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Acta Interna : The Journal of Internal Medicine
Published by Universitas Gadjah Mada
ISSN : 2303131X     EISSN : 25415441     DOI : -
Core Subject : Health,
Health Professions Medicine & Pharmacology
The Journal considers any original research that advocates change in, or illuminates, clinical practice. The journal also publishes interesting and informative reviews and opinions pieces on any topics connected with clinical practice. Manuscripts must be solely the work of the author(s) stated, not have been published previously elsewhere, and not be under consideration by another journal. all papers should be written to be clearly understandable to the journal`s readers in a wide range of specialities and countries. Diagrams, figures, and photographs should be used to supplement and enhance the text.
Arjuna Subject : -
Articles 129 Documents
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Association between Zinc Serum Level And CD4+ Count In Healthy Elderly Women At AISYIAH Elderly Club Kota Gede Yogyakarta Husni, Niko Adhi; Rochmah, Wasilah; Atmodjo, Suhardi Darmo
Acta Interna The Journal of Internal Medicine Vol 2, No 1 (2012): Acta Interna The Journal of Internal Medicine
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ABSTRACTIntroduction. 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, elderly
CORRELATION BETWEEN CHILD PUGH SCORE AND CYSTATIN C IN LIVER CIRRHOSIS PATIENTS Mulya, Deshinta Putri; Nurdjanah, Siti; Ratnasari, Neneng
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
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ABSTRACTBackground. Renal dysfunction is a serious problem and it provides a poor prognosis for patients with advanced liver cirrhosis, where this condition can progress to kidney failure. This condition is known as hepatorenal syndrome. Cystatin C utilization as a marker of decreased kidney function in patients with liver cirrhosis has been widely proven. Data on how far the severity of liver cirrhosis can affect the decline in renal function has not been widely known. Objective. This study aimed is to verify correlation between the severity degree of the liver (Child Pugh/CP score) with levels of Cystatin C serum. Methods. This study was a cross sectional study. Population studied were patients with liver cirrhosis who visited the clinic of Gastroentero-hepatology and treated in the department of Internal Medicine ward Dr. Sardjito Hospital - Yogyakarta during October 2009 - March 2010. Data were analyzed with a computer; the analyzed of the CP score correlation with increased levels of Cystatin C using Spearman correlation for data not normally distributed. Result. We found 48 research subjects during the month of October 2009 - March 2010. The subjects were 35 male (72.9%) and 13 female (27.1%) with average age 53.1 ± 11.9 years old. Subjects with CP-A were 9 patients (18.8%), CP-B were 14 patients (29.2%) and CP-C were 25 patients (52.1%). The range value of Cystatin C between CP class shows CP-A  0.7 - 0.97 mg/L, CP-B 0.7 - 0.49 mg/L, and CP-C 0.7 – 2.49 mg/L (statistically significant difference with p <0.05). Liver cirrhosis patients who had Cystatin C levels <0.96 mg/L were 22 patients (45.83%) and 26 patients (54.1%), had higher levels of Cystatin C> 0.96 mg/L. Child score was positively correlated to increased levels of Cystatin C (p= 0.000; r= 0.566) linear regression equation with Cystatin was = 0.37 + 0.08 * Child score (r square 0.32). Conclusion. This study concluded that the Child score had a moderate positive correlation with Cystatin C serum level.  Key words: Liver Cirrhosis – Child Pugh score - Cystatin C 
CORRELATION OF DEPRESSION SYMPTOMS WITH FEMALE SEXUAL FUNCTION INDEX IN FEMALE HEMODIALYSIS PATIENTS Bonendasari, Agni
Acta Interna The Journal of Internal Medicine Vol 3, No 1 (2013): Acta Interna The Journal of Internal Medicine
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ABSTRACTIntroduction. Hemodialysis patients experience major changes in lifestyle and suffer various physical and emotional symptoms, especially symptoms of depression and sexual dysfunction in more than half of patients. Sexual dysfunction in women is often not identified because of lack of attention, especially by the clinician. Symptoms of depression limit intimacy, and affect sexual arousal and orgasm. Aim : the aim of the study was to determine the correlation between depressive symptoms and female sexual function index (FSFI) in women hemodialysis patients in the Hemodialysis Unit of Dr. Sardjito General Hospital Yogyakarta.Methods. The method of this study was cross-sectional. Research was conducted at the Hemodialysis Unit by Dr. Sardjito General Hospital Yogyakarta from 10 April to 24 April 2012. Result. There were 42 female patients undergone routine hemodialysis who met the criteria. The median age was 49 years old and had undergone hemodialysis for a median duration of 40 months. Conclusion. There was a negative correlation of depression symptoms and female sexual dysfunction with a moderate strength (r = -0.421) and statistical significantly (P <0.05). Age and prolactin had a negative correlation with a moderate strength of FSFI score. HDL levels and menstrual status had a positive correlation with FSFI, with weak and strong correlation respectively. Key Words: Female sexual function index, depression, hemodialysis
Apoptosis In Sepsis Humardewayanti, Rizka
Acta Interna The Journal of Internal Medicine Vol 2, No 1 (2012): Acta Interna The Journal of Internal Medicine
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INTRODUCTION            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 $22,100 with total costs of $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 MODS3
CORRELATIONS BETWEEN SERUM LEVEL OF MATRIX METALLOPROTEINASE-9 (MMP-9) AND SERUM LEVEL OF TROPONIN-I IN PATIENT WITH ACUTE CORONARY SYNDROME (ACS) Ruchanihadi, Ruchanihadi; Setianto, Budi Yuli; Hariawan, Hariadi
Acta Interna The Journal of Internal Medicine Vol 1, No 2 (2011): Acta Interna The Journal of Internal Medicine
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ABSTRACTBackground. The pathophysiology of acute coronary syndromes (ACS) is now accepted as the rupture or erosion of an atherosclerotic plaque, initially occurs at the shoulder of the plaque and is followed by intra-plaque thrombosis then spread to the vascular lumen and cause total partial vascular occlusion. MMP-9 is an extracellular matrix degrading enzyme that plays a crucial role in the breakdown of the fibrous cap of plaque and subsequent rupture in the pathogenesis of ACS. Cardiac troponins are currently the most sensitive and specific biochemical markers of myocytes necrosis.Objective. To know the correlation between serum level MMP-9 and serum level of Troponin-I in patients with ACSMethod. Study design was cross sectional. Data were collected by consecutive sampling from patients in ICCU board of RSUP Dr. Sardjito Yogyakarta, in June 2008-August 2010. A questionnaire was used to collect information from patient. After admission, peripheral venous blood was drawn once and measuring concentration of serum level of MMP-9 and Troponin-I before definitive thrombolysis. Data are expressed as means ± standard deviation (SD). Correlation between serum level of MMP-9 and serum level of Troponin-I were assessed using Spearman’s rank correlations test. A value of p<0.05 was considered statistically significant.Result. There were 139 patients with ACS and comprising 63 patients with STEMI, 27 patients with NSTEMI, and 49 patients with UAP. Means±SD of Troponin-I from all of samples was 9.49±10.47 ng/dL. Mean±SD of MMP-9 from all of samples was 1296.06±729.97 ng/dL. There were significant correlations between MMP-9 and Troponin-I in patients with ACS (r=0.34, p=0.000).Conclusion. There were significant correlations between MMP-9 and Troponin-I in ACS patients in ICCU RSUP Dr. Sardjito Yogyakarta. Keywords: ACS, MMP-9, Troponin-I
LEPTIN LEVEL IN NON DIABETIC POPULATION WITH AND WITHOUT NON ALCOHOLIC FATTY LIVER (NAFL) Sofia, Noor Asyiqah
Acta Interna The Journal of Internal Medicine Vol 2, No 2 (2012): Acta Interna The Journal of Internal Medicine
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ABSTRACTBackground. 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
Correlation between the Symptoms of Depression and Sexual Function in Breast Cancer Patients Receiving Chemotherapy Rohmawati, Dwi; Siswanto, Agus; Kurnianda, Johan; Sofia, Noor Asyiqah
Acta Interna The Journal of Internal Medicine Vol 2, No 1 (2012): Acta Interna The Journal of Internal Medicine
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ABSTRACT             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 Dysfunction
LEVEL OF INTERLEUKIN-6 IN OBESE PEOPLE WITH AND WITHOUT INSULIN RESISTANCE Safitri, Nedya; Riyanto, Bambang Sigit; Asdie, H. Ahmad Husain
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
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ABSTRACTBackground. Obesity is one of the risk factor for type 2 diabetes mellitus characterized by insulin resistance, decrease insulin secretion and hyperglycemia. Chronic inflammation has been proposed to have an important role in the pathogenesis of obesity related insulin resistance. A number of studies have indicated that several humoral markers of inflammation are elevated in people with obesity and type 2 diabetes mellitus, because adipose tissue secretes a number of proinflammatory cytokines, including interleukin-6. The level of plasma IL-6 is increase in obese people.Objective. To investigate the mean of difference in the level of IL-6 in obese people with and without insulin resistance.Subjects and Method. The study design was cross-sectional. It was conducted in obese people with BMI ≥ 25 kg/m2. Insulin resistance were measured with HOMA-IR methode, calculated using the following formula: fasting serum glucose X fasting plasma insulin/22,5. Insulin resistance was defined when HOMA-IR > 2,77. Interlukin-6 was measured with Quantikine High Sensitivity human IL-6 ELISA. Difference of mean of IL-6 level was analyzed by student’s t-test for normal distribution and Mann- Whitney U-test if distribution was not normal.Results. There were 56 subjects, 24 (42,9%) subjects with insulin resistance and 32 (57,1%) subjects without insulin resistance. Obese people with insulin resistance had higher mean level of IL-6 than obese people without insulin resistance, although the difference was not significant (20,05±8,59 vs 18,98±8,15 pg/ml; p=0,639; 95% CI -5,58-3,46).Conclusion. There was no difference in the mean of IL-6 level in obese people with and without insulin resistance. Keywords. IL-6, obese, insulin resistance 
MANIFESTATIONS OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS-INDUCED KIDNEY DISORDERS Charisma, Tiwi
Acta Interna The Journal of Internal Medicine Vol 3, No 1 (2013): Acta Interna The Journal of Internal Medicine
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INTRODUCTIONNon-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed medication.1 The gastrointestinal tract and kidneys are important targets of clinical events associated with the use of NSAIDs.2 Selective COX-2 inhibitors have minimal gastrointestinal side effects. However, the newer NSAIDs also has nephrotoxic effects remain as nonselective NSAIDs.1The kidneys are the major organ for drug excretion, so that the renal arterioles and glomerular capillaries are especially vulnerable to the effects of drugs. 3 The spectrum of NSAID-induced nephrotoxicity includes acute tubular necrosis, acute tubulointerstitial nephritis, glomerulonephritis, renal papillary necrosis, chronic renal failure, salt and water retention, hypertension, and hyperkalemia. 1Among the various clinical complications, the effects on the kidney are probably the most common and severe due to the use of NSAIDs.4 Fifty million US citizens report NSAIDs use, and it has been estimated that 500.000 – 2,5 million people will develop NSAID nephrotoxicity in the US annually. 5 It has been reported that 37% of drug-associated acute renal failure is associated with the use of NSAIDs, and NSAID-induced acute renal failure accounts for 7% of overall cases of acute renal failure. 4This review discusses the NSAIDs, mechanisms and clinical manifestations of NSAID-induced renal impairment and some NSAID options that can be used in patients with renal failure. 
CORRELATION BETWEEN CARDIOMEGALY AND PULMONAL DYSFUNCTION IN CHRONIC HEART FAILURE Sutedjo, Isbianto
Acta Interna The Journal of Internal Medicine Vol 2, No 2 (2012): Acta Interna The Journal of Internal Medicine
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ABSTRACTBackground: 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 failure

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