Acta Interna: The Journal of Internal Medicine
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Anti-Tuberculosis Therapy after DRESS: Case Report
Get PDFIntroduction.Anti-tuberculosis-induced DRESS (drug reaction with eosinophilia and systemic symptoms) is uncommon, and usually delayed in diagnosis. The patient has minor complain and the clinical presentation involves the side effect on their heart and skin. Antituberculosis-related DRESS may have been present, but it has been underdiagnosed and underreported for several years. Management including discontinuation of the suspected drugs and changing it with second line treatment become less effective. Identifying the causative drug in DRESS is very difficult, especially in antituberculosis drugs.Case. A 34-year-old woman complains of having itch and redness throughout the body and fever. Two months before hospitalization, the patient was diagnosed with tuberculosis based on GeneXpert examination. Patients were given anti-tuberculosis drug therapy (OAT) which was 4 fixed drug combinations (FDC). Two weeks after taking the drugs, complains appeared. After 3 weeks the drug was stopped and in the next 1 week the patient's condition got worse, with itching and redness of the whole body accompanied by fever. Patients received treatment for 13 days with 125 mg/24-hour methylprednisolone therapy gradually reduced with OAT therapy levofloxacin 500 mg/24 hours and streptomycin 1 gram/24-hour IM (intramuscular).Conclusion. DRESS triggered by OAT was very rare and underreported. The choice of therapy after DRESS needed to be well considered, because it increased the risk for a DRESS to return with more severe manifestations when re-administering the same drug. The management in tuberculosis patients with a history of DRESS was given with second-line OAT with treatment options based on the clinician's experience
The Difference of Depression Score of Patients Failed Ultrafiltration Compared to Successful at Continuous Peritoneal Dialysis Patients in RSUP Dr. Sardjito Yogyakarta
No full textBackground. High mortality and morbidity in patients with Chronic Kidney Disease (CKD) are associated with psychological problems and poor quality of life. Depression is a psychological problem most often found in groups of CKD patients undergoing renal replacement therapy. Specific research that links the failure of ultrafiltration in Continuous Ambulatory Peritoneal Dialysis (CAPD) patients with depression does not yet exist today. So that further research is needed regarding this matter so that various depression intervention approaches can be carried out in the group of patients undergoing CAPD.Aims. This study aimed to determine the difference in depressive score of patients who failed ultrafiltration compared to those who did not fail in patients undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) in RSUP dr. Sardjito Yogyakarta.Method. A cross-sectional analytic study to assess differences in depressive score of CAPD patients with ultrafiltration failure compared to those who did not fail ultrafiltration in CAPD Clinic of RSUP dr. Sardjito Yogyakarta. The research subjects consisted of 41 people who fulfilled the inclusion and exclusion criteria. Depression assessment was carried out by calculating the total score of the BDI-II questionnaire and analyzing it using the Mann-Whitney method.Result. The average value of BDI-II in this study was 12 ± 8. 1. Depression scores based on BDI-II are if the score is equal to or more than 17. In this study 7 research subjects (17.1%) are depression. BDI –II values in the non-ultrafiltration failure group 10.96±7.25 and in the failed group 13.38±9.73 with p= 0.633.Conclusion. There were no significant differences in BDI-II score between groups that failed and those that did not fail ultrafiltration
Maxillary Reconstruction Timing in Severe Systemic Lupus Erythematous (SLE) Patient with Bone Destruction due to Invasive Aspergillosis: Case Report
Get PDFSevere Systemic Lupus Erythematosus patient was in the third of 28-days-cycle cyclophosphamide chemotherapy when the early symptoms of aspergillus infection occurred. This developed into extensive cranial bone damage. It was planned to get a biopsy and debridement for bone and soft tissue to diagnose and therapy palate osteonecrosis, followed by reconstruction surgery. This case report aimed to report the successful management of a severe patient on chemotherapy undergoing several operations so that the SLE aspergillosis is optimally managed
Impressive Result of Gemcitabine and Cisplatin Combination Therapy in Post-Operative Residual Cholangiocarcinoma Patient Presenting with Hyperbilirubinemia, an Experience in Indonesian Tertiary Hospital
Get PDFIntroduction: Cholangiocarcinoma (CCA) often presents at an inoperable or an advanced stage in which complete resection is not possible. In such scenario, chemotherapy often is the only option to improve patient’s survival. Severe hyperbilirubinemia, often associated with higher risk of developing chemotherapy-related adverse event, might complicates one’s decision in choosing chemotherapy regimen. Case Report: We present a case of 63-year-old post-operative CCA patient with residual mass and severe hyperbilirubinemia. The patient completed six cycles of gemcitabine (1000 mg/m2, day 1 and 8) and cisplatin (70 mg/m2, day 1) every 3 weeks with tolerable side effect. No sign of residual tumor was observed on CT-Scan performed one-month post chemotherapy. Conclusion: Combination of cisplatin and gemcitabine may offer safe treatment option for post-operative residual CCA patient presenting with hyperbilirubinemia
Comparison of the Effectiveness of Subcutaneous Insulin Injection between Upper Arm and Abdominal Sites in Type II Diabetes Mellitus Patients with Normal and Above Normal Body Mass Index
Get PDFBackground. Type II Diabetes Mellitus (DM) has high morbidity and mortality. One of DM therapy is insulin. Insulin effectiveness is affected by the injection site and the thickness of the fat in the injection site. Several studies on the effectiveness of insulin injection sites have been conducted, but the results still vary.Objective. To determine the difference in the effectiveness of subcutaneous insulin injections between the upper arm and abdominal sites on changes in capillary glucose levels in type II diabetes mellitus patients with normal and above-normal body mass index (BMI).Methods. The research design used a quasi-experimental repeated measure design. The research subjects were patients diagnosed with type II DM, age ≥ 40 years, hospitalized in the ward of Dr. Sardjito Hospital Yogyakarta. The effectiveness of insulin injection is described by the difference between 2-hours postprandial glucose (2hPPG) minus fasting blood glucose (FBG) (Δ2hPPG-FBG). Δ2hPPG-FBG was taken on the site of the upper arm and abdomen. Patients were classified based on normal and above normal BMI. Statistical analysis was performed using paired T-tests.Result. There were 14 patients with normal BMI and 11 patients with above normal BMI. Paired T-test showed a significant difference in Δ2hPPG-FBG between the upper arm and abdominal sites in normal BMI patients (p=0.028) with a mean of Δ2hPPG-FBG for the upper arm site of 26,14±38.18 mg/dL, and a mean of Δ2hPPG-FBG of the abdominal site -0.64±50,62 mg/dL. Paired T-test showed no significant difference in Δ2hPPG-FBG between the upper arm and abdominal sites in patients with an above-normal BMI (p = 0.239).Conclusion. The effectiveness of subcutaneous insulin injection in the abdominal site was better than in the upper arm site in patients with normal BMI. There was no difference in the effectiveness of subcutaneous insulin injection between the upper arm and abdominal sites in patients with an above-normal BMI
Association Between Irregular Eating Behavior, High Fat Intake, and Dyspepsia Syndrome of Male Adolescents at Selected Senior High School in Yogyakarta
Get PDFBackground. Dyspepsia syndrome is a group of symptoms consisting of epigastric discomfort, nausea, vomiting, bloating, early satiety, abdominal fullness, and belching. Dyspepsia syndrome is common in male adolescents. The causes of dyspepsia are multifactorial, one of the most common is diet and lifestyle changes. Objective. The aim of this study is to determine the association between irregular eating behavior, high fat intake, and dyspepsia syndrome of male adolescents in Yogyakarta senior high school.Methods. A cross-sectional study was performed among 255 male adolescents aged 15-19 years in Yogyakarta senior high school. The data were obtained using Gastrointestinal Symptoms (GIS) questionnaire, irregular eating behavior questionnaire, and Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ). Nominal variables were analyzed statistically by chi-square test and logistic regression test, numerical variables were analyzed by Mann-Whitney test and linear regression test. Result. Dyspepsia syndrome is positive in 54.9% of the subject. Seventy-four percent of subjects with irregular eating behavior had dyspepsia, p<0.001, OR 3.58 (CI 95%, 2.05-6.26). Seventy-five percent of subjects with high fat intake had dyspepsia, p= 0.005, OR 2.86 (CI 95%, 1.33-6.15). The median GIS score of the high fat and normal fat intake group are two to one (p=0.005). Median GIS scores of irregular and regular eating behavior groups are two to zero (p<0.001). The coefficient of determination (R2) from multivariate analysis is 0.065.Conclusion. There is a significant association between eating irregularities and high fat consumption patterns with the incidence of dyspepsia syndrome in male adolescents in Yogyakarta high school
Correlation Between Tp-Te Interval With the Degree of Disfunction in Liver Cirrhosis Based on Child Pugh Turcotte Score in Dr. Sardjito General Hospital
Get PDFBackground. Hyperdynamic syndrome due to portal hypertension in cirrhosis of the liver leads to failure ofcontractions and cardiac structures that result in complications of cardiomyopathy cirrhosis. The incidenceof arrhythmias was reported in various non- cardiac diseases including liver cirrhosis. We aim to evaluatethe T peak wave - T end (Tp-Te) as a parameter for suspected arrhythmias that occur in liver cirrhosis.Aims. To determine the correlation between the Tp-Te interval with dysfunction in the degree of livercirrhosis, which was assessed using the Child Pugh Turcotte score.Methods. This research is a cross-sectional study. Data taken from liver cirrhosis patients who has been metthe inclusion and exclusion criteria were admitted to the Inpatient and Outpatient Hospital Dr. Sardjito untilMay 2020, an assessment of the degree of dysfunction of liver cirrhosis with Child Pugh score Turcotte, andelectrocardiographic examination to assess Tp-Te wave. The independent variable was the Child Pugh Turcottescore, the dependent variable was the Tp-Te wavelength. Analysis of correlation data using the Spearman test.Results. Subjects included 51 patients with liver cirrhosis, correlation analysis found a strong correlation,the higher the Child Pugh Turcotte score was linearly correlated with the Tp-Te wavelength (r = 0.692; p<0.05). Wavelength Tp-Te at Child Pugh to any group showed a significant (p <0.001) , the wavelengthof Tp-Te Child Pugh A group 67.94 ± 7.80 ms, the Child Pugh B group 77.26 ± 8.38 ms, whereas inthe Child Pugh C group 92.31 ± 11.36 ms.Conclusion. There was a strong positive correlation between the Tp-Te interval with the degree of livercirrhosis dysfunction which was assessed using the Child Pugh Turcotte score
HALP Score as a Prognostic Factor of Mortality in Septic Patients at Dr. Sardjito General Hospital
No full textBackground. Sepsis is still an important health problem with a high mortality rate, an average of 44.5% in Asian countries. An easy and early biomarker is needed to determine the prognosis of sepsis. The HALP inflammation index can be used to predict mortality in malignancy conditions, yet has not been studied for sepsis.Objective. This study aimed to determine whether HALP score has a prognostic value for mortality in non malignant septic patients at Dr. Sardjito General Hospital.Methods. This was a retrospective cohort study of septic patients admitted to Internal Medicine wards between January 1, 2016 and December 31, 2018. The prognostic accuracy was evaluated by assessing the area under the receiver operating characteristic (AUC) curve. The primary outcome was mortality at the end of hospitalization. Results:. There were 125 adult patients, 104 with high HALP score (≥54,34), 21 low HALP score (<54,34), 45 patients died (36%). Patients with low HALP score were significantly at risk of death (p=0.007, OR 3.66, 95% CI 1.38-9.68) than high HALP score. Logistic regression was used to account for potential confounding factors. Low HALP score (p = 0.004, OR 4.74, 95% CI 1.63-13.76), sepsis diagnosed with quick SOFA (p = 0.006, OR 0.25, 95% CI 0.09-0.68), and multiple infections (p = 0.011, OR 2.93, 95% CI 1.28-6.73) were significantly associated with mortality in sepsis patients at Dr. Sardjito General Hospital.Conclusion. HALP score has a prognostic value of mortality in adult patients with sepsis at Dr. Sardjito General Hospita
The Effect of Weight Gain on Recurrence During Hormonal Therapy in Breast Cancer with Positive Estrogen Receptor and Negative Her2 Subtype
Get PDFBackground. Weight gain is found in patients with positive estrogen subtype breast cancer. The effect of weight gain on breast cancer recurrence is still being debated and associated with a poor prognosis. Being overweight is associated with an increase in estrogen production by adipose tissue.Methods. A retrospective and prospective cohort study with data collection was conducted from July 2018 - June 2019 at the outpatient unit of Dr. Sardjito Hospital. We reviewed medical records of patients who came from January 2013 - July 2018. Three categories of weight gain: weight loss, increase 0 - 5%, and increase > 5% from baseline will be evaluated.Statistical Analysis. The relationship between weight gain and some risk factors of recurrence was analyzed with cox regression and multivariate logistic regression tests. The Kaplan Meier method is used to show lifetime data.Result. Weight gain in breast cancer patients with positive Her2-negative estrogen receptor subtypes was not associated with recurrence (p = 0.264; HR 0.637; 95% CI 0.289 - 1.405). Patients with body mass index ≥ 25 kg / m2 at diagnosis had a lower risk of relapse than patients with body mass index < 25 kg / m2 (p = 0.026; HR 0.461; 95% CI, 0.234 - 0.912).Conclusions Weight gain after diagnosis in breast cancer patients with positive estrogen receptor-negative Her2 subtypes receiving hormonal therapy is not associated with recurrence
The Correlation between Thyroid Hormone Levels with Functional Mobility Performance among the Geriatric Patients in Dr. Sardjito General Hospital
Get PDFBackground. Alteration of the endocrine system in the elderly people may be caused by changes in secreted hormone levels or decreased sensitivity of target organs. These changes also apply to thyroid function, which can cause disability, cognitive impairment, cardiovascular risk, and decreased muscle mass and strength in the elderly. Physiologically, there are several changes in the concentration of thyroid hormone Concentrations due to aging process, such as reduced TSH (Thyroid Stimulating Hormone), total T3 (Triiodothyronine) and free T levels, and increased rT3 (Reverse triiodothyronine), which is an inactive T (Thyroxine) metabolite in the serum. Even so,the free T4 and the total T44 remain unchanged, except for the sick. As a result, proper diagnosis and management are expected to minimize the deprivation experienced by the subjects due to a decrease in functional mobility.Aims. The aim of the study was to assess the correlation between the levels of thyroid hormones and functional mobility among the elderly at Dr. Sardjito General Hospital, Yogyakarta.Method. Observational descriptive and analytical study with cross-section design was performed. Subjects were recruited used a consecutive sampling method for subjects who met the inclusion and exclusion criteria. The statistical analysis used to find a correlation between the levels of the thyroid hormone and the performance of the functional mobility by Pearson Correlation test. Here the study used Spearman Correlation test if the conditions were not met the criteria. Significance limit with p < 0.05.Results. A total of 36 research subjects who met the inclusion and exclusion criteria. The mean age was 69.67±6.164 years. Consisted of 16 (44.4%) male and 20 (55.6%) were female. The median of TSH (Thyroid Stimulating Hormone) was 1.170 (0.19-3.64) μIU/mL and the median free T was 1.280 (0.80-2.34) ng/dL. TSH level in male was more than female with same time in gait speed. The male median TSH level was 1.370 (0.60-3.64) μIU/mL and women 0.980 (0.19-3.17) μIU/mL. Slow gait speed more than thirty second (high risk of falling), the TSH mean in mas was 2.690 μIU/mL and women 1.150 μIU/mL. The test results indicate thyroid hormone level has no significant effect on functional mobility performance (timed up and go test score) in the elderly subjects (p value=0.531) and with level Free T4 (p value=0.721).Conclusion: In this study population, thyroid hormones did not have a statistically significant correlation with functional mobility in the elderly. Males with higher serum levels and females with lower serum TSH (Thyroid Stimulating Hormone) were at increased risk of frailty