Acta medica Indonesiana Journal Impact Factor & Information

Publisher: Indonesian Society of Internal Medicine

Current impact factor: 0.00

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Other titles Acta medica Indonesiana, Indonesian journal of medicine, Indonesian journal of internal medicine, IJIM
ISSN 0125-9326
OCLC 3568710
Material type Periodical
Document type Journal / Magazine / Newspaper

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim: to assess the current use of anticoagulants and implementation of International Guidelines in venous thromboembolism (VTE) prophylaxis in hospitalized patients with acute medical illnesses in Jakarta, Indonesia. Methods: a multicenter, prospective, disease registry, recruiting patients diagnosed as acutely ill medical diseases and other medical conditions at risk of VTE, with in-hospital immobilization for at least 3 days. Results: of 401 patients, 46.9% received anticoagulants which included unfractionated heparin (64.4%), fondaparinux (11.7%), enoxaparin (9.6%), warfarin (3.7%), and combination of anticoagulants (10.6%). VTE prophylaxis using physical and mechanical method was used in 81.3% of patients, either as a single modality or in combination with anticoagulants. During hospitalization, VTE were found in 3.2% patients; 10 patients (2.5%) had lower limb events and 3 patients (0.75%) had a suspected pulmonary embolism. The main reference international guidelines used were AHA/ASA 2007 (47.4%), followed by ACCP 2008 (21.7%). Conclusion: the study showed underutilization of prophylaxis anticoagulants in which mechanical thromboprophylaxis either alone or combination with anticoagulants was the most commonly used. Unfractionated heparin was the preferable choice. The most commonly used guideline was AHA/ASA 2007. VTE thromboprophylaxis in medically ill patients needs to be encouraged.
    Acta medica Indonesiana 08/2015; 47(2):136-45.
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    ABSTRACT: Pleural effusions can be the first presentation of a hematologic malignancy. The most common disorders with pleural effusion are Hodgkin and non-Hodgkin lymphoma with a frequency of 20 to 30%, especially if mediastinal involvement. Acute and chronic leukemia are rarely accompanied by pleural involvement. We describe a 46-year-old female with history of progressive dyspnoea. Physical examination was revealed massive left pleural effusion. Complete blood count revealed anemia, trombositopenia and normal leucocyte count. Viral serology test shown positive of HBsAg and total antiHBc. Chest X-ray revealed left pleural effusion. Pleural fluid cytology was myeloblast consistent with acute myeloid leukemia (AML). Bone marrow aspiration smear, bone marrow biopsy smear, and flow cytometry analysis were consistent with acute myeloid leukemia without maturation (AML M0-FAB classification).
    Acta medica Indonesiana 08/2015; 47(2):153-6.
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    ABSTRACT: Morphea is an uncommon connective tissue disease with the most prominent feature being thickening or fibrosis of the dermal without internal organ involvement. It is also known as a part of localized scleroderma. Based on clinical presentation and depth of tissue involvement, morphea is classified into several forms, and about two thirds of adults with morphea have plaque type. Overproduction of collagen production by fibroblast is the cause of abnormality in morphea, and the hyperactivity mechanism of fibroblast is still unknown, although there are several mechanisms already proposed. Plaque type morphea is actually a benign and self limited. Plaque type morphea that mimicking systemic lupus erythematosus in clinical appearance, such as alopecia and oral mucosal ulcers, is uncommon. A case of plaque type morphea mimicking systemic lupus erythematosus in a 20 year old woman was discussed. The patient was treated with local and systemic immunosuppressant and antioxydant. The patient's condition is improved without any significant side effects.
    Acta medica Indonesiana 08/2015; 47(2):146-52.
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    ABSTRACT: to investigate the effect of breastfeeding duration on vascular characteristics in adolescence. we conducted a retrospective cohort study on adolescents aged 15-18 years old. Breastfeeding duration was inquired using a questionnaire filled by parents and categorized into 0-<2, 2-<4, 4-<6, 6-<12, and >12 months. Outcomes assessed were flow mediated dilation (FMD), carotid intima media thickness (CIMT), anthropometrics. Analysis was done using linear regression and MANOVA general linear model with cardiovascular risk factors as the dependent variables and breastfeeding duration as the independent variable with further adjustment for confounders. 285 subjects aged 15-18 years were enrolled. Breastfeeding duration of 4-<6 months was associated with thinner CIMT and the effect was more prominent after adjustment for gender and postnatal tobacco exposure (mean difference=24.28 micrometer, p=0.045). No statistically significant association was found with FMD. breastfeeding duration of 4-<6 months is associated with thinner IMT and thus has a protective effect on the development of cardiovascular disease. However the association with FMD in adolescence is less clear.
    Acta medica Indonesiana 05/2015; 47(1):24-30.
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    ABSTRACT: Aim: to analyse the effects of immunoglobulin(Ig)G and IgM anti-beta-2 glycoprotein-1 (anti-2GP1) on the expression of tissue factor (TF), thrombomodulin (TM), and plasminogen activator inhibitor-1(PAI-1) of endothelial cells in the messenger RNA level. Methods: laboratory experimental study in human umbilical vein endothelial cells (HUVEC) was done at Cipto Mangunkusumo Hospital/Faculty of Medicine, Universitas Indonesia. Samples are purified IgG anti-2GP1 from six antiphospholipid syndrome (APS) patients serum and IgM anti-2GP1 from six APS patients serum. For controls, purified IgG from six normal human serum (IgM-NHS) and purified IgM from six normal human serum (IgM-NHS) were used. HUVEC were treated with purified IgG anti-2GP1, IgM anti-2GP1, IgG-NHS, IgM-NHS for four hours of incubation. We measured TF, TM, and PAI-1 of HUVEC in mRNA relative expression levels (before and after treatment) by real time reverse transcription polymerase chain reaction. Results: the mean value of TF, TM, and PAI-1 mRNA levels in HUVEC after treated with IgG anti-2GP1 compared to Ig-NHS were 3.14 (0.93)-, 0.31 (0.13)-, 5.33 (2.75)-fold respectively. In other hand, after treated with IgM anti-2GP1 compared to IgM-NHS, mRNA levels of TF, TM, and PAI-1 were 4.33 (1.98)-, 0.33 (0.22)-, 5.47 (2.64)-fold respectively. Before and after treatment with IgG anti-2GP1 showed significant differences of TF mRNA levels {1.09 (0.76) versus 3.14 (0.93), p=0.003}, TM mRNA levels {0.91 (0.11) versus 0.31(0.13), p=0.001}, and PAI-1 mRNA levels 0.93 (0.13) versus 5.33 (2.75), p=0.013}. Before and after treatment with IgM anti-2GP1 showed significant differences of TF mRNA levels {1.03 (0.11) versus 4.33 (1.98), p=0.008}, TM mRNA levels {0.93 (0.08) versus 0.33 (0.22, p=0.003}, and PAI-1 mRNA levels {1.02 (0.10) versus 5.47 (2.64), p=0.01}. Conclusion: IgG anti-2GP1 and IgM anti-2GP1 increased TF and PAI-1 mRNA levels. However, IgG anti-2GP1 and IgM anti-2GP1 decreased TM mRNA levels. It proved that the mechanism of thrombosis in APS occurs through coagulation activation, reduction of fibrinolysis activity, and reduction of anticoagulant activity.
    Acta medica Indonesiana 05/2015; 47(1):31-7.
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    ABSTRACT: to know the relationship between salted fish consumption and nasopharyngeal carcinoma (NPC). we searched for the articles from PubMed® and ScienceDirect® based on our clinical question. After filtered with our in- and exclusion criteria, we had six articles about this topic, all of them were case-control studies. All articles were then critically appraised for their validity, importance, and applicability. there was no consistent relationship between salted fish consumption and NPC. Worth to note that those studies wo showed the firm relationship were conducted in Southern China, where the incidence of NPC was extremely high and related to specific Chineese-style salted fish consumption. there was an inconsistent relationship between salted fish consumption and NPC.
    Acta medica Indonesiana 05/2015; 47(1):72-7.
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    ABSTRACT: to investigate the role of neutrophil-to-lymphocyte ratio (NLratio) in predicting in-hospital adverse cardiac events in patients with STEMI. this was a cohort study on patients with STEMI onset 24 hour hospitalised in ICCU. NLratio was calculated as absolute neutrophil count divided with lymphocyte count measured by automated blood cell counter on admission.The outcome was in-hospital adverse cardiac events, which were recorded during follow-up. The cut-off value of NLratio to predict outcome was determined by ROC curve analysis. Univariate and multivariable analysis to assess whether high NLratio was independent predictor for in-hospital adverse events were performed. among165 subjects, in-hospital adverse cardiac events occurred in 49 subjects (29%). The cut-off value of NLratio was 6.2. The univariate analysis showed that NLratio >6.2 had an odd ratio of 3.19 (95% CI 1.55-6.55, p=0.002) to develop in-hospital adverse cardiac events. The multivariate analysis showed that NLratio was an independent predictor of in-hospital adverse cardiac events with an odd ratio of 4.10 (95% CI 1.59-10.54, p=0.003). high on-admission NLratio is an independent predictor for in-hospital adverse cardiac events in patients hospitalised for STEMI.
    Acta medica Indonesiana 05/2015; 47(1):3-10.

  • Acta medica Indonesiana 05/2015; 47(1):1-2.
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    ABSTRACT: A forty four years old male patient presented with headache and dizziness in our outpatient department. On examination, he had pulse rate of 96 /min, blood pressure of 122/80 mmHg, JVP was not raised. He had clubbing and cyanosis on General physical examination. On auscultation pansystolic murmur was heard all over the chest. His respiratory and abdominal examination was normal. There were no significant findings on electrocardiography and skiagram chest. Echocardiography revealed ventricular septal defect with overriding of aorta, pulmonary artery could not be visualised. On computrized tomography pulmonary angiography revealed Ventricular septal defect with overriding of aorta. The main and normally confluent right and left pulmonary arteries were not visualized. On left side there was large MAPCA arising from descending thoracic aorta at D8 level and dividing into upper and lower lobar arteries and segmental branches were seen. On right side there were three large MAPCAS seen arising from (i) proximal right subclavian artery (supplying the rt upper lobe), (ii) arch of aorta (at D5 level supplying right middle and lower lobes), (iii) descending thoracic aorta (at D7, D8 level supplying right lower lobe) respectively were seen. Inferior vena cava and pulmonary veins were normal.
    Acta medica Indonesiana 05/2015; 47(1):70-1.
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    ABSTRACT: Aim: to identify the effect of high-PUFA dietary supplementation on inflammatory status of patients with advanced cervical cancer. Methods: a randomized double-blind clinical trial was conducted in patients with advanced cervical cancer who had undergone external radiation therapy at Department of Radiotherapy, Cipto Mangunkusumo Hospital, Jakarta, between April 2013 and April 2014. The inflammatory status was evaluated based on serum prostaglandin E2 (PGE2) levels using ELISA method. The dietary supplementation was isocaloric, isoprotein and contained PUFA with a ratio of -6: -3 fatty acid = 1.27:1 and supplementation without PUFA. Data were analyzed with statistical tests, including Shapiro-Wilk test, independent T-test and Mann-Whitney test. Results: there was statistically no significant difference on PGE2 level between treatment and control groups (p=0.127). However, there was clinically significant difference, in which the treatment group had reduced PGE2 level by 8.9%; while the control group had increased level by 28.1%. Conclusion: dietary supplementation enriched with PUFA can reduce inflammatory status in patients with advanced cervical cancer. Reduced PGE2 level will lower the survival of cancer cells; therefore dietary supplementation enriched with PUFA with a ratio of -6 : -3 fatty acid = 1.27 : 1 along with radiation therapy may improve tumor response to radiation.
    Acta medica Indonesiana 05/2015; 47(1):45-9.
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    ABSTRACT: Hypertension-related maternal mortality reaches 16% when it is compared to other causes of maternal mortality such as sepsis, bleeding or abortus. Pregnant women with hypertension disorder are at increased risk for experiencing numerous complications including disseminated intravascular coagulation (DIC), cerebral hemorrhage, liver dysfunction and acute renal failure; while to the fetus, it may cause intrauterine growth retardation, prematurity and perinatal mortality. Hypertension in pregnancy should be managed appropriately to reduce maternal and fetal morbidity and mortality rate, i.e. by preventing women from getting the risks of increased blood pressure, preventing disease progression and preventing the development of seizure and considering termination of pregnancy in life-threatening situation for maternal and fetal health.
    Acta medica Indonesiana 05/2015; 47(1):78-86.
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    ABSTRACT: to assess the use of of angiogenesis, inflammation, platelets count, and metastatic status as predictors for thrombosis risk represented by soluble P-selectin level in nasopharyngeal carcinoma (NPC) patients. a cross sectional study was conducted on NPC patients at the Hematology and Oncology Clinic of Cipto Mangunkusumo Hospital, Jakarta, during Mei to October 2012. Data regarding angiogenesis (CD105 and VEGFR-2), inflammation (IL-6), platelets count, and metastatic status were assessed at enrollment, as well as soluble P-selectin levels in all eligible patients. Bivariate analysis continued with multiple linear regression analysis were done to identify independent predictors for soluble P-selectin levels. sixty NPC patients were enrolled in the study. There was correlation between platelet counts (r=0.389; p=0.002), IL-6 (r=0.595; p<0.001) and number of metastatic sites (r=0.542; p<0.001) with soluble P-selectin level, and a linear regression analysis showed that these three variables can predict soluble P-selectin levels with adjusted R-square 65%. There was no correlation between VEGFR-2 and CD105 levels with soluble P-selectin levels. platelet counts, IL-6 level, and number of sites of metastasis can be used as predictors of soluble P-selectin level as parameter of thrombosis risk in NPC patients.
    Acta medica Indonesiana 05/2015; 47(1):11-5.
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    ABSTRACT: This is the first report of MRSA infection in Sanglah Hospital. We reviewed eight patients with MRSA infection from microbiologi laboratory records between January and May 2011, than followed by tracing medical records to obtained data of the patients. Five of cases with sepsis, 1 case with osteomyelitis, and the two others with mediastinitis and pneumonia. The patients were kept in private isolated room and barrier-nursing technique was strictly followed. Further action was culturing specimen taken from the patients nose, throat, axilla, and samples taken from the health care workers, with no MRSA colonization were found. Five patients demonstrated good respond to intravenous administration of either vancomycin or linezolide. Three were died due to septic shock before the laboratory culture and antimicrobial susceptibility availabled. All of the strains isolated more than 48 hours after admission and also demonstrated clinical risk factors for hospitalized acquired MRSA (HA-MRSA). These strains had resistance to b-lactams but remain susceptible to many non b-lactam antibiotics, as reported in some community acquired MRSA (CA-MRSA) isolates. Future study using molecular typing required to fully understand the magnitude and ongoing evolution of MRSA infections.
    Acta medica Indonesiana 05/2015; 47(1):50-5.
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    ABSTRACT: Aim: to develop a non-invasive diagnostic test for non-alcoholic steatohepatitis NASH. Methods: this is a cross-sectional study on non-alcoholic fatty liver disease (NAFLD) subjects. Sample was taken by consecutive sampling method. Diagnostic criteria of NAFLD were confirmed by liver biopsy. Clinical variables include metabolic syndrome, aspartate aminotransferase (AST), alanine aminotransferase (ALT), adiponectine, TNF-, insulin, homeostatic model assessment insulin resistance (HOMA-IR) index and liver biopsy. Patients were divided into two groups based on their liver biopsy, group 1: Non-NASH (NAFLD activity score <3) and group 2: NASH (NAFLD activity score of >4). Statistical analyses were performed using Student's t-test, Mann Whitney U, chi-square, the ROC curve, sensitivity and specificity test. Results: fifty NAFLD patients were recruited, 30 males and 20 females. Among these patients, 12 (24%) had type 2 diabetes, 36 (72%) had metabolic syndrome, the remaining 2 (4%) did not fulfilled metabolic syndrome. Liver biopsy confirmed 21 (42%) non- NASH and 29 (58%) NASH respectively. Level of AST and ALT, plasma level of adiponectine and TNF- were statistically different between two groups. The AST level (>25 U/L) in combination with TNF- (>3.28 pg/cc) demonstrated a good diagnostic accuracy for NASH (Accuracy 82%, Sensitivity 76%, Specificity 90%, PPV 92%, and NPV 73%). Conclusion: the combined diagnostic tests of AST and TNF- plasma levels demonstrated a good accuracy for the detection of NASH among NAFLD patients. This combination test can be used as a noninvasive method to diagnose NASH.
    Acta medica Indonesiana 05/2015; 47(1):16-23.
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    ABSTRACT: Dendritic cells are major antigen-presenting cells (APC) that stimulate naive T cells, which induce adaptive immune responses. Graves' disease (GD) is an autoimmune disease characterized by the presence of autoantibodies against Thyroid Stimulating Hormone Receptor (TSHR). The autoantibodies bind with TSHR and stimulate thyroid hormone production. Dendritic cells are still the major APC in GD immune response although thyrocytes in GD can also express Major Histocompatibility Class (MHC) class II molecule. Studies about DC in GD have been conducted by isolating intra-thyroid DC or DC in peripheral circulation. Results of DC studies in GD are still controversial. Changes in number and profile of DC are found, which indicate altered immune response activity and defects of regulator T cell (Treg) in GD.
    Acta medica Indonesiana 05/2015; 47(1):61-9.
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    ABSTRACT: to assess physiological and operative severity score for the enumeration of mortality (POSSUM) scoring system and compare it with European system for cardiac operative risk evaluation (EuroSCORE) scores in patients who underwent cardiac surgery from two hospitals in the southwestern region of Iran. in this retrospective study, total of all 1420 patients who were admitted for elective cardiac surgery at our centers, from 2007 to 2012, were scored using the POSSUM and EuroSCORE systems. the overall mortality rate was 0.87%. Among the risk factors, history of diabetes, smoking, respiratory disease, and myocardial infarction, were significantly affect the mortality rate. Therefore, of these risk factors, only the hemoglobin was significantly correlated with the morbidity rate. The predictive accuracy of mortality equations was 74.5%. The lower predictive accuracy of mortality equations was 67.8% was observed using EuroSCORE. although results are statistically significant, but the analysis have never intended to affect the decision to operate, and this decision must be based on clinical expertise, because of the need to standardize data collection and stratify the risks involved in operations, scoring systems such as POSSUM should be used prospectively. However, if analyzed correctly, POSSUM is a good predictor of mortality in patients undergoing cardiac surgery.
    Acta medica Indonesiana 05/2015; 47(1):38-44.
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    ABSTRACT: Osteoarthritis (OA) is the most common degenerative joint disease found in the elderly. Drug options that are recommended by the American Academy of Orthopaedic Surgeon (AAOS) are acetaminophen, NSAIDs, tramadol, capscaicin and intraarticular corticosteroids. However, there is concern for the possible side effects resulting from long term use of those medications. Researchers are searching for a safer treatment modality for OA. Leech therapy (hirudotheraphy) is one of the therapies under investigation, given its purported analgesic and antiinflammatory properties.
    Acta medica Indonesiana 04/2015; 47(2):176-80.
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    ABSTRACT: to analyze the safety and efficacy of early insulin initiation therapy for patients with type 2 diabetes mellitus (T2DM) in primary health care provided by general practitioners (GPs) in Surabaya, East Java, Indonesia. pre-post study of ninety nine diabetic patients without previous insulin treatment with HbA1c levels >8% were involved in this study. The study was conducted in 10 primary health care centers in Surabaya between October 2011 to June 2012. Each patient received insulin therapy for 12 weeks. Laboratory examination was performed for each patient including fasting plasma glucose (FPG), 2 hours post-prandial plasma glucose (2hPPG) and HbA1c examination before and after the study. Self monitoring blood glucose (SMBG) examination was conducted in order to adjust the insulin dose and prevent the incidence of hypoglycemia. Data was statistically analyzed using paired-T test. FPG level was decreased from baseline data (209 mg/dL) to 152.07 mg/dL at the end of the study (56.93 mg/dl; p=0.0001). The average of 2hPPG level was also decreased from 313.00 mg/dl to 220.72 mg/dL ( 92.28 mg/dL; p=0.0001). HbA1c was reduced from 11.60% at baseline to 8.95% at the end of study ( 2.65%; p=0.0001). Hypoglycemia was found in 6 patients (6.06%) in this study, but all events were mild and did not need to be admitted to hospital. the safety of insulin therapy iniatiation might be provided by GPs at primary health centers with significant efficacy and minimal side effects.
    Acta medica Indonesiana 04/2015; 47(2):104-10.