 2Susila Utama, 2Tuty Parwati M 1 Divisi Hematologi Onkologi Medik, 2 Divisi Penyakit Tropik dan Infeksi Bagian / SMF Ilmu Penyakit Dalam, FK Unud RSUP Sanglah Denpasar Email: renny_ang@ Renny A Rena, Ni Made; Utama, Susila; Parwati M, Tuty
journal of internal medicine Vol. 10, No. 3 September 2009
Publisher : journal of internal medicine

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Dengue infection can cause a unique and complex alteration to the homeostasis mechanism of the body. The underlying of bleeding, as a more frequent clinical manifestation of dengue was based on multiple factors such as thrombocytopenia, thrombopathy, Disseminated Intravascular Coagulation (DIC), prolonged of bleeding time and prothrombin time, decrease of some coagulation factors, hypoÞ brinogenemia and also increasing of Þ brin degradation products. Beside, kinin and bradikinin sytem was also activated. Endothelial dysfunction as one of coagulopathy disorder in dengue infection patients can shown as some clinical manifestation. Antigen antibody complex of dengue, activated the coagulation system, start from Haegeman factor (factor XII become factor XIIa). Therefore, factor XIIa activated the others coagulation factors respectively until Þ brin are produced, Þ brinolysis system are also activated, plasminogen change become plasmin through enzymatic process. Disseminated intravascular coagulation, is an emergency complication of dengue infection, which occur because activation of coagulation system and decreasing of thrombocyte level. Others condition such as shock, hypoxia, and acidosis also thought to be the factors that cause the DIC. Deterioration of all of the hemopoesis system, which are hypoplasia occur on the beginning of the infection and increasing of erythropoesis after Þ fth day of infection. This is caused by direct suppression of the viral and activation of the proinß ammatory cytokines

KARAKTERISTIK PASIEN KO-INFEKSI HIV-HCV DI RSUP SANGLAH DENPASAR Somia, Agus; Utama, Susila; Parwati, Tuti; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Human Immunode! ciency Virus (HIV) and Hepatitis C Virus (HCV) are similar in many respects. Both viruses have asingle stranded RNA genome, both share similar routes of transmission and both cause chronic infection. However, HIV andHCV are also different in the pathogenesis, clinical manifestation and treatment. The aim of this study is to know characteristicof HIV-HCV coinfection patients in Sanglah Hospital. This study was descriptive study. Data based on patients medical recordduring from 1 januari 2004 sampai 31 Desember 2007 at VCT-CST. There were 48 cases HIV-HCV coinfected. 81.6% was male,mean of age of the ! rst anti HIV positive was 29.19 ± 4.63 years old. The risk factor was 75% IVDU. Baseline data showed71.4% suffered from HIV infection stage IV (WHO). The mean of body mass index was 18.78 ± 2.965 kg/m2, the mean of CD4was median of CD 4 was 222.56 ± 155.4 cell/ul, mean WBC was 4.38 ± 7.06 K/ul, mean of TLC was 1.134 ± 0.689 k/ul, meanof Hb was 12.53 ± 2.29 g/dl, Mean of PLT was 247.9 ± 90.11 k/ul, mean of SGOT 62.29 ± 71.91 IU, mean of SGPT was 77.34 ±109.83 IU. HbsAg positif 8.3% and 79.6% with HAART. The mortality rate was 10.8%. Most of HIV-HCV coinfected was male,productive age and the risk factor were IVDU.

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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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.

KORELASI ANTARA GERIATRIC NUTRITIONAL RISK INDEX DENGAN LAMA RAWAT PASIEN GERIATRI DI RUMAH SAKIT SANGLAH, DENPASAR Andriyasa, K; Kuswardhani, RA Tuty; Aryana, IGP Suka; Astika, N; Putrawan, IB
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Patients at risk of malnutrition are associated with a poor outcome. There are several tools that we can use to assess thenutritional status. European Society of Parenteral and Enteral Nutrition (ESPEN) guidelines and the French Program NationalNutrition Sante (PNNS) recommend Mini Nutritional Assessment (MNA) to detect the risk of under nutrition among elderlysubjects. The MNA which based on a Questionnaire does not use biological indicators. It is more adapted to the elderly at homeor nursing home setting than hospitalization. We want to evaluate the new tool Geriatric Nutritional Risk Index (GNRI) that moresimple than MNA to assess nutritional status and predict hospitalization outcomes in geriatric patients.This is a cohort study to evaluated correlation between GNRI score with length of stay in elderly patients. We evaluatednutritional status using Geriatric Nutritional Risk Index (GNRI) and Mini Nutritional Assessment (MNA) for elderly patientsthat admitted in Sanglah Hospital (Internal Department, class III) between February 2010 and April 2010. The patients werenutritionally assessed within 48 hours of hospital admission and studied in correlation to length of stay and in-hospital mortality.Fifty complete assessments were available for analysis. There are 32 male (62%) and 18 female (38%) with mean age are67.2 (60 ? 82) years old. GNRI score and MNA correlated inversely with length of stay in elderly patients (r = -0.67; p < 0.000)and (r = -0.44; p = 0.004) respectively. There are three fatal outcome (death) and all of cases with GNRI score grade 4 (majorrisk, GNRI score < 82) . GNRI score has a significant correlation with MNA score (r = 0.72; p < 0.000).In conclusion: Poor nutritional status as measured by GNRI was associated with a longer length of stay and increased inhospitalmortality. GNRI is a simple tool and has more significant correlation with hospitalization outcomes than MNA.

BEBERAPA KASUS ABSES HATI AMUBA Junita, Arini; Widita, Haris; Soemohardjo, Soewignjo
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Amoebiasis is an infection caused by Entamoeba hystolitica intestinal protozoa. Extraintestinal complication is liverabscess (amoebeic liver abscess). The highest prevalence is in tropical and developing country, which have poor sanitation, badsosioeconomic condition, not well nutrition status, and in area which strain E. Hvstotistica is high. About 10% from all people inthe world had this infection, but only 10% became clinically. Amoeboic liver abscess is handled with chemotherapy usingnitromidazole derivate, aspiration or drainage with surgery. In case which needed operation, mortality is 12%. And if there is aamoeboic peritonitis, the mortality approximately 40% - 45%, High mortality rate is caused by severe condition. Malnutrition,icteric or shock. Patient died ussually caused by septic condition or hepatorenal syndrome. In this moment, we will report threecase of liver abscess with variable size, which made differential decisiton treatment. One case is liver abscess which contain 4.5 Lafter done surgery drainage.

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Journal Mail Official
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Kota denpasar,

Bali

INDONESIA