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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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PERANAN TERAPI INSULIN INTENSIF TERHADAP INTERLEUKIN-6 (IL-6) DAN LUARAN KLINIK PADA PENDERITA KRITIS DENGAN HIPERGLIKEMIA Wiryana, Made
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Abstract

Hiperglycemia and insulin resistance are common in critically ill patients, even that have not previously had diabetes.Though it has been reported that pronounced hyperglycemia may lead to complications in such patients and cause of reactiveoxygen species (ROS) production, although data from controlled trial are still lacking. The debatable issue focused on whetherintensive insulin therapy to normalized blood glucose improves prognosis. The debate is mainly about the time to start therapy,and target of blood glucose level. The main purpose of this research is to know the different between intensive insulin therapy andconventional insulin therapy on decreases of cytokine production (IL-6), increase of albumin level and event of systemic inflammatoryrespons syndrome (SIRS). The design of this study is randomized pre and post control group design involving 40 adultpatients that admitted to the ICU Sanglah hospital Denpasar. They were randomly assigned to receive intensive insulin therapy inwhich blood glucose at the level between 80 ? 110 mg/dL or conventionl insulin therapy in which insulin therapy start if the bloodglucose level exceed 215 mg/dL and blood glucose maintained at the level between 180 ? 200 mg/dL. The results of this studyshowed that: (1) Significant decrease of IL-6 level (10.25 vs 2.02; p=0.023); (2) Significant increase of albumin level (0.62 vs0.22); (3) Significant decrease of SIRS (10 % vs 45%, p=0.000) on intensive insulin therapy group compare to the conventionalinsulin therapy group. Conclusions of this study is that the increase insulin dose as well as intensive insulin therapy can maintainblood glucose level at the level normoglycaemia between 80-110 mg/dL faster compare to the conventional insulin therapy. Onthe otherhand, interleukin-6 decreases cause of decreases ROS production and anti inflammatory effect of insulin. Intensiveinsulin therapy can increase albumin level and decrease of SIRS event on hyperglycemia in critically ill ICU patients compare tothe conventional insulin therapy.
PENATALAKSANAAN KETOASIDOSIS DIABETIK (KAD) Gotera, Wira; Agung Budiyasa, Dewa Gde
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Abstract

Diabetic Ketoasidosis (DKA) is metabolic disturbance disorder that be signed by trias hyperglycemia, acidosis, andketosis, which one of very serious acute metabolic complication of diabetes mellitus. In Indonesia the incidence was not sohigh compare than the western countries, but the mortality is still high. In young age the mortality can be prevented by earlydiagnosis, rational and prompt treatment according to it!s pathophysiology. Succesfull of DKA treatment needs correction ofdehidration, hyperglycemia, acidosis, and electrolyte disturbance, identiÞ cation of comorbid precipitation factor, and the mostimportant one was continue monitoring. The treatment were adequate of ß uid therapy, sufÞ cient insulin theraphy, therapy ofpotassium, bicarbonate, phosphat, magnesium, hyperchloremic condition, and antibiotic administration according to indication.The important one was also awarness for therapy complications so that the therapy not to make worsening condition of thepatients.
INSUFISIENSI ADRENAL PADA PASIEN DENGAN PENYAKIT KRITIS Mariadi, I Ketu; Gotera, Wira
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Abstract

Stress from many sources, including pain, fever, and hypotension, activates the hypothalamic-pituitary-adrenal (HPA)axis with the sustained secretion of corticotropin and cortisol. Increased glucocorticoid action is an essential component of thestress response, and even minor degrees of adrenal insufficiency can be fatal in the stressed host. HPA dysfunction is a commonand underdiagnosed disorder in the critically ill. We review the risk factors, pathophysiology, diagnostic approach, and managementof HPA dysfunction in the critically ill
EFEK SITOTOKSIK DAN ANTIPROLIFERATIF EKSTRAK ETANOL UMBI UBI JALAR UNGU (Ipomoea batatas L) TERHADAP SEL LINE KANKER PAYUDARA T47D 1 Sumardika, I Wayan; Wiwiek Indrayan, Agung; Jawi, I Made; Suprapta, Dewa Ngurah; Adnyan, Losen
journal of internal medicine Vol. 11, No. 1 Januari 2010
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Abstract

Cancer is still one of the leading death causes worldwide. Consuming antioxidants can reduce the cancer incidence. Anthocyanin that contained in purple sweet potatoes can inhibit DNA damages. In order to prove the activity of purple sweet potatoes on cancer cell, it is necessary to have some direct research on cancer cell line.This study is a simple experimental research method. The activities of the anticancer are evaluated from cytotoxic and antiproliferative effects on cell line breast cancer T47D. Cytotoxic effects is examined with cultured cell stained with tryphan blue exlusion. Each well are contain of 36,000 cells, which is given ethanol extract purple sweet potatoes with 10 dose variation starting from 500  g/mL up to 10,000  g/mL replicated three times, then the inhibitory percentage is calculated. Antiproliferative activity is evaluated by incubating cancer cells that have been given ethanol extract purple sweet potatoes in 3 doses variation; 500, 1,000 and 2,000  g/ml in 24, 48 and 72 hours.Result of this study showed that ethanol extract purple sweet potatoes had cytotoxic activities on T47D breast cancer cell line in these dose variations, 500; 1,000; 2,000; 3,000; 4,000; 5,000; 6,000; 7,000; 8,000; 9,000 and 10,000  g/ml. The cytotoxic activity on each of dose variations above are 27.56; 42.67; 57.78; 66.67; 72.44; 79.56; 85.33; 87.56; 92.44;100; and 100 %. Ethanol extract purple sweet potatoes showed antiproliferative activities on T47D breast cancer cells in 24, 48, 72 hours incubation in concentrations 500; 1,000; and 2,000  g/ml; those are 35,700; 29,800; 25,500 cells (24 hours); 72,500; 60,300; 52,600 cells  (48 hours); 149,500;122,600;107,300 cells  (72 hours). In conclusion, ethanol extract purple sweet potatoes had cytotoxic and antiproliferative activities on cell line breast cancer T47D.
A FEMALE WITH MALIGNANT ASCITES: A DIFFICULT CASE WITH CARCINOMA OF UNKNOWN PRIMARY Retno W, Dyah; -, Supriono
journal of internal medicine Vol. 13, No. 1 Januari 2012
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Abstract

Malignant ascites is the abnormal accumulation of !uid in the peritoneal cavity associated with several intra-pelvicand intra-abdominal malignancies. Among the gynecologic malignancies, ovarian carcinoma predominates. Of thegastrointestinal malignancies, ascites can occur with advanced colon, pancreas, gastric carcinoma, and esophagealcarcinoma. Recent reports in the cytological literature suggest that 6% to 11% of malignant peritoneal effusions aredue to tumors of unknown origin.1 We reported a 62 years old female presenting adenocarcinoma ascites, which shownconfusing of site of primary origin from imaging examination. First ultrasound imaging showed mass on colon area, butre ultrasound of abdominal imaging showed the possibility of endometrium carcinoma. The CA 125 level was high (2.294u/ml). Open laparotomy showed milliar metastatic several nodule on omental, liver, and abdominal wall. There wasattachment of vesica urinaria, endometrium, colon, sigmoid, and rectum. All those result conclude this patient sufferedfrom malignant ascites of adenocarcinoma of unknown primary origin, with highly suggestive from malignant ascites ofadenocarcinoma of unknown primary origin, with highly suggestive from gynecologic malignancy that difcult to differwhether from ovarian cancer or endometrium cancer. Somehow, the epidemiology, pathophysiology, clinical presentationlead the diagnosis for ovarian cancer.
HUBUNGAN JUMLAH SEL LIMFOSIT T CD8+ PADA ULKUS KAKI DIABETIK DERAJAT 3, 4, 5 DAN ULKUS NON DIABETIK Putu Sutirta Yasa, I Wayan; Sudewa Djelantik, Anak Agung Gde; Suastika, Ketut; Mantik Astawa, Nyoma; Yuatmadja, Ignatius Ferdi
journal of internal medicine Vol. 10, No. 1 Januari 2009
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Abstract

Diabetes mellitus (DM) is a complex metabolism disorder characterized by a severe chronic hyperglycemia with a largenumber of complications, diabetic foot ulcer (DF) is one of its disastrous progressive complication. It can cause a significantmorbidity if not treated adequately. Diabetic foot ulcer is very difficult to heal as it is generally associated with other co-morbidities,such as vassal complications (peripheral vassal disease) that may cause ischemia sufficient to damage many tissues in thebody. The excess of free radical products induces widespread inflammatory reactions. These conditions may also be exacerbatedby neuropathy and foot injury which directly cause the formation of DF. If the process is followed by infection, the inflammatoryreaction will be more severe. All these events will disrupt the normal immune response to participate in wound healing process.This cross sectional study was performed to determine CD8+ T lymphocyte count in diabetic foot ulcer graded 3, 4, and 5based on Wagner Ulcer Classification System (1989) and to test the hypothesis that CD8+ T cells count in DF grade 3, 4, and 5 islower than non-DM ulcer. As many as 11 patients with DF grade 3, 10 patients with grade 4, 7 patients with grade 5 were includedin this study. Sixteen patients with non-DM ulcer as control group. Red pea-shaped fresh ulcer tissues of lower extremity werecollected from each group for CD8+ T cell lymphocyte count and 2 cc blood were collected from vein for blood glucose examination.The result showed that CD8+ T cell count consistently decreased along with the increase of DF grade. The greatest countwas observed in non-DM ulcer {26/10 field view (10 fv)}, followed respectively by grade 3 (12/10 fv), 4 (8/10 fv), and 5 (6/10fv). Statistical analysis showed the difference in CD8+ T cell count among diabetic foot ulcer groups and foot ulcer non diabeticwas highly significant (p<0.05). The relationship between CD8+ T cell lymphocyte count among groups (Non-DM ulcer, DFgrade 3, 4, 5) based on Spearman Correlation test was 0.84 for CD8+ T cell lymphocyte (r = -0,846, p<0.001).
KORELASI ANTARA DERAJAT PENYAKIT SIROSIS HATI BERDASARKAN KLASIFIKASI CHILD-TURCOTTE-PUGH DENGAN KONSENTRASI TROMBOPOIETIN SERUM Juliana, I Made; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Thrombocytopenia is one of the most frequent haematological abnormalities in patients with livercirrhosis. It is generally considered to be due to pooling and destruction of the platelets in enlarged spleenwhich was defined as hypersplenism. Portal decompression procedures, either by surgical shunts ortransjugular intrahepatic portosystemic shunt (TIPS) have not led to a consistent rise in thrombocytes count.With the discovery of the lineage specific cytokine thrombopoietin (TPO) in 1994, the missing link betweenhepatocelular function and thrombopoiesis was found. TPO is predominantly produced by the liver andconstitutively expressed by the hepatocytes. In liver cirrhosis, the damaged of liver cells reduced TPOproduction. This leads to reduce thrombopoiesis in the bone marrow and consquently causesthrombocytopenia. However, these two pathogeneses were still remained controversial results in previousstudy abroad.The aim of this study was to determine the correlation between disease severity of liver cirrhosisbased on Child-Turcotte-Pugh classification and serum thrombopoietin concentration. An analytic crosssectional study had been conducted among liver cirrhotic patients in Sanglah Hospital Denpasar. The subjectwere adult liver cirrhotic patients that were not on upper or lower gastro-intestinal tract bleeding, septiccodition/septic shock, without history of taking antithrombocytic drugs or received platelets transfusion inlast two weeks, and no history of thrombocytopenia due to primary haematologic disorders. Statisticalanalysis was done by Spearman’s test and multivariate linier regression model, with significant level p <0,05.The number of subjects were 39 liver cirrhotic patients consist of 28 (71.8%) men and 11 (28.2%)women. The median of age was 53 (25 – 68) years. We found subjetcs with Child-Turcotte-Pugh class A 3(7.7%), B 18 (46.2%) and C 18 (46.2%) respectively with the median of Child-Turcotte-Pugh score was 9 (6– 14). The range of serum TPO concentration was 1.10 – 224.60 pg/ml, median of serum TPO was 40.60pg/ml. The median of thrombocyte was 103 x 103/L with range of 30 – 729 x 103/L. Liver cirrhoticpatients with thrombocytopenia were 29 (74.4%), 41.0% of them with moderate thromboytopenia. We foundnegative correlation between Child-Turcotte-Pugh score and serum TPO concentration ( r = - 0.319; p = 0.048) but there was no correlation between Child-Turcotte-Pugh class and TPO concentration. (r = -0.303;p = 0.061). We found significant positif correlation between thrombocyte count and serum TPOconcentration also (r = 0.354; p = 0.027). Based on multivariate linier regression model, we did not findsignificant association between TPO concentration and Child-Turcotte-Pugh score (p = 0.153) orthrombocyte count (p = 0.208), respectively. Conclusion: there was no correlation between disease severityof liver cirrhosis based on Child-Turcotte-Pugh classification and serum thrombopoietin concentration.
PARANEOPLASTIC SYNDROMES Suega, Ketut
journal of internal medicine Vol. 12, No. 1 Januari 2011
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Abstract

The term Paraneoplastic Syndromes (PNS) refers to symptoms or signs resulting from damage to organs or tissuesthat are remote from the site of a malignant neoplasm or its metastases. Widely known examples include cancer cachexia,hypercalcemia,Cushing!s syndrome,and Trousseau!s syndrome . A particularly devastating form of paraneoplastic syndromes ia agroup of disorders classiÞ ed as Paraneoplastic Neurological Disorders (PND).The incidence of PNS varies with the neurologicalsyndrome and with the tumor. PNS can occurs in 7 to 10% of all patients with cancer. A paraneoplastic syndrome may resultfrom production and release of antibodies and physiologically active substances, or it may be idiopathic. However, not allparaneoplastic syndromes are associated with these antibodies. Symptoms can be atypical, psychiatric, or even ß uctuating,and PNS should often be in the differential diagnosis of otherwise unexplained neurological syndromes. An internationalpanel of neurologists has established diagnostic criteria that divide patients with a suspected PNS into deÞ nite and probablecategories. These criteria are based on the presence or absence of cancer, the presence of well-characterized antibodies, and thetype of clinical syndrome. Detection of a "well-characterized# paraneoplastic antibody is extremely helpful because it provesthe paraneoplastic etiology of the neurological syndrome. Usually, the paraneoplastic syndromes are divided into the followingcategories: (1) miscellaneous (nonspeciÞ c), (2) rheumatologic, (3) renal, (4) gastrointestinal, (5) hematologic, (6) cutaneous, (7)endocrine, and (8) neuromuscular. Treatment varies with the type and location of the paraneoplastic disorder, consist of treatmentof the underlying tumor, as well as the treatment of the presumptive immune-mediated disorder is based on immunosuppression.Because paraneoplastic syndromes differ widely from individual to individual, prognosis may vary greatly.
KORELASI ANTARA KONSUMSI ALKOHOL DAN FRACTIONAL URIC ACID CLEARANCE (FUAC) PADA POPULASI SUKU BALI DI DESA PENGLIPURAN, KUBU, BANGLI Rama Putra, I Made; Raka Putra, Tjokorda
journal of internal medicine Vol. 11, No. 3 September 2010
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Abstract

Hyperuricemia is a term for serum uric acid (UA) level above normal limit, cause by overproduction or underexcretion.Fractional Uric Acid Clearance (FUAC) can determine both conditions. One of many factors affect to FUAC is alcohol.A cross sectional analytic study perform on Balinesse people in Penglipuran Village, to know correlation between alcoholconsumption and FUAC. We arrange a questionaire with anthropometric data, physical and laboratory examinations, to collectdata on September 2009. Blood and urine examinations perform in Laboratorium Klinik Prodia Denpasar. Data was analyzed bycomputer software, result in charactericstic descriptions, Kolmogorov-Smirnov tests for data normality, Spearman!s correlationto analyze dependent variable and independent variable, and multiple linear analysis, with 95% conÞ dent interval (CI) andsigniÞ cance value p < 0.05.Ninety people fulÞ lled inclusions criteria, consist of 30 (33.3 %) female and 60 (66.7%) male. Mean age was 42.40 ± 13.91years, mean UA serum were 5.19 ± 1.40 mg/dl, with 79 people (88.9 %) normouricemia and 11 people (11.1 %) hyperuricemia.Alcohol consumption prevalence was 47.8%. Mean FUAC were 7.92 ± 2.97%. Spearman!s correlation coeÞ cients (r) were -0.24;p = 0.02 between alcohol consumption and FUAC, while Ancova multivariate result none of variable signiÞ cant to FUAC, butalcohol consumption. In conclusion, there is a signiÞ cant correlation between alcohol consumption and FUAC.
RANDOMIZED CLINICAL TRIAL OF OMEPRAZOLE AND RANITIDINE USING INDONESIAN TRANSLATED NEPEAN DYSPEPSIA INDEX Arinton, I Gede; Samudro, Pugud; Sutrisna, Eman; IDN, Wibawa
journal of internal medicine Vol. 7, No. 3 September 2006
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Abstract

In patients with dyspepsia, a common initial management strategy in primary care is to prescribe a course ofempiric antisecretory therapy. Ranitidin and omeprazole as antisecretory agents have been proven effective fortreatment of dyspepsia. This research was aimed to evaluate the effect of omeprazole and ranitidine by using NepeanDyspepsia Index (NDI) which was translated and validated in Indonesian language. Fifty healthy persons were askedto complete the Indonesia translated NDI(NDII) and Short Form(SF)- 36, which was previously validated. Cronbach' salpha and test-retest were performed for reliability analysis. Spearman's rank correlation was used to assess validity. P-value <0.03 was considered statistically significant. The results concluded that NDIl can be used in dyspepsia patientswho understand Indonesian language. The number of 104 subjects with a clinical diagnosis of dyspepsia according tothe inclusion and exclusion criteria were recruited and randomized to receive ranitidine 150 mg twice daily andomeprazole 20 mg twice daily. Symptoms of dyspepsia were evaluated by using NDIl at baseline one week aftertreatment. The outcomes of omeprazole and ranitidine were evaluated by comparing improved NDIl score in 5domains (tension, activities, eating/drinking, knowledge/control and work/study). The mean of age in the subjects was47 years old that consisted of 36% male. After one week treatment, the NDIl dyspepsia patients score in omeprazoletreated group was not significantly different from that in ranitidine treated group. The effect of omeprazole was notbetter than ranitidine when it was given as empirical treatment for dyspepsia patients in primary care.

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