Acta Interna: The Journal of Internal Medicine
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ACETAMINOPHEN AND DIPHENHYDRAMINE AS MEDICATION PRETRANSFUSION THE INCIDENCE OF FEBRILE NON-HAEMOLYTIC TRANSFUSION REACTION PLATELET RECIPIENTS
No full textABSTRACTBackground. Blood transfusion can save lives, patients get the benefit but also the risk of transfusion-related. Febrile non-haemolytic transfusion reaction (FNHTR) most frequently found and have similar symptoms of other transfusion reactions, causing delays in transfusion and decrease the quality of life. Platelet recipients have a higher incidence risk FNHTR than recipients of other blood products. Medications pre-transfusion acetaminophen and diphenhydramine reduce the incidence FNHTR.Methods. The study was conducted from May to November 2010 Internal Medicine Wards, Dr. Sardjito Hospital, Yogyakarta using the method of double-blind randomized controlled trial. Inclusion criteria were first recipient of random donor non leucodepleted platelets in thrombocytopenia malignant patients and willing to participate. Exclusion criteria were fever is when will transfusions or in 2x24 hours, allergies of acetaminophen and diphenhydramine, acetaminophen and diphenhydramine consumption in the last 6 hours, the consumption of continuous corticosteroids, history of transfusion reactions and critical conditions/sepsis. Assessment of the incidence FNHTR 15 minutes before transfusion to 4 hours after transfusion. Medication group will receive a capsule containing 650 mg acetaminophen and 25 mg diphenhydramine dissolved in 5 ml 0.9% NaCl intravenously. The control group received a placebo. Drugs are given 30 minutes before the first transfusion bag. Data were analyzed using Chi-square test and p <0.05 was considered statistically significant.Results. Thirty-two patients met the criteria, 15 patients (46.87%), medication group and 17 (53.13%) patients of control group. Eleven (31.43%) patients had FNHTR, 8 (47.06%) patients of control group and 3 (20%) patients. There are differences in the proportion of incident FNHTR in both groups although not statistically significant (P = 0.04). Every patient has different risk factors on parity, history of transfusion, history of FNHTR and the long of platelet storage. Conclusion. As pre-transfusion medications, Acetaminophen 650 mg and diphenhydramine 25 mg reduced the incidence of FNHTR compared to placebo in the first platelet recipients in malignancy Key words: Acetaminophen, diphenhydramine, medication pretransfusion, FNHTR.
LEPTIN LEVEL IN NON DIABETIC POPULATION WITH AND WITHOUT NON ALCOHOLIC FATTY LIVER (NAFL)
Get PDFABSTRACTBackground. Non alcoholic fatty liver disease (NAFLD) is a prevalent condition associated with obesity and insulin resistance. Leptin is an adipokine which plays role in decreasing food intake and controlling energy utilization. The role of leptin pathogenesis of NAFLD remains unclear. Former studies associated with the role of leptin in NAFL were never conducted in diabetic patients. Therefore we aimed to analyze the difference of leptin level in non diabetic population between subjects with and without non alcoholic fatty liver disease.Method. This was a non matching case control study in general check up polyclinic Dr.Sardjito Hospital Yogyakarta. The inclusion criteria were aged 30-60 years old, no history of alcohol consumption > 20 gr/day, no diabetes mellitus. The exclusion criteria were viral hepatitis (B and C), rapid weight loss, steroid therapy, and pregnancy. Diagnosis of NAFL was based on bright liver imaging from ultrasonography.Result. There were 48 subjects consist of 23 subjects with NAFL and 25 subjects without NAFL. Mean of leptin level in NAFL group was higher than non NAFL group and this difference was statistically significant (20.29 + 15.73 ng/ml and 12.27 + 10.1 ng/ml; p=0.040).Conclusion. The conclusion of this study was leptin level significantly higher in non diabetic population with NAFL compared with non NAFL. Keywords: leptin, non diabetic, non alcoholic fatty liver
LEPTIN LEVEL IN NON DIABETIC POPULATION WITH AND WITHOUT NON ALCOHOLIC FATTY LIVER (NAFL)
Get PDFABSTRACTBackground. Non alcoholic fatty liver disease (NAFLD) is a prevalent condition associated with obesity and insulin resistance. Leptin is an adipokine which plays role in decreasing food intake and controlling energy utilization. The role of leptin pathogenesis of NAFLD remains unclear. Former studies associated with the role of leptin in NAFL were never conducted in diabetic patients. Therefore we aimed to analyze the difference of leptin level in non diabetic population between subjects with and without non alcoholic fatty liver disease.Method. This was a non matching case control study in general check up polyclinic Dr.Sardjito Hospital Yogyakarta. The inclusion criteria were aged 30-60 years old, no history of alcohol consumption > 20 gr/day, no diabetes mellitus. The exclusion criteria were viral hepatitis (B and C), rapid weight loss, steroid therapy, and pregnancy. Diagnosis of NAFL was based on bright liver imaging from ultrasonography.Result. There were 48 subjects consist of 23 subjects with NAFL and 25 subjects without NAFL. Mean of leptin level in NAFL group was higher than non NAFL group and this difference was statistically significant (20.29 + 15.73 ng/ml and 12.27 + 10.1 ng/ml; p=0.040).Conclusion. The conclusion of this study was leptin level significantly higher in non diabetic population with NAFL compared with non NAFL. Keywords: leptin, non diabetic, non alcoholic fatty live
CORRELATION BETWEEN CARDIOMEGALY AND PULMONAL DYSFUNCTION IN CHRONIC HEART FAILURE
No full textABSTRACTBackground: Cardiac enlargement or cardiomegaly always found in chronic heart failure (CHF). Progressivity of cardiac enlargement relates with pulmonal function changes in CHF. This study examined the influence of increased cardiac enlargement on pulmonal function.Methods: This is a cross sectional study on 63 CHF patient of New York heart Association (NYHA) class I and II that fulfilled inclusion criteria. Definitions of CHF based on Framingham criteria. Cardiac enlargement measured by Danzer’s methods through postero anterior chest radiography. Spirometry used to evaluate FVC and FEV1.Results: Male subjects have an equal proportion (49.21%) with female subjects (50.79%) with mean of CTR 59.47 ± 5.57%. Spirometry test showed mean predicted FVC (%) 61.83 ± 9.62, predicted FEV1 (%) 75.27 ± 12.55, and FEV1/FVC mean ratio 95.53 ± 2.19%. Coefficient correlations between cardiomegaly and FVC (%) and FEV1 (%) predicted are -0.537 (p <0.001) and -0.460 (p <0.001). duration of diseased has a negative correlation with FVC (%) and FEV1 (%) predicted (-0.329; p= 0.008 and -0.341; p=0.006).Conclusions: Cardiomegaly on CHF showed a restriction type and has a negative correlation with pulmonal function. Keywords: cardiomegaly, pulmonal dysfunction, chronic heart failur
Apoptosis In Sepsis
Get PDFINTRODUCTION The word sepsis is derived from the Greek term for rotten or “to make putrid”. Sepsis, defined as the systemic host response to microorganisms in previously sterile tissues, is a syndrome related to severe infections and is characterized by end-organ dysfunction away from the primary site of infection. To meet the definition of sepsis, patients need to satisfy at least two of the Systemic Inflammatory Response Syndrome (SIRS) criteria in association with having a suspected or confirmed infection. The severity and mortality increase when this condition is complicated by predefined organ dysfunction (severe sepsis) and cardiovascular collapse (septic shock). The normal host response to infection is complex, aiming to both identify and control pathogen invasion and start immediate tissue repair. Both the cellular and humoral immune systems are activated, giving rise to anti-inflammatory and proinflammatory responses. Exacerbating these mechanisms can cause a chain of events that leads to sepsis, promoting massive liberation of mediators and the progression of multiple organ dysfunction1.Sepsis remains a critical problem with significant morbidity and mortality even in the modern era of critical care management. Despite intense efforts, sepsis remains a serious clinical problem and still associated with a high mortality rate. Septic shock and sequential multiple organ failure/dysfunction syndrome (MOF/MODS) correlate with poor outcome, and septic shock is the most common cause of death in intensive care units. A recent review by Angus et al estimated the 1995 incidence of sepsis in the United States to be 751,000 cases, resulting in 215,000 deaths. The average cost per case of sepsis was 16.7 billion nationally. A more recent analysis of hospital records indicates that the total number of patients who are dying is actually increasing. This study also confirmed the work of Angus et al that the incidence of sepsis is increasing and projected to continue to grow as the population ages. These studies concluded that “severe sepsis is a common, expensive, and frequently fatal condition, with as many deaths annually as those from acute myocardial infarction2,3.The immunological cascade resulting in the sepsis response can be initiated by tissue injury, ischemia reperfusion injury, gram-positive organisms, and fungi as well as gram-negative organisms and their constituent endotoxin. The sepsis response may begin with an infectious nidus, which may either invade the bloodstream, leading to dissemination and positive blood cultures, or proliferate locally and release various microbial products into the bloodstream3.Multiple derangements exist in sepsis involving several different organs and systems, although controversies exist over their individual contribution to the disease process. Septic patients have substantial, life-threatening alterations in their coagulation system. Previously, it was believed that sepsis merely represented an exaggerated, hyperinflammatory response with patients dying from inflammation-induced organ injury. More recent data indicate that substantial heterogeneity exists in septic patients’ inflammatory response, with some appearing immuno-stimulated, whereas others appear suppressed. Cellular changes continue the theme of heterogeneity. Some cells work too well such as neutrophils that remain activated for an extended time. Other cellular changes become accelerated in a detrimental fashion including lymphocyte apoptosis2.The role that apoptosis plays in sepsis syndromes and in the development of CARS and MODS has not been adequately explored, but there is rapidly developing evidence to suggest that increased apoptotic processes may play a determining role in the outcome to sepsis syndromes. In particular, increased apoptosis, particularly in lymphoid tissues and potentially in some parenchymal tissues from solid organs, may contribute to the sepsis-associated MODS
A CROSS SECTIONAL STUDY QUALITY OF LIFE PEOPLE LIVING WITH HIV&AIDS: EMPHASIZE IN ANTHROPOMETRIC VALUE
Get PDFABSTRACTBackground. The nutritional problem is a significant role factor in determine of health, mortality and quality of life of people with HIV&AIDS. Therefore, it is very important to provide the nutritional assessment, nutritional management, counseling and education which are very useful to upgrade the quality of life of people with HIV&AIDS.Objective. This study was designed to analyze the correlation between anthropometric measurement with quality of life of people with HIV&AIDS.Method. The study design was a cross sectional study. The subjects were HIV&AIDS patients who came to outpatient clinic in Dr. Sardjito General Hospital Yogyakarta, from November 2009 – January 2010. Subjects eligible with inclusion criteria were examined for anthropometric measurement and fill the WHOQOL-bref questioner.Result. There were 53 subjects eligible to the study criteria from November 2009 to January 2010. Majority of the subjects were man (73.6%), single (62.3%) and live alone (58.5%), last education was high school (41.5%) and employed (73.6%). Mean of ages was 33 years old, weight 53.67±10.3kg, height 161.28±7.68cm, BMI 20.57± 3.48 Kg/m2, MUAC 24.40 ± 3.23 cm, waist circumference 76.17 ± 8.10 cm, hip circumference 87.04 ± 8.03 cm , ST 11.17 ± 8.10 mm. Mean score of total WHOQOL-bref was 75.68 ± 10.3, Domain 1 (physics) 21.32 ± 3.07, Domain 2 (psychology) 19.75 ± 3.62 , Domain 3 (social) 10.04 ± 1.87, Domain 4 (environment) 24.75 ± 4.58. There was a very weak correlation between anthropometric measurements with quality of life; with the p value was statistically insignificant.Conclusion. There was no significant correlation between nutritional statuses which is measured by the anthropometric value with the quality of life in people with HIV&AIDS. Keywords: HIV, nutrition, anthropometric, QOL
Association between Zinc Serum Level And CD4+ Count In Healthy Elderly Women At AISYIAH Elderly Club Kota Gede Yogyakarta
Get PDFABSTRACTIntroduction. Old ages are associated with physiologic deteriorations of all organs and tissues, such as involution of thymus and decreased function of gastrointestinal tract which lead to malnutrition. Involution of thymus will caused reduction of T cell subset for instance T cell CD4+. Prevalence of nutrient deficiency in old age was high, according to a survey that 35% of subjects with age above 50 years old showed deficiency for one or more vitamins and trace-elements. Zinc as one of trace-elements has vital role for immune system.Aim. Aims of this study are to know the mean of zinc serum level, proportions of zinc deficiency in elderly and correlation between zinc and CD4+ count.Methods and Subjects. Design of this study is cross sectional, with study subjects including healthy elderly women from Aisyiah elderly club at Kota Gede Yogyakarta. Elderly who were eligible with study criteria were measured height, weight, zinc serum level, and CD4+ count. Correlation test was performed to know correlation between ages, weight, body mass index (BMI), and zinc serum level with CD4+ count. Significant variables will be tested with multiple linier regressions. Level of significance is p < 0.05.Results. A total healthy elderly women subjects were 60 persons with median of age 63.5 years old. Median zinc serum level was 5.47 umol/L with range between 3.25- 7.95 umol/L. Zinc deficiency (zinc serum level < 7.65 umol/L) occured in 95% of subjects. Mean of CD4+ count was 767.22±232.95 count/mm3. There were correlations between age, weight, and zinc serum level with CD4+ count (r= -0.296; 0.345; 0.324; 0.792, respectively). Results from linear regression model showed zinc serum level was the only variable that affect to CD4+ count (adjusted R2 = 0.622).Conclusion. Ninety five percent of healthy elderly women at elderly club Aisyiah Kota Gede Yogyakarta suffer from zinc deficiencies, and there is strong correlation between zinc serum level and CD4+ count. Keyword: zinc serum, CD4+ count, elderl
Correlation Between C-Reactive Protein And Left Ventricular Ejection Fraction InN Anterior ST Elevation Myocardial Infarction
Get PDFABSTRACTBackground: C-Reactive Protein (CRP) levels were found increase in ST elevation myocardial infarction (STEMI) patients, before and after STEMI. Increase of CRP levels were able to activate complement pathway to induce inflammation by attracting neutrophil and macrophage to enter to infarcted myocardial. Infarct expansion followed by remodeling process, led to left ventricular dysfunction and decrease of ejection fraction.Aim: This study aimed to investigate a correlation between CRP plasma levels and left ventricular ejection fraction (LVEF) in anterior STEMI patients.Subject and method: This study was conducted cross-sectionally. Subjects were new anterior STEMI patients, with maximum onset of 48 hours. Exclusion criteria included evidence of infection, inflammation, history of surgery or stroke in last three months, malignancy, congestive heart failure and inferior STEMI. There were 30 subjects who met the eligible criteria. CRP blood samples were collected at least 48 hours after onset. LVEF measurement was done during hospitalization. The correlation between CRP levels and LVEF was analyzed by Spearman rank correlation test.Result: CRP levels in female subjects were higher than males [CRP median 23.4 mg/l (5.73 – 61.4 mg/l) vs. 12. 2 mg/l (5.6 – 66.5 mg/l)], but with no significance (P= 0.297). The thrombolytic therapy group had lower CRP levels than non thrombolytic therapy group [10. 7 mg/l (5.6 – 44.5 mg/l) vs. 14.7 mg/l (8.7 – 66.5 mg/l), also with no significance (P= 0.178). There was a non-significantly negative correlation between CRP level and LVEF (r = - 0.100, P= 0.597).Conclusion: There was no correlation between CRP level and LVEF in anterior STEMI
Correlation between the Symptoms of Depression and Sexual Function in Breast Cancer Patients Receiving Chemotherapy
Get PDFABSTRACT Symptoms of depression and sexual problems that occur among breast cancer patients are a rarely detected and get good handling. Therefore, an early detection for any psychological problems that may affect the sexual life of patients with breast cancer is needed so that the patients can have better life. This study aims to assess the correlation between symptoms of depression and sexual function in women with breast cancer who undergo chemotherapy at Dr. Sardjito Hospital. Research design was cross sectional. The study necquited 38 breast cancer patients in Tulip outpatients Cancer Clinic in Dr. Sardjito Hospital. Assessment of depressive symptoms used Beck Depression Inventory questionnaire and Female Sexual Function Index to assess sexual function. The results showed that the proportion of subjects aged 46-55 years at 55.2% followed by 36-45 years of age at 39.5% and aged 26-35 years by 5.3%. The mean age of subjects was 45.4 + 6.5 years. Correlation between symptoms of depression with sexual function among participants was r=- 0.30 with significance p=0.068. Correlation between symptoms of depression with the domains of sexual function domain of desire (r=-0.296, p=0.072), stimulation (r = -0.470, p = 0.003), lubrication (r=-0.353, p=0.030), orgasm (r=-0.223, p=0.179), satisfaction (r=-0.233, p=0.158), pain (r=-0.186, p=0.262). The conclusion is that there is no correlation between symptoms of depression with sexual function. Keywords: Depression symptoms, Breast Cancer, Sexual Dysfunctio
Effect of Curcuminoid versus Diclofenac Sodium on Monocytes Secretion of Tumor Necrosis Factor–α in Knee Osteoarthritis
Get PDFABSTRACTBackground. Tumor Necrosis Factor-α (TNF-α), a pro-inflammatory cytokine produced by monocyte is increased in osteoarthritis synovial fluid. Curcuminoid from Curcuma domestica Val. suppresses the secretion of TNF-α.Objective. The purpose of this study was to investigate the suppression effect of curcuminoid from Curcuma domestica Val on synovial fluid monocyte’s TNF-α secretion compared to diclofenac sodium in knee osteoarthritisMethods. A prospective randomized open end blinded evaluation (PROBE) method was applied. Subjects were patients with knee osteoarthritis visiting Rheumatology Clinic Dr. Sardjito Hospital and Wirosaban Hospital Yogyakarta. Curcuminoid 30 mg three times daily or diclofenac sodium 25 mg three times daily were administered for 4 weeks. The level of TNF-α secreted by synovial fluid’s monocytes were measured by ELISA before and after treatment.Results. A total of 80 subjects were enrolled, 39 subjects on curcuminoid treatment groups and 41 subjects on diclofenac sodium group. Seven subjects were dropped out, 5 from the curcuminoid group and 2 from the diclofenac sodium group. There was a significant decrement of TNF-α level during 4 weeks treatment in both groups (p< 0.001 respectively). There was no significant difference on TNF-α levels between groups (p= 0,237), neither in 50% decrement of TNF-α levels (p= 518).Conclusion. The effect of curcuminoid in decreasing TNF- α level on patients with osteoarthritis is similar with sodium diclofenac. Keywords: osteoarthritis-monocyte-TNF-α-curcuminoid-diclofenac sodiu