Acta Interna: The Journal of Internal Medicine
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Prolong QTc Interval in Ethionamide-Induced Hypothyroidism in the Treatment of Multidrug Resistant Tuberculosis (MDR TB)
Get PDFBackground. Ethionamide, as part of multidrug resistant tuberculosis (MDR TB) treatment, is an antibiotic classified by WHO as a second-line drug with bactericidal property. Administration of ethionamide therapy is associated with the incidence of hypothyroidism in MDR TB patients. The resulting hypothyroidism can be a factor that triggers QTc interval prolongation on electrocardiogram (ECG) during anti-tuberculosis treatmentCase Presentation. A 77-year-old man with a history of pulmonary TB treatment one year ago, returned to undergo the intensive phase of pulmonary TB treatment for two months. Sputum evaluation at the end of the phase showed positive smear results, and the patient was diagnosed with MDR TB after further examination. Before starting MDR TB treatment, an initial ECG examination (QTc interval 0.41 seconds), TSH, and FT4 level were found to be within normal limits. MDR TB regimen including ethionamide 750 mg/day was given for the treatment. In the third month of treatment, the patient was diagnosed with hypothyroidism suspected to be related to ethionamide. In the seventh month of treatment, the patient complained of sudden weakness and QTc interval prolongation in the ECG (0.48 seconds). Ethionamide was stopped and the ECG was evaluated. No QTc interval prolongation was found after stopping ethionamide.Conclusion. This case emphasizes the importance of monitoring side effects arising from anti-tuberculosis treatment, especially ethionamide. Accuracy in diagnosing and following up the side effects of ethionamide administration in MDR TB patients is necessary to prevent worse cardiac events
The Association Between Physical Activity and Monocyte-HDL Ratio in Diabetes Mellitus Patients Who Have Exceed Life Expectancy in Yogyakarta Province
No full textBackground: The elderly population is expected to double in the upcoming three decades, due to increase in life expectancy. The province of DIY has the highest life expectancy in Indonesia (73.13 years and 76.67 years for men and women). Physical activity can reduce insulin resistance, improve lipid metabolism and reduce levels of inflammation in diabetes mellitus (DM). Physical activity can increase life expectancy. Many factors affect life expectancy, one of which is physical activity. This study investigated the association between physical activity and monocyte to HDL ratio (MHR) in diabetes mellitus patients who had exceeded their life expectancy in Yogyakarta.Method: This cross-sectional study was conducted in September 2022-April 2023 and using purposive sampling. Participants who meet the criteria and consent were asked to fast at least 8 hours, then be interviewed by a physical activity questionnaire and checked complete blood tests, fasting blood glucose and HDL cholesterol. The association between physical activity and MHR then analyzed using SPSS.Result: There were 50 participants with median age 78 (74-91) years. The mean score of physical activity is 100.28±7.96. Mean MHR is 0.0147±0.005. There is a significant relationship with weak correlation between physical activity and MHR (p 0.034, r -0.301), weak correlation between MHR and body mass index (BMI) (p 0.015, r 0.343), obesity (p 0.019, r 0.331) central obesity (p 0.032, r 0.303) and smoking (p 0.039, r 0.293). Multivariate analysis was performed, there is a significant relationship with weak correlation between physical activity and MHR (p 0.033, r -0.297).Conclusion: There is a negative correlation with weak strength between physical activity and MHR in patients with diabetes mellitus who have reached the life expectancy of province of DIY
Plateletcrit as Risk Factor of Major Adverse Cardiac Event in Elderly Patient with Acute Coronary Syndrome
Get PDFBackground. The morbidity and mortality of patients with acute coronary syndrome (ACS) are very high so it is important to do risk factor stratification. Several studies found that plateletcrit plays an important role in predicting mortality in STEMI patients and that it had a significant correlation as a predictor of a coronary slow flow phenomenon correlated with a worse cardiovascular outcome. The aging process is associated with altered platelet activity and a higher rate of vascular disease. The effect of aging on thrombotic function is not fully understood yet, so further research is needed. It is hypothesized that high plateletcrit increases the risk of major cardiovascular events (MACE) in elderly acute coronary syndrome (ACS) patients treated in intensive cardiac care unit (ICCU).Objective. To determine the role of plateletcrit as a risk factor for major cardiovascular events in elderly acute coronary syndrome patients.Method. We collected samples of elderly patients who experienced ACS in the period January 2016 - December 2019, recorded plateletcrit data and whether there were MACE incidents or not. The data were processed in SPSS to find a cut off of plateletcrit values which are a risk factor for the occurrence of MACE in elderly patients at Dr. Sardjito Hospital.Result. A total of 174 study subjects consisted of 58 MACE and 116 non-MACE groups, the results showed that platelecrit ≥0.35 increased the risk of MACE with a p value of 0.046 and OR 5.49.Conclusion. Plateletcrit is statistically significant to the incidence of MACE in elderly coronary syndrome patients who are treated in intensive cardiac are units
Change in Serum Cystatin C Level as Predictor for Length of Hospital Stay in Patients Undergoing Primary Percutaneous Coronary Intervention
Get PDFBackground. Percutaneous Coronary Intervention (PCI) is one of the most frequently performed medical procedures. Length of stay for patients after undergoing PCI should be standardized to achieve the best quality of health services. The existence of complications is one of the main factors considering the length of stay after PCI. Cystatin C has the ability as a predictor of complications in patients with acute coronary syndrome, especially those undergoing PCI, as well as the increase in length of stay associated with complications after the PCI procedure.Objectives. To determine the average changes in serum cystatin C levels, the correlation between serum cystatin C levels and length of treatment, and changes in serum cystatin C levels as predictors of length of stay in patients undergoing primary PCI at Dr. Sardjito Hospital.Methods. Analytical observational study with a prospective cohort method conducted on patients with a STEMI diagnosis who underwent primary PCI procedures in Emergency Room, Cardiovascular Care Unit (CVCU) of Dr. Sardjito Hospital, treated from November 2020 to April 2021. The data was then analyzed for normality, multicollinearity, bivariate, and multivariate tests to see the effect of changes in cystatin C and other variables on the length of stay for patients after primary PCI (p <0.05 is significant).Results. Of the 111 patients, 92 patients were subjected to further analysis. Patients included in the study had an average age of 59.55 (+10.80) years, majority of men, reduced LVEF, using trans-radial PCI access, Killip I, average eGFR of 64 ml / 1.73m2, length of stay in hospital is 5 days, delta cystatin C and creatinine 0.10 and 0.04 U / L, respectively. The increase in cystatin C had a moderate positive correlation (0.502) with the length of hospital stay (p<0.001), in multivariate analysis serum cystatin C does not correlate with length of hospital stay (p=0.590). Other variables including LVEF, eGFR, infection, and contrast-induced acute kidney injury had a significant correlation with length of stay (p<0.001). The multivariate test showed that LVEF, eGFR, and infection had the most significant correlation (p = 0.034; 0.001; 0.005 respectively) to the length of hospital stay with a regression coefficient of 0.72; -0.04; and 1.93.Conclusion. An increase of cystatin C serum does not correlate significantly with the length of hospitalization in STEMI patients undergoing PCI procedure in Dr. Sardjito Hospital
The Relationship between the Number of Major Organ Involvement and Therapeutic Response of Pulse Dose Methylprednisolone in Systemic Lupus Erythematosus Patients
Get PDFBackground. Systemic Lupus Erythematosus (SLE) requires comprehensive and integrated treatment because it can manifest in various organ systems, both non-major and major organs. Pulse doses Methylprednisolone used as induction therapy, it provides dramatic improvement in prognosis in severe lupus through its nongenomic effects. Not all SLE patients who received pulse dose methylprednisolone therapy gives complete response, several factors may influence the therapeutic response, one of which is thought to influence the difference in therapeutic response is the number of major organ involvement.Objectives. To determine the relationship between the number of major organ involvement and therapeutic response of pulse dose methylprednisolone therapy in SLE patients at Dr. Sardjito Hospital Yogyakarta.Methods. This study used a retrospective cross-sectional study. The subjects of this study were adult patients with SLE treated in the internal medicine ward at Dr. Sardjito Hospital Yogyakarta and met the inclusion and exclusion criteria from January 1, 2016 to December 31, 2019. The data on the characteristics of the research subjects were taken from the patient's medical records and laboratory data before giving pulse methylprednisolone.Results. A total of 88 research subjects were taken from medical records. Patients with major organ involvement 1 experienced more complete response (53.8%), major organ involvement 2 mostly partial response (66.7%), major organ involvement 3 (48.6%) and major organ involvement 4 (53.8%) no response, and major organ involvement 5 (75%) partial response. There is a significant relationship with the number of major organ involvement with therapeutic response p<0.001. The correlation coefficient r=0.382 means that the more major organ involvement the less therapeutic response. The results of multivariate analysis showed that only the number of major organ involvement had a dominant effect on the therapeutic response, p=0.001. Regression coefficient 0.797.Conclusion. The number of major organ involvement significantly affects the success of pulse dose methylprednisolone therapy in SLE patients
Prognostic Factors for Mortality in Patients With HIV/AIDS in Sardjito Hospital
No full textBackground. There are 3.8 million people infected with HIV in the Southeast Asia region. Even though it tends to fluctuate, cases of HIV AIDS infection in Indonesia continue to increase every year. HIV infection in Yogyakarta is also still relatively high. The treatment of HIV infection using ARV drugs is one of the spearheads to extend the life expectancy. The risk factors that influence the outcomes of patients receiving ARV therapy are varied. Slow immune improvement is greatly influenced by the patient's condition at the start of ARV therapy, such as age, long duration of HIV infection before therapy, specific immune activation, low CD4 count, and the period of AIDS at the start of ARV therapy.Objective. To find out the factors that significantly contributed to the mortality of patients with HIV/AIDS on ARV treatment at Sardjito Hospital.Methods. An observational study was conducted using a cohort retrospective method on HIV/AIDS patients who received ARV therapy for the first time in the period January 2008 – December 2021. Data extraction was conducted from December 2021 - February 2022. Multivariable analysis was carried out using multiple logistic regression. Survival analysis was measured by Kaplan-Meier curves.Results. The total number of HIV patients in the study was 1,591 people, with 199 patients having died. Variables associated with mortality in HIV patients in bivariate analysis were age, tuberculosis status, CD4 count, occupation, and clinical stage. Multiple logistic regression showed that occupation, CD4 count, and clinical stage were consistently associated with mortality among HIV patients. One and five-year survival rates for HIV patients were 89% and 87%.Conclusion. The CD4 count, occupation, and clinical stage of HIV are associated with mortality in HIV/AIDS patients receiving ARV treatment. Although variables other than the clinical stage are not independently related, some of these variables must still be considered in the care of HIV patients
The Impact of Starting Urate-Lowering Therapy (ULT) During A Gout Flare on The Ongoing Episode: A Systematic Review of Randomized Controlled Trials
No full textBackground. Gout is a prevalent form of arthritis caused by the accumulation of monosodium urate (MSU) crystals. Urate-lowering therapy (ULT) may be started once an acute flare has subsided to prevent the present episode from lasting longer. Nevertheless, ULT may be commenced during an acute flare-up in order to decrease the frequency of outpatient appointments and enhance patient adherence. The objective of this study was to conduct whether the commencement of urate-lowering therapy (ULT) during an acute gout flare is effective. Method. We performed a systematic review of articles published in MEDLINE, PubMed, Cochrane library, and EMBASE databases from 2018 to 2023. The search was limited to articles published in English, and RCTs in patients older than 18 years.Results and Discussions. Among 242 recorded studies, only four with 323 patients were eligible for this research. The treatment with Allopurinol began with a daily dose of 100 mg for the initial 14 days, followed by an increase to a daily dose of 200 mg for the subsequent 14 days. The reported time to resolution was 15.4 days for the group receiving allopurinol and 13.4 days for the group receiving the placebo. According to this review, the start of ULT (uric acid-lowering therapy) should be determined by sufficient anti-inflammatory measures. Commencing ULT during a gout flare has no impact on the intensity, duration, or likelihood of recurrence of the flare within the following 28 to 30 days.Conclusions. This study demonstrated that the commencement of urate-lowering therapy (ULT) during an acute gout flare did not result in a longer duration of the flare. Nevertheless, it is necessary to conduct a clinical studies with a bigger sample size in order to validate this review
The Combination Effects of Physical Exercise and Dzikr for Anxiety Symptoms Improvement in the Elderly Hajj Pilgrim Candidates in Sragen
Get PDFBackground. Anxiety disorders often occur in prospective elderly hajj pilgrims during preparation for departure. Physical exercise and dzikr are recommended as one of the non pharmacological efforts in reducing anxiety disorders.Method. Quasi-experimental one group pretest and post-test with research subjects elderly hajj pilgrim candidates in Sragen in 2019 with symptoms of anxiety that were assessed using the Beck Anxiety Inventory (BAI) score. The intervention was carried out in the form of a combination of forty minutes of physical exercise and thirty minutes of dzikr, 4 times during two weeks and assessed differences in BAI scores before and after the intervention.Aims. To find out the improvement of the BAI score after the combined intervention of physical exercise and remembrance, the Paired t-test was performed if the data distribution was normal and the Wilcoxon test if the data distribution was not normal. Differences were considered significant if p <0.05.Result. There were significant differences in the overall BAI score (p-value <0.001, p <0.05), mild anxiety BAI score (p-value 0.001; p <0.05), systolic blood pressure (p-value 0.002, p<0.05), and pulse frequency (p-value 0.012, p <0.05) before and after the intervention. Obtaining a decrease in systolic blood pressure and a decrease in pulse frequency are parameters for achieving a relaxation response.Conclusions. Significant anxiety symptom improvements were demonstrated as the effect of a combination of physical exercise and dzikr in the elderly hajj pilgrim candidates in Sragen
Association between Serum Vitamin D Level and Clinical Manifestations of Systemic Lupus Erythematous Patients in Dr. Sardjito General Hospital
Get PDFBackground. Vitamin D played a role in the pathogenesis of systemic lupus erythematosus (SLE). Vitamin D made dendritic cells more tolerogenic to autoantigens and inhibited B cells from producing autoantibodies. Vitamin D deficiency would make dendritic cells intolerant, increased production of interferons, and B cells produce excessive autoantibodies. These excessive autoantibodies and interferons would have caused severe clinical manifestations in SLE patients.Aims. This study was to find out vitamin D deficiency would increase the proportion of severe clinical manifestations in SLE patients in the Dr. Sardjito General Hospital. Methods. We conducted a cross-sectional study. Data was taken from medical records of SLE patients who went to Dr. Sardjito General Hospital in 2018. The independent variable was serum 25(OH) D levels, which were divided into deficiency (≤12 ng/ml) and not deficiency (>12ng/ml). The dependent variable was the clinical manifestations of SLE patients, which were divided into mild-moderate and severe. Association between two variables was analyzed using Chi-Square.Results. Vitamin D deficiency was observed in 19(54%) and not deficiency in 16(46%) subjects. SLE patients who underwent vitamin D deficiency more often experienced severe clinical manifestations than those without (52.6% versus 12.5%), prevalence ratio 4.2 CI 1.1-16.5 p=0.015. SLE patients who underwent vitamin D deficiency were more likely to suffer mucocutan, musculoskeletal, and kidney disorders. Also more likely to suffer more than 2 organ disorders than those without (57.9% versus 12.5%), prevalenceratio 4.6 CI 1.2-17.9 p=0.007.Conclusions. Vitamin D deficiency increased the proportion of severe clinical manifestations in SLE patients at Dr. Sardjito General Hospital. It also increased the proportion of mucocutan disorder, musculoskeletal disorder, and kidney disorder. Also, it increased the proportion of occurrence of more than 2 organ disorders in SLE patients at Dr. Sardjito General Hospital
Prognostic Nutritional Index (PNI) as a Prognostic Factor in Stage IV Lung Adenocarcinoma
Get PDFBackground. Based on nutritional and immunological indicators, the Prognostic Nutritional Index (PNI) is one of the prognostic indicators besides the Platelet-to-Lymphocyte Ratio (PLR) and Glasgow Prognostic Score (GPS). PNI can serve as a biomarker to help guide clinical practice and promote clinical outcomes for lung cancer patients. PNI was superior to Neutrophil- to- Lymphocyte Ratio (NLR) in the prediction of progression-free survival (PFS) and overall survival (OS). Objectives. To analyze the association between a low PNI score (PNI <40) and increased risk of mortality among stage IV pulmonary adenocarcinoma patients.Methods. A cohort-retrospective study was performed by extracting PNI data from medical records and the mortality of patients with stage IV pulmonary adenocarcinoma. A total of 265 patients met the inclusion and exclusion criteria, based on the medical records of patients with stage IV pulmonary adenocarcinoma who were hospitalized at Dr. Sardjito hospital Yogyakarta between January 1st, 2016 and July 1st, 2019. PNI score were calculated as follows: 10 x serum albumin (g/dl) + 0.005 x lymphocyte count (per mm3). Mortality was considered six months since the diagnosis. Chi-square tests were used to analyze the proportions of mortality and confounders. Multiple logistic regression tests were used to analyze the association between PNI and mortality.Results. Subjects with PNI score <40 were at risk of mortality three times higher than subjects with PNI score ≥40 (adjustedOR 3.356, 95% CI 1.165 - 9.670, p = 0.025).Conclusion. PNI score significantly affected the mortality in patients with stage IV pulmonary adenocarcinoma