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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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PENYAKIT MIELOPROLIFERATIF Putra Sedana, Made; Wulansari, T. Ivone
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Abstract

Myeloproliferative disorder (MPD) represent a group of disease marked by cellular proliferation of one or morehaematologic stem cells which include polycythemia vera, essential thrombocythemia, chronic idiopathic myelofibrosis withmyeloid metaplasia / MMM, hypereosinophillic syndrome / HES, unclassified myeloproliferative disease / U-Mpd, chronicmyelogenous leukemia / CML and chronic neutrophylic leukemia / CNL. The incidence and pathogenesis are still unknown.Chronicity which alterable to aggressive phase become acute leukemia and clonal cytogenetic abnormalities in erythroblast,neutrophyl, basophyl, macrophage, megakaryocytes and B-lymphocytes, but not in fibroblast are characteristics of the disease.Haematopoeisis is marked by autonomically growth and myeloid hyperplasia in bone marrow. Bone marrow aspiration showtrilineage hypercellularity. The complications include thrombotic phenomenon, micro and macrovascular arteries thrombosis,bleeding phenomenon, hypercatabolism and transformation into acute myelogenous leukemia / AML. Pseudocoagulopathy,pseudohyperkalemia, pseudohyperacydphosphatemia, pseudohypoglicemia and pseudohypoxemia can be seen.
SEORANG PENDERITA DENGAN KARSINOMA SEL SKUAMUS ESOFAGUS Arsana, I Putu; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 11, No. 1 Januari 2010
Publisher : journal of internal medicine

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Abstract

Oesophageal carcinoma still rare in Indonesia. Several centers reported low prevalence of oesophageal carcinoma.Three patients found in Palembang in one year, while four patients found in Bandung within ! ve years. Esophageal carcinomawas found in 1.1% of all cancer, and 7% of all digestive organ cancers in United States. Oesophageal carcinoma have mortalityratio of 0.95%. Oesophageal carcinoma more frequent in men with a ratio of 3:1. Diagnosis by anamnesis, physical examination,routine blood tests, barium esophagogram, esofago-gastroduodenoscopy, chest and abdominal CT-scan or MRI, bronchoscopy,endoscopic ultrasound, and also with laparoscopy. A 55-years old Balinese woman came with complaints of dif! culty inswallowing and diagnosed as squamous cell middle third oesophageal carcinoma stage III. Anamnesis, barium esofagogram,gastroduodenum endoscopy (OGD), and histopathological biopsy con! rmed the diagnosis of this patient. This patient givenchemotherapy with combination of 5-" uorouracil (5-FU) 40 mg/day and cisplatin 1500 mg/day 2 ? 3 cycles every 3 weeks
VENTILATOR ASSOCIATED PNEUMONIA Wiryana, Made
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Ventilator Associated Pneumonia (VAP) is defined as nosocomial pneumonia that occurred 48 hours afterthe patient had a mechanical ventilation support either from endotracheal tube or tracheostomy tube. VAPussually charactherized by 3 component sign of systemic infection: fever, tachycardia and leukocytosisfollowed by new infiltrate sign or a worsening scheme on the chest x ray and bacteriologic findings of thecausal of lung infection, but acctually we can diagnosed a VAP based on the findings of a number ofcriteria: histopathologic examination of the lung tissue from an open biopsy, a fast cavity formation of alung infiltrate without any sign of tuberculosis or malignancy and a positive pleural fluid culture, in whichthe species that found on the blood culture and airway were the same.The insidens of VAP are high, according to the foreign literature approximately between 9 – 27 % from allIntensive Care Unit population. This condition made VAP as the first causal of a nosocomial infection inthe Intensive Care Unit. The mortality rate of VAP is also high, Chastre and Fagon stated that the crudemortality rate can reach of 76%. Early onset VAP which occurred on the first 4th day after admission in theIntensive Care Unit ussually had a better prognosis because of caused by a still antibiotic sensitivepathogens. The Late onset VAP which occurred after 5 days or more after hospitalization, has worseprognosis because of caused by a multidrug resistance (MDR) pathogens. In order to define the pathogensthat caused VAP, some scientist made a classification of VAP patient based on the degree of disease, riskfactor and the onset, which is the group I with mild-moderate degree, common risk factor and the onset isanytime during hospitalization or a severe degree with an early onset, ussually caused by a gram negativebacteria. The group II, patient with a mild-moderate degree, specific risk factor that happened anytimeduring hospitalization, ussually caused by all bacteria in the group I added with an anaerob bacteria. Thegroup III, patient with a severe degree, early onset with specific risk factor or a late onset, ussually caused by Pseudomonas aeruginosa, Acinetobacter sp and MRSA. Other approach is by classifying the bacteriacausing VAP in a primary endogen, secondary and eksogen type.Prevention of VAP can be done by 2 different ways, first by a non pharmachologic way, routine andstandard things that ussually done in the ICU, but this action still could not enough in lowering the insidensof VAP. Second, by a pharmachologic way, Selective Decontamination of the Digestive Tract (SSD) andOropharyngeal Decontamitation (OD). SSD is proven effective empirically in preventing VAP but the usedof antimicrobial can caused a higher risk on resistention. SDD is not recommended as a routine action inpreventing VAP so that OD with the used of antiseptic is preferred as another alternative.
PREVALENSI ASMA EKSASERBASI PADA IBU HAMIL DAN PENGARUHNYA TERHADAP JANIN DAN IBU DI RSUP SANGLAH DENPASAR Ngurah Rai, I B
journal of internal medicine Vol. 10, No. 3 September 2009
Publisher : journal of internal medicine

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Abstract

The prevalence of asthma among pregnant females is increasing. Asthma is one of the most common chronic medicalconditions that cause complications in pregnancy. There is evidence that asthma can adversely impact on pregnancy outcomes,and conversely that pregnancy may result in a change in the clinical status of a female with asthma. The aim this study was toknow prevalence of asthma exacerbation in pregnancy and the effects to infant and maternal in Sanglah General Hospital. Thisstudy is retrospective study to medical record of pregnancy patients delivery at Sanglah General Hospital. In this study we found1959 pregnancy patients and prevalence of asthma exacerbation was 0.71% (14 asthmatic patients) Proportion of pathologicdelivery, pre-eclampsia and congenital malformations of the fetus was lower in asthmatic group than in group without asthmabut not signi! cant. The mean of birth weight was lower in asthma group than in group without asthma (3107.14 ± 521.78 grams: 3306.70 ± 366.21 grams) p = 0.05 95%CI (-399.14 ? 0.012). The conclusion this study is prevalence of asthma exacerbationson pregnant females in Sanglah General Hospital was 0.71%. Birth weight both in pregnant females with asthma and pregnantfemales without asthma was in normal limit but trend was lower in pregnant females with asthma than pregnant females withoutasthma.
ADIPONECTIN ACTIVITY IN ACUTE VIRAL HEPATTOBI Suryadarma, I Gusti Agung
journal of internal medicine Vol. 7, No. 3 September 2006
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Abstract

The mechanisms of hepatocellular necrosis in acute viral hepatitis, primarily through cytopathic immune mechanisms,however the processes of hepatic parenchyma necrosis also might be secondarily involved the roles of cytopathic non-immunemechanisms. Once of the defend mechanisms to the hepatic viral infection is through the releases of adiponectin. Adiponectin is ahormone secreted by adipocytes. The protective effect of adiponectin against liver injury likely involve multiple mechanisms,especially to the ability effects of adiponectin as a anti-inflammatory cytokines. Thus, decreased of the adiponectin concentration<10 mg/dl in the acute viral hepatitis, especially Hepatitis B and C perhaps as the early biomarkers of possibility progression tothe chronic hepatitis.
SEORANG PENDERITA DENGAN LEUKEMIA MIELOID KRONIK DAN MIELOMA MULTIPEL Suega, Ketut
journal of internal medicine Vol. 11, No. 3 September 2010
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Abstract

Chronic Myeloid Leukemia (CML) and Multiple Myeloma (MM) are two chronic progressive diseases characterizedby neoplastic proliferation of myeloid cell and monoclonal plasma cell. Chronic myeloid leukemia was recognized as a distinctentity, associated with massive splenomegaly and as ! rst malignant disease found to be constitutively associated with spesi! ccytogenetic abnormality the Philadelphia oncogene. Whereas MM is frequently recognized by monoclonal protein productionand either difuse osteoporosis or lytic bone lesion. Clinical manifestation are consequence of marrow in! ltration of plasma cells,production of M protein in blood or urine and immune de! ciency. Coincidence of these two diseases in one particular patient is avery rare occasion. Herewith we reported a woman 42 years old Balinese presented of abdominal enlargement without symptomof bone pain, anemic syndrome. After complete examination supporting by ! nding on bone marrow examination this patient! nally diagnosed of having chronic phase of CML and MM stage IIIB as well. Treatment was given with hydroxy urea andother supported measures and we planned to continue with melphalan and prednisone. There were no clear explanation for thiscondition whether it occur concomitantly or one disease follow with the other. Several reports found that in quite similar occasionMelphalan was the agent of suspected with induced secondary malignancy. Others also found twenty MDS patient togetherwith lymphoid malignancy and plasma cell. Tanaka et.al., noted that a more satisfactory explanation is that both disorders arefrom malignant transformation of a precursor cell capable of differentiating into both lymphoid and myeloid lines. In our casemore likely that CML concomitantly found with MM because there were no previous history of having chemotherapy norradiotherapy.
HUBUNGAN BESI DAN PRODUKSI SITOKIN Suega, Ketut
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

Iron deficiency is a widespread nutritional disorder in infant, children and women of reproductive age especially indeveloping countries where almost 2 billion individuals are concerned, particularly infant and children. The absorption ofintestinal iron as regulated in several ways such as dietary regulator, stores regulator and erythropoietic regulator. The negativeconsequence iron deficiency anemia on behavior, psychomotor development and growth rate are well established and underlinedthe need to control iron deficiency anemia. Iron supplementation has proven to be useful, particularly in infant and children,when iron deficiency is important and has to be corrected rapidly. However several studies have indicated that iron deficiencyprotects against infection and other studies show the opposite where morbidity is higher in iron deficient children. Iron deficiencywould decrease the resistance to infection through impairment of immune competence of the individual especially cell-mediatedimmunity. The mechanisms of impairment are very likely multifactorial and may include but not be limited to a reduction in theactivity of certain iron-dependent enzymes such as ribonucleated reductase. Other mechanism may include a defect in one orseveral of the early events of lymphocyte activation and cytokine productions such as IL-2. The main cellular source of IL-2 isactivated lymphocyte and TCR/CD3 actvation leads to autocrine IL-2/high affinity receptor signal transduction, resulting in cellproliferation. Iron deficiency may inactivated T cell proliferation and decreasing IL-2 production.
HUBUNGAN ANTARA PERUBAHAN VOLUME DARAH RELATIF DENGAN EPISODE HIPOTENSI INTRADIALITIK SELAMA HEMODIALISIS PADA GAGAL GINJAL KRONIK Agustriadi, Ommy; Suwitra, Ketut; Raka Widiana, Gde; Sudhana, Wayan; Sidharta Loekman, Jodi; Kandarini, Yenny
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

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Abstract

Intradialytic hypotension (IDH) is a common complication in chronic hemodialysis (HD) patients, in turn would increase morbidity and mortality. Relative blood volume changes during HD play a role in IDH episode. Those changes can be assessed by total plasma protein measurement before and after HD. To determine relationship between relative blood volume changes (assessed by percentage of total plasma protein changes during HD) and IDH episode during HD in chronic renal failure, an analytical cross-sectional study was perferomed in 51 patients (28 males and 23 females, age 47.8 ±11.6 years) underwent chronic HD at Hemodialysis Unit of Sanglah Hospital Denpasar. Data were collected during single HD session. Blood pressure was measured every 30 minutes and relative blood volume changes assessed by measuring percentage of total plasma protein changes during HD. Among them, IDH episode experienced in 10 (19.6%) patients. Logistic regression analysis revealed a strong and significant relationship between relative blood volume changes and IDH episode during HD in chronic renal failure (Beta = 0.29; OR = 1.35; CI 95%: 1.1 - 1.6; p < 0.01) and it was found that every 1% changes in relative blood volume, would increase risk of hypotension episode by 35%. This relationship was still strong and significant (Beta = 0.46; OR = 1.58; CI 95%: 1.11 -2.25; p = 0.01) after adjusted by hemoglobin levels, intradialytic body weight changes, use of antihypertensive medi¬cations and diabetes melitus. Using ROC curve, found that optimal cut of point of intradialytic total plasma protein changes to predict an IDH episode during HD was 5.56% with 90.0% sensitivity and 80.5% specificity (95% CI: 0.83-0.99; p < 0.01). Our data revealed a strong and significant relationship between intradialytic relative blood volume changes assessed by intradialytic total plasma protein changes and IDH episode during HD in chronic renal failure.
HUBUNGAN KENDALI GLIKEMIK DENGAN ASYMMETRIC DIMETHYLARGININE PENDERITA DIABETES MELITUS TIPE 2 LANJUT USIA Ngurah Hariawa, Kadek; Suastika, Ketut
journal of internal medicine Vol. 9, No. 3 September 2008
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Abstract

Increasing life expectacy is usually in line with increasing prevalence of matabolic diseases, especially diabetes mellitus(DM). Old age and DM are risk factors for cardiovascular disease. Endothelial dysfunction is the early process of atherosclerosis.Asymmetric dimethylarginine (ADMA) is a marker for endothelial dysfunction. Until recently however, there is a lack of studyon the correlation of diabetes control and ADMA in elderly with DM.The objective of this study was to assess the correlation of diabetes control with ADMA in diabetes elderly. The designof the study was cross sectional analytic study. The study subects were diabetic patients aged 60 years or above without smokingand existance of end stage renal disease.The 80 study subjects consisted of 57 males and 43 females, ages ranging from 60 to 80 years. The majority of thesubjects were with other diseases i.e. hipertension 62 (77.5%), dyslipidemia 51 (63.8%), overweight 59 (73.9%), decreased renalfunction with creatinin clearence below 60 ml/mnt 58 (72.5%), hyperhomocysteinemia 35 (43.8%). The subjects with goodglicemic control were 25 (32%), moderate 31 (38.8%), and bad glicemic control 24 (30%). Pearson correlation showed there wasno correlation between glicemic control (fasting blood glucose, 2 hour after meal blood glucose, HbA1c) and ADMA. Analysis onother factors showed a correlation of ADMA with sistolic blood pressure (r=-0.222; p=0.024) and homocystein (r=0.333; p=0.001).Multiple liniar regression analysis constanly showed a correlation between homocystein and ADMA (B=0.473; p=0.003). Thenew construction model of this study was the formula ADMA (µmol/L)= 0.213+0.473 log homocystein µmol/L. Based on thecriteria used diabetes control, we found mean difference of ADMA at systolic blood pressure (p=0.031). There was no meandiffrence of ADMA found based on the treatment regimens given i.e. those given insulin or not (p=0.547) and those givenmetformin or not (p=0.219).In conclusion, blood glucose control has no correlation with ADMA in the elderly with DM, however homocystein haspositve correlation with ADMA in elderly with DM. The elderly with DM have several accompanying of diseases.
ASOSIASI PENYAKIT ALERGI ATOPI DENGAN IgG ANTI HELICOBACTER PYLORI PENELITIAN OBSERVASIONAL KASUS KONTROL ANALITIK DI UNIT RAWAT JALAN PENYAKIT DALAM RSU Dr SOETOMO SURABAYA PP, Agung; H, Novida; D, Fetarayani; A, Baskoro; G, Soegiarto; C, Effendi
journal of internal medicine Vol. 12, No. 3 September 2011
Publisher : journal of internal medicine

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Abstract

Approximately  20%  of  the  world  populations  suffer  from  IgE-mediated  allergic  diseases. Although  genetic  factors play an  important  role  in  the manifestation of allergic disease,  the existence of other  factors  such as  lifestyle  factors, socioeconomic factors and presence of oro-fecal infection including Helicobacter pylori infection also take a part. This is  based  on  the  hygiene  hypothesis  that  infections  in  childhood  can  reduce  allergic  diseases. We  conduct  a  study  to analyze negative association between allergic diseases with IgG anti Helicobacter pylori. This is a matched case control study involved 52 patients in Internal Medicine outpatient ward Dr. Soetomo Hospital Surabaya consisting of 26 patients with allergic diseases as a group of cases and 26 non-allergic patients as controls. Allergic disease was diagnosed by anamnesis, physical examination, and skin prick tests, whereas IgG anti Helicobacter pylori was measured using immune-chromatography  technique. We  found  in  the allergic group  there were 19 patient  (73.08%) with positive Helicobacter pylori and 7 patient (26.92%) with negative result.Whereas in control group there were 21 patient (80.77%) with positive Helicobacter pylori  result and 5 patient  (19.23%) were negative. Helicobacter pylori serology had protective effect  to allergic disease (OR 0.67, CI 95%). Was the conclusion, there is negative association between atopic allergic diseases with IgG anti Helicobacter pylori

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