Ahmad H. Asdie Ahmad H. Asdie
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Diabetes Mellitus dan Sulfonilurea Ahmad H. Asdie, Ahmad H. Asdie
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 21, No 01 (1989)
Publisher : Universitas Gadjah Mada

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Abstract

Diabetes mellitus characterized by increased blood glucose level (hyperglycemia) is currently recognized to be a heterogenous disorder. Although there has been general acceptance of the classification adopted by WHO Expert Committee on Diabetes Mellitus in 1980, the WHO Study Group revised the classification in 1985. The most important change from the previous classification is the appearance of malnutrition-related diabetes mellitus as a major subclass, ranking with IDDM (insulin-dependent diabetes mellitus) or type I diabetes mellitus and NIDDM (non-insulin- dependent diabetes mellitus) or type II diabetes mellitus.Sulfonylurea orally administered hypoglycemic agents have been used in the treatment of NIDDM for more than 30 years. Despite this fact, the mechanism responsible for hypoglycemic action of sulfonylurea agents remains controversial. Sulfonylureas are now generally thought to act by improving both the ability of pancreatic islets to secrete insulin and the response of tissues to insulin. There are two kinds of sulfonylureas, so-called first•generation sulfonylureas (tolbutamide and chlorpropamide) and second-generation sulfonylureas (glybenclamide, glyclazide, glypizide, and glyquidone), now available in Indonesia. The indications, contraindications, and guidelines for the use of these agents, as well as their mechanisms of action and the differences among them, are reviewed in this article.Key Words: classification of diabetes mellitus - sulfonylureas - hyperglycemia - malnutrition -- insulin
Diagnosis dan Kelasifikasi Diabetes Mellitus Ahmad H. Asdie, Ahmad H. Asdie
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 20, No 02 (1988)
Publisher : Universitas Gadjah Mada

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This paper presented the main recommendations for the definition and classification.of diabetes mellitus and of impaired glucose intolerance in non-pregnant adults.Diabetes mellitus is not a disease in the classical sense but is more probably a syndrome best characterized as a state of chronic hyperglycemia of various etiology. It may present with acute symptoms that include polyuria, polydipsia and unexplained weight loss and these can progress to life threatening ketoacidosis or hyperosmolar coma. Chronic hyperglycemia may be asymptomatic, but it has long been recognized as a predisposing factor for specific microvascular complications, namely neuropathy, retinopathy and nephropachy.Blood glucose concentration is the most common, variable used to define diabetes mellitus, but the increased blood glucose is not the sole pathological manifestation, nor has it been proved beyond doubt to be first in the pathological sequence. The limit between physiological and pathological values of blood glucose concentration is still debatable. An area of particular difficulty is the evaluation of situation that are near the physiological limit.New criteria for the diagnosis of diabetes mellitus and other catagories of glucose intolerance have been developed by National Diabetes Data Group (1979) and these have been endorsed by World Health Organization in 1980 and revised in 1985.Key Words: diabetes mellitus — target screening — chronic hyperglycemia — glucose intolerance -- hyperosmolar coma
The management of hyperlipidemia Ahmad H. Asdie, Ahmad H. Asdie
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 23, No 03 (1991)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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In terest in hyperlipidemia is related to its role in atherogenesis. The connection between bloodcholesterollevels and varibus manifestations of coronary heart disease has long been apparent.However, proof that this connecton is causal has been more elusive. For particular subpopulations it has been demonstrated that lowering elevated cholesterol levels can lead to fewer coronary heart disease events; this provides strong evidence of a causal relationship which can furthermore be favourably influenced.The significant lipid element contributing of plaque formation appears to be low density lipoprotein cholesterol, but its derivation in plaques in quite complicated. Low density lipoprotein and possibly intermediate density lipoprotein, with a somewhat lower cholesterol content, are known to enter sub-in finial spaces directly and they may do so in association whit cellular migration. Locally produced endothelial-derived relaxing factor.Despite the massive study on the subject of lipids, atherogenesis and its complications, much of our therapeutic endeavour still relates to hypothesis rather than established facts based on observations in humans. Key Words: hyperlipidemia - lipoproteins diet - physical exercise - antilipidemic drugs
Penatalaksanaan Diabetes Mellitus pada Orang Dewasa Ahmad H. Asdie, Ahmad H. Asdie
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 20, No 03 (1988)
Publisher : Universitas Gadjah Mada

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The aim of the diabetic treatment is to restore glucose intolerance to normal. There are abundant evidence that chronic hyperglycemia, from whatever cause, leads to chronic complications, such as angiopa thy, retinopathy, nephropathy and neuropathy. Prophylactic treatment should include good diabetic control and avoidance of other factors involving pathogenesis of atherosclerosis, e. obesity, smoking and hypertension. To achieve this aim, all diabetics, regardless of their age or the severity of their diabetes, must take an active role in managing their disease, and they must have adequate information about the importance of dietary management and must be instructed in suitable diet planning. Diet remains the cornerstone of the treatment of diabetes in adults. Meal-schedule, caloric intake and the composition of the diet must be a relative constant, against which is computed the necessary medication and the individuals exercise habits.Education of diabetic patients and their families should begin at the time of diagnosis. In long term diabetes education, the basic concepts of management should be reviewed together with patients during clinic visits at stated interval.Ketonuria usually means that insulin will be necessary.Key Word: diabetes mellitus — home glucose monitoring — dietary management — glocuse intolerance — diabetic education.
Association ofIgpertension with diabetes mellitus Ahmad H. Asdie, Ahmad H. Asdie
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 24, No 01 (1992)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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Abstract

The clinical impression of association between hypertension and diabetes mellitus has not been consistently confirmed by epidemiological studies. The variety of methodological problems in this area of research includes the choice of appropriate patients and control group, the measurement techniques used, and consideration of many possible confounding variables.Hypertension in diabetes mellitus patients contributes substantially to the increased cardiovascular morbidity and mortality, and should be actively treated as accurately as diabetes mellitus itself. The first therapeuticstep is reduction of overweight, saltintake, and stopsmoking; the omission of interfering drugs and adequate education. Prescription of diuretic drugs or alternatively of calcium antagonists, vasodilators of hydralazin or prazosin. The adds of minoxidil or cap topril to the previousdrugsshouldonlybe taken after evaluation of the overall situation. It should be kept in mind that all anti-hypertensive agents have disadvantages, some of them serious, when used for diabetic patients Key Words: diabetes mellitus - hypertension - cardiovascular mortality - anti-hypertensive treatment - overweight
The Role of Lipids in Atherogenesis Ahmad H. Asdie, Ahmad H. Asdie
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 26, No 02 (1994)
Publisher : Universitas Gadjah Mada

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Abstract

Hiperkolesterolemia, hipertensi, diabetes dan merokok telah lama diakui sebagai faktor risiko utama penyakit jantung koroner. Komponen utama bercak aterosklerotik adalah timbunan lipid, terutama ester kolesterol dan kolesterol, proliferasi dan perubahan sel otot polos intima arteri. Timbunan lipid dalam intima arteri terutama berasal dari low-density lipoprotein (LDL) yang telah termodifikasi dalam darah. Hal ini terjadi sebelum proliferasi otot polos intima timbul. Walaupun hubungan kausal antara hiperkolesterolemia dan penyakit jantung koroner sudah lama diterima para pakar, namun mengenai peran trigliserida dan jenis lipoprotein lainnya (high density lipoprotein, HDL) masih belum didapatkan kesepakatan. Dalam makalah ini dibahas pecan lipid dalam proses aterogenesis.Disimpulkan bahwa kelainan lipid yang berupa peninggian kolesterol (dan LDL) dan trigliserida (VLDL, terutama VLDL-sisa), dan.penurunan HDL merupakan faktor risiko bebas aterogenesis. Faktor hormonal ikut berperan dalam proses aterogenesis, dan diduga melalui efek hormon terhadap metabolisme lipid.Key Words : atherosclerosis - lipid - lipoprotein - apolipoprotein - coronary heart disease
Role of insulin resistance and hyperinsulinemia in cardiovascular disease Ahmad H. Asdie, Ahmad H. Asdie
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 25, No 03 (1993)
Publisher : Universitas Gadjah Mada

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Abstract

Resi,stance to insulin-stimulated glucose uptake is present in the great majority of patients with impaired glucose tolerance or type 2 diabetes mellitus, in first degree relatives of patients with type 2 diabetes mellitus, as well as in approximately 25% of non-obese individuals with normal oral glucose tolerance. Deterioration of glucose tolerance can be prevented if beta cell is able to produce more insulin resulting hyperinsulinemia.The association between hypertension and diabetes mellitus is well recognized. Several reasons for the coexistence of these disorders have been postulated, i.e. as part of aging process, diabetes causes macrovascular and microvascular disease, renovascular stenosis which is enhanced by the development of hypertension. Insulin causes renal sodium reabsorption, stimulates the sympathetic nervous system, increases intracellular calcium, and is a vascular growth factor.Insulin resistance, hyperinsulinemia, impaired glucose tolerance, increased plasma triglyceride, and decreased HDL-cholesterol concentration have been shown to be associated with increased risk of coronary heart disease. Based upon these considerations, it raised the possibility that insulin resistance and hyperinsulinemia are involved in the etiology and clinical course of three major related disease; the type 2 diabetes mellitus, hypertension, and coronary heart disease.Key Words: hyperinsulinemia insulin resistance cardiovascular disease glucose homeostasis aging
Management of myocardial infarction and the post-infarction patient Ahmad H. Asdie, Ahmad H. Asdie
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 24, No 02 (1992)
Publisher : Universitas Gadjah Mada

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Acute myocardial infarction is the most common form of premature death in the industrial world. Its early recognition and active intervention are becoming important in the light of recent advances, particularly the use of streptokinase shortly after the onset of the infarct. Cardiopulmonary resuscitation (CPR) is important both inside and outside the hospital. General practitioners should be confident in performing both basic life support and advanced cardiac life support since the potential needs for resuscitation is becoming great.In semi-rural areas where the general practitioner is usually the first to be called for assistance, the use of advanced resuscitation and life support does save lives. The defibrillator is an essential piece of equipment for monitoring, diagnosis, management and treatment in these cases.Following myocardial infarction the family physician has a major role to play in rehabilitation and tertiary prevention by prescribing beta-blockers, starting within two weeks of the infarct.Key Words: myocardial infarction - premature death - CPR - streptokinase - defibrillator
The innocent murmurs Ahmad H. Asdie, Ahmad H. Asdie
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 13, No 02 (1981)
Publisher : Universitas Gadjah Mada

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In this article the innocent murmur includes only those murmurs that are associated with no known abnormality, either structural or physiologic. The term "functional murmur" and "physiologic murmur" are avoided, because they may include even murmurs resulting from dilatadon of valves, heart chamber, and vessels or are associated with acceleration of the circulation.The innocent murmurs are common and are often misinterpreted. Misinterpretation of innocent murmurs may lead to anxiety on the part of both physician and patient, to a prolonged period of unnecessary restriction of physical activity, and perhaps to permanent cardiac neurosis. They may also lead to exclusion of healthy young people from athletic activities, flying, and military service, or to the use of unnecessary prophylactic penicillin. The distinction between an organic murmur and an innocent murmur is enlargement, no history of rheumatic fever; absence of cyanosis, clubbing, and congestive heart failure.KeyWords: innocent murmur - functional murmur- physiologic murmur - venous hum
Patogenesis Diabetes Mellitus Tidak Bergantung Insulin (Non-/fain/in Dependent Diabetes Mellitus) Ahmad H. Asdie, Ahmad H. Asdie
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 21, No 03 (1989)
Publisher : Universitas Gadjah Mada

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Abstract

The paper described a Short review of mechanism of glucose intolerance in most non-innilin dependent diabetics which is now clear that is not caused by defect in insulin secretion.alone. Genetic predisposition, impaired glucose-mediated insulin secretion, excessive basal hepatiC gluciase production (HGP) and cellular resistance to insulin action have been docuthented in NIDDM:The increase in basal HGP is the primary factor responsible for fasting hyperglycemia, where as both insulin resistance in peripheral tissues and relative defective insulin secretion contribute to the impaired glucose disposal following oral or intravenous glucose administration. Both receptor and post-receptor defects contribute to the insulin resistance observed in non-insulin dependent diabetic patients.The heterogeneity of NIDDM may present as insulin "resistant or insulin sensitive variety:Key Words: NIDDM -- insulin secretion --hepatic glucose produCtion -- insulin resistance type -- insulin sensitive type,