Acta Interna: The Journal of Internal Medicine
Not a member yet
111 research outputs found
Sort by
Effect of Metformin and Valsartan Toward Homa-IR in Metabolic Syndrome Patient with Non-Alcoholic Fatty Liver Disease (NAFLD)
Get PDFABSTRACTBackground: Insulin sensitizer drugs such as metformin has suggested giving in metabolic syndrome patient and NAFLD, which both pathogeneses were insulin resistance. Angiotensin II receptor blocker (ARB), anti-hypertension drugs, has the similar properties to improve regulation of Proliferator-Activated Receptor Gama (PPARɤ). This aim of the study is to prove the improvement of insulin resistance which examined by HOMA-IR method on metabolic syndrome patient with NAFLD after receiving metformin and valsartan medication.Method: This study was conducted to the patient in Endocrinology Clinic Sardjito General Hospital aged 35-36 years who meet diagnostic criteria for metabolic syndrome based on the IDF in 2006 and NAFLD. Convenience sampling method is done for 11 months (May 2012 – March 2013) and was expected sample size 35. HOMA-IR examination made before and after administration of metformin and valsartan for 12 weeks. Cut off value for HOMA –IR on pathological metabolic syndrome and NAFLD was ≥ 2. Medical and Health Research Ethics Committee (MHREC) Faculty of Medicine Universitas Gadjah Mada approved this study protocol.Result: Subject of study retrieved 15 (43%), six males (40%) and nine females (60%) aged 43-63 years old. Median HOMA-IR baseline was 2.8 (0.6-14.5) and at the end of therapy was 3.8 (1.72-14.1). Eleven (74%) have increased HOMA-IR value and four (26%) experience declined but none of them reach the value below 2. In general clinical improvement occurs in the form of AST and ALT reduction but not statistically significant.Conclusion: This study does not prove that administration of metformin and valsartan in-patient with metabolic syndrome with NAFLD would improve insulin resistance assessed by the HOMA-IR method.Keywords: Metformin, valsartan, metabolic syndrome, NAFLD, HOMA-IR
Validation of the Palliative Prognostic Score (PaP score) in Patients with Metastatic Cancers in Dr. Sardjito General Hospital Yogyakarta
Get PDFBackground. The mortality burden of cancer continues to increase in developing countries, most likely because of a late-stage at diagnosis. Identify the terminal stage is important in patients with advanced cancer because no longer aggressive therapy in patients with terminal cancer. Palliative prognostic score (PaP score)is a scoring system to predict the probability of survival within 30 days in patients with advanced cancer. PaP score divided into the heterogeneous patient sample into three iso-prognostic groups related to the chance of 30-days survival. Group A, score: 0 to 5.5 (the probability of survival within 30 days > 70%); Group B, score: 6-11 (the probability of survival in 30 days 30-70%) and group C, the score: 11.5 to 17.5 (the probability of survival in 30 days <30%).Aims. The aim of this study was to validate and to evaluate the prognostic accuracy of the palliative prognostic (PaP score) to predict 30-days survival in patients with metastatic cancers in Dr. Sardjito General Hospital Yogyakarta.Methods. The design of this prognostic study was cohort, including patients with metastatic cancers who were visited in Tulip Hematology and Medical Oncology Clinic, inpatient and outpatient care in Dr. Sardjito General hospital during May 2015 until May 2016. The PaP score calculated in 159 consecutive patients with metastatic cancers. The positive predictive value of the PaP score was evaluated and survival analysis was performed to compare the survival of the three prognostic groups.Results. PaP score tested on 159 subjects with overall median survival was 90 days, 76 subjects categorized into group A, 22 subjects into group B and 61 patients into group C. The 30-day survival probability was 98.7% for group A (median survival could not be assessed), 63.6 % probability of 30-day survival for the group B with median survival was 35 days and for group C with 3.3% probability of 30-day and median survival was 6 days. These survival differences were highly significant (log-rank test of trends, X =203.97; P<0.0001).The positive predictive value of the PaP score in predicting 30-day mortality was 96.7% with an accuracy of PaP the score was 93.1%.Conclusion. PaP score was a valid test tool in determining prognosis in patients with metastatic cancers with high accuracy and precision in predicting 30-days survival.Keywords: PaP score, validation, survival, prognostic, metastatic cancers
Relationship between the MELD score with severity erectile dysfunction in cirrhotic patients
Get PDFBackground. Liver cirrhosis is a pathological condition that describes the end stage of hepatic fibrotic which progressively ongoing that signed by distortion from hepar architecture and the formation of the regenerative modulus. Liver cirrhosis causes impairment in most of the liver function including the hormonal balance and metabolism of steroids. In the male patients, liver cirrhosis causes hypogonadism and feminization. Sexual dysfunction in cirrhotic patients is still underestimated and underdiagnosed. The most common sexual dysfunction in male cirrhotic patients is impotence or erectile dysfunction. Erectile dysfunction (ED) is define as a persistence inability to reach and/ or maintain enough erection to satisfy the sexual activity. International Index of Erectile Function 5/IIEF-5 could mark erectile dysfunction. Despite the prevalence of erectile dysfunction is high in patients with liver cirrhosis, only a few studies revealing the relationship between severity of liver cirrhosis and severity of erectile dysfunction.Objective. The purpose of this study is to determine the correlation between MELD score and severity of erectile dysfunction (IIEF-5 score) in cirrhosis patients.Methods. This study is observational with a cross-sectional method. Subjects were patients with liver cirrhosis, male, age 18 to 65 years old, married, have a partner, and agreed participated to this study. We used Pearson the correlation to assess correlation between severity of liver cirrhosis (Child Pugh score) and severity of erectile dysfunction (IIEF-5 score) if the data were distributed normally and Spearman correlation if the distribution is abnormal.Conclusion. There is negative correlation with the moderate strength degree between MELD score (the degreee of severity in liver cirrhosis) with the IIEF-5 score (the degree of erectile dysfunction). Keywords: liver cirrhosis, MELD score, erectile dysfunction, IIEF-5, correlation
Effects of Erdosteine Administration in Serum C-Reactive Protein Level in Stable Chronic Obstructive Pulmonary Disease Patients
Get PDFBackground. Systemic inflammation contributes to the development of intrapulmonary and extra pulmonary disorders, and as an independent risk factor for exacerbation of chronic obstructive pulmonary disease (COPD) has proven. The use of corticosteroids as anti-inflammatory agents has limitation for their undesirable side effects and different efficacy among the patients. Erdosteine, a mucolytic agent widely used in COPD, has been proven to be able to inhibit several mediators such as reactive oxygen species (ROS) and eicosanoids, which are involved in oxidative stress and inflammation.Objective. This study aimed to discover the effects of erdosteine administration in serum C - reactive protein (CRP) level in stable COPD patients.Methods. The research was a randomized controlled trial, which compared add-on therapy used erdosteine 300 mg bid versus placebo, for 10 days, combined with COPD standard treatments. The patients was recruited at RSKP Respira Yogyakarta outpatient clinics. Diagnoses were confirmed used spirometry based on GOLD criteria. Evaluation of CRP levels was hold before treatment and on the eleventh day, used highly sensitive quantitative immunometric assay.Result. Thirty-eight legible COPD patients recruited and randomly assigned to either erdosteine group or placebo group. One patient in erdosteine group was drop out because of exacerbation and one patient from each group were lost to follow up. There are 35 subjects (97.1% men, age range 40-77 years, median FEV1 0.83 (0.50-10.08) L, hs-CRP 0.84 (0.18-18) mg/L) who completed the study, 19 subjects in erdosteine and 16 subjects in placebo group. Baseline characteristics were similar between two groups. There were no significant decreases in median hs-CRP level in erdosteine vs. placebo group at day 11 (-0.10 (-16.16-+4.31) vs. 0.005 (-11.7-+11.03) mg/L; p 0.275). In COPD GOLD 3 sub-population, hs-CRP serum level decline was greater in erdosteine group compared to placebo (-0.56 (-16.16-+0.44) vs. 0.11 (-11.7- +11.03) mg/L; p 0.03) this might be related to greater oxidative stress in severe COPD that makes antioxidative effects of erdosteine reduce CRP more significantly in severe COPD.Conclusion. Effects of erdosteine supplements, 300 mg bid for 10 days, could decrease hs-CRP level in erdosteine insignificantly compared to placebo. Keywords: table COPD, C-reactive protein, erdosteine, FEV1, GOL
Relationship between Interleukin-6 Expression with the Progressive and Severity of Ulcerative
Get PDFBackground. Based on international statistics, the incidence of Inflammatory Bowel Disease (IBD) is about 2.2-14.3 cases per 100.000 people per year for Ulcerative Colitis (UC). In Indonesia, there is no epidemiological study of IBD. To assess the degree of severity associated with the ulcerative colitis disease can be used a varietyof tools, including the Truelove Witts score which has sensitivity and specificity that high enough for UC in the phase of active disease. Interleukin-6 (IL-6) is a pro-inflammatory cytokine that plays a very important role in the self-defense mechanism and acts as an acute-phase protein. Serum levels of IL-6 and increased expression in the colonic mucosa of active IBD patients indicate the level of IBD disease activity.Aims. The aim of the study was to determine the relationship between Interleukin-6 expression (IL-6) and the severity of UC disease using Truelove Witts classification.Methods. This study used a cross-sectional method that analyzed the relationship between IL-6 expression and UC weighing based on Truelove Witts classification using colon tissue biopsy results from UC patients who met inclusion and exclusion criteria.Results. Th ere were 26 subjects studied and performed an endoscopic analysis and anatomical pathology. Mean age of research subjects were 52.73 + 11.11 years with men's favored subjects (n = 15). Subjects were severe UC 16 (61.5%), moderate 7 (26.9%) and mild 3 (11.5%). More male subjects in mild UC, 12 vs. 3 and more female subjects in moderate-severe UC, 4 vs. 7 (p 0.032). Signifi cant diff erences in IL-6 expression in defecation were > 4 times/day, IL-6 300 (285-400) versus defecation < 4 times/day, IL-6 295 (212.1-340) p 0.039. Signifi cant diff erence in IL-6 expression between mild UC 295 (212.1-340) with moderate- severe UC 301.66 (235.57-400) with p value 0.032.Conclusion. IL-6 expression in moderate-severe UC subjects was higher than mild UC subjects based on Truelove Witts criteria.Keywords: Inflammatory Bowel Disease, Ulcerative Colitis, Truelove Witts classification, Interleukin-6
Interleukin-8 expression differences in chronic and active chronic inflammation gastric mucosa biopsy with helicobacter pylori infection
Get PDFBackground: Infection with Helicobacter pylori (HP) estimated to occur in 50% of the population in the world. Helicobacter pylori infection causes inflammation of the gastric mucosa and gastric epithelial release of interleukin-1β, interleukin-6, interleukin-8 and tumor necrosis factor α. Interleukin-8 plays a role in the degree of chronic inflammation of the gastric mucosa and gastric cancer risk. There has been no research on differences in the expression of interleukin-8 is based on chronic and chronic active inflammation on biopsy of the gastric mucosa with Helicobacter pylori infection in Hospital Dr. Sardjito.Objective: To prove the differences in the expression of interleukin-8 of chronic inflammation and gastric mucosal biopsy active chronic infection with Helicobacter pylori.Methods: This study used a cross-sectional design. Examined the expression of interleukin-8 on the rest of the biopsy sample HP (+) in August 2009 to March 2014. Classification of chronic inflammatory and chronic active obtained through histopathology report. Categorical numerical data from the two groups, unpaired, the distribution is not normal: Mann-Whitney test. Differences were considered significant if it was obtained p 0.05Conclusion: There is no difference in the expression of interleukin-8 in inflammatory chronic active and chronic inflammation of the gastric mucosa with Helicobacter pylori infection.Keywords: Helicobacter pylori, interleukin-8, chronic inflammation and chronic inflammatory active
Effectiveness Combination of Ginger Extract (Zingiber officinale) and Ranitidine Compared with Combination of Ranitidine and Placebo against Severity of Functional Dyspepsia
Get PDFABSTRACTBackground: Efficacy ranitidine as dyspepsia functional treatment was 8-35 % and ginger extracts as a traditional recipe in various countries for generations could be used as a therapy dyspepsia, antinausea, spasm, colic, and other stomach complaints. Ginger therapeutic effectiveness could reach 68-77% in vivo studies (animal models).Objective: To determined how much influence combination of ginger extract and ranitidine could improve severity of dyspepsia compared with combination of ranitidine and placebo in patients with functional dyspepsia.Method: This study was a quasi experimental. The research was conducted from December 2015 until April 2016 with 26 participants.Results: After getting therapy for 2 weeks in group I, mean SODA score in the pain scale decreased (8.4 %) of 29.07 ± 7.29 to 25.08 ± 8.22, statistically significant (p <0.046). Mean SODA score in the pain scale group II decreased (7.2%) of 25.38 ± 6.19 to 24 ± 6.01 (p=0.302). Mean SODA score in the non pain scale in group I decreased (7.7%) of 16.84 ± 2.44 to 15.15 ± 2.64 (p=0.074), while in the group II decreased (1.6%) of 15.77 ± 2.71 to 15.23 ± 2.94 (p=0.470). Mean SODA score in the satisfaction scale in group I increased (19.9%) of 7.77 ± 3.63 to 10.08 ± 3.59 (p=0.053) while in the group II increased (8.4%) of 9.62 ± 2.72 to 10.92 ± 2.46 (p=0.072). Comparison decline of SODA score in the pain scale between group I was 4.31 ± 6.3 and in group II is 1.23 ± 4.91, greater in group I but not significantly (p=0.178) at baseline to week 2nd. Comparison decline of SODA score in the non pain scale between group I was 1.69 ± 3.11 and in group II was 0.54 ± 2.6, greater in group I but not significantly (p=0.316) at baseline to week 2nd. Comparison increasing of SODA score in the satisfaction scale between group I was – 2.31 ± 3.88 and in group II was -1.31 ± 2.39, greater in group I but not significantly (p=0.437). Conclusion: Combination of ginger extract and ranitidine could decrease pain scale, non pain scale and increase satisfaction scale more effective clinically than plasebo and ranitidine for functional dyspepsia patient, but not statistic significantlyKeywords: ginger extract, severity of dyspepsia, and functional dyspepsi
Overlap in Patient with Functional Dyspepsia and Unspecified Functional Anorectal Pain
Get PDFFunctional gastrointestinal disorders (FIGD) represent a common and important class of disorders within gastroenterology. FIGD are a cause of great anxiety, distress and morbidity. FIGD disorders maybe manifest as overlapping syndrome. Patients with functional dyspepsia (FD) show frequent overlapping of other gastrointestinal disease, such as functional anorectal pain. These overlap patients have more frequent or more severe symptoms, poor health related quality of life and higher somatization scores, and they are more likely to experience anxiety, depression or insomnia compared to non-overlap patients. These disorders were diagnosed according Rome III criteria and excluded structural diseases. Multimodalities approach should be used during treatment patient with FGID. It was reported a male patient with functional dyspepsia and unspecified functional anorectal pain overlap. Keywords: Functional gastrointestinal disorders, functional dyspepsia, functional anorectal pai
ASSOCIATION BETWEEN NUTRITIOUS STATUS AND LIFE QUALITY OF ELDER PEOPLE VISITING GERIATRIC CLINIC AT DR. SARDJITO HOSPITAL
Get PDFABSTRACTBackground. Successful development in health sector cause shift in world population to older age. Yogyakarta Special Territory reveals highest percentage in amount of elderly people in Indonesia (13.7%). Prevalence of decrease in nutritional status rise along with age. Individual with low nutritional status is vulnerable to some diseases such as depression, cognitive disturbance and dementia progressivity. Nutritional status on elderly people is subject ignored in clinical practice. Prevention and early intervention is the best approach to obtain optimal nutrition.Objective. To identify association between nutritional statuses measured using MNA score and life quality measured with WHOQOL-BREF at elderly patient visiting geriatric clinic in Dr. Sardjito Hospital.Method. This research used cross-sectional design on elderly population in Dr. Sardjito Hospital. The research was conducted in October 2014. It includes elderly persons meeting inclusion and exclusion criteria, nutritional status assessed with MNA score and measurement of life quality with QHOQOL-BREF including four domains: physical aspect, psychological aspect, social relationship and environment.Result: There is significant correlation with p<0.001 between MNA and domain 1 (physical aspect) where Pearson correlation of 0.546 indicates positive correlation with weak correlation. Association of MNA and domain 2 (physical aspect) indicates significant correlation with p =0.006 with Pearson correlation of 0.435 indicating positive correlation with moderate correlation. There is significant correlation between MNA and domain 3 (social aspect) with p=0.005 and Pearson correlation of 0.437 indicating weak correlation. Association of MNA and domain four (environment aspect) indicate significant correlation with p=0.007 and Pearson correlations core of 0.426 indicating positive correlation with moderate correlation.Conclusion. The results indicate significant association between nutritional status (MNA) and life quality based on WHOQOL viewed from physical aspect (domain 1), psychological aspect (domain 2), social aspect (domain 30 and environmental aspect (domain 4) on elderly person.Keywords: Geriatrics, MNA, quality of lif
The Effects of Aerobic Exercise on Functional Capacity of Geriatric Chronic Heart Failure Patients
Get PDFBackground: Chronic heart failure, a condition predominantly affecting the elderly, is a major clinical burden and cause death in admission patients especially the elderly population. The focus of cardiac rehabilitation recently is exercise used as one of the modality of therapy designed for stable heart failure patients. Exercise is recommended as one of modality in management of heart failure to improve prognosis, increase physical activity tolerance and quality of life of heart failure patients. Aim: The objective of this study is to understand is aerobic exercise program can improve functional capacity in geriatric heart failure patients. Methods: The design of this study is randomized controlled trial. Twenty subjects were cardiology outpatient clinic at Dr Sardjito hospital men and women with chronic heart failure functional class I-II of NYHA age > 60 years and agreed to be included to the study. Subjects were divided into two group randomly, which were the exercise group (10 subjects) and the control group (10 subjects). To compare the functional capacity of both groups, t-test independent is used with condition of normal data range and Mann Whitney test is used if abnormal data range is found. The level of significance was set at p<0,05 with confidence interval 95% Result : Comparison of the mean increase in the six minute walk test distance between aerobic exercise group 107.9 ± 22.153 meters compared with the control group 21.3 ± 16.166 was significantly better in the aerobic exercise group (p <0.001) Conclusion : Aerobic exercise can improve the functional capacity of patients with chronic heart failure in the elderly. Keyword: chronic heart failure, elderly, aerobic exercise, functional capacity.