Acta Interna: The Journal of Internal Medicine
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The Effect of Pursed-Lip Breathing on Functional Capacity of Stable Chronic Obstructive Pulmonary Disease Patient Assessed by Six Minutes Walk Test
Get PDFBackground. The number of people with Chronic Obstructive Pulmonary Disease (COPD) in Indonesia isestimated to continue grow and currently has reached 4.8 million sufferers resulting in a large socio-economic burden. Management of COPD requires a comprehensive approach involving rehabilitation activities such as Pursed Lip Breathing (PLB) in order to increase the functional capacity of sufferers. Assessment of physical functional capacity of COPD patients can be evaluated through the Six Minute Walk Test / 6-minutes walk test, which can also assess changes in post-intervention functional capacity such as pulmonary rehabilitationprograms.Aims. This study aimed to determine the effect of pulmonary rehabilitation with PLB technique for 4 weeks on the achievement of distance through a six-minute road test in COPD patients who received standard therapy.Methods. An experimental, Randomized Controlled Trial (RCT) study was conducted on stable COPD patients with classification of Global Initiative for Chronic Obstructive Lung Disease stage II (GOLD 2) and GOLD 3 ( Stage III). The study was conducted at the Rumah Sakit Khusus Paru (RSKP) Respira Bantul, Yogyakarta. Subjects were taken randomly as a treatment Pursed Lips Breathing (PLB) or control group. The treatment group consisted of 38 subjects, doing PLB 8 minutes for 28 days (4 weeks) in a row. The placebo group consisted of 37 subjects only continuing the previous standard therapy. Six-minute walking test measurements were carried out in both groups before and after treatment and compared between the PLB and control groups. The difference in average delta range between groups that received PLB and controls was tested by unpaired t-test.Results. There was a difference increase in the average delta range of the six-minute walk test which was not significant between the two study groups. The increase delta mean range in the six-minute walk test treatment group was greater (22.19 ± 45.54 meters) compared to the control group (18.54 ± 42.57 m), with a P = 0.720.Conclusion. There was an improvement in functional capacity in the form of increased performance distance in the six-minute walk test for COPD patients who received standard therapy and pulmonary rehabilitation by pursed-lip breathing (PLB) technique
Incorporation of Brentuximab Vedotin in the Treatment of Lymphoma: Current Evidence and Potential Use in Indonesia
Get PDFAlthough scientific advances have resulted in significantly improved survival among lymphoma patients, certain subsets of lymphoma patients still have poor prognosis, which includes relapsed and treatment refractory patients. Brentuximab vedotin, an anti-CD30 targeted therapy has shown remarkable results given in both Hodgkin and non-Hodgkin lymphoma, even in cases without CD30 expression. Unfortunately, evidence of its effectiveness in Indonesian patient is still limited as there is only 1 case report of such subject published.Conclusion: Brentuximab vedotin, an anti-CD30 targeted therapy presents as an effective therapeutic option for relapsed and treatment refractory lymphoma patients
Comparison of Prognostic Scores in Chronic Myeloid Leukemia (Cml) Patients with Bcr-Abl Mutation Types B3a2 and B2a2 in Dr. Sardjito General Hospital
Get PDFBackground. Chronic Myeloid Leukemia (CML) is a myeloproliperative malignancy that is caused byreciprocal translocation between chromosomes 9 and 22 which form the BCR-ABL fusion gene. Most CML patients have a major type of BCR-ABL mutation. There are b3a2 and b2a2 types, which produce different oncoproteins in 25 amino acid elements. The expression of different proteins is thought to cause differences in clinical manifestations, laboratory, and prognosis. In CML, there are several prognostic scoring systems, including Sokal, Hasford, andEUTOS scores which combine clinical and laboratory parameters. The effect of this genomic breakpoint location on clinical and biological characteristics is still controversial.Aims. The aim of this study was to determine the comparison of prognostic scores between CML patients with b3a2 and b2a2 BCR-ABL mutation types in Dr. Sardjito General Hospital.Methods. This study was a cross sectional retrospective study used secondary data from medical records of Dr. Sardjito General Hospital, from March 2014 to April 2016. The prognostic score of Sokal, Hasford, and EUTOS was calculated in the BCR-ABL mutation type groups b3a2 and b2a2. Data were analyzed by Chi Square test.Results. A total of 113 CML patients were analyzed with 74 (65.5%) b3a2 mutation type groups and 39 (34.5%) b2a2 mutation type groups. Hemoglobin levels, leukocytes, platelets, basophils, and eosinophils did not differ significantly between the two groups of mutation types. Meanwhile, the statistical test for the phase of disease when the patient was first diagnosed in both types of mutations showed a significant difference (p = 0.005). More patients with types of b2a2 mutations came in the acceleration and blast crisis phases than b3a2 types. However, Sokal, Hasford, and EUTOS prognostic scores in the b3a2 mutation type group were not significantly different from the b2a2 group (p> 0.05).Conclusions. There was no significant difference in prognostic scores of CML patients with the b3a2 BCRABL mutation type compared with the b2a2 mutation type in Dr. Sardjito General Hospital Yogyakarta
Persistent Lymphopenia as a Predictor of in-Hospitality in Septic Patients at Dr. Sardjito Hospital
No full textBackground: Sepsis, a life-threatening organ dysfunction caused by deregulation of body response to an infection with a high mortality rate. Pro-inflammatory cytokines are related to early mortality related sepsis, and immune dysfunction and suppression characterized by lymphocyte loss are related to late mortality. Persistent lymphopenia is a good biomarker for immunosuppression and predicts mortality in sepsis patients. Lymphocyte counts are easily measured and cheaper than other inflammation marker for sepsis.Aims: The objective of this study was to determine whether persistent lymphopenia has a predictive value for mortality in septic patients at Dr. Sardjito General Hospital.Methods: This study was a retrospective cohort study, sepsis and lymphogenic patients admitted to Internal Medicine ward between January 1, 2016 and December 31, 2017. Lymphocytes were count at day 1 and 4 following the diagnosis of sepsis. Persistent lymphopenia was defined as an absolute lymphocyte count of 1.62x10/μL or less on day 4. The primary outcome was mortality at the end of hospitalization.Results: 126 adult patients, 101 with persistent lymphopenia, 25 non-persistent lymphopenia, 47 patients died (37.3%). Patients with persistent lymphopenia significantly at risk of death (P=0.003, OR 5.66, 95% CI 1.59-20.13) than non-persistent lymphopenia. Logistic regression was used to account for potential confounding factors, persistent lymphopenia (p = 0.003, OR 8.01, 95% CI 2.04-31.45) and skin and soft tissue infection (p= 0.017, OR 2.94, 95% CI 1.21-7.14) were significantly associated with mortality in sepsis patients at Dr. Sardjito General Hospital.Conclusion: Persistent lymphopenia predicts mortality in adult patients with sepsis at Dr. Sardjito GeneralHospital
Transient Elastography Changes on Patient with Hepatic Cirhossis who were Treated by Simvastatin 20 Mg Compared to Simvastatin 10 mg
Get PDFBackground. Liver cirrhosis is a pathological condition that describes the end stage of liver fibrosis. Fibrosis is currently a two-way process. The process of returning from fibrosis now is a clinical reality. According to Abraldes et al. (2009), administration of simvastatin for one month will increase liver cell regeneration and improve endothelial dysfunction. Liver biopsy is still the gold standard for assessing liver cirrhosis, but this procedure is invasive and has the potential to cause life-threatening complications. Liver biopsy is complicated by sampling errors (reaching 30%) and different abilities between observers. Transient elastography (Fibro scan) is a non-invasive modality for diagnosing liver fibrosis that has high sensitivity and specificity.Aim. The aim of the study was to discover the difference in effect, of simvastatin 20 mg compared to 10 mg for 3 months to improve liver stiffness in patients with liver cirrhosis.Method. The study design used a double blind, randomized clinical trial. The subjects of the study consisted of a group given simvastatin 10 mg / day and the group given simvastatin 20 mg / day for 3 months. Routine medications for cirrhosis were still made according to the original dose. During the study, an initial and final transient elastography examination was carried out and monthly supervision of medication compliance and side effects. Data analysis for statistical tests was carried out by t-test, Mann Whitney test, fisher’s-exact test, and ANOVA test.Result. A total of 21 subjects underwent thorough research and transient elastography. The simvastatin 10mg group (n = 12) experienced a decrease in liver stiffness, with a delta mean of liver stiffness of -4.97+7.09 (p <0.023) compared to the simvastatin 20 mg group (n = 9) with a heart stiffness of -4.09 + 10.06 (p= 0.982). Changed liver stiffness in the two groups were not statistically significant differences. Etiology and confounding drugs showed statistically no significant effect.Conclusion. Both simvastatin 10 mg and 20 mg can reduce liver stiffness. The effect of the two doses of the drug in reducing liver stiffness was not statistically significant different
Infl uence of Pursed-Lips Breathing to Improve Quality of Life in Chronic Obstructive Pulmonary Disease Patients
Get PDFBackground. Worsening of Chronic Obstructive Pulmonary Disease (COPD) may decrease the quality of life of patients. Rehabilitation of patients with COPD may increase exercise tolerance and improve quality of life. Pursed-Lips Breathing (PLB) activates abdominal muscles during expiration for improving gas exchange and oxygen saturation in the arteries, increasing the tidal volume and reduce shortness of breath, anxiety, and tension thus improving the quality of life. St George's Respiratory Questionnaire (SGRQ) was a tool to measure the quality of life of patients with COPD, which has been validated. Patients with improved quality of life were characterized by a decrease in the SGRQ score after PLB training.Aims. Analyze the effect of improved quality of life in patients with stable COPD using PLB + standard therapy compared to standard therapy only.Methods. This research used an open-label Randomized Controlled Trial (RCT) design and conducted in patients with COPD stages 2 and 3. It was performed in Rumah Sakit Khusus Paru (RSKP) Respira Bantul, Yogyakarta. The study group was composed of 47 subjects, who continued the previous standard therapyand performed PLB 8 minutes once a day for 28 days. The placebo group (44 samples) continued the previous standard therapy alone. Measuring the quality of life using the SGRQ performed in both groupsbefore and after the experiment. Statistical analysis included independent t-test and Mann Whitney U-test.Results. Th ere were improvements in the quality of life that clinically characterized by a decrease in SGRQ total score of 12.19 points out of 100 points total in the PLB group. Th ere was a very significant difference in the decline in total SGRQ score between the study group and placebo groups (p <0.001).Conclusion. Pursed-Lips Breathing (PLB) improves the quality of life of patients with stable COPD was characterized by a decrease in SGRQ of 12.19 points out of 100 points total.Keywords. COPD (Chronic Obstructive Pulmonary Disease), PLB (Pursed-Lips Breathing), SGRQ (St George’s Respiratory Questionnaire), quality of lif
Th e Accuracy of Delta Neutrophil Index as a Marker of Sepsis Severity Level Compare to Serum Amyloid A
Get PDFBackground. Early diagnosis of infection before its progression to become organ dysfunction or circulation failure has an important clinical effect and critical patient outcome. Diagnostic modality used as a gold standard on diagnosing sepsis condition still relies on microbe culture. Microbial culture needed a long duration to grow bacteria in high numbers be identified. The upcoming alternative diagnostic modality used as a marker of sepsis severity level was Delta Neutrophil Index (DNI) and Serum Amyloid A (SAA). There were no references to compare the accuracy of DNI and SAA as a marker of sepsis severity level.Methods. 45 study subjects were patients with sepsis and severe sepsis or septic shock first known when first come to the ER or underwent treatment in the inpatient unit, ICU (Intensive Care Unit) or IMC (Intermediate Care) Sardjito’s Hospital that fulfilled the inclusion and exclusion criteria. The independent variable was DNI and the dependent variable was sepsis severity level. All of blood samples from septic patient undergo DNI and SAA test. Distributed data used the Kolmogorov-Smirnov test. DNI and SAA accuracy used sensitivity, specificity, positive predictive value, negative predictive value, like hood ratio and receiver-operating characteristics (ROC) curve.Results. The study consisted of 45 study subjects. The mean age was 52.98 years. The mean of SAA in this study was 54.39 ± 45.53 mg/L, while the mean of DNI in this study was 12.47 ± 8.79 %. Cut off point DNI 6.85% with value of sensitivity 93%, specificity 70%, positive predictive value (PPV) 79.31%, and negative predictive value (NPV) 87.5%, like hood ratio for a positive test result (LR+) (PLR) 14.28 and like hood ratio for a negative test result (LR-) (NLR) 3.3. Cut off for SAA 54.93 mg/L with value of sensitivity 60%, specificity 56%, positive predictive value (PPV) 52%, negative predictive value (NPV) 64%, like hood ratio for a positive test result (LR+) (PLR) 1.36 and likelihood ratio for a negative test result (LR-) (NLR) 0.71.Conclusions. DNI has better diagnostic accuracy value as a marker of sepsis severity level than SAA.Keywords. Sepsis, sepsis severity level, Delta Neutrophil Index (DNI), Serum Amyloid A (SAA
Effect Of Latihan Pasrah Diri (Lpd) Plus Fluoxetin Compared With Fluoxetin Alone To Improve Fructosamine Level In Tipe 2 Diabetes Mellitus Patients With Depression Symptoms
Get PDFABSTRACTBackground. Depression is a risk factor for diabetes and diabetes increase the risk for depression. Depression contributes to progression of diabetes mellitus. Examination of fructosamine is used to monitor blood sugar control for 2-3 weeks (according to age albumin). LPD evoke the relaxation response, which expected to improve symptoms of stress or depression.Objective. To determine the decrease in fructosamine levels in the group of patients with diabetes mellitus with depression symptoms after administration of fluoxetine alone compared with a combination of fluoxetine and LPD.Methods. This research conducted in Dr.Soeradji Tirtonegoro General Hospital, in May to August 2014. Distribution of data tested using the Shapiro-Wilk test. The differences between fructosamine and BDI (Beck Depression Inventory) before and after treatment tested with a pair t-test if normally distributed or Wilcoxon test if it was not normally distributed. The decrease in fructosamine and BDI both groups compared by independent t-test if normally distributed or Mann Whitney U test if not normally distributed. Differences were considered significant if p 0.05).Conclusion. LPD had no effect on fructosamine levels of type 2 diabetes mellitus patients with depression symptoms.Keywords: LPD, symptoms of depression, fructosamine, BDI (Beck Depression Inventory
Cisplatin Desensitization in a Patient with Nasopharyngeal Carcinoma Experiencing Urticarial Allergic to Cisplatin
Get PDFBackground. Allergic reactions to cisplatin are not uncommon situations with an incidence of 5-20%. In general, allergic reactions to cisplatin is a type 1 hypersensitivity with manifestations of itching, redness, papules, urticaria, chest pain, and anaphylactic symptoms. Desensitization methods are needed for patients who have no alternative medication.Case Report. A 59-year-old woman with nasopharyngeal carcinoma experienced urticaria because of cisplatin in her first cycle of chemotherapy. In the second cycle, chemotherapy desensitization program was applied using a 12-step Castell protocol. We measured vital signs and symptoms every 15 minutes. Administration of cisplatin was completed in 2 hours and the patient tolerated the whole program very well.Discussion. Risk factors of hypersensitivity to cisplatin include age 650 mg, mutation of BRACA1/2 gene, and administration of combined regimens with taxane groups or liposomal inhibitor. Desensitization uses 3 solutions with 12 steps. Solution is 100 times the dilution of the target dose. Solution 2 is 10 times the dilution of the target dose and solution 3 uses the appropriate target dose. Each solution is administered for 15 minutes using an infusion pump. Strict monitoring of vital signs and patient symptoms are done every 15 minutes during the program.Conclusion. Doctors should be aware of allergies to cisplatin. Currently, the allergic reaction to cisplatin can be overcome using the desensitization method when no alternative drug is not available
Th e eff ect of Providing Food Made from Resistant Starch Fiber (Dioscorea Esculenta, Maranta Arundinaceae L, Cucurbita Moschata, Manihot Utilissma) on the Improvement of Glycated Albumin in Type 2 Diabetes Mellitus Patients at Dr. Sardjito General Hospital
Get PDFBackground. One of the characteristics of the Diabetes diet is giving food with a high complex carbohydrates, particularly fiber. The benefit of resistant starch fiber includes maintaining blood glucose and increasing insulin sensitivity.Aims. This study aimed to find the effect of providing food made from resistant starch fiber (Dioscorea esculenta, Maranta arundinaceae L, Cucurbita moschata, Manihot utilissma) on the improvement of blood glucose control in diabetes patients based on glycated albumin test.Methods. The Quasi-experimental study was used in diabetes type-2 patients who visited endocrinology polyclinic at Dr Sardjito Hospital, during 1 November 2015-31 January 2016. Food made from the resistant starch fiber was served as a daily snack for one month. Blood glycated albumin was examined before and after food providence. SPSS was used for statistical analyses.Results. We recruited 17 subjects in the control group and 17 subjects in the treatment group. In the control group, the index of albumin was significantly deteriorated from 15.1% to 18.13%. In the treatment group, the index of albumin was reduced from 29.71% to 18.73% showing an improvement of 10.97% (p= 0.01).Conclusion. There was a significant improvement of blood glycated albumin (10.97%) after consuming food that was made from resistant to starch fiber (p=0.01)