Acta Interna: The Journal of Internal Medicine
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Characteristic Patients with Multiple Myeloma at Dr. Kariadi Hospital Semarang
Get PDFBackground. Multiple myeloma (MM) is a malignancy of differentiated B-lymphocytes characterized by accumulation of clonal plasma cells in the bone marrow (BM), the presence of a monoclonal immunoglobulin (Ig) in the serum and/or urine, and osteolytic bone lesions. Complications of this disease consist of recurrent bacterial infection, anemia, osteolytic lesion and decreased renal function. 2-5 MM is the cause of death in 1% of cancer death in Western countries. MM incidence is 1% of all malignancies and 10% of hematologic malignancies in Caucasian race and 20% in the Afro American race.Aim. The aim of the study is to know the descriptive data of characteristic of patients with MM at dr. Kariadi Hospital Semarang.Method. Despite of development in patient management, MM is still an incurable disease, with 5-year survival rates lower than 40%. There are many differences in myeloma and its clinical manifestations. Some patients can survive in the months until over than 10 years.5, 6, 7 The median survival was 33 months, this number is similar in Asian studies.Results. There are several prognostic factors in myeloma management, such as β2-Microglobulin (β2m), serum albumin, serum creatinine, plasma cell percentage in marrow, bone lytic lesion, anemia.10-13 β2m is a prognostic factor used by the International Staging System (ISS)11 to determine stadium and prognosis in MM. β2m correlates with other prognostic factors, such as serum creatinine, anemia, mechanism of bone destruction in MM patients.11,13Conclusion. MM in Indonesia has not been studied comprehensively and the β2m measurement is expensive and not widely available
Relationship between the Degrees of Severity Sequelae after Treatment with Quality of Life in Patients of Pulmonary Tuberculosis Patients
Get PDFABSTRACTBackground: Tuberculosis remains a global health problem, especially for developing countries.Tuberculosis can cause permanent deformity of the lung parenchyma, airways, pleura, mediastinum,chest wall, and vascular. This deformity is residual symptoms or sequelae. Tuberculosis sequelae mayoccur in most patients although has completed treatment. These sequelae can affect lung functionand will ultimately influence patient’s quality of life.Objective: This study aims to determine the relationship between the severities of sequelae aftertuberculosis based index Willcox with patient’s quality of life.Methods: The study design was cross-sectional at patients of outpatient clinic BP4Yogyakarta from September 2013 until the samples are met. The relationship between theseverities of the degree of sequelae after treatment with the quality of life in patients with pulmonarytuberculosis will be analyzed using t test. Relationship is significant if p <0.05 with 95% confidenceintervals.Results: The total of the subjects are 37 consist of 24 patients (64.9%) males and 13 (35.1%) women.Subjects who met the criteria will be examined the thoracic x-ray poster anterior (PA). Severity of tuberculosis sequelae will be assessed according to the index Willcox. Subjects also completed a SGRQ questionnaire as a tool for assessing their quality of life. There is a significant correlationbetween the severity of tuberculosis sequelae with the quality of life in the activity (ρ = 0.031) and total (ρ = 0.037) domain.Conclusions: There is a relationship between the severities of the quality of life in patients with pulmonary tuberculosis sequelae
The Relationship between 12MWD and Quality of Life in Tuberculosis Sequelae Patients
Get PDFBackground: The incidence of TB cases in Indonesia is very high. Although it was undergoing treatment and was declared cured the infection, but it does not mean that the infection does not leave sequelae.Patients TB sequelae decreased functional capacity and quality of life.Aim: The purpose of this study is to determine the relationship between functional capacity (12MWD) and quality of life (SGRQ) in tuberculosis sequelae patients.Method: Patients with TB sequelae aged 18-59 years without comorbid examined functional capacity with a 12-minute walking distance test and assessment of quality of life using the SGRQ questionnaires. Statistical analysis is using correlation and regression.Result: There were significant negative correlation (p<0.05) between the 12 minute walking distance and activity domain (r -.336). In other domains, there is a negative relationship but not significant at the totaldomain (r -.152), impacts (-.124), and symptoms (-.043).Conclusion: There is a significant negative relationship between the 12 minute walking distance and quality of life as assessed by questionnaire SGRQ in activity domain, in other domains there is also a negative correlation but was not statistically significant. The higher of functional capacity patients with tuberculosis sequelae, the quality of life also become higher
The Difference Plasma Levels of Endotelin-1 in Type 2 Diabetes Mellitus Women with and without Hypertension
Get PDFBackground. Diabetes and hypertension are related to each other and have a strong pre-disposition on the incidence of atherosclerosis. The incidence of hypertension 2 times greater in patients with DM than non DM. Endothelial dysfunction underlies these events. Endothelial markers, endothelin-1 is known to affect blood pressure.Aim. The aim of this study is to determine the difference plasma levels of endothelin-1 in type 2 diabetes mellitus in women with and without hypertension.Methods. The cross sectional design was conducted on women with type 2 diabetes mellitus with and without hypertension at metabolic and endocrinology clinic, Dr. Sardjito General Hospital Yogyakarta from July 2010 until the sample met the criterias. Subjects were divided into two groups, type 2 DM woman with hypertension groups and without hypertension. ELISA sandwich’s method was used to measure plasma levels of endothelin-1. Characteristics of the study are presented in the form of mean Kurniaatmaja et al.Results. In this research, the plasma levels of endothelin-1 in in type 2 diabetes mellitus in women with hypertension (n=32) and without hypertension (n=32) respectively 19.17±7.53 ng/ml and 13.75±6.19 ng/dl, and this difference was stastistically signifi cant with p= 0.003 CI 95% -8.87 to -1.97.Conclusion. Plasma levels of endothelin-1 in type 2 diabetes woman with hypertension higher than without hypertension.
The Difference of Average Mean Platelet Volume (MPV) Values in Stable Angina Pectoris Patients with Symptoms of Depression and without Symptoms of Depression
Get PDFBackground: Depression is an independent predictor of cardiovascular events. Increased platelet reactivity is one of several possible mechanisms proposed to explain the relationship between psychosocial factors to coronary heart disease. Mean platelet volume (MPV) is an indicator of platelet activation. MPV associated with major cardiovascular events in coronary heart disease.Objective: This study aimed to determine the average difference of mean platelet volume (MPV) in stable angina pectoris patients with symptoms of depression and without symptoms of depression.Methods: The study design was a cross-sectional study. Sampling was carried out in sequence from Stable Angina Pectoris patients who were treated in the internal medicine department of Dr. Sardjito hospital Yogyakarta. MPV and HAD score were measured once on admission. Data presented as a descriptive analysis of the subjects' characteristics on average and standard deviation. The difference average of MPVbetween Stable Angina Pectoris patients with symptoms, depression and without symptoms depression assessed with Pearson's correlation. The results were considered at the signifi cance level of p <0.05.Results: There were 40 subjects, consisting of 20 Stable Angina Pectoris patients with symptoms, depression and 20 Stable Angina Pectoris without symptoms depression. The difference average of MPV in this study was 7.56 ± 0.95 fl . Average MPV in Stable Angina Pectoris patients with symptoms depression was 8.45 ± 0.82 fl and without symptoms depression was 7.68 ± 0.99 fl with p = 0.009.Conclusion: In this study, there was a statistically signifi cant difference of average MPV values in stable angina pectoris patients with symptoms of depression and patients without symptoms of depression
Telomere and telomerase in hematological disorders Focusing on bone marrow failure syndromes and hematological malignancies
Get PDFABSTRACTWe review the present knowledge of telomeres and telomerase with special attention to their role in hematological disorders especially bone marrow failure syndromes including acquired aplastic anemia and myelodysplastic syndromes, as well as acute and chronic myeloid leukemia. The current understanding on the role of telomere and telomeres dysfunctions in hematological disorders leads us to a better understanding on the pathology of the diseases as well as considering some possibilities to employ the measurement of telomere length and telomere activity in disease prognostication. Several treatment options targeting telomere and telomerase being developed are also reviewed.Keywords: telomere- telomerase- bone marrow failure syndromes- hematological malignancie
Correlation of Ferritin Level to The Quality of Life
Get PDFABSTRACTBackground: Chronic kidney disease is a worldwide health problem. Circumstances that caused the condition of end-stage renal failure causes a decrease in quality of life with a high mortality rate ranging from 22% per year. Many ways to assess the quality of life, form-36 (SF-36) has undergone several revisions refi nement. Serum ferritin continues to be the focus of attention. Nearly half of all hemodialysis patients had serum ferritin > 500 ng/ml. Serum ferritin is a marker of infl ammation that is a good, low levels correlated with iron defi ciency and high levels correlated with infl ammation.Objective: To determine the correlation of high levels of serum ferritin to decline in the quality of life in patients with CRF who had been undergoing hemodialysisMethods: This study was a cross sectional study to determine whether high levels of serum ferritin may have an impact on the decline in the quality of life in patients with chronic renal failure (CRF) who had undergone regular hemodialysis. The study was conducted at Hospital Hemodialysis Unit Dr. Sardjito,Yogyakarta. Result: A total of 61 patients who met the inclusion criteria to undergo research. Score KDQOL-SF in this study, negative correlations (weak) significant in sleep (sleep disorders) 58.79 ± 1.95 (r = -0.306) and (p = 0.017). On the Role Physical scores (physical activity) 24.59 ± 3.21 obtained a negative correlation (weak) signifi cant (r = -0.268) and (p = 0.037). For Emotional Well Being scores (emotional condition) 70.85 ± 1.39 (r = -0.374) and (p = 0.003). On the score of Energy Fatigue (physical fatigue) 62.29 ± 1.61 (r = -0.261) and (p = 0.043).Conclusion: Overall, this study shows the lack of statistically signifi cant results showed a high correlation ferritin directly on quality of life.Keywords: chronic renal failure, hemodialysis, ferritin, KDQOL-S
The Accuracy of Wells Clinical Model for Predicting Pretest Probability in Deep Vein Thrombosis (DVT) at Dr. Sardjito Hospital
Get PDFABSTRACTBackground: The diagnosis of deep vein thrombosis (DVT) is an important issue in the medical field because a large number of cases are undiagnosed. The accurate diagnosis of the DVT is essential to prevent complications of acute pulmonary embolism and long-term complications. The complication such as pulmonary hypertension and post phlebitis syndrome. It also to avoid improper anticoagulant therapy associated with a high risk of bleeding. There are several models of clinical suspicion of DVT include Hamilton’s score and Wells’ score. The Wells clinical model for predicting pretest probability for DVT has been widely used and tested its validity in several countries in Europe. The accuracy of a Wells clinical model of pretest probability for DVT has not been done for the races of Asia especially in Indonesia.Objective: This study aimed to test the accuracy and precision (sensitivity, specificity and predictive value) of Wells clinical model for predicting pretest probability for diagnose DVT for patients in the Dr. Sardjito Hospital.Methods: This study was a diagnostic study with cross-sectional design. The subjects were patients with DVT symptoms who visited Tulip clinic, outpatient and inpatient in the department of Dr. Sardjito General Hospital during January 2011-May 2012. In this study, a total of 100 patients were participated the Wells clinical model of pretest probability for DVT examination, Doppler ultrasound and D-dimer examination. The negative results on the fi rst ultrasound examination will be examined again 1 week later.Results: DVT was confi rmed in 56 patients (56%) from 100 patients. The baseline characteristics showed the number of women more than men and the mean age was 52.98 ±1.335 years. The 57% of subjects were women and the median age was ≥60 years. The most frequent risk factors of DVT were cancer 49 patients (49%), bed ridden 42 patients (42%) and elderly 33 patients (33%). The accuracy of the Wells clinical model of pretest probability for DVT was 81%, precision was 77.6%, sensitivity was 92.8%, specifi city was 65.9%, and negative predictive value was 87.9%.Conclusion: The Wells clinical model for predicting pretest probability in DVT has a high accuracy, moderate precision, high sensitivity and poor specifi city to diagnose DVT at Dr. Sardjito Hospital.Keywords: deep vein thrombosis/DVT, the Wells clinical model of pretest probability for DVT, accuracy test, precisio
The effects of albumin concentration to outcome of acute respiratory distress syndrome (ARDS) patients in intensive care unit RSUP Dr. Sardjito Yogyakarta
No full textABSTRACTBackground: Hipoproteinemia mostly happened in critically ill patients, including ARDS, and usually comes toworst clinical appearance. Early ARDS is characterized by a rising of the permeability in the alveolar-capillarybarrier, leading to an infl ux of fl uid into the alveoli, and albumin also has a major role to control the osmolatoryof plasma.Aim: The aim of the study was to know about the effect of the albumin concentration to outcome (survivor/nonsurvivor) of the ARDS patient in the Intensive Care Unit (ICU) RSUP Dr. Sardjito.Methods: This study used cross-sectional method. The samples of this study were the patients at the ICU RSUPDr. Sardjito Yogyakarta, from January 2009 until December 2011. The diagnosed of ARDS based on EACCcriteria. The inclusion criteria were people with age ≥ 18 years old, fulfi ll diagnostic criteria of ARDS, and treatedin ICU. The demography, laboratory result, and curing process, have been tested statistically in SPSS 17. Thevariable was analyzed by chi-square and Mann-Whitney test, signifi cantly considered if p < 0,05.Results: The samples who fulfi ll these criteria were 61 patients. Mostly women (54,1%) with 49 years-old rangeand the result were 34 patients (55,7%) died. The biggest cause of ARDS was pneumonia (60,7 %) and thebiggest Comorbid was malignant (21,6%). The mortality rate of ARDS was 5,75%. The result of univariat analysiswas the increased of transaminase enzyme (p 0,007), COPD Co morbid (p 0, 02) and length of stay in the ICU (p= 0,021) which was signifi cantly given effect to the outcome of the patients. The survivors have higher albuminconcentration (2, 6) than in non survivors (2, 4), although not statistically signifi cant (p = 0,621).Conclusion:The albumin concentration did not have a statistically signifi cant effect to the outcome of the ARDSpatient in ICU RSUP Dr. Sardjito Yogyakarta. The main factor was the increase of transaminase enzyme, Comorbid COPD, and length of stay in the ICU.Keywords: ARDS, albumin concentration, IC
Changes in Anthropometry Measurement among Human Immunodefi ciency Virus/Acquired Immune Defi ciency Syndrome (HIV/AIDS) Patients Received Antiretroviral Treatment
Get PDFABSTRACTBackground: Estimated nearly 38.6 million people infected by HIV and 2.8 million died in 2005. Evidence suggests the existence of a very important relationship between the output and improved nutritional statusin HIV/AIDS patients. Poor nutritional status in HIV/AIDS can be caused by several factors, namely the intake and absorption of inadequate nutrition, metabolic changes, hyper metabolism, or a combination of these, changes in the gastrointestinal tract as well as interactions between drugs and nutrients. Losing weight remains on the HAART (Highly Active Antiretroviral Therapies) era, but the problems are the side effects of HAART and lipodystrophy.Objective: The purpose of this study is to determine the provision of anti- retroviral effect on changes in anthropometric values people with HIV/AIDS. Method: The study is using the one group pre-posttest design (quasi-experimental), by assessing changes in anthropometric values in subjects with HIV before and after the administration of ARVs. Analysis of the data is computerized by a computer program Result: Obtained 30 samples of the study with anthropometric changes pre and post ARVs 6 months. Theweight was 51.4 ± 9.12 to 53.6 ± 8.68 with a p-value 0.001. Body Mass Index (BMI) was 19.98 ± 3.47 into 20.84 ± 3.35 with a p-value 0.001 and upper arm circumference 24.13 ± 3.62 into 24.95±3.48 with a p-value 0.003. The provision of antiretroviral drugs for 6 months infl uences the change in nutritional status of HIV patients are assessed by anthropometric measure. Signifi cant changes in the changes body weight, BMIand upper arm circumference. Changes in anthropometric values ARV Efavirenz group and non-Efavirenz meaningful change signifi cant in skinfold thickness obtained at the value of p 0.010.Conclusion: There were no signifi cant changes in anthropometric values compared to patients with early stage HIV and advanced stage after 6 months of antiretroviral therapy.Keywords: HIV, antiretroviral drugs, anthropometric, nutritional statu