Acta Interna: The Journal of Internal Medicine
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THE DIFFERENCE OF SERUM CARBOXY-TERMINAL PROPEPTIDE OF PROCOLLAGEN TYPE I (PIP) IN STAGE A, B AND C HEART FAILURE PATIENTS CAUSED BY HYPERTENSION
Get PDFABSTRACTIntroduction. Arterial hypertension affects the heart tissue composition which leads to structural remodeling of the myocardium. The imbalance between synthesis and degradation of type I collagen leading to myocardial fibrosis in a form of type I collagen fiber accumulation in the interstitial and perivascular myocardium. Collagen fiber accumulation reduces relaxation stage, diastolic suction, myocardial stiffness and diastolic dysfunction which affect systolic dysfunction leading to heart failure. Concentration of carboxy-terminal pro peptide of pro collagen type I (PIP) in peripheral blood am a synthesis index of type I collagen in HHD. Thus, the measurement of PIP is useful to monitor myocardial fibrosis stage in heart failure and to determine the therapeutic strategy that aims not only to reduce arterial pressure and left ventricular mass but also to prevent myocardial remodeling.Aim of the study. The aim of the study was to ascertain the difference PIP level in patients with the heart failure stage A, B, and C which are caused by hypertension. The serum concentration of PIP was measured by enzyme immunoassay. This research was a cross sectional research designed for cardiology policlinic’s outpatients at Dr. Sardjito General Hospital Yogyakarta from August 2009 until the calculated sample number is fulfilled. Method. One-way ANOVA was used to analyze the differences between the three groups of heart failure stages after being tested for the normality using Kolmogorov-Smirnov normality test. If the result did not show a normal value, a non-parametric test would be undergone using Kruskal-Wallis test followed by Mann-Whitney U test. The differences considered as significant if p < 0.05 with a confidence interval of 95%.Result. The research was performed in 64 patients heart failure caused by hypertension consisted of 22 stages A, 19 stage B and 23 stage C. PIP mean levels of the group stage B 819.78 ± 91,03 ng/ml was higher compared stage A 808.47± 80.8 ng/ml and PIP mean level stage C 852 ± 55.51 ng/ml was higher compared stage B. The PIP mean levels did not differ statistically significantly (p=0. 317).Conclusion. There were no significant differences in serum level of PIP on the stage heart failure A, B and C. Keywords: Collagen, fibrosis, hypertension, heart failure, carboxy-terminal pro peptid
Impact of irrational antibiotic therapy to hospital cost of care of pneumonia in patients in Dr. Sardjito Hospital
Get PDFABSTRACTBackground: The mortality rate from pneumonia remains very high, reaching 15% in the United States while inIndonesia pneumonia is the second leading cause of death. Antibiotics improve outcomes in those with bacterialpneumonia. Irrational antibiotic therapy impacts to bacteria resistance, potentially increasing side effects of drugs,prolonged patient’s length of stay and higher total hospital costs.Aim: This study aimed to improve the service quality by calculating the percentage of irrational antibiotic therapybased on Gyssens workfl ow and the additional total of consumables antibiotics costs.Methods: The study design was retrospective, including 57 pneumonia inpatients in internal medicine departmentwards in Dr. Sardjito Hospital, from November 2011 to January 2012. Statistical analyses were conducted byusing Mann-Whitney U test.Results: From 57 pneumonia inpatients, irrational antibiotic therapy reached 68,4% (39 of 57 patients).Azithromycin was misused and overused antibiotic. Total excess cost of daily antibiotic were Rp 294,000.00and consumables antibiotics were Rp 215,000.00Conclusion: Irrational antibiotic therapy in pneumonia is associated with and an overall impacts on healthcarecosts.Keywords: irrational antibiotic therapy, health-care cost, and customer satisfaction
Plasma Angiotensin II Levels In Women With Type 2 Diabetes With Or Without Hypertension
Get PDFABSTRACT Background. Hypertension is a major risk for the development and progressivity complication of macro and microvascular of diabetes mellitus. Renin-angiotensin-aldosteron system (RAAS), insulin resistance, endothelial dysfunction and autonomic nervous dysfunction play an important part in the pathogenesis of hypertension and type 2 diabetes mellitus. In RAAS, increased angiotensin II constricts arterioles, raises total peripheral resistance and blood volume. The rise in intravascular volume increases risk of hypertension. Glucotoxicity or hyperglycemia in type 2 diabetes mellitus can increases angiotensin II levels.Aim. To evaluate plasma angiotensin II levels in type 2 diabetes mellitus women with or without hypertension.Methods. Cross sectional design was conducted on subjects from outpatients’ women with type 2 diabetes mellitus at endocrinology clinic, Dr. Sardjito General Hospital, Yogyakarta. Hypertension was assessed using criteria from Seventh Joint National Committee (2003). ELISA sandwich method was used to measure plasma angiotensin II levels from blood vein. Differences between groups were compared by student’s unpaired t-test and Mann-Whitney test.Results. Among 60 subjects, there are 30 with hypertension (50%) and 30 without hypertension (50%). Mean age were 54.11 ± 3.36 years old. Plasma angiotensin II levels was higher in women with type 2 diabetes mellitus with hypertension than without hypertension although significance was not reached (0.30 ± 0.15 ng/mL vs. 0.28 ± 0.18 ng/mL, p= 0.93).Conclusion. The plasma angiotensin II levels are not significantly different between type 2 diabetes mellitus women with or without hypertension. Key words: hypertension, plasma angiotensin II, type 2 diabetes mellitus, wome
MANIFESTATIONS OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS-INDUCED KIDNEY DISORDERS
Get PDFINTRODUCTIONNon-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed medication.1 The gastrointestinal tract and kidneys are important targets of clinical events associated with the use of NSAIDs.2 Selective COX-2 inhibitors have minimal gastrointestinal side effects. However, the newer NSAIDs also has nephrotoxic effects remain as nonselective NSAIDs.1The kidneys are the major organ for drug excretion, so that the renal arterioles and glomerular capillaries are especially vulnerable to the effects of drugs. 3 The spectrum of NSAID-induced nephrotoxicity includes acute tubular necrosis, acute tubulointerstitial nephritis, glomerulonephritis, renal papillary necrosis, chronic renal failure, salt and water retention, hypertension, and hyperkalemia. 1Among the various clinical complications, the effects on the kidney are probably the most common and severe due to the use of NSAIDs.4 Fifty million US citizens report NSAIDs use, and it has been estimated that 500.000 – 2,5 million people will develop NSAID nephrotoxicity in the US annually. 5 It has been reported that 37% of drug-associated acute renal failure is associated with the use of NSAIDs, and NSAID-induced acute renal failure accounts for 7% of overall cases of acute renal failure. 4This review discusses the NSAIDs, mechanisms and clinical manifestations of NSAID-induced renal impairment and some NSAID options that can be used in patients with renal failure.
JAK2 mutation and treatment of JAK2 inhibitors in Philadelphia chromosome-negative myeloproliferative neoplasms
Get PDFABSTRACTThe Philadelphia chromosome-negative (Ph-negative) myeloproliferative neoplasms (MPNs) polycythaemia vera (PV), essential thombocythaemia (ET) and primary myelofi brosis (PMF) are clonal disorders of multipotent haematopoietic progenitors. The genetic cause of these disorders was not fully defi ned until a somatic activating mutation in the JAK2 non-receptor tyrosine kinase, JAK2V617F, was identifi ed in most patients with PV and a considerable proportion of patients with ET and PMF. The discovery of JAK2 mutation has changed the molecular reclassification of MPNs and served as a genomic target for therapeutic implication. A number of JAK2 inhibitors have been developed and tested for MPNs. Several JAK2 inhibitors have reached the phases of clinical trial and included patients with intermediate-risk or high-risk MF. This population of MF is the best candidate for trials because currently it has no effective therapy besides patients’ poor survival. Considering all clinical data on Ph negative MPNs, JAK2 inhibitors have shown a clinical benefi t and reduced symptoms in the vast majority of MF cases. The most developed among JAK2 inhibitors is Ruxolitinib, which has demonstrated clinical improvement with well tolerated toxicities. However, JAK2 inhibitor was equally active in patients with and without JAK2 mutation. Other JAK2 inhibitors are less developed, but showed a similar clinical benefi t. Furthermore, its effect on the natural course of MPNs in treating patients needs to be investigated.Keywords: myeloproliferative neoplasms – JAK2 mutation – JAK2 inhibitors
CORRELATION OF DEPRESSION SYMPTOMS WITH FEMALE SEXUAL FUNCTION INDEX IN FEMALE HEMODIALYSIS PATIENTS
Get PDFABSTRACTIntroduction. Hemodialysis patients experience major changes in lifestyle and suffer various physical and emotional symptoms, especially symptoms of depression and sexual dysfunction in more than half of patients. Sexual dysfunction in women is often not identified because of lack of attention, especially by the clinician. Symptoms of depression limit intimacy, and affect sexual arousal and orgasm. Aim : the aim of the study was to determine the correlation between depressive symptoms and female sexual function index (FSFI) in women hemodialysis patients in the Hemodialysis Unit of Dr. Sardjito General Hospital Yogyakarta.Methods. The method of this study was cross-sectional. Research was conducted at the Hemodialysis Unit by Dr. Sardjito General Hospital Yogyakarta from 10 April to 24 April 2012. Result. There were 42 female patients undergone routine hemodialysis who met the criteria. The median age was 49 years old and had undergone hemodialysis for a median duration of 40 months. Conclusion. There was a negative correlation of depression symptoms and female sexual dysfunction with a moderate strength (r = -0.421) and statistical significantly (P <0.05). Age and prolactin had a negative correlation with a moderate strength of FSFI score. HDL levels and menstrual status had a positive correlation with FSFI, with weak and strong correlation respectively. Key Words: Female sexual function index, depression, hemodialysi
Differences of lung function in elderly patients with and without hypertension in RSUP Dr. Sardjito Yogyakarta
Get PDFABSTRACTBackground: In the elderly, there is a decrease in lung vital capacity to 68%. The prevalence of hypertension is at the age above 65 years with 13% of the population. The Incidence of lung function decline in chronic heart failure and hypertension was found mainly in the elderly.Aims: The aim of the study was to know the differences ilung function in elderly patients with and without hypertension.Methods: The Study was cross-sectional, a study in November 2012 until January 2013 of the elderly population over 60 years of research with a sample of 58 people (29 people and 29 groups of hypertensive people without hypertension). Inclusion criteria for the study subjects were elderly patients over 60 years of signing the informed consent, can perform spirometry maneuvers correctly. Data were analyzed by T-test to examine some differences in the mean or median, between the two groups.Results: In this research, there were no signifi cant difference in lung function as measured by FVC and FEV1 in the elderly with hypertension and without hypertension (p = 0.984, 95% CI-0, 13-0,139 for FVC and p = 0.83, 95 IK-0, 14-0,116% for FEV1).Conclusion: There is no signifi cant difference in lung function in the elderly with and without hypertension.Keywords: elderly, hypertension, pulmonary function1Specialit
TREATMENT PATTERNS OF PATIENTS WITH RHEUMATOID ARTHRITIS ACCORDING TO THE PRESENCE OF RHEUMATOID FACTOR
No full textABSTRACTBackground: High titer of rheumatoid factor (RF) in the serum of patients with rheumatoid arthritis (RA) is mostly associated with more severe disease and presence of extra-articular features. To choose the best treatment of RA need the combination of science and art. Objective: the aim of the study was to find the comparison of pharmacological treatment patterns in rheumatoid arthritis patients according to the presence of rheumatoid factor in the serum.Method: This study was a retrospective quantitative observational. The data was collected from medical records of new patients with rheumatoid arthritis who came to the appointment at Rheumatology Clinic Dr. Sardjito Hospital, Yogyakarta in 2010.Results: The total of 39 new patients was eligible in this study. A corticosteroid was the most commonly prescribed (93% of the sero-positive and 84% of the sero-negative patients). Disease modifying anti rheumatic drugs (DMARDs) were used in 92% sero-positive and 84% sero-negative patients (p=0.827; df=6). In choosing the DMARDs, Chloroquine was the most commonly prescribed (29% of sero-positive and 44% of sero-negative patients), followed by methotrexate (21% of sero-positive and 24% of sero-negative) and suphasalazine (21% of sero-positive and 0% of sero-negative). Leflunomide, doxycycline and combined DMARDs were some time prescribed. Non steroidal anti-inflammatory drugs (NSAIDs) were used in 64% sero-positive and 68% sero-negative patients. Conclusion: Corticosteroid was the most commonly prescribed drug. There was no difference between the sero-positive and sero-negative of total patients using DMARDs. Keywords: Rheumatoid arthritis, rheumatoid factor, corticosteroid, diseases modifying anti-rheumatic drugs, non-steroidal anti-inflammatory drugs
THE ENDOTHELIN-1 LEVEL OF FEMALE TYPE 2 DIABETIC PATIENTS WITH AND WITHOUT MICROANGIOPATHY COMPLICATIONS
No full textBackground. Chronic complications of diabetes mellitus (DM) include microangiopathy and macroangiopathy. Microangiopathy includes retinopathy, nephropathy and neuropathy, while macroangiopathy includes coronary heart disease, stroke and peripheral arterial disease. When the diagnosis is established in Type 2 Diabetes Mellitus (DM), approximately 25% had suffered non‐proliferative diabetic retinopathy. Within one to three years of non-proliferative retinopathy progresses to proliferative diabetic retinopathy can eventually be leading to retinal detachment, glaucoma and blindness. Diabetic nephropathy occurs in 20‐40% of patients with diabetes mellitus. Diabetic nephropathy is the leading cause of End Stage Renal Disease (ESRD) and is a high risk of Cardiovascular Disease (CVD). Endothelial dysfunction underlies all of this. Markers of endothelial dysfunction endothelin‐1 are assessed in patients with type 2 diabetes with retinopathy or nephropathy and without retinopathy and nephropathy.Aim of the study. The aim of the study is to show the differences between the level of Endothelin-1 on female patients Type-2 Diabetes Mellitus with retinopathy or nephropathy compared to those without retinopathy and nephropathy.Method and subjects. This study uses a cross sectional design which was conducted on subjects from outpatient type 2 diabetes mellitus women with retinopathy or nephropathy compared without retinopathy and nephropathy at endocrinology clinic, Dr. Sardjito General Hospital, Yogyakarta. ELISA sandwich’s method was used to measure plasma levels of endothelin‐1 from veins blood. Differences between groups were compared by student’s unpaired t‐test and Mann‐Whitney test (significant when p<0.05). Diabetic retinopathy is enforced through inspection fundoscopy. Diabetic nephropathy is diagnosed by albumin creatinine ratio (ACR) ≥ 30ug/mg.Result. The results showed that there were 52 female subjects with type 2 DM is composed of them 26 (50%) subjects with retinopathy or nephropathy and 26 (50%) subjects without retinopathy and nephropathy. Median age was 54 (44‐59) years. The mean level(s) of endothelin‐1 obtained (was higher) in women with type‐2 diabetes mellitus with retinopathy or nephropathy (was) 19,47 ± 9,94 ng / ml (and) (compared) with no retinopathy and nephropathy (was) 17,64 ± 11,63 ng / ml (with) (although the difference was not statistically significant) p = 0,944.Conclusion. (Endothelin‐1 levels were higher in women with type‐2 diabetes mellitus with retinopathy or nephropathy than without retinopathy and nephropathy, but the difference was not statistically significant.) No significant difference in endothelin-1 level between type 2 diabetic female patients with and without microangiopathy complications). Key words: endothelin‐1, diabetic retinopathy, diabetic nephropathy, type 2 diabetes mellitus.
Effects of latihan pasrah diri in quality of life in chronic kidney disease-dialysis patients with depression symptoms
Get PDFABSTRACTBackground: Patients with chronic kidney disease (CKD) suffering from various physical and emotional symptoms show depression and disturbance in quality of life. Patients with chronic kidney disease have a decreased quality of life, and mortality rate about 22% in every year. Depression in patients with CKD must be managed properly because a large effect on HRQOL (Health Related Quality of Life) and the potential side effects on the management of patients with CKD. Latihan pasrah diri (LPD) is a method combining relaxation and remembrance with a focus on breathing exercises and words contained in the dhikr (relaxation and repetitive prayer). The rise of the relaxation response is expected to improve the symptoms of stress or depressive symptoms, which is expected to improve HRQOL.Objective: This study aimed to determine the effect of LPD on quality of life in hemodialysis patients with depressive symptoms that was compared with controls.Methods: The research constituted the study of Randomized Control Trial. The research was measured the KDQOL-SF scores (Kidney Disease Quality of Life-SF) in subjects with LPD treatment during 21 days, compared with controls. The research was conducted at the Hemodialysis Unit of Dr. Sardjito Hospital, Yogyakarta, from May to June 2012. A total of 36 patients who met the inclusion criteria were randomized and divided into LPD group (n = 18) and control group (n = 18).Results: Found a statistically signifi cant decrease in BDI scores in both groups, 23.00 ± 5.34 to 15.00 ± 8.55 (p = 0.001) in the LPD group and 23.00 ± 5.34 to18.33 ± 6, 66 (p = 0.022) in the control group. KDQOL-SF scores after treatment when compared between the LPD and control groups experienced different changes were statistically signifi cant in domains effects of kidney disease 59.65 ±23.52 compared to 39.41 ± 20.03 (p = 0.022), sleep 69 ± 13.17 compared to 46.53. (p = 0.000), overall health 73.89 ± 16.85 compared to 57.22 ± 19.04 (p = 0.009), pain 64.86 ± 20.80 compared to 42.36 ± 24.90 (p = 0.005), general health 53.88 ±16.05 compared to 47.78 ± 20.74 (p = 0.014), and the physical component scale 35.98 ± 6, 83 compared to 29.12 ± 6.46 (p = 0.004). Despite increased KDQOL-SF domain scores, but there were 2 domains that Δ KDQOL-SF score changes were statistically signifi cantly different compared with the control group, which was the domain of sleep and overall health.Conclusion: Latihan pasrah diri twice a day during 21 days (3 weeks) can improved the quality of life of patients with symptoms depression in CKD patients undergoing hemodialysis in domains of sleep and overall health.Keywords: CKD, depression, latihan pasrah diri, KDQOL-SF