Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Early Implementation of Universal Health Coverage Among Hypertension Subjects in Sleman District of Yogyakarta
Get PDFAim: to evaluate the participant rate of the new universal health coverage (UHC) and its impact on the hypertensive subjects from the rural area in the Sleman-District of Yogyakarta during the early implementation. Methods: this epidemiological survey of the new UHC implementation was included as an analytical crosssectional study done with cluster random sampling. The subject criteria were aged 30-85 year, not in pregnancy, and signed the informed-consent. Subjects were grouped based on the health coverage disparity and analyzed with chi-square statistics for the hypertension prevalence, awareness, therapy, and control. The additional variables of BMI, education, occupation, income, smoking, diet control, physical activity, and health facilities were grouped into binomial data and analyzed based-on the health coverage disparity. Results: of 926 total subjects, 602 (65.0%) subjects had the health coverage including 9.2% of the new UHC. The groups of with and without health coverage were not significantly different in hypertension prevalence, the profile of age, blood pressure, and the proportion of the other variables (p>0.05) except for smoking and physical activities. In the high blood pressure sub-group (n=446), the subjects without health coverage had lower proportion of the hypertension awareness p<0.02; OR: 0.60 (CI95%:0.39-0.91) and therapy p<0.03; OR: 0.50 (CI95%:0.27-0.94), but not in the blood pressure control (p>0.05). Conclusion: the participant rate of new UHC was relatively low at 9.2%. Among the subgroup with ≥140/90mmHg blood pressure, the subjects without health coverage were more likely to have lower hypertension awareness and suboptimal therapy than those with the health coverage program.Key words: universal health coverage, hypertension, awareness, therapy
Indonesian Prostate Cancer Risk Calculator (IPCRC): An application for Predicting Prostate Cancer Risk (a Multicenter Study)
Get PDFAim: to develop a prediction risk model of prostate cancer based on Indonesia population. Methods: we included all benign prostate hyperthrophy (BPH) and PCa patients who had prostate biopsy and prostatectomy between January 2009 and December 2013 from 5 urology centers in Indonesia. The relationship between the possibility of PCa with the following variables including: age; PSA level, prostate volume (by transabdominal ultrasound or transrectal ultrasound) and digital rectal examination (DRE) finding. We calculated a predictive scoring equation to predict the possibility of PCa using chi-square analysis, Kolmogorov-Smirnov test, multiple logistic regression and ROC curve. Then, we designed an application for predicting prostate cancer risk called Indonesian Prostate Cancer Risk Calculator (IPCRC). Results: there were 784 PCa and 1173 BPH patients were used for developing the risk calculator in our study. The mean ages, PSA and prostate volume are 66.9±8.1 years old; 72.4±248.9 ng/ml and 49.6±28.2 ml, respectively. Abnormal DRE was found in 637 PCa and 56 BPH. We included age, PSA level, abnormal DRE finding (all showed significant p<0.05 in univariate model). Additionally, although not significant, we included prostate volume (p=0.157) due to its clinical importance. The corrected ROC analysis showed AUC 0.935, sensitivity of 90.1% and specificity 80% in predicting the prostate cancer in our population. Conclusion: we have developed the Indonesian Prostate Cancer Risk Calculator which includes age, PSA, DRE, and prostate volume as its variables. Future prospective study to validate the risk calculator is needed. Key words: prostate cancer, risk calculator, early detection
ST2 Levels Before and After Treatment of NYHA III and IV Heart Failure
Get PDFAim: to find whether ST2 can be used to determine clinical improvement in patients with NYHA III and IV heart failure. Methods: this is a longitudinal, pre and post-test study without a control group. Study subjects are 23 NYHA III and IV heart failure patients. ST2 was tested at the start and end of hospital treatment. Results: of 23 heart failure patients, 70% were classified as NYHA III while 30% were NYHA IV. There were more male subjects than females (51.4% vs. 48.6%). Median age for NYHA III heart failure patients was 52 years and mean age for NYHA IV heart failure patients was 58 years. Heart failure was mostly caused by coronary artery disease (52%). ST2 levels did not correlate with age, length of care, sex and cause of heart failure. ST2 levels in NYHA IV heart failure patients (58.82±37.36 ng/mL) tended to be higher than the one in NYHA III group (30.75 [14.4-84.5] ng/mL), but the difference was statistically not insignificant (p=0.89). ST2 levels at the start of treatment was significantly higher than at the end (31.4 [14-129.2] ng/mL vs. 18.4 [7.6-77.8] ng/mL), p=0.001. This shows that clinical improvement is associated with significant reduction of ST2 levels. Conclusion: ST2 can be used as a marker to determine clinical improvement in NYHA III and IV heart failure.Key words: ST2, heart failure, NYHA III and I
Safety and Efficacy in Early Insulin Initiation as Comprehensive Therapy for Patients with Type 2 Diabetes in Primary Health Care Centers
Get PDFAim: to analyze the safety and efficacy of early insulin initiation therapy for patients with type 2 diabetes mellitus (T2DM) in primary health care provided by general practitioners (GPs) in Surabaya, East Java, Indonesia. Methods: pre-post study of ninety nine diabetic patients without previous insulin treatment with HbA1c levels >8% were involved in this study. The study was conducted in 10 primary health care centers in Surabaya between October 2011 to June 2012. Each patient received insulin therapy for 12 weeks. Laboratory examination was performed for each patient including fasting plasma glucose (FPG), 2 hours post-prandial plasma glucose (2hPPG) and HbA1c examination before and after the study. Self monitoring blood glucose (SMBG) examination was conducted in order to adjust the insulin dose and prevent the incidence of hypoglycemia. Data was statistically analyzed using paired-T test. Results: FPG level was decreased from baseline data (209 mg/dL) to 152.07 mg/dL at the end of the study (Δ56.93 mg/dl; p=0.0001). The average of 2hPPG level was also decreased from 313.00 mg/dl to 220.72 mg/dL (Δ 92.28 mg/dL; p=0.0001). HbA1c was reduced from 11.60% at baseline to 8.95% at the end of study (Δ 2.65%; p=0.0001). Hypoglycemia was found in 6 patients (6.06%) in this study, but all events were mild and did not need to be admitted to hospital. Conclusion: the safety of insulin therapy iniatiation might be provided by GPs at primary health centers with significant efficacy and minimal side effects. Key words: insulin, general practioner, primary health center
Correlation between Receptor Activator of Nuclear Factor-κβ Ligand (RANKL), and Osteoprotegerin (OPG) with Cartilage Degradation in Rheumatoid Arthritis Patients
Get PDFAim: to analyze the correlation between Receptor activator of nuclear factor-κβ ligand (RANKL), Osteoprotegrin (OPG) serum level with cartilage oligomeric matrix protein (COMP) serum level as a marker of cartilage degradation in rheumatoid arthritis patients. Methods: a cross-sectional study was conducted on the subjects who came to the outpatient clinic of rheumatology in Cipto Mangunkusumo Hospital. Patients were diagnosed based on the American College of Rheumatology (ACR) 1987 revised criteria. All numerical data, both primary data and data transformation were not normally distributed, so we did bivariate analysis with Spearman correlation test. Results: we collected the data of 60 RA patients with majority of the subject had active disease activity (78.3%). Methotrexate was the most widely disease modifying anti-rheumatoid drug (DMARD) used, either as a single drug (51.7%) or in combination with another DMARD (25.1%). Bivariate analysis was revealed that RANKL, OPG, and OPG/RANKL serum level have no significantly correlation with COMP serum level (p=0.52; p=0.25; p=0.2, respectively). Conclusion: RANKL and OPG serum level, had no correlation with cartilage degradation in rheumatoid arthritis patients. Key words: RANKL, OPG, COMP, rheumatoid arthritis
A Validation Study for POSSUM and EuroSCORE as a Predictor of Mortality After Selective Cardiac Surgery
Get PDFAim: to assess physiological and operative severity score for the enumeration of mortality (POSSUM) scoring system and compare it with European system for cardiac operative risk evaluation (EuroSCORE) scores in patients who underwent cardiac surgery from two hospitals in the southwestern region of Iran. Methods: in this retrospective study, total of all 1420 patients who were admitted for elective cardiac surgery at our centers, from 2007 to 2012, were scored using the POSSUM and EuroSCORE systems. Results: the overall mortality rate was 0.87%. Among the risk factors, history of diabetes, smoking, respiratory disease, and myocardial infarction, were significantly affect the mortality rate. Therefore, of these risk factors, only the hemoglobin was significantly correlated with the morbidity rate. The predictive accuracy of mortality equations was 74.5%. The lower predictive accuracy of mortality equations was 67.8% was observed using EuroSCORE. Conclusion: although results are statistically significant, but the analysis have never intended to affect the decision to operate, and this decision must be based on clinical expertise, because of the need to standardize data collection and stratify the risks involved in operations, scoring systems such as POSSUM should be used prospectively. However, if analyzed correctly, POSSUM is a good predictor of mortality in patients undergoing cardiac surgery.Key words: cardiac surgery, physiological and operative severity score for the enumeration of mortality (POSSUM), European system for cardiac operative risk evaluation (EuroSCORE)
Managing Hypertriglyceridemia in Daily Practice
No full textHypertriglyceridemia is a form of dyslipidemia, which usually occurs in combination with hypercholesterolemia, high-LDL or low-HDL cholesterol level. Most studies suggest that hypertriglyceridemia is associated with many metabolic disorders such as metabolic syndrome, diabetes, obesity, and also cardio-cerebrovascular diseases. Treatment of hypertriglyceridemia is often not comprehensively addressed by many physicians, who usually only include prescribing drugs without encouraging patients to perform physical activity, to take a true healthy diet for dyslipidemia and to stop smoking. This review article discusses evaluation, diagnosis and a comprehensive, yet simple management of hypertriglyceridemia, which can be easily pplied in daily clinical practice.Key words: hypertriglyceridemia, dyslipidemia, management, clinical guidelines
Hemoperitoneum Caused by Spontaneous Rupture of Hepatocellular Carcinoma
Get PDFWe are reporting a male, 46 years old came to emergency unit with a chief complaint of abdominal tenderness since 1 day prior to admission. No history of abdominal trauma. He often felt abdominal discomfort for the last 5 years. Physical examination revealed decreased consciousness, shock, pale conjungtiva, distended abdomen, with tenderness of the whole abdomen on palpation, and no bowel movement. Laboratory examination found anemia, leucocytosis, normal amilase and lipase. FAST (focus assissted Sonography on trauma) found massive ascites. Patient underwent cito laparotomic exploration that found blood on abdominal cavity, nodular liver, and actively bleeding tumour of liver. During hospitalization, patient recovered and discharged.In the case of acute abdomen, spontaneous ruptured hepatocellular carcinoma (HCC) is one of differential diagnosis, considering high incidence of HCC in South East Asia, especially Indonesia. Confirming diagnosis of generalized peritonitis requires abdominal CT scan and ultrasonography, to rule out ruptured HCC.Key words: hemoperitoneum, ruptured hepatocellular carcinom
Hyperuricemia as a Risk Factors of Major Adverse Cardiac Events in Patients with Acute Coronary Syndrome: a Retrospective Cohort Study
Get PDFAim: to investigate the MACE-free survivals difference between hyperuricemic and normouricemic patients and to determine its role as risk factor for MACE occurrence in hospitalized acute coronary syndrome patients. Methods: retrospective cohort study with survival analysis approach was conducted in 251 patients with acute coronary syndrome who were treated in ICCU Cipto Mangunkusumo Hospital during period from January 2009 to December 2011. Clinical data, laboratory results, electrocardiography result, echocardiography result, and coronary angiography were collected. Patients were observed and followed on major adverse cardiac event during 7 days of hospitalization in ICCU. Major adverse Cardiac Event is an event as a complication occur after acute coronary syndrome such as cardiogenic syock, acute heart failure, stoke, reinfarct during early ward treatment, sudden cardiac death, repeat PCI during ward ulang and perform coronary artery bypass graft (CABG) surgery. Difference in survival is shown in Kaplan-meier curve and difference in survival between groups were tested with Log-rank test, and multivariate analysis with Cox proportional hazard regression to calculate adjusted HR on major adverse cardiac event with confounding variables as covariates. Results: there was a significant difference in survival between hyperuricemia group and non-hyperuricemia group (Log-rank test (p<0.001)) with crude HR 2.7 (CI 95% 1.6–4) and adjusted HR 2.67 (CI 95% 1.6-4.3).There was significant difference in survival between hyperuricemia group (mean survival 6.05 days with SE 0.2 (CI 95% 5.6-6.4) and non-hyperuricemia group (mean survival 7.33 days with SE 0.1 (CI 95% 7.0-7.6). Conclusion: survival of patients suffering from ACS with hyperuricemia is worse compared to those without hyperuricemia during ICCU hospitalization.Key words: hyperuricemia, acute coronary syndrome, major adverse cardiac event, surviva
On-admission High Neutrophil to Lymphocyte Ratio as Predictor of In-hospital Adverse Cardiac Event in ST-elevation Myocardial Infarction
Get PDFAim: to investigate the role of neutrophil-to-lymphocyte ratio (NLratio) in predicting in-hospital adverse cardiac events in patients with STEMI. Methods: this was a cohort study on patients with STEMI onset ≤24 hour hospitalised in ICCU. NLratio was calculated as absolute neutrophil count divided with lymphocyte count measured by automated blood cell counter on admission.The outcome was in-hospital adverse cardiac events,which were recorded during follow-up. The cut-off value of NLratio to predict outcome was determined by ROC curve analysis. Univariate and multivariable analysis to assess whether high NLratio was independent predictor for in-hospital adverse events were performed. Results: among165 subjects, in-hospital adverse cardiac events occurred in 49 subjects (29%). The cut-off value of NLratio was 6.2. The univariate analysis showed that NLratio >6.2 had an odd ratio of 3.19 (95% CI 1.55-6.55, p=0.002) to develop in-hospital adverse cardiac events. The multivariate analysis showed that NLratio was an independent predictor of in-hospital adverse cardiac events with an odd ratio of 4.10 (95% CI 1.59-10.54, p=0.003). Conclusion: high on-admission NLratio is an independent predictor for in-hospital adverse cardiac events in patients hospitalised for STEMI.Key words: neutrophil-to-lymphocyte ratio, adverse cardiac events, STEMI