Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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The Differences Between Interleukin-6 and C-reactive Protein Levels Among Adult Patients of Dengue Infection with and without Plasma Leakage
Get PDFAim: to determine the differences in IL-6 and CRP levels among groups of dengue infection patients with and without plasma leakage. Methods:a cross-sectional study was conducted in adult patients with dengue infection who were treated at Cipto Mangunkusumo and Persahabatan Hospital between 1 March 2014 and 1 April 2015. The study analyzed differences in IL-6 and CRP levels on the 3rd and 5th day of fever in both groups, as well as differences in each group. Interleukin-6 and CRP levels in both groups, was analyzed using unpaired t-test or MannWhitney and in each group, the data was subsequently analyzed using paired t-test or Wilcoxon test. Results: the samples of study consisted of 24 subjects with plasma leakage and 20 subjects without plasma leakage. The level of IL-6 for groups with and without plasma leakage for the 3rd and the 5th day of fever were 8.56 (1.85-96.15) vs. 3.80 (1.94-81.93) pg/mL (p=0.069) and 4.30 (1.60-70.28) vs. 2.76 (1.26-11.67) pg/mL (p=0.025), respectively; while for CRP level, there were 10.1 (4.3-36.5) vs 6.8 (3.0-21.6) mg/L (p=0.014) and 5.0 (2.0-20.1) vs 2.9 (0.1-9.9) mg/L (p=0.048). The level of IL-6 on the 3rd and the 5th day of fever in the group with and without plasma leakage were 8.56 (1.85-96.15) vs. 4.30 (1.60-70.28) pg/mL (p=0.037) and 3.80 (1.94-81.93) vs. 2.76 (1.26-11.67) pg/mL (p=0.005). The level of CRP on the 3rd and 5th day of fever in the group with and without plasma leakage were 10.1 (4.3-36.5) vs. 5.0 (2.0-20.1) mg/L (p=0.0001) and 6.8 (0.3-21.6) vs. 2.9 (0.1-9.9) mg/L (p=0.0001). Conclusion:there was no difference in IL-6 level on the 3rd day of fever between the two groups; while on the 5th day of fever, the IL-6 level was higher in the group with plasma leakage. The level of CRP on the 3rd and the 5th day of fever were higher in the group with plasma leakage. The levels of IL-6 and CRP on the 3rd day of fever were higher than the levels on the 5th day of fever in both groups
Hemostasis and Stem Cell Therapy in Myocardial Infarction
Get PDFCardiovascular disease has been well known as the most frequent cause of death in many countries all over the world.1 Acute myocardial infarction (AMI) is a sudden clinical coronary event that has high mortality and morbidity rate. The survivals of AMI will have left ventricle (LV) remodelling and decreased cardiac functions in the following years due to necrosis of cardiomyocites after AMI leading to chronic heart failure. However, revascularization therapy such as percutaneous coronary intervention (PCI) and medications cannot regenerate the necrotic cardiomyocites. Stem cell (SC) therapy as novel strategy in management of AMI has been developing so fast recently. Potential beneficial mechanism of SC therapy after AMI includes myocardial preservation, decreased infarct expansion and myocardial regeneration.2 To date, SC therapy in management of AMI seemed feasible and safe in clinical practice. Number of trials had been conducted to search for promising results and answers to many questions regarding the matter. The TOPCARE-AMI (transplantation of progenitor cells and regeneration enhancement in acute myocardial infarction) with 59 patients showed improvement in ejection fraction and infarct size after 1 year follow-up. The REPAIR-AMI (reinfusion of enriched progenitor cells and infarct remodelling in acute myocardial infarction) trial with larger samples of 204 patients showed improvement in global LVEF at 4 months follow up from 48.3%±9.2% to 53.8%±10.2%.6 A systematic review of SC therapy in AMI with 13 RCT and 811 enrolled patients indicated LV function improvement in short term follow-up
Diagnosis and Management of Infections Caused by Enterobacteriaceae Producing Extended-Spectrum b-Lactamase
Get PDFBacterial resistance to antibiotics is a serious problem worldwide that affect the increment of morbidity and mortality rate; Enterobacteriaceae producing ESBL is one of the causes. However, there are still limited information regarding diagnosis and management of ESBL-E infection. Detection of ESBL-E requires certain steps that are problematic and time consuming. Diagnosis and management of ESBL-E infection have become more and more challenging due to limited diagnostic method available and choice of antibiotics that may be used, along with growing subtyped of ESBL through various of mutations. This article is aimed to give an overview on current situation of ESBL-E infections, with a focus on diagnosis and management of such infection by reviewing several recent studies on related issue
Management of Irritable Bowel Syndrome in the Elderly
Get PDFIrritable bowel syndrome (IBS) is one of the most commonly encountered functional gastrointestinal disorders in the elderly. IBS is characterized by abdominal pain and altered bowel habits in the absence of specific organic pathology. The diagnosis of IBS usually depends primarily on established clinical criteria. Currently, Rome III criteria are the criteria of choice for defining IBS. However, aging itself is categorized as one of the alarm symptoms in the diagnosis of IBS that may warrant further investigation. Therefore, exclusion of organic diseases, using several investigations, is of paramount important in the older patients. In general, the treatment of IBS in the elderly is not different from the younger populations. However, greater caution needs to be considered before treating with drugs because of the altered risk-benefit profile in the elderly. Several studies have shown a strong relationship of IBS with psychiatric conditions. Thus, psychological treatments should also be considered in the management of IBS in the elderly. Key words: irritabel bowel syndrome, elderly, management
Colistin: an Antibiotic and Its Role in Multiresistant Gram-negative Infections
Get PDFIncreasing number of infection cases caused by multiresistant Gram-negative bacteria or multidrug resistant organism (MDRO) has become a major problem worldwide since there have been a lot of resistance to many classes of antibiotics. Mutant isolates such as fluoroquinolone-resistant and β-lactamase-resistant bacteria have been commonly found, particularly in intensive care unit (ICU). During the last two decades, there has been no study of developing antibiotics in search of discovering new type of antibiotics; meanwhile, the resistance of Gram-negative bacteria or MDRO to antibiotics is increasing. Colistin or polymyxin E is an old antibiotic, which has been used since 1959 for treating infection caused by Gram-negative MDRO. It was revealed that colistin has side effects of nephrotoxicity and neurotoxicity; therefore, the use of this antibiotic was stopped and it was replaced by other antibiotics which were effective and were considered safer at that time. There is an increasing number of infections with multi-resistant Gram-negative (MDRO) against the available antibiotics and the availability of alternative antibiotics has not been satisfying; therefore, microbiologists are searching back to the old option, which has been proven to be effective against multi-resistant Gram-negative bacteria, the old antibiotic that has been long forgotten, i.e. colistin, as an alternative treatment against Gram-negative MDRO. It is expected that colistin may have essential and reliable role as future antibiotics for treatment of multi-resistant Gram-negative infections and as an alternative of antibiotics that have been available so far. Key words: antibiotics, colistin, Gram-negative, multidrug resistant organism (MDRO)
Cost-effectiveness of Scaling Up Voluntary Counselling and Testing in West-Java, Indonesia
Get PDFAim: to evaluate the costs-effectiveness of scaling up community-based VCT in West-Java. Methods: the Asian epidemic model (AEM) and resource needs model (RNM) were used to calculate incremental costs per HIV infection averted and per disability-adjusted life years saved (DALYs). Locally monitored demographic, epidemiological behavior and cost data were used as model input. Results: scaling up community-based VCT in West-Java will reduce the overall population prevalence by 36% in 2030 and costs US9.17 per DALY saved. Cost-effectiveness estimation were most sensitive to the impact of VCT on condom use and to the population size of clients of female sex workers (FSWs), but were overall robust. The total costs for scaling up community-based VCT range between US$1.3 and 3.8 million per year and require the number of VCT integrated clinics at public community health centers to increase from 73 in 2010 to 594 in 2030. Conclusion: scaling up community-based VCT seems both an effective and cost-effective intervention. However, in order to prioritize VCT in HIV/AIDS control in West-Java, issues of budget availability and organizational capacity should be addressed. Key words: HIV infections, voluntary counselling and testing, cost-effectiveness analysis, decision maker
Are We Giving Optimal Dose of Efavirenz?
Get PDFAntiretroviral is one of the drugs that extensively been studied for its drug-to- drug interaction. Its long term used and the fact that many HIV-infected patients came in the late stage of disease make polypharmacy is unavoidable.Efavirenz is one of antiretroviral drugs that widely used in HIV-infected patients age more than 3 years old in many countries. Latest Indonesian antiretroviral guidelines recommend a combination of tenofovir, lamivudine and efavirenz given orally in one daily dose as the preferred primary fixed-drug combination treatment. This recommendation is based on many evidence supporting efficacy, tolerability, price, pregnancy safety, simplicity and the availability of the drug that will support the continuing comprehensive care for HIV-infected patients in primary care level
Successful Treatment of Unstageable Pressure Ulcer by Using Advanced Wound Dressing
Get PDFThis is a case of a 79-year old male, with late stage prostatic cancer, immobilization and having unstageable stage of lumbosacral pressure ulcer. We manage his ulcer locally with an advanced wound dressing. We apply hydrogel as a primary dressing and hydrofiber as secondary dressing. Advanced wound dressings are designed to maintain a moist environment at the site of application, allowing the fluids to remain close to the wound but not spread to unaffected, healthy skin areas. The relevance of the moist wound environment as a factor accelerating the healing process was first observed by Winter in 1962, but only recently has received more serious attention. An effective dressing should protect the wound, absorb exudate, preserve a moist wound base, and remove excess exudate. Design of effective dressings relies on an understanding of the healing process, as well as the specific conditions of a patient and the effect that each material used could have on the wound
The Effect of High Poly Unsaturated Fatty Acid (PUFA) Dietary Supplementation on Inflammatory Status of Patients with Advanced Cervical Cancer on Radiation Treatment
Get PDFAim: to identify the effect of high-PUFA dietary supplementation on inflammatory status of patients with advanced cervical cancer. Methods: a randomized double-blind clinical trial was conducted in patients with advanced cervical cancer who had undergone external radiation therapy at Department of Radiotherapy, Cipto Mangunkusumo Hospital, Jakarta, between April 2013 and April 2014. The inflammatory status was evaluated based on serum prostaglandin E2 (PGE2) levels using ELISA method. The dietary supplementation was isocaloric, isoprotein and contained PUFA with a ratio of ω-6: ω-3 fatty acid = 1.27:1 and supplementation without PUFA. Data were analyzed with statistical tests, including Shapiro-Wilk test, independent T-test and Mann–Whitney test. Results: there was statistically no significant difference on PGE2 level between treatment and control groups (p=0.127). However, there was clinically significant difference, in which the treatment group had reduced PGE2 level by 8.9%; while the control group had increased level by 28.1%. Conclusion: dietary supplementation enriched with PUFA can reduce inflammatory status in patients with advanced cervical cancer. Reduced PGE2 level will lower the survival of cancer cells; therefore dietary supplementation enriched with PUFA with a ratio of ω-6 : ω-3 fatty acid = 1.27 : 1 along with radiation therapy may improve tumor response to radiation.Key words: cervical cancer, ω-3 PUFA, ω-6 PUFA, PGE2 level
The Ability of Detecting Heart Rate Variability with the Photoplethysmography to Predict Major Adverse Cardiac Event in Acute Coronary Syndrome
Get PDFAim: to assess heart rate variability (HRV) measurements using pulse photoplethysmograph (PPG) in predicting major adverse cardiac event (MACE) in acute coronary syndrome (ACS) patients. Methods: a prospective cohort study was conducted among hospitalized ACS patients. Heart rate variability as predictor was measured by PPG within 48 hours after admission and the incidence of MACE as outcome was identified during ICCU stay. The ability of HRV in predicting MACE during hospitalization was determined by area under ROC curve (AUC) of low frequency (LF), high fequency (HF), and LF/HF ratio parameters. Results: among 75 subjects included in the study, 14 (18.7%) were experienced MACE during hospitalization. HRV parameters of LF and LF/HF ratio have AUC of 0.697 (95% CI, 0.543-0.850) and 0.851 (0.741-0.962), respectively. Using cut-off point of 89.673 ms2, LF had PPV and NPV of 13% and 71%, respectively; while LF/HF ratio of 1.718 had PPV and NPV of 6% and 50%, respectively. Conclusion: the HRV parameters of LF and LF/HF ratio are moderate predictors for MACE and predict better ACS patients who will not develop MACE during hospitalization