Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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The Effect of Enhanced External Counterpulsation Therapy and Improvement of Functional Capacity in Chronic Heart Failure patients: a Randomized Clinical Trial
Get PDFAim: to investigate the efficacy of enhanced external counterpulsation (EECP) therapy to improve functional capacity in patients with chronic heart failure (CHF). Methods: a double-blind random clinical trial was performed in 99 patients with CHF who had received EECP therapy at Jade Cardiovascular Clinic, Manado, North Sulawesi, Indonesia between January 2014 and June 2015. Subjects were categorized into 2 groups, i.e. 49 subjects had sham EECP therapy and 50 subjects had EECP therapy. All subjects performed six-minute walking test (6MWT) before and after receiving EECP therapy. Results: there was no significant difference between both groups regarding the basic characteristics of patients with CHF. The 6MWT result before EECP therapy showed that there were 30 patients (61.2%) with walk distance of <300 meter in the sham EECP group; while in the group receiving EECP therapy, we found 34 patients (68%); p=0.24. Post-EECP therapy, there were 33 patients (67.3%) with walk distance of <300 meters in EECP sham group; while in the group receiving EECP alone, there was only 1 patient (2%); p <0.01.The 6MWT walk distance in sham group before EECP therapy was 252.65 (SD 97.55) meters and it was 243.65 (SD 86.96) meters following the EECP therapy; p=0.18. In EECP group, the 6MWT walk distance before therapy was 256.88 (SD 85.56) meters and after EECP therapy the walk distance was 449.46 (SD 92.08) meters; p<0.01. Conclusion: EECP therapy is effective to improve functional capacity in patients with CHF.Key words: chronic heart failure, six-minute walk test, enhanced external counterpulsation (EECP) therapy
MRSA Infection in Patients Hospitalized at Sanglah Hospital: A Case Series
Get PDFThis is the first report of MRSA infection in Sanglah Hospital. We reviewed eight patients with MRSA infection from microbiologi laboratory records between January and May 2011, than followed by tracing medical records to obtained data of the patients. Five of cases with sepsis, 1 case with osteomyelitis, and the two others with mediastinitis and pneumonia. The patients were kept in private isolated room and barrier-nursing technique was strictly followed. Further action was culturing specimen taken from the patients nose, throat, axilla, and samples taken from the health care workers, with no MRSA colonization were found. Five patients demonstrated good respond to intravenous administration of either vancomycin or linezolide. Three were died due to septic shock before the laboratory culture and antimicrobial susceptibility availabled. All of the strains isolated more than 48 hours after admission and also demonstrated clinical risk factors for hospitalized acquired MRSA (HAMRSA). These strains had resistance to ß-lactams but remain susceptible to many non ß-lactam antibiotics, as reported in some community acquired MRSA (CA-MRSA) isolates. Future study using molecular typing required to fully understand the magnitude and ongoing evolution of MRSA infections.Key words: MRSA, Antimicrobial susceptibility, treatmen
Enhanced External Counterpulsation in Chronic Heart Failure: Where Do We Stand?
Get PDFHeart failure has been known as an increasing health burden worldwide and the prevalence is expected to rise more than 23 million in 2030. Chronic heart failure has characteristic of ventricular dysfunction which will cause dyspnea, fatique, and finally some limitation in functional capacity and reduced quality of life. Recent advances in treatment of chronic heart failure may give us option of wide variety of modalities from pharmacologic and nonpharmacologic therapy with invasive and noninvasive approaches. Each has its own benefit and risk. Structural heart disease of heart failure indicates non reversible damage. Thus, treatment will aim to prevent symptoms and improve quality of life. Enhanced external counterpulsation (EECP) was a non-invasive treatment originally to reduce symptom of refractory angina.2-4 In the newest European Society of Cardiology (ESC) guideline for management of stable coronary artery disease 2013, EECP had been approved as class IIa-recommended treatment for refractory angina
Tranexamic Acid in the Management of Upper Gastrointestinal Bleeding: an Evidence-based Case Report
Get PDFAim: to review the effectiveness of tranexamic acid therapy which has been proposed to reduce bleeding and in turn lower mortality rate. Methods: following literature searching based on our clinical question on Cochrane Library, PubMed, Clinical Key, EBSCO, Science Direct and Proquest, one systematic review that includes seven randomized controlled trials is obtained. The article meets validity and relevance criteria. Results: the systematic review found that there is no any clear evidence between intervention and control groups in term of mortality. Conclusion: the use of tranexamic acid to reduce mortality in patients with upper gastrointestinal bleeding is not recommended. Key words: tranexamic acid, mortality, upper gastrointestinal bleeding
Effectiveness of Short Term Percutaneous Tibial Nerve Stimulation for Non-neurogenic Overactive Bladder Syndrome in Adults: A Meta-analysis
Get PDFAim: to evaluate the effectiveness of short-term PTNS for non-neurogenic OAB in adults systematically by comparing with sham procedure and other treatments. Methods: we performed a systematic review of cohort study. Data sources were MEDLINE, EMBASE, CINAHL, National Library for Health, Cochrane, and google scholar from 2005 through 2015. Meta-analysis was performed using the random effects model. Heterogeneity of effects was assessed by calculating I2 statistic. Statistical analysis was performed using Review Manager 5.3 for RCT meta-analysis. Results: we analized 11 randomised controlled trial (RCT) and five prospective non-comparative studies with variable success rate. Based on percentage of responders, the results were 37.3% - 81.8% in PTNS group, 0% - 20.9% in sham group, 54.8% in anti-muscarinic group, and 89.7% in multimodal group. The decrease of voiding symptoms episodes per day was found in PTNS (0.7-4.5), sham (0.3-1.5), and anti-muscarinic (0.6-2.9) groups. In meta-analysis of four RCTs, the results favour PTNS over sham procedure with overall risk ratio of 7.32(95% CI of 1.69-32.16), p=0.09, I2=54%. Conclusion: there is an evidence of effectiveness of short term PTNS in treatment of non-neurogenic OAB. PTNS is proven significantly better than sham procedure.Key words: overactive bladder, percutaneous tibial nerve stimulation, sham, anti-muscarinic, voiding symptoms
The Influence of Hyperglycemia at Admission on In-hospital Arrhythmia Patients with Acute Coronary Syndrome
Get PDFAim: to determine the incidence of in-hospital arrhythmias in patients with acute coronary syndrome (ACS) andto determine the influence of hyperglycemia at admission (HA) on in-hospital arrhythmias complicating ACS. Methods: a retrospective cohort study was conducted using secondary data from medical records of patients with ACS who were admitted to ICCU RSCM, between January 1st-December 31st, 2014. Hyperglycemia at admission was defined when the blood glucose level at admission was >140 mg/dL. The in-hospital arrhythmias encompassed atrial arrhythmia, supraventricular tacchycardia (SVT), high grade AV block (HAVB), and ventricular arrhythmia, during the first seven days of hospitalization. Results: there were 232 subjects in this study. The prevalence of HA was 50.43%. The incidence of in-hospital arrhythmia was 21.55% (95% CI 16.26-26.84). In bivariate analysis, there was significant association between HA and in-hospital arrhythmia (RR 1.75; 95% CI 1.04-2.93). Therewere no association between type of ACS, diabetes mellitus (DM), obesity, and hypertension, with the in-hospital arrhythmias. In multivariate analysis, the adjusted OR of HA was 2.85 (95% CI 1.35-6.02), and DM was the confounding variable. Conclusion: the incidence of in-hospital arrhythmias in patients with ACS was 21.55% (95% CI 16.26-26.84). Hyperglycemia at admission may increase the risk of in-hospital arrhythmia in patients with ACS.Key words: hyperglycemia at admission; in-hospital arrhythmia; acute coronary syndrom
Major Aorto Pulmonary Collateral Arteries (MAPCA) with Tetralogy of Fallot and Pulmonary Artesia in Middle Age Adult: a Rare Finding
Get PDFA forty four years old male patient presented with headache and dizziness in our outpatient department. On examination, he had pulse rate of 96 /min, blood pressure of 122/80 mmHg, JVP was not raised. He had clubbing and cyanosis on General physical examination. On auscultation pansystolic murmur was heard all over the chest. His respiratory and abdominal examination was normal. There were no significant findings on electrocardiography and skiagram chest. Echocardiography revealed ventricular septal defect with overriding of aorta, pulmonary artery could not be visualised. On computrized tomography pulmonary angiography revealed Ventricular septal defect with overriding of aorta. The main and normally confluent right and left pulmonary arteries were not visualize
Septic Pulmonary Embolism Following Appendectomy Surgery
Get PDFSeptic Pulmonary embolism is a rare condition where there were numerous pulmonary infarcts resulting from blood clot emboli that also contains microorganism. This disorder is insidious onset, Its clinical features usually unspecific and the diagnosis usually difficult to establish. A 43 old woman who underwent an appendicitis surgery, reentered the hospital at the sixth day after surgery presented with fever, pain at the surgical site, progressive severe dyspnea and chest tightness. From the physical examination finding there were tachycardia, tachypneu, wet rough basal rhonki on the right rear and tenderness at right lower region of the abdomen. The thorax-abdomen CT scan result was pleuropneumonial with minimal effusion in the right side. ACT angiography scan of the chest and abdomen showed intralumen emboli in medial lobe segmen of right pulmonary artery, right pleuropneumonia with segmental lession in segmen 10 right lobe and inflammation process along right lateral wall of the abdomen. Laboratory results that also supported diagnosis were D dimer 3442 ng/mL and culture result from surgical site pus showed E. Coli ESBL (+). Base on these findings, this case was established as a septic pulmonary embolism.Key words: septic pulmonary embolism, appendicitis surgery, E. coli ESBL (+)
Evaluating Resistance to Acetyl Salicylic Acid Using Platelet Function Test in Patients with Ischemic Stroke at Cipto Mangunkusumo Hospital
Get PDFAim: to identify the prevalence of laboratoric ASA resistance using platelet function tests in patients with ischemic stroke at Cipto Mangunkusumo Hospital and its associated factors. Methods: this study was a cross-sectional study involving 50 patients with ischemic stroke who only received ASA treatment. Evaluation of resistance to ASA was performed using Verifynow® platelet function test. ASA resistance was defined as ASA reaction unit (ARU) ≥550. Results: there were 7 patients with ASA resistance. The mean age of subjects in ASA resistance group was 51.3±9.2 years; while in ASA responsive group was 57.8±9.7 years. In ASA resistance group, there were 85.7% male patients, 57.1% active smoker and 100% subjects with hypertension. Conclusion: the prevalence of laboratoric ASA resistance in patients with ischemic stroke evaluated using platelet function test at Cipto Mangunkusumo Hospital is 14%. The prevalence is more likely to occur in male patients who were active smoker, at younger age and with comorbidity of hypertension. Key words: ischemic stroke, ASA resistance, platelet function test
Diagnostic Test of a Scoring System for Frailty Syndrome in the Elderly According to Cardiovascular Health Study, Study of Osteoporotic Fracture and Comprehensive Geriatric Assessment Based Frailty Index Compared with Frailty Index 40 Items
Get PDFAim: to get a recommendation on the best frailty syndrome diagnostic tools, that will be able to be practiced on a daily setting in Indonesia. Methods: this is a cross-sectional study with diagnostic test approach, conducted to patients in the Geriatric Outpatient Clinic of Cipto Mangunkusumo National Referral Hospital on May-June 2013. Each subject underwent a frailty evaluation using CHS, SOF, FI-CGA and FI-40 scoring systems. Then, we calculate the sensitivity, specificity, PPV, NPV, LR+ and LR- of each scoring system compared to FI-40. Results: the proportion of frail, pre-frail and fit according to FI-40 are 25.3%,71% and 3.7% respectively. In terms of differentiation frail to non-frail, CHS had 41.2% sensitivity, 95% specificity, PPV 73.7%, NPV 82.7%, LR+ 8.41 and LR- 0.62. SOF scoring system had 17.6% sensitivity, 99.5% specificity, PPV 92.3%, NPV 78.1%, LR+ 35.2 and LR- 0.83. Furthermore FI-CGA had 8.8% sensitivity, 100% specificity, PPV 100%, NPV 76.4%, LR+ ∞ and LR- 0.91. Conclusion: There is no better scoring system that could be implemented to screen for frailty syndrome other than FI-40 items. However, other scoring systems could be used as a good diagnostictool for the syndrome.Key words: elderly patient, frailty syndrome, CHS index, SOF index, FI-CGA, FI-40