Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Low Plasma Atherogenic Index Associated with Poor Prognosis in Hospitalized Patients with Acute Myocardial Infarction
Get PDFAim: the impact of atherogenic index of plasma (AIP), calculated as logarithmic of triglyceride:HDL ratio (log10.[TG:HDL]), on major adverse cardiovascular events (MACE) during acute myocardial infarction (AMI) has not been fully accepted. This study aims to investigate the role of AIP in predicting major adverse cardiovascular events following AMI during intensive care in the hospital. Methods: this was a prospective cohort study. We enrolled subjects with AMI hospitalized in intensive coronary care unit at Dr. Sardjito General Hospital, Yogyakarta. The AIP was measured in fasting blood within 24 hours of hospital admission. The total cholesterol, LDL, HDL, and triglyceride (TG), were measured and AIP value was determined as log10.[TG:HDL]). Based on AIP value, subjects were allocated into low AIP (<0.24) and high AIP (≥0.24). The outcome of the study was major adverse cardiovascular events during hospitalization, i.e. multipart of all cause mortality, acute heart failure, cardiogenic shock, reinfarction, and rescucitated VT/VF. Results: among 277 subjects, the high AIP group comprised 213 subjects (77%) and low AIP group comprised 64 subjects (33%). During intensive hospitalisation, 66 subjects (24%) developed MACE and 20 subjects (7%) developed fatal outcome (all cause mortality). The incidence of MACE tended to be higher in low AIP group, however its difference was not significant. The incidence of all cause mortality was significantly higher in low AIP group (14%) than in high AIP group (5%). Multivariable analysis showed that low AIP predicted all cause mortality independently with a risk ratio 3.71 (95% CI 1.26 – 10.97, p=0.02). Conclusion: low AIP value (<0.24) is an independent predictor for all cause mortality in patients with acute myocardial infarction undergoing intensive hospitalisation
Adult Variant of Self-healing Cutaneous Mucinosis in a Patient with Epilepsy
Get PDFA 52-year-old woman was admitted with a 3 weeks history of periorbital edema and lips swelling. She developed several subcutaneous firm erythematous papules and nodules on the face, scalp and two indurated plaques on the upper back and left forearm. These lesions grew rapidly. The patient had a positive history of epileptic seizures since childhood. General examination was normal. There was a mild pitting edema on her hands and feet. Laboratory data were within normal limits. Histopathological examination revealed a well circumscribed accumulation of mucin in the dermis. Alcian blue stain was positive. Clinical and histopathological findings followed by spontaneous resolution of the lesions within a period of 4 months was compatible with diagnosis of self-healing cutaneous mucinosis. Herein we report the first case of self-healing cutaneous mucinosis associated with epilepsy
Endobronchial Valve as Treatment of Emphysema Compared with Standard Medical Care: an Evidence-based Case Report
Get PDFAim: to determine the effectiveness of endobronchial valve placement as treatment of emphysema compared to medical care. Methods: literature searching regarding comparison of endobronchial valve and medical care as treatment of emphysema on PubMed database. The quality of the literatures found was appraised by using critical appraisal sheet from Center of Evidence-Based Medicine, University of Oxford. Results: two randomized controlled trials (RCT) were obtained from literature searching. It was revealed that endobronchial valve placement improved quality of patients with moderate to very severe as compared to medical treatment significantly. However, these significant improvements occurred in patients with high heterogeneity emphysema, complete interlobar fissure, and absence of collateral ventilation. Conclusion: endobronchial valve placement was a more effective treatment in patients with high heterogeneity emphysema, complete interlobar fissure, and absence of collateral ventilation. Assessment by using High Resolution CT-scan (HRCT) must be conducted prior to valve placement to determine suitability of this approach in emphysema patients
Endothelial Dysfunction in the Young Adult: a Retrospective Cohort Study on the Effect of Low Birth Weight
Get PDFAim: to investigate the effect of low birth weight (LBW) on endothelial function, and to determine the role of plasma adiponectin in endothelial dysfunction by conducting flow mediated brachial artery (FMBA) test or vasodilation response (VR) and by measuring plasma asymmetrical dimethylarginine (ADMA) of young adults born with LBW. Methods: in a retrospective cohort study, subjects were randomly selected from the growth study cohort of Tanjungsari Sumedang district West Java. They consisted of 67 LBW and 67 NBW (Normal Birth Weight) young adults. Dependent variables were plasma adiponectin, plasma ADMA, and VR. The correlation between plasma adiponectin and ADMA level was examined using Pearson’s correlation. Results: the relative risk for LBW to have low brachialis artery vasodilation response was 2.94, (95% CI:1.91- 4.53), and to have low of plasma adiponectin concentration 1.53, (95% CI: 1.07-2.18). There was a statistically significant difference for all variables studied (FMBA, plasma ADMA, and plasma Adiponectin concentrations), while simultaneous confidence interval measurements indicated that the value of FMBA and the concentration of plasma adiponectin were significantly lower, respectively p<0.001, 95% CI: -4.409-(-2.114), and p=0.015, 95% CI: -1.083-(-0.082) in LBW compared to NBW subjects. The correlation between plasma adiponectin concentration and plasma ADMA concentration in LBW subjects was not significant. Conclusion: there is an effect of LBW on endothelial function. LBW compared to NBW subjects have lower VR and plasma adiponectin concentration. There may be a small role of plasma adiponectin in endothelial dysfunction of young adults with LBW. Key words: low birth weight, adiponectin, ADMA, FMBA tes
Management of Hypertension in Pregnancy
Get PDFHypertension-related maternal mortality reaches 16% when it is compared to other causes of maternal mortality such as sepsis, bleeding or abortus. Pregnant women with hypertension disorder are at increased risk for experiencing numerous complications including disseminated intravascular coagulation (DIC), cerebral hemorrhage, liver dysfunction and acute renal failure; while to the fetus, it may cause intrauterine growth retardation, prematurity and perinatal mortality. Hypertension in pregnancy should be managed appropriately to reduce maternal and fetal morbidity and mortality rate, i.e. by preventing women from getting the risks of increased blood pressure, preventing disease progression and preventing the development of seizure and considering termination of pregnancy in lifethreatening situation for maternal and fetal health.Key words: blood pressure, hypertension, eclampsia, preeclampsia, pregnant women, gestational
Association of Tumor Necrosis Factor Alpha and Lymphotoxin Alpha Gene Polymorphisms with the Presence of Chronic Obstructive Pulmonary Disease
Get PDFAim: to analyze the occurrence of chronic obstructive pulmonary disease (COPD) and its association with the polymorphisms of -308G/A, -238G/A of TNFα gene and +252A/G LTα gene polymorphism in smokers. Methods: cross-sectional study, comparing the genetic group of people who have COPD and who do not have COPD with the same smoking history. The study was conducted from January 2011 to March 2012 at several health centers; such as Adam Malik Hospital, Pirngadi Hospital, Tembakau Deli Hospital, Siti Hajar Hospital in Medan and several health centers in the city of Medan. Examination of lung function was done using spirometry and the existence of genetic polymorhisms in the TNFα and LTα gene was performed using polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP). Results: of the total of 227 samples that met inclusion criteria and after equalizing the age and history of smoking, 186 subjects were enrolled, of which, 93people as COPD group and 93 people as non-COPD group. Analysis of the association between the -308G/A polymorphism with the COPD revealed the odds ratio (OR) 0.436 (95% CI 0.224-0.850, p=0.014). Polymorphism at -238G/A of the TNFα gene showed the OR 2.094 (95% CI 0.608 - 7.211, p=0.241). Polymorphism at +252A/G LTα gene showed OR 1.256 (95% CI 0.694 - 2.272; p=0.450). The findings indicated that polymorphism at -308G showed a protective factor whereas the -238G/A of the TNFα and +252A/G of the LTα genes did not show any significant association with the COPD. Conclusion: polymorphism -308 TNFα gene shown to be a protective factor for the occurrence of COPD. Polymorphism -238 TNFα gene and +252 LTα gene did not show any significant association with COPD.Key words: chronic obstructive pulmonary disease, TNFα gene, LTα gene, polymorphism
Seroprevalence and Socio-demographic Factors of Helicobacter pylori Infection in Patients with Dyspepsia in Kalibaru Primary Health Care North Jakarta
No full textAim: to identify the seroprevalence and its association with socio-demographic factors of Helicobacter pylori infection. Methods: a cross-sectional study was performed in 111 patients with dyspepsia (according to ROME III) who got treatment at Kalibaru Primary Health Care, North Jakarta from January to February 2015. Patients aged over 18 years and no history of gastrectomy were interviewed and 3 cc venous blood was drawn. Bioramps Laboratories’s Immunochromatography Diagnostic Test (Bio M Pylori®) was used to diagnose patient with Helicobacter pylori infection. Chi Square were used to analyzed socio-demographic and T test were used to analyze age. Variables with p<0.25 were analyzed by logistic regression. Results: seroprevalence of Helicobacter pylori of 111 dyspepsia patients who got treatment in Kalibaru Primary Health Care in this study was 22.5% (95% CI 14.8% - 30.2%). There is no relation between age and Helicobacter pylori infection (p=0.270). Higher socio-economic class was related to lower risk Helicobacter pylori infection (OR 0.2; 95% CI 0.02 – 1.71). Higher crowding index was related to higher risk Helicobacter pylori infection (OR 1.2; 95% CI 0.37 – 4.49). Lower clean water index was related to higher risk Helicobacter pylori infection (OR 1.5; 95% CI 0.57 – 4.04). Lower sanitation status was related to higher risk Helicobacter pylori infection (OR 2.5; 95% CI 1.01 – 6.19). Conclusion: seroprevalence of Helicobacter pylori infection in patient with dyspepsia in Kalibaru village was 22.5%. There is an association between sanitation and Helicobacter pylori infection.Key words: seroprevalence, Helicobacter pylori, sanitation
Recurrent Bilateral Staghorn Stones as a Manifestation of Primary Hyperparathyroidism due to Parathyroid Adenoma
Get PDFPrimary hyperparathyroidism is a medical condition caused by overactive of parathyroid gland. It is most commonly caused by solitary adenoma of the parathyroid gland. Other causes of this condition are hyperplasia, multiple adenomas, and parathyroid cancer. Primary hyperparathyroidism has some metabolic consequences in the calcium metabolism. Hypercalcemia in patient with primary hyperparathyroidism will resulted to the most important comorbidity that is chronic deposition of calcium in the kidney forming nephrolithiasis or other urolithiasis. It is not uncommon, patient with parathyroid adenoma come to health care professionals with the chief complain of recurrence nephrolithiasis
Efficacy of Probiotic Escherichia coli Nissle 1917 in Patients with Irritable Bowel Syndrome: a Double Blind Placebocontrolled Randomized Trial
Get PDFAim: to evaluate potential improvement effect for probiotic E. coliNissle 1917 in the management of refractory IBS in an Iranian population. Methods: a double blind placebo controlled approach as been used in the current clinical trial. 139 confirmed IBS patients were included into the study, and were given probiotic E.coli Nissle 1917 for 6 weeks. 11 items Birmingham IBS Symptom Questionnairehas been used for evaluation of changes in the symptoms every 2 weeks. Results: sixty eight subjects (49%) were males. Mean±SD age of the participants was 38±13.3 years. 49(35.3%) of the patients were diarrhea-predominant. The total scores showed no significant difference between the intervention vs. control group(-6.7±6.8 vs. -6.7±6.5, respectively; p=0.95); neither did any of the questionnaire items any significant alterations in the two groups. After stratification of patients based on their IBS type, diarrhea-predominant patients showed a positive response to the probiotic improving their sleep (p=0.05&0.03 at weeks 2&6, respectively). Patients with constipation-predominant IBS showed no response to the probiotic; while patients with diarrhea-constipation mixed IBS showed unfavorable response to the probiotic in the need for strain to pass a motion compared to the placebo (p=0.03&0.02 at weeks 4&6, respectively). Conclusion: probiotic therapy with E.coliNissle 1917 was not able to induce significant improvement in the symptoms of patients with non-categorized IBS. Nevertheless, when IBS patients were recategorized to subgroups according to their main symptoms, evaluation of the efficacy of the probiotic on some individual items in the symptom list reached the significance level. Prospective clinical trials are recommended to confirm our findings.Key words: probiotic Escherichia Coli Nissle 1917, irritable bowel syndrome, double blind randomized controlled trial
Dendritic Cells in Graves’ Disease
Get PDFDendritic cells are major antigen-presenting cells (APC) that stimulate naïve T cells, which induce adaptive immune responses. Graves’ disease (GD) is an autoimmune disease characterized by the presence of autoantibodies against Thyroid Stimulating Hormone Receptor (TSHR). The autoantibodies bind with TSHR and stimulate thyroid hormone production. Dendritic cells are still the major APC in GD immune response although thyrocytes in GD can also express Major Histocompatibility Class (MHC) class II molecule. Studies about DC in GD have been conducted by isolating intra-thyroid DC or DC in peripheral circulation. Results of DC studies in GD are still controversial. Changes in number and profile of DC are found, which indicate altered immune response activity and defects of regulator T cell (Treg) in GD.Key words: dendritic cells, Graves’ diseas