Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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The Role of Incentive Spirometry in Primary Spontaneous Pneumothorax
Get PDFPneumothorax is the presence of air in the pleural space. Its management consists of noninvasive and invasive therapies and it is determined based on clinical manifestations, type and size of pneumothorax. We present a case of a patient with diagnosis of primary spontaneous pneumothorax treated with incentive spirometry (noninvasive therapy). A 20 year old man came to respirology clinic with chief complaint of shortness of breath. He was recently diagnosed with left pneumothorax based on previous chest X-ray in another health care facilities and was advised to undergo tube thoracostomy but he refused the procedure. On physical examination, vital signs were normal. Chest X-ray showed 33% of pneumothorax or 1.2 cm. He was asked to perform incentive spirometry therapy at home. During 12 days of therapy, shortness of breath slowly disappeared and on repeated chest X-ray, it showed minimal pneumothorax in the left upper hemithorax. Noninvasive treatment such as incentive spirometry can be considered in patient with minimal symptoms and no signs of life-threatening respiratory distress
Prevention and Control of Blood Stream Infection Using the Balanced Scorecard Approach
Get PDFAim: to obtain formulation of an effective and efficient strategy to overcome blood stream infection (BSI). Methods: operational research design with qualitative and quantitative approach. The study was divided into two stages. Stage I was an operational research with problem solving approach using qualitative and quantitative method. Stage II was performed using quantitative method, a form of an interventional study on strategy implementation, which was previously established in stage I. The effective and efficient strategy for the prevention and control of infection in neonatal unit Cipto Mangunkusumo (CM) Hospital was established using Balanced Scorecard (BSC) approach, which involved several related processes. Results: the BSC strategy was proven to be effective and efficient in substantially reducing BSI from 52.31o/oo to 1.36o/oo in neonates with birth weight (BW) 1000-1499 g (p=0.025), and from 29.96o/oo to 1.66o/oo in BW 1500-1999 g (p=0.05). Gram-negative bacteria still predominated as the main cause of BSI in CMH Neonatal Unit. So far, the sources of the microorganisms were thought to be from the environment of treatment unit (tap water filter and humidifying water in the incubator). Significant reduction was also found in neonatal mortality rate weighing 1000-1499 g at birth, length of stay, hospitalization costs, and improved customer satisfaction. Conclusion: effective and efficient infection prevention and control using BSC approach could significantly reduce the rate of BSI. This approach may be applied for adult patients in intensive care unit with a wide range of adjustment. Key words: balanced scorecard, birthweight 1000-1999 g, bloodstream infection, neonates
Metal Fume Fever among Galvanized Welders
Get PDFThe metal fume fever (MFF) is an inhalation fever syndrome in welders of galvanized steel, who join and cut metal parts using flame or electric arc and other sources of heat. Inhalation of certain freshly formed metal oxides produced from welding process can cause MFF as an acute self-limiting flulike illness. The most common cause of MFF is the inhalation of zinc oxide (ZnO). The inhalation of ZnO particles can provoke a number of clinical responses of which accompanied by changes in composition of bronchoalveolar lavage (BAL) fluid, including early increase in pro-inflammatory cytokines, inflammatory marker, and recruitment of inflammatory cells in the lungs. The MFF is characterized by fever, cough, sputing, wheezing, chest tightness, fatique, chills, fever, myalgias, cough, dyspnea, leukocytosis with a left shift, thirst, metallic taste, and salivations. The diagnosis of MFF diagnosis is based on clinical finding and occupational history. The symptoms resolved spontaneously. The treatment of MFF is entirely symptomatic, no specific treatment is indicated for MFF. The mainstay of management of MFF is prevention of sub-sequent exposure to harmful metals. Including public and physician awareness of MFF may help to reduce the occurrence of the disease. Key words: metal fume fever, zinc oxide, inflammation, prevention
Comparison Between End-to-end Anastomosis and Buccal Mucosa Graft in Short Segment Bulbar Urethral Stricture: a Meta-analysis Study
Get PDFAim: to compare long term follow-up between end-to-end urethroplasty and bucal mucosal graft for the management of patients with short bulbar urethral stricture. Methods:we conducted a meta-analysis of cohort studies. Literature research was performed on the MEDLINE, Science Direct, and EMBASE database including studies from 1980 through 2014. The inclusion criteria were patients with short bulbar urethral strictrure (sized ≤3 cm) undergoing end-to-end anastomosis (EE) and buccal mucosa graft (BMG) with the complication of voiding symptoms and sexual dysfunction ≥12 months. Pooled risk ratio (RRs) and 95% confidence interval (CIs) were calculated using Mantzel-Haenzel method, while the heterogeneity were determined through I2 value. Data analysis were done using Stata software version 10.0 (StataCorp). Results:We analyze 10 studies in this meta-analysis. Sexual dysfunction following EE and BMG were found in 24.6% (45/183) patients and 9.1% (11/122) patients, respectively (overall RR 2.54; 95% CI: 1,44-4,47; p=0.001). Voiding symptoms following EE and BMG were found in 14% (8/57) patients and 12.5% (7/56) patients, respectively (overall RR 0.77; 95% CI: 0.3–2.0; p=0.591). Furthermore, stricture recurrent following EE and BMG were 8.4% (8/107) and 30% (14/46), respectively (overall RR 0.38; 95% CI: 0.17–0.84; p=0.016). The effectiveness of EE and BMG were found to be equal as both demonstrated few complications. BMG were found to be superior than EE terms of minimal sexual dysfunction complication. On the contrary, EE were found to be superior than BMG in terms of stricture recurence following short bulbar urethral stricture surgery. Conclusion:BMG can be considered as the primary treatment rather than EE for managing short urethral stricture cases
Amoebic Anal Fistula: New Insight Into an Old Disease
Get PDFA 67-year-old gentleman underwent fistulectomy for low trans-sphincteric anal fistula along with curettage for an associated abscess extending proximally for half a centimeter into the intersphincteric plane. The roof of the cavity became clearly visible after satisfactory culmination of the surgical procedure. Histopathological examination of the fistulous tract and the curetted granulation tissue revealed presence of multiple trophozoites of Entamoeba histolytica exhibiting erythrophagocytosis in the background of mixed inflammatory infiltrate. This case report provides the outlook that yields the novel insight into the possible role of Entamoeba histolytica in the pathogenesis and persistence of the fistulous tract. Key words: anal fistula, Entamoeba histoliytica, fistula
Association Between the Low Levels of Vitamin D and Treg Function in Systemic Lupus Erythematosus Patients
Get PDFAim: to determine the relationships between vitamin D and CCR4 expression on Treg, and Treg migratory capacity in SLE patients in Indonesia. Methods: vitamin D level assesment, CCR4 expression on Treg and Treg migratory capacity were performed on 41 SLE patients and 20 healthy controls. Serum vitamin D levels were measured by ELISA (Cusabio). The expression of CCR4 on Treg was detected by flow cytometry and Treg migratory capacity was performed in chemotaxis chamber using CCR4 ligands, TARC and MDC, and subsequently analyzed by flow cytometry using FACS Calibur (Becton Dickinson). The number of migrated Treg is the ratio of CD4+CD25+CCR4+ cells number in lower chamber of chemotaxis compared to the total number of CD4+CD25+CCR4+ cells before migration, and stated in percentage. Results: vitamin D levels were significantly lower in SLE patients compared with healthy controls (p=0.000). The vitamin D levels were positively correlated to the percentage of migrated Treg toward TARC (p=0.015) and MDC (p=0.000), but there was no difference in Treg CCR4 expression between SLE patients and healthy controls. Conclusion: low vitamin D levels cause reduced Treg migratory capacity in SLE patients and healthy people. This influence occurs through other factors rather than CCR4 expression. Key words: vitamin D, treg function CCR4, MDC, TARC
Frailty Syndrome: an Emerging Geriatric Syndrome Calling for Its Potential Intervention
Get PDFIt is projected that the elderly population in Indonesia will increase from approximately 19 million people in 2010 with life expectancy of 69.8 years during period of 2005-2010 to 29 million people in 2020 (11.11% of total population) with life expectancy of 73.6 years during period of 2020-2025. Higher elderly female proportion compared to male (11.43% versus 10.78%) will also be found.1 Aging process happens as people get older. Its process is influenced by genetic and environmental factors that can lead to successful aging, usual (normal) aging or pathologic aging. People with pathologic aging would have an increased risk to become frail.2,3 Nowadays, frailty syndrome is considered as one of the geriatric syndromes which increase the risk of worsening clinical outcome in mobility, functional status, hospitalization, institutionalization and mortality, as well as lower health-related quality of life.4,5 Moreover, frailty syndrome reflects a biological age that predicts mortality risk better than chronological age [RR 1.57 (95% CI 1.41-1.74) versus RR 1.08 (95% CI 1.06-1.2)].6 No wonder, frailty syndrome has attracted clinician’s attention, especially the geriatricians, all over the world with increasing research in this field
Comparison of Coronary Angiography Characteristics among Acute Coronary Syndrome Patients in Young and Old Age Patients at Cipto Mangunkusumo Hospital Jakarta
Get PDFAim: to identify the difference between coronary angiography in patients with acute coronary syndrome (ACS) aged ≤45 years and those aged >45 years. Methods: a total of 322 ACS patients who underwent coronary angiography in ICCU of Cipto Mangunkusumo Hospital, Jakarta between January 2008 and December 2012 were included in this study. The severity of coronary stenosis was determined by vessel score and coronary score. A significant vessel score was defined as a stenosis of coronary vessel of >70%. Patients were divided into two groups: those aged ≤45 years (72 cases) and those aged >45 years (250 cases). The statistical analysis was performed with Chi-square test for categorical data with two-unpaired groups and the t-test or Mann-Whitney for numerical data. Results: the highest distribution of 1-VD (single-vessel disease) patients was found the group of patients aged ≤45 years (43.1% vs 26.0%); while for 3-VD (triple-vessel disease) patients, the highest distribution was noticed in the group of patients aged >45 years (31.6% vs 18.1%). The stenosis score was lower in patients aged ≤45 years compared those aged >45 years (median stenosis score 4 vs 8), p<0.001. Atherosclerosis was found most common for the left anterior descending artery in both age groups (65.3% and 74.0%). However, there was less significant stenosis lesion for the Left Circumflex and Right Coronary Arteries in patients aged ≤45. The result was statistically significant (26.4% and 31.9% vs 46.4% and 57.2%, p=0.002 and 0.001). Conclusion: the number of coronary artery diseases (vessel score) and stenosis score is lower in patients aged ≤45 years compared to patients aged >45 years. Key words: acute coronary syndrome, coronary angiography, young ag
Efavirenz Plasma Concentrations and HIV Viral Load in HIV/AIDS-tuberculosis Infection Patients Treated with Rifampicin
Get PDFAim:to determine the effect of a rifampicin-containing tuberculosis regimen on efavirenz plasma concentrations and viral load in HIV/AIDS-Tuberculosis infection patients who received efavirenz-based antiretroviral therapy. Methods:plasma efavirenz concentrations and HIV viral load were measured in HIV/AIDS patients treated with 600 mg efavirenz-based antiretroviral for 3 to 6 months and in HIV/AIDS-Tuberculosis infection patients treated with similar antiretroviral regimen plus rifampicin-containing antituberculosis in Sulianti Saroso Infectious disease Hospital, Jakarta. Plasma efavirenz concentration in both groups were compared using Mann-Whitney test, while proportion of patients with viral load >40 copy/mL were analyzed with chi-square test. Results:forty five patients (27 with HIV/AIDS and 18 with HIV/AIDS-Tuberculosis infections) were recruited during the period of February to May 2015. The median efavirenz plasma concentration obtained from HIV/AIDS group was 0,680 mg/L(range 0,24 to 5,67 mg/L and that obtained from HIV/AIDS-Tuberculosis group was 0.685 mg/L (0.12 -2.23 mg/L) which was not significantly different statistically. The proportion of patients with viral load ≥40 copies/mL after 3-6 months of ARV treatment in the HIV/AIDS group was 51.9%, and in the HIV/AIDS-Tuberculosis group was 72.2%, which was not significantly different statistically (Chi Square test, p=0.291). Conclusion:plasma efavirenz concentration in HIV/AIDS-tuberculosis patients receiving antiretroviral and rifampicin is not significantly different from that on HIV/AIDS patients without tuberculosis. Proportion of patients with viral load of >40 copy/mL is higher in HIV/AIDS-tuberculosis patients receiving rifampicin compared to HIV/AIDS patients that not receive rifampicin. However, this difference did not reach statistical significance. Confirmatory studies with bigger sample size are needed to clarify the influence of rifampicin on plasma level ofefavirenzand and on viral load
Traumatic Inhalation due to Merapi Volcanic Ash
Get PDFPneumonoultramicroscopicsilicovolcanoconiosis is fibrotic lung diseases of the pulmonary parenchyma following chronic inhalation of inorganic dusts containing crystalline silicon dioxide. The acute manifestations observed after heavy ashfalls include attacks of asthma and bronchitis, with an increased reporting of cough, breathlessness, chest tightness, and wheezing due to irritation of the lining of the airways. The chronic health condition of most concern is silicosis, a diffuse nodular fibrosis of the lungs, develops slowly, usually appearing 10 to 30 years after first exposure. A 35 years old male was admitted to Sardjito Hospital, Yogyakarta with complaints of progressive dyspnoea, right side chest pain since last 3 month and periodic episodes of dry cough. He had history of exposure to volcanic ash at the location around volcano eruption for about 10 month. Examination revealed hyperresonantnote, diminished vesicular breath sounds in lower right side of the chest. The chest X-ray presence leads to bleb. Based on the clinical and radiological suspicion of pneumoconiosis the patient was submitted to computed tomography of the chest and revealed bilateral multiple bullae mainly at the right lung field. The biopsy specimen verified the diagnosis of anthrocosilicosis. There is no proven specific therapy for any form of silicosis. Symptomatic therapy should include treatment of airflow limitation with bronchodilators, aggressive management of respiratory tract infection with antibiotics, and use of supplemental oxygen (if indicated) toprevent complications of chronic hypoxemia.Key words: Pneumonoultramicroscopicsilicovolcanoconiosis, inorganic particles inhalation, dyspnoea, bullae