Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Profile of PRMT-1 Gene Polymorphism in Hemodialysis Patients with Increased ADMA Levels
Get PDFAim: to determine the distribution of PRMT-1 gene polymorphism and ADMA levels among continuing hemodialysis patients. Methods: genotyping of PRMT-1 polymorphism was performed in 57 hemodialysis patients at Al Irsjad Hospital. All participants were recruited for physical examination, questionnaire, and collection of 5 mL fasting venous blood. The blood was treated with phenol-chloroform extraction of genomic DNA. The candidate’s single nucleotide polymorphisms (SNPs) were genotyped by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The ADMA plasma levels was determined by ELISA and all biochemical indicators of serum were examined. Results: fifty-seven hemodialysis patients participated in our study, 54 (95.4%) of them had increased ADMA plasma levels. DNA sequencing analysis of 13 patients showed a suspected PRMT-1 gene polymorphism at sequence 5837 as there were different genotypes between C and G. Conclusion: the increased levels of ADMA might be caused by PRMT-1 gene polymorphism.Key words: ADMA, PRMT-1 polymorphism, chronic kidney diseas
Bacteria Fight Back, Also in Indonesia!
Get PDFGet an infection, take an antibiotic. That simple, sensible, and often life-saving intervention, repeated myriad times, has triggered an ever-escalating war between humans and microbes—a war the microbes seem to be winning. Almost as soon as penicillin was introduced in 1942, bacteria started to develop resistance. Now, many common bacteria have acquired resistance to multiple antibiotics, making some infections extraordinarily difficult to treat. Antibiotic resistance is the ability of a microorganism to withstand the effects of an antibiotic. In Indonesia, antibiotics can be purchased even without a doctor’s prescription. Now, as bacterial resistance to antibiotic are increasing, the potency of an antibiotic to eradicate pathogenic bacteria seems to be decreasing, not very long after a new antibiotic is available in the market. Generally, the development of resistant bacteria to antibiotics happen spontaneously or because of a pressure of inappropriate antibiotic use in clinical practice. In Indonesia, the absence of antibiotic regulation to be used in human as well as animal health is also believed to have contributed to the rapidly increasing incidence of multidrug resistant bacteria. The antibiotic resistant bacteria has become a serious problem especially for patients hospitalized in intensive care units. More than 40% of the budget for drugs is allocated for antibiotics, and once the causative bacteria develops resistance to antibiotics, the case fatality rate of the infections increases
Prevalence of Urinary Incontinence, Risk Factors and Its Impact: Multivariate Analysis from Indonesian Nationwide Survey
Get PDFAim: to describe the profile of urinary infection (UI) and to analyze its risk factors and impacts. Methods: subjects were enrolled consecutively from pediatric, urology, obstetrics & gynecology, and geriatric outpatient clinics at six teaching hospitals in various regions of Indonesia. Those with urinary tract infection and diabetes mellitus were excluded. The UI questionnaire was adapted from the 3 Incontinence Questions (3IQ). Written informed consent was obtained prior to the interview. Results: about 2765 completed questionnaires were obtained. The overall UI prevalence was 13.0%, which consisted of prevalence of stress UI (4.0%), urgency UI/wet OAB (4.1%), dry OAB (1.6%), mixed UI (1.6%), overflow UI (0.4%), enuresis (0.4%), other UI (0.7%). The prevalence of UI was significantly higher (p<0.001) in geriatric population (22.2%) compared to the adult (12.0%), and pediatric population (6.8%). There was no prevalence difference (p>0.05) between male and female subjects. Enuresis and urgency UI/wet OAB were the most common UI in pediatric population. The prevalence was 2.3% and 2.1% respectively. Urgency UI and stress UI were the two most common type in adult and geriatric population. Both have an equal prevalence of 4.6%. The multivariate analysis showed that the prevalence of UI increased with LUTS (PR 4.22, 95%CI 2.98-5.97), chronic cough (PR 2.08, 95% CI 1.32-3.28), and fecal incontinence (PR 1.85, 95% CI 1.03-3.32). We found that UI impaired family life (25.3%), sexual relationship (13.6%), and job/school performance (23.7%). Frequent toilet use and reducing fluid intake were the two most common behavior changes. Conclusion: the prevalence of UI in Indonesia is nearly similar to other Asian countries. It increases with age and is not affected by gender. LUTS, chronic cough, and fecal incontinence may have significant effects on the prevalence. UI seems to impact daily life and behavior. Key words: urinary incontinence, daily life, LUTS, prevalence, age
The Role of Endothelial Progenitor Cell in Cardiovascular Disease Risk Factors
Get PDFEndothelial progenitor cells (EPCs) are cell derived from bone marrow and the cells circulate in peripheral blood. These cells have characteristics similar to stem cells, but their ability to proliferate and differentiate is more limited. EPC discovery has changed the old paradigm in the field of vascular biology and it brings huge implications in medicine as EPCs can mediate the processes of vasculogenesis and maintain the vascular integrity. Increasing amount of EPC in the circulation is important since it has positive correlation with reendothelialization and neovascularization and they are closely linked to cardiovascular health. Thus, EPC could potentially be used for treatment of disease caused by endothelial dysfunction.Key words: endothelial progenitor cell, endothelial dysfunction, vasculogenesis, reendothelialization
Graves’ Dermopathy: Responsive with Intralesion Steroid
Get PDFA 51-year-old male came with thickening lesion in both legs since 2.5 years before presented. It started with small lesion and went larger. Before diagnosed, he was admitted to hospital due to unresolved headache. He complainted nausea, easily hungry, protrusion of both eyes without diplopia or diminution of vision, tremor, palpitation, and unintentional weight loss (25-30 kgs in a year). On examination, it was found that he was in thyrotoxic condition and has diffuse goiter. From skin examination he had raised hyperkeratotic, and waxy plaque like lesions over both pretibial region. Laboratory examination confirm for thyrotoxic with presumably Graves’ disease with the result on Table 1. Thyroid scintigraphy showed diffused enlargement and increased uptake. Skin biopsy from the pretibial skin showed epidermis with vacuolar degeneration, partly spongiotic and hyperpigmentated, thickening basalis membrane, miksoid dermis and spreading chronic inflammatory cell in perivascular and periadneksal. It confirmed the diagnosis of myxedema hystologically
Adrenal Myelolipoma, Cholelithiasis and Calcified Spleen: Retrospective Diagnosis of Sickle Cell Anemia Using a Novel Triad of Abdominal Imaging Findings
Get PDFSickle cell anemia is an inherited abnormality of the globin chain with very high prevalence in the Indian subcontinent. A significant proportion of these patients present late in life and are at a risk of complications like acute chest syndrome and painful episodes till a definitive diagnosis is reached and appropriate treatment is started . We report a novel triad of abdominal imaging findings which is not reported in literature until now and which may suggest a diagnosis of sickle cell anemia in retrospect. Patients with this triad of abdominal findings should be suspected to have an underlying hemoglobinopathy and should be referred for further hematological workup. Although in our case the patient was diagnosed to have sickle cell anemia depending on the abnormal morphology of red cells and hemoglobin electrophoresis, it should be remembered that this triad of findings may be seen in other hemoglobinopathies which induce a state of chronic anemia. Key words: sickle cell anemia, adrenal myelolipoma, gall stones, calcified spleen
Integrative Approach in Haemophillic Arthropathy of The Knee: a Case Report
Get PDFHaemophilic arthropathy is the most prevalent joint disorder in haemophilia. This disorder is characterized by chronic synovitis and progressive destruction of joint cartilage. We report a case of arthroscopic synovectomy to reduce bleeding frequency in haemophilic arthropathy of the knee. Patient was a 15 years old male with haemophilic arthropathy of the left knee. We performed an arthroscopic synovectomy under tightly regulated factor VIII replacement therapy. There were villous synovial hypertrophy at all part of the joint, multiple bone and cartilage defect, and also anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) deficiency found intraoperatively. After 6 month follow up, subjective complain and bleeding frequency decreased significantly. The visual analog scale improved from 5-6 to 1-2, and the International Knee Documentation Committee Score increased from 49 to 66. Bleeding frequency decreased from 4-8 times per month to less than 1 time per month. Arthroscopic synovectomy performed in this case could reduce the pain, decrease the frequency of bleeding, and improve patient’s functional outcome.Key words: arthroscopic synovectomy, haemophilic arthropathy, haemophilia, anterior cruciate ligament, posterior cruciate ligament
Transcatheter Closure of Post-operative Residual Ventricular Septal Defect Using a Patent Ductus Arteriosus Closure Device in an Adult: a Case Report
Get PDFTranscatheter closure of perimembranous and muscular ventricular septal defect (VSD) has been performed widely and it has more advantages compare to surgery. However, transcatheter closure of residual VSD post operation of complex congenital heart disease is still challenging because of the complexity of anatomy and concern about device stability, so the operator should meticulously choose the most appropriate technique and device. We would like to report a case of transcatheter closure of residual VSD post Rastelli operation in a patient with double outlet right ventricle (DORV), sub-aortic VSD, severe infundibulum pulmonary stenosis (PS) and single coronary artery. The patient had undergone operations for four times, but he still had intractable heart failure that did not response to medications. On the first attempt. we closed theVSD using a VSD occluder, unfortunately the device embolized into the descending aorta, but fortunately we was able to snare it out. Then we decided to close the VSD using a patent ductus arteriosus (PDA occluder). On transesophageal echocardiography (TEE) and angiography evaluation, the device position was stable. Post transcatheter VSD closure, the patient clinical condition improved significantly and he could finally be discharged after a long post-surgery hospitalization. Based on this experience we concluded that the transcatheter closure of residual VSD in complex CHD using PDA occluder could be an effective alternative treatment. Key words: residual VSD, PDA occluder, transcatheter closure, heart failure, Rastelli
In-hospital Major Cardiovascular Events between STEMI Receiving Thrombolysis Therapy and Primary PCI
Get PDFAim: to compare the in-hospital major cardiovascular events between thrombolysis therapy and primary percutaneous coronary intervention (PCI) in patients with ST-elevation acute myocardial infarction (STEMI). Methods: the study design is retrospective cohort. Medical record of patients with STEMI onset <12 hour receiving thrombolysis treatment or primary PCI in Dr. Sardjito Hospital Yogyakarta between January 2008 and March 2010 are evaluated. The primary outcome is major cardiovascular events which comprise cardiovascular death, reinfarction and stroke during hospitalisation. The secondary outcomes are post infarction angina pectoris, heart failure, cardiogenic shock and bleeding. Results: among 78 patients with thrombolysis and 53 patients with primary PCI, in-hospital major cardiovascular events do not differ significantly (10.3% versus 9.4%; RR 1.09, 95%CI 0.33-3.55; p=0.87). Post infarction angina pectoris is 7% versus 3.8% (RR 2.51, 95%CI 0.50-12.60; p=0.24). The incidence of heart failure is significantly higher in thrombolysis (17.9% versus 5.7%; RR 3.64, 95%CI 0.99-13.38; p=0.04), primary PCI reduces 68.1% relative risk to develop acute heart failure in STEMI. The incidence of cardiogenic shock is not different. Major and minor bleeding do not differ significantly either. Conclusion: the in-hospital major cardiovascular events between STEMI receiving thrombolysis therapy and primary PCI is not significantly different. Heart failure is significantly higher in thrombolysis therapy and the primary PCI reduces the risk. Key words: major cardiovascular events, STEMI, primary PCI, thrombolysi