Acta medica Indonesiana

Publisher: Indonesian Society of Internal Medicine


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    Acta medica Indonesiana, Indonesian journal of medicine, Indonesian journal of internal medicine, IJIM
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    Journal / Magazine / Newspaper

Publications in this journal

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    ABSTRACT: A 51-year-old male came with thickening lesion in both legs since 2.5 years before presented. It started with small lesion and went larger. Before diagnosed, he was admitted to hospital due to unresolved headache. He complainted nausea, easily hungry, protrusion of both eyes without diplopia or diminution of vision, tremor, palpitation, and unintentional weight loss (25-30 kgs in a year). On examination, it was found that he was in thyrotoxic condition and has diffuse goiter. From skin examination he had raised hyperkeratotic, and waxy plaque like lesions over both pretibial region. Laboratory examination confirm for thyrotoxic with presumably Graves' disease. Thyroid scintigraphy showed diffused enlargement and increased uptake. Skin biopsy from the pretibial skin showed epidermis with vacuolar degeneration, partly spongiotic and hyperpigmentated, thickening basalis membrane, miksoid dermis and spreading chronic inflammatory cell in perivascular and periadneksal. It confirmed the diagnosis of myxedema hystologically. The patient was given methimazole with starting dose 3x10 mg and propanolol 2x10 mg. Methimazole was reduce according to lab result. The pretibial lesion was given Triamcinolone acetonide injection intralesion in both legs with starting dose 0.5 cc (preparation 10 mg/cc) per day and increased according to response. The patient was response to 1.5 cc per leg per day. The patient also given Kloderma Ointment used twice a day. The lesion now thinning, flat, and turn hyperpigmentation.
    Acta medica Indonesiana 04/2014; 46(2):148-9.
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    ABSTRACT: Irritable bowel syndrome (IBS) is one of the most commonly encountered functional gastrointestinal disorders in the elderly. IBS is characterized by abdominal pain and altered bowel habits in the absence of specific organic pathology. The diagnosis of IBS usually depends primarily on established clinical criteria. Currently, Rome III criteria are the criteria of choice for defining IBS. However, aging itself is categorized as one of the alarm symptoms in the diagnosis of IBS that may warrant further investigation. Therefore, exclusion of organic diseases, using several investigations, is of paramount important in the older patients. In general, the treatment of IBS in the elderly is not different from the younger populations. However, greater caution needs to be considered before treating with drugs because of the altered risk-benefit profile in the elderly. Several studies have shown a strong relationship of IBS with psychiatric conditions. Thus, psychological treatments should also be considered in the management of IBS in the elderly.
    Acta medica Indonesiana 04/2014; 46(2):138-47.
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    ABSTRACT: A 67-year-old gentleman underwent fistulectomy for low trans-sphincteric anal fistula along with curettage for an associated abscess extending proximally for half a centimeter into the intersphincteric plane. The roof of the cavity became clearly visible after satisfactory culmination of the surgical procedure. Histopathological examination of the fistulous tract and the curetted granulation tissue revealed presence of multiple trophozoites of Entamoeba histolytica exhibiting erythrophagocytosis in the background of mixed inflammatory infiltrate. This case report provides the outlook that yields the novel insight into the possible role of Entamoeba histolytica in the pathogenesis and persistence of the fistulous tract.
    Acta medica Indonesiana 04/2014; 46(2):131-3.
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    ABSTRACT: Sickle cell anemia is an inherited abnormality of the globin chain with very high prevalence in the Indian subcontinent. A significant proportion of these patients present late in life and are at a risk of complications like acute chest syndrome and painful episodes till a definitive diagnosis is reached and appropriate treatment is started . We report a novel triad of abdominal imaging findings which is not reported in literature until now and which may suggest a diagnosis of sickle cell anemia in retrospect. Patients with this triad of abdominal findings should be suspected to have an underlying hemoglobinopathy and should be referred for further hematological workup. Although in our case the patient was diagnosed to have sickle cell anemia depending on the abnormal morphology of red cells and hemoglobin electrophoresis, it should be remembered that this triad of findings may be seen in other hemoglobinopathies which induce a state of chronic anemia.
    Acta medica Indonesiana 04/2014; 46(2):134-7.
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    ABSTRACT: Aim: to compare the in-hospital major cardiovascular events between thrombolysis therapy and primary percutaneous coronary intervention (PCI) in patients with ST-elevation acute myocardial infarction (STEMI. Methods: the study design is retrospective cohort. Medical record of patients with STEMI onset <12 hour receiving thrombolysis treatment or primary PCI in Dr. Sardjito Hospital Yogyakarta between January 2008 and March 2010 are evaluated. The primary outcome is major cardiovascular events which comprise cardiovascular death, reinfarction and stroke during hospitalisation. The secondary outcomes are post infarction angina pectoris, heart failure, cardiogenic shock and bleeding. Results: among 78 patients with thrombolysis and 53 patients with primary PCI, in-hospital major cardiovascular events do not differ significantly (10.3% versus 9.4%; RR 1.09, 95%CI 0.33-3.55; p=0.87). Post infarction angina pectoris is 7% versus 3.8% (RR 2.51, 95%CI 0.50-12.60; p=0.24). The incidence of heart failure is significantly higher in thrombolysis (17.9% versus 5.7%; RR 3.64, 95%CI 0.99-13.38; p=0.04), primary PCI reduces 68.1% relative risk to develop acute heart failure in STEMI. The incidence of cardiogenic shock is not different. Major and minor bleeding do not differ significantly either. Conclusion: the in-hospital major cardiovascular events between STEMI receiving thrombolysis therapy and primary PCI is not significantly different. Heart failure is significantly higher in thrombolysis therapy and the primary PCI reduces the risk.
    Acta medica Indonesiana 04/2014; 46(2):124-30.
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    ABSTRACT: Aim: to determine the distribution of PRMT-1 gene polymorphism and ADMA levels among continuing hemodialysis patients. Methods: genotyping of PRMT-1 polymorphism was performed in 57 hemodialysis patients at Al Irsjad Hospital. All participants were recruited for physical examination, questionnaire, and collection of 5 mL fasting venous blood. The blood was treated with phenol-chloroform extraction of genomic DNA. The candidate's single nucleotide polymorphisms (SNPs) were genotyped by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The ADMA plasma levels was determined by ELISA and all biochemical indicators of serum were examined. Results: fifty-seven hemodialysis patients participated in our study, 54 (95.4%) of them had increased ADMA plasma levels. DNA sequencing analysis of 13 patients showed a suspected PRMT-1 gene polymorphism at sequence 5837 as there were different genotypes between C and G. Conclusion: the increased levels of ADMA might be caused by PRMT-1 gene polymorphism.
    Acta medica Indonesiana 04/2014; 46(2):97-103.
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    ABSTRACT: Aim: to determine the difference in serum matrix metalloproteinase-9 (MMP-9) levels among acute coronary syndrome patients with and without hyperglycemia. Methods: this study was a cross-sectional study on patients with acute coronary syndrome admitted to ICCU of Dr.Sardjito Hospital Yogyakarta Indonesia. Measurements of blood glucose level were performed on hospital admission, while measurement of MMP-9 level was performed upon arrival at the ICCU. Hyperglycemia was defined as a random blood glucose level of >140 mg/dL. Student's t test was performed to analyze the difference of MMP-9 level between subjects with and without hyperglycemia. Results: of 72 enrolled subjects, there were 34 subjects with hyperglycemia and 38 subjects without hyperglycemia. The mean blood glucose level was significantly different in subjects with hyperglycemia as compared to those without hyperglycemia (204.4±92.16 vs. 108.93±19.1 mg/dL, p=0.0001). The mean MMP-9 level in subjects with hyperglycemia was significantly higher than those without hyperglycemia (1574±573.61 vs. 1370±573.66 ng/mL, p=0.025). The prevalence ratio of high MMP-9 level among subjects with hyperglycemia was 2.88 (95% CI: 1.16-7.14), p=0.004. Conclusion: serum MMP-9 level in patients suffering from acute coronary syndrome with hyperglycemia was significantly higher than those without hyperglycemia.
    Acta medica Indonesiana 04/2014; 46(2):83-9.
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    ABSTRACT: Aim: to develop a reference equation for prediction of the total distance walk using Indonesian anthropometrics of sedentary healthy subjects. Subsequently, the prediction obtained was compared to those calculated by the Caucasian-based Enright prediction equation. Methods: the cross-sectional study was conducted among 123 healthy Indonesian adults with sedentary life style (58 male and 65 female subjects in an age range between 18 and 50 years). Heart rate was recorded using Polar with expectation in the sub-maximal zone (120-170 beats per minute). The subjects performed two six-minute walk tests, the first one on a 15-meter track according to the protocol developed by the investigator. The second walk was carried out on Biodex®gait trainer as gold standard. Results: an average total distance of 547±54.24 m was found, not significantly different from the gold standard of 544.72±54.11 m (p>0.05). Multiple regression analysis was performed to develop the new equation. Conclusion: the reference equation for prediction of the total distance using Indonesian anthropometrics is more applicable in Indonesia.
    Acta medica Indonesiana 04/2014; 46(2):90-6.
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    ABSTRACT: Aim: to compare the immunoexpression of BRAF V600E among stage of colorectal cancer. Methods: this was a cross sectional, and retrospective study involving Dukes' stage A, B, and C colorectal carcinoma, each with 15 cases. Immunohistochemistry was performed in paraffin-embedded specimens of tumor mass for the assessment of BRAF V600E. The proportion differences of immunoexpression of BRAF V600E among Dukes' stage A, B, and C were tested using Chi-Square test. Results: the result of positive BRAF V600E immunoexpression (moderately to strongly positive) in Dukes' stage A, B, and C were found in 1 of 15 cases, 4 of 15 cases and 13 of 15 cases respectively. BRAF V600E immunoexpression was statistically significant more frequent in Dukes' stage C (p<0,001, Chi-Square test). Conclusion: positive BRAF V600E immunoexpression could be used as a marker of aggresive colorectal carcinoma.
    Acta medica Indonesiana 04/2014; 46(2):104-10.
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    ABSTRACT: Aim: to investigate the effect of low birth weight (LBW) on endothelial function, and to determine the role of plasma adiponectin in endothelial dysfunction by conducting flow mediated brachial artery (FMBA) test or vasodilation response (VR) and by measuring plasma asymmetrical dimethylarginine (ADMA) of young adults born with LBW. Methods: in a retrospective cohort study, subjects were randomly selected from the growth study cohort of Tanjungsari Sumedang district West Java. They consisted of 67 LBW and 67 NBW (Normal Birth Weight) young adults. Dependent variables were plasma adiponectin, plasma ADMA, and VR. The correlation between plasma adiponectin and ADMA level was examined using Pearson's correlation. Results: the relative risk for LBW to have low brachialis artery vasodilation response was 2.94, (95% CI:1.91-4.53), and to have low of plasma adiponectin concentration 1.53, (95% CI: 1.07-2.18). There was a statistically significant difference for all variables studied (FMBA, plasma ADMA, and plasma Adiponectin concentrations), while simultaneous confidence interval measurements indicated that the value of FMBA and the concentration of plasma adiponectin were significantly lower, respectively p<0.001, 95% CI: -4.409-(-2.114), and p=0.015, 95% CI: -1.083-(-0.082) in LBW compared to NBW subjects. The correlation between plasma adiponectin concentration and plasma ADMA concentration in LBW subjects was not significant. Conclusion: there is an effect of LBW on endothelial function. LBW compared to NBW subjects have lower VR and plasma adiponectin concentration. There may be a small role of plasma adiponectin in endothelial dysfunction of young adults with LBW.
    Acta medica Indonesiana 04/2014; 46(2):111-6.
  • Acta medica Indonesiana 04/2014; 46(2):81-2.
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    ABSTRACT: Aim: to identify the difference between coronary angiography in patients with acute coronary syndrome (ACS) aged 45 years and those aged >45 years. Methods: a total of 322 ACS patients who underwent coronary angiography in ICCU of Cipto Mangunkusumo Hospital, Jakarta between January 2008 and December 2012 were included in this study. The severity of coronary stenosis was determined by vessel score and coronary score. A significant vessel score was defined as a stenosis of coronary vessel of >70%. Patients were divided into two groups: those aged 45 years (72 cases) and those aged >45 years (250 cases). The statistical analysis was performed with Chi-square test for categorical data with two-unpaired groups and the t-test or Mann-Whitney for numerical data. Results: the highest distribution of 1-VD (single-vessel disease) patients was found the group of patients aged 45 years (43.1% vs 26.0%); while for 3-VD (triple-vessel disease) patients, the highest distribution was noticed in the group of patients aged >45 years (31.6% vs 18.1%). The stenosis score was lower in patients aged 45 years compared those aged >45 years (median stenosis score 4 vs 8), p<0.001. Atherosclerosis was found most common for the left anterior descending artery in both age groups (65.3% and 74.0%). However, there was less significant stenosis lesion for the Left Circumflex and Right Coronary Arteries in patients aged 45. The result was statistically significant (26.4% and 31.9% vs 46.4% and 57.2%, p=0.002 and 0.001). Conclusion: the number of coronary artery diseases (vessel score) and stenosis score is lower in patients aged 45 years compared to patients aged >45 years.
    Acta medica Indonesiana 04/2014; 46(2):117-23.
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    ABSTRACT: Primary breast tuberculosis is a rare entity. We are reporting a case of primary breast tuberculosis, which presented as breast abscess. On histopathology, it was diagnosed as breast tuberculosis. Aspiration cytology was not done due breast abscess. Patient was put on anti-tubercular drugs. In follow up, after 3 months patient condition was improved.
    Acta medica Indonesiana 01/2014; 46(1):51-3.
  • Acta medica Indonesiana 01/2014; 46(1):66-7.
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    ABSTRACT: Aim: to analyze the correlation between Receptor activator of nuclear factor-κβ ligand (RANKL), Osteoprotegrin (OPG) serum level with cartilage oligomeric matrix protein (COMP) serum level as a marker of cartilage degradation in rheumatoid arthritis patients. Methods: a cross-sectional study was conducted on the subjects who came to the outpatient clinic of rheumatology in Cipto Mangunkusumo Hospital. Patients were diagnosed based on the American College of Rheumatology (ACR) 1987 revised criteria. All numerical data, both primary data and data transformation were not normally distributed, so we did bivariate analysis with Spearman correlation test. Results: we collected the data of 60 RA patients with majority of the subject had active disease activity (78.3%). Methotrexate was the most widely disease modifying anti-rheumatoid drug (DMARD) used, either as a single drug (51.7%) or in combination with another DMARD (25.1%). Bivariate analysis was revealed that RANKL, OPG, and OPG/RANKL serum level have no significantly correlation with COMP serum level (p=0.52; p=0.25; p=0.2, respectively). Conclusion: RANKL and OPG serum level, had no correlation with cartilage degradation in rheumatoid arthritis patients.
    Acta medica Indonesiana 01/2014; 46(1):24-9.
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    ABSTRACT: Aim: to assess the safety and efficacy of telbivudine therapy in adult patients with CHB in Indonesia. Methods: the study design was prospective cohort study. Multicenter study of adult CHB patients requiring oral antiviral therapy in daily practice setting. All patients received 600 mg of telbivudine daily for one year. Recruitment and decision to start telbivudine therapy was based on clinical indication as assessed by the participating physicians. The primary end-point was patient safety (adverse event or serious adverse events); while the secondary end-points were HBeAg seroconversion, changes of serum HBV DNA levels and serum ALT normalization. Patients were assessed at week-24 and week-52 of treatment. Results: a total of 176 cases were eligible for analysis, comprising 104 (59.8%) HBeAg-positive and 70 (40.2%) HBeAg-negative patients. Adverse events were reported in 7 (4.0%) patients, most of them were mild. HBeAg loss and seroconversion rate was 28.8% and 14.14% at week-52 respectively. Undetectable HBV DNA (PCR negativity) was 51.8% at week-24 and 62.7% at week-52. Median HBV DNA levels were significantly reduced from baseline to week-24 and week-52 treatment (both p<0.001; Wilcoxon's signed-rank test). Normalization of serum ALT activity occurred in 85 (73.28%) patients at week-52. Conclusion: Telbivudine therapy is generally safe and well tolerated among adult Indonesian patients with chronic hepatitis B. Treatment efficacy in terms of HBeAg loss and seroconversion, changes of HBV DNA levels and serum ALT normalization were similar to previous reported studies.
    Acta medica Indonesiana 01/2014; 46(1):38-43.
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    ABSTRACT: Aim: to evaluate the serum levels of anti-tetanus toxin antibodies (anti-TTA) in patients with type 2 diabetes mellitus (DM) and in a control group. Methods: totally, 100 patients with type 2 DM and 100 age- and sex-matched healthy individuals were enrolled to study. The presence of type 2 DM confirmed according to the clinical and para-clinical criteria such as fasting plasma glucose above 126 mg/dl. A peripheral blood sample was collected from all subjects. The serum samples of participants tested for the levels of anti-TTA by ELISA method. The serum antitoxin concentration 0.1 IU/mL was considered as a protective level of antibody. Results: the seroprotective rate in healthy group was significantly higher than diabetic group (99% vs. 92%; p<0.02). The mean titer of anti-TTA in healthy group (5.32±0.26 IU/ml) was also significantly higher than diabetic patients (3.46±0.26 IU/ml; p>0.001). In diabetic men the mean titer of anti-TTA was significantly higher in comparison to diabetic women (3.94±0.34 IU/ml vs 2.59±0.36 IU/ml; p<0.01). In diabetic patients the seroprotective rate and the mean titer of anti-TTA in subjects with age >40 years was also lower in comparison to those with age <40 years (89.23% vs 97.14%; p<0.15 and 4.57±0.38 IU/ml vs 2.86±0.32 IU/ml; P<0.002, respectively). The mean titer of anti-TTA was significantly higher in patients with diabetes duration <5 years in comparison to patients with disease duration >5 years (3.91±0.35 IU/ml vs 2.85±0.38 IU/ml; p<0.04). Conclusion: these results showed lower levels of anti-TTA in patients with type 2 DM, in diabetic women, in patients aged >40 years and in diabetic patients with disease duration >5 years.
    Acta medica Indonesiana 01/2014; 46(1):44-50.
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    ABSTRACT: Aim: to determine the current prevalence of hepatitis B infection among parturient women in Jakarta, Indonesia. Methods: a cross-sectional study was conducted in women giving birth between May and July 2009, recruited by consecutive sampling technique in 2 hospitals and 13 public health centers in Jakarta. Mothers with history of chronic liver disease were excluded. Data were collected by questionnaires including obstetric history, hepatitis B immunization history, and the presence of jaundice; maternal venous blood samples were taken before parturition for HBsAg determination that was performed by ELISA. Results: of 1,009 parturient women screened for hepatitis B infection, 22 were found positive, giving an overall hepatitis B prevalence of 2.2%, previous 5.2% in 1985. None of the subjects had any symptoms of HBV infection. The highest HBsAg prevalence was found in the East Jakarta study site, with predominance in mothers aged <20 years and those with multi-parities. Conclusion: present prevalence of HBsAg among Indonesian parturient women in Jakarta was 2.2% and markedly reduced compared with prevalence in 1985.
    Acta medica Indonesiana 01/2014; 46(1):3-9.
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    ABSTRACT: Aim: to detect the levels of CEC and expression of NFκB in the three groups of subjects with certain conditions. Methods: this study is an exploratory study using human peripheral blood samples. The study subjects comprised three groups, the group of 23 healthy people, a group of 35 people that has one or more risk factors for vascular disease and a group of 15 vascular disease patients (coronary heart disease, diabetes mellitus, stroke). CEC were isolated from peripheral blood mononuclear cells (PBMC). CEC level is identified through the measurement of CD45 and CD146 by flowcytometry method. NFκB expression is recognized by ELISA method (imgenex, USA). Results: the highest average levels of CEC were found in the sick group (28.6%). The highest average expression of NFκB (924.9495) is found in the group with risk factors. The lowest average expression of NFκB and CEC is found in the healthy group. Statistical analysis of ANOVA at the interval confidence of 95% shows a significant difference (p=0.00) levels of CEC and NFκB expression between the healthy group with the group with the risk of cardiovascular disease (CVD) and patients with known CVD. Conclusion: increase of level CEC and NFκB expression has a strong relationship with vascular disease and its risk factors.
    Acta medica Indonesiana 01/2014; 46(1):30-7.

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