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FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KEJADIAN MAKROSITOSIS PADA PASIEN HIV/AIDS YANG MENDAPAT TERAPI ZIDOVUDIN DI RUMAH SAKIT SANGLAH DENPASAR Ridana Wibawa, Ketut; Parwati Merati, Tuti; Somia, Agus; Utama, Susila
journal of internal medicine Vol. 11, No. 1 Januari 2010
Publisher : journal of internal medicine

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Zidovudine is a Þ rst line drug used for treating HIV/AIDS patients in Indonesia and has been associated with prolongedsurvival, a reduction in the frequecy and severity of opportunistic infections, transient increases in the number of CD4 Tlymphocytes, and decreases in serum HIV p24 antigen. However prolong use of zidovudine associated with bone marrowtoxicity manifested by macrocytosis until anemic condition which need the transfusion. Some factors has been identiÞ ed canincreasing the bone marrow toxicity like: age, sex, cotrimoxazole, anemic and neutropenia condition, CD4 count < 200 cells/ L,vit B12 and folic acid level.To determine the risk factors correlated with incident of macrocytosis on HIV/AIDS patients treated with zidovudine,an analytical retrospective cross sectional study was done. The patients were selected using WHO criteria and the antiretoviraltherapy as Depkes guideline which zidovudine base with dose 600 mg/day. The age, sex, cotrimoxazole use and CD4 count wereassesed from all the patients by review medical record when the macrocytosis exist.This study included 140 subyects, age arround 19 ! 65 years old, sex male 72 % and female 28%. Cotrimoxazole use as atreatment or prophylaxis for PCP infection is 90% and the median CD4 count is 24.5 cells/ L. The incidence of macrocytosis is54.3% which is 46.4% without anemia and 7.9% present with anemia. The mean MCV value before zidovudine therapy is 86.27fL and elevated to 110.11 fL after zidovudine therapy. The median time of macrocytosis is 5 month. With bivariat analysis wedidn"t Þ nd correlation betwen age, sex, cotrimoxazol use and CD4 count with incident of macrocytosis (age p = 0.935 95% CIOR = 0.963 sex p = 0.800 95% CI OR = 0.846 cotrimoxazol use p = 0.237 95% CI OR = 0.403 and CD4 count p= 0.646 95%CI = 0.997 respectively).This study concluded no correlation betwen age, sex, cotrimoxazol use and CD4 count with incident of macrocytosis onHIV/AIDS patients whom treated with zidovudine. We suggest to routinely monitoring the MCV value every a month in a year,be cause the incidence of macrocytosis cause by toxicity effect of zidovudine to bone marrow is high.

INTERRELASI BESI DENGAN SITOKIN DAN VICE VERSA Suega, Ketut
journal of internal medicine Vol. 13, No. 1 Januari 2012
Publisher : journal of internal medicine

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Iron is an essential substance needed for metabolism process, such as for transporting oxygen to the tissues for energyproduction in cells. Iron is also important for transporting electrons in the mitochondria for cell respiration process, andfor synthesizing Deoxyribo Nucleic Acid (DNA). In addition to its role in oxygen transport and metabolic pathways, ironplays a pivotal role in immune function by promoting lymphocyte activation and proliferation. On the other hand, ironover-load can have immune disorders and yet pathogenic microorganism require iron for their growth and proliferation.Therefore iron homeostasis must be maintained through careful regulation of duodenal absorption and recycling of ironstores since human body has no ideal excretory system for iron. Discovery of hepcidin peptide help clarify molecularbased of cellular interaction between duodenal iron absorption capacity and iron stores cells. Hepcidin a putative negativehumoral regulator of iron homeostasis by inhibiting iron absorption and couple with ferroportin preventing iron exportedfrom intracellular iron stores. Hepatic hepcidin expression is increased in iron overload and decreased in iron deciency. Inaddition to regulation by body iron needs, hepcidin is increased during an acute phase respone of inlammation processed.When an in!ammation is initiated, liberation of proin!ammatory cytokine IL-6 stimulate hepcidin expression causingiron absorption and iron release from the macrophage of the reticuloendotheleal system are decreased. Many other studieson humans and experimental animals have shown signicant change of the levels of certain cytokines in iron deciencystate such as IL-2; IL-4; IL-6; IL-10; IL-12; IFN gamma. As summarized, cytokines in!uence iron homeostasis and in theother way iron in!uences activity of cytokines and immune effector mechanism of macrophages, and all these affect thelevel of immune defence against invading pathogens.

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
Publisher : journal of internal medicine

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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.

RELATIONSHIP OF INFECTION AND GAMMA INTERFERON ( IFN ) OF PLASMA AND LYMPHOCYTE CULTURE SUPERNATANT IN IRON DEFICIENCY ANEMIA PATIENTS WITH INFECTION Suega, Ketut; Bakta, I Made
journal of internal medicine Vol. 10, No. 3 September 2009
Publisher : journal of internal medicine

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Iron is an essential nutrient for every living cells because of it role as molecule for transport of oxygen, as well as DNAsynthesis through synthesis of ribonucleotide reductase. Although the underlying mechanism of immune defect in iron deÞ ciencyanemia (IDA) is not clearly understood, multifactor events considered play their contributing roles such as impairment of T-cellproliferation and activities, altered cytokine production of Interleukin-2 (IL-2) and Interferon gamma (IFN ).Cross sectional study was done to asses the relationship of gamma IFN with infection in IDA patients on plasma andlymphocyte culture supernatant of IDA patients. Sixty-four IDA patients treated in Sanglah General Teaching Hospital wererecruited, and 31 (48.4%) out of 64 IDA patients were man and 33 (51.6%) women, have been selected for the study. This studyfound 17 (26.7%) IDA patients with infection, aged 38 ± 14.48 years and 47 (73.3%) IDA patients without infection, with ageaverage of 40.5 ± 14.4 years. The study revealed that there were no differences of cytokine level observed between older andyounger age (upper and below 44.5 years) in IDA patients. Furthermore, no differences of cytokine level were found based ongender between IDA male 10.9 pg/l (8.60 ! 12.65) patients and IDA female patients 10.6 pg/l (7.50 ! 13.43) with Z -0.490,p = 0.624. Nevertheless, signiÞ cant differences were noted between plasma and supernatant of IFN in IDA patients withinfection when compared to IDA patients without infection (Z = - 2.638, p = 0.008 for plasma IFN ; and Z = -2.569, p = 0.010for supernatant IFN ).The study conclusion is that level of IFN from plasma and lymphocyte culture supernatant of patient suffered from IDAwith infection is signiÞ cantly lower when compared to IDA patient without infection

PENGARUH HIPERGLEMI TERHADAP PERAN SITOSKELETON (CYTOSKELETON) SEBAGAI JALUR TRANSDUKSI SIGNAL (SIGNAL TRANSDUCTION) Rudijanto, Achmad; Kalim, Handono
journal of internal medicine Vol. 7, No. 3 September 2006
Publisher : journal of internal medicine

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Intracellular signal transduction occurs through cascades of reactions involving dozens of proteins that transmit signalsfrom the cell surface, through a crowded cellular environment filled with organelles and a filamentous cytoskeleton, to specifictarget. For most characterized signal transduction pathway, the initial signaling event and the end point are well known. In order tofully understand intracellular signal transduction, it is essential to know the intermediate signaling molecules and to understandhow information flows from one to the next. The cytoskeleton , an interconnected assembly of actin (microfilament), intermediatefilament and microtubule networks that extend throughout the entire cell, is involved in intracellular signal transduction.Individual proteins of the cytoskeleton might participate directly in signal transduction by linking two or more signaling proteinand might also provide a macromolecular scaffold, which spatially organizes components of a signal transduction cascade.Diabetes mellitus is an increasingly common disease. Absolute or relative deficiencies of insulin are common in this disease.Insulin has been suggested to play a key regulatory role in the functional organization of actin filaments. The microtubules are alsothe targets of insulin. A chronic insulin deficiency may could lead to impairment in the organization of the cytoskeleton. Thiscould entail a compromised or slower action of some activated enzymes in cells, affect to intracellular signal transduction.

HUBUNGAN PENYAKIT GINJAL KRONIS PREDIALISIS DENGAN BEBERAPA PARAMETER PENYAKIT ATEROSKLEROSIS ARTERI KAROTIS Sutarka, Nyoma; Suwitra, Ketut; Loekman, Jodi S; Sudhana, Wayan; Kandarini, Yenny; Martadiani, Elysanti Dwi; Margian, Nyoman
journal of internal medicine Vol. 11, No. 3 September 2010
Publisher : journal of internal medicine

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Carotid artery intima media thickness (cIMT) is valid marker of subclinical atherosclerosis because it gives sign of earlyatherosclerosis process. We conduct this study to know the relationship between predialysis chronic kidney disease (CKD) withseveral parameters of carotid arterial atherosclerosis.A cross sectional study was done in patients with predialysis CKD who came to outpatient Clinic of Nephrology inSanglah General Hospital from May 2009. CKD criteria is based on KDQQI 2003. Estimated Glomerular Filtration Rate (eGFR)was calculated with Cockroft-Gault formula. Measurement of cIMT is done by USG B-Mode with USG Logig-5.There were 30 patients (20 with eGFR < 60 ml/mnt and 10 with eGFR 60 ml/mnt). Mean of cIMT in eGFR < 60ml/mnt: right/left cIMT1 0.24445 ± 0.3096/0.3210 ± 0.4006 mm; IMT2 0.2405 ± 0.3138/0.2825 ± 0.3971 mm; IMT3 0.2315 ±0.3026/0.2820 ± 0.3672 mm; bifurkatio IMT 0.3115 ± 0.4069/0.3515 ± 0.4991 mm; total IMT 0.6350 ± 0.1738/0.6938 ± 0.1912mm. For eGFR > 60 ml/mnt: right/left IMT1 0.1120 ± 0.1722/0.1030 ± 0.1398 mm; IMT2 0.0880 ± 0.1103/0.1130 ± 0.1718mm; IMT3 0.1010 ± 0.1408/0.1170 ± 0.1700 mm; bifurcatio IMT 0.1920 ± 0.3545/0.1980 ± 0.3527 mm, total IMT 0.6250 ±0.1269/0.6750 ± 0.1124 mm. There was signiÞ cant difference in eGFR < 60 ml/mnt the left IMT1 (MD: 0.21 CI95% 0.01 ! 0.42;p = 0.038). Five out of 20 patients with eGFR < 60 ml/mnt and 6 among 10 patients of eGFR 60 ml/mnt were found plaques.There are no signiÞ cant difference of plaque location, plaque width, and lumen diameter between carotid arterial with andwithout plaque. As a conclusion we found there is no signiÞ cant difference between predialysis CKD with several parameters ofcarotid arterial atherosclerosis but cIMT tends to be thicker on predialysis CKD patients with eGFR < 60 ml/mnt.

PERAN PENURUNAN BERAT BADAN TERHADAP KADAR PLASMINOGEN ACTIVATOR-1 PADA OBESITAS ABDOMINAL Budhiarta, A.A.Gd.
journal of internal medicine Vol. 7, No. 3 September 2006
Publisher : journal of internal medicine

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Analytical cross-sectional study involving 77 subjects (male 31, female 46) with abdominal obesity (Ab-Ob) and 27 subjects non obese (male 20; female 7), age between 30-60 years were conducted and continued withrandomized pre-post test control group study involving 66 subjects (male 25, female 41) with Ab-Ob recruitedfrom the analytical cross-sectional study. Using random permuted block 30 subjects ( male 12; female 18) weretreated with hypocaloric diet and regular physical exercise for 12 weeks and 36 subjects (male 13; female 23) ascontrols. Compare with non obese subjects there were higher levels of active PAI-1, insulin and HOMA-IR insubjects with Ab-Ob (p<0.001 ; p = 0.001 and p < 0.001 respectively). There were significant correlation betweenfasting insulin level and HOMA-IR with active PAI-1 ( r = 0.488, p <0.001 and r = 0. 543, p <0.001 respectively).Among treated group decreased in body weight 5.9 kg or 7.4% followed by decreased in WC ( p <0.001), insulin(p = 0.005), and active PAI-1 (p <0.001). Among treated group decreased in WC ( p<0.001), insulin (p = 0.001),and active PAI-1 ( p = 0.003) were higher than control group. There were positive correlation between decreasedbody weight ( r = 0.297; p <0,001), decreased decreased FBS ( r = 0.307 ; p = 0.012), decreased insulin (r =0.360 ; p = 0.003), with decreased active PAI-1. To test the independence of associations between decreased inactive PAI-1 and decreased body weight, fasting blood sugar and insulin levels during program, a multivariatelinear regression analysis was performed. Only decreased in body weight and decreased fasting blood sugarsignificantly and independently associated with decreased in active PAI-1 and accounted for 23.4% of the varianceof decreased in active PAI-1. Decreased body weight accounted for 17.1% and decreased fasting blood sugaraccounted for 6.3% of decreased in active PAI-1.

WISATAWAN ASING DENGAN PENYAKIT INFEKSI SALURAN NAFAS YANG DIRAWAT DI RSUP SANGLAH - DENPASAR - BALI Ngurah Ra, Ida Bagus; Sajinadiyasa, I Gede Ketut
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

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Each year 1 billion passengers travel by air, and over 50 million people from industrialized countries visit the developingworld and Bali is one of their choice. Travelers may be exposed to variety of pathogens and risk, and 20 to 70 percent of peoplereport some health problems while traveling. After diarrhea, respiratory infection is the most common illness affecting travelers.The aim of the study was to now characteristic foreign patients with respiratory infections hospitalized at Sanglah GeneralHospital. We have done retrospectif study to medical record of foreign patients hospitalized at Sanglah General Hospital onJanuary 2004 Ð June 2008.We had 17 patients with 13 (76.47%) Pneumonia and 4(23.53%) COPD with acute exacerbation, 13man and 4 woman, the mean of age 55.33 years old and more patients ³ 60 years old. Country of origin of patients mostlyAustralia, US, Germany, Nederland. Patients outcome; improve 14 (82.4%) and die 3 (17.6%), mean length of stay 4.35 days.Two die patients more than 60 years old and one below than 60 years but with coronary heart disease. The conclusion of this studyis respiratory infection who hospitalized at Sanglah General Hospital are dominated by pneumonia and eldery, possibility ofinfected respiratory disease seem higher in longer flight

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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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.

HUBUNGAN ANTARA KADAR HIGH SENSITIVE-C REACTIVE PROTEIN DENGAN DERAJAT ASMA BRONKIAL AKUT Jaya Santika, I Wayan Agus; Suryana, Ketut
journal of internal medicine Vol. 12, No. 3 September 2011
Publisher : journal of internal medicine

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Bronchial asthma is a chronic inß ammation in the air way. There are some element of cell and cell also to interventionin the inß ammation process. Chronic inß ammation has caused hyper responsiveness in air way, which is episodic attacksign, like wheezing, cough, shortness of breath usually in the night. C-reactive protein is one of the protein which changesin acute infection and acute inß ammation. C-reactive protein is a acute phase response protein which responsibility todefense mechanism. Acute phase protein produced induction by injury or infection. Acute phase reactant synthesis byliver which induction by cytokine like IL-6. In acute asthma attack produced some cytokine pro inß ammatory like IL-1,IL-6 and TNF. All of that cytokine induced liver to produced CRP. Aim for this study, to know the level hs-CRP in asthmaattack patient and also to know correlation between the severity of asthma attack and level of hs-CRP in patient whotreated in Sanglah General Hospital. This study was enrolling 53 patient acute asthma attack, cross sectional study. Allthe data collected by interview, physical examination, blood examination which cbc, hs-CRP, also with peak ß ow meter.The data analyzed by SPSS. And the result is the median of level hs-CRP is 7.3 mg/l, and the correlation in odd ratio(OR) is 3.73; CI 95% (1.66 ! 8.41). Based on this study we have the conclusion there strong correlation between level ofhs-CRP and severity of asthma attack.

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Bali

INDONESIA