Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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Immunologic and Hormonal Effects of Prophylthiouracil Treatment Using Maintenance Dose in Graves’ Disease Patients
Get PDFAim: to assess immunologic remission in patients with Graves’ disease following euthyroid condition at the end of treatment with maintenance dose of PTU. Methods: this is an intervention study using one-group pre-post design. Subjects were 25 Graves‘ disease patients visiting Metabolic Endocrinology Clinic at Dr. M.Djamil hospital Padang and met the inclusion criteria. Patients were given PTU treatment for 12 months. Blood samples were taken at the beginning and at the end of treatment to determine immunological remission reflected by differences in IL-4serum levels. Results: after maintenance therapy, we found significant decrease of T3 levels (2.29±0.57 nmol/L vs. 1.87±0.34 nmol/L, p<0.05), significant decrease of T4 levels (118.15±25.99 nmol/L vs. 94.15±23.76 nmol/L, p<0.05), significant increase of TSH levels (0.379±0.548 vs. 0.859±0.990, p<0.05) and significant decreased levels of IL-4 (12.23±5.74 vs. 3.84±0.42, p<0.05). The IL-4 level, however, did not decrease to the normal levels. Conclusion: PTU administration in maintenance dose can significantly reduce thyroid hormonal parameter levels down to euthyroid condition, but cannot reduce immunological parameter (IL4) to normal limit. Key words: hormonal, immunologic, interleukin-4, Graves’ disease
Guidelines on the Management and Prevention of Prediabetes
Get PDFPandemic obesity and diabetes mellitus (DM), particularly type-2 DM (T2DM) now has become a serious threat for people worldwide. The International Diabetes Federation (IDF) suggests that the prevalence of DM in the world is 1.9% and it has made DM as the 7th leading cause of death worldwide. It has been estimated that the prevalence of diabetes between 1994 and 2010 was projected as much as 215.6 milion people; however an evaluation in 2007 revealed that the number of diabetic patients has reached 246 million people and it has been concerned that the number would increase in 2025 reaching more than 300 million people. Patients with DM may have various complilcations, including macrovascular diseases (heart disease, stroke and peripheral vascular disease) and microvascular diseases (retinopathy, neuropathy and nephropathy). Complications of DM have started early before the diagnosis of DM has been made. About 50% of patients have alreadly had one chronic complication at the time of diagnosis. Therefore, it is necessary to have a guideline on management of prediabetes condition associated with prevention of chonic complication and cardiovascular risk of diabetes. The guideline is expected to improve the skills of health care professionals in recognizing prediabetes condition, identifying people at high risk for diabetes and providing an appropriate management so that the incidence and complication of DM can be reduced. Key words: diagnosis, risk, prediabetes, diabetes mellitus, managemen
Adherence to Highly Active Antiretroviral Therapy (HAART) in HIV/AIDS Patient
Get PDFHIV infection has been considered as a chronic illness since the availability of highly active anti retroviral treatments (HAART). The introduction of HAART to HIV/AIDS patient improve quality of life, life expectancy, decrease rate of resistance and further decrease mortality to AIDS related causes. Many studies showed the evidence of HAART efficacy to suppress viral replication among patient with continuum adherence to treatment. However, unlike other chronic medications which were only needed at least 70% adherence; success virological suppression rate in HIV/AIDS in patient required as high as 95% or near perfect adherence; and this remains to be an important issue for patient on HAART.In term of treatment, a long-term follow up of patient’s adherence, i.e. daily medication intake monitoring for life, becomes a routine practice. However, no gold standard is established to measure patients’ adherence. Thus in the beginning of treatment, assessment on how patient would be ready to take medication, existing any limitations such as mental illness or active drug use, understanding of disease and regimen, social support and patient schedule, should be asses. Clinicians have to educate patient starting on HIV treatment for having very low missed doses, and this was based on evidence we have from a decades ago. By that time, treatment regimens were more complex. Lowering the threshold of adherence would not be possible because allowing for missed dose will only favor to poor compliance within time. Then, continuous support and intervention during treatment are needed to maintain high level of adherence to HAART intake
Correlation Between High-sensitivity C Reactive Protein and Local Arterial Stiffness Measured by Radio Frequency Echotracking System in Type 2 Diabetic Patients
Get PDFAim: to identify the correlation between hsCRP and arterial stiffness in type-2 diabetic patients. Methods: a cross-sectional study was conducted to assess the plasma levels of hsCRP and carotid arterial stiffness in 40 patients with type-2 diabetes mellitus. The common carotid artery stiffness was evaluated using radio frequency echo-tracking system to determine the local carotid pulse wave velocity (carotid-PWV). Results: median value of hsCRP in this study was 4.5 (0.2 to 18.9) mg/L and the average value of local carotid stiffness was 8.8±1.7 m/sec. High sensitive CRP showed a strong correlation with carotid-PWV (r=0.503, P=0.001). hsCRP level was independently associated with carotid-PWV after adjustment for age, body mass index, and mean arterial pressure (r=0.450, P=0.005). Conclusion: hs-CRP has moderate positive correlation with arterial stiffness in patients with type-2 diabets mellitus. Key words: arterial stiffness, C-reactive protei
Level of Circulating Endothelial Cells and Expression of Nuclear Factor Kappa Beta of Human’s Peripheral Blood Mononuclear Cells in Subjects with Certain Conditions
Get PDFAim: to detect the levels of CEC and expression of NFκB in the three groups of subjects with certain conditions. Methods: this study is an exploratory study using human peripheral blood samples. The study subjects comprised three groups, the group of 23 healthy people, a group of 35 people that has one or more risk factors for vascular disease and a group of 15 vascular disease patients (coronary heart disease, diabetes mellitus, stroke). CEC were isolated from peripheral blood mononuclear cells (PBMC). CEC level is identified through the measurement of CD45 and CD146 by flowcytometry method. NFκB expression is recognized by ELISA method (imgenex, USA). Results: the highest average levels of CEC were found in the sick group (28.6%). The highest average expression of NFκB (924.9495) is found in the group with risk factors. The lowest average expression of NFκB and CEC is found in the healthy group. Statistical analysis of ANOVA at the interval confidence of 95% shows a significant difference (p=0.00) levels of CEC and NFκB expression between the healthy group with the group with the risk of cardiovascular disease (CVD) and patients with known CVD. Conclusion: increase of level CEC and NFκB expression has a strong relationship with vascular disease and its risk factors. Key words: circulating endothelial cells (CEC), nuclear factor kappa beta (NFκB), peripheral blood mononuclear cell (PBMC), vascular disease
Coronary Artery Sequel of Kawasaki Disease in Adulthood, a Concern for Internists and Cardiologists
Get PDFYoung adults suffered from acute cardiac event, such as acute coronary syndrome, ischemic-associated arrhythmia and sudden death, are frequently encountered without known etiology and significant risk factors. Coronary vasculitis due to Kawasaki disease contributes to be a risk factor in young adult population to develop acute coronary event. Afflicted predominantly during childhood, Kawasaki disease gives rise to vasculitis of coronary artery which becomes major concern since it leads to coronary aneurysm and stenosis. Self-limited nature of Kawasaki disease make those suffered in childhood survive into adult life. Accelerated coronary atherosclerosis in the Kawasaki disease-related lesion occurring in young adult and subsequent acute coronary syndrome and sudden death in this population are devastating impacts of the sequel of Kawasaki disease. It is expected that internists and adult cardiologists become familiar with this sequel and provide better care for the patients. Key words: Kawasaki disease, coronary aneurysm, atherosclerosi
Reactivation of Hepatitis B Virus Associated with Chemotherapy and Immunosuppressive Agent
Get PDFHepatitis B virus (HBV) reactivation after chemotherapy or immunosuppressive therapy is a serious cause of liver-related morbidity and mortality. The mechanism of HBV reactivation is still unclear, but it is believed due to the suppression of immune response hence increasing the viral load. No uniform diagnostic criteria are available, HBV reactivation can be confirmed by an increase in serum HBV-DNA level. There are many consensus regarding this issue, including the type and duration of nucleoside analogue therapy which need to be understood as not all chronic hepatitis B patients will lead to HBV reactivation. Recently, there has been an increased awareness of reactivation of occult hepatitis B virus, especially in hepatitis B virus endemic area, including Indonesia as part of Asia Pacific region. Preempative antiviral therapy was the best approach to prevent the HBV reactivation. Key words: hepatitis B virus reactivation, chemotherapy, immunosuppressiv
A Case with Pancytopenia: The Role of Cytomorphology
Get PDFA 63-year year old lady presented with prolonged fever, frequent abdominal pain and a history of melena. Physical findings revealed an anemic appearance and splenomegaly. She was treated by the gastroenterologist and subsequently referred to the hematologist as the peripheral blood count revealed pancytopenia with a hemoglobin level of 6.5 g/dl, WBC 4000/ uL and a platelet count of 50.000 /uL. No blast cells were found. Patient subsequently underwent a marrow aspiration. Cytomorphology assessment of the marrow specimen revealed the presence of abnormal megakaryocytes and leukocytes (see figures) which was in accordance with dyshematopeosis, and the diagnosis of MDS (myelodysplatic syndrome) was established. The patient was then started on thalidomide 100 mg daily. There was no significant complications nor side-effects and after almost 2 years her hemoglobin level is now normal (between 12 and 14 g/dl), a dramatic reversal of her condition
Bone Metastases and Bone Loss Medical Treatment in Prostate Cancer Patients
Get PDFProstate cancer is a malignancy in urology with the highest incidence metastasize to the bone up to 70%. The incidence of skeletal related event (SRE) by 46.1% such as severe pain, pathologic fractures, spinal compression syndrome and hypercalcemia, with a consequence of higher inpatient care and worsen the patient’s prognosis. Androgen deprivation therapy (ADT) as a metastatic prostate cancer treatment itself causes an osteopenia or osteoporosis. Bisphosphonate inhibits normal and pathologic osteoclast-mediated bone resorption by several mechanisms. Denosumab is the latest treatment option in bone metastases. Multi-study shows the efficacy of denosumab is better than zoledronic acid for SRE prevention. Adverse events between denosumab and bisphosphonate are comparable. Key words: prostate cancer, bone metastases, bone loss, treatment
Comparative Study of Antimalarial Effect of Sambiloto (Andrographis paniculata) Extract, Chloroquine and Artemisinin and Their Combination Against Plasmodium falciparum In-vitro
Get PDFAim: to compare the anti-malarial effect among sambiloto extract, chloroquine and artemisinin-only as well as those of their combination. Methods: the study was conducted in Central Biomedical Laboratory, Faculty of Medicine, Brawijaya University, Malang, Indonesia from January to February 2006. Malaria culture used Plasmodium falciparum of Papua strain (2300) that was obtained from Namru-2 Jakarta. Five drugs applied in this test; those were chloroquine, artemisinin, the extract of sambiloto, the combination of sambiloto and chloroquine, and the combination of sambiloto and artemisinin. Parasite density was determined by counting the number of Plasmodium falciparum infected erythrocyte in 5,000 erythrocytes of the culture. Single drug (Chloroquine-only or artemisinin only) and either combination with sambiloto at dose 0.5 ug/ml had killing-effect against the parasite, measured by the appearance of “crisis form” on the infected erythrocytes. This killing-effect was dose dependent, and reached its optimum effect of 200 ug/ml. Results: treatment of single sambiloto extract with dose 0.5 ug/ml increased the density of the parasite, however after every 1ug increasing dose of sambiloto extract, the killing effect also increased. The reduction of the parasite density was also seen by increasing the Sambiloto dose in the group of combination of sambiloto-chloroquine as well as the group of combination of sambiloto and artemisinin. Statistically, there was no difference in the anti-malaria efficacy among of five test drugs (p=1.00). The correlation between the reduction of the parasite with the increasing of dose in all groups is statistically significance (p=0.001). Conclusion: the extract of sambiloto in a single dose or in a combination evidently has the effect of anti-falciparum malaria.Key words: extract of sambiloto, antimalaria effect, in-vitro test