Acta Interna: The Journal of Internal Medicine
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Correlation between Depressive Symptom Score and Geriatric Handgrip Strength at Nursing Home Province of Yogyakarta
Get PDFABSTRACTBackground: By the year of 2020, Indonesia’s elderly population will be expected to the fourth highest number in the world after China, India and USA. Special Region of Yogyakarta has the highest percentage that is equal to 13.72%. Depression may increase the risk of mortality, disability and motivation of physical Low grip strength would increase mortality and morbidity in the elderly.Objective: This study aimed to assess the correlation between depressive symptoms and handgrip strength in the elderly population in nursing homes at province of Yogyakarta.Methods: This study was a cross-sectional study that conducted in October 2010 at the nursing home residents. Depression was assessed by the Geriatric Depression Scale Cronbach’s alpha 0.88. Handgrip strength was measured by a handgrip dynamometer. Data of age, education and gender was collected by questionnaire. The study performed statistical tests to assess the correlation of symptoms depression and grip strength.Results: The mean age of subjects was 73.84 ± 8.36 years with 36 subjects (35.3%) were between 60-69 years and 66 subjects (64.7%) were over 70 years. There were 33 men (32.4%) and 69 women (67.6%). MeanGDS score was 12.76 ± 3.22. Handgrip strength in the depression group 16.94 ± 6.96 kg was higher than the non-depressed group 15.23 ± 6.79. There was correlation between severity of depression symptom byhandgrip strength with r = 0.235 (weak correlation) and statistically signifi cant with p = 0.017.Conclusion: The severity of depressive symptom scores was correlated significantly to the handgrip strength in elderly nursing homes in the province of Yogyakarta.Keywords: elderly, nursing homes, depression, handgrip strength.confi dent interval
Ex vivo Generation of Platelets from Umbilical Cord Blood Hematopoietic Stem Cells with Amniotic Membrane Mesenchymal Stem Cells Support
Get PDFoai:jurnal.ugm.ac.id:article/3845ABSTRACTBackground: Platelet refractoriness is a major problem among patients requiring repeated transfusion. Production of less immunogenic platelets is required to overcome this problem. Umbilical cord blood (UCB) is rich in hematopoietic stem cells (HSC), which may serve as a potential source of less immunogenic ex vivo generated platelet. Development of methods to generate platelet from HSC in UCB with additions of various growth factors made a very high production cost. Amniotic membrane is widely known as the best source of mesenchymal stem cells (MSC), which may support the growth of platelet from HSC in UCB due to its abundant productions of cytokines and low cost . Aim: This study aimed to generate platelet from UCB co-cultured with MSC derived from amniotic membrane.Methods: Gradient density separation was performed to obtain mononuclear cells from UCB. The resulted mononuclear (MN) cells were selected for CD34+ by magnetic sorter beads. CD34+ HSC and non-CD34+ MN cells were each cultured in standard medium plus 10 ng/ml thrombopoietin (TPO), 50 ng/ml stem cell factor (SCF), and 25 ng/ml interleukin-11 (IL-11), with or without co-cultured with MSC. The MSC was also cultured alone with the addition of the above mentioned cytokines. Cultures were incubated in 37o C with 5% CO2 and half of the medium was changed twice a week. Formations of platelets were confirmed by flowcytometry after two weeks culturing.Results: Total number of CD34+ HSC was 1x106, the non-CD34+ MNC was 1.78x107 and the MSC was 3x105. Following the culture systems, the number of platelets produced from CD34+ HSC with and without MSC were 1.17% and 0.84%, respectively. The numbers of platelets produced from non-CD34+ MN cells with and without MSC were 7.94% and 8.85%, respectively. The number of platelets produced from 105 MSC was 1.43%.Conclusions: There was a greater increment in ex vivo production of platelets in CD34+ HSC isolated from UCB co-cultured with MSC, compared to that of without MSC. Further study to evaluate the significancy of the increament and the platelet function produced by this system is warranted. Keywords: platelet, hematopoietic stem cells, - mesenchymal stem cell
Relationship between plasma fi brinogen levels with model of end stage liver disease score in patients with liver cirrhosis
Get PDFABSTRACTIntroduction. One of the complications which often occur in the liver cirrhosis is bleeding. Closely associated with weighing of bleeding were disturbance haemostatic homeostasis disorders that commonly associated with impaired liver function. Therefore certain biomarkers are needed to objectively measure the severity of liver cirrhosis. Fibrinogen is one of the clotting factors that can be used to determine the severity of liver cirrhosis.The model of end-stage liver disease (MELD) score is most excellent alternative of the Child-Pugh score. It can be used in patients with liver cirrhosis spacious ranges severity of disease and etiology even in patients whose cirrhosis etiology are not clear. Currently, there was not any data showing the correlation between the level of plasmatic fi brinogen and MELD score in patients with liver cirrhosis. Aims. This study aimed to determine the correlation between level of plasmatic fi brinogen and MELD score in patients with liver cirrhosis.Method. This study was cross-sectionally conducted used consecutive sampling. Study population were eligible patients with liver cirrhosis who visited outpatient and inpatient clinic in the Division of Gastroentero-hepatology, Dr. Sardjito general hospital, between November 2011 to October 2012. Correlation between the level of plasmatic fibrinogen and MELD score was statistically assessed using correlation test with fi nal result stated as correlation coefficient (r).Result. There were 40 subjects that met criteria, 28 male and 12 female, with average age of 53 ± 12,51 years. Etiology of cirrhosis was viral hepatitis B in 16 (40,0%) subjects, hepatitis C in 11 (27,5%) subjects and non viral in 13 (32,5%) subjects. Subjects with ascites were 19 (47, 5%) and without ascites were 20 (52.5%). Bleeding was experienced by 30 (80.0%) subjects while 10 (20,0%) subjects did not present with bleeding. Mean of plasma fibrinogen was 198 ± 102, 89 mg/dl, and mean of the MELD score was 17,05 ± 8.79. Spearman correlation coefficients between fi brinogen and MELD score was r = -0,404 (p = 0,010).Conclusion. There was a negative correlation between plasma fi brinogen and the MELD score in liver cirrhosis patients visiting our local setting.Keywords: liver cirrhosis, fi brinogen, MELD scor
Reactivation and Flare of Chronic Hepatitis B: Natural History, Diagnosis, Therapy and Prevention
Get PDFABSTRACTAlmost 30% of the world population has been exposed to hepatitis B virus (HBV) and 400 millionof these are chronically infected. 20–30% of HBsAg carriers may develop reactivation or fl are (acuteexacerbation) of chronic hepatitis B with elevation of biochemical levels, high serum HBV DNA level with orwithout sero-coversion to HBeAg. In countries with intermediate or high endemicity for HBV, compoundedin use cytotoxic or immunosuppressive therapy for the treatment of a wide variety of clinical disease,reactivation or fl are may be the fi rst presentation of HBV infection. Sometime it is diffi cult to differentiatebetween acute hepatitis B and reactivation (fl are). Accurate diagnosis in these cases is very important fordeciding whether to start treatment or not, because acute hepatitis B does not require treatment, whilereactivation or fl are may take benefi t from it. Effort to early detect, to treat and to prevent the reactivationor fl are of chronic hepatitis B is very crucial to reduce morbidity and mortality.Keywords: Reactivation, fl are (acute exacerbation) of chronic hepatitis B, acute hepatitis B, nucleos(t)ideanalogue
Differences in lung function in various degrees of pulmonary tuberculosis sequale
No full textLatar belakang: Tuberkulosis masih menjadi masalah kesehatan global untuk negara berkembang khususnyadi Indonesia yang merupakan urutan kelima tertinggi di dunia. Sekuele tuberkulosis dapat terjadi padasebagaian besar pasien yang mengalami penyembuhan setelah mendapatkan pengobatan. Perubahan sekueletuberkulosis menimbulkan perubahan pada paru sehingga mengalami penurunan fungsi paru.Tujuan: Penelitian ini bertujuan mengetahui perbedaan fungsi paru forced expiratory volume in one second(FEV1) dan forced vital capacity (FVC) pada berbagai derajat sekuele tuberkulosis.Metode: Desain penelitian ini adalah potong lintang pada pasien rawat jalan poliklinik BP4 Yogyakarta dariSeptember 2013 hingga sampel terpenuhi. Perbedaan dianalisis dengan uji t dan analisis normalitas denganuji Shapiro-Wilk. Perbedaan bermakna bila p< 0.05 dengan interval kepercayaan 95%.Hasil: Hasil penelitian didapatkan subyek penelitian sebanyak 44 pasien yang terdiri dari 29 (65,9%)laki-laki dan 15(34,1%) perempuan. Subyek yang memenuhi kriteria dilakukan pemeriksaan foto thorakposteroanterior (PA). Derajat keparahan foto thorak dinilai menurut indeks Willcox. Tes spirometri dilakukanuntuk mendapatkan gambaran fungsi paru berupa FEV1 dan FVC. Karakteristik dasar subyek penelitianmenurut fungsi paru menunjukkan kelainan restriksi yang paling banyak yaitu 28 (60,9%). Perbedaan fungsiparu FEV1 bermakna pada derajat ringan dengan derajat berat (p= 0,024) dan bermakna pada fungsi paruFVC pada derajat ringan dengan derajat berat (p= 0,031).Kesimpulan: terdapat perbedaan bermakna fungsi paru FEV1 dan FVC pada derajat ringan dengan derajatberat.Kata kunci: Sekuele tuberkulosis, fungsi paru, indeks Willcox.ABSTRACTBackground: Tuberculosis remains a global health problem to developing countries, especially in Indonesiawhich is the fi fth highest in the world. Tuberculosis sequelae can occur on most patients who experiencedhealing after treatment. Tuberculosis sequelae changes cause changes in the lungs so that the decline inlung functions.Objective: This study was to determine differences in lung function, forced expiratory volume in one second(FEV1) and forced vital capacity (FVC) at various degrees of sequelae tuberculosis.Method: This is a cross-sectional study in an outpatient BP4 Yogyakarta from September 2013 until thesample met. Differences were analyzed by t-test and analysis of normality with Shapiro-Wilk test. Signifi cantdifference is when P <0.05 with 95% confi dence intervals.Result: The study subjects were 44 patients consisted of 29 (65.8%) males and 15 (34.1%) women. Subjectswho met the criteria examined thoracic images posteroanterior (PA). The degrees of severity of thoracicimages were assessed by Willcox index. Spirometry tests performed to get an overview of lung functionsuch as FEV1 and FVC. Basic characteristics of the study subjects according to pulmonary functionabnormalities restriction showed at most that 28 (63.6%). Signifi cant differences in FEV1 lung function in mild degree with severe degree (p = 0024) and FVC signifi cantly in lung function in mild degree withsevere degree (p= 0.031).Conclusion: There are signifi cant differences in lung function, FEV1 and FVC at mild degree by severedegree.Keywords: Tuberculosis sequelae, pulmonary function, index Willco
Correlation of thirst with ejection fraction and plasma sodium level in elderly with chronic heart failure
No full textABSTRAKLatar Belakang: Haus merupakan simptom yang umum dan mengganggu bagi pasien gagal jantung.Banyak pasien gagal jantung usia lanjut mengeluh rasa haus berlebihan. Perjalanan alamiah gagal jantung,terapi farmakologi dan non farmakologi dapat meningkatkan rasa haus. Cardiac output yang rendah danpeningkatan aktivasi sistem neurohormonal seperti sistem renin-angiotensin aldosteron akan merangsangpusat haus di hipotalamus. Hubungan antara rasa haus dengan fraksi ejeksi dan kadar natrium plasma padapasien gagal jantung kronis usia lanjut belum diketahui.Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui hubungan antara derajat rasa haus denganfraksi ejeksi dan kadar natrium plasma pada gagal jantung kronis usia lanjut.Metode: Penelitian menggunakan metode potong lintang, dilakukan di Bagian Penyakit Dalam dan BagianKardiologi RSUP Dr. Sardjito Yogyakarta. Subyek penelitian adalah pasien usia lanjut penderita gagal jantungkelas fungsional III-IV sesuai dengan kriteria NYHA, usia ≥60 tahun. Pengukuran rasa haus dilakukandengan menggunakan skor VAS. Pemeriksaan fraksi ejeksi dilakukan dengan ekokardiografi . Karakteristiksubyek penelitian disajikan dalam bentuk rerata dan simpangan baku. Hubungan antara derajat rasa hausdengan fraksi ejeksi dan kadar natrim plasma dianalisis dengan menggunakan uji korelasi Pearson. Nilai p<0.05 dianggap signifi kan.Hasil: Didapatkan 30 subyek sebanyak 63.3% laki-laki dengan median usia 69.5 tahun. Diperoleh rerata rasahaus 63.67±17.5 mm dan rerata fraksi ejeksi sebesar 41.93±15.5%. Rerata hasil pemeriksaan kadar natriumadalah 139.7±4.1 mmol/l sedangkan rerata osmolalitas plasma 296.4±10.1 mOsm/kg.Kesimpulan: Pada uji korelasi Pearson didapatkan korelasi antara rasa haus dengan fraksi ejeksi adalahkorelasi negatif lemah namun tidak signifi kan secara statistic (r=-0.314, p=0.091). Tidak didapatkan korelasiantara rasa haus dengan kadar natrium plasma (r=-0.04 p=0.833).Kata kunci: usia lanjut, rasa haus, gagal jantung kronis, fraksi ejeksi, natrium plasmaABSTRACTBackground: Thirst is a common symptom that disturbs patient with heart failure. Many elderly patients withheart failure get severe thirst. Natural history of heart failure, pharmacological and non-pharmacological therapiescould increase the thirst level. Low cardiac output and activation of neuro-hormonal system e.g. renin angiotensinaldosteronesystem, would stimulate the thirst center in hypothalamus. Correlations of thirst with ejection fractionand plasma sodium level in elderly with chronic heart failure have not been known yet.Aims: The aims of this study are to investigate the correlations of thirst with ejection fraction and plasmasodium level in elderly with chronic heart failure. Cross sectional design has been conducted on elderly patients(age of ≥60 years) with heart failure of functional class of III-IV (based on NYHA criteria) in Departmentof Internal Medicine and Department of Cardiology, Dr. Sardjito General Hospital, Yogyakarta.Method: Measurement of thirst was done using VAS score, while the investigation of ejection fraction wasperformed using echocardiography. Characteristics of subjects were presented in the average and standarddeviation values. Correlations between thirst with ejection fraction and plasma sodium level were analyzedby using Pearson correlation test with p < 0.05 considered to be signifi cant.Result: There were 30 subjects, 63.3% male, median of age of 69.5 years. The average of thirst value was63.67} 17.5 mm and the ejection fraction was 41.93} 15.5%. The averages of plasma sodium level andplasma osmolality were respectively 139.7} 4.1 mmole/l and 296.4} 10.1 mOsm/kg.Conclusion: Pearson correlation test has revealed a weak negative correlation of thirst and ejection fraction(r= -0.314, p=0.091). On the other hand, there was no correlation between thirst and plasma sodium level(r=-0.04 p=0.833).Keywords: thirst, elderly, chronic heart failure, ejection fraction, plasma sodium leve
Evaluating Indications and Diagnostic Yield of Colonoscopy in Sardjito General Hospital
Get PDFABSTRACTBackground: Colonoscopy is the gold standard procedure which is widely used in the diagnosis and treatment of colonic mucosal disorder. Inappropriate colonoscopy indications increase rate of complications.Aim: The main aims of our study were to evaluate indications, fi ndings and diagnostic yield at colonoscopy.Methods: A retrospective study of all colonoscopy was conducted from January 2012 through August 2013, at Dr. Sardjito General Hospital, Yogyakarta and there were 688 colonoscopy reports. Seven colonoscopy indications were documented and presented: rectal bleeding or hematochezia, chronic diarrhea, abdominal pain, constipation, screening and surveillance for colonic neoplasia, change in bowel habit and anemia. Diagnostic yield was defi ned as the ratio between signifi cant fi ndings detected on colonoscopy and the total number of procedures performed for the indication. In our study, diagnostic yield was established by colonoscopy, not confirmed by biopsy.Results: Overall diagnostic yield was 72.53%. The leading indication for colonoscopies was rectal bleeding or hematochezia (36.19%), followed by chronic diarrhea (23.11%), abdominal pain (14.09%), constipation (13.37%), screening and surveillance (5.66%), change in bowel habit (5.52%) and anemia (2.02%). Diagnostic yields according colonoscopies examination were normal (37.14%), colorectal cancer (19.33%), proctitis (14.24%), infl ammatory bowel disease (12.50%), polyps (11.19%),hemorrhoid (10.03%), and diverticel(3.78%). Colorectal cancers were found in patients with hematochezia (74 patients, 29.71%), chronic diarrhea (34 patients, 21.38%), constipation (13 patients, 14.13%). Of 249 patients presenting with hematochezia were found colorectal cancer (74 patients), hemorrhoid (50 patients), proctitis (30 patients), normal (30 patients). Our study showed that diagnostic yield was far lower in patients below 50 years (38.48%) compared > 50 years (61.52%), especially for colorectal cancer (p < 0.001), polyps (p = 0.004) and diverticular (p < 0.001).Conclusions: Hematochezia was the leading indication for colonoscopy and the diagnostic yield was 72.53%. The leading of colonoscopy fi ndings were normal colonoscopies, followed by colorectal cancer, proctitis,infl ammatory bowel disease, polyps and diverticel. Colonoscopy indications should be based on the available guidelines to minimize as much as possible the number inappropriate procedures and complications.Keywords: Colonoscopy, diagnostic yield, colonic indications, appropriateness of colonoscop
Acute Coronary Syndrome in Young Patients at Dr. Sardjito General Hospital
Get PDFABSTRACTBackground: The incidence of acute coronary syndrome in the young patients is increased recently. Several studies reported that young patients have distinct clinical characteristics as compare with older patients.Objective: To assess the prevalence, risk factors and clinical presentation of acute coronary syndrome(ACS) in young patients at Dr. Sardjito Hospital, Yogyakarta.Methods: We conducted a cross sectional study between September 2008-May 2009 at intensive cardiovascular care unit (ICCU) of Dr. Sardjito Hospital. We enrolled consecutive patients admitted with acute coronary syndrome. We divided the patients as young ACS (age ≤ 45 years) and older ACS (age >45 years). We compared cardiovascular risk factors, clinical presentation and clinical spectrums from both groups. Statistics analysis was performing using chi-square test, p value < 0.05 was considered significantly different.Results: In our study there were 20 (13.5%) young ACS and 128 (86.5%) older ACS patients. Most young ACS patients are male (90%). Proportion of diabetes mellitus in young ACS was not different from that in older ACS patients (20% vs. 18.8%; p=0.55). Hypertension was not different either (50% vs. 53.1%; p=0.49). Sixty percent of young ACS patients were smoker, however its proportion did not differ from older ACS patients (p=0.84). There were no signifi cant differences of dyslipidemia. The young ACS patients mostly experienced STEMI than NSTEMI and unstable angina (55% vs. 15% vs. 30%), but there were no signifi cant differences when compared to older ACS patients (p=0.65). Thirty percent of young ACS patients presented with Killip class II or higher, however there were no significant differences between groups (p=0.40).Conclusion: In this study we found that there were no signifi cant differences in risk factors, clinical presentation and spectrums between young ACS and older ACS patients. The need for prevention program in both groups should not be difference.Keywords: ACS– young– older– clinical presentation
Relationship Between Systemic Lupus Activity Measurement (SLAM) Score and Mortality in Systemic Lupus Erytemathosus (SLE) Inpatients
Get PDFABSTRACTBackground: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder that can be severe and life threatening. Mortality in SLE may due to lupus activity or long-term sequel. Systemic Lupus Activity Measurement (SLAM) score is a tool that can count lupus disease activity inpatients.Aims: To analyze the relationship between SLAM score and mortality in lupus inpatients.Methods: Retrospective cohort study used for reaching objective of the study. Lupus inpatients was used as research population. Medical record was used as study data collection over periods of 2006 until 2011. Independent variable was a SLAM score. The cut point of SLAM score was made based on the mean of SLAM score (16.7 point score). Dependent variable was mortality.Results: There were differences between number of ACR criteria fi ndings, pneumonia, heart rate with SLAM score (p value 0.001; 0.001; 0.002 respectively).There was a difference of median survival between less and more than 16.7 point score, 45 and 28 respectively (p 0.034). There was a relationship between SLAM score (more than 16.7 point score) and mortality HR 2.78 (96% CI 1.01-7.53). There was a difference of mortality incidence between more and less than 16.7 point score, 0.35 and 0.10 respectively. There was a relationship between SLAM score (more than 16.7 point score) and mortality RR 3.5 (95% CI). Mortality in lupus inpatients was 23%.Conclusion: There was a relationship between SLAM score and mortality on lupus inpatients.Keywords: SLE, SLAM, Mortalit
The Effect of Telmisartan and Metformin on Insulin Resistance in Metabolic Syndrome Patients with Insulin Therapy
Get PDFABSTRACTBackground: Recommendations for therapy insulin resistance are metformin and thiazolidindion. Side effects of thiazolidindion due to peripheral edema occurs to 2-5% and increased 5-15% when combined with insulin therapy. Telmisartan, an angiotensin receptor blocker, has anti-hypertensive effects and improve insulin resistance. Telmisartan effect on peroxisome proliferator activated receptor γ agonist and has the same structure of the group thiazolidindion, pioglitazone. The research objective was to determine the effects of telmisartan and metformin on insulin resistance in metabolic syndrome patients with insulin therapy.Methods: This study used a before-after design. The study was conducted in the internal medicine clinic of the endocrinology department of Dr. Sardjito Hospital Yogyakarta. Subjects were patients who met the diagnosis of metabolic syndrome based on the IDF 2005, hypertension and receive insulin therapy. Subjects given metformin and telmisartan therapy for 12 weeks. Subjects examined HOMA IR before and after treatment. The average decrease in HOMA IR was tested by paired t test or Wilcoxon test. P value <0.05 was considered signifi cant.Result: The total sample were 27 subjects. Data analysis was performed on 11 subjects. Fasting blood glucose before and after treatment was signifi cantly decreased (p<0.001) whereas the fasting insulin levels increased. HOMA IR was signifi cantly decreased after treatment {p = 0.004 (5.79 – 20.26), CI 95%}.Conclusion: this study found insulin resistance decreased signifi cantly in patients with the metabolic syndrome of insulin therapy who received metformin and telmisartan.Keywords : metabolic syndrome, insulin therapy, metformin, telmisartan, HOMA I