Acta Interna: The Journal of Internal Medicine
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Correlation Between the Presences of Ascites with MELD-Na Scoring in Liver Cirrhosis Patients
Get PDFBackground. Global prevalence of liver cirrhosis (LC) ranges from 4.5% to 9.5% of the general population amounting to more than fifty million people in the world. The Model for End Stage Liver Disease (MELD-Na) is commonly used to determine the prognosis and survival of liver cirrhosis patient. MELD-Na scoring consists of creatinine, bilirubin, international normalized ratio (INR), and serum sodium. Ascites is one of the clinical signs of decompensated liver cirrhosis, as well as present in Child Turcotte Pugh (CTP). The purpose of this study was to investigate the association between the presence of ascites and MELD-Na scores of LC patients.Methods. This cross-sectional study was performed in LC patients who met the inclusion without exclusion criteria. The study was conducted at RSUP Dr. Sardjito, Yogyakarta, Indonesia during 2017-2018 periods. The MELD-Na value was calculated using the following equation:MELD-Na = 9.57 ln (creatinine mg/dL) + 11.2 ln (INR) + 3.78 ln (bilirubin mg/dL) + 1.59 (135-Na [mEq/L]) + 6.43. Differences of mean MELD-Na scores based on presenting of ascites were tested by independent T-tests. The cut-off value of MELD-Na was determined through the Receiver Operating Characteristic (ROC) curve. The relationship between the presence of ascites and the MELD-Na value was determined by the Fisher exact test; the correlation strength was determined by Phi and Crammer's V test. Prevalence ratio (PR) was calculated for determining the predictor factors. The results were considered statistically significant when the probability value p <0.05 was obtained.Results. There were 59 subjects (41 male and 18 female). The mean age of subjects was 52.05 years old. The 39 patients were found ascites and 20 patients were not. Based on independent T test results there was a significant difference in mean values of MELD-Na (p=0.006). Based on the ROC curve result, a cut-off point of 20.7 (95% specificity, 35% sensitivity) with Area under the Curve (AUC) was 0.662 (p=0.042). Based on the cut-off, Fisher test with 2x2 tables, Phi and Cramer's V test were done with p value 0.022; 0.015; 0.015 respectively. The PR value was 1.607 (95% CI: 1.203-2.145).Conclusion. There was a significant correlation between the presences of ascites with MELD-Na scoring using cut-off point of 20.7 and value of Prevalence Ratio of 1.6
Correlation Between Systemic Immune-Inflammation Index and Depression in Patient with Heart Failure Reduced Ejection Fraction in Sardjito Hospital Yogyakarta
No full textBackground. Depression is highly prevalent in patients with heart failure reduced ejection fraction (HFrEF). The pathophysiology between these two conditions is related to the inflammation process, therefore some inflammatory markers can be used to assess those conditions. In recent years, the systemic immune-inflammation index (SII) has been developed as a simple and inexpensive indicator of inflammation. Unfortunately, we did not find any study that assessed the correlation between SII and depression in patients with HFrEF.Objective. To investigate the correlation between SII and depression in patients with HFrEF in Sardjito Hospital YogyakartaMethods. This was a cross-sectional study on patients with HFrEF in Sardjito Hospital between February 2023 and May 2023. The normality test was carried out using the Shapiro-Wilk test. Bivariate analysis was carried out using the Spearman correlation test. The result was considered statistically significant when p-value <0.05. Multivariate analysis was carried out using multiple linear regression test.Results. There were 47 HFrEF patients with depression. There was a significant relationship between SII and depression scores from the Spearman Correlation test results of SII with depression scores, with p=0.009. The result showed that the higher the SII, the higher the depression score. The correlation coefficient between the two variables was r=0.375, showing that the correlation was in the weak category.Conclusion. There is a positive correlation between the systemic immune-inflammation index and depression in patients with heart failure reduced ejection fraction
Positive Anti-Histone Antibodies in Patients with Polymyositis
No full textBackground. Polymyositis is an idiopathic inflammatory myopathy characterized by proximal symmetric muscle weakness, increased skeletal muscle enzyme levels, electromyographic abnormalities, and nonspecific muscle biopsy findings. Autoimmune mechanisms are thought to be the pathogenesis of the disease. Some autoantibodies have specificity and a high relationship with myositis.Case. A 23-year-old male presented with progressive quadriparesis, with predominant lower limb weakness, and severe myalgia of one-month duration, significantly impairing ambulation. He has a history of occupational exposure to propylene gas and atmer liquid while working in a plastic factory. Muscle strength in upper extremities were 4 and lower extremities were 3. Laboratory examination showed CK level 11856 U/L, SGOT 773 U/L, SGPT 486 U/L, LDH 1601 U/L, ANA IF 1:1000 with speckled pattern, normal electroneuromyography, anti-Histone antibodies (++). The patient refused a muscle biopsy. The patient met 2 of the 4 criteria so he was diagnosed with possible polymyositis and was treated with methylprednisolone injection 125 mg/ 6 hours for 3 days then tappering down , mycophenolate acid 2x180 mg , mecobalamin 2x500 mcg, and vitamin D 1x400 mg. After 1 month of therapy, muscle weakness improved and he was able to walk again.Discussion. Specific antibodies for myositis include antisynthetase, anti-Jo-1, anti-PL-7, anti-EJ, anti-PL-12, and anti-Mi-2, antibodies associated with myositis include anti-PM-Sci, anti-Ku , anti-KJ, anti-Ro/SSA.Anti-histone antibodies are commonly present in drug-induced lupus, but some studies have shown an association with other autoimmune and rheumatic diseases. Specificity pattern of serum anti-histone antibodies (AHA) on part of polymyositis patient similar with serum pattern of systemic sclerosis. Another study showed positive results in 17% of 46 polymyositis and dermatomyositis patients.Summary. A young man with clinical and laboratory criteria fulfilling the diagnosis of possible polymyositis, positive anti-histone antibodies were obtained, which is an antibody that is rarely found in cases of polymyositis
Effect of Combination Hemodialysis Hemoperfusion on Lowering Leptin Level in Patients with Kidney Failure Receiving Routine Hemodialysis: A Multi-Center Study
No full textBackground: Leptin clearance during conventional haemodialysis (HD) has been found to be minimal or absent. Some authors reported the possibility of decreasing leptin serum levels with high flux membranes, but limited date are available. Leptin has been reported as a marker of inflammation and long-term complications such as cardiovascular events leading to increased quality of life deterioration. Haemodialysis hemoperfusion (HD+HP) has been reported to effectively decrease middle-sized and macromolecular toxin concentrations. In the present study, we compared the effectiveness of high-flux HD and HD + HP can effectively remove serum leptin levels, and is expected to reduce cardiovascular events in patients with kidney failure.Objective: To assess the influence of HD+HP therapy on serum leptin level in routine haemodialysis patients.Metode: Quasi experimental with pre and post exposure measurements in 26 kidney failure patients who received routine HD at three hospital sites were selected according to inclusion criteria and divided into intervention group (HD twice a week + Hemoperfusion once a week) and control group (HD twice a week). Serum leptin levels were compared before and after 8 weeks of therapy, and differences were then compared from each group.Result: Leptin levels reduced significantly (p = 0.017) in the control group (High-Flux HD). Serum leptin levels decreased in HD+HP group but there was no significant differences (p = 0.784). Significant differences were not observed between two modalities (HD and HD+HP) (p = 0.258).Conclusion: Haemodialysis plus hemoperfusion once a week for 8 weeks was not found effectively lowering leptin level compared high-flux HD alone
The Role of Neutrophil-Lymphocyte Ratio (NLR) as a Predictor of Successful Thrombolysis in Patients with STEMI at RSUP Dr. Sardjito
Get PDFBackground. Coronary atherosclerosis is a major cause of ST-elevation acute myocardial infarction (STEMI). Many factors influence the pathophysiology of atherosclerosis formation, and one of the most important is inflammation. Neutrophils have an important role in the progression and instability of atherosclerotic plaques that lead to acute coronary syndromes, while lymphopenia is caused by an increase in endogenous cortisol that occurs during acute stress in acute coronary syndromes. The neutrophil-lymphocyte ratio (NLR) is a combination of inflammatory markers, integrating the two roles of leukocyte subtypes with their respective pathways into one predictor factor that can be applied to the outcome stratification of patients with STEMI undergoing thrombolytic therapy.Objectives. To identify the role of NLR as a predictor of successful thrombolysis in patients with STEMI and knowing the NLR cut-off point that can act as a predictor of successful thrombolysis in patients with STEMI.Method. This study was a retrospective cohort study. The research subjects were patients who were first diagnosed with STEMI in the ER/ICCU Dr. Sardjito Hospital and who met the inclusion and exclusion criteria, from January 1, 2016, to November 30, 2020. The independent variable in this study was the NLR at admission. The dependent variable in this study was the success of thrombolysis. Characteristic data in this study are presented in the form of categorical data. Bivariate statistical analysis with Chi-Square test. The prognostic value for success of thrombolysis was analyzed using the Receiver Operating Characteristic curve to determine the NLR limit value, followed by calculating the Relative Risk (RR). Variables having p<0.25 were continued in multivariate analysis.Result. A total of 162 subjects met the inclusion and exclusion criteria. Overall, the success of thrombolysis was 81.5%. NLR values are in the range of 6 to 13 with a median value of 6.38. ROC NLR analysis on the success of thrombolysis obtained a cut-off of 10.16 fL. From the bivariate analysis for all possible predictors, 6 predictors had logistical significance (p<0.25) namely NLR, gender, age, BMI, onset, and Killip. From multivariate analysis, statistically significant independent predictors of thrombolysis success were NLR (p=0.007, OR 3.44), onset (p=0.003, OR 4.13), and Killip (p=0.009, OR 6.76).Conclusion. A low NLR can be used as a predictor of successful thrombolysis in STEMI patients at RSUP Dr. Sardjito, with 3.44 times higher compared to the high NLR
Prognostic Values of Hemoglobin and Red Blood Cell Distribution Width to Overall Survival in Non-Hodgkin Lymphoma
Get PDFBackground. After the Rituximab era, baseline International Prognostic Index (IPI) is not sufficient for the initial risk stratification of patients with Non-Hodgkin lymphoma (NHL). Low hemoglobin (Hb) levels and high red blood cell distribution width (RDW) baseline are known to be associated with poor outcomes and overall survival in malignancy. This study aimed to evaluate the prognostic value of Hb and RDW to overall survival in NHL patients who undergoing chemotherapy at Dr. Sardjito Hospital.Method. A retrospective cohort study in NHL from patients’ medical records diagnosed from 2014 to 2018 and undergoing chemotherapy at Dr. Sardjito Hospital. The prognostic influence of clinical factors including Hb and RDW on 3 years of overall survival were studied by using Kaplan-Meier curves and univariate Cox regression tests. To evaluate the independent prognostic relevance of basic characteristics data (age, gender, BMI, performance status, Ann Arbor stage, extranodal involvement), Hb, and RDW, multivariate Cox proportional hazards regression was applied. Results. From 292 NHL patients included, the median Hb was 12.7 g/dL and the median RDW was 14.2%. The mean survival time was 31.13 months, 38 patients (13%) died during the 3 years of follow-up. The most common causes of death were sepsis (68.4%) and 12 patients (4.1%) died within 10 gr/dL (71% vs. 87%, CI 95%, p=0.014), with Hazard Ratio 2.49 (p=0.02). Patients with higher RDW>15.5 levels had lower overall survival than patients with RDW<15.5 levels (77.5% vs. 91.1%, CI 95%, p=0.002), and Hazard Ratio 2.78 (p=0.02). Based on multivariate analysis, performance status (OR=2.589, CI 95%, 1.225-5.471, p=0.013) and RDW (OR=2.292, CI 95%, 1.106-4.48, p=0.026) are independent predictor factors of 3-year overall survival.Conclusion. NHL patients with lower Hb and higher RDW levels have lower 3-year overall survival
The Relationship of Thyroid Stimulating Hormone Receptor Antibody (TRAb) Levels to Activity and Clinical Severity of Graves' Ophthalmopathy in RSUP Dr. Sardjito
Get PDFBackground: Graves' disease (GD) is an autoimmune disease that is the most common cause of hyperthyroidism. Thyroid stimulating hormone receptor antibody (TRAb) is a specific biomarker for diagnosing GD. Graves' ophthalmopathy (GO) is the most common extrathyroid manifestation in Graves'. Each GO was assessed for activity and clinical severity for treatment.Objectives: To determine the relationship between TRAb levels and GO clinical activity in Clinical Activity Score (CAS) classification and clinical severity of The European Group on Graves' Orbitopathy (EUGOGO).Methods: This is a cross-sectional study, conducted from January to August 2021 at RSUP Dr. Sardjito Yogyakarta. 30 newly diagnosed Graves' patients or previously diagnosed with Graves' presented symptoms of hyperthyroidism were included. The patients had TRAb levels > 1.75 IU/L, and diagnosed with Graves' ophthalmopathy based on clinical criteria according to Bartley and Gorman and has not received steroid injections. Serum TRAb examination by electrochemiluminescence immunoassay (ECLIA) method. Clinical activity are assessed with CAS, while severity are assessed with EUGOGO criteria. The data are analyzed using Spearman correlation, multivariate analysis with linear regression and logistic regression.Results: 30 study subjects mean age 35.43 years, female dominant (80%), median GD duration of 13 months. Median TRAb 8.15 IU/L, median CAS score 2 with 46.3% active. Mild severity 40% and moderate-severe 60%. Correlation of TRAb with CAS (r=0.576, p=0.001), EUGOGO (r=0.535, p=0.002). Multivariate analysis of TRAb with CAS (B= 0.076, p=0.01) while EUGOGO (OR=1.198, p=0.045)Conclusion: TRAb is positively correlated with activity and clinical severity of OG
Effect of Pursed-Lips Breathing on Quality-of-Life Chronic Obstructive Pulmonary Disease Patients with The Short Form-36 (SF-36)
No full textBackground. Chronic obstructive pulmonary disease (COPD) is a disease of high prevalence that is characterized by irreversible airway obstruction. The most frequent symptoms such as tightness during activity and fatigue have a negative impact on the quality of life of patients and limit physical activity in everyday life. One of the goals of COPD therapy is to improve the quality of life of patients. Pursed-Lips Breathing (PLB) as one of the pulmonary rehabilitation options is known to improve breathing patterns, increase tidal volume, and reduce shortness of breath.Objective. To demonstrate the influence of PLB on the quality of life of COPD patients as measured by The Short-Form 36 questionnaire.Methods. A prospective, single-blind, randomized controlled trial study was conducted at RSKP Paru Respira, Bantul, Yogyakarta. The subjects of the study were stable COPD patients who met the inclusion and exclusion criteria. The SF-36 score was assessed in both groups before and after 28 days (4 weeks). The independent variable PLB treatment and the dependent variable SF-36 score were measured before and after treatment. Statistical analysis was carried out by a mean difference test between the treatment group and the control group.Results. Seventy-eight patients (mean age, 63 years) were randomized into the treatment group (n=41 patients) continuing standard therapy and doing 8-minute PLB for 28 days and the control group (n=37 patients) only continuing the previous standard therapy. The PLB treatment group showed an increase in the mean delta of the SF-36 score which was especially significant in aspects of physical function, physical role, and social function. There was a significant difference in the increase of average total SF-36 score in the PLB treatment (8.93 ± 15.85) compared to the control group (2.09 ± 8.15) of the 100 points total score (p=0.033).Conclusion. There was an improvement in the SF-36 score in COPD patients who received standard therapy and pulmonary rehabilitation with a PLB technique for four weeks
Absolute Eosinophil Counts and Colonic Mucosal Eosinophils Based on Inflammatory Bowel Disease Severity
Get PDFBackground. The inflammatory process in Inflammatory Bowel Disease (IBD) involves various types of inflammatory cells, including eosinophils. Eosinophils are not only associated with the severity of IBD but are also associated with clinical improvement. In contrast to the confirmed role of neutrophils, the role of eosinophils either in the blood or in the colonic mucosa of IBD patients have not been fully understood and confirmed.Objectives. To determine the difference in absolute eosinophil counts in the blood based on the severity of IBD and to determine the differences in the density of colonic mucosal eosinophil based on the severity of IBD.Methods. This is a cross-sectional study with consecutive sampling in the period August 2020 - July 2021. The research subjects were IBD inpatient or outpatient at Dr. Sardjito Hospital who met the inclusion and exclusion criteria. Researcher assessed data on absolute eosinophil counts in peripheral blood and eosinophil density in the colonic mucosa. The number of biopsies and the location of the biopsy were determined based on a colonoscopy performed by a Gastroentero-Hepatology Consultant. The calculation of eosinophils in the colonic mucosal tissue was carried out by an Anatomical Pathologist Specialist. IBD severity was assessed using the Truelove Witts score for Ulcerative Colitis (UC) and Crohn's Disease Activity Index (CDAI) for Crohn's Disease (CD) patients. Analysis using a computer program with a p value <0.05 was considered statistically significant.Results. There were 50 research subjects with a median age of 55 years (24-77 years). There was not a big difference between the number of male and female patients, namely 26 people (52%) vs 24 people (48%). The number of UC patients were dominant, namely 48 people (96%). The severity of IBD were divided into three groups with the number of patients with mild IBD were 22 (44%), moderate were 11 (20%), and severe IBD were 18 (36%). The number of patients with eosinophilia were 7 patients (14%) and colonic mucosal eosinophilia were 5 patients (10%). Kruskal Wallis test found that the mean absolute eosinophil blood in mild IBD was 21.45 cells/µL, moderate IBD was 25.50 cells/µL, and severe IBD was 30.44 cells/µL (p = 0.152). The mean of colonic mucosal eosinophils in mild IBD was 19.48 cells/hpf, in moderate IBD was 27.00 cells/hpf, in severe IBD was 32.03 cells/hpf (p = 0.023) and there was a statistically significant moderate correlation (r = 0.392; p = 0.005).Conclusion. There is no significant difference in absolute eosinophil counts in the blood based on the severity of IBD and there is a significant difference in the density of colonic mucosal eosinophil based on the severity of IBD
Thyrotropin Receptor Antibody as a Risk Factor for the Occurrence and Severity of Graves' Ophthalmopathy
Get PDFBackground. Graves' disease (GD) is an autoimmune disorder known to be the most common cause of hyperthyroidism. Thyrotropin receptor antibody (TRAb) might be involved in the occurrence and the disease process of Graves’ ophthalmopathy (GO).Objectives. This study aimed to evaluate whether TRAb levels are associated with the occurrence and severity of GO based on the clinical severity of The European Group on Graves' Orbitopathy (EUGOGO).Methods. A case-control study of 44 patients with newly diagnosed Graves’ disease (22 with GO compared to 22 without GO). Diagnosis of GO was made according to Bartley and Gorman’s criteria. Level of thyrotropin receptor antibody was tested with electrochemiluminescence immunoassay (ECLIA) method. Assessment of the clinical severity of GO was documented with EUGOGO scores.Results. Baseline characteristics were similar between 22 patients with GO compared to 22 patients non-GO group. Thyrotropin receptor antibody (TRAb) significantly increased in the GO group (11.223±7.116 IU/L) when compared to non-GO (6.720±3.442 IU/L; P=0.035). Multiple logistic regression analysis shows that 1 IU/L increase of TRAb has a 1.610-fold higher risk for developing GO. In the GO group, there is correlation between TRAb and the severity of GO-based on EUGOGO (r =0.794, P<0.001).Conclusion. Thyrotropin receptors antibody is a risk factor for the occurrence and severity of GO-based on EUGOGO