Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Obstructive Sleep Apnea and Atherosclerosis
Get PDFObstructive sleep apnea (OSA) is a sleep respiratory disorder characterized by recurrent episodes of complete or partial airway obstruction, resulting in apneas or hypopneas. OSA could contribute to atherosclerosis through direct and indirect mechanisms.Endothelial dysfunction, sympathetic stimulation, and proinflammatory cytokine modulation caused by OSA play significant role to an atherosclesrotic event. Other risk factors of atherosclerosis like hypertension and diabetes mellitus also associated with OSA. Animal and clinical studies recently showed promising data to prove association between OSA, atherosclerosis, and its risk factors. However, provided data has not showed consistent result. In the future, demand of further research both basic and clinical sciences need to be fulfilled
Serum Matrix Metalloproteinase-9 Levels in Acute Coronary Syndrome Patients with and without Hyperglycemia
Get PDFAim: to determine the difference in serum matrix metalloproteinase-9 (MMP-9) levels among acute coronary syndrome patients with and without hyperglycemia. Methods: this study was a cross-sectional study on patients with acute coronary syndrome admitted to ICCU of Dr.Sardjito Hospital Yogyakarta Indonesia. Measurements of blood glucose level were performed on hospital admission, while measurement of MMP-9 level was performed upon arrival at the ICCU. Hyperglycemia was defined as a random blood glucose level of >140 mg/dL. Student’s t test was performed to analyze the difference of MMP-9 level between subjects with and without hyperglycemia. Results: of 72 enrolled subjects, there were 34 subjects with hyperglycemia and 38 subjects without hyperglycemia. The mean blood glucose level was significantly different in subjects with hyperglycemia as compared to those without hyperglycemia (204.4±92.16 vs. 108.93±19.1 mg/dL, p=0.0001). The mean MMP-9 level in subjects with hyperglycemia was significantly higher than those without hyperglycemia (1574±573.61 vs. 1370±573.66 ng/ mL, p=0.025). The prevalence ratio of high MMP-9 level among subjects with hyperglycemia was 2.88 (95% CI: 1.16-7.14), p=0.004. Conclusion: serum MMP-9 level in patients suffering from acute coronary syndrome with hyperglycemia was significantly higher than those without hyperglycemia. Key words: acute coronary syndrome, matrix metalloproteinase-9, hyperglycemia
Cellular Cardiomyoplasty For Myocardial Infarction: a 2014 Evidence-based Update
Get PDFMyocardial infarction is one of the main cause of mortality in many countries. Therefore, an effective therapy for myocardial infarction is required. Reperfusion and other conventional therapy have been the mainstay therapy for myocardial infarction. However, many patients remain refractory to this therapy. Cellular cardiomyoplasty is considered a novel therapy, in which stem cells are used for cardiac repair. Stem cells are potential therapeutic approach that could be the ultimate solution for salvaging damaged cardiomyocyte. Based on current studies, stem cells are a promising therapeutic approach for myocardial infarction. However, some challenges need to be answered by future studies before this novel therapy can be widely applied. As we advance our understanding, all questions behind stem cell therapy would finally be revealed, and eventually provide the ultimate solution for ischaemic cardiac repair. This paper provide an overview of the latest progress in stem cell therapy for myocardial infarction. Key words: stem cells, cellular cardiomyoplasty, myocardial infarctio
The Role of Per Oral Cholangiopancreatoscopy (POCPS) in Complicated Pancreaticobiliary Disease
Get PDFA fifty-five year old female patient presented with jaundice, subfebrile fever and dark yellow urine since one month before admission. She lost weight 10 kilograms during one month. One day before admission to Ciptomangunkusumo General Hospital, she complained of worsened abdominal pain at right upper quadrant urging her to come to the emergency room. An abdominal examination revealed Murphy sign, mild hepatomegaly and deeply icteric sclera. Serum bilirubin was 21.8 mg/dl, alkaline phosphatase and gamma-glutamyltransferase levels were significantly elevated (1090 IU/L and 560 IU/L consecutively) while the transaminases were moderately high (ALT 80 U/L). The C-reactive protein was 555 mg/L. An abdominal ultrasound examination revealed dilatation of right and left intrahepatic bile duct and presence of common hepatic duct stone. Subsequent magnetic resonance imaging/ magnetic cholangiopancreatography (MRI/ MRCP) revealed intrahepatic bile duct dilatation, multiple CBD stone and benign stricture at common hepatic duct causing right and left intrahepatic bile duct obstruction.We assessed the patient as acute cholangitis and obstructive jaundice suspected to be caused by biliary duct stone then we performed endoscopic retrograde cholangiopancreatography (ERCP), we revealing stenosis at distal CBD, multiple CBD stone, giant stone in CHD and dilatation of bilateral IHBD. We performed CBD stone extraction then inserted biliary stent for drainage. Then we planned to do second ERCP with SpyGlassTM for giant stone extraction. After the first ERCP, the clinical condition of the patient improved and the bilirubin decreased to 10 mg/dL. In the next two weeks we performed a second ERCP to extract the giant stone with SpyGlass TM. However, after we inserted SpyGlassTM into the biliary duct, what we found were not as we expected before. We revealed that there was a mass in biliary duct and there was no CBD stone. We did the biopsy and inserted a new plastic stent (after removed the older one) to the common biliary duct. Surprisingly, the result of histopathology also supports our findings, which was the adenocarcinoma at common bile duct
Performance of Alpha Fetoprotein in Combination with Alpha-1-acid Glycoprotein for Diagnosis of Hepatocellular Carcinoma Among Liver Cirrhosis Patients
Get PDFAim: to evaluate the use of alpha-1-acid glycoprotein (AAG) for diagnosing hepatocellular carcinoma (HCC), and to combine with alpha fetoprotein (AFP) as part of routine examination in liver cirrhosis patients. Methods: this is a diagnostic study using cross-sectional design. A hundred and six patients were included in this study. Baseline data such as age, gender, AFP, AAG, peripheral blood count, AST and ALT were consecutively collected from liver cirrhosis patients with or without HCC. Serum AAG were measured quantitatively using immunoturboditimetric assay and AFP with enzyme immune assay (EIA). Statistical analysis were done using SPSS 13.0. Data comparisons between group were done using Mann-Whitney test. Diagnostic performance for each marker alone was compared to the surrogate use of both markers (combined parallel approach) in HCC cases. Results: receiver operating characteristic (ROC) analysis showed that area under the curve for AFP AAG combination was 88.1% and higher than AFP only (86.2%) or AAG only (76.5%) with sensitivity of 83%, 73% and 44%, respectively, at specificity of >80%. Conclusion: our study showed that combination of AFP and AAG is superior than either marker alone in diagnosing HCC in liver cirrhosis patients. Combination of AFP and AAG may be used to prompt early diagnosis screening of HCC.Key words: alpha fetoprotein, alpha-1-acid glycoprotein, biomarker, liver cance
Reference Equation for Prediction of a Total Distance During Six-minute Walk Test using Indonesian Anthropometrics
Get PDFAim: to develop a reference equation for prediction of the total distance walk using Indonesian anthropometrics of sedentary healthy subjects. Subsequently, the prediction obtained was compared to those calculated by the Caucasian-based Enright prediction equation. Methods: the cross-sectional study was conducted among 123 healthy Indonesian adults with sedentary life style (58 male and 65 female subjects in an age range between 18 and 50 years). Heart rate was recorded using Polar with expectation in the sub-maximal zone (120-170 beats per minute). The subjects performed two six-minute walk tests, the first one on a 15-meter track according to the protocol developed by the investigator. The second walk was carried out on Biodex®gait trainer as gold standard. Results: an average total distance of 547±54.24 m was found, not significantly different from the gold standard of 544.72±54.11 m (p>0.05). Multiple regression analysis was performed to develop the new equation. Conclusion: the reference equation for prediction of the total distance using Indonesian anthropometrics is more applicable in Indonesia. Key words: six-minute walk test, reference equation for prediction of total distance, Indonesian anthropometric
Lower Serum Level of Anti-tetanus Toxin Antibodies in Patients with Type 2 Diabetes Mellitus
Get PDFAim: to evaluate the serum levels of anti-tetanus toxin antibodies (anti-TTA) in patients with type 2 diabetes mellitus (DM) and in a control group. Methods: totally, 100 patients with type 2 DM and 100 age-and sex-matched healthy individuals were enrolled to study. The presence of type 2 DM confirmed according to the clinical and para-clinical criteria such as fasting plasma glucose above 126 mg/dl. A peripheral blood sample was collected from all subjects. The serum samples of participants tested for the levels of anti-TTA by ELISA method. The serum antitoxin concentration ≥0.1 IU/mL was considered as a protective level of antibody. Results: the seroprotective rate in healthy group was significantly higher than diabetic group (99% vs. 92%; p<0.02). The mean titer of anti-TTA in healthy group (5.32±0.26 IU/ml) was also significantly higher than diabetic patients (3.46±0.26 IU/ml; p<0.001). In diabetic men the mean titer of anti-TTA was significantly higher in comparison to diabetic women (3.94±0.34 IU/ml vs 2.59±0.36 IU/ml; p<0.01). In diabetic patients the seroprotective rate and the mean titer of anti-TTA in subjects with age >40 years was also lower in comparison to those with age <40 years (89.23% vs 97.14%; p<0.15 and 4.57±0.38 IU/ml vs 2.86±0.32 IU/ml; P<0.002, respectively). The mean titer of anti-TTA was significantly higher in patients with diabetes duration <5 years in comparison to patients with disease duration >5 years (3.91±0.35 IU/ml vs 2.85±0.38 IU/ml; p<0.04). Conclusion: these results showed lower levels of anti-TTA in patients with type 2 DM, in diabetic women, in patients aged >40 years and in diabetic patients with disease duration >5 years . Key words: immunity, tetanus, antibody, type 2 diabetes
Colloids Versus Albumin in Large Volume Paracentesis to Prevent Circulatory Dysfunction: Evidence-based Case Report
Get PDFLarge volume paracentesis may cause paracentesis induced circulatory dysfunction (PICD). Albumin is recommended to prevent this abnormality. Meanwhile, the price of albumin is too expensive and there should be another alternative that may prevent PICD. This report aimed to compare albumin to colloids in preventing PICD.Search strategy was done using PubMed, Scopus, Proquest, dan Academic Health Complete from EBSCO with keywords of “ascites”, “albumin”, “colloid”, “dextran”, “hydroxyethyl starch”, “gelatin”, and “paracentesis induced circulatory dysfunction”. Articles was limited to randomized clinical trial and meta-analysis with clinical question of “In hepatic cirrhotic patient undergone large volume paracentesis, whether colloids were similar to albumin to prevent PICD”.We found one meta-analysis and four randomized clinical trials (RCT). A meta analysis showed that albumin was still superior of which odds ratio 0.34 (0.23-0.51). Three RCTs showed the same results and one RCT showed albumin was not superior than colloids. We conclude that colloids could not constitute albumin to prevent PICD, but colloids still have a role in patient who undergone paracentesis less than five liters
Immune Response of Thalassemia Major Patients in Indonesia with and without Splenectomy
Get PDFAim: to describe non-spesific and specific immune response profile in Indonesian thalassemia major with and without splenectomy. Methods: this study was held at Thalassaemia Centre, Cipto Mangunkusumo Hospital Jakarta on September 2013 – February 2014. A comparative cross sectional study was conducted in healthy, thalassemia major aged more than 12 year and seronegative HIV. They were matched in age and sex for splenectomised and non-splenectomised groups, analysing the non-spesific immune response (neutrophil count and phagocytosis) and specific immune response (count and function of cellular immunity). Infection episodes were also analized as immune response in vivo parameter. Results: splenectomised thalassemia major showed increased neutrophil count but significantly decreased non-spesific immune response (neutrophil phagocytosis). Spesific immune response of splenectomised group presented significantly higher absolute lymphocyte, lymphocyte T, CD4+ and CD8+ counts compared to non-splenectomised thalassemia major (p<0.05). Ratio CD4+/CD8+ were similar in these groups. Serum marker of activated cellular imunity function (IL-2 and TNF-α) were similar among two groups. Mild infection episodes on splenectomised and non-splenectomised group were 2.02 (ranged 0 to 12) times and 0.81 (ranged 0 to 8) times (p=0.004), respectively. Severe infection on splenectomised group were sepsis for 2 weeks and diarrhea for 1 week, whereas on non-splenectomised group was typhoid fever for 4 days. Conclusion: there were significant differences on immune response among thalassemia major patients. Splenectomised thalassemia major showed a greater degree of susceptibility to infections than non-splenectomised thalassemia major. Key words: immune response, thalassemia major, splenectomy
Pain Reduction After Laser Acupuncture Treatment in Geriatric Patients with Knee Osteoarthritis: a Randomized Controlled Trial
Get PDFAim: to compare the effectiveness of active laser acupuncture with placebo on reducing pain intensity and improving functional outcome in geriatric patients with knee osteoarthritis (OA). Methods: a double-blind randomized controlled trial was conducted in geriatrics with knee OA at Medical Acupuncture Outpatient Clinic, Integrated Geriatric Outpatient Clinic, Rheumatology Outpatient Clinic of Cipto Mangunkusumo Hospital, Jakarta, during May to October 2015. Sixty two patients with knee OA were randomly assigned into two groups: active laser acupuncture group or placebo laser acupuncture group. Interventions were carried out using a gallium aluminum arsenide laser device at the ST35 Dubi, ST36 Zusanli, SP9 Yinlingquan, GB34 Yanglingquan and EX - LE - 4 Neixiyan acupuncture points on the affected knee for ten sessions of treatment, i.e. twice a week. Patients were assessed using a visual analogue scale (VAS) and Lequesne index at baseline, after four sessions, after nine sessions and at 2 weeks after the treatment had been stopped. Results: the VAS scores were significantly improved in the active laser acupuncture group compared to the placebo group. The evaluation of VAS scores was carried out after four treatment sessions (mean difference: 0.39; p<0.001), after nine treatment sessions (mean difference: 37.48; p<0.001) and at 2 weeks post intervention (mean difference: 39.15; p<0.001). The evaluation also showed significant improvement of Lequesne index after four treatment sessions (mean difference: 4.68; p<0.001), after nine treatment sessions (mean difference: 5.90; p<0.001) and at 2 weeks post intervention (mean difference: 6.48; p<0.001). Conclusion: active laser acupuncture is effective in reducing pain