Acta Interna: The Journal of Internal Medicine
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EFFECT OF NARROW BAND ULTRA VIOLET B (NBUVB) PHOTOTHERAPY TO DECREASE SERUM FERRITIN LEVELS IN URAEMIC PRURITUS PATIENTS WHOSE UNDERGOING REGULAR HEMODIALYSIS IN DR. SARDJITO HOSPITAL YOGYAKARTA
Get PDFABSTRACTBackground. Uraemic pruritus is the complaint most often found in patients with terminal renal failure (15-49 %) and hemodialysis patients (50-90%). Mikroinflamasi role as ferritin be one cause. Phototherapy NBUVB theoretically can lower serum ferritin, thereby reducing the intensity of pruritus in patients .Objective. The main objective to determine the effect of phototherapy NBUVB to decrease serum ferritin levels of uremic pruritus patients undergoing regular hemodialysis. The next goal NBUVB know the influence of phototherapy to decrease the intensity of itch (VAS).Methods. Quasi experimental with pre-post comparison design, comparing the reduction in serum ferritin levels before and after phototherapy NBUVB, here p < 0.05 is said to be significant.Results. A total of 29 subjects who underwent the study protocol, 18 were male, the average age was 55.7 years, the largest cause of kidney disease is hypertension (48.3%), average 4.2 years old undergoing hemodialysis. There was a decrease which signifkan where median serum ferritin levels before phototherapy 1693 ng/mL (12.05 to 6000) and after phototherapy 275 ng/mL (12.55-6000) with p 0.001. The degree of intensity of pruritus also decreased significantly where the median VAS before phototherapy 7 (4-10) and after phototherapy 4 (2-8) with p 0.001.Conclusions. Phototherapy NBUVB lowering serum ferritin levels and degrees of intensity of pruritus (VAS) of uraemic pruritus in patients undergoing regular hemodialysis.Keywords : CRF (Chronic Renal Failure), Hemodialysis, Uraemia pruritus, Serum Ferritin, Phototherapy NBUV
The relationship between six minutes walking distance and quality of life in pulmonary tuberculosis sequelae patients
Get PDFABSTRACTBackground: Tuberculosis is an infectious disease that affects the lung and has high incidence. It could leave sequelae in the patient that has been declared cured. Tuberculosis sequelae results in changes of lung function that could lead to deteriorating of functional capacity and quality of life.Aim: The study aim to determine the relationship between functional capacity (6MWD) and quality of life (SGRQ) within pulmonary tuberculosis sequelae patients.Method: This study used cross sectional design and performed on pulmonary tuberculosis sequelae patient in pulmonary clinic of Dr. Sardjito General Hospital and BP4 Yogyakarta. Functional capacity was assessed with six minutes walking distance and assessment of quality of life using SGRQ questionnaire. Distribution of data was tested using the Shapiro-Wilk statistical test. Spearman correlation test and regression test was used to analyze the correlation between 6-minute walking distance test and assessment of quality of life using the SGRQ questionnaire.Result: The 6 minutes walking distance was 257.02±64.56 m. There were significant negative correlation between 6 minutes walking distance and SGRQ score activity domain (r=-.333, p<0.05). The others domains in SGRQ, there were no significant negative correlation at domain symptoms (r-.062), impacts (-.114), and total (-.135).Conclusion: There were negative correlation between the 6 minutes walking distance (6MWD) and SGRQ score. There was significant negative correlation between 6 minutes walking distance (6MWD) and activity domain in the SGRQ score.Keywords: tuberculosis sequelae, functional capacity, 6MWD, quality of life, SGRQ
Relationship between Degrees of Dyspnea with Functional Capacity in Pulmonary Tuberculosis Sequelae Patients
Get PDFABSTRACT Background: TB disease is still a serious health problem. Due to the changes that occur because of TB infection, appears sequelae in patients with pulmonary tuberculosis. TB sequelae will have an impact on the patient’s life, especially to do with the degree of dyspnea and functional capacity.Objective: To know the relationship between degree of dyspnea with functional capacity in pulmonary tuberculosis sequelae patients.Method: The design of this study is cross-sectional observational study. Subjects were patients with TB who have had at least 6 months of therapy that has been declared cured by leaving sequelae in Dr. Sardjito Hospital and BP4 Yogyakarta in September 2013. The sample was selected based on the selection criteria. Statistical analysis is using One-Way ANOVA.Results: From the 42 patients, there were 78.6% of patients with MRC scale 0, 11.9% of patients with MRC scale 1, and 4.8% respectively of patients with MRC scale 2 and 3. The mean of 6-minute walk test distance is 257.02±64.56 meters. There is a significant relationship on comparison of the mean of 6-minute walk test distance on each MRC scale (p = 0.028).Conclusion: There is a relationship between degrees of dyspnea with functional capacity in pulmonary tuberculosis sequelae patients. Keywords: tuberculosis sequelae, degrees of dyspnea, functional capacit
Correlation Between Neutrophil To Lymphocyte Ratio With Child Turcotte Pugh In Liver Cirrhosis Patients
Get PDFBackground: Neutrophil to lymphocyte ratio (NLR) is an index that iswidely used these days. RNL has been widely studied as a predictor of poor survival and outcome in patients with liver cirrhosis, hepatocellular carcinoma, coronary heart disease, rheumatoid arthritis, sepsis and malignancy.Objective: To determine whether there is a correlation between NLR with a score of Child turcotte pugh (CTP) in patients with liver cirrhosis in Dr. Sardjitogeneral Hospital.Methods :The study design was cross-sectional study. The study began in December 2014 until the number of samples are met. The subjects of this study were patients with liver cirrhosis at affordable populations undergoing inpatient and outpatient care in the Dr. Sardjito Hospital that meet the inclusion and exclusion criteria. Venous blood test to measure neutrophils,lymphocytes, albumin, total bilirubin, INR (Internationale normalized ratio). Data presented in the form of descriptive analysis of the characteristics of the study subjects such as the mean and standard deviation values of lymphocyte and neutrophil ratio scores CTP. For analyze the correlation between NLR with CTP scores Spearman nonparametric analysis p <0.05.Results : There are 33 subjects in the study. Based on the results of this study found a positive significant correlation between the ratio of neutrophils to lymphocytes CTP with r = 0.749 andp= <0.0001 and obtained the formula Y = 7.797 + 0,067x. Thus increasing of neutrophils to lymphocytes ratio positive correlated with the severity of liver cirrhosis.Conclusion. There are positive correlation between the neutrophil to lymphocyte ratio with CTP scores in patients with liver cirrhosis
Prognostic Value Of Chemotherapy-Induced Neutropenia In Metastatic Colorectal Cancer At Rsup Dr Sardjito Yogyakarta
Get PDFBackground: Colorectal cancer is the third largest incidence of cancer in the world and is the third most common cause of death in women and men . Five-year overall survival (OS) in colorectal cancer who have undergone metastasis was 10 % . Hematologic toxicity may be a marker of biological activity of cytotoxic drug on various types of cancer . Neutropeniaafter chemotherapy known to be associated with increased patient survival .Objective : To establish whether chemotherapy-induced neutropenia is predictive of better outcome in patients with metastatic colorectal cancer (mCRC).Methods: This research was a case-control study. Subjects were patients with metastatic colorectal cancer in the Cancer Instalation Center Tulip RSUP dr. Sardjito who meet the inclusion and exclusion criteria. Data were analyzed by bivariate analysis using chi square test and multivariate analysis with logistic regression.Results: Neutropenia present in 26 patients (32.5%) of the total 80 patients of the study. Neutropenia were significantly affect OS ( p = 0.001 and OR 7.73, 95% CI: 2.51-23.80). Multivariate logistic regression analysis showed neutropenia and the number of metastases affect OS with p <0.001 and p <0.003.Conclusion: Neutropenia occurring during the two first lines of chemotherapy for metastases colorectal cancer is associated with better survival. Variables that affect OS is the number of metastases and incidence of neutropenia after chemotherapy
Treating depression in diabetic patients: Latihan pasrah diri (LPD) revisited
Get PDFThe condition accompanying depression will always be progressing into poor prognosis if the depression itself is not recognized and treated properly. Among diabetic patients, depression was associated with increased mortality and poor quality of life . It was observed that diabetes and depression has a bidirectional relationship, where the clinical course of both conditions are affecting each other. Despite the effectiveness of psychological and psychopharmacological interventions in treating depressive symptoms in diabetic patients, the effect of such interventions on glycemic control is still inconsistent. Complementary alternative medicine (CAM) alone or in combination with standard medical treatment, targeting both depression and diabetes, appears to be promising. Latihan Pasrah Diri (LPD) has been recognized as a type of relaxation technique under CAM. It is initially directed to provide adequate relieve of depression using both religious and relaxative approach. Among patients with comorbid diabetes and depression, this approach has long been known and utilized over the counter, but its formal practice is seldom advocated, whereas, many clinical trials has been conducted locally to reveal its potential use. Combined with standard therapy, LPD is expected to show its beneficial effects
Maximum Tolerated Volume in Nutrient Drinking Test for Diagnosis of Functional Dyspepsia
Get PDFBackground. Methods to evaluate pathophysiology of functional dyspepsia (FD) such as barostat are invasive, expensive and not readily available. Nutrient drink test was developed as noninvasive, safe and low cost means to assess impaired gastric accommodation in FD patients. The aim of this study is to evaluate whether this test could be used for diagnostic tool for FD patients.Method. A cross sectional study was conducted from July 2014 to December 2014, at Sardjito General Hospital, Yogyakarta, Indonesia. Twenty FD patients (according Rome III criteria with normal gastroscopy) were matched by age, gender and body mass index with 20 healthy controls. All of FD patient and healthy controls ingested nutrient drink tests (UltraMilk contain 0.6 kcal /mL). Maximum tolerated volume (MTV) of each subject was recorded. Sensitivity, specifi city, positive predictive value (PPV) and negative predictive value (NPV) were analyzed.Results. Using ≤ 950 mL of maximum tolerated volume as cut off point, sensitivity, specificity, PPV and NPV were 95%, 100%, 100% and 95%.Conclusions. A nutrient drinking test can discriminate between FD patients and healthy controls with high sensitivity and specifi city. This test could be used as objective, safe and non-invasive diagnostic tool for FD patients
The Differences of Average Level Serum N Terminal Prob-Type Natriuretic Peptide (NTPROBNP) in Hypertension Patients with and without Left Ventricular Hypertrophy At Cardiology Outpatients Dr. Sardjito General Hospital Yogyakarta
Get PDFIntroduction. Hypertension cause changes in the structure and function of cardial as triggers neurohormonal and vascular changes that concentric cardiac hypertrophy. Myocyte volume expansion or increased pressure will trigger the synthesis of pre-proBrain Natriuretic Peptide (BNP) in the ventricular myocardium. Pre-proBNP will be converted into proBNP and proBNP will be converted into the form of BNP and N-terminal proBNP (NT proBNP).Aim. This study aimed to determine differences in BT pro BNP in hypertensive patients without LVH and hypertensive patients with LVH. The study design was cross-sectional in cardiology polyclinic`s outpatient at Dr. Sardjito General Hospital Yogyakarta from August 2009 until the sample number is fulfi lled.Method. To analyze the difference between the two groups of hypertensive patients using the t-test for normal distribution, while for abnormal distribution were analyzed with the Mann-Whitney U test. To analyze the normality of data conducted by Kolmogorov-Smirnov. The differences of two groups of hypertensive patients considered as signifi cant if p < 0.005 with confi dence interval of 95%.Results. The results showed 73 study subjects grouped subjects into 2 groups: hypertensive subjects without LVH (31 subjects) and with LVH (42 subjects) based on echocardiography parameters (IVSD, LVPWd, LVIDd, LVM, and LVMI) consisting of 24 males and 49 females. The baseline characteristics between the study groups of hypertensive subjects with and without LVH did not differ signifi cantly either in age, BMI, blood pressure, duration of hypertention therapeutic characteristics of the use of drugs such as ACEI, ARB, β-blocker, CCB, spironolactone and furosemide. Mean NT proBNP levels in hypertensive group without LVH (46.60 ± 45.51) and hypertention with LVH group (201.60 ±192.30 ng/ml). From the results of the Kolmogrov-Smirnov test result that the data distribution was not normal then used Mann-Whitney U test, obtained a statistically significant differences.Conclusion. There were significant differences in the mean levels of serum NT proBNP in hypertensive patients without LVH and hypertensive patients with LVH.
Prolonged Survival in a Non-Small Cell Lung Cancer with Brain Metastasis Treated with a Brain Mass Evacuation and Gefi tinib
Get PDFThe incidence of brain metastasis (BM) is reported to be increase about 20-40% over the last few years in patients with non-small-cell lung cancer (NSCLC).1 The use of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) in NSCLC patients with BM, especially those harboring EGFR mutations have been reported
Type of Psychosocial Stressor as Risk Factor of Depressive Symptom in Metabolic Syndrome
Get PDFBackground: Metabolic syndrome and depression are two major diseases over the world, which are increasing in prevalence over time. Depression is major mental health burden over the world. In long time, depression can lead to metabolic syndrome, while metabolic syndrome is risk factor for developing depression. Chronic stress that induced by psychosocialstressor lead to the development of both metabolic syndrome and depression. Further research is important to identify which type of psychosocial stressor is the risk factor for depression symptom in patient with metabolic syndrome.Aims: This study is to identify the type of psychosocial stressor which could be the risk factor for depressive symptom.Method: The study design was case control. The case group consisted of metabolic syndrome patients with depressive symptom, while the control group consisted of metabolic syndrome patients without depressive symptom. Metabolic syndrome was diagnosed based on International Diabetes Federation (IDF) criteria. Depressive symptom was measured by Beck Depression Inventory (BDI). Psychosocial stressors were measured by Stressful Life Events (SLE) questionnaire. Dependent variable was depressive symptom, while independent variables were type of psychosocial stressors (finance, work, social relationship, health and housing). Analysis methods that used in this study were independent t test, Pearson/Spearman correlation analysis, chi square and logistic regression.Result: There were 54 patients in this study, consisted of 24 in case group and 30 incontrol group. There was no significant difference in most basic characteristics between two groups. There was significant difference of SLE score between two groups. Chi square analysis showed that housing, finance, health, social relationship, and work stressors were risk factors fordeveloping depressive symptom in metabolic syndrome (OR 24.5; 9.7; 8.4; 5.4; 3.9 respectively, significant). Demographic factor which also influenced depressive symptoms was salary less than 1 million per month (OR 45, significant). According to logistic regression analysis, psychosocial stressors which most influenced the depressive symptom were finance and housing.Conclusion: The study showed that housing, finance, health, social relationship and work stressors were risk factors for developing depressive symptomp in metabolic syndrome