Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Improvement of Metabolic Parameters Resulted from Levothyroxine Therapy in Hypothyroid Type 2 Diabetes Mellitus Patient
Get PDFThis is a case of 51 year-old woman with uncontrolled type 2 diabetes mellitus which was diagnosed 1.5 year earlier, obesity with body mass index 32.2 kg/m2, waist circumference of 113 cm, diffuse goiter with neck circumference 40 cm, and hypertension with blood pressure >140/90 mmHg. Since 6 months ago, she often seemed like having less concentration or daydreaming, chronic fatigue, depression, and low food intake. Her body weight had been increasing over time. Her hypothyroidism clinical scoring Billewicz and Zulewski criterias were 17 and 8 respectively, showing that she tended to experience hypothyroidism. From laboratory examination, fasting blood glucose was 216 mg/dL and 2-hour postprandial blood glucose was 320 mg/dL with level of HbA1c was 9.9%, triglyceride level was 486 mg/dL, HDL cholesterol 46 mg/dL, LDL cholesterol 157 mg/dL, and total cholesterol was 269 mg/dL. Thyroid ultrasound showed a diffuse goiter in both lobes of her thyroid gland
Phenotype Characterization of Beta-Lactamase Producing Enterobacteriaceae in the Intensive Care Unit (ICU) of Cipto Mangunkusumo Hospital in 2011
Get PDFAim: the goal of this study is to understand the phenotype characteristic of beta-lactamase enzymes producing Enterobacteriaceae, such as ESBL, AmpC, and carbapenemase. Methods: three different methods are performed to confirm those phenotypic characteristics, namely double disk diffusion method to confirm ESBL, AmpC disk test (cefoxitin-based) to confirm AmpC, and modified Hodge test to confirm carbapenemase. Results: using double disk diffusion method, we found 58.42% isolates are ESBL-producing, whereas the outcomes of AmpC disk test shows 1.98% are AmpC-producing. By conducting modified Hodge test (MHT), 27.59% isolates are confirmed as carbapenemase-producing bacteria. Conclusion: this study confirmed the prevalence of beta-lactamase producing Klebsiella pneumoniae is very high. Nevertheless, AmpC and carbapenemase should not be ignored despite their low prevalence. Key words: Enterobacteriaceae, antibiotic resistance, ESBL, AmpC, carbapenemase
Kaposi Sarcoma of the Eye in an HIV Patient Well-responded to HAART
Get PDFKaposi sarcoma defined as a multifocal lesion in mucocutaneous sites which has low-grade malignant potential. Kaposi sarcoma also commonly found in visceral organs. This malignancy is very popular among elderly men before the epidemic of HIV/AIDS in the decade of 1980-1990 Kaposi sarcoma known to be associated with immunodeficiency state as in HIV/AIDS patients. Nowdays, incidence of Kaposi sarcoma has decreased in developed countries in the era of Highly Active Antiretroviral Therapy (HAART) but still a big problem in resource-limited areas such as Sub- Saharan Africa.Eye is an unusual location for Kaposi sarcoma. There are not many study published about eye involvement of Kaposi sarcoma. Kaposi sarcoma of the conjunctiva and ocular adnexa has been reported to be strongly associated with HIV/AIDS patients.1 An old case report published Kaposi sarcoma in the eye of HIV negative patient, which stated as a unique case because of his good immunological performance.6 It is reported from the study of HIV/AIDS patients in Argentina that Kaposi sarcoma in the eye found in 0,25% patients
Impact of Frailty on the First 30 Days of Major Cardiac Events in Elderly Patients with Coronary Artery Disease Undergoing Elective Percutaneous Coronary Intervention
Get PDFAim: to obtain the proportion of frailty and the incidence of 30-day major adverse cardiovascular events (MACE) as well as to review the impact of frailty on the prognosis of elderly patients with coronary heart disease who underwent elective PCI. Methods: this is a prospective cohort study to assess the frailty of elderly patients with coronary artery disease that underwent elective PCI in Cipto Mangunkusumo Hospital using the frailty phenotype criteria. They were subsequently followed-up for 30 days to see whether there was any MACE developed. Results: there were 100 elderly patients with coronary artery disease who underwent elective PCI between September 2014 and June 2015. The mean age of patients was 66.95 (SD 4.875) years and 69% of the patients were males. Frailty was present in 61% of the patients. MACE were occurred in 8.19% of frail patients and 5.12% were occurred in non-frail patients. The association between frailty and MACE was demonstrated by the result of crude HR of 1.6 (CI 95% 0.31-8.24). In our study, the 30-day survival rate was 95% in frail patients and 98% in non-frail patients. Conclusion: there is a 1.6-fold increased risk of 30-day MACE in elderly frail patients undergoing elective PCI; however, it is not statistically significant
The Effectiveness of a Three Day Course Antibiotic Post-urodynamic Study in Preventing Lower Urinary Tract Infection
Get PDFAim: to evaluate the effect of a 3-day course antibiotic post-urodynamic study (UDS) to prevent urinary tract infection (UTI). Methods: this was a randomized double blind clinical trial on the proportion of UTI in patients who received levofloxacin 500 mg once a day for 3 days after UDS compared to nontreated patients. The outcome of this study was the incidence of lower UTI in levofloxacin group and placebo group. Lower UTI was defined as patient with one or more clinical symptoms of lower UTI and one or more urinalysis parameter of UTI. Chi-square was used to evaluate the association between the lower UTI and treatment group. Results: a total of 126 patients were enrolled in this study from two outpatient urology clinics in Jakarta: Cipto Mangunkusumo Hospital and Asri Hospital. Overall, 26 patients (20.6%) had UTI post UDS (8 out of 63 patients from levofloxacin arm (12.7%) and 18 out of 63 patients from placebo arm (28.6%); p=0.028). The most common isolate found was E. coli (n=18 patients; 69.2%). The most common indications to perform UDS were Lower Urinary Tract Symptoms (LUTS) with failure of therapy (n=43 patients; 25%), LUTS after invasive treatment (n=29 patients; 16.9%), and overactive bladder with failure of therapy (n=22 patients; 12.7%). Conclusion: the use of antibiotic post-UDS can prevent incidence of lower UTI
Snakebite in Indonesia
Get PDFIndonesia as one of the largest tropical and agricultural countries in the world shared the particularly high burden cases of snakebite. In the last decade, World Health Organization (WHO) has listed snakebite as one of the neglected tropical disease. The clinical manifestations of snakebite could vary according to the type of venoms ranging from mild to life threatening condition. Appropriate first aid treatment and comprehensive management of snakebite cases are warranted to reduce mortality and morbidity rates.Key words: snakebite, neglected tropical disease, Indonesia, treatment, antiveno
National Consensus on Management of Non-Variceal Upper Gastrointestinal Tract Bleeding in Indonesia
Get PDFhe Indonesian Society of Gastroenterology has compiled a national consensus guideline for the management of non-variceal upper gastrointestinal bleeding (NVUGIB). It is an endeavor to raise the quality of service for NVUGIB patients associated with peptic ulcer. The references for developing this consensus include three recent consensus guidelilnes on the management of NVUGIB and a modification of Delphi process was done to develop clinical guidelines. The three references are: The International Consensus Recommendations on the Management of Patients with Non-variceal Upper Gastrointestinal Bleeding (ICON-UGIB), 2010; Asia-Pacific Working Group consensus on non-variceal upper gastrointestinal bleeding, 2011; and Management of Patients with Ulcer Bleeding, ACG guidelines, 2012. The consensus is compiled as a reference for Indonesian medical practitioners all across the country on the management of patients with non-variceal upper gastrointestinal bleeding associated with peptic ulcer. However, the technical implementation extremely depends on diagnostic and therapeutical facilities available in each health care center. Key words: endoscopy, bleeding, non-variceal upper gastrointestinal bleeding/NVUGIB, peptic ulcer
National Consensus on the Management of Gastroesophageal Reflux Disease in Indonesia
Get PDFGastroesophageal reflux disease (GERD) is a disorder, which gastric content repeatedly reflux into the esophagus causing disturbing symptoms and/or complications. Various epidemiological studies show that there is regional difference on the aspect of prevalence and clinical manifestation. Regional data also demonstrates increased incidence of complications such as the Barret’s Esophagus and adenocarcinoma. In response to the situation, the Asia-Pacific GERD experts, including Indonesia, had published a consensus on the management of GERD in 2004, which was subsequently revised in 2008. Advances in medical technology, especially on gastrointestinal endoscopy technique and other diagnostic instruments such as 24-hour pH-metry and manometry, have improved the capacity of management of GERD. On the other hand, we feel that adequate knowledge and skills of doctors, both for general physicians and specialists of internal medicine in our country are not well-distributed. Moreover, the availability of instruments for diagnostic and therapeutical supports differs from one region to the others. The Organizing Committee of Indonesian Society of Gastroenterology or Pengurus Besar Perkumpulan Gastroenterologi Indonesia (PB PGI) considers that it is important to revise the National Consensus on the Management of GERD in Indonesia 2004, which is expected to be the guideline of GERD management. Key words: Barret’s esophagus, diagnosis, endoscopy, GERD, manometry, pH-metry
Role of Oxidative Stress on Chronic Kidney Disease Progression
Get PDFChronic kidney disease (CKD) is a worldwide health problem with a high incidence not only in western countries but also in Indonesia as well. The majority of patients with CKD died due to cardiovascular disease than CKD progression itself. In addition to traditional risk factors, cardiovascular disease in CKD might also due to non-traditional risk factors. Oxidative stress, as non-traditional risk factors, is not only able to explain the high incidence of cardiovascular disease in CKD, but also become a new target in therapeutic intervention. Oxidative stress in patients with CKD appears due to increased oxidant activity and decreased antioxidant system. Hemodialysis (HD) with the use of a cellulose and semi-cellulose membrane also contribute to increase oxidant that can activate the complement pathway. It stimulates inflammation that will further expand the production of oxidants and will ultimately increase oxidative stress. Key words: chronic kidney disease, oxidant, oxidative stress
Early Realignment Versus Delayed Urethroplasty in Management of Pelvic Fracture Urethral Injury: A Meta-analysis
Get PDFAim: this meta-analysis study will evaluate the incidence of urethral stricture as a successfull parameter in the management of PFUI through early realignment, compared with delayed urethroplasty. Long-term complications such as erectile dysfunction and incontinence on both methods will also be evaluated. Methods: online literature was sourced from Pubmed, Embase, Cochrane, and Google Scholar. The incidence of stricture was evaluated from the entire study group of ER and DU. Stricture of the urethra is diagnosed by the symptoms such as the obstruction that felt by the patient, uroflowmetry examination, and urine residual post micturition that supported by urethrography examination at regular interval. In some cases the incidence of stricture also diagnosed by urethroscopy. The patient is assessed as not having stricture when it is no longer needed to do urethral dilatation or advanced urethrotomy. The rate of incontinence was assessed subjectively from the patient’s complaints. The erectile function assessed subjectively; decreased of tumesen’s degree, reduced the duration of erection, and penetration failure diagnosed as erection dysfunction. The data were processed as dichotomy data to calculate the risk ratio using Review Manager 5.1. Results: five relevant literatures reviewed in this study. The incidence of urethral strictures are statistically significant lower in early realignment group (RR=0.70, 95% CI 0.50-0.99, P<0.05). There were no statistically significant differences between both treatment groups on the incidence of erectile dysfunction (RR=0.72, 95% CI 0.39-1.34) nor the incidence of incontinence (RR=0.74, 95% CI 0.36-1.51). Conclusion: early realignment decrease the occurrence of stricture on PFUI treatment compared to delayed urethroplasty method. Between the two methos, the complications such as erectile dysfunction and incontinence; however, there was no significant difference