Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Vitamin D Prevents Endothelial Damage Induced by Increased Neutrophil Extracellular Traps Formation in Patients with Systemic Lupus Erythematosus
Get PDFAim: to investigate the effects of Vitamin D calcitriol/1,25(OH)2D3 on NETosis in systemic lupus erythematosus (SLE) patients with hypovitamin D. Methods: neutrophlis of five SLE patients with hypovitamin D were divided into 4 groups, P0 (0 nM/control), P1 (1 nM), P2 (10 nM), and P3 (100 nM) as cultured samples. Phorbol Myristate Acetate (PMA) was used to stimulate NETs formation. The supernatant was separated and cocultured with HUVECs. Externalization of Neutrophil Elastase (NE) and Myeloperoxidase (MPO) during NETosis was measured by immunofluorescence and ELISA respectively. Early and late apoptosis of endothelial cell was measured by flowcytometry using cell death kit (Annexin V and PI antibody). Results: this study showed significant decrease in early apoptosis with 10 nM of 1,25(OH)2D3 compared to control group. Significance of NE externalization found in all treatment groups (p<0.05), while MPO absorbance in the same tendency but not statistically significant. Further analysis also found a moderate positive correlation between NE externalizations with early apoptosis. Conclusion: vitamin D 1,25(OH)2D3 could reduce endothelial damage by decreasing NETosis activity. This result may reveal the possibility of Vitamin D as supplementary therapy for SLE patients with hypovitamin D to prevent endothelial damage. Key words: NETs, NE, MPO, 1,25(OH)2D3, HUVECs
From Basic to Clinical Practice in Internal Medicine
Get PDFoai:ojs.www.actamedindones.org:article/1Acta Medica Indonesiana, today is The Indonesian Journal of Internal Medicine, addresses all the concerns of science on Internal Medicine. In this edition, we publish a study conductedby Putra ST.1, a cohort retrospective study on teenager subjects who were breast-fed as infants and the effects on the development of atherosclerosis. This study supported the idea that breastfeeding may have protective effect on the development of atherosclerosis. We publish the study since it included the health issues of teenagers.We also publish a study from Yogyakarta conducted by Hartopo AB, et al. which found that neutrophil to lymphocytes ratio of more than 6.2 is correlated to the increased in-hospital adverse events. The subjects were patients with ST elevation myocardial infark (STEMI). Based on the results of the study, the neutrophil/lymphocyte ratio can be utilized as a predictor of adverse events in patients with STEMI
A Biomarker for Metastatic Colorectal Cancer and Treatment Goals
Get PDFThe incidence of colorectal cancer (CRC) is rapidly increasing world-wide including in Indonesia and controversy not with standing, making it as the second most common malignancy (GLOBOCAN 2012). As with other cancers – more importantly with its adenoma-carcinoma sequence being one of the first to be elucidated by Vogelstein1 – its treatment and prognosis are determined by disease staging and molecular profile. Yet, identifying those for whom chemotherapy is indicated is still a challenge due to its histopathological heterogeneity; with special emphasis on stage II disease, for example, having a five-year survival that ranges from 87.5% for IIA to 58.4% in stage IIC. It is in such situation that predictive and prognostic markers are constantly being investigated. As one of the leading causes of cancer death in developed countries, much interest has grown in research in the development of biomarkers to improve the diagnostic process and to predict efficacy of chemotherapy.2 Only a few biomarkers are qualified as such, and the paucity of data has resulted in under- and overtreatment when relying only on the current TNM system. At present, only mutant KRAS, mutant BRAF, Microsatellite Instability (MSI) and the Oncotype DX® ColonCancer Assay are used in clinical practice. MSI and mutant KRAS are the established markers to date.3 But as the world is shifting towards personalized medicine (or “precision therapy” as is more frequently called), much work remains to be done
Nocturnal Hypertension: Neglected Issue in Comprehensive Hypertension Management
Get PDFThe body circardian rhythm affects blood pressure variability at day and night, therefore blood pressure at day and night might be different. Nocturnal hypertension is defined as increase of blood pressure >120/70mmHg at night, which is caused by disturbed circadian rhythm, and associated with higher cardiovascular and cerebrovascular events also mortality in hypertensive patients. Nocturnal hypertension and declining blood pressure pattern, can only be detected by continuous examination for 24 hours, also known as ambulatory blood pressure measurement (ABPM). Chronotherapy, has become a strategy for managing the hypertensive nocturnal patients, by taking hypertensive medication at night to obtain normal blood pressure decrease in accordance with the normal circadian rhythm and, improving blood pressure control
Opioid Use in Cancer Pain Management in Indonesia: a Call For Attention
Get PDFSevere pain is a major problem for cancer patients, and pain management often requires the use of opioids. Indonesia is one of the countries where the use of opioids for cancer patients is extremely low, and this calls for attention, as many cancer patients in the country undergo unnecessary suffering as the consequence of this opioid underuse. The inability to assess pain correctly, failure to determine the correct dose, fear of addiction, overly tight regulation, all contribute to the failure to implement rational use of opioids for cancer patients. Breakthrough pain, a problem which requires special attention not only because it is commonly found but also requires proper knowledge to handle them. These hurdles are discussed in the present review, in order to bring a better understanding about the correct use of opioids in severe cancer pain. Some examples where opiods are used inappropriately in cancer pain management are also discussed.Key words: opioid, break through pain, cancer pain, morphine
Chronic Hypoparathyroidism Due to Partial Thyroidectomy with Intracranial Calcification
Get PDFA 57 year old female came with the complaint of recurrent headache, often fatigue, and sometimes feel numbs and rigid in her extremities, no other symptom was noted. Her body weight is stable and she was in menopausal state (Figure 1a and 1b). She had a history of partial thyroidectomy 20 years ago and continues thiamazole 2.5 mg with seldom regular consult to physician.From the physical examination, the patient had a scar from thyroid surgery and other organs were in the normal condition. From laboratory examination, there was slight normocytic normochromic anemia (Hb: 10.7 gr/dL), normal fT4: 1.21 ng/dL (0.7-1.48 ng/dL), slightly low Calcium: 8.3 mg/dL (8.5-10.2 mg/dL), others were within normal limit but there was no Phosphorus level data
Obstructive Jaundice as a Complication of Macrocystic Serous Cystadenoma of the Pancreas
Get PDFMacrocystic serous cystadenoma is an unusual and essentially benign pancreatic tumor. Herein, we report on a 40-year-old woman diagnosed with macrocystic serous cystadenoma who presented with obstructive jaundice. A cystic lesion in the head and body of the pancreas was revealed by abdominal computed tomography. Intraoperative pancreatic cyst aspiration ruled out mucinous cystic neoplasm which has a malignant potential. The pancreatic cyst fluid cytology was basophilic amorph materials concluded as benign cystic lesion. Internal drainage was performed instead of pancreatic resection which showed good outcome. Biliary obstruction is a rare complication of serous cystadenoma. This case describes an unusual clinical presentation of macrocystic serous cystadenoma
Effect of a Weight Loss Program on Body Composition and Metabolic Syndrome Markers in Obese Weight Cyclers
Get PDFAim: to evaluate the effect of weight loss program on fat mass, visceral fat rating and metabolic syndrome markers in obese subjects with weight cycling. Methods: this was an 8-week open trial. The subjects were recruited consecutively from Balai Kota DKI Jaya. Subjects were classified into two groups according to the fluctuation of weight gain (weight cycling/WC and first encounter obesity/FEO group). Both groups were assigned to receive weight loss program consisted with following goals: a 1000 kcal energy intake reduction and 45 minutes mild-to-moderate intensity physical activity three times a week. Body composition (fat mass, visceral fat rating), and metabolic syndrome markers (waist circumference and triglyceride levels) were measured at baseline, week 4 and at the end of study. Results: seventy two subjects completed the study (34 subjects in WC group and 38 subjects in FEO group). Following weight loss program, a decrease in fat mass, visceral fat rating, and waist circumference was lower in WC group compared with FEO group but it was not statistically significant (p>0.05). Triglyceride levels were decreased in the FEO group while it was increased in WC group. However the difference was not significant (p=0.055). Conclusion: weight loss program may contribute to changes in body composition and metabolic syndrome markers in obese subjects, which the response appears to be worse in weight cyclers. Key words: weight loss program, weight cycling, fat mass, visceral fat rating, metabolic syndrome
REM Desensitization as a New Therapeutic Method for Post- Traumatic Stress Disorder: A Randomized Controlled Trial
Get PDFAim: to evaluate potential efficacy of a new therapeutic approach in posttraumatic stress disorder in comparison with eye movement desensitization and reprocessing (EMDR), a standard treatment approach and controls. Methods: the study was designed using a randomized controlled trial methodology. Participants were recruited from military servicemen aged between 25 to 50 years who were admitting hospitals of Bushehr, Iran, with the final diagnosis of PTSD. Finally 33 male patients were devided into three subgroups: G1: EMDR; G2: REM Desensitization; and group 3: controls who received no therapy. Mississippi Scale for Posttraumatic Stress Disorder, Pittsburgh Sleep Quality Index (PSQI) and a 37 item death anxiety questionnaire were used for measures. Results: multiple comparisons showed that intrusive thoughts were significantly more likely to improve with REM Desensitization versus EMDR (P=0.03), while depression was more responsive to EMDR (p=0.03). Among the Pittsburgh scale for the quality of sleep items, sleep quality (p=0.02), sleep duration (p=0.001), and total sleep quality score (p=0.002) were significantly more likely to improve in the REM Desensitization group. Change in the absolute death anxiety scores was not different between subgroups excepting EMDR versus control group (p=0.05). Conclusion: REM, desensitization, the new therapeutic approach to PTSD is a highly effective strategy, even more than EMDR, the standard treatment, in most of the evaluated subjects, with special emphasis on sleep symptoms, and also in the management of intrusive thoughts. Depression is the only factor in which, REM Desensitization was significantly less likely to represent a superior therapeutic effect than EMDR. Key words: post traumatic stress disorder (PTSD), eye movement desensitization and reprocessing, new treatment
Profile and Factors Associated with Mortality in Mediastinal Mass During Hospitalization at Cipto Mangunkusumo Hospital, Jakarta
Get PDFAim: to obtain characteristics, variations of the type of mass, diagnostic modalities, and mortality factors during hospitalization in patients with mediastinal mass at our institute during a 10-year period. Methods: a case-control study was conducted, by browsing through the medical records of 113 mediastinal mass patients who were treated at Cipto Mangunkusumo Hospital, Jakarta, during a 10-year period (January 2000-December 2009). Factors associated with mortality, i.e; sepsis, septic shock, pneumonia, lung tuberculosis, superior vena cava syndrome, massive pleural effusion, pericard effusion, and respiratory failure were analyzed by logistic regresion multivariate analysis. Results: two hundred and one mediastinal mass patients were diagnosed and treated at our institute, 113 medical records were available to be included in this study. There were 69 males and 44 females with the age range of 18-60 years. One-hundred and seven patients were symptomatic at presentation. Mediastinal tumor was the most common mediastinal mass found among the subjects. The most frequent mass location was in the anteriosuperior compartement. Chest X-ray imaging were able to detect 61 cases of mediastinal mass, while 42 patients underwent thoracotomy (open biopsy) to acquire histopathology diagnosis. The proportion of mortality during hospitalization reached 39.8%. Logistic regression multivariate analysis found sepsis (p=0.000), superior vena cava syndrome (p = 0.000), and massive pleural effusion (p=0.047), were significant factors associated with mortality during hospitalization. Conclusion: the clinical and radiologic features of mediastinal mass patients in our institute showed that mediastinal mass may resemble the symptoms of other diseases. Types and diagnostic modalities performed in our study differs from other studies previously reported in other countries with a high proportion of mortality during hospitalization.Key words: mediastinal mass, sepsis, superior vena cava syndrome, massive pleural effusion