Acta Interna: The Journal of Internal Medicine
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ANTI-INFLAMMATORY ACTIVITIES OF TEMULAWAK, GINGER, SOYBEAN AND SHRIMP SHELL EXTRACTS IN COMBINATION COMPARED TO DICLOFENAC SODIUM
Get PDFABSTRACT Background: The prevalence of osteoarthritis (OA) in the community is high. This disease is the second most common cause of physical disability worldwide. Pain in OA is caused by several factors, such as inflammation. Non steroidal anti-inflammatory drugs (NSAIDs) were the most common drugs given worldwide to reduce pain in OA. NSAIDs were also associated with a high incidence of gastrointestinal side effects. An alternative to manage this problem is by using the combination of Curcuma xantorrhyza Roxb. (commonly known as temulawak) extract, ginger (Zingiber officinale) extract, soybean (Glycine max), and shrimp shell. Curcuma xantorrhyza contains curcumin which has anti-inflammatory effect by suppressing cyclo-oxygenase (COX-2) enzyme activity, suppressing lipo-oxygenase enzyme activity, and play a role as a free radical scavenger. Ginger can inhibit COX-2 activity in PGE-2 production. Shrimps shell contains glucosamine and chondroitin which can increase proteoglycan in articular chondrocytes and inhibit COX-2 synthesis. Isoflavone in soybean can inhibit articular cartilage degradation and COX-2 synthesis.Study Aims: The purpose of this study is to compare the effect of the combination to diclofenac sodium in reducing synovial fluid leukocyte count and joint pain in patients with osteoarthritis.Study Method:This study was a prospective randomized open end blinded evaluation (PROBE). Twenty one patients with knee osteoarthritis diagnosed by American College of Rheumatology criteria were included in this study. Patients were randomized into two groups to receive either diclofenac sodium 25 mg (control group) or the combination of Curcuma xantorrhyza extract 50 mg, ginger extract 100 mg, shrimp shell 100 mg, and soy bean flour 50 mg (treatment group) three times daily for 14 days. Independent t-tests and Mann-Whitney-Wilcoxon tests were used to evaluate changes between prior and post intervention.Results: There were significantly reduction of synovial fluid leukocyte count in both control group (p=0.017) and treatment group (p=0.008) respectively. The reduction of synovial fluid leukocyte count was not significantly different between control group and treatment group (p=0.929). There were significant improvement of joint pain (VAS score) in both control group (p=0.012) and treatment group (p<0.001). The reduction of VAS score was not significantly different between diclofenac group and treatment group (p=0.607).Conclution: These results indicate that the evicacy of this combiation was not significantly different with diclofenac sodium in reducing the synovial fluid leukocyte count and joint pain in patients with osteoarthritis.Keywords: osteoarthritis, Synovial fluid leukocyte count, Pain, VAS, Diclofenac sodium,Combinaion of curcuma, ginger, shrimp shell and soybean
LEVEL OF INTERLEUKIN-6 IN OBESE PEOPLE WITH AND WITHOUT INSULIN RESISTANCE
No full textABSTRACTBackground. Obesity is one of the risk factor for type 2 diabetes mellitus characterized by insulin resistance, decrease insulin secretion and hyperglycemia. Chronic inflammation has been proposed to have an important role in the pathogenesis of obesity related insulin resistance. A number of studies have indicated that several humoral markers of inflammation are elevated in people with obesity and type 2 diabetes mellitus, because adipose tissue secretes a number of proinflammatory cytokines, including interleukin-6. The level of plasma IL-6 is increase in obese people.Objective. To investigate the mean of difference in the level of IL-6 in obese people with and without insulin resistance.Subjects and Method. The study design was cross-sectional. It was conducted in obese people with BMI ≥ 25 kg/m2. Insulin resistance were measured with HOMA-IR methode, calculated using the following formula: fasting serum glucose X fasting plasma insulin/22,5. Insulin resistance was defined when HOMA-IR > 2,77. Interlukin-6 was measured with Quantikine High Sensitivity human IL-6 ELISA. Difference of mean of IL-6 level was analyzed by student’s t-test for normal distribution and Mann- Whitney U-test if distribution was not normal.Results. There were 56 subjects, 24 (42,9%) subjects with insulin resistance and 32 (57,1%) subjects without insulin resistance. Obese people with insulin resistance had higher mean level of IL-6 than obese people without insulin resistance, although the difference was not significant (20,05±8,59 vs 18,98±8,15 pg/ml; p=0,639; 95% CI -5,58-3,46).Conclusion. There was no difference in the mean of IL-6 level in obese people with and without insulin resistance. Keywords. IL-6, obese, insulin resistance
PROGNOSTIC FACTORS OF LEPTOSPIROSIS PATIENTS IN DR. SARDJITO GENERAL HOSPITAL, YOGYAKARTA, INDONESIA
Get PDFBackground: Leptospirosis, an infectious disease that affects humans and animals, is a common zoonosis with a variety of clinical manifestations. Yogyakarta is one of the cities with a high incidence of leptospirosis. It is important to recognize the clinical features and prognostic factors of this disease. Severe disease can be fatal, although majority of cases are mild and self-limited. Objective: To determine the prognostic factors for leptospirosis that associated with mortality in patients with leptospirosis in Dr. Sardjito General Hospital, Yogyakarta. Methods: We conducted a retrospective study of data collected in our hospital between Jan 2010 until May 2011, from whom the diagnosis of leptospirosis was confirmed based on pertinent clinical and epidemiological data and positive serology. Result: Thirty two patients were included in this study, including 29 survivors (90.62%) and 3 non-survivors (9.38%). Of these 32 patients, 26 patients (81.25%) were admitted to the medical ward and 6 patients (18.75 %) were admitted to the ICU. Multivariate logistic regression demonstrated that three factors were independently associated with mortality: oliguria (OR 0.75; CI 0.541–1.04; p 74.7 mmol/L (OR 0.813; CI 0.642-1.028; p<0.05), and neurological symptoms (altered mentation or seizure) (OR 30; CI 4.367–206.07; p<0.05) Conclusion: The mortality of leptospirosis remains high despite improvements in patients care. In order to improve the early treatment of high-risk patients, these 2 clinical and 1 laboratory criteria which are associated with mortality, can be used at the time of admission as prognostic factors. Keywords : Leptospirosis, prognostic factors, mortalit
CORRELATION BETWEEN CYSTATIN C TO SEVERITY DISEASE OF CIRRHOSIS BASED ON MODEL OF END STAGE LIVER DISEASE SCORE
No full textABSTRACTBackground: Cirrhosis patients with renal failure are at high risk for death and reduced survival as compared with those without renal failure, and have poor prognosis. Some studies have suggested that cystatin C did more accurate than creatinine /0 detect glomerulusfiltration rate (GFR) in patients with cirrhosis. Model of End Stage Liver Disease (MELD) score can be used in patients with cirrhosis with variously Widely severity disease and etiologies. Until nmv, there is no study about correlation between levels of cystatin C to disease severity in cirrhosis based on MELD score.Objective: This present study was to investigate the correlation between levels of cyst at ill C with disease severity in cirrhosis based on MELD score.Method: Study design was cross sectional s t u d y, This study was conducted at Gastoenterohepatology outpatient clinic and Internal Medicine ward of Dr Sardjito General Hospital, Yogyakarta. Inclusion criteria were patients with cirrhosis diagnosed by clinical criteria, laboratory and USG.findillg, age > 18 years, had complete medical record and obtained informed consent. Exclusion criteria were chronic kidney disease, sepsis, hepatocellutare carcinoma, used high doses of steroid, had thyroid dysfunction. hypertension and diabetes mellitus.Result: The mean of cystatin C based on categorical MELD score were MELD 40 = 2.43 mgll; 0)=0.013; 95% CI 0.000-0.061). There was a significant correlation between cystatin C to MELD score as demonstrated byp=O.OOOand r=0.485.Conclusion: Our data suggested a significant correlation with medium strength between cystatin C to severity disease of cirrhosis based 011 MELD score. Keywords: cirrhosis, cystatin C, MELD score ABSTRACTBackground. Cirrhosis patients with renal failure are at high risk for death and reduced survival as compared with those without renal failure and poor prognosis. Some studies have suggested that cystatin C did more accurate than creatinine to detect glomerulus filtration rate (GFR) in patients with cirrhosis. Model of End Stage Liver Disease (MELD) score can be used in patients with cirrhosis with variously widely severity disease and etiologies. Until now, there is no study about correlation between levels of cystatin C to disease severity in cirrhosis based on MELD score.Objective. This present study was to investigate the correlation between levels of cystatin C with disease severity in cirrhosis based on MELD score.Method. Study design was cross sectional study. This study was conducted at Gastoenterohepatology clinic and Internal Medicine at Dr Sardjito General Hospital, Yogyakarta. Inclusion criteria were patient with diagnosed cirrhosis based on clinical criteria, laboratory and USG finding, age ≥ 18 years, had complete medical record and obtained informed consent. Exclusion criteria were chronic kidney disease, sepsis, hepatocellulare carcinoma, used high doses of steroid, have thyroid dysfunction, hypertension and diabetes mellitus.Result. The mean of cystatin C based on MELD score categorical were MELD 40 = 2.43 mg/l; (p=0.013; 95% CI 0.000-0.061). There was a significant correlation between cystatin C to MELD score were demonstrated p=0.000 and r=0.485.Conclusion. Our data suggested a significant correlation with medium strength between cystatin C to severity disease of cirrhosis based on MELD score.Keywords: cirrhosis, cystatin C, MELD scor
EFFECTS OF LATIHAN PASRAH DIRI ON THE IMPROVEMENT OF DEPRESSIVE SYMPTOMS
Get PDFABSTRACTBackground. Depression is more common in persons with chronic illnesses such as diabetes, epilepsy and infection of Human Immunodeficiency Virus (HIV). Depression can make HIV worse. Antidepressant may need, but there can be interaction and side effect when use Antiretroviral (ARV) and antidepressant in combination. Complementary and alternative medicine (CAM) include Latihan Pasrah Diri(LPD) may seem safe to treat depression in HIV patient.Methods. This is a quasi experimental study, participant include outpatient dan inpatient at RSUP Dr. Sardjito, Yogyakarta. They were aged >18 years. After scoring with Zung Self Rating Scale for depression, participants allocated into two groups, with dan without Latihan Pasrah Diri program. Zung Self Rating Scale for depression was evaluated after 1 cycle of program.Result. The means of Zung Self-Rating Depression Scale score before and after LPD were 42,21 ± 9,3 and 35 ± 10,73 (p 0,003). While in control group (without LPD / brief psychotherapy) the means of Zung Self-Rating Depression Scale score before and 3 weeks after brief psychotherapy were 42,93 ± 7.45 and 39,36 ± 7,69 (p 0,019). Statistically there was no significancy in the means of delta Zung Self-Rating Depression Scale in LPD group and control group.Conclusion. It was concluded from this study that there is an influence on the improvement of depressive symptoms post- Latihan Pasrah Diri program to people with HIV / AIDS. Key words: depression, HIV, Latihan Pasrah Diri, Zung Self-Rating Scal
CORRELATION BETWEEN MAGNESIUM SERUM LEVELS AND PEAK EXPIRATORY FLOW IN CHRONIC ASTHMA PATIENTS
Get PDFABSTRACT Background: Magnesium Serum in some previous studies had been related to asthma events and severity levels. Correlation between magnesium serum levels and severity of asthma was controversies. It might be influenced by race, genetic pattern, diet and demography factor.Objective: The objective of this study was to know relationship between magnesium serum levels and predictive PEF (Peak Expiratory Flow) in chronic asthma patients in Yogyakarta.Method: This was a cross-sectional study; subjects were asthma patients who visited Pulmonology Outpatient Department in Dr. Sardjito General Hospital Yogyakarta, from September 2004 - March 2005. We performed clinical evaluation, magnesium serum levels (normal 0.65 mmol/L-1.04 mmol/L), predictive PEF and medications. Correlation between magnesium serum levels and PEF were analyzed by Pearson correlation test. This study used analysis of variance (anova) to analyze mean difference among more than 2 groups and multiple regressions to know the variables which influenced serum magnesium levels.Result: There were 62 asthma patients in this study. There was no hypomagnesaemia. The mean of magnesium was 0.89 ± 0.08 mmol/L. Results showed that serum magnesium levels and predictive PEF had weak correlation (r= 0.281; p=0.027). There was no significant correlation between admission rate to Emergency Room due to asthma by magnesium levels (r=0.029 p= 0.8).Conclusion: Results showed weak relationship serum magnesium levels and PEF in chronic asthma patients. Keywords: bronchial asthma; serum magnesium levels, Peak Expiratory Flow rat
CORRELATION BETWEEN CHILD PUGH SCORE AND CYSTATIN C IN LIVER CIRRHOSIS PATIENTS
Get PDFABSTRACTBackground. Renal dysfunction is a serious problem and it provides a poor prognosis for patients with advanced liver cirrhosis, where this condition can progress to kidney failure. This condition is known as hepatorenal syndrome. Cystatin C utilization as a marker of decreased kidney function in patients with liver cirrhosis has been widely proven. Data on how far the severity of liver cirrhosis can affect the decline in renal function has not been widely known. Objective. This study aimed is to verify correlation between the severity degree of the liver (Child Pugh/CP score) with levels of Cystatin C serum. Methods. This study was a cross sectional study. Population studied were patients with liver cirrhosis who visited the clinic of Gastroentero-hepatology and treated in the department of Internal Medicine ward Dr. Sardjito Hospital - Yogyakarta during October 2009 - March 2010. Data were analyzed with a computer; the analyzed of the CP score correlation with increased levels of Cystatin C using Spearman correlation for data not normally distributed. Result. We found 48 research subjects during the month of October 2009 - March 2010. The subjects were 35 male (72.9%) and 13 female (27.1%) with average age 53.1 ± 11.9 years old. Subjects with CP-A were 9 patients (18.8%), CP-B were 14 patients (29.2%) and CP-C were 25 patients (52.1%). The range value of Cystatin C between CP class shows CP-A 0.7 - 0.97 mg/L, CP-B 0.7 - 0.49 mg/L, and CP-C 0.7 – 2.49 mg/L (statistically significant difference with p 0.96 mg/L. Child score was positively correlated to increased levels of Cystatin C (p= 0.000; r= 0.566) linear regression equation with Cystatin was = 0.37 + 0.08 * Child score (r square 0.32). Conclusion. This study concluded that the Child score had a moderate positive correlation with Cystatin C serum level. Key words: Liver Cirrhosis – Child Pugh score - Cystatin C
CORRELATIONS BETWEEN SERUM LEVEL OF MATRIX METALLOPROTEINASE-9 (MMP-9) AND SERUM LEVEL OF TROPONIN-I IN PATIENT WITH ACUTE CORONARY SYNDROME (ACS)
Get PDFABSTRACTBackground. The pathophysiology of acute coronary syndromes (ACS) is now accepted as the rupture or erosion of an atherosclerotic plaque, initially occurs at the shoulder of the plaque and is followed by intra-plaque thrombosis then spread to the vascular lumen and cause total partial vascular occlusion. MMP-9 is an extracellular matrix degrading enzyme that plays a crucial role in the breakdown of the fibrous cap of plaque and subsequent rupture in the pathogenesis of ACS. Cardiac troponins are currently the most sensitive and specific biochemical markers of myocytes necrosis.Objective. To know the correlation between serum level MMP-9 and serum level of Troponin-I in patients with ACSMethod. Study design was cross sectional. Data were collected by consecutive sampling from patients in ICCU board of RSUP Dr. Sardjito Yogyakarta, in June 2008-August 2010. A questionnaire was used to collect information from patient. After admission, peripheral venous blood was drawn once and measuring concentration of serum level of MMP-9 and Troponin-I before definitive thrombolysis. Data are expressed as means ± standard deviation (SD). Correlation between serum level of MMP-9 and serum level of Troponin-I were assessed using Spearman’s rank correlations test. A value of p<0.05 was considered statistically significant.Result. There were 139 patients with ACS and comprising 63 patients with STEMI, 27 patients with NSTEMI, and 49 patients with UAP. Means±SD of Troponin-I from all of samples was 9.49±10.47 ng/dL. Mean±SD of MMP-9 from all of samples was 1296.06±729.97 ng/dL. There were significant correlations between MMP-9 and Troponin-I in patients with ACS (r=0.34, p=0.000).Conclusion. There were significant correlations between MMP-9 and Troponin-I in ACS patients in ICCU RSUP Dr. Sardjito Yogyakarta. Keywords: ACS, MMP-9, Troponin-
THE COGNITIVE FUNCTION OF ANTHRACYCLINE-BASED ADJUVANT CHEMOTHERAPY IN WOMEN WITH BREAST CARCINOMA
Get PDFABSTRACT Objective. The objective of this study was to determine the changes cognitive function of anthracycline-based adjuvant chemotherapy in women with breast carcinoma.Method. The study design was prospective longitudinal study. The breast cancer patients who received anthracycline-based adjuvant chemotherapy were recruited from internal medicine wards and TULIP outpatient department Dr. Sardjito General Hospital Yogyakarta. Subjects eligible with inclusion and exclusion criteria were examined for cognitive function by mini-mental state examination (MMSE) before chemotherapy (T0), 3 weeks after 2nd adjuvant chemotherapy (T1), 3 weeks after 4th adjuvant chemotherapy (T2), and 3 months after 4th adjuvant chemotherapy (T3). The mean difference of MMSE scores were analyzed with Wilcoxon-signed rank test and P<0.05 was considered statistically significant.Result. There were 47 subjects eligible to study criteria in October 1st 2008 – October 31st 2009. Forty subjects finished this study and were analyzed. The mean age was 47.08±6.65 with age ranged from 27 to 61 years old. The mean MMSE scores before chemotherapy (T0), 3 weeks after 2nd adjuvant chemotherapy (T1), 3 weeks after 4th adjuvant chemotherapy (T2), and 3 months after 4th adjuvant chemotherapy (T3) were 29.28±1.20, 28.60±1.69, 28.18±1.89, and 27.85±2.03, respectively. The mean MMSE score changes (ΔT0-T1), (ΔT0-T2), and (ΔT0-T3) were 0.68±0.80, 1.10±1.06, and 1.43±1.36, respectively and P<0,001. The incidence of cognitive impairment with MMSE scores < 24 was 2.5% and P=1.0.Conclusion. There was a significant decline of MMSE score in women with breast carcinoma who received anthracycline-based adjuvant chemotherapy at 3 weeks after 2nd adjuvant chemotherapy, 3 weeks after 4th adjuvant chemotherapy, and 3 months after 4th adjuvant chemotherapy compared with before chemotherapy. Key Words: Cognitive Function, Breast Cancer, Adjuvant Chemotherapy, Anthracycline
ACUTE PULMONARY EMBOLISMS
Get PDFABSTRACTAcute pulmonary embolisms is a major cause of complications and death associated in surgery, medical illnesses, injury, and also may occurs after a long-distance air travel. It is often originating from deep-vein thrombosis and has a wide spectrum of clinical manifestation ranging from asymptomatic, incidentally discovered emboli, to massive embolism causing immediate death. Incidence of pulmonary embolism ranges from 23-69 cases per 100,000 populations. Case fatality rates vary widely depending on the severity of the cases; at an average case fatality rate within 2 week of diagnosis of approximately 11%. It may have chronic sequele as post thrombotic syndrome and chronic thromboembolism pulmonary hypertension. Acute pulmonary embolism is often difficult to diagnose. The predisposing factors for pulmonary embolisms consist of hereditary factors, acquired factors, and probable factors. Patients with symptoms of dyspnea, chest apnea, tachypnea or tachycardia arise suspiciousness of pulmonary embolisms therefore should be screened their probability for developing the disease. Low risk patients will then be evaluated for d-dimer test. Treatment should be initiated promptly in high risk patients, followed by imaging procedure evaluation. Chest radiographs, CT scan arteriography, VQ scan are performed to either include or exclude diagnosis of pulmonary embolisms. Treatments consist of thrombolysis for acute and unstable massive pulmonary embolisms, and anticoagulation with heparin for stable acute pulmonary embolism. A meta-analysis of several major trials showed that low molecular weight heparin is at least as effective as unfractionated heparin in preventing the recurrence of venous thromboembolism events and at least as safe with respect to the rate of major bleeding. This review will further describe in detail the pathomechanisms, diagnosis, and management of acute pulmonary embolisms.