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journal of internal medicine
Published by Universitas Udayana
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Articles 162 Documents
FAKTOR-FAKTOR YANG MEMPENGARUHI TINGKAT KETIDAKPATUHAN PENDERITA TUBERKULOSIS DALAM BEROBAT DI POLIKLINIK DOTS RSUP SANGLAH DENPASAR Bagiada, I Made; Putri Primasari, Ni Luh
journal of internal medicine Vol. 11, No. 3 September 2010
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Abstract

Tuberculosis (TB) is a major public health problem in the world, especially in developing countries such as Indonesia. Itremains a major contributor to the global burden of disease and has received considerable attention in recent years, particularlyin developing countries. In our country, there is a little information about factors that can predict the adherence of TB patients.The objective of this study was to know factors contributing in non-adherence TB patients in polyclinic DOTS RSUP SanglahDenpasar. This study was a cross-sectional descriptive study of 15 adult newly diagnosed TB patients. Patients interviewed withquestionnaires consist of demographic and reasons of their non-adherence for TB treatment. About 12 (80%) of TB patients weremale. We didn?t ! nd much different in knowledge, work, educational status, and home distance among TB patients to in" uencethe adherence of the patients. The most important factor in" uencing the adherence of TB patients were drug side effects. Thedrug side effects were gastritis and skin itch (found in 10 and 3 patient respectively). Another reason for non-adherence in TBtreatment were over estimated and cost.Adherence was one of the potential factors to increase cure rate in TB patients. Non- adherence not only decreasing curerate in TB patients, but also as a risk for MDR TB. By determining inhibition factors in the treatment of TB patients, we canimprove the effectiveness of TB treatment.
KORELASI ANTARA OBESITAS SENTRAL DENGAN ADIPONEKTIN PADA LANSIA DENGAN PENYAKIT JANTUNG KORONER Aryana, IGPS; Kuswardhani, RA Tuty; Suastika, K; Santoso, A
journal of internal medicine Vol. 12, No. 2 Mei 2011
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Obesity is rapidly becoming a global problem not only in developed countries but also in developing countries such asIndonesia. Visceral obesity (central obesity) is an importance risk for cardiovascular disease and recognition that adipose tissuecan be regarded as a large endocrine organ that secreted inflammatory and anti inflammatory molecules (adiponectin). This studyaims to know the correlation between central obesity and adiponectin in geriatric Coronary Heart Disease (CHD) patients.Thisstudy was cross sectional analytic study of geriatric CHD at out and in patients in Sanglah Hospital. Data are presented as groupmean ± SD and analyzed by t-test, chi-square, and Pearson correlation with SPSS 12 software.Forty five patients (35 males and 10 females), 23 patient unstable angina pectoris, 14 patient acute myocardial infarction,and 8 patient stable angina pectoris were recruited and examined. There was high prevalence of central obesity 51.1% (23patients). Mean of log adiponectin were significantly difference between central obese and non central obese (1.80 ± 0.61 vs 1.09± 0.41 with p). Central obesity increased risk of hypoadiponectinemia 5 times than non central obesity (p = 0.011, CI 95% 1.4- 17.8). Waist circumference has negative correlation with log plasma adiponectin (R = -0.663, p < 0.001).There was high prevalence of central obesity in geriatric coronary heart disease patients. Central obesity increased risk ofhypoadiponectinemia 5 times than non central obesity. Waist circumference has negative correlation with plasma adiponectin.Increased of waist circumference will decrease of adiponectin (cardioprotective protein) and will increase risk of Acute CoronarySyndrome in geriatric patients.
DISTRIBUSI GEOGRAFIS PENYAKIT GINJAL KRONIK DI BALI: KOMPARASI FORMULA COCKCROFT-GAULT DAN FORMULA MODIFICATION OF DIET IN RENAL DISEASE Raka Widiana, I Gde
journal of internal medicine Vol. 8, No. 3 September 2007
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Chronic kidney disease (CKD) is related to the increased of cardiovascular morbidity and mortality. Thisstudy is aiming to identify the prevalence of CKD based on demographical distribution in Bali. A communitybased study has been conducted in Bali, 1) height region among indigenous community in a village at northernpart of Bali island using cluster random samples.; 2) in urban area at Denpasar city using stratified randomsampling and 3) in isolated coastal area in Nusa Ceningan island using cluster random sampling. The glomerularfiltration rate was calculated by Cockroft-Gault (C-G) formula and abbriviated Modification of Diet in RenalDisease ringkas with 4 variables (MDRD-4). The results of GFR using both calculation were compared. CKDwas defined based on KDOQI classification, namely GFR less than 60 ml/mnt. During the study 826 sampleswere collected consisted of 219 from height region (males/females 118/101, aged 48±15 years, BW 48.9±10.4kg, creatinine 0.97±0.64 mg/dL), 302 from urban area (males/females 137/165, aged 43±16 years, BW56.1±12.1 kg, creatinine 0.81±0/.19 mg/dL) and 305 isolated coastal area (males/females 150/155, aged 42±16years, BW 53.5±10.3 kg, creatinine 1.00±0.18 mg/dL). Using C-G, mean prevalence of CKD was 56.0%(95%CI 51.2-60.7%) consisted of 69.9% (95%CI 60.6-77.9%) in height region, 61.9% (95%CI54.5-68.8%) inurban and 42.3% (95%CI 33.7-51.4%) in isolated coastal area. Using 4-MDRD formula, mean prevalence ofCKD was 6.0% ( 95%CI 1.4-18.2%) consisted of 4.8% (95%CI 0.00-31.2%) in height region, 2,6% (95%CI50.3-43.1%) in urban and 9.8% (95%CI 2.5-27.4%) in isolated coastal area. In conclusion, there is a significantdifference of CKD prevalence in Bali if calculated by C-G compared with MDRD-4. Prevalence of CKD in Baliwith MDRD-4 (6.0%) is similar to those in other countries such as USA (4.2%) and Thailand (8.8%). Whetherthe calculation of GFR using MDRD-4 is more accurate than C-G in this setting, needs further study.
DIAGNOSIS DAN PENATALAKSANAAN PNEUMONITIS HIPERSENSITIVITAS Dary, I Wayan; Ngurah Rai, Ida Bagus
journal of internal medicine Vol. 9, No. 3 September 2008
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Hypersensitivity pneumonitis (HP), or extrinsic allergic alveolitis, is a group of immunologically mediated lung diseasesin which the repeated inhalation of certain finely dispersed antigens of a wide variety, mainly including organic particles or lowmolecular weight chemicals, provokes a hypersensitivity reaction with granulomatous inflammation in the distal bronchioles andalveoli of susceptible subjects. HP can be classified as acute, subacute, and chronic form. Clinically its presented as fever, fatique,myalgia, cough and shortness of breath after exposured and physical finding with fever, takipneu, diffuse rhales bibasal. Chestradiograph showed diffuse micronodular pattern or ground-glass appearance on lower and mid field lung only found on tenperse10%n of cases. HRCT can show more specific abnormalities of the lung. Lung function test describe restrictive type.Hystopathologic features are noncaseating granulomas, giant cells with a lot of nucleus, and mononuclear cells infiltration. Themost diagnostic criteria used is made by Richerson et al. the history and physical findings and pulmonary function tests indicatean interstitial lung disease, the X-ray film is consistent, there is exposure to a recognized cause, and there is antibody to thatantigen. Being an immune reaction in the lung, the most obvious treatment of HP is avoidance of contact with the offendingantigen. Systemic corticosteroids represent the only reliable pharmacologic treatment of HP but do not alter the long-term outcome.On the acute HP, prednisone administrate 1 mg/kgBW/day or its equivalent dose for 7 ? 14 days than tapering off foe 2 ? 6 weeks.
HUBUNGAN ANTARA KADAR HIGH SENSITIVE-C REACTIVE PROTEIN DENGAN DERAJAT ASMA BRONKIAL AKUT Jaya Santika, I Wayan Agus; Suryana, Ketut
journal of internal medicine Vol. 12, No. 3 September 2011
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Bronchial asthma is a chronic inß ammation in the air way. There are some element of cell and cell also to interventionin the inß ammation process. Chronic inß ammation has caused hyper responsiveness in air way, which is episodic attacksign, like wheezing, cough, shortness of breath usually in the night. C-reactive protein is one of the protein which changesin acute infection and acute inß ammation. C-reactive protein is a acute phase response protein which responsibility todefense mechanism. Acute phase protein produced induction by injury or infection. Acute phase reactant synthesis byliver which induction by cytokine like IL-6. In acute asthma attack produced some cytokine pro inß ammatory like IL-1,IL-6 and TNF. All of that cytokine induced liver to produced CRP. Aim for this study, to know the level hs-CRP in asthmaattack patient and also to know correlation between the severity of asthma attack and level of hs-CRP in patient whotreated in Sanglah General Hospital. This study was enrolling 53 patient acute asthma attack, cross sectional study. Allthe data collected by interview, physical examination, blood examination which cbc, hs-CRP, also with peak ß ow meter.The data analyzed by SPSS. And the result is the median of level hs-CRP is 7.3 mg/l, and the correlation in odd ratio(OR) is 3.73; CI 95% (1.66 ! 8.41). Based on this study we have the conclusion there strong correlation between level ofhs-CRP and severity of asthma attack.
PERAN PENURUNAN BERAT BADAN TERHADAP KADAR PLASMINOGEN ACTIVATOR-1 PADA OBESITAS ABDOMINAL Budhiarta, A.A.Gd.
journal of internal medicine Vol. 7, No. 3 September 2006
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Analytical cross-sectional study involving 77 subjects (male 31, female 46) with abdominal obesity (Ab-Ob) and 27 subjects non obese (male 20; female 7), age between 30-60 years were conducted and continued withrandomized pre-post test control group study involving 66 subjects (male 25, female 41) with Ab-Ob recruitedfrom the analytical cross-sectional study. Using random permuted block 30 subjects ( male 12; female 18) weretreated with hypocaloric diet and regular physical exercise for 12 weeks and 36 subjects (male 13; female 23) ascontrols. Compare with non obese subjects there were higher levels of active PAI-1, insulin and HOMA-IR insubjects with Ab-Ob (p<0.001 ; p = 0.001 and p < 0.001 respectively). There were significant correlation betweenfasting insulin level and HOMA-IR with active PAI-1 ( r = 0.488, p <0.001 and r = 0. 543, p <0.001 respectively).Among treated group decreased in body weight 5.9 kg or 7.4% followed by decreased in WC ( p <0.001), insulin(p = 0.005), and active PAI-1 (p <0.001). Among treated group decreased in WC ( p<0.001), insulin (p = 0.001),and active PAI-1 ( p = 0.003) were higher than control group. There were positive correlation between decreasedbody weight ( r = 0.297; p <0,001), decreased decreased FBS ( r = 0.307 ; p = 0.012), decreased insulin (r =0.360 ; p = 0.003), with decreased active PAI-1. To test the independence of associations between decreased inactive PAI-1 and decreased body weight, fasting blood sugar and insulin levels during program, a multivariatelinear regression analysis was performed. Only decreased in body weight and decreased fasting blood sugarsignificantly and independently associated with decreased in active PAI-1 and accounted for 23.4% of the varianceof decreased in active PAI-1. Decreased body weight accounted for 17.1% and decreased fasting blood sugaraccounted for 6.3% of decreased in active PAI-1.
WISATAWAN ASING DENGAN PENYAKIT INFEKSI SALURAN NAFAS YANG DIRAWAT DI RSUP SANGLAH - DENPASAR - BALI Ngurah Ra, Ida Bagus; Sajinadiyasa, I Gede Ketut
journal of internal medicine Vol. 10, No. 2 Mei 2009
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Each year 1 billion passengers travel by air, and over 50 million people from industrialized countries visit the developingworld and Bali is one of their choice. Travelers may be exposed to variety of pathogens and risk, and 20 to 70 percent of peoplereport some health problems while traveling. After diarrhea, respiratory infection is the most common illness affecting travelers.The aim of the study was to now characteristic foreign patients with respiratory infections hospitalized at Sanglah GeneralHospital. We have done retrospectif study to medical record of foreign patients hospitalized at Sanglah General Hospital onJanuary 2004 Ð June 2008.We had 17 patients with 13 (76.47%) Pneumonia and 4(23.53%) COPD with acute exacerbation, 13man and 4 woman, the mean of age 55.33 years old and more patients ³ 60 years old. Country of origin of patients mostlyAustralia, US, Germany, Nederland. Patients outcome; improve 14 (82.4%) and die 3 (17.6%), mean length of stay 4.35 days.Two die patients more than 60 years old and one below than 60 years but with coronary heart disease. The conclusion of this studyis respiratory infection who hospitalized at Sanglah General Hospital are dominated by pneumonia and eldery, possibility ofinfected respiratory disease seem higher in longer flight
HUBUNGAN PENYAKIT GINJAL KRONIS PREDIALISIS DENGAN BEBERAPA PARAMETER PENYAKIT ATEROSKLEROSIS ARTERI KAROTIS Sutarka, Nyoma; Suwitra, Ketut; Loekman, Jodi S; Sudhana, Wayan; Kandarini, Yenny; Martadiani, Elysanti Dwi; Margian, Nyoman
journal of internal medicine Vol. 11, No. 3 September 2010
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Carotid artery intima media thickness (cIMT) is valid marker of subclinical atherosclerosis because it gives sign of earlyatherosclerosis process. We conduct this study to know the relationship between predialysis chronic kidney disease (CKD) withseveral parameters of carotid arterial atherosclerosis.A cross sectional study was done in patients with predialysis CKD who came to outpatient Clinic of Nephrology inSanglah General Hospital from May 2009. CKD criteria is based on KDQQI 2003. Estimated Glomerular Filtration Rate (eGFR)was calculated with Cockroft-Gault formula. Measurement of cIMT is done by USG B-Mode with USG Logig-5.There were 30 patients (20 with eGFR < 60 ml/mnt and 10 with eGFR 60 ml/mnt). Mean of cIMT in eGFR < 60ml/mnt: right/left cIMT1 0.24445 ± 0.3096/0.3210 ± 0.4006 mm; IMT2 0.2405 ± 0.3138/0.2825 ± 0.3971 mm; IMT3 0.2315 ±0.3026/0.2820 ± 0.3672 mm; bifurkatio IMT 0.3115 ± 0.4069/0.3515 ± 0.4991 mm; total IMT 0.6350 ± 0.1738/0.6938 ± 0.1912mm. For eGFR > 60 ml/mnt: right/left IMT1 0.1120 ± 0.1722/0.1030 ± 0.1398 mm; IMT2 0.0880 ± 0.1103/0.1130 ± 0.1718mm; IMT3 0.1010 ± 0.1408/0.1170 ± 0.1700 mm; bifurcatio IMT 0.1920 ± 0.3545/0.1980 ± 0.3527 mm, total IMT 0.6250 ±0.1269/0.6750 ± 0.1124 mm. There was signiÞ cant difference in eGFR < 60 ml/mnt the left IMT1 (MD: 0.21 CI95% 0.01 ! 0.42;p = 0.038). Five out of 20 patients with eGFR < 60 ml/mnt and 6 among 10 patients of eGFR 60 ml/mnt were found plaques.There are no signiÞ cant difference of plaque location, plaque width, and lumen diameter between carotid arterial with andwithout plaque. As a conclusion we found there is no signiÞ cant difference between predialysis CKD with several parameters ofcarotid arterial atherosclerosis but cIMT tends to be thicker on predialysis CKD patients with eGFR < 60 ml/mnt.
PENGARUH HIPERGLEMI TERHADAP PERAN SITOSKELETON (CYTOSKELETON) SEBAGAI JALUR TRANSDUKSI SIGNAL (SIGNAL TRANSDUCTION) Rudijanto, Achmad; Kalim, Handono
journal of internal medicine Vol. 7, No. 3 September 2006
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Intracellular signal transduction occurs through cascades of reactions involving dozens of proteins that transmit signalsfrom the cell surface, through a crowded cellular environment filled with organelles and a filamentous cytoskeleton, to specifictarget. For most characterized signal transduction pathway, the initial signaling event and the end point are well known. In order tofully understand intracellular signal transduction, it is essential to know the intermediate signaling molecules and to understandhow information flows from one to the next. The cytoskeleton , an interconnected assembly of actin (microfilament), intermediatefilament and microtubule networks that extend throughout the entire cell, is involved in intracellular signal transduction.Individual proteins of the cytoskeleton might participate directly in signal transduction by linking two or more signaling proteinand might also provide a macromolecular scaffold, which spatially organizes components of a signal transduction cascade.Diabetes mellitus is an increasingly common disease. Absolute or relative deficiencies of insulin are common in this disease.Insulin has been suggested to play a key regulatory role in the functional organization of actin filaments. The microtubules are alsothe targets of insulin. A chronic insulin deficiency may could lead to impairment in the organization of the cytoskeleton. Thiscould entail a compromised or slower action of some activated enzymes in cells, affect to intracellular signal transduction.
RELATIONSHIP OF INFECTION AND GAMMA INTERFERON ( IFN ) OF PLASMA AND LYMPHOCYTE CULTURE SUPERNATANT IN IRON DEFICIENCY ANEMIA PATIENTS WITH INFECTION Suega, Ketut; Bakta, I Made
journal of internal medicine Vol. 10, No. 3 September 2009
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Iron is an essential nutrient for every living cells because of it role as molecule for transport of oxygen, as well as DNAsynthesis through synthesis of ribonucleotide reductase. Although the underlying mechanism of immune defect in iron deÞ ciencyanemia (IDA) is not clearly understood, multifactor events considered play their contributing roles such as impairment of T-cellproliferation and activities, altered cytokine production of Interleukin-2 (IL-2) and Interferon gamma (IFN ).Cross sectional study was done to asses the relationship of gamma IFN with infection in IDA patients on plasma andlymphocyte culture supernatant of IDA patients. Sixty-four IDA patients treated in Sanglah General Teaching Hospital wererecruited, and 31 (48.4%) out of 64 IDA patients were man and 33 (51.6%) women, have been selected for the study. This studyfound 17 (26.7%) IDA patients with infection, aged 38 ± 14.48 years and 47 (73.3%) IDA patients without infection, with ageaverage of 40.5 ± 14.4 years. The study revealed that there were no differences of cytokine level observed between older andyounger age (upper and below 44.5 years) in IDA patients. Furthermore, no differences of cytokine level were found based ongender between IDA male 10.9 pg/l (8.60 ! 12.65) patients and IDA female patients 10.6 pg/l (7.50 ! 13.43) with Z -0.490,p = 0.624. Nevertheless, signiÞ cant differences were noted between plasma and supernatant of IFN  in IDA patients withinfection when compared to IDA patients without infection (Z = - 2.638, p = 0.008 for plasma IFN ; and Z = -2.569, p = 0.010for supernatant IFN ).The study conclusion is that level of IFN  from plasma and lymphocyte culture supernatant of patient suffered from IDAwith infection is signiÞ cantly lower when compared to IDA patient without infection

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