Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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The Role of a Novel Digital Microcapillary Instrument in Detecting Blood and Plasma Hyperviscosity
Get PDFAim: to test the precision and accuracy of a Digital Microcapillary instrument in measuring blood and plasma viscosity. Methods: about 40 blood samples were drawn for precision test. The samples were obtained from patients admitted for Medical Check-Up at CiptoMangunkusumo Hospital (RSCM) in December 2011. Accuracy test was evaluated using cross-sectional design and involving 135 patients with acute ischemic stroke. The patients underwent either inpatients or outpatients care at Department of Clinical Pathology, Department of Neurology,and Emergency Unit of RSCM, Fatmawati Hospital Jakarta, Prikasih Hospital Jakarta, and Bhakti Yuda Hospital Depok. The precision test was evaluated by calculating the coefficient of variation (CV), interrater variability of Cronbach Alpha, and reliability coefficient of Bland Altman. The accuracy of the test was evaluated with a diagnostic test. The gold standard used for these tests was Brookfield LV-DV III viscometer. Results: the results of precision test were: CV = 0.04; interrater variability of blood and plasma viscosity = 0.94 and 0.82, respectively; the Bland Altman mean difference = –0.19. The results of accuracy test were: sensitivity of blood and plasma viscosity measurement were 88.9% and 100%, respectively; specificity of blood and plasma viscosity measurement were 88.9% and 84%, respectively. Conclusion: the digital microcapillary has high sensitivity and specificity; therefore the instrument can be considered to be used as screening test tool to measure blood and plasma viscosity. Key words: digital microcapillary, blood viscosity, plasma viscosity, acute ischemic strok
Chemotherapy-induced Spontaneous Pneumothorax: Case Series
Get PDFWe present 2 patients who developed spontaneous pneumothorax (SP) following rapid regression of lymphoma and rhabdomyosarcoma with lung metastases. Case 1, a 43-year old man was admitted to our hospital with dyspnea 10 days before admission. He denied any recent trauma or previous treatment for lung tuberculosis. Three weeks prior to admission, he received first cycle of CHOP for non-Hodgkin’s lymphoma stage II BE. Chest X-ray consistent with right pneumothorax. After treatment with chest tube drainage for about 1 month, the patient recovered and chemotherapy could be continued without further complications. Case 2, a 35- year old man was admitted to other hospital with dyspnea and chest pain on day 4 after second cycle of systemic combined chemotherapy for rhabdomyosarcoma stage IV (lung metastases) with doxorubicin, ifosfamide, mesna, and dacarbazine. Chest X-ray showed hydropneumothorax on right and left lung. After treatment with chest tube drainage about 2 weeks, the patient recovered and chemotherapy could be continued without further complications.The mechanism of pneumothorax following chemotherapy is not clearly understood yet, however, several hypotheses have been considered: 1) the rupture of a subpleural bulla after chemotherapy; 2) the rupture of an emphysematous bulla in an over expanded portion of the lung which is partially obstructed by a neoplasm; 3) tumor lyses or necrosis due to cytotoxic chemotherapy directly induces the formation of fistula. Dyspnea and chest pain suddenly appear during successful chemotherapy for metastatic chemosensitive tumors should alert the physician to the possibility of SP. The treatment is directed toward lung re-expansion. Chemotherapy induced pneumothorax should be considered as oncologic emergency
Induction of Rat Germ Cell Apoptosis by Testosterone Undecanoate and Depot Medroxyprogesterone Acetate and Correlation of Apoptotic Cells with Sperm Concentration
Get PDFAim: to investigate the safety and effectiveness of dose TU+DMPA hormones in developing potential male contraceptives. Methods: suppression of rat sperm concentration through increased apoptotic germ cells by in vivo administration of a long-acting androgen composed of a combination of testosterone undecanoate (TU) and depot medroxyprogesterone acetate (DMPA) was performed. Adult Sprague-Dawley rats received 2.5 mg TU every 6 week and 1.25 mg DMPA every 12 week for 60 week, a regimen known to rapidly reduce testosterone production by the testes and produce azoospermia within 12 week. Sperm concentration data were log transformed before analysis. Results are expressed as the mean±SEM. ANOVA, followed by post hoc test was used to determine differences across time and phase. T test was employed to determine differences between two groups. Results: apoptosis revealed significant increase in apoptotic germ cells (80% when rats were administered with TU+DMPA. Apoptotic germ cells can be found in several spermatogonia (20%), spermatocytes (30%), and spermatids (50%). Conclusion: dose TU+DMPA hormones may be a safe and effective way to develop potential male contraceptives. Key words: TU, DMPA, sperm concentration, apoptosis
An Observational Study to Evaluate the Safety and Efficacy of Telbivudine in Adults with Chronic Hepatitis B
Get PDFAim: to assess the safety and efficacy of telbivudine therapy in adult patients with CHB in Indonesia. Methods: the study design was prospective cohort study. Multicenter study of adult CHB patients requiring oral antiviral therapy in daily practice setting. All patients received 600 mg of telbivudine daily for one year. Recruitment and decision to start telbivudine therapy was based on clinical indication as assessed by the participating physicians. The primary end-point was patient safety (adverse event or serious adverse events); while the secondary end-points were HBeAg seroconversion, changes of serum HBV DNA levels and serum ALT normalization. Patients were assessed at week-24 and week-52 of treatment. Results: a total of 176 cases were eligible for analysis, comprising 104 (59.8%) HBeAg-positive and 70 (40.2%) HBeAg-negative patients. Adverse events were reported in 7 (4.0%) patients, most of them were mild. HBeAg loss and seroconversion rate was 28.8% and 14.14% at week-52 respectively. Undetectable HBV DNA (PCR negativity) was 51.8% at week-24 and 62.7% at week-52. Median HBV DNA levels were significantly reduced from baseline to week-24 and week-52 treatment (both p<0.001; Wilcoxon’s signed-rank test). Normalization of serum ALT activity occurred in 85 (73.28%) patients at week-52. Conclusion: Telbivudine therapy is generally safe and well tolerated among adult Indonesian patients with chronic hepatitis B. Treatment efficacy in terms of HBeAg loss and seroconversion, changes of HBV DNA levels and serum ALT normalization were similar to previous reported studies. Key words: Alanine aminotransferase, chronic hepatitis B, HBV DNA, oral antiviral treatment, telbivudine therapy
Controversy: Hirudotherapy (Leech Therapy) as an Alternative Treatment for Osteoarthritis
Get PDFOsteoarthritis (OA) is the most common degenerative joint disease found in the elderly. Drug options that are recommended by the American Academy of Orthopaedic Surgeon (AAOS) are acetaminophen, NSAIDs, tramadol, capscaicin and intraarticular corticosteroids. However, there is concern for the possible side effects resulting from long term use of those medications. Researchers are searching for a safer treatment modality for OA. Leech therapy (hirudotheraphy) is one of the therapies under investigation, given its purported analgesic and antiinflammatory properties. Key words: osteoarthritis, hirudotherapy, leech therapy, NSAIDSs, elderly, alternative terapy
Hypertensive Crises in the Adolescent: Evaluation of Suspected Renovascular Hypertension
Get PDFHypertensive crises can be divided into two categories as hypertensive emergency and hypertensive urgency. Most authorities have defined hypertensive emergency as a situation that requires immediate reduction in blood pressure (BP) with parenteral agents because of acute or progressive target organ damage, whereas hypertensive urgency is a situation with markedly elevated BP but without severe symptoms or progressive target organ damage, wherein the BP should be reduced within hours, often with oral agents. Adolescent with hypertension should be suspected of having renovascular hypertension in spite of other causes. This case is presenting a 16-year-old boy with hypertensive crises due to suspected renovascular hypertension. His blood pressure was 240/120 at admission with hypertensive retinopathy grade III and there was increase in creatinine after administering ACE-inhibitor but his renal arteriography revealed normal, other physical examination and laboratory findings was normal. Regarding these findings, the conclusion was this patient got essential hypertension. As many hypertensive crises occur in any ages, clinicians should aware the possibility of renovascular hypertension in young patients with hypertensive crises. An early detection and urgent treatment are needed to prevent the implication of progressive target organ damage.Key words: hypertensive crises, adolescent
Current Prevalence of Hepatitis B Infection among Parturient Women in Jakarta, Indonesia
Get PDFAim: to determine the current prevalence of hepatitis B infection among parturient women in Jakarta, Indonesia. Methods: a cross-sectional study was conducted in women giving birth between May and July 2009, recruited by consecutive sampling technique in 2 hospitals and 13 public health centers in Jakarta. Mothers with history of chronic liver disease were excluded. Data were collected by questionnaires including obstetric history, hepatitis B immunization history, and the presence of jaundice; maternal venous blood samples were taken before parturition for HBsAg determination that was performed by ELISA. Results: of 1,009 parturient women screened for hepatitis B infection, 22 were found positive, giving an overall hepatitis B prevalence of 2.2%, previous 5.2% in 1985. None of the subjects had any symptoms of HBV infection. The highest HBsAg prevalence was found in the East Jakarta study site, with predominance in mothers aged <20 years and those with multi-parities. Conclusion: present prevalence of HBsAg among Indonesian parturient women in Jakarta was 2.2% and markedly reduced compared with prevalence in 1985. Key words: hepatitis B, parturient women, immunization, prevalence
Hemostatic Status of Pre and Post Intracoronary Injection of Peripheral Blood Stem Cells in Patients with Recent Myocardial Infarction
Get PDFAim: to investigate hemostatic parameter changes, such as platelet aggregation, blood and plasma viscosity, prothrombin time, APTT, CRP and fibrinogen, before and after administration of stem cell therapy. Methods: a total of 24 patients were enrolled. Peripheral blood stem cells (PBSCs) were harvested and injected into the infarct-related artery after 5 consecutive days of G-CSF administration. Recombinant human erythropoietin was administered at the time of intracoronary PBSCs injection. Results: we were able to evaluate 11 from 24 of patients regarding hemostatic status pre–post stem cell injection. There were no significant difference between baseline vs 3 months in spontaneous aggregation (p=0.350), PT (p=0.793), aPTT (p=0.255) and TT (p=0.254). There were also no significant difference between baseline vs 3 months in plasma viscosity (p=0.442) and blood viscosity (p=0.843). Nevertheless the patient who had their blood and plasma viscosity above or below normal laboratory range return to normal level after the treatment. Both PT and APTT also show normalization value. Both Fibrinogen and CRP level show significant decrease between baseline and 3 months after treatment (p=0.009) and (p=0.04) respectively. Conclusion: combined G-CSF and EPO based-intracoronary infusion of PBSCs may open new perspective in the treatment of hypercoagulable state post AMI. Key words: coagulation, platelet aggregation, myocardial infarction, hypercoagulatio
Underutilization of Anticoagulant for Venous Thromboembolism Prophylaxis in Three Hospitals in Jakarta
Get PDFAim: to assess the current use of anticoagulants and implementation of International Guidelines in venous thromboembolism (VTE) prophylaxis in hospitalized patients with acute medical illnesses in Jakarta, Indonesia. Methods: a multicenter, prospective, disease registry, recruiting patients diagnosed as acutely ill medical diseases and other medical conditions at risk of VTE, with in-hospital immobilization for at least 3 days. Results: of 401 patients, 46.9% received anticoagulants which included unfractionated heparin (64.4%), fondaparinux (11.7%), enoxaparin (9.6%), warfarin (3.7%), and combination of anticoagulants (10.6%). VTE prophylaxis using physical and mechanical method was used in 81.3% of patients, either as a single modality or in combination with anticoagulants. During hospitalization, VTE were found in 3.2% patients; 10 patients (2.5%) had lower limb events and 3 patients (0.75%) had a suspected pulmonary embolism. The main reference international guidelines used were AHA/ASA 2007 (47.4%), followed by ACCP 2008 (21.7%). Conclusion: the study showed underutilization of prophylaxis anticoagulants in which mechanical thromboprophylaxis either alone or combination with anticoagulants was the most commonly used. Unfractionated heparin was the preferable choice. The most commonly used guideline was AHA/ASA 2007. VTE thromboprophylaxis in medically ill patients needs to be encouraged. Key words: venous thromboembolism (VTE), prophylaxis, registry, non-surgery hospitalization
Use of BRAF V600E as a Molecular Marker in Aggressive Colorectal Cancer
Get PDFAim: to compare the immunoexpression of BRAF V600E among stage of colorectal cancer. Methods: this was a cross sectional, and retrospective study involving Dukes’ stage A, B, and C colorectal carcinoma, each with 15 cases. Immunohistochemistry was performed in paraffin-embedded specimens of tumor mass for the assessment of BRAF V600E. The proportion differences of immunoexpression of BRAF V600E among Dukes’stage A, B, and C were tested using Chi-Square test. Results: the result of positive BRAF V600E immunoexpression (moderately to strongly positive) in Dukes’stage A, B, and C were found in 1 of 15 cases, 4 of 15 cases and 13 of 15 cases respectively. BRAF V600E immunoexpression was statistically significant more frequent in Dukes’stage C (p<0,001, Chi-Square test). Conclusion: positive BRAF V600E immunoexpression could be used as a marker of aggresive colorectal carcinoma. Key words: BRAF V600E, Dukes, immunoexpression, colorectal carcinom