Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Effects of Duration of Breastfeeding During Infancy on Vascular Dysfunction in Adolescents
Get PDFAim: to investigate the effect of breastfeeding duration on vascular characteristics in adolescence. Methods: we conducted a retrospective cohort study on adolescents aged 15-18 years old. Breastfeeding duration was inquired using a questionnaire filled by parents and categorized into 0-<2, 2-<4, 4-<6, 6-<12, and >12 months. Outcomes assessed were flow mediated dilation (FMD), carotid intima media thickness (CIMT), anthropometrics. Analysis was done using linear regression and MANOVA general linear model with cardiovascular risk factors as the dependent variables and breastfeeding duration as the independent variable with further adjustment for confounders. Results: 285 subjects aged 15-18 years were enrolled. Breastfeeding duration of 4-<6 months was associated with thinner CIMT and the effect was more prominent after adjustment for gender and postnatal tobacco exposure (mean difference=24.28 micrometer, p=0.045). No statistically significant association was found with FMD. Conclusion: breastfeeding duration of 4-<6 months is associated with thinner IMT and thus has a protective effect on the development of cardiovascular disease. However the association with FMD in adolescence is less clear.Key words: breastfeeding duration, vascular structure and function, cardiovascular risk
Serum TNF-α, IL-8, VEGF Levels in Helicobacter pylori Infection and Their Association with Degree of Gastritis
Get PDFAim: to investigate the serum levels of TNF-α, IL-8, VEGF in Helicobacter pylori infection, and their association with the degrees of gastritis histopathology. Methods: a cross-sectional study was done on 80 consecutive gastritis patients admitted to endoscopy units at Adam Malik General Hospital and Permata Bunda Hospital, Medan, Indonesia from July-December 2014. The Rapid Urease test was used for the diagnosis of H. pylori infection. The severity of chronic inflammation, neutrophil infiltration, atrophy, and intestinal metaplasia were assessed. Serum samples were obtained to determine circulating TNF-α, IL-8, and VEGF. Univariate and bivariate analysis (chi square, fisher’s exact, and mann-whitney test) were done using SPSS version-22. Results: there were 41.25% of 80 patients infected with Helicobacter pylori. Serum TNF-α and VEGF levels in the infected group were significantly higher compared to H. pylori negative, but there were no significant differences between serum levels of IL-8 in H. pylori positive and negative. There were significant associations between serum level of TNF-α and IL-8 with degree of chronic inflammation, and also between serum level of IL-8 and degree of neutrophil infiltration. There were significant associations between serum level of VEGF and degree of atrophy, and also between serum level of VEGF and degree of intestinal metaplasia. Conclusion: High levels of TNF-α were associated with severe degree of chronic inflammation, high levels of IL-8 associated with severe degree of chronic inflammation and neutrophil infiltration, and high levels of VEGF associated with severe degree of premalignant gastric lesion. Key words: cytokine, neoangiogenesis, Helicobacter pylori, atrophic gastritis, intestinal metaplasia
Factors Associated with In-stent Restenosis in Patients Following Percutaneous Coronary Intervention
Get PDFAim: to determine factors associated with In-Stent Restenosis (ISR) in patients following Percutaneous Coronary Intervention (PCI). Methods: a retrospective cross-sectional study was conducted using secondary information from medical records of post-PCI patients who underwent follow-up of angiography PCI between January 2009 and March 2014 at The Integrated Cardiovascular Service Unit, Cipto Mangunkusumo Hospital, Jakarta. Angiographic ISR was defined when the diameter of stenosis ≥50% at follow-up angiography including the diameter inside the stent and diameter with five-mm protrusion out of the proximal and distal ends of the stent. Results: there were 289 subjects including 133 subjects with and 156 subjects without ISR. The incidence of ISR in patients using of bare-metal stent (BMS) and drug-eluting stent (DES) were 61.3% and 40.7%, respectively. Factors associated with ISR are stent-type (OR=4.83, 95% CI 2.51-9.30), stent length (OR=3.71, 95% CI 1.99-6.90), bifurcation lesions (OR=2.43, 95% CI 1.16-5.10), smoking (OR=2.30, 95% CI 1.33-3.99), vascular diameter (OR=2.18, 95% CI 1.2-3.73), hypertension (OR=2.16, 95% CI 1.16-4.04) and diabetes mellitus (OR=2.14, 95% CI 1.23-3.70). Conclusion: stent type, stent length, bifurcation lesions, smoking, vascular diameter, hypertension and DM are factors associated with ISR in patients following PCI.Key words: bare-metal stent; drug-eluting stent; in-stent restenosis
Plasma Sodium in Relation with the Extracellular Fluid Volume in Chronic Hemodialysis Patients
Get PDFAim: to obtain a causal relationship between changes in plasma sodium levels and increased extracellular fluid volume between post-hemodialysis and pre-hemodialysis on the following day or plasma sodium serves as a predictor of extracellular fluid volume. Methods: the study was conducted on 40 subjects randomly selected from the 247 chronic hemodialysis patients in Hemodialysis Unit of Nephrology and Hypertension Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital that met the inclusion and exclusion criteria. Their plasma sodium levels, post-hemodialysis weight and pre-hemodialysis weight on the following day were examined. Results: There was no significant difference in the plasma sodium levels between post-hemodialysis and pre-hemodialysis on the following day. However, there was a considerable differences between post-hemodialysis weight and pre-hemodialysis weight on the following day (p = 0.0000). In regression analysis that were conducted on the relationship between the difference in pre-hemodialysis sodium levels subtracted by previous post-hemodiaysis sodium levels (Y) and the difference in pre-hemodialysis weight subtractted by previous post-hemodialysis weight (X), a significant causal relationship was found with the regression formula of Y = - 2.205 + 0.937 X. Conclusion: plasma sodium levels in chronic hemodialysis patients can be used as predictors of body fluid volume or extracellular fluid volume. At each dialysis unit, the recommended weight gain for the patients are 2.5 kg-2.9 kg, in order to prevent a significant decrease in plasma sodium levels that could lead to mortality.Key words: plasma sodium, weight gain, hemodialysis
Unilateral Leg Swelling
Get PDFA 50-year old man was consulted due to right leg swelling concomitant with redness and pain since two months between admission. The patient experienced fever and dull pain in right inguinal region before the leg became swollen. Antibiotic and antipyretic had been given but gave unsatisfaction response. No history of bedridden, hospitalization, or malignancy. He worked as a palm oil farmer in Geragas Village, langkat District, North Sumatera, Indonesia, an endemic region of Bancroftian filariasis. Physical examination revealed normal vital signs, there was non pitting oedema and redness in right gastrocnemius region (Figure 1). Laboratory results of routine blood count and haemostasis were within normal limit, except leucocytosis (12000/m3) and eosinophilia (15%). Peripheral blood sample was drawn between 10 pm and 2 am and showed positive microfilariae with gently curved body, a tail that is tapered to a point, and the nuclear column is loosely packed, appropriate for Wuchereria bancrofti (Figure 2)
Dengue Convalescent Rash in Adult Indonesian Patients
Get PDFDengue hemorrhagic fever is still a serious problem in Indonesia. Since the first cases reported in 1968, incidence rate has increased and around 37.3/100.000 populations was infected with the Dengue virus in 2012 with case fatality rate of 0.9%. Dengue is a self-limited, systemic viral infection. Efforts to understand the disease in terms of spectrum of illness, clinical manifestation, pathogenesis, diagnosis and management were made to decrease morbidity and mortality.Dengue virus infection involves three phases of illness; the febrile phase, the critical phase (plasma leakage) and the convalescent (reabsorption) phase.3 During the febrile phase, most patient a reported high peak of fever with frontal headache, with and without hepatomegaly or hemorrhagic manifestation. This will last around the first 3 days of illness. Following the absence of the fever, there is a higher risk of having plasma leakage or hemorrhage. Patient also more prone of become shock. On this second phase of illness, WHO developed the warning signs to guide clinician to perform immediate medical evaluation
Adult Necrotising Enterocolitis: a Rare Entity
Get PDFA case of Adult Necrotising Enterocolitis in an adult female whom diagnosed with intestinal obstruction was reported. On exploratory laparotomy, the mechanical caused was not found although major part of small bowel, caecum and proximal ascending colon were gangrenous along with intervening normal parts. Resection of affected bowel was performed followed by jejunostomy and transverse colostomy. Unfortunately, the patient not survive in the postoperative periods. Adult Necrotising Enterocolitis may mimic intestinal obstruction clinically or radiologically and prompt medical and surgical intervention is indicated in doubtful cases although it carries a poor prognosis. Key words: adult necrotizing Enterocolitis, non-occlusive mesenteric ischemia, gangrenous bowe
Effectiveness of Renal Denervation for Treatment of Resistant Hypertension: an Evidence-based Case Report
Get PDFAim: to determine whether the renal sympathetic – nerve ablation method is more effective compared to multiple anti – hypertensive drug among patients with resistant hypertension. Methods: a search was conducted on PubMed. The selection of title and abstract was conducted using inclusion and exclusion criteria, which led to five relevant articles. The selected studies were critically appraised for its validity, importance and applicability. Results: one of studies showed that renal denervation is not effectively reduced blood pressure in patients with resistant hypertension; nevertheless other studies showed significant results. Conclusion: literature with strongest evidence showed that there is no relationship between renal sympathetic-nerve ablation procedure and reduction of blood pressure. However, as there is still some methodological flaw on the literature, we recommend doing another study that may find the appropriate results. Key words: renal denervation, resistant hypertension
Estrogen and Body Weight Regulation in Women: The Role of Estrogen Receptor Alpha (ER-α) on Adipocyte Lipolysis
Get PDFEstrogen has an important role in regulation of fat metabolism. Recent studies indicated that this process occurred due to inhibition of lipolysis by external estrogen administration. However, there was limited information regarding molecular process responsible for this phenomenon. This paper was aimed to present a brief update on recent studies explaining the effect of estrogen on adipose tissue lipolysis and the molecular pathway involved in this process. It is suggested that the effect of estrogen to reduction of lipolysis was through activation of estrogen receptor alpha (ER-α) in adipose tissue. This finding is supported by the fact that mice lacking of ESR1 gene (encodes ER-α) accumulate more fat and ESR1 mRNA in human adipose tissue was inversely correlated with body mass index (BMI). Future study should be aimed to clarify the role of ER-α on lipolysis in adipose tissue during weight loss intervention. Additionally, new pharmacological or nutritional treatment with ability to modulate ER-α activity/expression could be used as a potential weight loss intervention. Key words: adipose tissue, estrogen, estrogen receptor, lipolysis, obesity, woman
Correlation between Vitamin D Receptor Gene FOKI and BSMI Polymorphisms and the Susceptibility to Pulmonary Tuberculosis in an Indonesian Batak-ethnic Population
Get PDFAim: to explore the role of FokI and BsmI polymorphisms the VDR gene in the susceptibility to pulmonary tuberculosis (PTB) in an Indonesian Batak ethnic population. Methods: matched case-control study was conducted on 76 PTB patients and 76 healthy normal control. Genetic polymorphisms of Vitamin D Receptor (VDR) gene were analysed using PCR-RFLP. Results: the frequencies of FokI genotypes were FF 35.5%, Ff 55.3%, ff 9.2% for PTB patients and FF 39.5%, Ff 44.7.% and ff 15.8% for normal control. The BsmI genotypes frequencies were BB 0%, Bb 68.4%, bb 31.6% for TB patients and BB 2.6%, Bb 23.7% and bb 73.7% for control. There was no significant association between FokI genotype and PTB (OR 1.39, 95% CI: 0.69-2.77 for Ff genotype and OR 0.64, 95% CI: 0.22-1.86 for ff genotype). There was a significant association between BsmI genotype and PTB; the bb genotype was associated with a decreased risk to PTB (OR 0.22, 95% CI: 0.11-0.45). Conclusion: in Indonesian Batak ethnic population, there was no association between FokI polymorphism of VDR gene with host susceptibility to PTB. There was a significant association between BsmI polymorphism of VDR gene; bb genotype was associated with a decreased risk to PTB. Key words: pulmonary tuberculosis, polymorphisms, vitamin D receptor gene, Batak, Indonesi