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INDONESIA
journal of internal medicine
Published by Universitas Udayana
ISSN : -     EISSN : -     DOI : -
Core Subject : Health,
Medicine & Pharmacology
Arjuna Subject : -
Articles 162 Documents
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ASOSIASI CARA PEMBERIAN OBAT DENGAN ONSET DAN DERAJAT KLINIS REAKSI HIPERSENSITIFITAS AKUT/ANAFILAKSIS PADA PENDERITA YANG DIRAWAT DI RSUP SANGLAH DENPASAR BALI Eka Imbawan, I GN; Suryana, Ketut; Suardamana, Ketut
journal of internal medicine Vol. 11, No. 3 September 2010
Publisher : journal of internal medicine

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Abstract

Acute hypersensitivity reaction/anaphylaxis is a post exposure acute reaction involving dermatologic system/mucosal and subcutaneous tissue; while anaphylaxis is an acute systemic reaction involving two or more organ systems (the skin/mucosa and subcutaneous tissue, respiratory system, cardiovascular system, gastrointestinal system). Drugs as allergens can trigger these reactions orally, parenteral, or topically (contact). Different modes of drug administration are known to relate with onset and degree of the resulting clinical features. We conduct a cross sectional study to determine the association between modes of drugs administration with onset and clinical degree in patients hospitalized at Sanglah General Hospital Denpasar. This study involved 205 patients with acute hypersensitivity reactions/anaphylaxis (105 male and 100 female). Mean age was 33.12 (12 ! 80) years, 131 persons (63.9%) were triggered by drugs, while 57 patients (27.8%) were triggered by food, 13 patients (6.3%) by insect sting, and 3 patients (1.5% ) by other allergens. Of 131 patients with drugs as the trigger, 108 patients (82.4%) were given orally, 22 patients (16.8%) were given parenterally and 1 patient (0.8%) was triggered via contact. The mean onset of an acute hypersensitivity reaction/anaphylaxis triggered by oral and parenteral drugs were 4.2 hours and 0.6 hours respectively (p < 0.01). We conclude that modes of drug administration are associated with the onset of symptoms, but not with the degree of clinical manifestation of acute hypersensitivity reaction/anaphylaxi
PERAN BIOPSI HEPAR DALAM MENEGAKKAN DIAGNOSIS IKTERUS OBSTRUKTIF EKSTRA HEPATIK Sherly M, Yuliana; Widita, Haris; Ardita, IG; Soemohardjo, Soewignjo
journal of internal medicine Vol. 7, No. 3 September 2006
Publisher : journal of internal medicine

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Abstract

Obstructive icterus is caused by 2 major group from the intrahepatic and ekstrahepatic and ekstrahepatic. Generally toconfirm clinical diagnosis is done with USG imaging. In which USG easily could differentite the cause of the bile duct (accuracy90%). The mothode of biopsy is only to evaluate the intrahepatic icterus. In certain cases, it is not easy to confirm either itsobstructive icterus extraheaptic or intrahepatic, as the bile duct smetimes to seen clearly on the USG examination, which is toassure the side of obstructive because the distal part of the bile duct difficult to be seen in 30%-50% cases until hepatic biopsy isreduced. Meanwhile the histopatology appearance of extrahepatic icterus are marked by classis changes known as ductulerreaction, which as the oedema of connective tissue, ductular proliferation and neutrofil infiltration. There by here, we report thecase of a man, 53 years old with obstructive icterus, where in the beginning is suspected as intrahepatic cholestasis and the causeof extrahepatic icterus is unknown, then the diagnosis was confirmed with histopatology examination.
ASPEK IMUNOLOGI SLE -, Yuriawantini; Suryana, Ketut
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Systemic Lupus Erythematosus (SLE) is autoimmune disease characterised by the production ofautoantibodies to component of the cell nucleus in association with a diverse array of clinical manifestations.The patho-aetiology of systemic Lupus Erythematosus probably involves multifactorial interaction amongvarious genetic and environmental factors. Multiple genes contribute to disease susceptibility, including genesencoding complement and other components of the immune response. The interaction of sex, hormonal millieuand the hypothalamus-pituitary-adrenal axis modifies this susceptibility and the clinical expression of thedisease. Defective immune regulatory mechanism, such as the clearance of apoptotic cells and immunecomplexes, are important contributors to the development of SLE. The loss of immune tolerance, increaseantigenic load, excess T cells helper, defective B cell suppression, and the shifting of T helper 1 (Th1) to Th2immune responses leads to the B cell hyperactivity and the production of pathogenic autoantibodies. ANAs areantibodies against both functional and structural in the cell nucleus. ANA is early detection of autoantibodies forthe patient with clinical features that suggest SLE. Positive test for antinuclear antibodies may support thediagnosis, especially if more spesific autoantibodies are present, such as anti-double-stranded DNA, anti-Sm,anti-RNP or anti-Ro. Understanding the value of autoantibody testing in patient care requires clinical judgmentand experience.
SEORANG PENDERITA SINDROM NEFRITIK AKUT PASCA INFEKSI STREPTOKOKUS Renny A Rena, Ni Made; Suwitra, Ketut
journal of internal medicine Vol. 10, No. 3 September 2009
Publisher : journal of internal medicine

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Abstract

Acute nephritic syndrome is classically de! ned by symptoms of oliguria, oedem, hypertension and also urinalysisabnormality such as proteinuria less than 2 grams/day, hematuria, or ! nding of erytrocite silinder in the urine. The etiology ofacute nephritic syndrome are disorders of primary glomerulopathy (idiopathic), glomerulopathy after infection, DisseminatedLupus Erythomatosus (DLE), vasculitis and hereditary nephritis (Alport syndrome). Acute nephritic syndrome is one of clinicalmanifestation of acute glomerulonephritis after streptococcal infection, which is in" lamation occur on tubulus and glomerularof the kidney, after streptococcal infection of skin or upper respratory tract. The most frequent cause by particular strain ofhemolyticus streptococcus ß group A type 12. Herewith, we reported a case of acute glomerulonephritis after streptococcalinfection with clinical manifestation acute neph! tic syndrome. A fourteen years old Balinese male patient found with anasarcaoedem, oliguria and hematuria. Previous medical history with infection of throat 2 weeks before admitted to hospital. On physicalexamination, we found with Stage II hypertension, laboratory data shown urinalysis: hematuria and proteinuria, protein esbach3.25 gram/liter/day, ASTO 200 IU/ml, ANA test negative and throat swab isolated Streptococcus viridans, alpha hemoliticus.Imaging data showed right pleural effusion and bilateral nephritis of the kidney. Patient gives a good respon to corticosteroid(metilprednisolone), diuretic and also ACE inhibitor
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.
A CASE OF METHANOL INTOXICATION COMPLICATED WITH ACUTE PANCREATITIS, ALCOHOLIC KETOACIDOSIS, AND INTRACEREBRAL HEMORRAGE Rahardi, Eric; Moda Arsana, Putu
journal of internal medicine Vol. 12, No. 3 September 2011
Publisher : journal of internal medicine

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Abstract

Methanol intoxication occurs after accidental or suicidal ingestion occasionally and the toxicity is due to the formationof formaldehyde and formic acid. Methanol ingestion can also lead to acute pancreatitis, a sudden in! ammation of thepancreas, and high metabolic acidosis as a complication. Brain injury in methanol intoxication could be ischemia orhemorrhage form. Therefore we?d like to present a report a male with methanol intoxication with several complicationsuch, acute pancreatitis, alcoholic ketoacidosis, and CVA-ICH. The patient presented with hemodynamic instability andsevere metabolic acidosis with pH 6.991. The anion gap was 30 mmol/l. Amylase was 187 U/l and CT scan showed intracerebralhemorrhage at right fronto temporo parietal lobe with peri-focal edema (volume 48 cc). Patient unfortunatelydied three days later after force discharge by his families. Brain injury in methanol toxicity is characterized by lesionsaffecting both basal ganglia and subcortical regions. The lesion could be ischemia/necrosis or hemorrhage, selectivelyaffecting the putamenal bilaterally.
LUPUS ERITEMATOSUS SISTEMIK PADA KEHAMILAN Jaya Kusuma, Anak Agung Ngurah
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Abstract

Systemic lupus erythematosus (SLE) is an auto immune disease which is charaterized by the production of antibodiestowards the nucleus of the cell. The mechanism is not well defined, but there seem to be some exacerbating factors like physicaland metal stress, infection, ultraviolet radiation and drugs. The various cell of our body are recognized as antigen thereforeleading to the formation of immune complexes which will be deposited in organs and eventually cause inflammation. The processwhich affects the placenta is known as deciduas vasculitis. The effects of pregnancy towards SLE in unclear, but the risks ofexacerbation increases as pregnancy advances. Complications such as death of the fetus, premaurity and restricted growth mayoccur. Complication of pregnancy with SLE which affects the fetus characterized by congenital heart block, cutaneus lesion,cytopenia, liver disorders and other systemic manifestation. The pathogenesis of fetal heart block is not well understood, but themechanism seems to be transfers of antibody through the placenta on the second trimester which then will lead to immunologicaltrauma of the heart and its conduction system which will manifest upon delivery. There are two major points to be considered inthe management of SLE in pregnancy; pregnancy can affect the course of SLE and the fetus may become the target of autoantibody which will lead to failure of the pregnancy itself. Corticosteroids have a significant effect and is normally tolerable bymay be considered. Contraception becomes an important key in SLE as estrogens concentration of 20-30 urg/day may exacerbateSLE and will increase the risk of thromboemboli, therefore progesterone containing contraceptives are highly recommended.
PREVALENSI DAN HUBUNGAN SINDROM METABOLIK DENGAN PENYAKIT GINJAL KRONIK PADA POPULASI DESA LEGIAN, KUTA BALI Ayu, Paramita; Kandarini, Yenny; Widiana, G Raka; Sudhana, W; Loekman, Jodhi S; Suwitra, K
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Abstract

Metabolic syndrome may relate to pathogenesis of chronic kidney disease (CKD). There is scarce data with regard to thatphenomenon in Indonesian general population. We conduct a study to determine the prevalence of metabolic syndrome and itsrelationship with CKD individuals in general population of Legian Village, Bali. An analytical cross sectional study was carriedout in the community of Legian Village, a tourist destination in Bali. Samples were selected through simple random sampling.Two hundred and eighty four samples (117 males and 107 females, aged 46.1 ± 10.02 years) were included. Prevalenceof hypertension, hypertrigliseridemia, hypoHDL-cholesterol, central obesity, impaired fasting glucose (IFG), obese and CKDwas 14.1%, 38.4%, 25%, 18%, 11.6%, 51.8% and 11.6% respectively. Using bivariate analysis, there were strong and significantrelationship between hypertension (OR 2.6, 95%CI 1.12 to 6.19, p = 0.02) and IFG (OR 5.21; 95%CI 2.23 to 12.13, p = 0.00) withCKD. Using multivariate logistic regression entering those components of metabolic syndrome into the model, it was consistentlyfound that hypertension and DM is the associated factors for CKD in the population. There was increasing odds of CKD about1,0-fold every augment of metabolic syndrome components (OR 1.098; 95%CI 0.83 to 1.44). As our conclusion, hypertensionand IFG are associated factor for CKD in general population. Multiple components increased risk factor for CKD.
PENATALAKSANAAN HIPERTENSI PADA LANJUT USIA Kuswardhani, RA Tuty
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

The more increasing of life expectancy is more complex disease in elderly. One of cause disease in elderly is hypertension Theisolated systolic hypertension (ISH) the most risk factor in stroke, coronary failure, and coronary heart disease, their role ispredicted more their in the youth. The definition of hypertension is not change in the age : systolic blood pressure (SBP) 140mmHg, and or diastolic blood pressure (DBP) 90 mmHg. The Joint National Committee on Prevention, Detection, Evaluationand Treatment of high blood pressure (JNC VI) and WHO or International society of hypertension guidelines sub committeesagree that SBP and DBP, both are used to classify the hypertension. Patophysiology of blood pressure is not clear. The most effectof the mortal aging in the cardio vascular system includes the changing of compliance aorta and systemic vessels. The thickeningof aorta wall are major vessels are increasing while the elasticity of vessel is decreasing in aging. This changing brings thecompliance of aorta is decreasing and the major vessel, it causes the increasing of peripheral vascular resistance. Baroreceptorsensitivity is also changing in aging. The changing in the metabolism of baroreceptor reflex possibly can explain the existence thevariability pressure. The changing of vasodilatation adrenergic and vasoconstriction of adrenergic a in balance will tendvasoconstriction are will bring the increasing of peripheral vessel resistance and blood pressure. The management of hypertensionin the elderly includes behavior, exercise, and pharmacology therapy.
CROSSLINK TELOPEPTIDA C-TERMINAL (CTx) SEBAGAI PETANDA AKTIVITAS SEL OSTEOKLAS PADA OSTEOPOROSIS PASCA MENOPAUSE DEFISIENSI ESTROGEN Kawiyana, I Ketut Siki
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

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Abstract

Osteoporosis occurs due to the increase of active osteoclastic bone resorption activity. This condition favors for bonemass decreased. The examination of Crosslink Telopeptida C-Terminal (CTx)serum concentration is a good indicator to determineosteoclastic bone resorption activity. The finding of that biochemical substance in serum indicates that there is increase ofosteoclast cell activity. The aim of the study was to prove that in estrogen deficient post-menopausal women, the CTxwas higherin the osteoporosis compared than the non-osteoporosis. The study was an analytic-observational study in case-control design,which was done at Sanglah General Hospital, Denpasar. The sample size was 41 case subjects (osteoporosis) and 41 controlsubjects (non-osteoporosis) using paired case-control sample size formula. The t-paired test result were: CTx serum concentrationwas higher significantly in case compared than control (0.60 ± 0.22ng/mL vs 0.46 ± 0.16ng/mL; p = 0.004). Therefore fromthe study we may conclude that: (1) CTx was higher in the osteoporosis compared than the non-osteoporosis in estrogen deficientpost-menopausal women. (2) Osteoclastic bone resoprtion activity was higher in the osteoporosis compared than the non-osteoporosisin estrogen deficient post-menopausal women

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