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HUBUNGAN ANTARA KONSENTRASI ASAM URAT SERUM DENGAN RESISTENSI INSULIN PADA PENDUDUK SUKU BALI ASLI DI DUSUN TENGANAN PEGRINGSINGAN KARANGASEM Ngurah Wises, Ida Bagus; Suastika, Ketut
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

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Elevated serum uric acid concentrations are commonly seen in association with individual cardiovascular risk factorsuch as hypertriglyseridemia, hypertension, obesity, and hyperglycemia, a cluster that, when found together in the same person,characterizes the so-called metabolic syndrome. The original conceptualization of this syndrome was on the basis of resistance tothe actions of insulin. The reduction of endothelial nitric oxide bioavailability and the production of reactive oxygen species byuric acid may be the mechanism for insulin resistance. Otherwise insulin has a physiological action on renal tubules by stimulatingreabsorption of sodium and urate, resulting an increase in serum uric acid levels. In this condition, HOMA-IR was the modelwhich is a convenient means of evaluating insulin resistance.To know the association between serum uric acid concentration and insulin resistance, a cross sectional analytic studywas conducted on Balinese in Tenganan region between Desember 2007 and January 2008. The study involved 80 participantsage of 18-65 years old, agree to participate by informed consent. Serum concentration of insulin was measured by immunoassaymethod, plasma glucosa, serum uric acid, HDL-cholesterol, trigycerides, serum creatinin, were determined by enzymatic procedureafter overnight fast. Descriptive statistic analysis on numeric data presented as mean ± SD, nominal and ordinal data inproportion. Inferential statistic analysis with bivariate KendallÕs tau correlation and simple logistic regression was performed andmultiple logistic regression was used to know the independency of its association.Of 80 eligible samples, 39 (49%) men, and 41 (51%) women, mean age was 41.73 ± 12.41 yo, mean of waist circumferencewas 77.99 ± 10.91 cm, mean of serum uric acid concentration was 5.49 ± 1.38 mg/dL, mean of plasma glucosa was 92.04± 8.79 mg/dL, median of insulin was 2.70 (2.00 Ð 17.90) mIU/mL, median of HOMA-IR was 0.685 (0.38-4.10), mean of HDLcholesterol was 59.19 ± 14.01 mg/dL, and median of triglycerides was 122.50 (48 Ð 369) mg/dL. In univariate analysis, theinsulin resistance were positively correlated with serum uric acid, waist circumference, and triglycerides (r= 0.234; P = 0.003),(r = 0.269; P = 0.001), and (r = 0.153; P = 0.046) respectively and negatively with HDL cholesterol (r = -0.297; P = 0.009). Inmultivariate analysis with multiple logistic regression both the 2nd tertile of uric acid (4,7 Ð 6,6 mg/dL) and waist circumferencewere independently associated with the insulin resistance (PR 3.97; IK 95% : 1.273 Ð 12.386; P = 0.018), and (PR 5.79; IK 95%: 1.417 Ð 23.650; P = 0.014) respectively. Conclusion: There is association between serum uric acid concentration and insulinresistance, and both the 2nd tertile of uric acid and waist circumference are independently and significantly associated with insulinresistance.

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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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.

KORELASI KADAR MATRIX METALLOPROTEINASES 3 (MMP-3) DENGAN DERAJAT BERATNYA OSTEOARTRITIS LUTUT Eka Imbawan, IGN; Raka Putra, Tjokorda; Kambayana, Gede
journal of internal medicine Vol. 12, No. 3 September 2011
Publisher : journal of internal medicine

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Osteoarthritis (OA) is one type of arthritis which commonly found especially in elderly and become the common cause ofdisability in elderly people. Recently known that immunologic respons and homeostasis of cartilage metabolism have animportant role, and MMP-3 as one of degradative enzyme which has a pivotal role in OA patogenesis. Aim of this studyis to determine correlation between level of MMP-3 and radiographic grading of knee OA, in Sanglah Hospital, DenpasarBali. An analytical cross sectional study was carried out in Policlinic Sanglah Hospital, enrolled 76 samples with kneeOA. Of all sample, 32 (42.1%) were males and 44 (57.9%) famales. The mean of MMP-3 serum level is 25.2 ± 20.7ng/ml. Radiographic grading of knee OA based on Kelgren and Lawrence criteria 4 (5.3%) grade 1,29 (38.3%) grade 2,28 (36.8%) grade 3 and 15 (19.7%) grade 4. The mean level of MMP-3 on grade 1 group is (24.7 ng/ml), grade 2 (17.8ng/ml), grade 3 (28.3 ng/ml) and grade 4 is 32.8 ng/ml. Using Spearman!s analyses, there were signiÞ cant correlationbetween MMP-3 and radiographic grading of knee OA (r = 0.25 and p = 0.03).There were signiÞ cant positive correlation between MMP-3 and radiographic grading of knee OA.

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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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.

FAKTOR-FAKTOR YANG MENENTUKAN KEKUATAN GENGGAMAN TANGAN PADA PASIEN LANJUT USIA DI PANTI WREDHA TANGTU DAN POLIKLINIK GERIATRI RSUP SANGLAH - DENPASAR Putrawan, IB Putu; Kuswardhani, RA Tuty
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Handgrip strength is necessary for performing activities of daily living, which, in turn, are required to maintain functionalactivity. The purpose of this study was to determine anthropometric and personal factors that affect handgrip strength in groupsof nursing home and out patients of Sanglah Teaching Hospital Denpasar-Bali. Body weight and height, Waist Circumference(WC), Mid-Upper-Arm Circumference (MUAC) and triceps skinfold, scapula skinfold and supra iliaca skinfold were obtainedusing standard techniques. Body height was estimated from kneeheight. Handgrip was measured using a mechanical handgripdynamometer. A total of 38 male and 53 female aged 60 ? 82 years participated in the study. Both groups were statistically similarregarding all factors studied. Bivariate analyses showed that handgrip strength was associated with sex, age, WC, hemoglobin,albumin and body mass index in both of groups. Multiple linear regression analysis identified sex and WC (r = 0.39; p = 0.00),sex and age (r = 0.71; p = 0.00), as independent determinants of handgrip strength in both of groups. We conclude that womenhave a smaller handgrip strength than men. In addition, handgrip strength decreases with increasing age and decreasing WC.

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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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.

POLA KEPEKAAN BAKTERI PADA PASIEN KEGANASAN HEMATOLOGI DI RSUP SANGLAH DENPASAR Rena, Renny A; Suega, Ketut; Bakta, I Made
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Hematology malignancies patient are particulary susceptible to infection associated with endogen microorganism whichorigin from body or nosocomial from hospital. The most common etiology of infection is gram-positive oral and gastrointestinaltract. A worsening infection can lead patient to severe septic condition and death. In the last decade, many studies found thatspecies of fungi and virus also has an important etiology of infection in hematology malignancies patient.Empirical antibiotic therapy on the ! rst onset of infection of hematology malignancy are very recomended. It has beenproven to decrease morbidity and mortality rate. Empirical antibiotic therapy suitable with the pattern of the microbial in hospitalis an important way to overcome the infection on hematology malignancies patient.A total of 36 patient with hematology malignancy who done the blood culture in Sanglah hospital were consecutivelyrecruited and studied in order to study the pro! le of blood culture in hematology malignancy patient. Within six months 36patients were included, consist of 26 male (72.2%) and 10 female (27.8%). Characteristic of patient are mean of age 42.78 ± 14.25years. Mean of leukosit 45.76 ± 69.32 x 103/ul, mean of neutrophil dan lymphosit consecutively 27.17 ± 55.80 x 103/ul and 10.29± 19.81 x 103/ul. The mean of hemoglobin 8.48 ± 3.26 g/dl, and mean of trombosit 181.21 ± 230.63 x 103/ul. The most commondiagnosis found is Acute Myeloblastic Leukemia (AML) 33.3% and Non Hodgkin Lymphoma 22.2%. The result of blood culturemostly no growth (56.3%). The most microbial isolated from the culture is Coagulase Negative Staphilococcus / CONS (11.1%).Antibiotic susceptibility testing for Coagulase Negative Staphilococcus / CONS shows linezolid and chloramphenicol are themost sensitive.

PREVALENSI, KARAKTERISTIK DAN FAKTOR-FAKTOR YANG TERKAIT DENGAN INFEKSI SALURAN KEMIH PADA PENDERITA DIABETES MELITUS YANG RAWAT INAP Ariwijaya, Made; Suwitra, Ketut
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Diabetes Melitus (DM) is related with the increased risk of Urogenital Tract Infection (UTI). Prevalence and characteristicorganisms from urine suprapubic aspiration in DM patient who admitted to the hospital is rare. The aim of the study wasto now prevalence, characteristic and related factor with UTI in DM patient who admitted. We have done cross sectional analyticstudy in admitted DM patient more than 12 years old, less than 3 days admission. The patients who used antibiotic last 7 daybefore urine culture dan pregnancy were excluded. Urine specimen were taken via suprapubic aspiration. We had 100 respondenwith 53 men (53%), 47 women (47%), age 56 ± 11.9 yo., mean Body massa indeks (BMI) 23.99±2.56 Bw/ m2.SBP 130.7 ± 28.5mmHg. DBP 80 ± 14.65 mmHg. WBC 14.5 ± 11.9 K/ml . Hb 12.5± 3.1 mg/dl. BUN 32.2± 33 mg/dl. SC 2.2± 3.3 mg/dl. HbA1C13.8 ± 6.4 g%. Cholesterol 173.7 ± 61.6 mg/dl. HDL-cholesterol 39.06 ± 28.0 mg/dl. LDL-cholesterol 115.0 ± 55 mg/dl.trigliserida 138.8 ± 71.5 mg/dl, Fasting BS 196.6 ± 94 mg/dl, after meal BS 243.2 ± 110 mg/dl. We found 36 patient UTI (36%)with upper UTI 9 (25%). Lower UTI 27 (75%). Asymptomatic bacteriuria 25 (69.4%). Symptomatic bacteriuria 11 (30.6%).About 2.8% of recurrent UTI. Prevalence of UTI in patients less than 50 yo. were more than patient above 50 yo. UTI in womenwere higher than men. We found E. coli 30.5%, S. epidermidis 27.7% S. aureus 11.1%, E. zakazakii, and S. marcescens, C.albican respectly 5.5%, S. coagulase, S. liquyacians, E. cloaceae, E. hapniae, C. violaleum respectly 2.7%. as cause UTI thisstudy. We found Sensitivity test with antibiotic, imipenem 23%, amoxicillin-clavulamic acid 20%, ceftazidin 19%, gentamisin19%, cefoxitin 17%, piperacillin/ tazobactam 14%, sulphamethoxazol, ofloxasin, ceftriaxon 13% respectly, cefuroxime 12%,cifroploxasin 11%, ampicilin, linezolide 6% respectly. vancomisin 4%, cephazolin, cefoperazone-sulbactam 3% respectedly.meticilin, cefoperazone, erithromisin, amoxillin, oxacilin respectly 1%. We found E. coli 100% sensitive with imepenem,amoxicillin-clavulamic acid, piperasillin-tazobactam. 90.9% Sensitivity for ceftazidin, gentamycin. From six independen variabel(dyslipidemia, BMI catagori, hipertension, sex, age, blood sugar controled, stone in urinary tract, chronic renal disease, lungTB, pneumonia, cancer, user of chateterization) only BMI significant correlation (X2 = 13.8, p= 0.03 OR= 2.14) with prevalenceUTI in patient DM.

TINGKAT KETERGANTUNGAN NIKOTIN DAN FAKTOR-FAKTOR YANG BERHUBUNGAN PADA PEROKOK DI DESA PENGLIPURAN 2009 Bagus Artana, IGN; Ngurah Rai, IB
journal of internal medicine Vol. 11, No. 1 Januari 2010
Publisher : journal of internal medicine

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Smoking causes many harmful side effects to our health. Cardiac diseases, lung and respiratory problems, and almostevery malignancies had a very close relationship with cigarrete smoking. Smoking cessation is a di! cult thing to do. We haveto obtain data about nicotine dependence before starting a smoking cessation program for patients or in comunity. Nicotinedependence based on structural interview using The Fagerström Test for Nicotine Dependence (FTND) questionaire. We conducta population-based survey to ! nd out about nicotine dependence in a traditional balinese vilage, called Penglipuran. Penglipuranis one sample of traditional vilage in Bali with very tight traditional law. We found 72 smokers among 920 people in Penglipuran(7.78%) with mean age 40.67 ± 14.05 years old and almost 100% was male (only one female sample). They started to smokeat very young age (18.24 ± 3.07 years old) and take approximately 8.44 ± 6.76 cigarettes per day. We found the mean nicotinedependence level was 3.63 ± 1.41 (moderate dependence). As for factors related to nicotine dependence, we found that smokingonset, occupation, and length of smoking correlate with nicotine dependence signi! cantly (p < 0.05). While the other factors suchas age, sex, and educational level didn?t have any correlation with nicotine dependence. Our survey conclude that Penglipuransmokers had moderate nicotine dependence.

PERBANDINGAN EFEKTIFITAS ASAM FOLAT DOSIS STANDAR DENGAN DOSIS TINGGI TERHADAP HIPERHOMOSISTEINEMIA PADA GAGAL GINJAL DENGAN HEMODIALISIS REGULER Darmaja, I Made Gede; Suwitra, Ketut
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Prevalence of hyperhomocysteinemia(HHcy) in regularly hemodialysis chronic kidney disease (RHDCKD) is high.HHcy in RHD CKD related to atherosclerosis an increase risk of cardiovascular disease. Increasing 5 ?mol/L of Hcy level from10?mol/L correlate with increasing 60% cardiovascular risk in male and 80% in female and also increasing 50% risk of strokeboth in male and female. Folic acid, vitamin B 12 and vitamin B 6 is needed to decrease Hcy level according homocysteine trialystlowering collaboration (HTLC), folic acid may decrease the Hcy level by 25%, vitamin B 12 7% but no significance effect ofvitamin B 6. Standard dose of folic acid 2-5 mg/day may normalized HHcy in predialysis CKD but most of RHDCKD fail toreach normal level. Treatment result of RHDCKD before is varied and inconsistent. This study was randomized double blindcontrolled clinical trial aimed to know whether higher dose of folic acid decreased Hcy greater than standard dose, that using 15mg/day compare to 5 mg/day of folic acid treatment for 4 weeks RHDCKD with hyperhomocysteinemia. Thirty patients wererecruited base on exclusion and inclusion criteria and two weeks standardization using 1 mg/day folic acid was performed.Complete blood count, lipid profile, blood sugar, albumin and globulin, BUN, creatinine serum, SGPT/SGOT and Hcy wereexamined in the beginning of the study and after 4 weeks. Permuted block randomization was done among participant in order togrouping them into 15 mg/day and 5 mg/day folic acid group. Compare means of decreased Hcy in each group as primaryoutcome was analyzed using student t test, 95% confidence interval (CI) , p<0,05. During study, 15 patients were treated with 15mg/day folic acid and 13 patients with 5 mg/day folic acid. Increased of Hcy was 1,00±4,11 ?Mol/L among 15 mg/day folic acidgroup (20,67 ±6,69 ?Mol/L increased to 21,68±4,59 ?Mol/L ) and 1,93±3,40 ?Mol/L (18,77±5,38 increased to21,00±5,24?Mol/L) among 5 mg /day folic acid group, CI 95% -2,03 to 3,88, p = 0,53. ANCOVA analyzed of other variableseffect such as BMI, blood sugar, age and sex on Hcy level was not found. We conclude that 15 mg/day comparing to 5 mg/dayfolic acid is not more effective in decreasing Hcy level of regularly hemodialysed patient with hyperhomocysteinemia.

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Kota denpasar,

Bali

INDONESIA