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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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TERAPI TERKINI MULTIPLE MYELOMA Suega, Ketut; Sripurnama Sjah, Yunny
journal of internal medicine Vol. 10, No. 3 September 2009
Publisher : journal of internal medicine

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Abstract

Management strategies for Multiple Myeloma (MM) have continued to evolve as the result of innovative treatmentmodalities and efÞ cacy data used in establishing new standard of care. In 2004, multiple myeloma was diagnosed in more than15.000 people in the United States and will account for approximately 20% of deaths due to hematologic malignancies. Mostcommonly diagnosed in the growing elderly population.Until recently, few effective treatment existed. The use of alkylating agents and corticosteroid had remained the treatmentof choice for almost four decades. On a cellular level, the disease is characterized by complex interactions between tumor cellsand the surrounding bone marrow microenvironment. Understanding of the relationship between malignant plasma cells andthe microenvironment has sparked ongoing efforts to develop targeted therapeutic agents for treatment of this disease. Recentadvances in its treatment including using of the immunomodulatory drugs such as thalidomide and lenalidomide as well as theproteasome inhibitor bortezomib. Each of these agents is undergoing extensive clinical evaluation in combination with othertherapies to produce unprecedented response rates in newly diagnosed and relapsed MM. They have each improved the responseto therapy, but they are expensive. In recent years, evidence supporting a survival beneÞ t for three new drugs have resulted intheir inclusion, in combination with older drugs, in the management of younger and older patients. Each of these new drugs hasmultiple mechanisms of action, targeting both intracellular signaling pathways and tumor microenvironment. This review focuson the newer agents such as thalidomide, bortezomib, and lenalidomide in treatment of patient with newly diagnosed MM andrelapsed MM, treatment-related side effect, and future using of these agent including new combination therapy
ADVERSE DRUG REACTION Mariyono, Harbanu H; Suryana, Ketut
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Abstract

There are lots of new drugs that made for therapy, prevent and even as a diagnostic tools. Beside the desired effect therewere also undesired effect that can occur when managing patient with drugs which then we call adverse drugs reaction. Anadverse reaction to a drug has been defined as any noxious or unintended reaction to a drug that is administered in standard dosesby the proper route for the purpose of prophylaxis, diagnosis, or treatment. Adverse drug reaction can be devided in two groups,which is reactions than can occur on everyone and the ones that can only occur on susceptible ones. One of the adverse drugreaction is drug allergy. History taking is the most important thing on diagnosing drug allergy, one that can help was Naranjosscore. We can run few more test to defined the type of Adverse Drug Reaction. For managing patient with adverse drug reaction,we have to avoid drugs that induce the reaction, premedication and also desensitisation.
KEJADIAN PERITONITIS PADA PASIEN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS: IDENTIFIKASI MIKROORGANISME DAN SENSITIFITAS ANTIBIOTIK Haryanti, Elizabeth; Kandarini, Yenny; Widiana, I Gde Raka; Sudhana, Wayan; Loekman, Jod; Suwitra, Ketut
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Abstract

Patients treated with Continuous Ambulatory Peritoneal Dialysis (CAPD) are constantly exposed to microbial invasionof the peritoneal cavity and rapid microbiological diagnosis of peritonitis is essential due to Hospitalization and imposes asignicant burden of morbidity. The aims of this study were to enumerate the association between microorganisms, sensitity,and resistence of antibiotic on CAPD patients with clinical peritonitis.We collected data through medical records by the number of CAPD patients with clinical peritonitis from June 2004 untilJune 2009. The study was analysis with one-way ANOVA. We found 23 patients clinical peritonitis out of 77 CAPD patients,with insidence was 14% per-year, aged 14 ? 65 y (15M; 8F). The chronic pyelonephritic was a leading (16/23) cause of endstages renal disease. Each patients underwent HD prior (5 ? 60 months) to CAPD, with survival time was 2 ? 51 months. Out of23 patients, 4 were returned to hemodialisis, 15 were died, due to cardiogenic shock 46.7%. Aseptic peritonitis was 31.3%, andthe common microorganism was staphylococcus 18.8%. Peritoneal !uid test showed mean score of sensitivity were tetracycline22.93, cipro!oxacin 19.36, piperacillin-tazobactam 17.36, thrimetropin/sulfamethoxazole 16.5, fosfomycin 15.78, consecutivelyand the rest were resistent. Staphylococus was strongly related to insidence peritonitis, and tetracycline was the most highlysensitive antibiotic in CAPD patients.
SEORANG PENDERITA HEPATITIS KRONIK B DAN C DENGAN MUTASI PADA GEN P53 KODON 249 PADA JARINGAN HATI Eka Saputra, I Wayan; Gunawan, Stephanus; Muttaqin, Zainul; Soemoharjo, Soewignjo
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Abstract

Role of gene P53 as a tumor suppressor gene in generating primary liver cancer is very important primarily in cellgrowth regulation and apoptosis. By using AS-PCR method, the gene mutation can be recognized. It has been reported a chronichepatitis B and C case with experiencing mutation of gene P53 Codone 249 in liver tissue of a 33 years old male with anti HCVpositive, HBsAg positive, on the liver biopsy indicated of chronic hepatitis without cirrhotic features and malignancy signs. OnAS-PCR examination found mutation on gene P53 codone 249. This finding was expected to be an early warning sign foroccurrence of primary liver cancer, so that, early intervention could be performed.
PENGARUH PEMBERIAN KOMBINASI ANTI RETRO VIRUS LEBIH AWAL TERHADAP MORTALITAS PADA KO-INFEKSI TB-HIV DI RUMAH SAKIT SANGLAH DENPASAR Utama, Susila
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Abstract

TB and HIV are closely interlinked. TB is a leading cause of HIV-related morbidity and mortality. Mortality amongpatients with TB-HIV co-infection is known to be high despite the use of effective TB treatment. Many studies have indicatedthat the initiation of Combination Anti Retro Virus (cARV) during TB treatment improves outcomes. The optimal timing forthe initiation of cARV in patients with TB-HIV co-infections remains unclear. The aims of this study is to know the impact ofearly initiation of cARV during TB treatment on mortality in TB-HIV co-infected patients at Sanglah Hospital Denpasar. Cohortretrospective study was conducted from medical record of TB-HIV co-infected patients from June 2004 until August 2009. Theinclusion criteria was TB-HIV co-infected patients with TB treatment earlier than cARV. The cARV treatment was differentiatedinto 2 category, before 2 months of TB treatment (during intensive phase) and after 2 months (maintenance phase). All of thepatients were followed for mortality after one year of cARV treatment. There were 60 TB-HIV co-infected patients, 50 (83.3%)male and 10 female (16.7%). The CD 4 level less than 50 cell/mm3 were 48 (80%) and CD 4 level more than 50 cell/mm3 were 12(20%). The cARV treatment during intensive phase of TB treatment were 20 (33.3%) and cARV treatment after intensive phasewere 40 (66.7%). Mortality after one year cARV treatment were 28.3%. The mortality on cARV treatment after 2 intensive phasewas 32.5% (13 patients) and mortality on ARV treatment during intensive phase was only 20% (4 patients). The odds ratio was1,926 with confidence interval 0.536 ? 6.926. The mortality on the group of CD 4 level less than 50 cell/mm3 was not different.The mortality on ARV treatment after intensive phase were 34.5% and only 21.1% when cARV during intensive phase. Oddsratio was 1.974 with confidence interval 0.515 ? 7.558. The initiation of cARV during intensive phase of TB treatment on TBHIVco-infected patients will decreased mortality in one year of cARV treatment, but statistically not significance. The sameresult was also found in CD 4 less than 50 cell/mm3.
SEORANG PENDERITA HEMOFILIA RINGAN DENGAN PERDARAHAN MASIF Renny A.R, Ni Made; Suega, Ketut
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

Haemophilia A is the most common of the hereditary clotting factor deficiencies, which have defect of absence or lowlevel factor VIII in the plasma. It is a X-linked recessive inheritance disease, with incidence approximately 1 per 10.000 malebirth. In the middle of the year 2001,it were reported 314 cases in Indonesia. The clinical features of the bleeding may be shownmany various severity, and classified into mild, moderate and severe disease. The clinical severity of the disease correlates withthe extent of the factor VIII deficiencies. Diagnostic confirm by specific clinical features, there is a history of the bleeding in thefamily, and laboratorium examination to measure the factor VIII level in the plasma. We reported a case, male, 46 years old,Balinese, reffered from private hospital with complaining profuse bloody vomiting and blackish stool and has been done bloodtransfusion for 15 bags, with history of haemophilia confirmed. The history of bleeding before classified patients into a milddisease, but in the present the patient suffered from chronic liver disease and erosive gastritis, that can lead patients has moreprofuse bleeding. A good respons shown by giving the transfusion of the cryopresipitate and packed red cell.
PERBEDAAN KUALITAS FRESH FROZEN PLASMA YANG DICAIRKAN DENGAN METODE KONVENSIONAL DAN DENGAN METODE ALAT FFP THAWER Retno, Didin; Riza Zainal, Ahmad; D Machsoos, Budi; Heri Hermanto, Djoko; Oktya Wardhani, Shinta
journal of internal medicine Vol. 13, No. 1 Januari 2012
Publisher : journal of internal medicine

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Abstract

Saiful Anwar Hospital (SAH) doesn?t have standardized Fresh Frozen Plasma (FFP) liquefying tools. Standard OperatingProcedure (SOP) to liquify FFP at SAH is put the FFP on the table until diluted. Recently a new Thawer of FFP wasdeveloped in SAH. In this study we compared between the two methods which are convensional and the new one. Thirttytwo bag of FFP were divided in two different treatments which is group of new Thawer and the convensional. Eachliqueed bag of FFP was recorded the time of liquefaction, aPTT, PPT and INR. Statistical analyses using independent Ttest or Mann-Whitney as alternative. In this study found mean time of liquefaction of FFP on Thawer group were shorterthan conventional method 25.32 ± 3.4 vs 50.38 ± 5.52 minutes and statistically signicant (p < 0.05). Mean of aPTT onnew Thawer group is 36.79 ± 5.94; but on conventional method is 36.94 ± 5.53 second (p = 0.67). Mean of PPT 11.71 ±0.95 second on new Thawer group and 11.84 ± 2.22 second on conventional method (p = 0.249). Mean INR each groupwere 1.02 ± 0.08 on new Thawer group and 1.03 ± 0.19 on conventional method (p = 0.234). This study shows that newFFP Thawer liquifay FFP more quickly than conventional method without decreasing the quality of FFP.
HEMOLYTIC UREMIC SYNDROME Ngurah Wisesa, Ida Bagus; Loekman, Jodi S
journal of internal medicine Vol. 10, No. 1 Januari 2009
Publisher : journal of internal medicine

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Abstract

Hemolytic uremic syndrome (HUS) is caused primarily by Shiga toxin–producing Escherichia coli O157:H7. Hemolyticuremic syndrome can occur in adults, and the most common cause of acute renal failure in children. Characteristic features of thesyndrome are microangiopathic anemia, thrombotic thrombocytopenia, and renal failure. Although the presentation of this syndromeis diverse, the classic prodromal illness is bloody diarrhea. Children with HUS generally present with gastroenteritiscomplaints (e.g., abdominal pain or tenderness, nausea or vomiting, fever, anemia); affected adults may be asymptomatic. Complicationsfrom HUS can include intussusception, chronic renal failure, and seizures in severe cases. Because an incubation periodof approximately one week occurs between the start of diarrhea and the onset of HUS, physicians should maintain a high index ofsuspicion; early laboratory testing is important to diagnose and manage this syndrome. Obtaining a complete blood count andstool culture and performing Shiga toxin testing are the first of a series of tests that may help diagnose of HUS.
GAGAL JANTUNG Mariyono, Harbanu H; Santoso, Anwar
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Heart failure were the end stage of all heart disease and the cause of the increasing morbidity andmortality among patient. Almost five percent from all inhospital patient were heart failure. Heart failure hasbeen defined as the failure of the heart to pump blood to systemic. It can be classify into acute, acutedecompensated and chronic heart failure. New York Heart Association, Stevenson, Forrester have madeclassification based on the clinical symptoms. All cardiac problems can ended into heart failure, thepathogenesis was very complex including renin-angiotensin-aldosteron system, neurohormonal, sympatic nervesystem, nattriuretic peptide, and others. Twelve leads ECGs, echocardiography, chest x-rays, blood chemistries,catheterisation can help us diagnose patient with heart failure. Management of heart failure consist ofmanagement of acute and chronic heart failure, non drugs management, drugs and even an invasive treament.
PERBANDINGAN ANTARA PEMBERIAN ANTIBIOTIKA MONOTERAPI DENGAN DUALTERAPI TERHADAP OUTCOME PADA PASIEN COMMUNITY ACQUIRED PNEUMONIA (CAP) DI RUMAH SAKIT SANGLAH DENPASAR Sajinadiyasa, I GK; Ngurah Rai, IB; Sriyeni, LG
journal of internal medicine Vol. 12, No. 1 Januari 2011
Publisher : journal of internal medicine

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Abstract

Among CAP patient, there are still some controversies about eÞ cacy of various approach management for the patient.There are important issues about using the dual therapy improving the better outcome compared to monotherapy of CAP patient.A retrospective study was held on CAP patients, who were hospitalized in Sanglah Hospital in 2008-2009 to compare betweendual versus monotherapy antibiotic with the outcome.Seventy Þ ve subjects were included in this study. About 73.3% subjects received dual therapy (cefotaxim and azitromicyn)and 26.7% received monotherapy (levoß oxacin). There were no signiÞ cant correlation between dual vs monotherapy antibioticwith length of stay (LOS) (p = 0.075) or with mortality (p = 0.367). Also there were no correlation between PSI score and LOS(p = 0.303) and mortality (p = 1.000). In age group, there was signiÞ cant correlation between age and mortality (p = 0.025), butthere were no signiÞ cant correlation with LOS (p = 0.265). As our conclusions, we Þ nd there were no signiÞ cant correlationbetween dual vs monotherapy antibiotic with outcome patient CAP. But there was signiÞ cant correlation about patient in olderage had higher mortality compare with younger age.

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